AHCA

I won’t have much to say about the Republicans’ health care reform reform bill until the ink dries and we see what the Senate does with it. When I get around to writing about its merits I suspect there won’t be any.

All I can is that this is what happens when you enact major social legislation without substantial bipartisan support.

The tragedy of it all is that once it’s stamped out the Affordable Care Act the Congress might think it’s finished with health care but health care will definitely not be finished with the Congress.

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My Day Yesterday

Yesterday after a very successful day of meetings in Toronto I had the misfortune of flying out of Toronto’s airport. I don’t think I’ve ever had a more miserable experience in an airport and I’ve flown in and out of the Lafayette, Indiana airport. And Ontario International Airport outside LA. It makes O’Hare look like the Earthly Paradise by comparison.

Tom Friedman would have a field day. Why doesn’t he write about Canadian infrastructure? There’s an enormous amount of building going on in Toronto but its highways are obviously undersized for the need and any shortcomings of big city American airports are dwarfed by what I experienced in Toronto.

The Canadians certainly aren’t putting their money into infrastructure.

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I Dream of Afghanistan

Hawks continue to dream of an Afghanistan that does not exist, that has never existed, and that for all we know will never exist. Michael Gerson, writing at the Washington Post, reveals that he’s one of them:

The United States eventually needs a capable, nonradical government in Afghanistan that controls as much of its own territory as possible. This will not be achieved by bombing the hell out of the Taliban alone. It will also not be achieved without bombing the hell out of the Taliban, because it has no current incentive to come to the peace table.

If you throw out the qualifiers and weasel words, e.g. “eventually”, “as possible”, there isn’t much left there. In Afghanistan “the Taliban” isn’t a cohesive identifiable group. It’s Afghan religious conservatives who are willing to take up arms. You can be Taliban this week and not the next. They don’t have large military bases, lots of military collateral, or massed forces. They will be in Afghanistan next week, next month, and next year. Will we?

There will never be a “capable, nonradical government in Afghanistan” as long as government is looked at as a device for enriching yourself, your friends, and your family which is pretty much the way it’s always been.

Additionally, no imaginable Afghan government will ever have the resources to control its own territory. The numbers just don’t add up. It will be lucky if it can control Kabul and its environs.

Rather than dreaming of some fantasy Afghanistan, it might be helpful to consider what achievable objectives we have in Afghanistan, what is needed to accomplish them, and do that instead.

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Paying for the Care of People with Pre-Existing Conditions

At e21 Charles Blahous reviews the alternatives for paying for the health care of people with pre-existing conditions. He considers four alternatives:

1) Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become.
2) Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs.
3) Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab.
4) Require a targeted group to shoulder the costs.

My own preference is for a version of #3 but I would ask another question. Who should capture the economic surplus in health care? Consumers or producers? Right now producers capture the economic surplus.

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Policing Has Conflicting Goals

While I have some sympathy with German Lopez’s statement of the problem in his article at Vox:

But when you zoom out to look at all the investigations the Justice Department has done over the past several years, typically after protests ignite due to a police shooting perceived as unjust, a pattern emerges: Whether it’s Baltimore; Cleveland; New Orleans; Ferguson, Missouri; or, most recently, Chicago, the Justice Department has found horrific constitutional violations in how police use force, how they target minority residents, how they stop and ticket people, and virtually every other aspect of policing. These issues come up time and time again, no matter the city that federal investigators look at.

One is left with just one possible conclusion: Policing in America is broken.

Here are the bullet points of his proposed solution:

  1. Police need to apologize for centuries of abuse
  2. Cops should be trained to address their racial biases
  3. Police should avoid situations that lead them to use force
  4. Officers must be held accountable in a very transparent way
  5. On-the-job incentives for police officers need to change
  6. We need higher standards for police — and better pay for cops
  7. Police need to focus on the few people in communities causing chaos and violence
  8. We need better data to evaluate police and crime

Even if fully implemented I don’t think his list would change much. For example, #1 is flummery. It would make Mr. Lopez feel better but it wouldn’t do much to change the underlying issues. I don’t believe an apology would result in people on the South Side of Chicago trusting the CPD more. And while we’re apologizing how about an apology for generations of indifference and corruption on the part of mostly-Democratic city officials?

I think a much more basic problem is that police departments have conflicting goals. Here’s an example.

Something that police officers are taught at the academy is “command bearing” and strategies for maintaining it. The reality is that command bearing is a lot easier when you’re a 250lb. 6’2″ man than when you’re a 110lb. 5’2″ woman. My point is that introducing women and minorities into the police force has changed policing in both good ways and bad. I strongly suspect that one of the effects it’s had has been to make the use of deadly force more likely.

But that brings us to #3. Let’s get real and back to the basics of why we have police departments at all. If force protection is the highest priority (“avoid situations that lead them to use force”), we shouldn’t have police departments at all. You can’t avoid situations in which the use of force is required any more than that.

#6 sounds nice but in Chicago police officers already make six figures when you include overtime and have very generous benefits packages. By far the greater effect of raising pay is to pay more for the police officers you already have and, frankly, Chicago has no problem attracting applicants, suggesting that present pay is already above the market-clearing price. Also, where does he expect Chicago to get the money? The city is already broke.

#7 is fatuous. It boils down to “only arrest criminals”. The problem, to repurpose Chou En-Lai, is that criminals are fish and people in the neighborhoods are the sea.

My priorities would be different than Mr. Lopez’s. Among them would be changing the requirements for joining the police force so that military service does not substitute for education (as it does now at least in Chicago). I’d also change the career path for police officers so that far fewer cops would spend 30 years on the streets. And I’d encourage police to enforce the law more and maintain order less.

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What in the World Did He Think Would Happen?

In an op-ed in the New York Times Robert P. Jones laments the collapse of American identity:

But recent survey data provides troubling evidence that a shared sense of national identity is unraveling, with two mutually exclusive narratives emerging along party lines. At the heart of this divide are opposing reactions to changing demographics and culture. The shock waves from these transformations — harnessed effectively by Donald Trump’s campaign — are reorienting the political parties from the more familiar liberal-versus-conservative alignment to new poles of cultural pluralism and monism.

An Associated Press-NORC poll found nearly mirror-opposite partisan reactions to the question of what kind of culture is important for American identity. Sixty-six percent of Democrats, compared with only 35 percent of Republicans, said the mixing of cultures and values from around the world was extremely or very important to American identity. Similarly, 64 percent of Republicans, compared with 32 percent of Democrats, saw a culture grounded in Christian religious beliefs as extremely or very important.

These divergent orientations can also be seen in a recent poll by P.R.R.I. that explored partisan perceptions of which groups are facing discrimination in the country. Like Americans overall, large majorities of Democrats believe minority groups such as African-Americans, immigrants, Muslims and gay and transgender people face a lot of discrimination in the country. Only about one in five Democrats say that majority groups such as Christians or whites face a lot of discrimination.

and he cites G. K. Chesterton from “What I Saw in America”, an essay I encourage you to read. In that same essay Chesterton characterizes the United States as a country founded on a creed, unlike other countries that were founded on ties of blood or shared history.

What he doesn’t point out is that Chesterton visited the United States the last time the percentage of immigrants in the country reached 15% and that time we responded very differently. We founded the public school system with the explicit purpose of teaching and promoting the American creed.

Now not only do our schools not promote the American creed, many of them reject it outright or even view it as disturbing. That is not a formula for developing a new shared creed but, as Mr. Jones observes, for fraction.

I don’t know what will happen. The one thing I caution those who long for a new American creed, “weaving a new national narrative in which all Americans can see themselves” as Mr. Jones puts it, that the latest wave of immigrants are much more socially conservative than previous waves and much less embracing of liberal democracy. If we don’t teach it, what do we think will happen?

As I’ve pointed out here before at length, every wave of immigrants has left its mark on our politics and society. New immigrants may not arrive with much in the way of material possessions but they do bring their political, social, and religious beliefs with them when they arrive here. Add that when immigrants come here today they don’t cut ties with the old country the way immigrants use to. I know lots of recent immigrants who still call Mama every night.

I don’t think that’s a durable foundation for a new American creed. Maybe I’m wrong.

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Agenda-Driven Analysis Strikes Again

At RealClearPolicy John R. Lott presents us the latest instance of agenda-driven analyses, this time directed at proving that the number of homicides in the United States isn’t a serious problem:

According to a 2013 PEW Research Center survey, the household gun ownership rate in rural areas was 111 percent greater than in urban areas. Suburban households are 28.6 percent more likely to own guns than urban households. Despite lower gun ownership, urban areas experience much higher murder rates. One should not put much weight on this purely “cross-sectional” evidence at one point in time. But it is hard to overlook the fact that so much of the country has both very high gun ownership rates and few, if any, murders.

To put it simply, murder isn’t a nationwide problem; it’s a problem in a very small set of urban areas.

If I use precisely the same approach as Mr. Lott does, I could demonstrate to you that homicide isn’t a problem in Chicago, despite the city having a higher homicide rate per 100K population than at any time in its history.

The demonstration would go like this. Chicago has 77 neighborhoods. Two-thirds of the homicides here take place in just four neighborhoods (5%) and 89% in just six (7.8%). Not a problem, right? But, as I pointed out above, the homicide rate is the highest in city’s history.

The United States does have a homicide problem and it’s concentrated in cities of over a half million people with 20% or more black population. Even within that group of cities there are exceptions. Rather than saying “there’s no problem” find out what they’re doing differently.

There’s one thing that I suspect Mr. Lott and I would agree on: the difference isn’t guns.

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The Decline of Black-Owned Businesses

The Great Recession was particularly hard on black-owned businesses. The National Black Chamber of Commerce, for example, points out that black-owned auto dealerships were severely affected:

Thousands of auto dealers were casualties of the economic crisis. But Lee is part of an especially vulnerable group: black dealers, whose businesses rose and fell with the domestic automakers.

Black dealers have taken a disproportionate hit — “drastic” in the words of one minority dealer spokeswoman — in the past three years. There are 261 black-owned dealerships in the United States today, half as many as three years ago. That’s a much sharper drop than the 18 percent decline in dealerships overall.

Those numbers reflect a seismic shift in the tradition of black business in this country. Just as a UAW factory job provided middle-class security for black workers, owning an auto dealership traditionally has been a path to wealth for black businesspeople.

while Black Enterprise points out that black-owned advertising agencies have suffered:

One devastated sector has been advertising. In fact, our BE Advertising Agencies roster, reeling from corporate clients shifting from targeted messaging to the so-called “total market approach” (see Advertising Overview, this issue), dropped from 10 to eight firms. Many among the Financial Services sector didn’t fare much better.

In that vein according to AfricanGlobe there are about half as many black-owned banks as there were in 2007:

The Federal Deposit Insurance Corp. counted 25 Black-owned banks remaining in the country last year, down from 48 in 2001. That decrease came even as the overall number of minority-owned banks increased slightly, going from 164 to 174. In addition, the majority of Black-owned banks that remain open are on shaky ground and struggling to hold on in the face of the economic devastation that has ravaged many of their customers.

A recent article at Atlantic charts how industry consolidation has affected black-owned businesses:

The decline of black-owned independent businesses traces back to many causes, but a major one that has been little noted was the decline in the enforcement of anti-monopoly and fair-trade laws beginning in the late 1970s. Under both Democratic and Republican administrations, a few firms that in previous decades would never have been allowed to merge or grow so large came to dominate almost every sector of the economy.

This change has hurt all independent businesses, but the effects have disproportionately hit black business owners. Marcellus Andrews, a professor of economics at Bucknell University, says that pulling back on anti-monopoly enforcement was a “catastrophic intellectual and political policy mistake,” and that for the black community, the “presumed price advantages of concentration often do not translate into better economic opportunities.”

I don’t know that I have any great point to make with this post other than to note that indifference to small businesses while catering to big businesses will inevitably be hard on black-owned businesses.

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Cognitive Dissonance

Americans suffer from a very bad case of cognitive dissonance and Robert Samuelson summarizes it well in his most recent Washington Post column:

Our wants and needs from government — the two blur — exceed our willingness to be taxed.

It isn’t a new phenomenon. Sen. Russell Long characterized the same phenomenon 40 years ago, saying: “Don’t tax you, don’t tax me, tax that fellow behind the tree!” I’ve called it the “roomful of money” hypothesis—the idea that somewhere there’s a roomful of money, all you need to do is find it, and all fiscal problems will be solved. That’s the theory behind the funding of the Chicago Public Schools.

I oppose cuts in the personal income tax rates. I don’t believe they will stimulate the U. S. economy as much as its proponents do and I don’t believe it will spur domestic investment. I do believe that we should cut the business income tax so that it’s comparable to that of other OECD countries. When even Nancy Pelosi says that, as she did on the Sunday morning talking heads programs yesterday, it’s hard to claim that’s a far right wing position.

If you feel the need to maintain a balanced budget, introduce another tax bracket that will tax those in the top .01% of income earners. Or cut spending. The idea that in the half trillion annual Medicare tab there is absolutely no waste, fraud, or abuse doesn’t pass the smell test.

Or don’t balance the budget and just issue the credit. That level of money expansion won’t cause a run on the bank.

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Debt and the Health Care Industry

Despite its eye-catching caption, “The health care industry is bound to collapse soon, experts say”, this New York Post article is terribly short on details. Here are their main bullet points:

  • Health care company debt is up 308 percent since 2009.
  • The number of hospitals in health systems has expanded by 26 percent since 1999.
  • The yearly medical costs for a family of four have jumped 189 percent since 2002, from $9,000 to $26,000.

all of which I believe are true. I don’t see how that results in “a couple of big health care companies take the economy down”. To their list of factors I’d add that people in the health care sector both personally and professionally assume that prices in the sector can rise at a multiple of prices in the rest of the economy indefinitely.

Regardless of the risk to individuals and companies I still don’t think that it present systemic risk. Increasing health care costs could take out some state and local governments, however. That’s why I’ve felt that controlling costs is the single most important health care reform.

Well, now we can say with confidence that increasing coverage doesn’t necessarily of itself result in cost control so at least we have that.

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