There were three posts yesterday. The first was “Stealth Single Payer:”
The Kaiser Family Foundation has a new survey (pdf) on Obamacare in California, and it’s full of remarkably good news. For those who haven’t been following this, CA — with its now-dominant Democratic Party — is where Obamacare was implemented the way it was supposed to be implemented: the website worked pretty well from the beginning, Medicaid expansion was implemented, and the state worked hard on outreach. It was also a place that really needed reform: the uninsured were a high percentage of the population, and an individual market without community rating meant that the mere hint of a preexisting condition was enough to prevent coverage.
So it now appears that most of California’s uninsured — 58 percent of the total, or well over 60 percent of those eligible (because undocumented immigrants aren’t covered) have gained insurance in the first year. Considering the complexity of the scheme, that’s really impressive, and it strongly suggests that next year, once those who missed out have had a chance to learn via word of mouth, California will have gotten much of the way toward universal coverage for legal residents.
But there’s something else the Kaiser report drives home: most of those gaining coverage are doing so not via the exchanges (although those are important too) but via Medicaid. And that’s important as an answer to critics of Obamacare from the left.
There have always been critics complaining that what we really should have is single-payer, and angry that subsidies were being funneled through the insurance companies. And in principle they’re right; the trouble was that cutting the insurers out of the loop would have made the plan politically impossible, both because of the industry’s power and because of the unwillingness of people with good coverage to take a leap into a completely new system. So we got this awkward public-private hybrid, which I supported because it was what we could get and despite its impurity it dramatically improves many people’s lives.
But it turns out that many of the newly insured are in fact being covered under a single-payer system — Medicaid. And as I’ve pointed out before,
Medicaid is actually the piece of the US system that looks most like European health systems, which cost far less than ours while delivering comparable results.
All in all, liberals really should be celebrating. California shows how Obamacare can and should work, and it’s looking pretty good.
The second post yesterday was “Useless Expertise:”
Justin Wolfers calls our attention to the latest IGM survey of economic experts, which revisits the question of the efficacy of fiscal stimulus. IGM has been trying to pose regular questions to a more or less balanced panel of well-regarded economists, so as to establish where a consensus of opinion more or less exists. And when it comes to stimulus, the consensus is fairly overwhelming: by 36 to 1, those responding believe that the ARRA reduced unemployment, and by 25 to 2 they believe that it was beneficial.
This is, if you think about it, very depressing.
Wolfers is encouraged by the degree of consensus — economics as a discipline is not as quarrelsome as its reputation. But I think about policy and political discourse, and note that policy has been dominated by pro-austerity views while stimulus has become a dirty word in politics.
What this says is that in practical terms the professional consensus doesn’t matter. Alberto Alesina may be literally the odd man out, the only member of the panel who doesn’t believe that the fiscal multiplier is positive — but back when key decisions were being made, it was “Alesina’s hour” in Europe and among Republicans.
You might want to say that the professional consensus was rejected because it didn’t work. But actually it did. Mainstream macroeconomics made some predictions — deficits wouldn’t drive up interest rates in a depressed economy, “fiat money” wouldn’t be inflationary, austerity would lead to economic contraction — that drew widespread scorn; Stephen Moore at the WSJ (which was predicting soaring rates and inflation) dismissed “fancy theories” that “defy common sense.” The fancy theorists were, of course, right — but nobody who rejected the consensus has changed his mind. Oh, and Moore became the chief economist at Heritage.
So, two thoughts. One is a point I think I’ve made before. You fairly often hear people describe the very poor track record of policy since 2008 as an indictment of economists, who clearly didn’t have the right answers. But actually mainstream macro has a pretty decent track record since 2008 — the problem was that what it said about policy was disregarded by the policymakers, who went with what they wanted to believe.
The other is that you have to wonder what good we’re all doing. If policymakers ignore professional consensus, and if views about how the world works are completely insensitive to evidence and results, does knowledge matter. If a tree falls in the academic forest, but nobody in Brussels or Washington hears it, did it make a sound?
Yesterday’s last post was “Ending Prohibition 2.0:”
I haven’t written on it, but the Times editorial board has been doing a major public service by pushing for marijuana liberalization. Read the intro to the series, with links to the articles.
Oh, and for the record, I never have smoked pot (I tried once, but went into a coughing fit) — but I do drink alcohol, and I see no reason to accord special privilege to my recreational drug of choice.