Today marks the 10th anniversary of the opening of the Affordable Care Act’s portal, Healthcare.gov. Ignoring the disastrous first few days, as good an illustration of the federal government’s shortcomings in managing technology as any, how would we evaluate the success of the Affordable Care Act (ACA)?

According to the Department of Health and Human Services (HHS), the objectives of the ACA are:

• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
• Expand the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs.
• Support innovative medical care delivery methods designed to lower the costs of health care generally.

Since 2012 the percentage of Americans with some form of healthcare insurance has increased from 84.6% to 92.1%. The percentage of people covered by Medicaid has increased from about 12% to 18.8%. However, according to Peterson-KFF per capita spending on health care has increased from $3,152.30 in 2012 to $4,255.10 in 2021 (in constant 2021 dollars). On that basis I think we should consider the ACA a qualified success. That can be explained a variety of ways but most of those ways were known in 2012 and the opposite was claimed. The bottom line is that costs have increased while life expectancy has decreased.

Where to go from here? Will we be able to continue spending a greater percentage of the national income on healthcare indefinitely? It seems unlikely that covering the remaining 8% of people under Medicaid will reduce costs. Will it increase life expectancy?

One of the key provisions that the Writers Guild of America secured was a minimum staffing level guarantee. Exempt from that are shows in which all episodes are written by a single writer.

Will the provision:

1. Improve the quality of scripted shows
2. Reduce the quality of scripted shows
3. Both (improve some; reduce others)
4. Have no effect

I think that scripts written by focus groups or committees other than sitcoms become worse the more writers are involved in the process. Option D would be an indictment of writers 9in general.

I should add that otherwise I have no problem with what the WGA achieved.

The problem with Bidenomics is summed up pretty well by economist James K. Galbraith in a piece at Project Syndicate:

Unlike unemployment, inflation does affect everyone. But what matters to working people is not the monthly or yearly price change taken alone. What matters is the effect on purchasing power and living standards over time. Whether these are rising or falling depends on the relationship of prices to wages. When wage growth exceeds price increases, times are generally good. When it doesn’t, they aren’t.

It is here that Biden has a problem. During his presidency, living standards have not risen. From early 2021 to mid-2023, prices have increased more than wages, implying that real (inflation-adjusted) hourly wages and real weekly earnings have fallen, on average. Not by much, but they have fallen. Worse, the average figure probably masks a larger fall, in real terms, for families that started out below the average. And given how income distributions work, there are always many more families earning less than the average than there are who earn more.

The only strategy working people have to pay their bills is to take on extra work and a lot of them are. The number might be as many as 10% of American workers. Telling them they should be happy about that is probably not a winning political strategy.

I’m a sucker for taxonomies and this one of foreign policy views by Ash Jain at Foreign Policy is no exception. Mr. Jain divides the spectrum of foreign policy thought into six “camps”:

I found his “camps” a bit jumbled—he probably needs more than one axis rather than just the internationalist to non-internationalist one. Is it actually possible to be “unilateral” and “internationalist” simultaneously? Similarly, are realists internationalists at all? Furthermore, I think that ascribing any policy to Donald Trump is a stretch. I think he is much more transactional than that. His classification of the late John McCain as a “democratic internationalist” ignores his stated views on American greatness. I think that any taxonomy of American foreign policy views that places John F. Kennedy, John McCain, Ronald Reagan, and Joe Biden in the same “camp” is puzzling.

For one thing I would place “multilateral” at one end of the spectrum and “unilateral” at the opposite end.

If I had to place myself into a “camp”, it would be realist. Here’s how he describes it:

• View great-power rivalry as inevitable in the global system and support U.S. alliances and active efforts to deter rival powers and maintain global order
• Are willing to engage adversaries and work with all nations, regardless of regime type, to advance strategic objectives
• Are prepared to make mutual accommodations with rivals, or seek to divide them, to achieve a stable balance of power
• Are inclined to “accept the world as it is” and are wary of U.S. intervention and democracy promotion efforts
• Support a strong U.S. defense posture and are willing to use force when required to defend vital national interests

I think that “realistic Jeffersonian” is actually a better description of me. Like Jefferson I think that the U. S. is an outlier and too great a reliance on international institutions will inevitably destroy what makes the United States the country it has been.

I have just learned that California Sen. Dianne Feinstein has died. She was a great woman with many accomplishments, not the least of us was providing some stability to San Francisco under tragic circumstances. I thought she would have made an excellent president. I would have preferred her over Al Gore in 2000.

More recently she has become a lightning rod for controversy around her age. I suspect there will be some turmoil in California over replacing her. Presumably, Gov. Newsom will appoint someone to serve at least temporarily. His choice may have some impact on his presumed presidential candidacy.

Did anybody listen to the Republicans’ second candidates’ debate? I don’t mean anybody here—I certainly didn’t. I mean anybody at all who wasn’t being paid to listen.

I was startled by Janan Ganesh’s speculation at Financial Times on what Donald Trump’s foreign policy would be like should he be elected for a second time. There’s one thing I think he gets absolutely correctly:

Elsewhere, expect more continuities than ruptures. This is because, on protectionism, on Iran, on the withdrawal from Afghanistan, Joe Biden hardly deviated from Trump in the first place. Even his detachment from Saudi Arabia on ethical grounds has given way to the more transactional approach of his predecessor.

There are actually two points combined in that brief passage. First, that what is notable about U. S. foreign policy is the continuity from administration to administration rather than the differences but, second, that President Trump tended to use a highly transactional approach.

Beyond that I have few insights into the workings of Trump’s mind and no real sense of what his second term foreign policy might be. Will he, as Mr. Ganesh avers, “jilt” Ukraine? Reduce the scope of sanctions against Russia? Moderate our opposition to China? I have no idea.

Something unmentioned by Mr. Ganesh is that I think it’s almost a certainty that if he were re-elected President Trump would dispatch the National Guard to our southern border as some of the Republican presidential aspirants have been saying. The situation there is pretty dire, it’s well within his authority, and there is no prospect for an additional term to stay his hand. I also think the “stay in Mexico” policy for asylum-seekers would be revived.

Jake Beardslee’s coverage of Bill Maher’s interview of James Carville at LightWave is pretty interesting. Here are a few choice snippets:

Legendary Democratic strategist James Carville did not hold back in mocking the far-left wing of the Democratic Party, calling them “stupid” and “naive” on Bill Maher’s “Club Random” podcast.

and

Carville revisited his criticisms of progressive Democrats later in the program, calling them a burden to the party. He argued that while only 10% of the party actually identified as progressive, they drag the entire party down.

and

“If we could just get the humanities faculty at Amherst [College] to shut the F up, we’d be a lot better off,” Carville said.

I found this the most telling:

Both Carville and Maher went on to voice concerns that President Biden’s age could hurt him in a potential 2024 rematch against Trump.

“He cannot run for president. He’ll look bad in the debates,” Maher said.

I don’t disagree with him but I think it illustrates just how far the Clintonistas are removed from the locus of power in the party. Nancy Pelosi is a progressive. Hakeem Jeffries is a progressive. Katherine Clark is a progressive. Chuck Schumer is more closely aligned with Congressional progressives than he is with centrists. Power is concentrated in the leadership these days.

I’m going to take the unusual step of quoting Holman Jenkins’s column from the Wall Street Journal in full:

Joe Biden showed up on a Detroit picket line Tuesday to support a strike by local auto workers. Meanwhile a discordant intuition, if not yet a complete thought, was forming in the minds of many of his backers: If the United Auto Workers union succeeds in its aims, it will gobble up funds needed to sustain Mr. Biden’s government-mandated transition to electric vehicles.

These proto-dissenters are right even if they probably don’t fully understand why. The union likes to point to the recent anomalous profits at Ford, GM and Chrysler, but the union really has its eye on what are better defined as “rents”—an economics term for the excess margins the companies have enjoyed on their domestically built pickup trucks and large SUVs thanks to a 25% import tariff in place since 1964.

In some years, these rents materialize as accounting profits; in other years they are fully absorbed by the cost of building money-losing cars mandated by Washington, most recently electric cars. Either way, more for the UAW inevitably means less to subsidize these so-called compliance vehicles.

Additionally, a second stream of “rents” has lately appeared in the form of direct federal handouts to builders and buyers of EVs. UAW chief Shawn Fain makes no bones about wanting to get his hands on these rents too: “If the government is going to funnel billions in taxpayer money to these companies, the workers must be compensated with top wages and benefits.”

Have no illusion. The union is engaged in a financial negotiation, however filigreed with talk of workers vs. the capitalist class. Mr. Fain also has a strategic motive: If battery production for EVs is allowed to take root in nonunion plants, it will accelerate the doom of the government-sanctioned UAW labor monopoly over the Big Three. That monopoly is already self-liquidating, but slowly, as U.S. auto manufacturing increasingly takes place in foreign-owned factories not subject to union control.

But now the UAW faces a new risk from normally friendly territory. A meme is rolling: The union’s largely white, working-class membership, already suspected of Trumpist sympathies, stands in the way of the EV transition that has become a major progressive fetish.

The EV transition is a climate fraud for many reasons. As understood even by top Biden officials (though don’t expect them to say so on the record), subsidizing “green” energy doesn’t actually cause other forms of energy to remain unconsumed and therefore has little or no effect on emissions.

On his best day, however, Joe Biden was never a politician from whom you expected a deep understanding of government policy and its effects. Even less, at age 80, is he thinking about the long-term sustainability of anything right now. He’s thinking about Michigan’s 15 electoral votes.

This is one place where UAW leadership, in its political cynicism, sees more clearly than its allies or critics. The strike can only have one ending, requiring even more interventions in the future to keep the UAW-staffed companies afloat. LBJ’s pickup tariff to block the import of a VW light truck was only the first. In 1979-80, Jimmy Carter bailed out Chrysler with loan guarantees. Ronald Reagan connived with the Japanese over import restrictions. The colossal 2008-09 auto bailout came with Obama and Bush fingerprints.

Mr. Biden’s “EV transition” itself is a Potemkin arrangement of government words to conceal billions in taxpayer aid to the UAW-controlled companies. Recall President Obama’s similar promise of 54.5-mpg cars, his way of disguising an emissions carve-out that continues to enable today’s inflated SUV and pickup profits for domestic manufacturers under the so-called chicken tax (look it up).

Even a vow by California and nine other states to ban sales of new gasoline-powered cars after 2035 is an exercise in political dissembling, embodied in a rulemaking that can be waved away, rather than in legislation. This promise will disappear into the mists when elected officials eventually discover that voters who were willing to indulge a pro-climate talking point aren’t willing to have their choice of vehicles severely restricted.

Mr. Biden may not be clinically senile, but his limited personal stake in the future makes him unlikely to admit or care about the expensive phoniness of America’s climate and auto-regulation policies. The country needs a non-senile president, one who genuinely cares about America’s condition 20, 30, 40 years in the future. It also needs a non-senile news media, devoted to penetrating reality and accurately reflecting it. Today’s understanding of climate science and climate policy is so catastrophically poor, so addicted to virtue signaling, that it’s less than worthless to the public. Change this and politicians might rediscover an incentive to be more truthful and rational in the things they promise.

I don’t subscribe to everything in the piece but I do think he touches on a number of interesting points and it is thought-provoking.

As an example of something in it with which I do not entirely agree, my own view of EVs is that hybrids and EVs are vehicles well-suited to a particular niche, e.g. well-to-do urban commuters in places like Chicago where most of the electricity is derived from nuclear, hydroelectric, wind, solar, and similar sources. Electric trains would probably be an even better choice where they already exist. With present technology hybrids are probably a better choice than EVs.