Let’s take a trip down memory lane. Back in the 1960s I was skeptical about Medicare. Its stated objective was to prevent the further impoverishing of the elderly poor, a worthy goal. I thought it was overly broad, the estimates of its costs were wildly optimistic, and there was a more direct way of accomplishing the objective: a system of federal clinics modeled on the VA system. Fast forward a few years and physicians who had opposed Medicare until the sweeteners added to the bill got large enough were earning more than ever before, got used to their new-found economic status, and began raising prices to maintain their standards of living, as Uwe Reinhardt among others has documented. By that time I had lived and worked in Germany for a while, seen how things operated in France, and had come to support a single-payer system for the United States to control costs.

When the Clinton Administration’s proposal for health care reform failed due to a combination of political mismanagement and steadfast opposition from the entire health care sector and it subsequently became obvious that the Congress was strongly disinclined to control the cost of health care, that reinforced for me the primacy of cost control. The math is extremely simple. There is no way we can afford anything that is increasing in cost three times as fast as incomes are. Just draw it out on a graph and you’ll see what I mean.

When President Obama turned his attention, prematurely in my opinion, from the economy to health care, I was lukewarm to the Affordable Care Act on the grounds that I doubted it would accomplish its goals and I was skeptical of the president’s claims that it would control costs.

Here’s Megan McArdle’s status report for the Affordable Care Act from her Washington Post column:

The rate of Americans without health-care insurance is now within a percentage point of where it was in the first quarter of 2008, a year before Obama took office. Yet in 2008, the unemployment rate was more than a full percentage point higher than it is now. Given how many people use employer-provided health insurance, the uninsured rate ought to be markedly lower than it was back then.

Overall, the effect of Obamacare seems to be marginal, or perhaps nonexistent.

You can chalk that up to Republican interference, since the uninsured rate has risen substantially in the Trump era. But Democrats weren’t really making that argument, perhaps because they realized that a system so vulnerable to Republican interference isn’t really a very good system.

But even before January 2017, Obamacare was failing to deliver on many of its key promises. At its best point, in November 2016, the reduction in the number of the uninsured was less than the architects of Obamacare had expected. And the claims that Obamacare would “bend the cost curve” had proved, let us say, excessively optimistic.

Adjusted for inflation, consumer out-of-pocket expenditures on health care have been roughly flat since 2007. Obamacare didn’t make them go up, but it didn’t really reduce them, either. The rate of growth in health-services spending has risen substantially since 2013, when Obamacare’s main provisions took effect. And since someone has to pay for all that new spending, premiums have also risen at about the same pace as before Obamacare. So much for saving the average American family $2,500 a year.

No wonder the Democratic presidential candidates are reluctant to speak about the ACA. They’ve turned their attention to another bright, shiny object.

The “Medicare For All” bill presently before the House depends on two things for cost control: savings in administrative costs from pushing health care administrative costs from wherever they are now to the roughly 2% that is Medicare’s present administrative overhead and reducing reimbursement rates to the Medicare reimbursement rates. I’m skeptical that the Congress will have the political will to do that but let’s assume they do. That will mean that hospitals that are presently teetering on the brink of bankruptcy, mostly rural hospitals, will fold, leaving people who live in those counties, a very large proportion of U. S. counties, without hospital care within a reasonable distance. That’s if it’s successful.

I also look forward to the Congress’s directing the CBO to estimate the costs of the Democratic presidential candidates’ promise that M4A will cover all comers including illegal migrants. That should make for entertaining reading.

I didn’t want to let the day go by without remarking on the supplemental spending bill AKA “humanitarian aid bill” passed by the House yesterday. I disagree with nearly every characterization I’ve read of it so far.

It was not a defeat for Speaker Pelosi and the Democrats. It was not a victory Majority Leader McConnell, President Trump, or the Republicans. The Democrats were overtaken by events. The situation at our southern border is a crisis and it’s not a crisis created by President Trump. It’s the same crisis as was faced by President Obama: families with children crossing the border in unprecedented numbers. House Democrats realized that they could not coherently rail against the Trump Administration’s detention practices but refuse to fund more humane detention practices in favor of what is euphemistically called “comprehensive immigration reform” without being reasonably accused of playing politics with people’s lives. Trump did not back them into a corner. Hundreds of thousands of Guatemalan, Salvadoran, Nicaraguan, and Honduran migrants did.

It was a pragmatic decision.

Here’s my major point. Stuff like this used to be easy or at least easier. It used to be much easier to do the right thing without every editorial page in the country complaining about defeat. It didn’t used to be the case that the only way to win was for the other party to lose.

Most people under the age of 40 don’t remember it but it wasn’t always this way. It hasn’t always been duels to the death 100% of the time. You can blame it on Newt Gingrich or farther back to Jim Wright but Congressional politics has not always been as fiercely partisan as it is now.

So, what happened in the “debate” last night? My understanding is that Joe Biden didn’t rise to the occasion, Kamala Harris did, and Marianne Williamson was Marianne Williamson. The quotes I’ve seen from her debate performance sound a bit as though the Reverend Jim (from the old TV show Taxi played by Christopher Lloyd = “Doc Brown” from the Back to the Future) were running for president.

It will be interesting to see the post-debate polls. I suspect that Beto O’Rourke is effectively out. I’m surprised he lasted this long.

I believe that admitting significant numbers of unskilled migrant workers into the United States injures the most vulnerable citizens and recent immigrants by ensuring that entry-level wages remain low. There are multiple studies which have supported that conclusion and you can seek them out for yourself if you are interested. I also believe that a reliable, continuing supply of such workers changes how businesses structure their workforces in such a way as to create minimum wage jobs at the expense of jobs that would inevitably pay more and hurts everyone except those at the very top of the food chain. I know of no study that supports that. I don’t even know how you’d construct one but I’ve observed it personally so I believe it.

Can someone explain to me the distinction between decriminalizing entering the United States without authorization and open borders other than not saying the words “open borders”? I think it would be a disastrous policy but a majority of the Democrats running for their party’s nomination for president have endorsed it.

I thought you might be interested in this graphic, thoughtfully provided by the New York Times. It actually surprised me a little. I would have thought that Warren would have received the most time by far. As it is she came in third.

How is it that Booker managed to capture as much time as he did? Were the moderators afraid to cut him off?

Apparently, Gabbard followed by Booker were the most Googled following the event. I would think that bodes well for both of them. I’m not as surprised by the interest in Gabbard as much as the pundits seem to be.

So, one down and one to go. Will the second Democratic presidential candidate debate be a rerun of last night’s or will it be the “Biden and Bernie Show” with the two principals squaring off against each other and the other eight lining up behind one or the other (my prediction would be everybody lining up behind Biden)?

Apparently, the editors of the Wall Street Journal have noticed the same op-eds I have. Here’s their response:

Nineteen uberwealthy Americans posted an open letter Monday calling on “all candidates for President” to support a “moderate” wealth tax. Signatories include the investor George Soros, Berkshire Hathaway scion Molly Munger, Mickey Mouse heiress Abigail Disney, Facebook co-founder Chris Hughes, and a couple of Hyatt Hotel progeny from the Pritzker family.

“America has a moral, ethical and economic responsibility to tax our wealth more,” they say. Revenue squeezed from the top 0.1% could fund “smart investments,” such as “clean energy innovation,” “infrastructure modernization,” “student loan debt relief,” and “public health solutions.” A wealth tax could safeguard democracy, too, since countries with high economic inequality are more likely to “become plutocratic.”

The letter brushes by the arguments against a wealth tax, calling them “mostly technical and often overstated.” Would courts find it unconstitutional? How would assets like Picassos be valued? Why has Europe largely abandoned this kind of taxation? Doesn’t it diminish the incentive to save and invest? What’s to keep a wealth tax from expanding, like the income tax did, to cover more and more Americans?

Instead of seriously grappling with these objections, the letter tries to sweep readers along in sheer patriotic fervor. The rich “should be proud to pay a bit more,” the authors say. “Taking on this tax is the least we can do to strengthen the country we love.”

Well, what’s stopping them? If billionaires see themselves as a threat to “the stability and integrity of our republic,” they could cease being billionaires any day. If retiring student debt is vital, they could put out a call to graduates and start paying off loans. If the climate is a priority, they could fund a green Manhattan Project.

My response was a bit more sophisticated than that but it’s a start.

It has been explained to me that billionaires will never voluntarily pay more taxes because they “don’t want to be chumps”. I’m skeptical of the notion that social pressure will motivate them. It’s contrary to my personal experience of the ultra-wealthy. Besides it would require that tax returns be public record. Not manipulating the tax code for private benefit would require Congressmen to disarm voluntarily, freely relinquishing one of Congress’s greatest powers. For those reasons I doubt it can happen.

The consensus among pundits and editorial writers appears to be that, since Elizabeth Warren didn’t fall on her face in the first Democratic presidential candidate debate, she won. In an op-ed in the Washington Post Stephen Stromberg explains another reason that she won:

If the first Democratic presidential debate is any measure, practically all the candidates who are not Elizabeth Warren seem to think they can distinguish themselves by sounding exactly like Elizabeth Warren, despite lacking the long record of being Elizabeth Warren. In a political epoch that rewards authenticity and boldness, candidate after candidate embraced the populism they believe Democratic voters desire.

Warren set the tone for the evening by railing against the drug companies, the oil companies and private prisons. She is right that some companies have behaved dishonorably. But she is wrong to make it seem as though, if there is a problem, some corporation somewhere must have caused it, and the only way to solve it is to find and break up that corporation.

“When you’ve got an economy that does great for those with money and isn’t doing great for everyone else, that is corruption, pure and simple,” she said, apparently reducing wealth inequality to an evil plot cooked up by a few billionaires in a room. The question was about talking to people, including 60 percent of Democrats, according to debate moderator Savannah Guthrie, who think the economy is doing well.

What followed was a competition to see who could sound more Warren-esque.

Former Texas congressman Beto O’Rourke blasted “an economy that is rigged to corporations and to the very wealthiest.”

Sen. Cory Booker (N.J.) distanced himself from his previous criticism of politicians who single out companies for breaking up, attacking “pharmaceutical companies that often have monopolistic holds on drugs” — in other words, a legal patent — and bragging that “one of the most aggressive bills in the Senate to deal with corporate consolidation is mine.”

Sen. Amy Klobuchar (Minn.), who had previously mocked candidates who promised free everything, stuck by her promise that she would not give everyone free college, because rich people can pay for their own college educations. But she would give everyone free community college. “If billionaires can pay off their yachts, students should be able to pay off their student loans,” Klobuchar said.

The candidate who came closest to matching Warren populist zinger for populist zinger was New York Mayor Bill de Blasio, probably because he started his rise to prominence as a Warren-like progressive. “You hear folks say there’s not enough money. What I say to them every single time is, there’s plenty of money in this world, there’s plenty of money in this country. It’s just in the wrong hands.”

But unfortunately for those candidates who tried to channel their inner Warren, there was nothing like the real thing. “I want to return government to the people, and that means calling out the names of the monopolists and saying I have the courage to go after them,” Warren said. The monopolists! Vote Bull Moose!

which is as good a definition of winning as any.

I don’t believe I have ever expressed my opinion of Elizabeth Warren here. I think she makes an excellent junior senator from Massachusetts which, as fate would have it, is her present job. If she were 15 years younger, my advice would be to run for governor of Massachusetts, serve a couple of terms there, and then run for president. But she’s too old. She should stay right where she is.

Haven’t we learned our lesson yet? We need a president with executive branch experience. Either that or we should amend the Constitution to divide the powers of the presidency between a head of government and a head of state. If we allow executive branch officials, appointed or civil service, become precinct captains for the digital age, Washington will fall into even further disrepute if such a thing be possible. The executive branch needs serious attention not to mention pruning and it will never get it by electing senators. Or amateurs. We need a government wonk not just a policy wonk.

I found this fact-checking article at CNN of the Democratic presidential candidates made pretty interesting reading. To my eye they don’t understand the tax system (who does?) or income inequality but they do have a pretty good grasp of policy proposals presently being discussed and violence in our cities. And, of course, they never let a good opportunity for demagoguery go to waste.

From an economic efficiency and fairness standpoint we should abolish all income taxes (private and corporate) and replace them with a VAT very broadly applied accompanied by monthly prebate to make it progressive. Such a plan would be hated by the left and the right but most especially by the Congress which would find its ability to raise campaign funds would practically vanish so it will never see the light of day.