Video of the day

This was making the rounds all over FB last week.  It really is pretty amazing on many levels.

The Two Americas of health care

So, loyal reader and great guy (really, saying the second after the first is a redundancy), Bob A., sent me a forwarded email from the White House with anecdotes of ACA success stories.  E.g.,

Here’s what getting covered sounds like:

Lucy from Texas:

“I signed up at and I’m going to save $2,300 a year on my premium alone — and more, because my deductible will drop from $7,500 a year to $3,000 a year. It’s still Blue Cross insurance, and I don’t have to change doctors, either. I had a choice of over 30 plans and several different companies.”

In response, Bob wrote:

So Steve, please help me out here.

Is it just because our Governor is a whacko and turned down the federal money, that he can now point to much poorer statistics in NC – compared to the others below?  I wonder if there will be a clear, decisive average difference between the states that turned down the fed money vs the rest of the states.  He broke the ACA system and now says – see, a broken system…

Or am I mixing apples and oranges?

Both.  First, I don’t think its fair to characterize McCrory as a whacko on this.  A very poor policy decision? Yes.  A decision pretty much demanded of you if you are a Republican governor and lacking unusual bravery (see John Kasich)?  Yes.  Anyway, I cannot remember all the various posts I’ve read on it, but the short version is that hell yes the ACA works better when it works like it was designed– full Medicaid expansion with a state-run exchange.  And part of that working better is better prices on health insurance.  McCrory’s refusals of the Medicaid money had not only direct impact on the thousands directly denied Medicaid expansion but probably made for a less efficient overall healthcare marketplace in NC, thereby negatively impacting thousands more.

This very much reminded me of an Ezra post a few weeks ago which suggests that–admittedly worst case scenario– we are heading for two Americans… A Blue state America where the ACA is allowed to function as intended and a red state America where health care is far worse due to Republican obstruction and sabotage.  Ezra:

It’s increasingly possible that Obamacare, at least in its early years, will be a success in blue states (and red states run by Democrats, like Kentucky) even as it flails in red states.

Alice Rivlin likes to say that if the law “really were a federal power grab it wouldn’t be so complicated.” Instead, it relies heavily on states. And some states are doing a much better job than others — and the federal government’s failures are further pulling the laggards down.

“Unlike Medicare before it,” write Sheila Burke and Elaine Kamarck in a new report for the Brookings Institute, “the ACA has built into it a number of key decisions that were left up to states. Among the most important was the decision whether or not to create an insurance exchange. Another decision, whether to expand Medicaid coverage (or not) was not built into the law but came as a result of the Supreme Court’s decision on it.”

The law’s drafters never really saw those as actual decisions. They expected most every state to want to build its own exchange. And, prior to the Supreme Court decision, they believe it impossible for any state to reject the Medicaid expansion…

The result may be that Obamacare doesn’t do anything as simple as succeed or fail. Instead, it vastly improves the health-care systems of the states that wanted to use it to improve their health-care system while collapsing in the states where the leadership did what they could to undermine the law.

Over time, that could lead to a country with two health-care systems: One, a near-universal system based around Obamacare and centered in blue states; the other, a policy mess based around the rejection of Obamacare in the red states.

I suppose that outcome is possible, but I honestly don’t see it as very likely.  If there really are these clear disparities, I think it (and plenty of interest group lobbying from hospitals, etc.,) will get red states to eventually come on board.  Or, I think a true health care policy disaster in red states (still quite unlikely, I think) would do enough damage to the overall law that it could actually be repealed across the board.  I have a hard time seeing this outcome as a long-term status-quo.  That said, in the meantime, as usual, it sure is a heck of a lot worse to be poor or even lower middle class in Red America.

Photo of the day

From the National Geographic tumblr:

A WWI allied soldier bandages the paw of a Red Cross working dog in Flanders, Belgium, May 1917.<br /> We want to hear your dog stories - how Devoted is your dog? Tell us on National Geographic Your Shot. Photograph by Harriet Chalmers Adams, National Geographic

A WWI allied soldier bandages the paw of a Red Cross working dog in Flanders, Belgium, May 1917.


Do Americans always think crime is getting worse?

Pretty much.  It is now fairly well-documented (and I think percevied) that crime underwent a substantial decline in the 1990’s.  The great irony is that during this period, American became convinced crime was growing ever worse.  A recent Gallup release looks at the past couple of decades of both perceptions of crime and the actual crime rate.

U.S. Violent Crime Rate^ vs. Americans' Perception of Crime Rate vs. Year Ago

Basically, there’s a couple years there right at the turn of the century where the news of declining crime rates seemed to have made it through to a majority of Americans.  Excepting that brief period, though, a solid majority of Americans seems to be convinced that crime is always going up– regardless of the empirical reality.  There’s got to be a nice academic paper (or maybe there already has been) in here somewhere.


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