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	<title>The Instant Future</title>
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		<title>The Instant Future</title>
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		<title>Douthat And Our Precarious Existential Position</title>
		<link>http://theinstantfuture.wordpress.com/2009/12/21/douthat-and-our-precarious-existential-position/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/12/21/douthat-and-our-precarious-existential-position/#comments</comments>
		<pubDate>Mon, 21 Dec 2009 21:52:19 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[Religion exists, in part, precisely because humans aren’t at home amid these cruel rhythms. We stand half inside the natural world and half outside it. We’re beasts with self-consciousness, predators with ethics, mortal creatures who yearn for immortality. This is an agonized position, and if there’s no escape upward — or no God to take [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=35&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<blockquote><p>Religion exists, in part, precisely because humans aren’t at home amid these cruel rhythms. We stand half inside the natural world and half outside it. We’re beasts with self-consciousness, predators with ethics, mortal creatures who yearn for immortality.</p>
<p>This is an agonized position, and if there’s no escape upward — or no God to take on flesh and come among us, as the Christmas story has it — a deeply tragic one.</p>
<p>Pantheism offers a different sort of solution: a downward exit, an abandonment of our tragic self-consciousness, a re-merger with the natural world our ancestors half-escaped millennia ago.</p>
<p>But except as dust and ashes, Nature cannot take us back.</p></blockquote>
<p><a title="NYT" href="http://www.nytimes.com/2009/12/21/opinion/21douthat1.html">http://www.nytimes.com/2009/12/21/opinion/21douthat1.html</a></p>
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		<title>Paulson and Goldman</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/20/paulson-and-goldman/</link>
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		<pubDate>Tue, 20 Oct 2009 21:22:14 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[Submitted without comment, from Felix Salmon linking to Andrew Sorkin: Andrew Ross Sorkin’s new book is out today, and breaks some pretty stunning news, dating from the end of June, 2008. At this point, we’re still months away from the now-famous but then-secret waiver, issued in mid-September, which allowed Hank Paulson to talk to Goldman [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=31&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>Submitted without comment, <a href="http://blogs.reuters.com/felix-salmon/2009/10/20/the-secret-paulson-goldman-meeting/">from Felix Salmon</a> linking to Andrew Sorkin:</p>
<blockquote>
<div>
<p><a href="http://www.andrewrosssorkin.com/">Andrew Ross Sorkin’s</a> new book is out today, and breaks some pretty stunning news, dating from the end of June, 2008. At this point, we’re still months away from the now-famous but then-secret <a href="http://www.andrewrosssorkin.com/2009/10/paulsons-secret-waiver-to-work-on-goldman-matters/">waiver</a>, issued in mid-September, which allowed Hank Paulson to talk to Goldman Sachs; he’d promised not to do that when he moved from Goldman to Treasury.</p>
<p>But it turns out that Paulson just happened to be in Moscow at the same time that Goldman’s board of directors was having dinner there with Mikhail Gorbachev. (You know, as one does.) Take it away, Andrew:</p>
<blockquote><p>When Paulson learned that Goldman’s board would be in Moscow at the same time as him, he had [Treasury chief of staff] Jim Wilkinson organize a meeting with them. Nothing formal, purely social — for old times’ sake.</p>
<p><em>For fuck’s sake!</em> Wilkinson thought. He and Treasury had had enough trouble trying to fend off all the Goldman Sachs conspiracy theories constantly being bandied about in Washington and on Wall Street. A private meeting with its board? <em>In</em> <em>Moscow</em>?</p>
<p>For the nearly two years that Paulson had been Treasury secretary he had not met privately with the board of any company, except for briefly dropping by a cocktail party that Larry Fink’s BlackRock was holding for its directors at the Emirates Palace Hotel in Abu Dhabi in June.</p>
<p>Anxious about the prospect of such a meeting, Wilkinson called to get approval from Treasury’s general counsel. Bob Hoyt, who wasn’t enamored of the “optics” of such a meeting, said that as long as it remained a “social event,” it wouldn’t run afoul of the ethics guidelines.</p>
<p>Still, Wilkinson had told [Goldman chief of staff John] Rogers, “Let’s keep this quiet,” as the two coordinated the details. They agreed that Goldman’s directors would join him in his hotel suite following their dinner with Gorbachev. Paulson would not record the “social event” on his official calendar…</p>
<p>“Come on in,” a buoyant Paulson said as he greeted everyone, shaking hands and giving bear hugs to some.</p>
<p>For the next hour, Paulson regaled his old friends with stories about his time in Treasury and his prognostications about the economy. They questioned him about the possibility of another bank blowing up, like Lehman, and he talked about the need for the government to have the power to wind down troubled firms, offering a preview of his upcoming speech.</p></blockquote>
<p>How on <em>earth</em> did Paulson think this was OK? Goldman Sachs was a hugely powerful for-profit investment bank, and there he is, giving private chapter and verse on his opinions about the US and global economy, talking about internal Treasury matters, and previewing an upcoming (and surely market-moving) speech. All in secret, at a “social event” which somehow got kept off his official calendar. Oh, yes, and one other thing — the whole shebang took place in the Moscow Marriott Grand Hotel, in the context of Goldman directors joking about how all the Moscow hotels were surely bugged.</p>
<p>This is sleazy in the extreme, and will only serve to heighten suspicions that Paulson’s Treasury was rigging the game in favor of Goldman all along. (It’s also a bit peculiar, to say the least, that the only two times Paulson met with private-sector boards he was out of the country, and arguably outside US jurisdiction.)</p>
<p>Paulson didn’t have this meeting out of fear or necessity: in fact, he told the directors that although there might be tough times ahead, “I think we may come out of this by year’s end.” (Blankfein was skeptical.) There was nothing in the way of extenuating circumstances which could possibly justify the secret rendezvous. This is definitely a situation where Wilkinson should have pushed back and said no way — but it’s hard to say no to Hank Paulson. Whose reputation has now taken yet another serious lurch downwards.</p>
</div>
</blockquote>
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		<title>Wyden Prefers Good Policy To Partisanship</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/20/wyden-prefers-good-policy-to-partisanship/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/10/20/wyden-prefers-good-policy-to-partisanship/#comments</comments>
		<pubDate>Tue, 20 Oct 2009 21:18:54 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[It&#8217;s obvious what Olympia Snowe got out of being the lone Republican to break rank and sign on for health care reform:  publicity out the ass, every last one fawning over her bipartisan courage.  This in turns plays well in Maine.  Senator Ron Wyden, who&#8217;s been more or less on his own in pushing his [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=29&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>It&#8217;s obvious what Olympia Snowe got out of being the lone Republican to break rank and sign on for health care reform:  publicity out the ass, every last one fawning over her bipartisan courage.  This in turns plays well in Maine.  Senator Ron Wyden, who&#8217;s been more or less on his own in pushing his (better, iirc) reform bill and assorted amendments, has no such motivation in his battle against his own party.  Ezra Klein on Wyden:</p>
<blockquote><p>As you might expect, the Senate Democratic leadership was not too pleased with Hoelzer&#8217;s decision to press &#8220;send.&#8221; But this is further evidence of the increasingly interesting space that Wyden&#8217;s office is carving out for itself. There are a lot offices on the Hill that annoy the leadership because they are insufficiently loyal to the party, or because they eagerly cultivate a reputation for centrism. But so long as that heterodoxy comes from a vulnerable senator, it&#8217;s considered part of the cost of a doing business. A guy like Ben Nelson is protected because everyone agrees that if Nebraska weren&#8217;t represented by a centrist Democrat, it would be represented by a conservative Republican, and that would make life harder overall. If he has to be seen as anti-liberal crusader to keep his seat, then so be it.</p>
<p>Wyden, however, is a liberal in a safe seat. And he&#8217;s not even <em>that</em> liberal. By all rights, he shouldn&#8217;t be causing anyone any headaches. But he&#8217;s beginning to fashion a reputation for himself not as a crusader against liberal policies, but against <em>bad policy compromises.</em> That makes everyone&#8217;s life more difficult, because the Senate pretty much runs on bad policy compromises, and the people making those compromises prefer it if they&#8217;re not pointed out. Indeed, as the talking points show, they sometimes try and pretend those compromises were never made at all. But Wyden keeps pointing them out, and loudly. And as he develops a reputation for being an independent policy voice, he&#8217;s becoming more popular with the media, which is further amplifying his criticisms. It&#8217;s an important role for somebody to be playing, but I imagine Wyden is going to start getting yelled at a whole lot.</p></blockquote>
<p>If there&#8217;s going to be a mandate, the least we could do is let consumers maneuver as much as possible in getting the best plan for them.  Access to the exchange is exactly that.  Moreover, it doesn&#8217;t seem to violate any of the precepts laid out by Austin Frakt.  A competitive enough market is required to ensure that the lower prices enabled by leverage are actually passed on to consumers.  But there&#8217;s no opting out here, nor any slicing and dicing of current insurance firms.  If there was significant friction propping up insurance profits before (i.e. consumers may have wanted to get in on cheaper prices offered by different firms, but couldn&#8217;t move from plan to plan), this will surely help.</p>
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		<title>Quiggin on Contrarianism</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/19/quiggin-on-contrarianism/</link>
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		<pubDate>Mon, 19 Oct 2009 19:03:46 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[To sum up my current view in a contra-contrarian style: “contrarianism” is mostly contrary to reality, the “conventional wisdom” is probably wiser than the typical unconventional alternative, and “politically incorrect” views are almost always incorrect in every way: literally, scientifically and morally. Link<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=27&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<blockquote><p>To sum up my current view in a contra-contrarian style: “contrarianism” is mostly contrary to reality, the “conventional wisdom” is probably wiser than the typical unconventional alternative, and “politically incorrect” views are almost always incorrect in every way: literally, scientifically and morally.</p></blockquote>
<p><a href="http://johnquiggin.com/index.php/archives/2009/10/19/the-importance-of-being-earnest-how-superfreakonomics-killed-contrarianism/">Link</a></p>
<blockquote></blockquote>
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		<title>Krugman Maybe Not So Worth Listening To</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/19/krugman-maybe-not-so-worth-listening-to/</link>
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		<pubDate>Mon, 19 Oct 2009 17:35:04 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[Paul Krugman has been lambasting his profession, I think, more or less since the crisis started.  In any case, he&#8217;s talked plenty (along with Brad DeLong) about a Great Forgetting in the economics profession, one where Keynesian economics got the short shrift as a result of&#8230;bias?  I guess?  John Cochrane, a focal point of the [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=23&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>Paul Krugman has been lambasting his profession, I think, more or less since the crisis started.  In any case, he&#8217;s talked plenty (along with Brad DeLong) about a Great Forgetting in the economics profession, one where Keynesian economics got the short shrift as a result of&#8230;bias?  I guess?  John Cochrane, a focal point of the Krugman-Delong axis, <a href="http://faculty.chicagobooth.edu/john.cochrane/research/Papers/krugman_response.htm">responds</a>:</p>
<blockquote><p>Most of all, it’s sad. Imagine this weren’t economics for a moment. Imagine this were a respected scientist turned popular writer, who says, most basically, that everything everyone has done in his field since the mid 1960s is a complete waste of time. Everything that fills its academic journals, is taught in its PhD programs, presented at its conferences, summarized in its graduate textbooks, and rewarded with the accolades a profession can bestow, including multiple Nobel prizes, is totally wrong.  Instead, he calls for a return to the eternal verities of a rather convoluted book written in the 1930s, as taught to our author in his undergraduate introductory courses.  If a scientist, he might be an AIDS-HIV disbeliever, a creationist, a stalwart that maybe continents don’t move after all.</p>
<p>It gets worse. Krugman hints at dark conspiracies, claiming “dissenters are marginalized.” Most of the article is just a calumnious personal attack on an ever-growing enemies list, which now includes “new Keynesians” such as Olivier Blanchard and Greg Mankiw.  Rather than source professional writing, he plays gotcha with out-of-context second-hand quotes from media interviews. He makes stuff up, boldly putting words in people’s mouths that run contrary to their written opinions.  Even this isn’t enough: he adds cartoons to try to make his “enemies” look silly, and puts them in false and embarrassing situations.  He accuses us of adopting ideas for pay, selling out for “sabbaticals at the Hoover institution” and fat “Wall street paychecks.” It sounds a bit paranoid.</p></blockquote>
<p>The killshot:</p>
<blockquote><p>That’s the biggest and saddest news of this piece: Paul Krugman has no interesting ideas whatsoever about what caused our current financial and economic problems, what policies might have prevented it, or what might help us in the future, and he has no contact with people who do. “Irrationality” and advice to spend like a drunken sailor are pretty superficial compared to all the fascinating things economists are writing about it these days.</p></blockquote>
<p><a href="http://www.huffingtonpost.com/david-k-levine/an-open-letter-to-paul-kr_b_289768.html">David Levine</a> (WashU) echoes as much in the HuffPo.  In the very least, Cochrane has me wondering about the efficacy of stimulus:</p>
<blockquote><p>In economics, stimulus spending ran aground on Robert Barro’s Ricardian equivalence theorem. This theorem says that debt-financed spending can’t have any effect because people, seeing the higher future taxes that must pay off the debt, will simply save more. They will buy the new government debt and leave all spending decisions unaltered. Is this theorem true? It’s a logical connection from a set of “if” to a set of “therefore.” Not even Paul can object to the connection.</p>
<p>Therefore, we have to examine the “ifs.” And those ifs are, as usual, obviously not true. For example, the theorem presumes lump-sum taxes, not proportional income taxes. Alas, when you take this into account we are all made poorer by deficit spending, so the multiplier is most likely negative. The theorem (like most Keynesian economics) ignores the composition of output; but surely spending money on roads rather than cars can affect the overall level.</p>
<p>Economists have spent a generation tossing and turning the Ricardian equivalence theorem, and assessing the likely effects of fiscal stimulus in its light, generalizing the “ifs” and figuring out the likely “therefores.”  This is exactly the right way to do things.  The impact of Ricardian equivalence is not that this simple abstract benchmark is literally true. The impact is that in its wake, if you want to understand the effects of government spending, you have to specify why it is false.  Doing so does not lead you anywhere near old-fashioned Keynesian economics. It leads you to consider distorting taxes, how much people care about their children, how many people would like to borrow more to finance today’s consumption and so on. And when you find “market failures” that might justify a multiplier, optimal-policy analysis suggests fixing the market failures, not their exploitation by fiscal  multiplier.  Most “New Keynesian” analyses that add frictions don’t produce big multipliers.</p></blockquote>
<blockquote><p>This is how real thinking about stimulus actually proceeds. <em>Nobody ever</em> “asserted that an increase in government spending cannot, under any circumstances, increase employment.” This is unsupportable by any serious review of professional writings, and Krugman knows it. (My own are perfectly clear on lots of possibilities for an answer that is not zero.) But thinking through this sort of thing and explaining it is much harder than just tarring your enemies with out-of-context quotes, ethical innuendo, or silly cartoons.</p></blockquote>
<p>I wish John Cochrane was a blogger.  It&#8217;s hard to pick through who&#8217;s right as a layman, but there&#8217;s a reason I mostly skip Krugman columns/blogs and make sure to read things like Marginal Revolution and Overcoming Bias and The Money Illusion.  I don&#8217;t feel like I learn anything when I read Krugman columns.  And while I do learn from Brad DeLong&#8217;s blog&#8230;it&#8217;s more about journalism and history than economics.  I don&#8217;t feel capable of articulating the difference just now and I wonder exactly how my biases are manipulating my response to these various bloggers.  Is there a tone/rhetorical style that I&#8217;m responding to rather than an appeal to logic?  Perhaps, but that doesn&#8217;t explain why Krugman can&#8217;t convince me of the necessity of the public plan.  Why should Ezra Klein be more elucidating about health care reform than an honest-to-goodness Nobel laureate in economics?  Is his style so persuasive? Whatever the case, Cochrane sees there&#8217;s something weird about Krugman&#8217;s advocacy and it runs parallel to my reading preferences.  Krugman will stay for now in the ol&#8217; g-reader, but he&#8217;s going to have to start making a case for himself on the merits of his work.</p>
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		<title>What Kind Of Insurers Do We Want?</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/15/what-kind-of-insurers-do-we-want/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/10/15/what-kind-of-insurers-do-we-want/#comments</comments>
		<pubDate>Thu, 15 Oct 2009 21:02:20 +0000</pubDate>
		<dc:creator>BG</dc:creator>
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		<description><![CDATA[Austin Frakt evidently has an interesting blog.  More: In his 1998 Health Services Research article Managed Care, Market Power, and Monopsony, Mark Pauly lays out some helpful theory. In the case of a monopsony insurer (a market with only one health insurance plan) overall welfare (consumer plus producer surplus) is lower than in the case [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=20&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>Austin Frakt evidently has an interesting blog.  More:</p>
<blockquote><p>In his 1998 Health Services Research article <a href="http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1070328&amp;blobtype=pdf">Managed Care, Market Power, and Monopsony</a>, Mark Pauly lays out some helpful theory. In the case of a monopsony insurer (a market with only one health insurance plan) overall welfare (<a href="http://theincidentaleconomist.com/an-illustrative-welfare-analysis-of-google-reader/">consumer plus producer surplus</a>) is lower than in the case of a more competitive market. However consumer surplus (the value of the product to consumers less the price they pay) may increase depending on the type of insurer. A for-profit monopsony health insurer may not pass the lower provider prices to consumers through lower premiums. A nonprofit monopsony health insurer, on the other hand, will (in theory).</p>
<p>OK, what does this mean? It means that, according to theory, consumers get the best deal when the health insurer has considerable market power (monopsony or market share concentrated in very few insurers) and when the insurer is a nonprofit entity (as would be the <a href="http://www.kaiserhealthnews.org/Daily-Reports/2009/June/22/Coops.aspx?referrer=search">co-ops</a> recently proposed by Senator Kent Conrad). Nevertheless, a monopsony insurer reduces producer surplus (and therefore overall welfare) by extracting prices from providers below those of a competitive market.</p></blockquote>
<p>With what I&#8217;ve read over the past few days, I think I&#8217;m more amenable to Rahm&#8217;s strong arm tactics in Congress toward the progressive left.  It doesn&#8217;t seem like their sticking point, the public option, is especially good policy.  Here&#8217;s <a href="http://krugman.blogs.nytimes.com/2009/09/08/why-the-public-option-matters/">Paul Krugman</a>, responding to Ezra Klein:</p>
<blockquote><p>The first is that I suspect that Ezra and others understate the extent to which even a public plan with limited bargaining power will help hold down overall costs. Private insurers do pay providers more than Medicare does — but that’s only part of the reason Medicare has lower costs. There’s also the huge overhead of the private insurers, much of which involves marketing and attempts to cherry-pick clients — and even with community rating, some of that will still go on. A public plan would probably be able to attract clients with much less of that.</p></blockquote>
<p>Bargaining power is the price determiner per Frakt, which means limited bargaining power isn&#8217;t going to extract good prices.  This would not be a robust public option.  Interestingly, you can see the logic for single payer in Frakt&#8217;s citation: a theoretical single payer would be both non-profit and a monopsony.  With all the good and bad of the defense industry, I assume.</p>
<blockquote><p>Second, a public plan would probably provide the only real competition in many markets.</p></blockquote>
<p>Frakt suggests at least that competition may not be a good thing in those markets.</p>
<blockquote><p>Third — and this is where I am getting a very bad feeling about the idea of throwing in the towel on the public option — is the politics. Remember, to make reform work we have to have an individual mandate. And everything I see says that there will be a major backlash against the idea of forcing people to buy insurance from the existing companies. That backlash was part of what got Obama the nomination! Having the public option offers a defense against that backlash.</p></blockquote>
<p>This gets back to the <a href="http://www.overcomingbias.com/2009/09/against-this-med-reform.html">mandate problem</a> and wondering why it exists in the first place.  There&#8217;s no obviously preferable alternative structure, it seems.  Single payer is apparently right out, though I wonder how good it is.  I also wonder: How do the unemployed get health care?  Isn&#8217;t that keeping the economy underemployed to some degree?</p>
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		<title>Anti-Trust Exemption A Good Thing?</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/15/anti-trust-exemption-a-good-thing/</link>
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		<pubDate>Thu, 15 Oct 2009 20:20:13 +0000</pubDate>
		<dc:creator>BG</dc:creator>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[exemption]]></category>
		<category><![CDATA[Harry Reid's balls]]></category>
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		<description><![CDATA[Not that I've looked it up, but I wonder how often this particular measure has been brought up by Democrats in an effort to beat back on certain lobbying groups?  It turns out such legislation might be more like a mutually-assured destruction kind of device, which keeps it from ever getting passed...but you have to remind everyone you have it when you feel sufficiently threatened.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=17&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>via <a href="http://www.marginalrevolution.com/marginalrevolution/2009/10/austin-frakt-on-the-insurance-antitrust-exemption.html">MR</a>, Austin Frakt and Ian Crosby:</p>
<blockquote><p>How to balance the power of insurers and providers is far from simple. Many have pointed to the alleged dominant market position of insurers as a substantial source of high health care costs. However, the <a href="http://theincidentaleconomist.com/who-has-power-health-insurers-vs-providers/">health economics literature</a> supports the notion that recent increased market power of insurers does not lead toward monopolistic pricing, but rather it provides a counter-balance to the power held by hospitals and provider groups.</p>
<p>Moreover, insurance companies are partially exempt from federal antitrust law for an important reason: so they can share rate-making data. This function actually benefits small insurers who would not otherwise have sufficient data to properly adjust premiums. Paradoxically, removing the legal cover for data sharing would harm small insurers more than large ones.</p>
<p>All this suggests that repealing the federal antitrust exemption for insurers may be misguided. Though the insurance antitrust exemption is a popular whipping boy for Democratic politicians, it is by no means clear that repealing it is practical or beneficial to consumers. Instead, antitrust law might better aid the cause of health care reform by first focusing on providers. While a few proposed hospital mergers have been <a href="http://theincidentaleconomist.com/economics-of-antitrust-hospital-mergers/">blocked recently</a>, it follows a long period of hospital consolidation.</p>
<p>Yet even here, antitrust exemptions may be inevitable to allow doctors and hospitals to negotiate bundled payments contingent on performance under the guise of accountable care organizations (<a href="http://theincidentaleconomist.com/accountable-care-organizations-health-insurer-market-power-and-antitrust/">ACOs</a>). It is not unreasonable to worry that providers might try to use the ACO structure to lobby Congress and negotiate more favorable Medicare payments and regulation (in fact, such activities are constitutionally protected under the <a href="http://en.wikipedia.org/wiki/Noerr-Pennington_doctrine">the Noerr-Pennington doctrine</a>). So we have to encourage provider integration without unduly increasing the strength of providers with respect to insurers or their regulators. This will be hard indeed and could be harder still with a weakened insurance industry.</p>
<p>All this suggests a confused focus in Washington, though one consistent with populist sentiment. Insurers, rightly or wrongly, are the scapegoat and providers (with the exception of the drug industry) are viewed more favorably. There are clearly insurance reforms worth implementing, but weakening insurers’ market power while strengthening that of providers may not be one of them.</p></blockquote>
<p>Not that I&#8217;ve looked it up, but I wonder how often this particular measure has been brought up by Democrats in an effort to beat back on certain lobbying groups?  It turns out such legislation might be more like a mutually-assured destruction kind of device, which keeps it from ever getting passed&#8230;but you have to remind everyone you have it when you feel sufficiently threatened. F&amp;C say as much:</p>
<blockquote><p>In the wake of AHIP’s promotion of the <span style="text-decoration:line-through;">report</span> <a href="http://theincidentaleconomist.com/the-pwc-report/">sham study</a>it commissioned from PricewaterouseCoopers (PWC), Senate Democrats are <a href="http://prescriptions.blogs.nytimes.com/2009/10/14/for-insurers-a-question-of-trust-and-antitrust/?hp">pushing to repeal</a> a 1945 statute that partially exempts insurers from national antitrust law. While it may be wise to regulate insurers at the national as opposed to the state level, legislating in anger is not. At this stage, however, this <a href="http://voices.washingtonpost.com/ezra-klein/2009/10/harry_reid_gets_tough_with_the.html">isn’t anywhere near</a> serious legislation. It is a signal of Democrats’ intent and a warning shot across the bow of the insurance industry.</p></blockquote>
<p>Corollary: the greater capacity to pass legislation, the greater leverage on lobbies.  A truly populist agenda (i.e.. enacting only laws that reflect the will of a filibuster-proof majority), then, would have the greatest leverage over corporate lobbying.</p>
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		<title>More On Insurance Anti-Trust</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/14/more-on-insurance-anti-trust/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/10/14/more-on-insurance-anti-trust/#comments</comments>
		<pubDate>Wed, 14 Oct 2009 22:31:00 +0000</pubDate>
		<dc:creator>BG</dc:creator>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Harry Reid's balls]]></category>
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		<description><![CDATA[Ezra Klein, responding to Tyler Cowen: Tyler Cowen, however, is upset by the timing of Democratic threats to repeal the provision: &#8220;Everyone who cares about American democracy and rule of law should be complaining about Harry Reid, Patrick Leahy and their allies in this move,&#8221; he writes. I&#8217;m not convinced. For one thing, Leahy has [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=10&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>Ezra Klein, <a href="http://voices.washingtonpost.com/ezra-klein/2009/10/why_are_insurers_exempt_from_a.html">responding</a> to Tyler Cowen:</p>
<blockquote><p>Tyler Cowen, however, is upset by the timing of Democratic threats to repeal the provision: &#8220;Everyone who cares about American democracy and rule of law should be complaining about Harry Reid, Patrick Leahy and their allies in this move,&#8221; he writes. I&#8217;m not convinced.   For one thing, Leahy has been trying to repeal this provision for years. He&#8217;s been consistent on this. But more broadly, this is a case where a particular industry got its friends in Congress to do it a favor, convinced its friends in Congress to protect that favor, and now that it&#8217;s losing its friends, that favor looks unlikely to survive. When an industry gains by spending countless millions effectively lobbying Congress, it opens itself to losing by spending countless millions ineffectively lobbying Congress.</p></blockquote>
<p>I was maybe overexcited about the provision.  Cowen <a href="http://www.marginalrevolution.com/marginalrevolution/2009/10/political-extortion.html">says</a> he doesn&#8217;t know whether it&#8217;s a good or bad policy and Ezra doesn&#8217;t really come out for or against on that important point.  And either way, it still constitutes an existential threat to insurance companies.  It&#8217;s a policy that has plenty of leverage.  Co-sign Megan McArdle&#8217;s <a href="http://meganmcardle.theatlantic.com/archives/2009/10/democrats_try_to_hit_the_insur.php">comment</a>:</p>
<blockquote><p>In principal, I&#8217;m in favor of anti-collusion laws, though in practice, anti-trust cases are more often a weapon used to quell competition, rather than an actual benign force in the market, and by the time the case has wrapped up, they&#8217;re usually moot.  (See, AT&amp;T, IBM, Microsoft).    And I certainly don&#8217;t see why insurance companies should have an exemption from whatever laws we do have.  But it&#8217;s hard to escape noticing that this basically amounts to political extortion, which is not the way our laws should be used.</p></blockquote>
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		<title>A Glimmer Of Health Care Hope</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/14/a-glimmer-of-health-care-hope/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/10/14/a-glimmer-of-health-care-hope/#comments</comments>
		<pubDate>Wed, 14 Oct 2009 21:29:58 +0000</pubDate>
		<dc:creator>BG</dc:creator>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Harry Reid's balls]]></category>
		<category><![CDATA[health care reform]]></category>
		<category><![CDATA[insurance]]></category>

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		<description><![CDATA[So let's instead let the person who buys the product use the product.  The feedback mechanism would be more or less money for providers based on results, rather than confused consumers yelling at congressmen through megaphones with no clear idea of what the hell is going on.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=8&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<blockquote><p>Jim Manley, a spokesman for Mr. Reid, said that Senator Olympia J. Snowe of Maine, the lone Republican on the Finance Committee to vote in favor of the bill, would be invited to future sessions. And Mr. Manley said the Democratic leader was prepared to go to substantial lengths to keep Ms. Snowe’s support.</p></blockquote>
<blockquote><p>“He is prepared to do what he can to keep her on board while putting together a bill that can get the 60 votes necessary to overcome a Republican filibuster,” Mr. Manley said.</p></blockquote>
<p><a href="http://prescriptions.blogs.nytimes.com/2009/10/13/next-up-harry-reid-and-the-blenders/">This</a> is straight up crazy.  The 60 votes are already in his caucus.  Snowe should be a total non-sequitur as far as this procedure is concerned unless there is some Senate Democrat threatening to blow it up.  So we should see this as Reid putting on a show running parallel to their give-and-take (that is, give Americans expanded coverage without taking anything from Democratic coffers) with the insurance industry.  Can we really take seriously the notion that the Senate Majority cannot whip their own votes?  History says hell no.  Ben Nelson says well, <a href="http://tpmdc.talkingpointsmemo.com/2009/10/nelson-i-dont-know-if-i-could-support-a-health-care-bill-without-snowe.php?ref=dcblt">perhaps</a>:</p>
<blockquote><p>There&#8217;s been a flood of speculation in the past 24 hours about the possibility that Snowe&#8217;s vote might now become the glue that keeps conservative Democrats on board with the reform process. I asked Nelson whether he could imagine voting for a bill that does <em>not</em> have Snowe&#8217;s support. Nelson didn&#8217;t answer one way or another&#8211;but without saying yes or no, Nelson indicated that her final position will weigh heavily on members like him.</p>
<p>&#8220;I will be a team player,&#8221; Nelson told TPMDC, with one condition: Democrats must be careful not to tack too far to the left when the health care bill reaches the floor.</p></blockquote>
<p><a href="http://tpmdc.talkingpointsmemo.com/2009/10/secret-ahip-talking-points-mandates-good-public-option-bad.php">Meanwhile</a>, we know what the insurance industry is after:</p>
<blockquote><p>The group dismisses a public plan, stating government-run insurance &#8220;would dismantle employer-based coverage, thereby violating the shared commitment to ensure that those who like their current coverage can keep it.&#8221;</p>
<p>The lobbying group expresses support for another controversial aspect of the current health care debate, however. AHIP calls for &#8220;an enforceable personal coverage requirement that brings everyone into the system.&#8221; Of course, the system AHIP refers to is the private health insurance system.</p></blockquote>
<p>The mandate increases demand and is obviously good for business.  As for what&#8217;s good policy, it seems this whole argument is resting on the canard that is employer-based health care.  See <a href="http://www.overcomingbias.com/2009/09/against-this-med-reform.html">Robin Hanson</a>:</p>
<blockquote><p>At the moment US folks have their med plan tied to their employer, and so are only insured over the timescale of their job.  If they have a medical condition when they switch jobs, they are no longer covered for that “pre-existing” condition under their new insurance.  This is a real problem.  The best solution is to break the employer-insurance tie and then encourage longer term insurance contracts, <strong>but that is said to be politically infeasible now</strong>.  So instead the Dems propose to make it illegal for insurance companies to raise prices or exclude coverage based on pre-exisiting conditions.</p>
<p>But by itself that rule would tempt people to skip med insurance, or only get very cheap insurance, and wait to buy generous insurance only when they have a serious medical problem.  After all, the new rule on pre-existing conditions would make their insurance just as cheap even after their problem appeared.</p>
<p>To avoid this behavior, the Dems also propose to require that everyone get insurance.  But that won’t really work if there are really cheap no-frills plans available – then people would just buy cheap plans while waiting for a problem to appear.  So the Dem’s fix is to specify in some detail just what all med plans have to cover, and to not allow prices to vary much.  Yes this avoids the wait-to-insure problem, but at the cost having the government decide which are the good treatments, and then make everyone buy them; skeptics could no longer opt out of tossing their money down the med money pit.</p></blockquote>
<p>Bold mine.  Starting with the assumption that reform must be employer based really is the keystone that began  this convoluted process.  This is not what an elegant solution looks like.  Rather, because one potential solution has been deemed too radical thanks to the inertia caused by a system set in place a half century ago, Congress must carefully construct legislation that balances handouts to old power players with the demands of the people.  This Senate process is mostly about the level of handouts: doing enough to keep industry lobbyist efforts at bay (they have access to the cable networks, too) and donating on their side of the aisle. So is abolishing the employer-centric system actually so radical as to be politically infeasible?  Or is it merely that the prospect of donations and rigged legislation make it the preferred method?  If it&#8217;s the latter, then what to make make of <a href="http://firedoglake.com/2009/10/14/house-judiciary-sens-schumer-reid-call-for-break-up-of-insurance-trust/">this</a>:</p>
<blockquote><p>As part of the <a href="http://en.wikipedia.org/wiki/McCarran-Ferguson_Act">McCarran-Ferguson Act</a>, the insurance industry has an anti-trust exemption that has allowed it to basically enact regional monopolies.  <a href="http://hcfan.3cdn.net/1b741c44183247e6ac_20m6i6nzc.pdf">Over 94%</a> of all insurance markets in the United States are “highly concentrated.”  A few weeks ago, Patrick Leahy and John Conyers <a href="http://crooksandliars.com/dday/conyers-leahy-introduce-bill-end-health-insur">introduced a bill</a> to repeal the exemption.</p>
<p>A House Judiciary Subcommittee <a href="http://www.americanprogressaction.org/issues/2009/10/balto_health_testimony.html">held a hearing</a> last week on the legislation, and the bills continues to add co-sponsors – <a href="http://pottstownherald.com/sestak-supports-preventing-health-insurance-monopolies/2172/">Joe Sestak recently signed on</a>.  The Senate <a href="http://www.opencongress.org/bill/111-s1681/show">bill</a> has 8 cosponsors, including the entire Senate leadership.  Chuck Schumer will <a href="http://www.politico.com/playbook/1009/playbook832.html">reportedly call for the repeal</a> today at a Senate Judiciary hearing&#8230;</p>
<p>At that hearing today, Harry Reid <a href="http://prescriptions.blogs.nytimes.com/2009/10/14/for-insurers-a-question-of-trust-and-antitrust/?partner=rss&amp;emc=rss">endorsed repeal</a>, and given that he’ll be in the room when the bills get merged, that’s a positive sign.</p></blockquote>
<p>I was going to say it&#8217;s probably an empty threat to get AHIP back at the table, but the update to the FDL post has Schumer sticking to his guns:</p>
<blockquote><p>On Dylan Ratigan’s show this morning, Schumer reiterated his call for repealing the anti-trust exemption and said it would be added to the final bill! “The Justice Department should be allowed to go into Alabama and say that one company shouldn’t be 81% of your market,” he said. Ratigan pushed Schumer on the firewall on the exchanges, which disallows people who get insurance from their employer to sign up, and Schumer endorsed Ron Wyden’s efforts on that, and believed that over time, the exchanges would open up. “I think we will get (repealing) the anti-trust exemption through.”</p></blockquote>
<p>So maybe we&#8217;re starting to see the beginnings of real progress on health care.  People need to know what their health care is costing them and be able to use their own dollars (right now, it&#8217;s just being taken out of their paychecks regardless of use) and planning to make it happen.  Forethought enables healthier lifestyle choices and puts the cost/benefit calculation in the hands of the person receiving treatment.  And they need to be able to choose from as many plans as possible.  This is the efficiency mechanism, as far as I can tell, that is lacking in the present system.  Right now we&#8217;re paying vast sums for mediocre results.  So let&#8217;s instead let the person who buys the product use the product.  The feedback mechanism would be more or less money for providers based on results, rather than confused consumers yelling at congressmen through megaphones with no clear idea of what the hell is going on.  It&#8217;s critical that we sidestep the mandate and open up the marketplace, as both move away from the aforementioned inertia and take positive steps toward actual, simpler reform.  The mandate and public option debates are false choices brought about by a desire to treat legislative side effects with more legislation that leads to further side effects.  Screw that.</p>
<blockquote></blockquote>
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		<title>The Pajama Imbroglio</title>
		<link>http://theinstantfuture.wordpress.com/2009/10/13/hello-world/</link>
		<comments>http://theinstantfuture.wordpress.com/2009/10/13/hello-world/#comments</comments>
		<pubDate>Tue, 13 Oct 2009 23:32:37 +0000</pubDate>
		<dc:creator>BG</dc:creator>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[DADT]]></category>
		<category><![CDATA[Obama]]></category>
		<category><![CDATA[progressives]]></category>

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		<description><![CDATA[Obama isn't wrong to say he has a lot on his plate, but it's all the more reason to get DADT over with.  Liberal criticism of Obama has gotten mainstream enough to the point Jon Stewart is criticizing him openly.  If you don't want primary opponents and apathy in the base, following through seems like good strategy.  It's long been good morally.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=theinstantfuture.wordpress.com&amp;blog=9926096&amp;post=1&amp;subd=theinstantfuture&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>I like <a href="http://www.salon.com/opinion/greenwald/2009/10/12/fringe/index.html">Glenn Greenwald</a>.  Here he is on the Harwood anonyquote:</p>
<blockquote><p>&#8220;Every standard form of Washington behavior is on display here:  reporters like Harwood with absolutely no standards who grant anonymity to pass along playground insults.  Obama officials &#8212; part of the Most Transparent Administration Ever &#8212; who seem <a href="http://campaignsilo.firedoglake.com/2009/10/11/white-house-thinks-demonstrators-internet-left-fringe-who-need-to-take-off-the-pajamas/#comment-53219" target="_blank">incapable of speaking about anything</a> without cowardly hiding behind anonymity, <a href="http://gawker.com/5271429/why-the-press-revolt-against-anonymous-briefings-is-a-farce" target="_blank">even for on-the-record briefings</a>.  Snide, Fox-News-mimicking dismissals from the Democratic establishment of any discontent or criticism of the President as coming from the fringe, Far Left.  And particular disdain for any instruments &#8212; blogs, marches and  protests &#8212; which the White House cannot control, which exist independent of the <a href="http://www.politico.com/blogs/bensmith/0409/Common_Purpose.html" target="_blank">tightly coordinated</a>, <a href="http://theplumline.whorunsgov.com/health-care/rahm-slammed-dems-attacking-other-dems-as-f-king-stupid-sources-say/" target="_blank">Rahm-dominated</a> <a href="http://campaignsilo.firedoglake.com/2009/09/06/van-jones-a-moment-of-truth-for-liberal-institutions-in-the-veal-pen/" target="_blank">&#8220;veal pen&#8221; messaging system</a> to which so many <a href="http://www.thenation.com/doc/20091026/hayes" target="_blank">leading progressive organizations have meekly submitted themselves</a> in order to ensure their own continued access, funding and future career options within the Democratic establishment&#8230;It&#8217;s the Democrats who have won the last two elections by large margins and wield all the power, and increasingly the defining conflict is between those whose overarching allegiance is to Obama and the Party as ends in themselves, and those who see those things as mere means to more important ends.&#8221;</p></blockquote>
<p>So despite what <a href="http://www.fivethirtyeight.com/2009/10/just-words.html">Nate Silver says</a>, it&#8217;s hard to believe that Harwood wasn&#8217;t on to something.  I&#8217;m sure Harwood saw his shenanigans getting at least a chance at the kind of coverage it&#8217;s received and all the better for his organization.  Meanwhile, Greenwald and <a href="http://campaignsilo.firedoglake.com/2009/09/06/van-jones-a-moment-of-truth-for-liberal-institutions-in-the-veal-pen/">Jane Hamsher</a> have all along been making a pretty convincing argument that the Obama Administration&#8217;s SOP has been to dismiss and threaten the progressive left any time it interferes politically.   For one, I mention it because their reporting is mostly outside the mainstream Klein/Yglesias axis and given Greenwald&#8217;s hypothesis it&#8217;s not hard to guess why.    But I also wonder where it&#8217;s coming from and whether or not it&#8217;s good that progressives be undermined.</p>
<p>On this particular issue, I don&#8217;t understand it at all.  Don&#8217;t Ask Don&#8217;t Tell is shit policy and regardless of whether or not it takes an executive order or an act of Congress.  The President sets the agenda on both points, though the former is obviously more expedient.  It&#8217;s more than disappointing to be shot down on this particular point, it&#8217;s baffling.  As Greenwald notes in the linked piece, repealing DADT has 3:2 support from the American people.  Obama promised in the campaign to repeal.  So what changed?</p>
<p>He got elected and did the re-election math.  In short: Obama suspects nothing fills Republican coffers like the prospect of gays with guns.  Running with that cynical train of thought (and I swear I remember being admonished by Obama for such cynicism), if everyone who cares about the issue now is donating at the same rate, even if 3/4 of the opposition to DADT double their would be donations (i.e. the Republican base makes it a big issue), that&#8217;s barely enough to outman the majority&#8217;s donation on the issue.  It&#8217;s such a small margin that it can&#8217;t possibly outweigh the benefits of repealing DADT, let alone the monster issues that are going to command the national attention come election time.  And it&#8217;s a policy that actively makes the armed forces better at a time when Obama will likely be heavily reliant on them.</p>
<p>Obama isn&#8217;t wrong to say he has a lot on his plate, but it&#8217;s all the more reason to get DADT over with.  Liberal criticism of Obama has gotten mainstream enough to the point where I&#8217;m aping <a href="http://www.indecisionforever.com/2009/05/15/jon-stewart-nails-obama-on-dont-ask-dont-tell/">Jon Stewart</a>.  DADT seems like a particular sticking point for those liberals.  If you don&#8217;t want primary opponents from the left and apathy in the base, following through just seems like good strategy.  It&#8217;s long been good morally.</p>
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