Wednesday, January 27, 2010

SOTU Thoughts

President Obama will give the SOTU in five minutes. It will be very interesting to see what remarks he has on health care reform. I can see him going one of three ways: 1. Trying to sell reform and implore the House to finish up the job; 2. Also suggest a path to a scaled down health care bill; 3. Not mentioning it. My guess is he will go with option 1. There is some discussion bubbling up that the House would be willing to vote on the Senate bill if the Senate took up amendments to the Senate version in Reconciliation. The other big expectations are that Obama will publicly push Congress to repeal "Don't Ask, Don't Tell". Obama is also expected to announce a spending freeze in discretionary spending. That is small beer. The other issue to watch out for is financial reform.

The Apple iPad

It will f$%k you up for life. Just Kidding. I don't really get it. It seems like a netbook with a little more content. It looks really pretty and some people think it will be the neatest thing since sliced bread. My track record is horrible on these things.

note: I don't think my predictions were totally off base about the smart car. They haven't taken the world by storm but they are common enough to be considered mainstream (to the extent that driving a clown car can be considered mainstream).

More Proof that NoVa is better than MoCo

Courtesy of Urban Turf.

PeP Link Farm

Saab is officially undead.

Union membership dropped 10% last year. Which makes it all the more galling that the House won't vote on the senate health care bill so as to appease unions (why appease them when they are disappearing).

Ezra Klein wonders why Obama is proposing the discretionary budget freeze in a vacuum as opposed to using it as a negotiating ploy. I wonder myself, seems like an unforced error.

Garret Jones has a provocative twitter- If you want to decrease spending increase earmarks.

Chuck Schumer and Orrin Hatch have an op-ed in the NY Times proposing a temporary cut in the employer portion of the payroll tax to stimulate employment. This is something we should have done with the first stimulus.

Ezra Klein has a sort of stupid take on the Hatch proposal, but not completely wrong. He sees the virtue of the proposal as harnessing the rich's irrational desire to avoid taxes. I think most would simply note that its chief virtue is reducing the cost of hiring someone. I suppose though they are two sides of the same coin.

Raghuram Rajan proposes eliminating deposit insurance. It's certainly a provocative proposal.

Tuesday, January 26, 2010

My Modest, Scaled Down Bipartisan Healthcare Plan

Step 1- Revenues and moving away from the employer-based system-
I propose a full phase out of the employer exclusion for those with incomes above $125 k for an individual/ $250 k for a household. This would only yield a modest amount of revenue assuming a static model. There aren't all that many households that would fall into bracket, however, those that do tend to be upper middle management. I think once hr directors across the country see their tax liability go up anywhere from $2-5k that they may rethink the virtues of having their company "provide" their healthcare. This would not cause every company to cash out their fringe benefits and only pay cash wages but it would significantly shift things in this direction.

Now, obviously, getting rid of the employer exclusion would transform compensation norms away from non-taxable benefits to taxable wages much more quickly, but this is probably not politically possible. One could argue that touching the employer exclusion is basically impossible as evidenced by the fact that an incredibly weak excise tax (this was basically a roundabout way of gradually eroding the employer exclusion-really gradually, like decades) sent labor into a tizzy and is arguably the proximate cause for the failure of current health reform bill (that and the fact that house democrats are apparently stupid and timid). I think what distinguishes this proposal is that labor's ox is not getting gored by and large. Most union members do make good salaries but not on this order. Rather, it is a soak the rich proposal which usually is politically palatable. The strength of the proposal is not that the rich will be successfully soaked but in attempting to avoid being soaked explicitly will drastically change the way companies pay their employees. Far fetched, I don't think so.

Step 2- Dump people into the individual market and let them buy insurance across state lines

I know, the individual insurance market is horrible, yadda yadda yadda. One of the basic problems with the individual market is that many states suffer from minimum benefit creep. If you live in New York or some other states where there are very generous mandated benefits chances are your choice is between buying a policy that is exorbitantly expensive and going uninsured. Given that you need food and shelter, the choice most people make is to go uninsured. In choosing between protecting folks from catastrophe on one side and providing insurance that has a no-copay for acupuncture treatments on the other side, I think the providing protection against catastrophic bit is more important.

Why propose buying across state lines as opposed to a national exchange? National exchanges, while a great idea in theory, are likely to be a cess pool for rent seeking. The notion of a basic catastrophic plan being offered unmolested by gentle nudges from the hill (in response to contributions from the AMA) is simply inconceivable. One could counter that without national exchanges, buying across state lines will promulgate a regulatory race to the bottom. Yes, this is a feature of my plan, not a bug (within reason, addressed later in the blog). In the end, my underlying assumption is that we insure ourselves in a perverse manner, and are incentivized to do so by tax incentives. I don't think it is necessary to add third and fourth parties to a simple transaction covering a predictable expense. Thus, my optimal insurance plan would be a pure high deductible plan where you pay cash directly to the provider until you hit the deductible where the insurer would take over (as the deductible would be around $2,500 for an individual the likelihood that you would hit it in a given year is very low). By going the federalism route such a insurance product is more likely to survive.

Step 3. Mandate a couple of insurance reforms- no rescission, guaranteed issue

The danger of buying across state lines and the attendant race to the bottom is the prospect of incentivizing rescission. Ban it, problem solved. This would make premiums more expensive, however...

Step 4. A Federal Catastrophic Reinsurance Plan

People with pre-existing conditions are basically uninsurable. I liked John Kerry's proposal during the 2004 campaign for catastrophic reinsurance. The basic contours of his plan was that after a certain threshold (I think it was $75k) the government would pay half the cost. I wouldn't touch community rating however as it does away with the one thing insurers do well, price risk(never mind that whole AIG thing, nothing to see here). If there was a federal catastrophic reinsurance plan insurers wouldn't have the incentive, or nearly as much of one to screen for pre-existing conditions, but they would have an incentive to price according to certain unhealthy behaviors- like smoking.

Step 5. Use revenues from step 1 to provide a refundable tax credit to those under 200% of the poverty line in amount sufficient to cover the premium and 75% of the deductible. Phase out the deductible contribution and premium coverage by 350% above the poverty level.

Step 6. An individual mandate. Again, if people want to blow their nonrefundable tax credit on crack that is fine with me, but they should have to pay a penalty. A HDHP by itself in VA (my lovely home state) is about $1500 per annum. A penalty of $500 would probably incent most to go ahead an buy the insurance.

Sidebar- Federalize medicaid and get rid of the State and Local tax deduction.

This plan would be considerably less expensive than the currently proposed one, would do more to reform the system, and in the long run would have greater likelihood of containing costs. It would probably be disruptive though.

Thursday, January 21, 2010

Wednesday, January 20, 2010

Health Care Reform is Dead

Labor is throwing a fuss about the excise tax and has now declared opposition to the Senate bill.

I think this effectively kills the reform effort. Even with Brown's election the house could vote on the Senate bill that has passed exactly as it was written and pass it into law (the ping-pong route). This would obviate the need for an additional senate cloture vote that would be necessary if the bill went to conference, which became increasingly important as of yesterday when the Democrats lost their 60th vote. However, now that labor is opposing the senate bill this makes ping pong route unlikely.

The Senate could try to craft new legislation but it no longer has the 60 votes unless it is able to turn a republican or two. Obviously this raises Olympia Snowe's importance. The important question is will Olympia Snowe be willing to ditch the excise tax and embrace a revenue measure that is likely to pass in the house (such as a surcharge on top-earners). I view this as unlikely.

I still think some bill will be passed that is called health care reform but it will be substantially less ambitious.

Sunday, January 10, 2010