More on that bombshell study out of Oregon
It's time for another post on last week's study out of Oregon, which showed--much to the surprise of practically everybody--that putting people into Medicaid didn't seem to significantly improve their physical health.
I know it's a lovely spring day and you're looking longingly at the happy hour specials, or that riding lawnmower you'd like to test drive one more time. But stay with me, because this debate is literally the most important thing to happen to health care policy since . . . well, for a long time, anyway. If the Oregon results hold, they will radically change the way that we think about health care policy: what it's for, what it can do, and how it should be constructed.
And contrary to what you might have heard, this is not some weird, outlying result that doesn't mean anything. There are other studies which have found surprisingly small effects of giving people insurance. I commend to you Levy and Meltzer's very thorough literature review from 2008, in which they point out just how mixed the data are:
How does health insurance affect health? After reviewing the evidence on this question, we reach three conclusions. First, many of the studies claiming to show a causal effect of health insurance on health do not do so convincingly because the observed correlation between insurance and good health may be driven by other, unobservable fac- tors. Second, convincing evidence demonstrates that health insur- ance can improve health measures of some population subgroups, some of which, although not all, are the same subgroups that would be the likely targets of coverage expansion policies. Third, for pol- icy purposes we need to know whether the results of these studies generalize. Solid answers to the multitude of important questions about how specific health insurance policy options may affect health seem likely to be forthcoming only with investment of substantial resources in social experiments.
"Count all the Votes" became the rallying cry after the courts told Democrats they couldn't just count some of the votes
Last week I wrote that "count all the votes" emerged comparatively late in the game of the Bush v. Gore saga. A number of people have pushed back, here and elsewhere, have pushed back. Gore, they say, offered to do a hand recount of all 67 Florida counties on November 15th; if Bush would support it, and withdraw his lawsuits, Gore said he would withdraw his lawsuits too. Bush turned him down. This is supposed to prove that Democrats always had a committment to counting all the votes.
Well, not so fast. For starters, when Bush turned him down, Gore didn't go and start asking for recounts in all 67 Florida counties. His committment to "counting all the votes" was conditional on Bush withdrawing all of his lawsuits. It was a second-best alternative to just counting some of the votes, one which he offered when it looked like he might be losing. When it was turned down, he went on with his partial recount strategy.
And because of this, the voices raised in favor of counting all the votes were somewhat muted. A Nexis search for the phrase "Count all the votes" in major newspapers turns up just 26 uses in the week after the Florida election--before Gore had made his offer. In the first 17 days of the recount, it occurs just 57 times. Then, on November 24th, the Supreme Court accepted cert for the Florida recount, with a hearing to be held on December 1st.
Observers knew that this meant the Florida Supreme Court ruling allowing partial recounts was likely going to be overturned (if they weren't likely to overturn, they would have just dodged the case on a technicality). Suddenly, folks get very interested in counting all the votes: there are almost 100 mentions between November 24th and November 30th, with most of those seeming to come in the few days before the hearing. Then things quite down for the three days until the court decides: just 25 mentions.
Shifting business models mean that sales tax is no longer a competitive advantage
It looks like the Marketplace Fairness Act--the official name for a proposal to allow states to collect sales tax on internet sales made to their residents--will pass the Senate sometime today. It will have a tougher time in the House, where Republicans still aren't keen on supporting anything that smacks of higher taxes. Still, it's remarkable, at least because it shows that under the right circumstances, you can get at least some members of the GOP to support a tax increase.
I wrote about this plan a couple of weeks ago, noting that the biggest issue with the bill is the disproportionate burden it will put on small businesses. Amazon can afford to pay a small army to hassle with states who claim that Amazon isn't paying enough tax. Mom's Cupcake Bakery and Cable Store cannot.
The really interesting story of this whole case is Amazon's shift from a staunch foe of taxing the internet, to one of its biggest boosters. A few years back, Amazon was waging a scorched-earth campaign against states that attempted to collect sales taxes from internet businesses. For example, when various states passed laws claiming that affiliate links represented a physical nexus in those states that would allow them to collect taxes, Amazon said they were closing down associates who were residents of those states.
Both the states and Amazon clearly believed that freedom from sales tax constituted a major competitive advantage for Amazon. Yet a few years later, they're all sunshine and smiles when it comes to taxing the internet. In fact, they're lobbying for it. Why the shift?
Is it time to drop your health insurance?
On Wednesday, a team of researchers released a new study on Oregon's Medicaid expansion, showing that people who gained access to treatment had no statistically significant improvement on physical health measures like blood pressure or cholesterol. I wrote: "Given this result, what is the likelihood that Obamacare will have a positive impact on the average health of Americans? Every one of us, for or against, should be revising that probability downwards. I'm not saying that you have to revise it to zero; I certainly haven't. But however high it was yesterday, it should be somewhat lower today."
But how should we update our beliefs? Does this mean there's a chance that health care doesn't work?
That's one possible interpretation. Let's look at the strongest case. Assume for a moment that if we could somehow study the entire population of the United States, we'd find that gaining access to health insurance doesn't improve blood pressure, blood sugar, or cholesterol control. What would that tell us? That health care doesn't work?
That's not actually as crazy as it sounds. Lots of treatments are bad for you, and gaining access to the health system may just give you opportunities to get sicker. Say you're an 88 year old with bad hips. Now, maybe sitting still and not exercising is making you sick. But going to get a hip replacement gives you all sorts of ways to die: blood clot, hospital acquired infection, adverse reaction to anaesthesia. If it's not covered by insurance, maybe you'll stay home, take aspirin, and live longer.
The jobs report isn't bad. But it's not great, either.
This morning's job report was in some ways a relief, and in some ways a disappointment. The retail sector is weak right now, and retail can be a leading indicator of economic weakness (and also, a source of employment). So I now have this sort of reflexive flinch when the jobs report comes out, as I half-expect a big blow to fall.
That didn't happen this month, thankfully. The jobs report was fine. Payroll employment increased by 165,000--more than enough to soak up population growth. Long term unemployment dropped by a quarter of a million people. Retail employment was actually up.
But if it wasn't too worrying, it also wasn't particularly cheering. This is a middling jobs report for the middle of the business cycle. But five years after the financial crisis, we still haven't had a month of really good job growth--the kind that America needs to put some of those long-term unemployed folks back to work. The employment-to-population seems stuck at 58.6%. That's the lowest it's been since the early eighties, when fewer women worked.
Take a look at the employment-to-population ratio since 1990.
One of the most important health insurance studies ever done shows surprisingly little effect
Bombshell news out of Oregon today: a large-scale randomized controlled trial (RCT) of what happens to people when they gain Medicaid eligibility shows no impact on objective measures of health. Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively--glycated hemoglobin, a measure of blood sugar levels; blood pressure; and cholesterol levels--there was no significant improvement.
I know: sounds boring. Glycated hemoglobin! I might as well be one of the adults on Charlie Brown going wawawawawawa . . . and you fell asleep, didn't you?
But this is huge news if you care about health care policy--and given the huge national experiment we're about to embark on, you'd better. Bear with me.
Some of the news reports I've seen so far are somewhat underselling just how major these results are.
Neat stories are too good to be true. True stories are too boring to sell.
Almost two years ago, the field of social psychology was rocked by some astounding news: Diederik Stapel, one of its stars, had been faking his research. I don't mean that he'd been subtly altering figures to give better results, or maybe running through a series of increasingly implausible modeling assumptions until they delivered the results he'd expected. I mean he'd apparently given up doing experiments entirely. Instead he imagined experiments, imagined which results would look good, and then sat down at a computer and entered those numbers into a spreadsheet.
The New York Times Magazine has an incredible article this week describing what Stapel did, and how he did it. What's less clear is why he did it, or how he was able to get away with faking results for seven long years. To his credit, Stapel, unlike most such fraudsters, does seem to grasp that what he did was wrong, and that he alone was responsible for his misbehavior. It was a refreshing change from the complaints about witch hunts, bad childhoods, or the weakness of one's "standard operating procedures" that have accompanied most such revelations. When Stapel's parents try to excuse him by criticizing the system, he corrects them:
The unspooling of Stapel’s career has given him what he managed to avoid for much of his life: the experience of failure. On our visit to Stapel’s parents, I watched his discomfort as Rob and Dirkje tried to defend him. “I blame the system,” his father said, steadfast. His argument was that Stapel’s university managers and journal editors should have been watching him more closely.
Stapel shook his head. “Accept that this happened,” he said. He seemed to be talking as much to himself as to his parents. “You cannot say it is because of the system. It is what it is, and you need to accept it.” When Rob and Dirkje kept up their defense, he gave them a weak smile. “You are trying to make the pain go away by saying this is not part of me,” he said. “But what we need to learn is that this happened. I did it. There were many circumstantial things, but I did it.”;
Questions linger in the wake of the Bangladeshi disaster
Matt Yglesias took a lot of flak last week for responding to an Erik Loomis post about the tragic collapse of a Bangladeshi garment factory by saying:
It's very plausible that one reason American workplaces have gotten safer over the decades is that we now tend to outsource a lot of factory-explosion-risk to places like Bangladesh where 87 people just died in a building collapse.* This kind of consideration leads Erik Loomis to the conclusion that we need a unified global standard for safety, by which he does not mean that Bangladeshi levels of workplace safety should be implemented in the United States.
I think that's wrong. Bangladesh may or may not need tougher workplace safety rules, but it's entirely appropriate for Bangladesh to have different—and, indeed, lower—workplace safety standards than the United States.
The reason is that while having a safe job is good, money is also good. Jobs that are unusually dangerous—in the contemporary United States that's primarily fishing, logging, and trucking—pay a premium over other working-class occupations precisely because people are reluctant to risk death or maiming at work. And in a free society it's good that different people are able to make different choices on the risk–reward spectrum. There are also some good reasons to want to avoid a world of unlimited choice and see this as a sphere in which collective action is appropriate (I'll gesture at arguments offered in Robert Frank's The Darwin Economy and Tom Slee's No One Makes You Shop At Walmart if you're interested), but that still leaves us with the question of "which collective" should make the collective choice.
Art may be valuable. But it's not deductible unless it turns a profit.
Maria at Crooked Timber wonders why the Minnesota Department of Taxation is hassling artists:
One of the days, I’ll get around to reading the copy of Sandel’s ‘What Money Can’t Buy; The Moral Limits of Markets’. It’s even made the exquisitely painful cut of being one of only two dozen books brought on our three-month sojourn on the south coast of England. When I do read Sandel, I hope to acquire a greater appreciation for exactly how market thinking has permeated and corrupted so many aspects of human life.
One surprising place a weirdly attenuated and manically zealous form of market thinking has popped up is in the Minnesota tax office. (via BoingBoing) They’re running a quite unhinged vendetta against Lynette Reini-Grandell and Venus DeMars, a married couple who make music, art, poetry and teach English. The taxman running their audit says Reini-Grandell and DeMars’ creative activities don’t make enough money, and haven’t for years, thus proving the artists are mere hobbyists who shouldn’t get a tax break. Either they should turn a consistent profit by now, or have given up already and gone back to being good little consumers.
Fascinated, I clicked through the link she provides, and I think I can tell her: the couple in question are not actually making any money.
They'd have had to take it eventually
Political Scientist Chris Lawrence makes an astute point in the comments of a Doug Mataconis post: the way things were heating up in Florida, the case would have ended up before the United States Supreme Court, one way or another.
One other thing to bear in mind: as of the date of the court’s decision, the Florida state legislature was in the process of moving a bill to award all of the state’s electors to Bush (which under the 12th Amendment was its right; Scalia is often mocked on the left for saying in Bush v. Gore there is no right for the people to elect the president, but it’s right there in the text of the Constitution). Inevitably that would have been challenged in court. And inevitably that case would have ended up on the U.S. Supreme Court’s docket, because I can’t imagine the equally-politicized Florida Supremes ruling for the legislature’s position. So denying cert here just would have delayed matters further.
The original sin, in my view, was Gore's attempt to recount just the votes in a few heavily Democratic counties. I'm not saying that Bush would have done any different, had the positions been reversed. But once that had happened--and Democrats on local election boards and the Florida Supreme Court had decided to go along--there was no longer even a pretense that this was about anything other than naked post-facto power grabs, using whatever political levers your party controlled. "Count all the votes", which most progressives now remember as the rallying cry, actually came very late in the process, and only after the Supreme Court of the United States told the Florida Supreme Court that no, it couldn't just let Al Gore add in some new votes from Democratic Counties his team had personally selected.
By the time Bush v. Gore petitioned for cert, both sides were more or less nakedly maneuvering to declare their candidate the winner. The Florida Supreme Court's November 21st decision was outrageous and completely unjustifiable. So was Katherine Harris's clear determination to stop any recount that might help Gore. And while the Florida legislature was arguably within its constitutional rights to intervene to declare Bush the winner, this contravened more than a century of custom . . . and the behavior of the state Republican Party in the weeks prior made this seem less like a bid for fairness and closure than a bid to make their guy president. The Florida Supreme Court would undoubtedly have ruled against the legislature, but of course, their prior behavior made it impossible to claim that they were just trying to insure a fair and democratic process.
Sandra Day O'Connor says that maybe the Supremes should have sat that one out. What if they had?
Teeth are grinding in front of computers from Bangor to Baltimore, San Diego to San Jose. In a quiet interview with the editorial board of the Chicago Tribune, Sandra Day O'Connor mused of Bush v. Gore, "Maybe the court should have said, 'We're not going to take it, goodbye.'"
How much would have changed if they had just said "Thanks, but no thanks?"
I love me some counterfactuals, and there's nothing more fun than ripping open ten year old wounds, so I thought I'd take a look at the likely outcomes if the Supreme Court had just bowed out of the whole mess in Florida.
It turns out that this is not a simple question. Much depends on when they'd bowed out, and what decisions were made by various parties in Florida.
Is education turning into a caste system?
There used to be a big educational gap between poor children and everyone else. And not just because they were in failing schools; poor kids showed up at school less prepared than the other kids, and the gap widened over the years.
Now, according to Sean Reardon, there is also a gap between the middle class and the elite. American society is increasingly stratified, he says, because elite parents are investing so much in the cognitive enrichment of their kids.
But is that really the right explanation? The rich pulling away from the middle class is also exactly what we would see if test-taking ability has a substantial inherited component, and the American economy is increasingly selecting for people who are very, very good at taking tests. The latter is undoubtedly true, and there's some fairly strong evidence for the former, in the form of studies of adopted kids. Such studies tend to show that adopted kids bear a much stronger resemblance to their biological parents in terms of lots of things, from weight to income to test scores, than they do to their adoptive parents. Once you've hit a fairly basic parenting threshhold--food, health care, touching and talking to your kid, and not physically or sexually abusing them--the incremental benefits of more intensive parenting seem at best small, at worst unclear.
I have no doubt that Reardon is right, and wealthy parents are investing more in their kids because they can. But how do we know that this, rather than the fact of having parents who are great at taking tests, makes the difference. If you take a newly married graduate of the Naval Academy with strong SAT scores, do their kids show up at kindergarten meaningfully less prepared than the children of a hedge fund manager who makes many times more?
Are newspapers liberal because the market makes them that way?
David and Charles Koch, the billionaire brothers who fund a number of libertarian causes, are rumored to be interested in buying the Tribune Group, which includes the LA Times. (Full disclosure: my husband received a one-year fellowship from the Charles Koch Foundation, and works for Reason Magazine, which I believe receives some funding from David Koch.) As you can imagine, this has stirred up quite a bit of anxiety in some quarters. Steve Pearlstein, the Washington Post's liberal business columnist, has suggested that perhaps the LA Times staff should threaten to quit if the Kochs buy the paper.
But regardless of labor action, my former colleague, Garance Franke-Ruta, writes that the Kochs effort is doomed. Newspapers are liberal because their audience is liberal, she says. And they're staffed by the people who live in cities, who are also liberal.
A friend who is 1) not liberal and 2) not in the news business asks me what I think of this. Is it really impossible to imagine a conservative newspaper?
Why no. I don't have to even imagine. The Wall Street Journal and the New York Post spring readily to mind. So do smaller papers from smaller cities, like New Hampshire's Union Leader.
Farm loans. Sympathetic administrations. And a judge who didn't worry about false positives.
A New York Times story this morning suggests a pattern of massive fraud and abuse, abetted by a complaisant government, in government settlements that were supposed to compensate for discrimination by the USDA against minority farmers.
Long story short: black farmers complained that they had been discriminated against when seeking loans from a USDA program. Those loans are supposed to help farmers buy seed and fertilizer, and float the long period between sowing and harvest. They sued the Clinton administration, which settled even before they'd opened the discovery process. This is known as the Pigford settlement, a name which will be familiar to readers of conservative news sites, which have been on this case for some time.
The New York Times reports that the judge initially restricted the settlement to people who had actually been farming during the period covered by the settlement, but some people complained. What about people who had attempted to farm, but been stymied by their inability to procure government loans? Should they be shut out of the settlement? So the judge expanded the criteria to include people who'd attempted to farm. Unfortunately, the government doesn't keep track of people who have maybe thought about farming. And apparently, it didn't have decades worth of records of the loans they'd denied. So the government was forced to rely on the word of the applicants. Here's what happened next:
Delton Wright, a Pine Bluff justice of the peace, recalled what happened after word of the settlement reached his impoverished region: “It just went wild. Some people took the money who didn’t even have a garden in the ground.” He added, “They didn’t make it hard at all, and that’s why people jumped on it.”
Stick to what you know
Jonathan Mahler has a very entertaining roundup of Curt Schilling's adventures in corporate life. It seems that Schilling assumed that if he was good at being a pitcher, he'd probably also be good at running a video game company. This was not the case:
Schilling had no idea how much time and money it took to build the software required for such a game. And he didn’t exactly help matters by weighing in with suggestions of his own. There was, for example, that instance when he mentioned in an e- mail that it might be cool to have mounted combat on flying pigs. The design team worked on nothing else for a week.
Indeed, Schilling didn’t know the first thing about the world outside baseball. That’s not hyperbole: He once asked the president of 38 Studios if employees got weekends off. Another time he suggested that they work 14 days straight so as not to lose their momentum. (No need for travel days when you’re playing only home games!) Schilling was so clueless that he had to be told by his wife’s uncle, a retired corporate executive, not to personally guarantee the company’s lease.
Schilling filled his board with family members and, to the dismay of his president, promised employees half of 38 Studios’ (notional) profits. He also insisted on retaining majority control of the company -- which became something of a problem when he started his search for outside investors.
Instead of repenting, Weiner is trying to build a future based on $4 million and change collected from people he fooled, writes Stuart Stevens.
Did Obama lock down the independent vote with his move to reform immigration law? Newsweek and The Daily Beast’s Michael Tomasky and David Frum debate the liberal and conservative perspective on the latest immigration reform.