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Posted at 07:03 PM ET, 05/10/2011

Reconciliation

Recap: The first-annual No-Brainer awards; some optimistic political science, for once; and the eight facts I keep in mind when thinking about Social Security.

Elsewhere:

1) This is a great picture of Benjamin Franklin and the Kool-Aid guy.

2) “Since politicians talk about energy prices so much — and those prices become perceived as a legitimate topic of political debate — voters assume that government must be able to have some impact.”

3) Super Mario Bros. — on ice.

4) Congrats to the District’s Jose Andres for winning the James Beard Outstanding Chef Award.

By Ezra Klein  |  07:03 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 06:50 PM ET, 05/10/2011

Obama’s economic argument for immigration reform


(Brendan Smialowski - Getty Images)
The president delivered his big address on immigration reform in El Paso today. And his big pitch could be summed up in four words that aren’t generally associated with immigration policy: It’s the economy, stupid.

Because undocumented immigrants live in the shadows, where they’re vulnerable to unscrupulous businesses that skirt taxes, and pay workers less than the minimum wage, or cut corners with health and safety laws, this puts companies who follow the rules, and Americans who rightly demand the minimum wage or overtime or just a safe place to work, it puts those businesses at a disadvantage. . . . So one way to strengthen the middle class in America is to reform the immigration system so that there is no longer a massive underground economy that exploits a cheap source of labor while depressing wages for everybody else. I want incomes for middle-class families to rise again. I want prosperity in this country to be widely shared. I want everybody to be able to reach that American dream. And that’s why immigration reform is an economic imperative. It’s an economic imperative.

And reform will also help to make America more competitive in the global economy. Today, we provide students from around the world with visas to get engineering and computer science degrees at our top universities. But then our laws discourage them from using those skills to start a business or a new industry here in the United States. Instead of training entrepreneurs to stay here, we train them to create jobs for our competition. That makes no sense. In a global marketplace, we need all the talent we can attract, all the talent we can get to stay here to start businesses — not just to benefit those individuals, but because their contribution will benefit all Americans. Look at Intel. Look at Google. Look at Yahoo. Look at eBay. All those great American companies, all the jobs they’ve created, everything that has helped us take leadership in the high-tech industry, every one of those was founded by, guess who, an immigrant.

So we don’t want the next Intel or the next Google to be created in China or India. We want those companies and jobs to take root here. [Applause.] Bill Gates gets this. He knows a little something about the high-tech industry. He said, “The United States will find it far more difficult to maintain its competitive edge if it excludes those who are able and willing to help us compete.” So immigration is not just the right thing to do. It’s smart for our economy.

Full remarks here.

Related: The economic benefits of immigration.

By Ezra Klein  |  06:50 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 05:27 PM ET, 05/10/2011

What should South Sudan do first?

David Leonhardt asked all-star developmental economist Abhijit Banerjee what the world’s newest country, South Sudan, could do to improve the lives of its citizens. His answer:

Here are two policies that I think every poor country should implement. A small universal cash grant to everyone over 12, based on biometric identification. This guarantees that no one has to face the humiliation of being totally indigent, and from our evidence, makes people more productive as well. Making it universal is important, so that they do not attempt to identify the poor (which is very difficult to do effectively in poor countries).

Second, a free universal health insurance policy that covers catastrophic health events, which allows people to go to private or public hospitals. Catastrophic health shocks do enormous damage to families both economically and otherwise, and are easy to insure, because nobody gets them on purpose. On the other hand, insurance policies that only treat certain catastrophic illnesses are hard to comprehend, especially if you are illiterate and unused to the legalistic nature of exclusions etc. Therefore people do not value them as much as they should which makes it hard for markets to supply them. This is an obvious thing for governments to take on.

You can read — and see and hear — much more from Banerjee and his co-author, Esther Duflo, at the homepage for their new book, “Poor Economics.” As you’re reading this blog, you’ll probably be glad to know there are lots of graphs.

By Ezra Klein  |  05:27 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 05:23 PM ET, 05/10/2011

Eight facts and three thoughts about Social Security


Earlier, I criticized Alan Simpson for not knowing — and, more to the point, being actively hostile to — accurate demographic data about Social Security, but perhaps it’d be more useful to run through some of the numbers I find it helpful to keep in mind while writing about the issue:

1) Over the next 75 years, Social Security’s shortfall is equal to about 0.7 percent of GDP. Source (PDF).

2) For the average 65-year-old retiring in 2010, Social Security replaced about 40 percent of working-age earnings. That “replacement rate” is scheduled to fall to 31 percent in the coming decades. Source.

3) Social Security’s replacement rate puts it 26th among 30 Organization for Economic Cooperation and Development nations for workers with average earnings. Source.

4) Without Social Security, 45 percent of seniors would be under the poverty line. With Social Security, 10 percent of seniors are under the poverty line. Source.

5) People can start receiving Social Security benefits at age 62. But the longer they wait, up until age 70, the larger their checks. Waiting to 66 means checks that are 33 percent larger. Waiting to 70 means checks that are 76 percent larger. But most people start claiming benefits at 62, and 95 percent start by 66. Source.

Continue reading this post »

By Ezra Klein  |  05:23 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 04:25 PM ET, 05/10/2011

What Alan Simpson doesn’t know about life expectancy and Social Security


Since Social Security’s inception, life expectancy at age 65 has risen about five years and the retirement age has increased by two years, so beneficiaries are getting three more years of Social Security now than they were then. Most people don’t know this, but most of the experts who deal with these programs do. In fact, you can find most of this data in the annual reports released by the Social Security actuaries. Which brings us to fiscal commission co-chairman Alan Simpson.

I try not to write a lot of posts in the “politician said stupid/inflammatory thing” genre, and so I’ve ignored most of Alan Simpson’s piquant outbursts on the grounds that they’re largely irrelevant to the issues at hand. But if he seriously doesn’t know that life expectancy from birth has increased dramatically over the last 70 years while life expectancy at age 65 hasn’t, well, he needs a new job.

As co-chairman of the President Obama’s deficit commission, Simpson is one of the guys tasked with figuring out what to do about Social Security, and one of the arguments he’s charged with evaluating is that we should raise the retirement age specifically because people are living so much longer. There’s no way for him to make a sound judgment if he lacks a basic familiarity with this data. But it seems that in this conversation with Huffington Post reporter Ryan Grim, Alan Simpson not only didn’t know the numbers but was so unfamiliar with them that he refused to believe they were true:

Simpson said that questioning his data wasn’t helping to solve the underlying problem. “This is the first time, the first time — and Erskine [Bowles, the deficit commission co-chairman] and I have been talking for a year and many months — that anyone’s going to sit around and play with statistics like this,” he told HuffPost. “Anything I tell you, you repudiate. You’re the first guy in a year and a half who’s stood out here with a sharp pencil playing a game that doesn’t have a damn thing to do with: ‘What the hell are you going to do with the system? ’”

Sigh. Let me add to Grim’s numbers: As the graph atop this post shows, the life expectancy increases we’ve seen have not been shared equally; the richer and whiter you are, the more your life expectancy has stretched. So raising the retirement age inflicts a double-blow on lower-income Americans: They already work more physically demanding jobs and die younger than the rich, but now they’re being told to work those jobs longer because people who aren’t them have seen large increases in life expectancy.

Related: The case against cutting Social Security and the pro-Social Security case for Social Security reform.

By Ezra Klein  |  04:25 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 02:42 PM ET, 05/10/2011

Our undemocratic democracy

It’s not likely that anyone will win a two-person presidential election with only 23 percent of the vote, but according to Ryan Cooper’s calculations, it’s possible that someone could. Nor is it likely that the 41 senators representing the 11 percent of the population in the 21 smallest states will band together to filibuster all action in the United States Senate, but, again, they certainly could.

An easy kicker for a post like this would be to say, “This is no way to run a democracy,” but the point, of course, is that we’re not technically a democracy, even if we tell schoolchildren otherwise, and we permit all sorts of undemocratic rules to remain on the books because we usually don’t notice their existence or implications. But does anyone seriously believe that we wouldn’t rid ourselves of the electoral college if we had a few elections in a row where the winner of the popular vote lost the election? Of course not. So why leave it on the books until then?

By Ezra Klein  |  02:42 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 02:20 PM ET, 05/10/2011

Lunch break: Angry bird songs

Pomplamoose covers the Angry Birds theme song. It’s about as manic and whimsical as you’d expect:

By Ezra Klein  |  02:20 PM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 11:39 AM ET, 05/10/2011

Will deficit reduction require a crisis?

Paul Posner is director of George Mason University’s public administration program and a 14-year veteran of the Government Accounting Office’s budget and public finances division. His recent paper “Will It Take a Crisis” (pdf) uses recent political science research to question the idea that the only way the U.S. political system can make hard decisions is in the face of an emergency. We spoke yesterday afternoon.

Ezra Klein: Let’s start with the main question of your paper. Will the political system be able to make fiscal adjustments before a crisis hits, or are we now so gridlocked that we’re basically going to govern in the moments following major crises, some of which we could’ve prevented?

Paul Posner: There are some mornings I wake up and it certainly seems like these guys are going to need a crisis. But looking at our history and the history of other countries, I think the chances are we’ll get around to this before a crisis hits. In some ways, our strength is our biggest weakness. Our relative immunity from market pressures allows us to go much longer than other countries can. Argentina, remember, had a fiscal crisis when their debt was only 60 percent of their GDP.

Your paper defines “crisis” very specifically, but you note that politicians often elevate smaller problems, or problems they’ve created and could solve, into “crises” more loosely in order to make it easier to act. So what is a “crisis”?

I started my career in the New York City budget office during the fiscal crisis. The markets simply would not finance our debt. And I don’t see that happening to this country before we act. Having said that, I think we will appropriate the rhetoric of crisis to make it happen. We’ll point to some fall in the currency, or to Greece and Portugal, or to some other tea leaves suggesting the wolf is at the door and call it a crisis. But that’s political artifice. It might be good political artifice, but it’s artifice.

And you also make the point that some crises are literally just created by political actors to justify future action. The “crisis” behind the 1990 budget deal was that Congress had passed a law that would make large, automatic cuts in the absence of a budget deal. But Congress could’ve just ignored that law. They chose to see it as a crisis. And the Obama administration has proposed a debt trigger that could work in a similar way this time. So is that how we’ll get out of this?

Continue reading this post »

By Ezra Klein  |  11:39 AM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 10:00 AM ET, 05/10/2011

The No-Brainer awards

This column is usually about the Big Issues. Health-care reform. The deficit. The debt ceiling. The grand, Ragnarok-level clashes (yes I just saw ‘Thor’) between the two parties.

But not today. Today, I want to introduce the No-Brainer Awards: a roll call honoring some of the best legislative ideas you won’t see leading the evening news. These thoughtful bills and responsible reforms aren’t polarizing or sweeping, which you’d think would make it easier for them to pass. But for many of them, the absence of partisan passion means they never make it to the front of the congressional agenda. So let’s give them a push.

The taxpayer receipt: When I buy groceries, I get a receipt. When I buy a chair whose name I can’t pronounce from Ikea, I get a receipt. But once a year, I send a whole heap of money to the federal government and I get . . . nothing. But it would be trivial for Treasury to provide me with an itemized receipt showing how my money was spent. Then, for good or for bad, I’d know.

The White House created an online tool where you can enter your income and tax payments and see what your receipt would look like (make your own at www.whitehouse.gov/taxreceipt), but there are bipartisan bills in both the House and the Senate to go even further and have Treasury send all taxpayers the receipt they deserve.

The Weekend Voting Act: Ever wondered why Election Day always falls on a Tuesday? It dates to 1845, when Congress was trying to find a convenient day for a largely agrarian society to vote. It took many voters a day or so to travel into town, and a day to travel back out, and it was important for everyone to be home on Sunday, as that was the Lord’s day. So Tuesday seemed like a good compromise. And maybe, in 1845, it was. But in 2011? It looks less like a compromise and more like a conspiracy.

“They don’t want you to vote,” Chris Rock said. “If they did, we wouldn’t vote on a Tuesday.”

Continue reading this post »

By Ezra Klein  |  10:00 AM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 09:22 AM ET, 05/10/2011

Things we now know

Michael Bolton has a terrific sense of humor.

By Ezra Klein  |  09:22 AM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 09:17 AM ET, 05/10/2011

Health-care reform’s attack on the courts


(Evan Vucci - AP)
There are 14 judges on the Fourth Circuit Court of Appeals, but only three will sit on the panel that hears today’s arguments over the health-care law. Those three are chosen by way of “a computer program designed to achieve total random selection.” And today, that computer program chose two Clinton nominees and an Obama nominee. Game over, says conservative policy reporter Phillip Klein. “ObamaCare is likely to be upheld by 4th circuit.”

I don’t disagree. As Klein says in a longer post at the Washington Examiner, “Democratic judges have upheld the law while Republican judges have declared it unconstitutional.” Which just goes to show that the legal channel here has become little more than politics by another name. Republicans know it and Democrats know it. Everybody knows it.

After all, what’s the alternative explanation? That in 2010, the Republican Party’s entire political and legal establishment suddenly realized than an idea they’d developed in 1991 and pushed through 2008 was an unconstitutional monstrosity? Did the Constitution get amended in 2009? Was the study of constitutional law transformed by a flood of new evidence on the original intent of the “necessary and proper” clause? Of course not. What changed is that Obama and the Democrats passed a health-care law including an individual mandate. And the GOP underwent reverse-Obamafication and turned, en masse, against a provision that many of them had supported for decades.

Of course, the courts aren’t supposed to care about the opportunistic wiggles of elected politicians. Which is why, when the campaign to redefine the individual mandate as unconstitutional began, conservative legal scholars laughed it off. “There is a less than 1 percent chance that the courts will invalidate the individual mandate,” said former Anthony Kennedy clerk Orin Kerr. But both sides were substantially underestimating the partisanship of the judiciary on a big, polarizing issue like this one. In the short term, that might be bad for the health-care law. In the long term, it’s bad for the judiciary, which looks less and less insulated from politics, and for the stability of future legislation, as the unexpected success of this campaign is going to lead to many more like it.

Further reading: The obvious constitutionality of health-care reform.

By Ezra Klein  |  09:17 AM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 07:44 AM ET, 05/10/2011

Wonkbook: Boehner's debt-ceiling demands


(Kathy Willens - AP)
In a speech before a Wall Street crowd on Monday, John Boehner laid out the three legs of the GOP's opening bid on the debt ceiling. They are:

1) "Without significant spending cuts and reforms to reduce our debt, there will be no debt limit increase. And the cuts should be greater than the accompanying increase in debt authority the president is given. We should be talking about cuts of trillions, not just billions."

2) "They should be actual cuts and program reforms, not broad deficit or debt targets that punt the tough questions to the future."

3) "With the exception of tax hikes -- which will destroy jobs -- everything is on the table. That includes honest conversations about how best to preserve Medicare."

So at least $2 trillion in cuts, no tax hikes -- though it's unclear whether taking "tax hikes" off the table leaves room for cuts in tax expenditures that raise revenue while lowering rates -- and no recourse to debt triggers or other procedural mechanisms. In a subsequent interview with the Washington Post, Boehner's "aides declined to say over what period the cuts would have to take effect, saying only that they could be achieved on a time frame longer than the life of the debt-limit increase."

Boehner's got a big number, but it's not, over time, an impossible number. All of the major long-term budgets cut and raise more than $2 trillion over the next 10 years, so Boehner's demands, though impressive in the abstract, are actually in the center of deficit-reduction consensus. What's more questionable is his timetable. It's very unlikely that Congress will be able to cut a multi-trillion dollar deal on deficit reduction before early-August, when the Treasury runs out of financial gimmicks to delay a default. And if Boehner and the Republicans won't accept fiscal rules as a downpayment on deficit reduction, that leaves us with few options save for a series of hard-to-negotiate, short-term increases in the debt ceiling -- which is to say, an extremely extended period of uncertainty for the market.

Five in the morning

1) John Boehner has started listing debt limit demands, report Paul Kane and Lori Montgomery: "House Speaker John A. Boehner defined the GOP’s terms for raising the legal limit on government borrowing Monday, demanding that President Obama reduce spending by more than $2 trillion in exchange for an increase big enough to cover the nation’s bills through the end of next year. Delivering a sermon on fiscal austerity to a Wall Street crowd clamoring for compromise on the debt limit, Boehner (Ohio) firmly rejected any effort to raise taxes. He also called on Democrats to engage in 'honest conversations about how best to preserve Medicare,' signaling that House Republicans remain committed to restructuring at least some portions of the program."

Read Boehner's full speech: http://bit.ly/mExcJH

2) Obama will meet with the whole Senate to talk debt reduction, reports Felicia Sonmez: "President Obama will hold two separate meetings later this week with all Democratic and all Republican senators to talk about deficit reduction, White House Press Secretary Jay Carney announced Monday. Obama’s meeting with the Senate Democrats is scheduled to take place on Wednesday. He is expected to meet with Senate Republicans on Thursday. The meetings will come on the heels of Tuesday’s meeting at Blair House between Vice President Joe Biden and negotiators from both chambers, the second round in the White House-led deficit-reduction talks."

3) Sen. Kent Conrad is suggesting a short-term debt limit increase, reports Felicia Sonmez: "Senate Budget Committee Chairman Kent Conrad (D-N.D.) said Monday that Congress may need to approve a short-term increase in the nation’s debt ceiling to allow time to work out a comprehensive deficit-reduction plan without defaulting on its debt obligations. Currently, the Treasury Department projects that the country will reach its legal borrowing limit on Aug. 2. Republicans and Democrats have been jousting over the conditions under which members of Congress would be willing to take the politically unpopular vote to raise the debt limit. 'I can see a circumstance in which there would be some short-term [increase] so that the overall plan can be given the consideration that it deserves,' Conrad told reporters at the Capitol on Monday evening."

4) A Senate panel is finally voting on Obama's Nobel laureate Fed nominee, reports Victoria McGrane: "The Senate Banking Committee is slated to vote Thursday on the nomination of Peter Diamond to join the Federal Reserve Board, but his confirmation by the full Senate still remains doubtful. President Barack Obama first nominated Mr. Diamond to the post in April 2010. In the meantime, the Massachusetts Institute of Technology economist in October won a Nobel Prize in economics. But Republican opposition to Mr. Diamond hasn't waned. Sen. Richard Shelby (R., Ala.), the top-ranking Republican on the banking panel, continues to lead the fight against the nomination, arguing that Mr. Diamond doesn't have any direct monetary policy experience. Mr. Shelby said last week that the nomination remains 'in trouble.'"

5) Obama is speaking at the border today, report Peter Wallsten and Perry Bacon: "President Obama will stand on the U.S.-Mexico border Tuesday and try to take credit for something that eluded predecessors in both parties: successfully cracking down on illegal immigration. It is a record that Republicans roundly dispute. And it has drawn fire from many in Obama’s Latino base, who say the president has stepped up enforcement measures such as deportations while failing to deliver on his pledge to create a path to citizenship for millions of illegal immigrants. But in using a speech in El Paso to highlight his enforcement record, Obama will signal that he intends to try turning the immigration debate into a political winner among conservative swing voters who back tougher immigration policies."

Canadian pop interlude: The New Pornographers play "Use It" live.

Got tips, additions, or comments? E-mail me.

Still to come: Greece is edging closer to default; Sheila Bair is leaving the FDIC; Vermont is getting closer and closer to single payer; introducing the no-brainer awards; the GOP is holding up a top Justice nominee; the administration is moving around high-speed rail money; and two chinchillas in wine glasses.

Continue reading this post »

By Ezra Klein  |  07:44 AM ET, 05/10/2011 |  Permalink  |  Comments ( 0)

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Posted at 07:30 PM ET, 05/09/2011

Reconciliation

Recap: Vermont is getting closer and closer to single payer; how a mistake created an opportunity in Medicare; and a super-long graphic showing why America’s health-care costs are so high.

Elsewhere:

1) “Bachmann wields more power outside the U.S. Capitol than within. She hasn’t shepherded any major legislation through the House. And a search of congressional records turns up just three resolutions in which she was the major sponsor that passed the chamber — honoring organizations that provide services for foster children, the State of Minnesota’s 150th anniversary, and ‘National Hydrocephalus Awareness Month.’”

2) The average member of the class of 2011 will graduate college with more than $22,000 in debt.

3) Boehner gets specific on the debt limit.

4) Crispy potato roast.

By Ezra Klein  |  07:30 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 06:54 PM ET, 05/09/2011

The reverse-Obamaization of the Republican Party

Republicans haven’t just abandoned their pre-2009 positions on cap-and-trade and health-care reform and the admissibility of tax increases in deficit reduction. They’ve also abandoned their position on campaign-finance disclosure:

In March of 2000, a Wall Street Journal editorial said, “Our view is that the Constitution allows consenting adults to give as much as they want to whomever they want, subject to disclosure on the Internet.” That same year, Republican Senator Mitch McConnell asked, “Why would a little disclosure be better than a lot of disclosure?” As recently as 2007, John Boehner said on “Meet the Press,” “I think what we ought to do is we ought to have full disclosure, full disclosure of all the money that we raise and how it is spent. And I think sunlight is the best disinfectant.” And the public resoundingly agrees: In an October 2010 CBS/New York Times poll, 92 percent of Americans said it is important for the law to require campaigns and outside spending groups to disclose how much money they have raised, where the money comes from, and how it was used.

Yet, since the Citizens United decision, the once-unifying disclosure issue has degenerated into another divisive set of battles, as long-time conservative proponents of disclosure have changed their positions so dramatically they could be treated for whiplash.

More here. I’ve come to think of this as the reverse-Obamaization of the Republican Party. Much as the Democratic Party is now defined by Obama’s agenda, the Republican Party is now defined by opposition to his agenda. That must be a real bummer for the GOP senators who entered public life to actually do things.

The Democratic Party, at the very least, chose Obama and has real influence over his agenda. The Republican Party didn’t choose Obama and has little influence over his agenda, but their platform is, if anything, even more dependent on Obama than the Democratic Party’s. There are plenty of Democrats who disagree with health-care reform because they think it’s too far left and plenty who disagree with it because they think it’s too far right and they all get to speak their mind. But Republicans who once loved the Obama/Romney model — and this includes Mitt Romney — now have to pretend they hate it, and since they haven’t had time to come up with alternatives, they’ve got no health-care policy at all. I can’t imagine that’s very fun for politicians who built their self-image around problem-solving and big ideas.

By Ezra Klein  |  06:54 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 05:54 PM ET, 05/09/2011

Why American health-care costs so much in one (very long) graphic

By Ezra Klein  |  05:54 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 03:43 PM ET, 05/09/2011

Why aren’t we keeping the engineers we graduate?


That’s from this report (pdf) by Third Way, which does a good job explaining the basic shape of the river: We make it very easy for talented students to come here, and very hard for them to stay. That mattered less when China, India, and many of the other countries that contributed bright students to our universities had few attractive opportunities to lure them back home, and it would matter less if we were graduating more students in the hard sciences ourselves. But those days are over.

Now there’s lots of opportunity in China and India (and Singapore and Brazil and...) and so talented foreign engineers are less interested in signing up for an uncertain series of temporary visas. So if we don’t reform the laws so we keep more of these students, or we don’t find some way to graduate more of these students on our own, we’re going to start finding ourselves at a real disadvantage in some extremely key sectors. This is one of those policy problems that’s very easy to solve as a technical matter — just let these students stay — but very difficult to solve as a political matter.

By Ezra Klein  |  03:43 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 02:33 PM ET, 05/09/2011

How to improve Medicare in five quotes

Earlier today, I recommended Michael Chernew’s testimony (pdf) on reforming the way Medicare pays doctors. But on the off chance that you didn’t take time out of your workday to study a proposal on quality-based payments in Medicare, here’s what caught my eye:

- “It is important to distinguish between the form of payment (fee-for-service vs. bundled payment) and the level of payment. The form of payment creates incentives .... But even if we adopt the best form of payment, it will be a challenge to set the right level of payment. Provider costs vary across and within markets, in some cases due to factors beyond the providers control and in other cases due to factors providers can control .... In my opinion a discussion of post-SGR payment should primarily focus on the form of payment, not the level of payment.”

- “A colonoscopy preformed in a physician’s office costs Medicare on average about half of the cost if it is performed in a hospital outpatient setting.”

Continue reading this post »

By Ezra Klein  |  02:33 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 01:52 PM ET, 05/09/2011

Want to buy some federal property?

Hope someone does, because the Obama administration is planning to sell14,000 buildings and structures over the next three years. They’ve even got an interactive map you can use to see what they’re selling in your area — the look of which might surprise you. As you can see from this graph, you’re really in luck if you’re trying to buy in Tennessee, and you’re really out of luck if you were hoping for some space in the District.


By Ezra Klein  |  01:52 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 01:42 PM ET, 05/09/2011

Vermont closing in on single payer

Kevin Outterson is an associate professor of health law, bioethics and human rights at Boston University, as well as a blogger at the Incidental Economist. He’s also been following the Vermont health-care reform process in some detail, and is one of fairly few people who has actually read the 141-page single-payer bill that the governor is poised to sign. Earlier this afternoon, he walked me through what he’s learned.

Ezra Klein: What is Vermont passing, exactly? My understanding is that they’re not going to sign this legislation and wake up with single-payer health care the next day. So what’s in this bill, and what does it do?

Kevin Outterson: This bill is more of a framework. For example, they left out all the financing. But it sets a planning process for a single-payer — or what they’re calling a “single-payment” — system. If you read the various reports and presentations they’ve released so far, you can get a sense of where that’s going. Their plan is to roll every payer they can into one system. It’s easy to do with state and municipal employees. They might be able to do it with the individual and small-group markets that they regulate under the terms of the Affordable Care Act. They are going to ask the Obama administration for waivers for Medicaid, so they’d get the Medicaid money and use it in this system, and they also want a waiver for Medicare, which I’m not sure anyone has ever done before. And the last group they’re trying to woo in are the large, national employers who are regulated by ERISA. Their plan is to tax these employers whether they pay in or not, and then these employers have to ask themselves, “We’re already paying this tax, why wouldn’t we just put our employees into Green Mountain Care?”

EK: So all these different players remain part of the health-care system. But now their payments run through the Vermont state government.

KO: Right. So employers would still be paying in, the Vermont state government would still pay in, the federal government would still be paying in, but all the money would then flow through Green Mountain Care, the single-payment system. And for all providers, there’d just be one contract. It’d equalize payment rates between private insurance and Medicare and Medicaid. It’ll dramatically reduce their paperwork. That’s why they’re supporting it. And Blue Cross/Blue Shield of Vermont, which is the biggest insurer in the state, supports it.

EK: Wait, Blue Cross/Blue Shield supports it? Why? Won’t this put them out of business?

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By Ezra Klein  |  01:42 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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Posted at 01:08 PM ET, 05/09/2011

Lunch break: Into the cold

Tales — and pictures — from deep in the Antarctic:

By Ezra Klein  |  01:08 PM ET, 05/09/2011 |  Permalink  |  Comments ( 0)

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