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Tag Archives: Affordable Care Act

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University of Chicago economist Casey Mulligan believes that the US unemployment rate has remained high because of many separate public policy changes. Big and small, each one influenced workers, businesses and consumers by creating new incentives.

For workers, Dr, Mulligan described a bigger safety net:

  • People could collect unemployment insurance (UI) for 99 weeks instead of 26.
  • Food stamp programs became more inclusive with less stringent qualifications.
  • The food stamp benefit grew by 40% in 2 separate stages.
  • A $25 “bonus” was added to the usual unemployment benefit.
  • The duration of work history was decreased as a qualification for UI.
  • Mortgage help increased for longer unemployment.
  • The unemployed could receive 65% of their health insurance expense.

 

He also explained why, for businesses, the incentive to fire workers increased:

  • Concerned employers knew that fired workers would get relatively high benefits.
  • Obamacare taxes and tax hikes are making employees more expensive.
  • It became increasingly attractive to replace workers with less expensive capital.
  • Employees had to be fired (rather than quitting) to qualify for unemployment benefits.

 

In addition, certain consumers had less to spend.

  • Increased taxation involves taking more money from one group than it gives to the other group.

 

As a result, several million lower income workers had more when unemployed than with a job while the majority had the equivalent of 85% to 90% of their previous income. Yes, of course, depending on the individual, the new incentives have a varied impact. Still though, Dr. Mulligan asks all of us first to recognize that our lawmakers have implemented changes that he believes have increased the unemployment rate substantially.

Then we have to decide whether we support the tradeoff: More support for the unemployed or more efficiencies that lead to fewer unemployed?

7.9% during January, the civilian unemployment rate touched 10% during October, 2009.

7.9% during January, the civilian unemployment rate touched 10% during October, 2009.

Sources and Resources: An hour long, every minute of the econtalk podcast in which Casey Mulligan described his research and new book to Russ Roberts was captivating. It perfectly conveyed the tradeoff that we all need to know, whatever our preferences. Then, for recession data, here is the BLS website.

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The Congress and the Fiscal Cliff

There might be 2 ways to look at the fiscal cliff.

Specifically, we can focus on tax increases and spending cuts:

Tax Increases

  1. Bush era tax cuts: expire
  2. 2010-2011 2% payroll tax cut: expire
  3. Affordable Care Act taxes: kick in

 

Spending Cuts

  1. Emergency unemployment benefits: expire
  2. Budget sequester (cuts) from Super Committee failure: kick in
  3. Previously legislated budget cuts: kick in
  4. Defense cuts from Iran/Afghanistan reductions: kick in
  5. Medicare payment rates for physicians: reduced

 

More broadly, we can take a step backward and look at the bigger problems that really have to be solved:

  1. 63% of the 2011 federal budget was on “autopilot.” Debating cuts, the Congress only looked at 37% of spending.
  2. 1 of 4 budget dollars is spent on healthcare. Looking back 50 years ago, less than 10% of all spending was healthcare, and looking forward, we are heading toward 33%.
  3. Slicing federal employees and agencies would save money but not nearly enough. Even if we fired the entire federal payroll, the deficit would dip by less than one third.
  4. Defense spending is massive. We spent 1 out of every 5 dollars on defense in 2011.
  5. We now borrow close to 36 cents for every dollar we spend. And yet still, the more affluent are paying a larger proportion in taxes and the middle of the middle class (as expressed in the video) is paying a lower proportion.

 

Where does this leave us? Defined as taxing, spending and borrowing, US fiscal policy is the real fiscal cliff.

Sources and Resources: The specifics of the fiscal cliff are from a past econlife post while the summary of the big issues is from the David Wessel/WSJ video that follows. For even more detail, this Tax Foundation description of the fiscal cliff is good.



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Flawless Monarch Butterfly Flying on Isolated White

I’ve been thinking about the economic connection between sitting and butterflies.

Our story starts with sitting studies. Pulling together the data from surveys covering 167,000 adults, researchers have concluded that you might live longer if you sit less. More specifically, people who sit for less than 3 hours daily live two years longer. MIGHT is crucial here because the study, based on data amassed from other studies, seemed to establish more correlation than causation.

The physiological reason for the downside of sitting involves how we metabolize fats. Standing, we activate more muscle groups and process more fats and burn more calories. There is no free lunch though since too much standing harms us also. From varicose veins to impeding fine motor skills from poor posture, the problems of standing when we work are potentially life threatening also. To avoid all the complications of sitting and standing, you could just decide to exercise energetically before and after work. However, scientists believe vigorous exercise does not offset the impact of excessive sitting.

Perceiving sitting as inactivity, how does the US compare with other countries? We are relatively inactive. Few of us bicycle or walk to work compared to China or France or Denmark.  Based on exercise also, we are low on the scale although one reason is that more affluent developed nations tend toward inactivity. Bangladesh and India have relatively active populations while the US and the UK do not.

Okay, what difference does all of this make? It took me to butterflies. In his Teaching Company course, “Thinking Like An Economist,” Smith Professor Randall Bartlett places the butterfly effect with other five basic ideas in his economic toolkit. A part of chaos theory, the butterfly effect was explained by James Gleick in Chaos (p. 23 ):

  • “For want of a nail, the shoe was lost;
  • For want of a shoe, the horse was lost;
  • For want of a horse, the rider was lost;
  • For want of a rider, the battle was lost;
  • For want of a battle, the kingdom was lost!”

 

One tiny butterfly flutter (no nail) and the results built to a seemingly unrelated massive consequence (no kingdom). Or as Barlett says, “the law of unanticipated consequences.”

The millions of jobs (the butterflies) created by our service based economy generate the inactivity that affects our health negatively and continues to build with massive consequences. Do you agree?

Research reports on inactivity and sitting were in The Lancet and  BMJ Open while news articles appeared in WSJ.com and Slate.com. And here is a Forbes slideshow on “The Laziest Countries in the World.”

Finally, some stats on worldwide inactivity from The Lancet:

Percent of Population That is Inactive: Self-Reports No Moderate or Vigorous Exercise Routine

Country Percent Inactive
UK 63.3
UAE 62.5
Japan 60.2
Portugal 51.0
Spain 50.2
Brazil 49.2
USA 40.5
Denmark 35.1
Canada 33.9
China 31
Germany 28.0
Estonia 17,2
India 15.6
Greece 15.6
Mongolia 9.4

 

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Tomatoes

Trying to make pretty tomatoes, plant breeders inadvertently created a tasteless fruit.

It all started 70 years ago with a gene mutation that evenly ripened tomatoes. Seeing the commercial potential of uniformly colored bright red tomatoes, growers bred the gene into most of their crop. Scientists recently discovered though that the same gene that perfectly ripens tomatoes also diminishes their sugar content and fragrance.

This tomato story started me thinking about other unintended consequences.

In France, one extra worker can mean that a firm needs to create worker councils, establish profit sharing, and report to employee representatives when firing people for economic reasons. But, that worker has to be #50. Similarly, the Affordable Care Act requires that firms with the equivalent of 50 or more full-time employees will have to offer health insurance or pay a penalty. In France there are more than twice as many firms with 49 employees as with 50. Will the Affordable Care Act have a similar unintended consequence?

And finally, one last unintended consequence from Adam Smith:

“It is not from the benevolence of the butcher, or the baker, that we expect our dinner,” Smith wrote, “but from regard to their own self interest.” And yet, jobs are created, goods and services are produced, wants and needs are satisfied, and economic growth results.

More in Econlife about the unintended consequence of French regulations is here and about tomatoes, here and here.

 

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I get concerned when people say we may need to start rationing health care. Like most goods and services, because there is a limited supply of health care, we have always rationed it. In some way, we had to decide who would get more and who would get less. And that is rationing.

Now, with a SCOTUS decision that has validated an insurance buying mandate, it is possible that our rationing system will change. Princeton economist Uwe Reinhardt suggests that cost effectiveness will have to enter health care decisions.

And that takes us to the price of an extra year of a human life.

Explaining how to price life, Dr. Reinhardt uses QALY: Quality-Adjusted Life Years and a curve (below) that represents the most cost effective approach. Starting on the curve at the far left and moving rightward on the curve to point Z, every dollar spent has a relatively good extra year return. Then though, as the curve goes vertical, the extra life span diminishes.

Where on the curve do you say no?

At $10 for an extra year of life? $100? $1000? $100,000? $10 billion?

For whom?  A hip replacement for a healthy 35 year-old? For a healthy 85 year-old? Yearly mammograms for all women past 50? A 45 year-old who is grossly obese, has diabetes and heart problems and now needs a kidney? A $100,000 drug dose after a heart attack?

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From: http://economix.blogs.nytimes.com/2009/03/20/pricing-human-life-years/

Discussing how to ration, Dr. Reinhardt suggests we contemplate the following:

1. Should we establish a maximum price beyond which society will not buy additional QALYs out of collective insurance funds?

2. If there is a maximum price, should it apply to everyone equally? Rich and poor? Famous and unknown? Science researcher and manual laborer? Old and young?

Whether our current health care system is based on individual decision-making, ability to pay or government, it still is all about rationing.

Here and here, Dr. Reinhardt clearly explains key issues that have become the “third rail” of health care politics like cost effectiveness. He also directs us to this paper with a fascinating chart of the cost of a life for 500 life-saving interventions.

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