tag:blogger.com,1999:blog-14766956774540443082024-02-01T21:06:54.298-08:00An Academic in ExileMusings on finding a job, adjusting to Texas, politics and public policyAnonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.comBlogger29125tag:blogger.com,1999:blog-1476695677454044308.post-74129094231012713932013-10-02T23:17:00.001-07:002013-10-02T23:17:03.132-07:00Moving daySo we're moving to a another blog. It's a bit more unique, so visitors can perhaps find it more easily (As it turns out, there are already several academics in exile blogging away).<br />
<br />
Other than that, business as usual.<br />
<br />
We're at <a href="http://themakeshiftacademic.blogspot.com/" target="_blank">The Makeshift Academic</a> now, so all of my readers (both of you) can update your links.<br />
<br />
My blog is dead. Long live my blog!Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com1tag:blogger.com,1999:blog-1476695677454044308.post-79070277881053093592013-10-02T09:02:00.000-07:002013-10-02T10:07:40.986-07:00Ignorance is bliss: How Americans' low political knowledge may help "Obamacare" work better<!--[if gte mso 9]><xml>
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<br />
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For those of you nervous about the success the health-care
exchanges, take a look at this letter:</div>
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<br /></div>
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<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5a90SxfOG7wb-3pr7qFSlnRDkwEMji_abJ7NmImr-nmV7GAmvBN9dkABQvqCYJjLvzxmVkDLnWI_wFWKW_q3bqmBYQB3KMiY4wpOrb9GOqnod3rkRMmVkAArQa-14Z-HKgc-J4D-1MByk/s1600/insurance+exchanges+HR+letter.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5a90SxfOG7wb-3pr7qFSlnRDkwEMji_abJ7NmImr-nmV7GAmvBN9dkABQvqCYJjLvzxmVkDLnWI_wFWKW_q3bqmBYQB3KMiY4wpOrb9GOqnod3rkRMmVkAArQa-14Z-HKgc-J4D-1MByk/s320/insurance+exchanges+HR+letter.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><h4>
It's a boring HR letter. That's actually the point. </h4>
<h4>
(Photo by Patrick O'Mahen)</h4>
</td></tr>
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It comes from the benefits office of my most recent
employer, the University of Michigan, with which I am still nominally
affiliated. The letter describes coming options under the Affordable Care Act.
It indicates that UM offers many employees health care benefits that meet
standards for the ACA, and indicates that other employees can go get health
insurance on the exchanges.</div>
<div class="MsoNormal">
Polls suggest that Americans <a href="http://kff.org/interactive/health-tracking-poll-exploring-the-publics-views-on-the-affordable-care-act-aca/" target="_blank">don’t particularly love</a>
the ACA. Most polls also suggest that they don’t
<a href="http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-april-2013/" target="_blank">understand it</a>. With uncertain roll-out and the loud and well-funded campaign
encouraging people not to sign up on the exchanges, many of the law’s backers
(including me) are a bit nervous. But it’s reassuring that a letter like this
that will be many Americans’ first contact with the health care law. </div>
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<br /></div>
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Follow me below the fold for my reasoning.</div>
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</div>
<a name='more'></a><br />
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One thing that’s easy for many of us in the activist and
political science community to forget is that most Americans pay very little
attention to politics, and know even less.</div>
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<br /></div>
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Political Scientist <a href="http://en.wikipedia.org/wiki/Philip_Converse" target="_blank">Phillip Converse</a> was one of the first
who widely <a href="http://www.brucesabin.com/nature_of_belief_systems.html" target="_blank">popularized this notion with survey research </a>in the 1950s and 1960s,
which found that few Americans had a very well-developed political ideology, in part because they didn't have basic knowledge of politics.
Many respondents could not even identify the stances of major parties or
identify which party was in control of Congress.<span style="mso-spacerun: yes;"> </span>Other <a href="http://www.amazon.com/What-Americans-about-Politics-Matters/dp/0300072759" target="_blank">studies</a> have generally confirmed
relatively low levels of knowledge, though they disagree about precisely
whether it matters or not for how well Americans can intelligently make
political decisions. See <a href="http://www.amazon.com/Reasoning-Choice-Explorations-Political-Psychology/dp/0521407702" target="_blank">here</a> and <a href="http://www-personal.umich.edu/~lupia/Papers/Lupia1994_ShortcutsEncyclopedias.pdf" target="_blank">here</a> for scholars suggesting knowledge isn’t
too important, while see <a href="http://www.uvm.edu/~dguber/POLS234/articles/bartels2.pdf" target="_blank">here</a> and <a href="http://faculty.las.illinois.edu/salthaus/Publications/althaus_1998_apsr.pdf" target="_blank">here</a> for studies suggesting that it
makes a big difference. And yes, the quality of media makes a large
difference in knowledge: see this excellent <a href="http://poq.oxfordjournals.org/content/70/3/278.short" target="_blank">article</a> and this <a href="http://themonkeycage.org/2013/09/03/creating-more-knowledgeable-americans-via-public-broadcasting/" target="_blank">review</a> designed
for a layperson.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here I’ll step outside the bounds of strict scholarship and
offer up some (hopefully) reasoned speculation about how middle- and
low-information Americans might view health reform.</div>
<br />
I strongly suspect
that one effect of low knowledge is that many citizens believe that there is a disconnection
between many things in their everyday lives and the “politics” of far-off
Washington. (Read Chapter 1 of <a href="http://www.gutenberg.org/ebooks/6456" target="_blank">Public Opinion</a> by Walter Lippmann for a succinct
example of how this theory might work)<span style="mso-spacerun: yes;">
</span>That was often frustrating for me when teaching – one of the things that
I emphasized to my students over and over and over again was that government
policy making connected quite clearly with their personal lives. And it’s frustrating for us,
especially as progressives because we see people who generally might be (or
ought to be) on our side tuning out.
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But for the ACA, that might be a good thing, because
people’s first experience with “Obamacare” won’t be a political one, but rather
an administrative one. Remember that letter I posted at the beginning? That’s
the first contact with this law for millions of apolitical or occasionally political
people. They don’t pay much attention to the background noise of politics, but
they’ll pay attention to a letter from their employer talking about their
health insurance. And they will interpret that letter in an immediate way
disconnected from the politics of health reform. For most people the letter
will say that they have insurance through the company and they won’t have to
change a thing. But people who don’t have insurance will have the ability to
call a number, or visit a Web site, or talk to an administrative professional
(not a politician) about how they can get health insurance. When they realize
they can get it, they’ll be happy. Then they might tell their friends and
family, who might be able to get their own insurance. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Millions of letters like <a href="http://www.eclectablog.com/2013/10/obamacare-day-one-my-hideous-experience.html" target="_blank">this</a> are going out from thousands of
companies. Remember that the vast majority of mid-level human resources
department employees are pretty professional, especially for mundane administrative issues that don’t
expose the company to liability or cost.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And thus Obama-care spreads successfully beyond the reach of
any multimillion dollar ad campaign from the Club for Growth. Sometimes even
some political people might get affordable insurance in spite of themselves,
because they don’t connect the insurance exchanges with the hated “Obamacare” –
like this <a href="http://www.huffingtonpost.com/2013/08/22/kentucky-obamacare_n_3801054.html" target="_blank">poor sap</a>, God bless him. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are still some serious challenges – states <a href="http://www.nytimes.com/2013/09/18/us/florida-among-states-undercutting-health-care-enrollment.html?pagewanted=all&_r=0" target="_blank">blocking </a>navigators from
helping poor or unemployed people from registering will do damage, for example, but overall I have considerable confidence.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I suspect that 75 percent of Americans have never heard of
Grover Norquist. And the beauty of it is in this case that what they don’t know
not only isn’t going to hurt them, but might very well help them and all of us. </div>
Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-82819212434206612592013-10-01T10:00:00.000-07:002013-10-01T10:02:26.980-07:00"The Sound of Freedom"When Texas Gov. Rick Perry officially marked the opening of the Katy Freeway expansion in 2008, he declared that the roar of traffic in the background was <a href="http://www.chron.com/neighborhood/katy-news/article/Festivities-celebrate-the-completion-of-Katy-1758066.php" target="_blank">"the sound of freedom."</a><br />
<br />
Freedom: <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zFtDFWrnVLz6nSX5f6rz0F-blFc97jYJWTRj5Ap9pizQMsh1FGcjvsFkPfZcT1cYaAY-KP6cKOBvuRKmyl_wNEhqXzJpq_Ec6Sfshp-84QjESxdmf1ohbhwTv7qBJY3n9RcI4gXkeuU4/s1600/Houston+Traffic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zFtDFWrnVLz6nSX5f6rz0F-blFc97jYJWTRj5Ap9pizQMsh1FGcjvsFkPfZcT1cYaAY-KP6cKOBvuRKmyl_wNEhqXzJpq_Ec6Sfshp-84QjESxdmf1ohbhwTv7qBJY3n9RcI4gXkeuU4/s1600/Houston+Traffic.jpg" /></a></div>
<br />
10 mph, <a href="http://offthekuff.com/wp/?p=55636" target="_blank">thousands of unnecessary of tons of carbon emissions and particulate pollution, thousands of wasted hours sitting in traffic</a>. Freedom, indeed. Didn't George Orwell write a few things about this?<br />
<br />
Sure, technically that's is the Southwest Freeway I snapped walking home a few days ago, but I guarantee that I-10 looked the same or worse. And yes, that bumper-to-bumper center lane is the HOV toll lane. At least the toll-authority was collecting $4.75 for every non-HOV vehicle to recoup some of the costs for ramming this monstrosity through a residential neighborhood. (The rich white neighborhoods got expensive trenching and soundproofing -- African American communities didn't make out so well in highway construction.)<br />
<br />
Thank God I can walk home -- it's faster.<br />
<br />
And thank God that (some parts of)] this region has finally started to get serious about transportation planning over the last decade -- because if 13- and 18-lane freeways can't handle the volume, I doubt that it's cost effective or desirable to build any road that can.<br />
<br />
The <a href="http://offthekuff.com/wp/?p=54907" target="_blank">University Light Rail Line</a> can't get here fast enough. <br />
<br />Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-26386592079960910422013-09-30T08:30:00.000-07:002013-09-30T08:30:00.726-07:00Compromising on Medicaid Expansion: Real Alternatives, or GOP trap?<!--[if gte mso 9]><xml>
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Tomorrow, the big news for the Affordable Care Act will be the opening of the state-level insurance exchanges. But the other major part of the law, Medicaid expansion, proceeds apace. Republican governors in many states have simply rejected Medicaid increases, presumably on the grounds that providing poor people with health insurance is a nefarious communist plot. However, some GOP-dominated states like Michigan or divided-control states like Arkansas are working with the Department of Health and Human Services to develop alternative routes for expanding Medicaid coverage to the working poor. The challenge for the Obama administration (and progressive activists) is to determine which plans stay true to the spirit of the ACA and which ones may dangerously undermine it.</div>
<div class="MsoNormal">
<br /></div>
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Obviously, the biggest goal is to increase coverage, but we also need to be mindful of the
various strings that conservative governors and legislators might attach to the
modified plans seeking waivers from the Department of HHS.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Medicaid expansion was originally supposed to automatically
apply to all states, but the Supreme Court’s 2012 ruling on the Affordable Care
Act <a href="http://kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-decision/" target="_blank">made it optional</a>. Not surprisingly, 14 states with unified Democratic
control immediately signed up for the expansion; the opportunity to provide
universal health insurance to residents under 138 percent of the poverty line
fulfilled a longstanding progressive dream – all made possible by the federal
government picking up 90 percent of the long-term costs. </div>
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<br /></div>
<div class="MsoNormal">
Of 24 states under complete GOP control, only two took the
traditional expansion (North Dakota and Arizona) while 17 rejected it entirely.
Six of the 12 states with divided control governments agreed to the standard
expansion, while three have passed for now. (Here's a handy <a href="http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/" target="_blank">map</a> with the state decisions)</div>
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<br /></div>
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That leaves six states under GOP control
(Pennsylvania, Ohio, Michigan, Indiana, Tennessee and Florida) and three states
under with split control (Arkansas, Iowa and New Hampshire)<span style="mso-spacerun: yes;"> </span>that are either still actively considering
the expansion or have proposed a non-traditional style of expanding Medicaid
more agreeable to Republican majorities.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And that’s where things have gotten interesting. Follow me
below the break for details.</div>
<a name='more'></a><div class="MsoNormal">
The story starts in Arkansas last winter, where Democratic
Gov. Mike Beebe favored expansion, but faced a newly elected hostile GOP
legislature, which needed to approve any expansion plans by a ¾ vote. <span style="mso-spacerun: yes;"> </span>Republican leaders told Beebe they would only
consider doing an expansion if it were “market-based.” In response, Beebe and
his staff <a href="http://www.pewstates.org/projects/stateline/headlines/obama-administration-poised-to-approve-arkansas-style-medicaid-expansions-85899473677" target="_blank">proposed</a> using the federal Medicaid dollars to let newly-eligible
Medicaid recipients purchase commercial plans on Arkansas’ insurance exchange.
Beebe got the votes for the compromise (SSH! don’t tell Ted Cruz or the Club
for Growth), and last Friday the Department of Health and Human Services <a href="http://www.dailykos.com/story/2013/09/27/1241908/-Arkansas-gets-Medicaid-expansion-nbsp-waiver" target="_blank">approved</a>
Arkansas’ waiver.
</div>
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<br /></div>
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Iowa soon <a href="http://www.huffingtonpost.com/2013/05/22/iowa-medicaid-expansion_n_3321970.html" target="_blank">followed suit</a> by approving a similar plan and is
waiting for a final ruling on its waiver application from HHS, which should
come in the next several weeks.</div>
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<br /></div>
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This <a href="http://kff.org/health-reform/fact-sheet/medicaid-expansion-through-premium-assistance-arkansas-and-iowas-section-1115-demonstration-waiver-applications-compared/" target="_blank">analysis</a> from the Kaiser Foundation compares
Iowa’s and Arkansas’ expansion plans. In both states, the newly eligible
Medicaid population would be allowed to choose one of several "high-value" Silver-level exchange plans. Arkansas’ plan would mandate some cost-sharing through
co-pays for medical services for those above 50 percent of the poverty line,
while Iowa’s would mandate paying a premium of $20 a month – which could be
waived if the recipient met several health-improvement activities. Both plans
would cap medical expenses (including premiums) at 5 percent of income. </div>
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Last month, Michigan <a href="http://www.eclectablog.com/2013/08/michigan-senate-passes-medicaid-expansion-20-18.html" target="_blank">passed</a> its own
expansion bill with a <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1310910?query=featured_home" target="_blank">different wrinkle</a>. New enrollees in
Medicaid would have to enroll in managed-care plans run by a private
contractor selected by the state.<span style="mso-spacerun: yes;"> </span>Most
states already have some of their Medicaid populations in this model, though opinions differ on <a href="http://www.kaiserhealthnews.org/Stories/2011/December/29/Connecticut-Drops-Insurers-From-Medicaid.aspx" target="_blank">whether it actually saves money or improves services.</a> Michigan follows the lead of Florida Governor Rick Scott’s
<a href="http://ccf.georgetown.edu/all/floridas-medicaid-managed-care-waiver-receives-final-approval-some-strong-consumer-protections-included-oversight-will-be-critical/" target="_blank">attempt </a>to expand Medicaid in Florida under a managed-care model. Florida’s
legislature <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/05/florida-rejects-medicaid-expansion-leaves-1-3-million-uninsured/" target="_blank">balked</a> last summer and the plan is on life support (unlike the roughly <a href="http://www.cbsnews.com/8301-503544_162-57465110-503544/states-opting-out-of-medicaid-expansion-could-leave-many-uninsured/" target="_blank">950,000</a>
Florida citizens eligible for the expansion, who currently get no support.)</div>
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Other features of <a href="http://www.legislature.mi.gov/documents/2013-2014/billanalysis/House/pdf/2013-HLA-4714-D0B38F1F.pdf" target="_blank">Michigan’s plan</a> include mandatory health
savings accounts, to which those covered must contribute at least 2 percent of
their income to help pay for co-pays.<span style="mso-spacerun: yes;"> </span>Cost
sharing would be capped at 5 percent, increasing to 7 percent after four years
in the program. Those enrolled in Medicaid after four years can escape the
higher cost savings requirements by purchasing insurance on the exchanges with state
funds.</div>
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<a href="http://www.pewstates.org/projects/stateline/headlines/obama-administration-poised-to-approve-arkansas-style-medicaid-expansions-85899473677" target="_blank">Ohio </a>is also looking seriously at a
similar plan, while <a href="http://delong.typepad.com/annmariemarciarille/2013/09/the-private-option-for-medicaid-expansion.html" target="_blank">Missouri</a>, <a href="http://www.alaskapublic.org/2013/08/21/state-eyes-arkansas-plan-as-model-for-medicaid-expansion/" target="_blank">Alaska</a>, <a href="http://www.fox16.com/webmd/story/Medicaid-Expansion-in-South-Dakota-Uncertain/-sBw_uHm50Kka_9drb8RYA.cspx" target="_blank">South Dakota</a> and <a href="http://www2.ljworld.com/news/2013/mar/27/former-kansas-officials-may-provide-path-current-l/" target="_blank">Kansas</a>(!) have at least started publicly
discussing a premium-support model for Medicaid. Pennsylvania Gov. Tom Corbett
has come out grudgingly in <a href="http://www.pennlive.com/midstate/index.ssf/2013/09/corbett_representatives_meet_w.html" target="_blank">favor</a> of an Arkansas-style model.</div>
<br />
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For progressives, these plans hold certain promise and some
potential pitfalls. Most obviously, these plans get the working poor and
near-poor health insurance coverage – <a href="http://www.eclectablog.com/2013/09/why-we-need-a-gop-government-shutdown.html" target="_blank">470,000 in Michigan</a>, <a href="http://www.pewstates.org/projects/stateline/headlines/obama-administration-poised-to-approve-arkansas-style-medicaid-expansions-85899473677" target="_blank">250,000 in Arkansas</a> and <a href="http://www.cbpp.org/files/healthtoolkit2012/Iowa.pdf" target="_blank">106,000 in Iowa</a>. This coverage is real coverage. By the terms of the ACA, plans offered on the marketplace
need accept all applicants regardless of pre-existing conditions, include a
basket of standard services and provide free preventative care. <span style="mso-spacerun: yes;"> </span>Covering these individuals would <a href="http://familiesusa2.org/assets/pdfs/Dying-for-Coverage.pdf" target="_blank">easily save several hundred, perhaps several thousand lives in a year</a>.</div>
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<br /></div>
<div class="MsoNormal">
If the choice for liberals are these hybrid premium support
or managed-care plans, or nothing, the choice is clear – that showed up in the
unanimous Democratic legislative support in Arkansas, Iowa and Michigan, as
well as left-wing interest groups that enthusiastically backed the measure.
(Labor pushed hard in Michigan to get votes, especially the nurses unions)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But there are trade-offs for compromising to achieve this
long-cherished goal. In particular, the emphasis the plans put on cost sharing
for the working poor is disturbing. Though all three plans place hard caps as a
percentage of income on cost sharing from premiums, co-pays and co-insurance,
the push to make sure that poor people have “skin in the game” for their health
care seems at best misplaced. The emphasis on wellness programs and goals seems
a bit intrusive as well (though it’s a good thing to get the working poor
access to things like smoking cessation programs that are easily in reach of the
financially well-off). It’s a stretch to compare it to mandatory drug testing
for welfare recipients, but there does seem to be the whiff of a paternalistic stigma
about poor people’s bad health habits being responsible for their poverty.</div>
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<br /></div>
<div class="MsoNormal">
Finally, there is the question of having private contractors
getting more influence in running greatly expanded managed care programs, some
of which have <a href="http://ccf.georgetown.edu/all/floridas-medicaid-managed-care-waiver-receives-final-approval-some-strong-consumer-protections-included-oversight-will-be-critical/" target="_blank">quite a checkered history</a>. One of the major progressive
accomplishments of the ACA was that it increased the breadth of government
insurance programs like Medicaid, limited corporate welfare for companies
selling Medicare advantage plans and greatly tightened regulations on
commercial insurers if they wanted to be able to take part in the exchanges. Allowing
too great of an expansion of managed care and premium support for the working
poor may give conservatives the ability to erode the strength of Medicaid and even
Medicare over time. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
HHS Secretary Kathleen Sibelius and her staff have their
hands full as they try to balance all these issues against the primary goal of
better coverage as they consider waivers. </div>
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Ultimately, remember that elections have consequences. If
you elect competent people who favor good public policy, you tend to get good
public policy – just look at the 14 Democratic controlled states that quickly
accepted the Medicaid expansion. (Now, if only we could get them to think
productively <a href="http://www.rollingstone.com/politics/blogs/taibblog/looting-public-pensions-a-new-think-tank-study-20130926" target="_blank">about public pensions</a> and education)</div>
Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-69607763626625552942013-09-29T09:00:00.000-07:002013-09-29T09:00:03.300-07:00Adjusting to Texas Part ISo I traded this:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAmq61mcZP-OkC1SlJD4NI8XHTfEByH7V8XCj-bzdAiqiPR5dm6AlTJzBvXtl5OGsbC64Ol41THsYoaGJftrMetTydu_VPNWGO1P61EIDJu6if2WGTj6ylslAIPdyISSLNQLbbfCp5BJ3G/s1600/Stabenow+Headshot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAmq61mcZP-OkC1SlJD4NI8XHTfEByH7V8XCj-bzdAiqiPR5dm6AlTJzBvXtl5OGsbC64Ol41THsYoaGJftrMetTydu_VPNWGO1P61EIDJu6if2WGTj6ylslAIPdyISSLNQLbbfCp5BJ3G/s320/Stabenow+Headshot.jpg" width="252" /></a></div>
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<br />
For this:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9THz_GxBjhNKeu0GpaxlKVebySrnBx_cgmNchGJ59BhlrIhjyscsdMX2xDWBs2ifokoomhVFG3jaz7-yU5l8ag2IydpqleL-d752v38fwmts_aimkwrWls33yK3jfGSCcZdrmWO7ilUIP/s1600/Cruz+Headshot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9THz_GxBjhNKeu0GpaxlKVebySrnBx_cgmNchGJ59BhlrIhjyscsdMX2xDWBs2ifokoomhVFG3jaz7-yU5l8ag2IydpqleL-d752v38fwmts_aimkwrWls33yK3jfGSCcZdrmWO7ilUIP/s320/Cruz+Headshot.jpg" width="239" /></a></div>
<br />
Ouch.<br />
That's an Omar-Vizquel-for-Felix-Fermin-level trade. Rust Belt wins this one.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-15594507135288142442013-09-25T21:25:00.001-07:002013-09-25T21:25:25.104-07:00A good ACA info sourceBalloon Juice has a new front pager named Richard Mayhew. He's a bureaucrat at some private insurance company someplace and a political liberal. He's also been using his inside knowledge of health insurance to write a serious of very informative posts about the nuts and bolts of why health insurance works the way it does and how the Affordable Care Act changes incentives. The comment threads that follow are also unusually thoughtful and informative with real questions from real people about real situations.<br />
<br />
I highly recommend checking him out. <a href="http://www.balloon-juice.com/author/richard-mayhew" target="_blank">Here's a link</a> to a collection of all of his posts.<br />
<br />
On specific topics, see a list below:<br />
<br />
<a href="http://www.balloon-juice.com/2013/09/05/what-are-those-charges/" target="_blank">How and why deductibles and co-payments work</a> the way they do.<br />
<br />
What <a href="http://www.balloon-juice.com/2013/09/06/hey-baby-whats-your-network/" target="_blank">networks are</a> and how they affect costs.<br />
<br />
The problem of <a href="http://www.balloon-juice.com/2013/09/10/adverse-selection-in-new-york-state/" target="_blank">adverse selection and how it hampered reforms in New York</a> and other states<br />
(THIS IS WHY WE NEED AN INDIVIDUAL MANDATE PEOPLE) <br />
<br />
An explanation of <a href="http://www.balloon-juice.com/2013/09/25/time-to-make-the-donuts/" target="_blank">the rationale behind Medicare Part D doughnut hole</a> and why it doesn't work out well in practice. <br />
<br />
This is how the Internet ought to work. Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-28302309087368579202013-09-25T12:27:00.001-07:002013-09-25T12:27:24.064-07:00The Affordable Care Act: Obama's greatest achievement on gender equality?As we count down the days to the opening of the health-care exchanges, it's worth mentioning that the Affordable Care Act is easily the biggest law promoting gender equality since the Violence Against Women Act of 1994 for the Family Medical Leave Act of 1993.<br />
<br />
Barrack Obama has taken his share of flack on women's issues. Most recently, people have challenged <a href="http://www.nytimes.com/2013/08/27/us/politics/under-obama-little-progress-on-high-level-jobs-for-women.html?pagewanted=all" target="_blank">his record of high-level executive-branch appointments for women,</a> which has been considerably better than George W. Bush's but weaker than Bill Clinton's. On the other hand,Obama has <a href="http://www.abajournal.com/news/article/obama_leads_by_a_mile_in_women_judicial_picks_study_says/" target="_blank">appointed a record percentage of female judges</a> -- by a country mile. (He's still not appointing women at their prevalence level in the population, but he's getting close) And the <a href="http://www.forbes.com/sites/meghancasserly/2013/09/19/the-geography-of-the-gender-pay-gap-womens-earnings-by-state/" target="_blank">pay gap </a>between men and women is stubbornly constant, with women (still) making roughly 77 cents on average for every man.<br />
<br />
But starting January 1, 2014, the ACA will remove several billion dollars in annual gender discrimination. <br />
<br />
<a name='more'></a><br />
It's currently legal in 34 states for insurance companies to charge men and women different rates for insurance. The problem is worst on the individual market, where people without access to insurance from their employer or a government program like Medicare or Medicaid have to go. A recent study from the National Women's Law Center (NWLC) estimated that differences in rates charged to females add up to <a href="http://www.nationaljournal.com/healthcare/report-women-pay-more-for-health-insurance-20120319" target="_blank">more than $1 billion </a>every year.<br />
<br />
At first glance, the reasons for the discrepancy seem obvious (though unfair) -- women get pregnant, and pregnancies carry the potential for a host of medically expensive complications. Of course, having good maternity care is useful for both males and females, as Sen. Debbie Stabenow (D-Mich) <a href="http://thinkprogress.org/health/2009/09/25/170969/kyl-stabenow-benefits/" target="_blank">memorably pointed out </a>to her colleague Jon Kyl (R-Ariz.) during a Senate Finance Committee hearing on the ACA held in 2009: <br />
<blockquote class="tr_bq">
<blockquote class="tr_bq">
Jon Kyl: "I don’t need maternity care, and so requiring
that to be in my insurance policy is something that I don’t need and
will make the policy more expensive."</blockquote>
<blockquote class="tr_bq">
Stabenow: "I think your mom probably did."</blockquote>
</blockquote>
(Can we please summarily declare this the best use of the "your mom" put-down line, ever?) <br />
<br />
But as the <a href="http://www.nwlc.org/sites/default/files/pdfs/nwlc_2012_turningtofairness_report.pdf" target="_blank">NWLC's study</a> pointed out, more than 85 percent of individual policies they surveyed exclude maternity care and still charge women anywhere from 7 to 57 percent more for insurance.<br />
<br />
The problems extend to the group insurance markets, where 34 states allow insurers to charge employers with a disproportionate share of female employees higher rates. <br />
<br />
The ACA ends gender discrimination in all plans, individual and group. The resulting changes will equalize insurance rates and will likely save women several billion dollars a year -- not nearly enough to close the pay gap, but several billion bucks of progress is a reason to celebrate.<br />
<br />
As importantly, the ACA mandates that insurance policies offered under the exchanges need to include prenatal and maternity care as part of their standard benefit packages, ending the need for women to purchase expensive riders. <a href="http://kff.org/womens-health-policy/issue-brief/health-reform-implications-for-womens-access-to/" target="_blank">Birth control coverage is also mandatory</a>, which is another large win for women, both in cost savings and in personal autonomy. <br />
<br />
Of course, other reproductive health services, notably abortion, won't be covered in exchanges and will require purchasing riders, thanks to the <a href="http://www.guttmacher.org/pubs/gpr/13/4/gpr130402.html" target="_blank">Ben Nelson. </a>So the ACA is not perfect from a women's equality standpoint.<br />
<br />
However, it eliminates a large part of the insurance discrimination that both overcharges women for insurance and limits their access to critical health services --it goes a long way, baby, indeedAnonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-45642759310351456482013-09-24T11:40:00.002-07:002013-09-24T11:40:28.499-07:00Will the ACA's medical device tax be repealed?Today I explore a different aspect of yesterday's topic of the Affordable Care Act's Medical Device Tax. It's more political science (the factors that influence public policy making) than public policy (how effective actual policy ideas are). <br />
<br />
The <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1304175" target="_blank">original perspectives piece</a> on the tax in the New England Journal of Medicine by Daniel Kramer and Aaron Kesselheim report that the U.S. Senate voted 79-20 to repeal the tax as part of its non-binding budget resolution that passed last March. The authors then note that the repeal vote was bipartisan, overwhelming, and came after an intense lobbying campaign by the medical device industry. Based on this vote, they suggest that the tax is in imminent danger of repeal.<br />
<br />
I think this fear of repeal likely overblown for now because talk is cheap and there were too many possible factors that into each Senator's vote to repeal to figure out if a majority of Senators would have actually voted to repeal the tax if push came to shove (the fancy social science term is to say the result was <i>overdetermined)</i><br />
<br />
<a name='more'></a><br /><br />
First talk is cheap. This budget resolution is non-binding, which meant that it did not have the force of law. Senators had an opportunity to express support for the medical device industry -- and all the jobs it creates in their home states -- via a mechanism that had no chance of becoming law. In exchange, they could probably count on some campaign donations. The action of voting for repeal was completely symbolic with no policy ramifications, unlike a real repeal vote. An analogy would be the difference between a legislator sending out a generic press release in favor of Earth Day and doing the heavy lifting on a bill that regulated greenhouse gas emissions. <br />
<br />
Just because talk is cheap doesn't mean that a real repeal would get through the Senate. Some Senators who voted to repeal -- for example Amy Klobucher (D-Minn) whose home state is loaded with medical device manufacturers and worked hard to weaken the tax during the original health reform debate-- undoubtedly were sincere in their vote. But many others might simply want to reform the tax slightly. Or they might be unsure about the tax. Or they might have other issues to prioritize on a complicated budget bill in exchange for which they would tolerate the continued existence of a tax. Or they might even be for the tax, but see no point in picking a fight with the medical device lobby on a symbolic piece of legislation. That 79-20 bipartisan vote might conceal all of these motives.<br />
<br />
Finally, keep in mind that any repeal would have to get through the House, and be signed by the President -- and I seriously doubt that Obama would agree repeal the device tax without some sort of replacement.<br />
<br />
All these uncertainties and institutional hurdles add up to the strong likelihood that the device tax is around for at least the next three years.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-77510199492143366952013-09-23T15:24:00.002-07:002013-09-23T20:26:32.884-07:00Chait on the GOP's desperate push to kill ObamacareHere's a fascinating <a href="http://nymag.com/news/features/gop-obamacare-plot-2013-9/" target="_blank">must-read </a>on the implementation of Obamacare regarding the differences of rhetoric between the pro- and anti- Affordable Care Act factions. It's a wonderfully researched summary full of very interesting political science hypotheses waiting to be tested.<br />
<br />
Jonathan Chait was one of the earliest, best and most thorough reporters on the ACA as it wheezed toward passage. It's only fitting that he's here writing excellent stuff at the end of the journey.<br />
<br />
<b>Update:</b> <a href="http://krugman.blogs.nytimes.com/" target="_blank">Krugman </a>nails it:<br />
<br />
<blockquote class="tr_bq">
<blockquote class="tr_bq">
Yep, when it comes to reaching hipsters, or young people in general —
I know, Katy Perry — Dems have big advantages; all that coastal
cultural elite hatred suddenly turns into a big disadvantage for the
right.</blockquote>
</blockquote>
<blockquote class="tr_bq">
<blockquote class="tr_bq">
But that’s not all: there are also channels of influence the party of
Fox News simply cannot reach: Spanish-language radio and TV, black
churches (which played a big role in 2012), and more.</blockquote>
</blockquote>
<blockquote class="tr_bq">
<blockquote class="tr_bq">
I don’t know whether anyone thought this out in advance, but the
battle of the exchanges is indeed being fought on remarkably favorable
ground for the reformers. And I, for one, find the thought of
conservatives humiliated by an army of tweeting hipsters remarkably
cheering.</blockquote>
</blockquote>
Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-50166006681717955872013-09-23T12:30:00.002-07:002013-09-23T12:43:04.917-07:00Does the medical device tax cut innovation? Maybe sometimes -- and that's the point<br />
<a href="http://www.nejm.org/doi/full/10.1056/NEJMc1307587" target="_blank">In the Sept. 5 issue of the New England Journal of Medicine's correspondence section</a>, several physicians jousted over the impact of the Affordable Care Act's 2.3 percent excise tax on medical devices. I was disappointed in the focus of the argument on the tax's effect on innovation in the medical device industry. The entire exchange missed the broader point: how much does "innovation" in medical devices actually improve health care and how much of it is rent-seeking that siphons off patient and taxpayer dollars without helping patients?<br />
<br />
Right now, most of my readers are probably asking, "Wait, what's this medical device tax?"<br />
<br />
Good question. Part of the negotiations behind the ACA entailed major stakeholders in the health care industry -- hospitals and provider organizations, health insurance companies, drug companies and medical device manufacturers to contribute to cost savings as the law was implemented. Hospital associations agreed to cuts in reimbursement rates in Medicare and Medicaid payments valued at about $155 billion from 2010-2020, health insurance companies had an annual fee levied on them that works out to about $60 billion over the same decade, while drug maker agreed to levies on branded drugs of about $27 billion. The medical device industry reluctantly acceded to a 2.3 percent tax on all sales of medical devices not available on the retail market (i.e. we're taxing M.D Anderson's newest CT Scanner and not grandma's wheelchair). The tax is projected to bring in about $20 billion over the first decade of the ACA's existence and went into effect at the beginning of 2013<br />
<br />
I'm getting all of these details out of John E. McDonough's superb <i><a href="http://www.ucpress.edu/book.php?isbn=9780520270190" target="_blank">Inside National Health Reform</a></i>, which is a must-read for anyone who wants to understand Obamacare. You should buy this book.<br />
<br />
OK, now back to the debate in the <i>New England Journal of Medicine</i>.<br />
<br />
<a name='more'></a><br /><br />
The original <i>NEJM</i> perspectives piece from the<a href="http://www.nejm.org/doi/full/10.1056/NEJMp1304175" target="_blank"> May 9 issue</a> by Daniel Kramer and Aaron Kesselheim is a decent outline of the excise tax itself and a fair look at some of its effects. They note that the medical device industry has been fighting the tax tooth and nail since the ACA went into effect and argue the claims tax will kill innovation, cripple the medical device industry rest on untested assumptions. <br />
<br />
In the Sept. 5 <a href="http://www.nejm.org/doi/full/10.1056/NEJMc1307587" target="_blank">correspondence section</a>, several physicians based in the medical devices industry struck back. In two separate letters, A. Gregory Sorensen, a physician working as an executive with Siemen's Health care division, and Stephen J Ubl of the Advanced Medical Technology Association, an industry group argue the following five propositions:<br />
<br />
<blockquote class="tr_bq">
1. The tax has a broader effect because it also affects sales to most government and non-profit groups, sales to which usually aren't taxed </blockquote>
<blockquote class="tr_bq">
2. expanded coverage will increase preventative care, which will decrease the need for advanced medical devices </blockquote>
<blockquote class="tr_bq">
3. Sorenson argues that his personal experience has shown the medical tax has already forced layoffs at his company and cost "hundreds" of research jobs at Siemens. Ubl argues that the tax will cost 40,000 jobs. </blockquote>
<blockquote class="tr_bq">
4. diagnostic errors are most common and dangerous so we need more advanced medical devices to avoid the errors. The tax will kill these sales</blockquote>
<blockquote class="tr_bq">
5. the tax money merely goes into general government revenues and does not expand coverage. </blockquote>
<br />
With the partial exception of No.1, these are the arguments of hacks employed by the medical device industry -- misleading, irrelevant or highly questionable. Let me take them in turn:<br />
<br />
<blockquote class="tr_bq">
1. This is true. But considering non-profit hospitals and government systems (the Veteran's Administration) are the biggest purchasers of medical devices, the tax would have little reach otherwise. </blockquote>
<blockquote class="tr_bq">
2. Great! We can stop buying your overpriced screening technology and focus spending on preventative care for everyone. And you can find a useful line of work. Society wins all around.</blockquote>
<blockquote class="tr_bq">
3. This is the classic "executive blames layoffs on a regulation he doesn't like" move. Notice how details are lacking in Sorenson's case. Ubl also cites two industry-funded studies that I wouldn't touch with a 10-foot-pole. </blockquote>
<blockquote class="tr_bq">
4. Diagnostic errors are a major problem. But why should we assume that introducing even more complicated and expensive imaging equipment will limit the number of diagnostic errors instead of compounding them? </blockquote>
<blockquote class="tr_bq">
5. Bitch, please. Revenue is fungible. Have your accountant punch you in the face twice and call me in the morning. Wait --on second thought, don't call me.</blockquote>
<br />
I award this round to the original authors who suggest that the effect of the excise tax on medical innovation is unknown, and suggest rumors of the impending demise of the highly profitable medical device industry are greatly exaggerated.<br />
<br />
But there's a broader assumption here that I want to challenge: Why do we take for granted that innovation in the medical device industry is the most effective way to improve the quality of health care? Heck, why are we assuming that innovation in medical devices actually improves health at all?<br />
<br />
Take an example: over the last decade, one of the coolest new toys in surgery is the <a href="http://www.intuitivesurgical.com/products/davinci_surgical_system/" target="_blank">da Vinchi</a>, a robot that minimizes invasive surgery for any number of operations. Each robot <a href="http://www.technologyreview.com/news/418141/the-slow-rise-of-the-robot-surgeon/page/2/" target="_blank">costs </a>about $2.5 million plus annual maintenance costs. Around 2008, area hospitals in southeastern Michigan began installing them and advertising them on television to attract patients. Every time one of the commercials would come on in Ann Arbor, my fiance, then a medical student at the University of Michigan, would react in a manner I usually reserve for political ads sponsored by the Club for Growth.<br />
<br />
"They don't do anything to <a href="http://www.kaiserhealthnews.org/features/insuring-your-health/2013/042313-michelle-andrews-robotic-surgery.aspx" target="_blank">actually patient safety or health outcomes</a>" she would spit between involuntary face-crunching spasms (It was <i>so</i> adorable). But because all the other hospitals in the region were buying them, UM would have to as well to keep its reputation as the "leader and best." Shannon Brownlee outlines a similar phenomenon with CT scanners ($2 million a pop) in her classic book on the U.S. health care system, <i><a href="http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791" target="_blank">Overtreated</a></i>.<br />
<br />
Brownlee's main point is that American health care suffers from two problems: First, a large portion of Americans (the uninsured) don't get enough health care treatment, while wealthy people with gold-plated insurance policies get too much -- as evidenced by too many tests and the arms races to buy the latest equipment which actually might not do anything. At best, the over treatment is unnecessary and merely wastes money that could be spent on other things. At worst, it's actively harmful -- those CT scanners give hefty doses of radiation.<br />
<br />
And here's the great thing about the medical device tax: by taxing sales of medical devices, it takes money from one sector that we're over-investing in (medical technology, much of which has dubious benefits). In turn, the government reinvests that $20 billion a year in a sector that we're under-investing in (getting people insurance coverage so they can get basic medical care.)<br />
<br />
There are probably hidden pitfalls and unintended consequences, but overall taxing medical device sales to invest in expanding the insured population is a good way to reduce a deadly set of externalities in the U.S. health system.<br />
<br />
Now why the heck did 79 senators vote to repeal it? I'll speculate a bit about that tomorrow.... Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com1tag:blogger.com,1999:blog-1476695677454044308.post-52757440286039819662013-09-22T17:36:00.002-07:002013-09-22T17:36:30.821-07:00Increasing ProductivityLook, it's whatever it takes to get us going and help us be productive, right?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbxKxQErGQy7npY31wTbsKTdrWqe0cYkoupvkZ7XuKpP0WtM1s1IZRSLFi_iUQzjnYLRSQBFIojx7-vXX08_ziz-QweLhr3SGJWSGAkQK1DxkQ2MlEUnFiRtLNbvW989f5tZGUbr8zZhio/s1600/dora+and+kitty.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbxKxQErGQy7npY31wTbsKTdrWqe0cYkoupvkZ7XuKpP0WtM1s1IZRSLFi_iUQzjnYLRSQBFIojx7-vXX08_ziz-QweLhr3SGJWSGAkQK1DxkQ2MlEUnFiRtLNbvW989f5tZGUbr8zZhio/s320/dora+and+kitty.jpg" width="320" /></a></div>
And if sugary fruit snacks from children's cartoons improve my productivity, no one should judge. Hey -- they do have those box top that contribute to schools. That sort of makes up for all the high-fructose corn syrup, right? Right?<br /><br />Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-89982225839160334262013-09-20T16:31:00.002-07:002013-09-23T12:52:20.782-07:00Does GOP hate Obamacare or Unions more?The post title here is rhetorical. Conservative Republicans hate both with equal fervor. But it is interesting to watch them twist themselves into knots with the Obama administration's move last week to deny a waiver sought by labor unions to cover multi-employer health plans common in some industries.<br />
<br />
First, Republicans <a href="http://www.politico.com/story/2013/09/questions-about-unions-obamacare-96738.html#ixzz2fTYXIV00" target="_blank">praised unions for criticizing</a> the Affordable Care Act:<br />
<br />
<blockquote class="tr_bq">
“It’s encouraging to see those who strongly endorsed the health care law
finally recognize its fundamental problems,” the GOP-led House
Education and Workforce Committee said in a statement Thursday.</blockquote>
<br />
Then they immediately <a href="http://www.politico.com/story/2013/09/questions-about-unions-obamacare-96738.html#ixzz2fTYXIV00" target="_blank">made hay bashing unions again:</a><br />
<br />
<blockquote class="tr_bq">
And even if the administration isn’t signaling that it’s going to
respond to union demands — Republicans are moving to preempt any such
accommodation.</blockquote>
<blockquote class="tr_bq">
Sen. John Thune (R-S.D.) has introduced the Union Bailout Prevention
Act and filed it as an amendment to the energy bill the Senate is
debating. By Thursday, he had 10 co-sponsors.</blockquote>
<blockquote class="tr_bq">
“The Republicans are perfectly happy to crow about how the unions
hate the law too, but hell will freeze over before they agree to do”
anything legislatively to address their concerns, [Washington & Lee University Professor Tim] Jost said.</blockquote>
Sigh.<br />
<br />
My personal favorite commentary was <a href="http://www.blogger.com/Roy%20article:%20http://www.forbes.com/sites/theapothecary/2013/09/14/obama-to-labor-unions-multi-employer-health-plans-drop-dead/1/" target="_blank">this rather unhinged reaction by Aik Roy</a>, allegedly one of the smarter conservative commentators on health care. He's does an about face from (<a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares-rate-shock/" target="_blank">incorrectly</a>) <a href="http://www.forbes.com/sites/theapothecary/2013/05/30/rate-shock-in-california-obamacare-to-increase-individual-insurance-premiums-by-64-146/" target="_blank">hyperventilating that ACA exchanges</a> will lead to rate shocks people paying much more for insurance to crowing about how workers will get better insurance and lead to the end of unions in the United States.<br />
<br />
Why?<br />
<br />
Well, because government-sponsored health insurance remove union's role in managing health care and show workers that unions are unnecessary:<br />
<br />
<blockquote class="tr_bq">
The great irony—one that union leaders are only now starting to
recognize—is that by [backing universal health insurance], they’ve accelerated their own demise, at
least in the private sector. Today, less than 7 percent of American
private-sector workers are unionized. That number will continue to
decline as workers realize they don’t need unions for their health
benefits. The labor movement will increasingly become comprised of
public-sector unions, giving it a far different character than it has
today.</blockquote>
<blockquote class="tr_bq">
Most importantly, workers will benefit from this change. Instead of
paying a big chunk of their wages to labor unions and insurance
companies, they’ll be able to keep those wages for themselves. </blockquote>
<br />
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But we can test this hypothesis. According to Roy's logic, countries with universal government-sponsored health insurance -- especially single-payer systems -- should cut unions out of the system. Without health insurance to dangle in front of their members, unions should then whither away and these countries should have low union densities. </div>
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Do Roy's contentions hold up? Not so much. <a href="http://www.bls.gov/opub/mlr/2006/01/art3full.pdf" target="_blank">According to a study by the U.S. Bureau of Labor Statistics</a>, 23.5 percent of the U.S. work force was unionized in 1970. In 2003, that had dropped to 12.4 percent, a decline of 47 percent. In contrast, Canada with its universal health insurance went from a union density of 31.8 percent to 28.4 percent, a decline of 10.7 percent. The average European Union country dropped from 37.8 percent to 26 percent - a decline of 32 percent. (See page 8 of the study)</div>
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Not only are the absolute levels of union membership higher in countries with universal healthcare, but their decline have been slower than in the United States. Sorry Aivk, thanks for playing.</div>
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<br />
Roy is likely to get his wish of weaker unions. But it has nothing to do with universal health insurance. The long shadow of the Taft-Hartley law, the destruction of traditionally unionized manufacturing industries, and <a href="http://www.democracynow.org/2012/12/11/michigan_gop_push_through_anti_union" target="_blank">state governments run by vandals</a> have done a quite effective job of destroying organized labor and eroding workers living standards over the last four decades.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-55573226277509433052013-09-19T14:20:00.000-07:002013-09-19T14:23:38.396-07:00Thoughts on Obama administration denying union attempts for an ACA waiverUPDATE: There's a political dimension to this, which I'll deal with in another post.<br />
<br />
<a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/13/obama-administration-denies-labors-request-for-health-care-waiver/" target="_blank">Ezra Klein</a>, <a href="http://www.politico.com/story/2013/09/questions-about-unions-obamacare-96738.html" target="_blank">Politico</a> and <a href="http://www.forbes.com/sites/theapothecary/2013/09/14/obama-to-labor-unions-multi-employer-health-plans-drop-dead/1/" target="_blank">Avik Roy</a> reported that the Obama administration denied a key waiver sought by labor leaders for a type of multiple-insurer insurance plan that covers more than 20 million American workers.<br />
<br />
Unions, particularly the Teamsters, United Food and Commercial Workers and the garment workers union (UNITE HERE) wanted the Obama administration to make these plans (called "Taft-Hartley" plans after the legislation that created them) eligible for subsidies offered under the new state health exchanges. As Klein notes, however, they don't comply with some of the requirements of the exchange plans (general issue for example) Also, the plans are already tax-exempt -- and will be until 2018 when taxes will be levied on the company-paid plan premiums in excess of $10,000 for an individual and $27,000 for a family. <br />
<br />
Labor is a bit miffed because they believe that the administration is <a href="http://boss.blogs.nytimes.com/2013/08/22/employer-mandate-delayed-by-paperwork-and-efforts-to-reduce-it/" target="_blank">delaying regulations for businesses</a> while leaving labor out. I'm sympathetic to this, but I'm not really sure how how the administration could have ruled otherwise. If they make this exemption for the labor plans, it might open up Pandora's box. How will they stop businesses from claiming both subsidies and tax-exemptions for offering insurance? How will they deny insurers who want to open plans on the exchanges that don't have guaranteed issue (i.e. exclude sick people)? It has the potential to undermine some pretty big parts of the Affordable Care Act in the way the delaying other regulations for 12-24 months won't.<br />
<br />
What are the ramifications of the Obama administration's refusal to grant a waiver for these plans? The short answer is that we don't know. There are several shifting incentives here that may shift the state of the Taft-Hartley plans in a variety of directions.<br />
<br />
<br />
<a name='more'></a>However, one thing is comforting: Workers currently covered by these plans will have affordable health insurance options regardless of what happens. They might get to continue coverage under their current plans, they might get to continue coverage under adjusted plans that qualify for subsidies, or they might end up on the health insurance exchanges like<a href="http://anacademicinexile.blogspot.com/2013/09/trader-joes-decision-good-sign-for.html" target="_blank"> Trader Joe's part-time employees</a>. Under the last scenario, workers with better incomes will pay a bit more out of pocket for a plan, while those less well off will pay less. The bottom line is that the workers don't get screwed, like they do all too often when companies engage in <a href="http://www.newrepublic.com/article/112449/peabody-energys-disappearing-health-benefits" target="_blank">cute reorganization tricks</a>.<br />
<br />
<br />
Beyond that, however, there are some big unknowns: Unions fear that the availability of the exchanges will encourage small businesses that pay into these plans to opt-out and go to the exchanges, destroying a major visible benefit that organized labor has won through years of membership agitating. However, I'm not sure that result will come to pass. First, it's possible (though I could be wrong) that the small-business tax incentives to provide insurance coming on line over the next few years might actually convince businesses to stay in these plans. I'm also not aware of any Taft-Hartly plans going under in Massachusetts' reform, which would be an indicator that these sorts of plans are non-viable in a health care world dominated by the Affordable Care Act. <br />
<br />
(Again, I don't know what the AFL-CIO economists are saying on these issues -- and I wish I knew, because it would inform my speculation more. <a href="http://blogs.wsj.com/corporate-intelligence/2013/07/12/union-letter-obamacare-will-destroy-the-very-health-and-wellbeing-of-workers/" target="_blank">The union-backed letter</a> to congressional leaders doesn't really get into policy details)<br />
<br />
Finally, even if these plans go away, the reality would open up all sorts of new opportunities for labor unions. If employers pull out of the plans and save a ton of money thanks to government subsidies, it sounds like union members have a big case to make for a larger-than normal raise so workers can share in the companies new windfall. Or perhaps they can argue for more generous company contributions to pension and 401k plans. Or maybe they can get big investments and improvements in equipment and safety procedures. The point is that with health care off the table (and secure) there's plenty of issues around which to mobilize the rank-and-file. I'd imagine that it would be quite easy to fire up a bunch of construction workers by saying "Hey, they dumped you on the exchanges and saved a ton of money -- we should get to share in those profits too."<br />
<br />
I suspect there are also going to be some opportunities over the coming months to work with the administration to iron out nuts and bolts -- possibly make the plans exchange compliant through general issue and swapping out the current tax-free nature in exchange for making them eligible for subsidies. This course of action carries some opportunities and risks of its own.<br />
<br />
Addendum: I observe that we have an assistant treasury secretary named <a href="http://www.treasury.gov/about/organizational-structure/Pages/fitzpayne-e.aspx" target="_blank">Alastair Fitzpayne</a>. This is outstanding. If he didn't exist, the Onion would have to make him up. Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-53227216375890807462013-09-18T20:28:00.000-07:002013-09-18T20:33:55.602-07:00Trader Joe's decision good sign for ObamacareRecently, Trader Joe's made waves when it announced that it would <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/16/trader-joes-cut-health-benefits-last-week-heres-its-side-of-the-story/?tid=pm_business_pop" target="_blank">stop offering health insurance</a> to currently eligible part-time employees (about 17,000 employees) and give them an extra $500 in pay to let them shop for coverage on the new <a href="https://www.healthcare.gov/" target="_blank">health care exchanges</a> that will open on Oct. 1. <br />
<br />
At first glance, this looks terrible: a private company is taking advantage of the Affordable Care Act and dumping workers' benefits to save money -- others surely will soon. <br />
<br />
On reflection though, this is probably a good thing. After all, <a href="http://www.epi.org/publication/bp337-employer-sponsored-health-insurance/" target="_blank">the private insurance market has been unraveling for over a decade anyway</a>. Trader Joe's is still offering benefits to its full-time employees. Health reform <a href="http://www.forbes.com/sites/kenrapoza/2012/01/20/romney-care-massachusetts-healthcare-reform/" target="_blank">hasn't caused the collapse of employer insurance in Massachusetts</a>. Finally, Trader Joe's part-timers will on the balance have access to health insurance for a fair price -- regardless of their future employment.<br />
<br />
Like many economic developments, this move creates winners and losers. But we can't stop there: we need to ask two questions: First, who wins and who loses? Second, how much do they win or lose?<br />
<br />
<a name='more'></a><br />
Company employees getting sent to the exchanges face a mixed bag: Some will pay less on the exchanges than they would for their current plans, while others will pay more. But the difference won't be that stark: <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/13/what-trader-joes-teaches-us-about-obamacare/" target="_blank">Wonkblog's Sarah Kliff notes</a> that an employee who earns about $20,000 a year will be charged between $26 and $85 a month for insurance on the Washington DC exchange (after subsidies), depending on the plan she selects, which compares favorably with the $70 a month she pays for a "robust" health plan with Trader Joes. The comparison looks even better after factoring in the company's annual $500 payment to help part-time employees currently eligible for insurance afford exchange plans.<br />
<br />
Some workers will lose in the change; <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/16/trader-joes-cut-health-benefits-last-week-heres-its-side-of-the-story/?tid=pm_business_pop" target="_blank">Trader Joe's own letter</a> points out an example of an employee who will go to the exchanges and have to pay the full premium without federal subsidies. That cost is likely several hundred dollars a month more than he pays under the current structure, but only because his spouse makes $200,000 a year. For a good progressive, the cost shifts seem to work out well -- less well-off people tend to save money, while wealthier ones pay more.<br />
<br />
Additionally, every employee affected by the switch actually gains two things. First, they likely gain some more choice for their insurance coverage: generally at least eight to 10 plans at four distinct levels of coverage, depending on the state of residence instead of company plans, which tend to be more limited (though some companies do offer considerable options).<br />
<br />
Second, all people who purchase on the exchanges also gain portable health policies. Employees who get sick may to quit their jobs. This situation is perverse; precisely when they need to get insurance, they lose it or have to at least pay the full cost of the premium through COBRA. Insurance purchased on the exchanges doesn't go away when a job does, however. <br />
<br />
More broadly, consider the societal costs: Kliff points out that Trader Joe's saves a considerable sum of money by pushing several thousand employees on the exchanges. The federal government, --taxpayers, will have to pick up those costs. But which taxpayers? As it turns out, the wealthiest ones. Obamacare gains that lion's share of its funding from two mechanisms: cutting subsidies to private health insurers for certain types of Medicare plans (i.e. cutting corporate welfare) and by raising the Medicare Hospital Tax on all income earned above $200,000 from 1 to 1.9 percent. Additionally, it put in place a Medicare tax of 3.8 percent on investment income for all earners with more than $200,000.<br />
<br />
Let me repeat that: The ACA makes the Medicare tax progressive, it places a Medicare tax on investment income for the first time ever, and it uses the proceeds to help working class individuals pay for health insurance. <a href="http://www.nytimes.com/2010/03/24/business/24leonhardt.html?ref=davidleonhardt&_r=1&" target="_blank">As David Leonhart of the New York Times argued</a>, this is the most progressive piece of legislation since the Great Society of the 1960s.<br />
<br />
On the net then, the move of Trader Joe's to shift its part-time employees to the exchanges is likely to be slightly disruptive at this moment, but only because employees will need to enroll in a new health plan. Over the long term, however with <a href="http://www.newrepublic.com/article/113289/obamacare-california-no-sticker-shock-here" target="_blank">exchange insurance rates coming in at reasonable prices</a>, the shift will be broadly beneficial. Employees who come from poorer families will likely pay a bit less than they do now, thanks to subsidies; while employees from wealthier families will pay a bit more. The subsidies allow Trader Joe's to discharge some of its costs of benefits on the federal government, but those costs are paid for by the wealthiest members of society.<br />
<br />
All in all, better times are coming for health care in America.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-41758895163487800312013-09-17T16:20:00.001-07:002013-09-17T16:21:29.627-07:00Generation Y and "Entitlement"<a href="http://aweinstein.kinja.com/fuck-you-im-gen-y-and-i-dont-feel-special-or-entitl-1333588443" target="_blank">Amen Mr. Weinstein.</a><br />
<br />
I have a PhD from one of the finest universities in the country and I've taught more classes than many tenure-track professors have, but after applying for 85 academic jobs in two years, I've come up empty. It's a simply terrifying experience for most of us on the market --we're generally far better qualified than our peers who graduated in the 1960s and 1970s were, but we're being shut out. I'll be writing more on the problems of contingent short-term labor in academia over the coming months, but they're pretty similar to the ones journalists and others of our generation face. <br />
<br />
And Weinstein nails my attitude toward people who look at us in the 22-35 crowd with contempt:<br />
<br />
<blockquote class="tr_bq">
This state of affairs does not exist because we're entitled and have
simply declined to work as hard as the people that birthed us. American
workers <i>have</i> changed from generation to generation: Since 1979, the alleged Dawn of the Millennial, the average U.S. worker <a href="http://www.epi.org/publication/a-decade-of-flat-wages-the-key-barrier-to-shared-prosperity-and-a-rising-middle-class/" target="_blank">has endured</a> a 75 percent increase in productivity...while real wages stayed flat.</blockquote>
Any lecturer with a PhD. patching together a 4-4 course load across three different universities for $19,000 a year gets it.<br />
<br />
As <a href="http://anacademicinexile.blogspot.com/2013/08/privilege-and-unemployment-yes-you-can.html" target="_blank">I've written,</a> I'm one of the lucky ones -- no student debt, decent health, a soon-to-be spouse with a decent job. I always wonder if I have the right to complain -- well, here's Weinstein's answer to that question:<br />
<blockquote class="tr_bq">
So no, we shan't be doing as well as our parents, and no, we shan't be
shutting up about it. If anything, those of us who have been cowed into
silence because college-educated poor problems aren't <i>real</i> poor problems should shed our fears and start talking about just how hard it really <i>is</i> out there, man.</blockquote>
So, complain it shall be, though with the awareness that some one is always worse off -- and an emphasis on effective action as well.<br />
<br />
As usual, invoking Atrios' <a href="http://www.eschatonblog.com/2013/09/shit-is-fucked-up-and-bullshit_14.html" target="_blank">sentiment </a>in the titles of his posts sums up the point pithily.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-11389928440359728112013-09-17T12:57:00.000-07:002013-09-17T12:57:33.851-07:00Home-care workers get federal wage protectionsThe Obama administration <a href="http://www.nytimes.com/2013/09/18/business/us-to-include-home-care-workers-in-wage-and-overtime-law.html?_r=0" target="_blank">just announced</a> that home-care workers qualify for federal wage protections under the Fair Labor Standards Act. This is a big deal. Most of these workers already make at least the minimum wage, but they don't qualify for overtime salaries because they were literally classified as babysitters.<br />
<br />
According to the <a href="http://www.dol.gov/opa/media/press/whd/WHD20131922.htm" target="_blank">Department of Labor, </a>there are about 2 million workers that qualify for the new protections --nearly 50 percent of whom are minorities. <br />
<br />
It's not surprising that a job classification dominated by minorities (and women, but that's another story) was exempt from the FLSA. The exemptions were part of the price that Jim-Crow-era Southern politicians extracted as their price for the passage of much of the New Deal. They wanted relief from the Great Depression, but only would agree to social programs that did not interfere with the peculiar institutions of the south that kept African Americans on the bottom of the labor and social structure. (It's also why every Southern Democrat joined pro-business owner Republicans in backing the anti-labor Taft-Hartley Act) For those looking for a good history on the subject, Ira Katznelson's <a href="http://www.amazon.com/When-Affirmative-Action-White-Twentieth-Century/dp/0393328511" target="_blank">When Affirmative Action Was White</a> details the whole depressing process.<br />
<br />
Today's long-overdue step eradicates a small part of the poisonous legacy over despite the opposition of for-profit nursing homes.<br />
<br />
Finally: Elections have consequences. This wouldn't have happened in a Mitt Romney administration.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-32285521057305000352013-09-17T12:20:00.000-07:002013-09-26T23:44:06.470-07:00Houston's baby bike-share grows into a precocious toddlerSo walking home recently from the library, I found this nice surprise:<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTEsn1VimA2Ma_2BLTFaY-BErgVvC9ZZ-2W78TI3AOj0wmqn4K99HBLFTcvPCIdIsnO5ni7R8M8IuuQIEmBkOhSOVPrjI6L_tYTr9FU1sf9Qam8VaXthZK0EEyx6ARefOg9b9wvmgjWNnp/s1600/New+B-Cycle.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTEsn1VimA2Ma_2BLTFaY-BErgVvC9ZZ-2W78TI3AOj0wmqn4K99HBLFTcvPCIdIsnO5ni7R8M8IuuQIEmBkOhSOVPrjI6L_tYTr9FU1sf9Qam8VaXthZK0EEyx6ARefOg9b9wvmgjWNnp/s1600/New+B-Cycle.jpg" width="227" /></a></div>
<br />
<br />
<a href="http://houston.bcycle.com/" target="_blank">Houston B-cycle</a> is apparently in expansion mode again.<br />
<br />
The system, which started in the <a href="http://offthekuff.com/wp/?p=44837" target="_blank">spring of 2012</a> as a three-station pilot program and 18 bikes, is now 26 stations with roughly 200 bikes. Early signs of the first part of the expansion last spring seemed to <a href="http://www.houstonchronicle.com/news/houston-texas/houston/article/Bikesharing-booming-after-major-expansion-4404551.php" target="_blank">be a success</a>, as the increased network led to a large jump in users. According to Houston's office of sustainability, now an average of <a href="http://offthekuff.com/wp/?p=53656" target="_blank">1,300 trips are taken every week</a> on Houston B-cyle around downtown. That's up from <a href="http://offthekuff.com/wp/?p=52019" target="_blank">150 checkouts immediately before the system expanded in March and 500 the week after</a>.<br />
<br />
Of course, ridership is a drop in the bucket of the several <i>million</i> auto trips taken in the city every day, and only a fraction of a decently used bus route (think about 2,000-3,000 boardings a day), but it's a start that will only grow bigger as the system spreads out within the I-610 Loop -- and remember, bike-share complements mass transit, it doesn't compete with it<br />
<br />
Houston's bike-share folks seem to know what they're doing. You start in the densest parts of the city and build outward to develop a strong network. What's frustrating is the pace. Some bike-share systems subscribe to the "go-big or go home" school of building a network on the theory that a few stations give users few options and will be underused. What cities like <a href="http://www.thehubway.com/about" target="_blank">Boston</a>, <a href="http://citibikenyc.com/stations" target="_blank">New York</a>, <a href="http://www.capitalbikeshare.com/about" target="_blank">Washington DC, </a>and <a href="https://www.niceridemn.org/about/" target="_blank">Minneapolis</a> did was to launch a large network of at least 60 stations and several hundred bikes to give instant access -- and all were wildly successful.<br />
<br />
Like all public infrastructure, bike-share needs help for capital costs -- and government grants are a bit tougher to get in Texas for these sorts of things, as <a href="http://www.elpasotimes.com/news/ci_23860793/txdot-denies-funding-el-paso-bicycle-sharing-program" target="_blank">El Paso has found out to it's frustration.</a> Houston B-cycle's pilot program was sponsored by a small federal grant that came from the stimulus package, while the expansion is being funded by a $750,000 sponsorship package from Blue Cross and Blue Shield of Texas. Membership fees defray a good portion of the operating costs of the system. Similar-sized programs have taken root and are succeeding in places like <a href="http://www.bizjournals.com/sanantonio/blog/2012/03/san-antonio-b-cycle-program-a-big.html?page=all" target="_blank">San Antonio</a>.<br />
<br />
But it still seems expansion is maddeningly slow. Imagine if we could get a $7.5 million grant to fund a 1,800 bike expansion instead of a $750,000 grant for a 180-bike expansion? Imagine getting 13,000 checkouts (or more -- a denser network makes this more attractive) instead of 1,300 I mean, if TxDOT will move heaven and earth for a<a href="http://dc.streetsblog.org/2011/09/13/exxon-one-mega-highway-please-texas-coming-right-up/" target="_blank"> $5.2 billion sprawl-inducing third beltway</a> for Houston, $7.5 million ought to be pocket change, right?<br />
<br />
There are advantages to going under the radar too. The city can keep quietly improving the bicycle and cycling infrastructure in central neighborhoods and build a constituency for the program. As the <a href="http://www.nyc.gov/html/om/pdf/bike_lanes_memo.pdf" target="_blank">safety and environmental benefits</a> become apparent, bikes should become a much more accepted part of Houston, just like Metrorail has become. Every little expansion will gain new community groups and stake holders buying in (Rice University is hopefully next) who will push and defend the program as it continues to expand. precocious<br />
<br />
Also, starting small and expanding incrementally might not draw the notice of <a href="http://culberson.house.gov/" target="_blank">this guy</a>, which would be very much a positive thing, as any Metro planner can tell you. <br />
<br />
So slow it is. Right now, it's tantalizing close to being useful to me -- but not quite. I now have two stations within a 15-minute walk of my home, but the problem is that it's a 10-minute walk in the opposite direction from many of the places I need to go. This isn't something that's convenient for me and thousands of my neighbors yet -- but it will be someday very soon.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-67737443203122615022013-09-16T15:19:00.002-07:002013-09-16T15:19:33.964-07:00From the "Signs that Work" file.<span id="goog_320312296"></span><span id="goog_320312297"></span><br />
<br />
<span id="goog_320312296">Here's an example of honesty/utility in Parks and Recreation advertising:</span><span id="goog_320312297"></span><br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj6DJ1pXETvosuKSX7pefMrwGuHCY2_Wi8IDbplnHyxhNzogT290HEuBqsmmdiImQ7kcf85LOtbsIMNYTv2YLaDFzPntuF6TrqO50vlBiTWxBQ-KQcnDSdsS4YdmKjN9d3cDdfNS_WJYVJ/s1600/Chew+Park.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj6DJ1pXETvosuKSX7pefMrwGuHCY2_Wi8IDbplnHyxhNzogT290HEuBqsmmdiImQ7kcf85LOtbsIMNYTv2YLaDFzPntuF6TrqO50vlBiTWxBQ-KQcnDSdsS4YdmKjN9d3cDdfNS_WJYVJ/s320/Chew+Park.jpg" width="320" /></a></div>
<br />
<br />
<br />
<br />
There's a large dog park about 10 feet to the right of this photo. It's amusing watching the mutts run around with each other when I jog by every morning. Every time I read this sign, I crack up inside.<br />
<br />
OK, so my sense of humor is rather simple, but it's Monday. <br />
<br />
More posts coming later this week: one on Houston's slowly expanding bike-share program and several on some recent happenings in Obamacare implementation.<br />
Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-19380994456567470482013-09-15T12:48:00.002-07:002013-09-15T12:48:48.118-07:00Saved by the StimulusLast night I went out to grab a drink with the fiance and a few of her friends. I met one of her college friends for the first time, and as we fell into conversation. She had an interesting personal story to tell about the impact of the much-maligned American Recovery and Reinvestment Act of 2009 (AKA "the stimulus").<br />
<br />
You see, she's a lawyer who now works for the federal government. But she wasn't working when she graduated law school in the summer of 2008. She went to a top-50 law school and probably one of the 3 best ones in the south-central region -- so not tip-top, but solid quality. Insofar as law school prepares you to be a lawyer, this lady was prepared to be a lawyer. Over the next year, she applied for dozens of law jobs -- many in areas she didn't specialize in or had little interest in. But with the economy crashing around her, law work had dried up.<br />
<br />
But in the spring of 2009, the Social Security Administration suddenly got an influx of federal from the ARRA to hire employees and improve administration -- <a href="http://www.aging.senate.gov/crs/ss19.pdf" target="_blank">about $1.1 billion</a> (see page 6, footnote A). <br />
<br />
Guess who got hired to work with disability claims?<br />
<br />
Notice four things happen here. First, Fiance's College Friend (FCF) gets a job. Second, because FCF gets a job, she's able to go out more often for drinks at fine eating establishments in Houston, which helps those establishments stay in business and helps their employees get bigger paychecks and tips. That money then keeps accelerating through the economy. Note that those two things would happen even if FCF does nothing but look at cat pictures on the Internet and does nothing useful for society or Social Security. But that's not the case, because third, she actually gains skills at a job that she seems to like and becomes more useful over time. And finally, skillfully evaluating disability claims means more efficient service for people filing claims and better value for taxpayers wanting efficient use of government resources.<br />
<br />
Look, we can argue about how well the stimulus was targeted, or whether it was big enough, but it's actually full of <a href="http://www.amazon.com/The-New-Deal-Hidden-Change/dp/1451642326" target="_blank">millions of little stories similar to FCF's</a>. And, as Alan Blinder and Mark Zandi (among others) <a href="http://www.economy.com/mark-zandi/documents/end-of-great-recession.pdf" target="_blank">h</a><a href="http://www.economy.com/mark-zandi/documents/end-of-great-recession.pdf" target="_blank">ave shown</a> (see page 8 in particular, those stories cumulatively added up to keep the unemployment rate about 1.5 percentage points lower than it otherwise would have been -- saving or creating roughly 2.7 million more jobs across the public and private sectors<br />
<br />
Food for thought for policymakers, especially as I keep searching for a job.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-90396640564380062912013-09-14T14:03:00.001-07:002013-09-14T14:03:17.529-07:00In which I climb into the Monkey CageSo I write things for other places too. I suppose it makes sense to link to <a href="http://themonkeycage.org/2013/09/03/creating-more-knowledgeable-americans-via-public-broadcasting/" target="_blank">this piece</a> in the Monkey Cage, which highlights some of the work in my dissertation about the relevance of public broadcasting for increasing political knowledge. Despite our best efforts as political scientists, political science actually remains a relevant discipline for making public policy from time to time.<br />
<br />
Now if some one would tell <a href="http://www.huffingtonpost.com/2013/03/21/tom-coburn-national-science-foundation_n_2921081.html" target="_blank">Tom Coburn</a>. Actually don't -- the problem is that he understands all too well that political science has found some <a href="http://press.princeton.edu/titles/8664.html" target="_blank">uncomfortable truths</a> about how modern democracy works -- or might not work -- in the United States.Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-40297503192683975052013-09-13T22:12:00.000-07:002013-09-13T22:12:26.082-07:00Running<br />
So I'm a runner.<br />
<br />
For the last five months, it's been my freedom and maintained my sanity. <br />
<br />
Two years ago, I started racing again. After a few 5ks, I set myself a goal to run a half marathon; it seemed a good goal -- long but not dangerously long, difficult but achievable, a challenging yet reasonable <a href="http://www.halfmarathons.net/training_tips_schedule_beginner_runners.html" target="_blank">training schedule</a>. <br />
<br />
In training, I finally discovered the true joys of distance running. I can try to <a href="http://theoatmeal.com/comics/running6" target="_blank">explain it</a>, but you really have to experience it. The physiological benefits are clear enough: you burn calories, improve muscle tone, increase lung capacity, strengthens the cardiovascular system. It also calms me and helps me focus on work. There's the sense of working toward a goal: with two half marathons under my belt, I have a quite respectable time (I broke 1:45 last June and am eying a late October race for my first real crack at 1:40 -- not setting the world on fire, but quite solid for a casual runner). Distance running also forces you to execute a strategy on the course in a way that running a 5 or even 10k really doesn't. It's a wonderful feeling when you successfully execute your strategy -- and break out from your pace group on mile 10.<br />
<br />
But more than any of these things, running gives me autonomy. It gives me an identity. It gives me a purpose. It gives me achievements. All those things that unemployment takes away, running returns a measure. <br />
<br />
<a name='more'></a><br /><br />
I am in control of myself when I run. I set my route; I vary my pace in accordance to my judgement. I can compete or not when I choose to do so. I experience a part of the richness of the world -- and running the Rice loop or Herrman Park are lovely parts of the world -- on my own terms. When people see me, they know what I am doing and where I am going. It gives me things to discuss -- an identity.<br />
<br />
It means that for one hour five days a week, I belong.<br />
<br />
I first joined the track team when I was in eighth grade, as a way to
keep in shape for soccer. By the time I was a junior in high school, I
had traded in my soccer cleats for cross country spikes. I appreciated
that cross-country was both a team sport and an individual one in a way
that soccer wasn't. Every race was against the other team, but it was
also against the clock -- there was always a chance to get measurably
better, even when you were completely overmatched or were far ahead of
your opponent.<br />
<br />
Distance runners fit my personality a
bit better than the typical jock mode of the higher profile team
sports; they were quirky, friendly and more tolerant of
outsiders. Running for me was associated with the social home I found on
my high-school cross country team and the delightfully mild-mannered
coach we fondly called the "stat rat" for the notebooks full of split
times on each of us on the team.<br />
<br />
I wasn't fast enough
to run competitively in college, but I always kept my running shoes
updated and never quite gave up training -- though sometimes months
would slip by between runs. <br />
<br />
But I'm back now. <br />
<br />
I too believe in <a href="http://theoatmeal.com/comics/running" target="_blank">the Blerch</a> -- but five times a week, I lace up my sneakers, charge outside and I belong.<br />
<br />Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-75253030244461319422013-09-12T15:03:00.000-07:002013-09-12T15:03:10.312-07:00The hidden costs of being unemployedOne of the disadvantages of being poor is that everything costs more. Because you can't put up a month's security deposit on an apartment, you're forced to pay out the nose for a a low-end motel that actually costs a lot more per month than a decent one-bedroom apartment (This <a href="http://www.amazon.com/Nickel-Dimed-Not-Getting-America/dp/0312626681" target="_blank">book</a> documents this unfortunate reality first hand). Since the poor live paycheck to paycheck, they can't maintain minimum balances in their checking account and can't take advantage of the traditional banking system. Instead they're forced to "bank" with payday lenders who charge exorbitant interest rates for <a href="http://npa-us.org/files/profiting_from_poverty_npa_payday_loan_report_jan_2012_0.pdf" target="_blank">short-term loans</a>, and even face large fees for the simple act of <a href="http://abcnews.go.com/Business/mcdonalds-worker-sues-franchise-paying-wages-debit-card/story?id=19420181" target="_blank">cashing their paycheck</a>. <br />
<br />
As discussed previously,<a href="http://anacademicinexile.blogspot.com/2013/08/privilege-and-unemployment-yes-you-can.html" target="_blank"> I am by no means poor</a> -- thanks in part to a previous career, supportive upper-middle class parents who helped me get through college, and a soon-to-be spouse who's taking care of pesky things like rent. However, I've made the lovely discovery that being unemployed offers some of the same hidden costs as poverty. Take for example my recent attendance at an academic conference.<br />
<br />
In political science, as well as many other disciplines, attending national conferences is an integral part of being a successful academic. You can get your work noticed, get feedback on your scholarship, start to build up your CV and network with other academics. And most importantly for some one without a job, you can get job interviews, which can be your opportunity to stand out from the 50 to 150 other highly qualified applicants who want the same jobs you do. <br />
<br />
But you have to get to the conference first. And attending the annual meeting of the American Political Science Association costs a considerable amount of money. First, you have to be an APSA member, which costs an annual fee. Then you have to register for the conference, which costs more. I needed to find a flight from Houston to Chicago and stay in the city for four nights to accomodate several interviews and a scholarly presentation. If you shop around, you can find quite reasonable hotel and flight rates, but I still paid roughly $600 for travel and hotel expenses to spend four days at the conference. Then you still need money for food and travel. You can minimize these costs by taking public transit (a $5 train ride from the airport and $2 bus ride to to hotel beats a $50 cab fare any day), but over four days it still adds up. <br />
<br />
Here's the thing: most professors get many of these expenses reimbursed by their employers. As a part of their compensation package, they usually get an annual research grant that can be used for memberships in scholarly organizations and attendance at conferences. In political science, this often ranges from several hundred dollars at small liberal arts colleges to several thousand dollars at large research schools. Graduate students can often (though not always) tap funds to attend conferences as well, either through their professors or through their institutions. At my old school, grad students could attend one conference a year and get up to a $700 <a href="http://www.rackham.umich.edu/funding/from_rackham/student_application/rackham_conference_travel_grant/" target="_blank">grant</a> to cover it -- this little benefit got me about $1500 over three years (and three lines on my CV). Of course, privilege plays a role here too -- richer grad schools generally provide more funding for their grad students to attend conferences, as well as providing better pay and benefits. <br />
<br />
Because I'm unemployed however, now I do research on my own dime. Somewhat perversely then, it costs me much more out of pocket to attend a conference than it costs my better-off-financially colleagues who could actually afford it.<br />
<br />
I'm not complaining about APSA's management here. The organization tries to mitigate inequality through several mechanisms. First, they have a <a href="http://www.apsanet.org/content_1457.cfm" target="_blank">progressive membership fee structure</a> -- members with higher incomes pay more, and unemployed members pay much less. They also have <a href="https://www.apsanet.org/content_11228.cfm" target="_blank">travel grants</a> to help less well-off members come to the conference -- the $150 they awarded me essentially defrayed the costs of registration and my travel within Chicago.<br />
<br />
But like <a href="http://www.eschatonblog.com/2013/09/these-days.html" target="_blank">affordable housing units</a> and <a href="http://www.npr.org/templates/story/story.php?storyId=213578203" target="_blank">Head Start slots</a>, there isn't enough aid to go around to all the deserving recipients, let alone fully defray their costs. <br />
<br />
Again, please don't take this to mean that I'm putting myself on the same level as a person who needs a payday loan at 50 percent interest to make rent for the month (Remember that <a href="http://anacademicinexile.blogspot.com/2013/08/privilege-and-unemployment-yes-you-can.html" target="_blank">context</a> is everything). But it is rather depressing to get a first-hand taste of how the structures that reinforce privilege play out in all sectors of the economy. Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-73226686578426859052013-08-21T23:37:00.000-07:002013-08-21T23:37:30.950-07:00Privilege and unemployment (Yes, you CAN have one with the other)So far this blog has been me reflecting (or perhaps in a moment of weakness, whining) about the difficulties I have faced as a newly minted member of the unemployed army of Americans. One of my goals with this site is to give a bit of insight into some of the challenges that unemployed people face. <br />
<br />
Here's the thing though: I'm unemployed, but I'm shielded from some of the worst aspects of it. I've got a lot of angst, diminished future career prospects, some short-term cash-flow problems, a possible gap in my health insurance (and annoying increased costs in any case) and social isolation.<br />
<br />
You see, my Fiance's an MD. She has a job, which pays quite well. In fact, we're above the median household income for Americans. We can afford good food, rent on a nice apartment in a nice neighborhood in Houston. We drive modest used cars, but we can put gas in them and travel around town without undue worry (repair bills have moved from minor to major annoyances, but they aren't savings account killers for us, or even for me-- yet)<br />
<br />
Oh, and neither of us are struggling under a dime of student loans -- that's another trifling matter of $200,000 that's off our backs. Part of that is our own careful financial management; part of it was the luck to be born to loving, stably employed, upwardly mobile, generous parents who believed strongly in funding their children's education. Part of it is a strong public school system funded by taxpayers in Ohio and Michigan. It's wrenching watching my carefully hoarded emergency savings diminish, but I'm not staring at a mountain of debt to pay back.<br />
<br />
The fact that we're both white and look a lot like an idealized successful American couple portrayed on TV (minus considerable muscle tone, make-up and eating disorders) doesn't hurt either.<br />
<br />
<br />
<br />
<br />The whole thing is kind of like being Dante traveling through the Inferno: I'm getting a taste of how bad everything is. It's depressing. It's terrifying. It's painful. It's isolating And that depression, terror, pain and isolation are REAL. But I'm just visiting Hell and I'm shielded from the worst of the suffering. Perhaps as I peer out from around Virgil's skirts, I can gain some wisdom and insight in to what the true suffering is; the hope is I can put it to use when I get out of this dreadful pit and can behold the stars again. <br />
<br />
But here the metaphor breaks down; most of the unemployed end up so through no fault of their own. They get cast into this particular hell because they happened to graduate during a nasty recession, or happened to have a job in a struggling industry, or became a target for the budget ax in the public sector. No, most of the unemployed are innocent of the malice and sloth they routinely get accused of by some elements of our political system. And most of use feel like failures and want to work. We want to provide, we want to serve society -- it just seems that society doesn't have a place for us.<br />
<br />
The final judgement is reserved for those with power who could help the unemployed (and the poor, oppressed, ill etc) ease their suffering, but fail to do so. Sadly, my new home state seems to have quite a few policymakers who fit the bill. <br />
<br />
So as you read my musings, please keep in mind that I know paradoxically that I am incredibly lucky in my particular unfortunate situation. Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-6875659216660204892013-08-20T11:08:00.000-07:002013-08-20T11:08:39.538-07:00On an Island -- unemployment and social contactsYesterday I wrote a brief note about how our jobs become a large part of our identity. The focus was on how a profession gives us identifying markers that underline our social status and mark us as interesting people.<br />
<br />
But having a job or profession also builds our identities through giving us social contact as well. One of the toughest things I've found about living in Houston is that not only do I have few social contacts, but the fact that I'm unemployed makes developing social contacts an order of magnitude more difficult.<br />
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Below the jump, I discuss these dynamics in more detail.<a name='more'></a><br />
Think about it: much of the social contact you have on a day-to-day basis is with your colleagues at work. Professions vary in the amount and quality of social contact on the job, but most in professions you'll have co-workers. And on the job, your work gives you something in common. Even if the job is horrible, your bad boss, the lousy scheduling or other difficulties provide a place to bond with other human beings -- your coworkers. If the job is satisfying, you and your colleagues will probably have the opportunity to develop deeper friendships that can transcend time.When we have jobs, we take these interactions for granted. <br />
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My last two jobs encouraged me to get to know a lot of people. Like many grad students, I taught to work my way through graduate school and at least twice a week I would interact with more than 50 students for an hour. The contact was a natural part of the profession, but it was considerable social contact all the same. Ditto for my previous job as a journalist: I had to make contacts with dozens of people in the communities I covered to do my job well. Much of that contact was "professional," but I developed a great number of acquaintances and several friendships.<br />
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Being in school provides the same opportunities. Even when you go off to college in a faraway place and you don't know anyone, the adjustment can be hard. But you're always in class with fellow students and interacting with them.<br />
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When you're in a new place and know few people in town, however, unemployment also removes your easiest avenue for social interaction and developing friends. Some readers might suggest that this is a great opportunity to actually go out in the community and join groups. But the truth is in my experience that relationships developed through coworkers actually make it easier to join outside activities. In grad school, my extra curricular activity was working with the labor union that represented graduate employees. But I didn't just find it randomly, it was my fellow grad students that introduced me to the organization.<br />
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Finally, the fact that you don't have an income exacerbates that because without money it's more difficult to join organizations you might want to get involved with. <br />
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Don't get the idea that I'm just a blogger sitting in his mom's basement. (My mother is 1,500 miles away and I'm on an upper floor -- with windows and everything). I'm also slowly working on developing contacts and friends in this town. The process is just much slower, more deliberate for an unemployed person. <br />
<br />Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0tag:blogger.com,1999:blog-1476695677454044308.post-47659802769255756362013-08-19T10:42:00.003-07:002013-08-19T10:43:31.702-07:00Identity theftIn many unspoken ways, your job is a large part of your identity.<br />
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When you meet some one for the first time in a social setting, one of the first questions that often comes up is what you both do for a living. You might answer with the profession you're in ("I'm an engineer") or you might talk about where you work ("Oh, I work over at Dell"). Either answer stakes out in a simple sentence a large part of the story of who you are. After all, your job generally is the single thing you spend the largest amount of your waking hours doing. Your job also gives hints to a number of other aspects of who you are as a person: your schedule, your values, your politics, your social class, your higher vocation in life ("I'm a doctor -- I save people's lives")<br />
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When you're unemployed though, you lose that part of your identity, or at least the ability to easily convey it. That's tough personally. As I type this, I can say I'm a "scholar," but no one really knows what that means in a way that "I'm a professor at X university" does. The latter is translatable, while the former is opaque. I'm still the same (reasonably) intelligent, (hopefully) engaging, (occasionally) witty and (arguably) responsible person I was before. I still have the same experiences that make up much of who I am, but I've lost the ability to convey a lot of those experiences in an easy way. And the things that being "unemployed" do announce about me tends to set me on a lower level in the conversation.<br />
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It's not that your job is your whole identity -- nor should it be. However, your job not only signifies a lot about who you are, but also sets a foundation for who you might aspire to be -even if its diametrically opposed to what you currently do.<br />
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But right now, I'm not quite sure how to think about what I might want to do, because I'm not officially doing anything for a living. I'm stuck in a holding pattern while I wait for the phone to ring. <br />
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And while you wait, you begin to question your place in the world, because without the identity and purpose a job often provides, you don't know how you fit in.<br />
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Without a job, not only is it more difficult to share who I am with everyone else, it's that much more difficult to understand who I am myself. <br />
<br />Anonymoushttp://www.blogger.com/profile/09825177783624513614noreply@blogger.com0