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Fixing Obamacare

November 15, 2016 Leave a comment

Now that the election is over and President-Elect Trump has begun the transition to his administration, there has been some discussion of reforming the market for health insurance. I have written previously that Obamacare is in the process of collapsing because of its structural defects. For example, the Obamacare feature of guaranteed issue has caused a phenomenon known as adverse selection which is driving insurance companies out of the health insurance exchanges (links to other posts on Obamacare are given below). Here I thought it would be useful to outline some changes that seem to be sensible reforms to the currently-available flawed system.

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Obamacare Slowly Implodes (Updated)

November 30, 2015 3 comments

Readers of this blog know that I am a critic of the Affordable Care Act.  My view is that it was poorly designed and it has harmed millions of people who have lost access to their doctors and hospitals. (There are links at the end of this article to previous posts on this profoundly misguided law.) There is now accumulating evidence that the insurance exchanges are moving into what has been termed a “death” spiral, a process which can lead to the collapse of the insurance exchanges set up by the law.

This death spiral refers to a situation where insurance companies lose money selling health insurance on the exchanges and thus stop selling insurance to avoid these losses. The exchanges can collapse if all insurers withdraw from the exchanges, leaving millions of Americans without coverage. The design of the Affordable Care Act raises the possibility of this collapse because it limits the ability of insurers to charge higher prices to riskier applicants and because the law requires guaranteed issue, meaning that insurers must sell a policy to anyone who applies. Thus insurers must treat everyone as if they are bad risks and charge correspondingly higher prices for insurance but, if the applicant pool of insurance buyers is dominated by bad risks, insurance companies may lose money on their policies. This latter situation is known as “adverse selection.” There is now accumulating evidence that adverse selection has occurred in these insurance exchanges.

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More Fallout from Obamacare

November 11, 2015 1 comment

I recently saw a news item regarding the events at the University of Missouri resulting in the resignations of two senior university administrators.  That article suggested that the Affordable Care Act had a role in the student protests at the university. Turns out that this is indeed the case.

It appears that one of the student grievances, and also one reason for a hunger strike by a student, involves the loss of health insurance by the university’s graduate students. This loss of insurance was explicitly mandated by Obamacare as explained by a university post last August (you can read it here). That web site reports the following.

Due to changes in federal policy and IRS interpretation of that policy, general counsel has informed us that the University of Missouri no longer is allowed to pay for graduate students’ health insurance. (Previously, the university provided a subsidy to those students who opted in for insurance and were paid from a qualifying assistantship or fellowship). The IRS considers our student health insurance plan an “individual-market plan” rather than an “employer-sponsored plan,” such as our health plans for MU employees.

The Affordable Care Act prevents employers from giving employees money specifically so they can buy health insurance on the individual market. Graduate teaching and research assistants are classified as employees by the IRS, so they fall under this ruling.

So the university finds itself in violation of federal law if it pays for graduate student insurance. I wonder how many students realized this element of the university’s policy? I regard this as just another example of the Law of Unintended Consequences arising from central planning by the government. It also reveals that as the law continues to grow in complexity and in size, it is no wonder that it has been said that every day, each resident of the U.S. commits three felonies and has no idea that he or she has done so.

Random Thoughts After a Long Hiatus

September 21, 2015 2 comments

It has been quite a while since I last posted on this blog. I finally decided to catch up by posting a series of remarks on a number of issues that are of interest to economists and (hopefully) others.

Disparate Impact Analysis

I teach in a university economics department. If you were to attend one of our faculty meetings, you would observe that nobody in the room is a seven-foot Chinese basketball player. Does that mean the faculty in my department discriminated against the seven-foot Chinese basketball players in the world who wanted to be on our staff and attend this meeting? If you were to use a nonsensical theory known as disparate impact analysis, then if seven-foot Chinese basketball players were a politically-protected group, the answer is yes and my university could be charged with discrimination in federal court.

To say the least, disparate impact analysis ignores the scientific method which most of us learned in primary school. The fact that a person has the disease known as AIDS does not imply how the person got that disease. The reason is that medical science has determined that the disease can be contracted in more than one way. Similarly, if one group of individuals makes less money than another group, there are many reasons why this may be so.  One of those reasons could be discrimination but how do we know this to be true? Put differently, there are causal relationships in an economy and there are many random events that can make a group of individuals have the demographic characteristics that they have. Read more…

Government as a Unicorn

August 22, 2014 Leave a comment

I recently saw an amusing and informative article by Michael Munger, an economist at Duke University (the article is here). The article concerns how one can explain the behavior of people who advocate more government while, at the same time, expressing disgust with many government policies, politicians, and so on.

Professor Munger has observed academic economists regularly express their disapproval of government actions and then, once they observe what they perceive to be poor policies, advocate more government to fix the perceived problems. This is logically inconsistent in the extreme and he puzzled over this (as I and other colleagues have done over the years) and finally realized that those who advocate more government, after expressing disapproval of government, expect a government that does not exist to solve problems they see. Thus Professor Munger sees his colleagues as wishing for a unicorn to exist. They want government to be what they imagine that it should be, not the one that we have.

For some recent evidence supporting this detachment from reality, consider a liberal economist who recently wrote that we should want the government to narrow the income distribution because this will improve the “supply-side” of the economy. How you ask? Well doing so, which I presume will follow an increase in tax rates paid by the rich however defined, will lead to some programs, programs unspecified by the liberal economist engaging in this advocacy, that will improve the quality of the workforce, thus raising productivity in the economy. So the same government that brought us healthcare.gov, the site so successful that people could not use it, will then turn around and successfully design programs to raise the human capital of the impoverished. To me, this “supply-side” story reveals a staggering ignorance of the reality of government.

I have been an academic economist for many years and I can say, based upon my own observations over the years, that Michael Munger has it right. Many academics are oblivious to the real world that surrounds them.

The Affordable Care Act As Lawyer Relief Act

July 25, 2014 3 comments

This week brings us media reports of two conflicting decisions by federal appellate courts regarding the Affordable Care Act. The issue in each decision is whether subsidies may be provided in states that do not run their own insurance exchange where policies may be purchased. One court decided that the law was unclear and that the IRS was therefore justified in making the decision to permit subsidies in all states. Another court decided that the law was clear and that subsidies could not be given to people in states that do not run their own insurance exchange. What accounts for this conflict? Several possibilities come to mind.

One possibility is that the Congress was unable to write a document that makes clear its intentions. This is always a possibility of policy by committee. Whenever a large number of individuals get involved in a policy process, there is always the possibility that what comes out, intended to accommodate everybody on the committee, is so confusing that the end product is a logical mess.

A second possibility is that the people drafting the legislation are simply incompetent and did not notice the inconsistencies built into the law. Related to this is the fact that the law ran thousands of pages and was not read by many who voted for it. It is hard to be sympathetic with any politician voting for a law when he or she has no clue as to the law’s contents.

Finally, there is always the possibility that judges just “make it up” to satisfy their prior policy preferences.

My own belief is that the conflicting legal decisions speaks to the complete breakdown of the federal government’s ability to function. No sane person can read a document that is two thousand pages long while having any real idea about what is in the law. In addition, why even construct laws that are this long and detailed? Surely the size of the law by itself reveals profound incompetence since it is incomprehensible to the politicians asked to consider it. Or perhaps the law is so large precisely to prevent many politicians from knowing what is in it to allow the few who do know to have an unduly large effect on the law’s contents.

Whatever the explanation, it is hard to put a good face on the Affordable Care Act. Whatever the economic merits of the law (and I have written frequently about how bad it is as economic policy), this is a prime example of incompetent policymaking, no matter how you slice it. The spate of lawsuits generated by this law, while a great boost to the incomes of lawyers, partly reflects policy differences between political parties but it also reveals that the law is dreadfully constructed.

Two Lessons from the VA Scandal

The press has been full of reports on the dreadfully low quality health care provided by several VA hospitals and the attempts to cover up this low quality by VA employees. As most all of us would agree, this really is a terrible and tragic situation but, as with almost every tragedy, there are lessons to be drawn from it. Two are worth mentioning here both of which have been stated previously on this blog.

One is that there is simply no good management in government by the Congress because of the sheer size of the organization. The federal government is now a gargantuan bureaucracy with thousands of employees (the Bureau of Labor Statistics provides data on government employment at bls.gov).  One of the best arguments for shrinking the size of the federal government is that it may be possible to do a better job of management if the government is smaller. It is hard to believe that anything like the VA scandal could arise if there was competent management by the Congress.

Second, the VA scandal reveals the reality of what government-run health care would be if we actually had socialized medicine as found in the U.K. and elsewhere. Barack Obama and other Democrats have expressed the opinion that what they would prefer is a single-payer medical insurance system or Medicare for all. On first glance, you might say that this system would not be what is found in other countries but look at the way Medicare currently operates. It sets the prices that it will pay for medical services and it determines the quantities (that is, the medical procedures) that it will cover. This is functionally equivalent to running almost all medical care facilities since, for the vast majority of patients, the Medicare insurance system will dictate how they are treated. People with the resources will go outside the system to get whatever care they deem best for their health. This is precisely how the U.K. system operates. People who stay in the system get lower quality care (for example, they may wait months to see a specialist) whereas those who go outside the system and pay their own way get higher quality care (they get to see the same specialist in a short time). Medicare for all will provide low quality health care for all are confined to it.

If you want to know why the VA scandal is a disaster for Democrats, it is not just because of the scandal itself which is indeed terrible. It is a disaster for what it reveals about the espoused health care policies of the Democratic Party.

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