Some Background On the “Genealogy” of Obamacare, Romneycare, Bill Clinton’s Proposed Reforms, and Republican Ideas

Alan Blinder:†

… Before the ACA, the U.S. stood out from the international pack on health care in two very unpleasant ways. First, it spent a far larger share of gross domestic product on health care. Second, it was the only advanced industrial nation that left vast swaths of its population uninsured. These two doleful facts remain true …

There are several ways to get more people covered. One is to adopt a system in which the government provides or pays for universal coverage—the British or Canadian model. This won’t happen soon in the U.S., not even as Medicare for All.

A second route, advocated unsuccessfully by President Clinton in 1993, is to mandate that every employer provide health insurance to its workers. This approach might seem natural in the U.S. context because so many workers already receive health insurance that way. But the employer mandate has fatal flaws. It wouldn’t cover the nonworking population, and it would impose heavy burdens on small businesses.

For these and other reasons, many economists in the Clinton administration—including me—favored an individual mandate. But that idea was dead in the water in 1993 because it had been advocated by the Heritage Foundation starting in 1989. It was therefore a “right wing” idea.

There are problems with an individual mandate, too. For one, the high cost of U.S. health insurance means that many low- and moderate-income families cannot afford to buy policies on their own. For another, if for-profit insurance companies are made to lose money by covering people with pre-existing conditions, the government must also force young healthy people, who tend to have limited medical expenses, into the insurance pool.

Fortunately, both problems are easily solved—conceptually, that is, not politically—by mandating that everyone buy a policy and providing subsidies to the needy. Massachusetts legislators understood this in 2006. They also knew they were not writing on a blank slate; many citizens received health insurance through their jobs and didn’t want to lose it. Hence the hybrid system that became known as RomneyCare.

If this short description reminds you of the ACA, it should. The two plans are not identical twins, but there is a family resemblance. In 2010 Democrats didn’t follow in the footsteps of Romney Republicans to make them look good; they designed their plan that way because under the constraints of precedent, the underlying logic practically forces you there.

Keep that in mind: If there ever is a TrumpCare, an unlikely proposition, it’s bound to resemble RomneyCare and ObamaCare—no matter what the president claims.

Parse that again: yes, the individual mandate that Obamacare included, and which drew from Romenycare in Massachusetts, that was struck down in 2018 (to the cheers of Republicans), was originally a Republican idea which the Clinton administration rejected (The Heritage Foundation is a conservative think tank).

Read the whole thing, entitled “The Individual Mandate Is Here to Stay”, in the April 14, 2019 issue of The Wall Street Journal.

† Alan Blinder is a pretty big name in macroeconomics, and one you should familiarize yourself with. He’s been a professor at Princeton for a long time, served in the Clinton White House, was vice chair of the Federal Reserve Board of Governors, and is co-author of one of the major principles texts. While he’s published a ton, my sense is that he’s never had the one hugely cited article that puts you on any list for a Nobel Prize.

Barro On GDP and Welfare

Barro [2019] observes that GDP is not a good measure of welfare. Yes, we already knew that, but we use it anyway because it so comprehensive.

But that comprehensiveness gets us into trouble because GDP is a better measure of effort than consumption/welfare.

In particular, he points out that we double-count investment. It’s counted initially when it’s purchased and added to the existing stock of capital. But it’s counted a second time when we include the income from what the existing capital stock produces.

It’s a good thing to count his somewhere, but it’s probably not a good thing to count it in something you’re going to use to assess welfare.

The upshot is that countries that invest more have higher GDP without necessarily making their people better off. That’s not an argument to not invest, but rather an argument that ranking outcomes by GDP will make countries that gyp their citizens look better off than they are.

Here’s a low level discussion of the results, asserting that over half of the capital share of GDP (that thing progressives are so worried about going up) should not be included in GDP at all.

FWIW: this paper shows one of the top macroeconomists of the last 50 years using a model not much beyond what we do in ECON 3020 and the Handbook for the class to make a fundamental point about how we should think about the world. And the method is calculatable with currently existing data.

Why Is Macro So Hard? Marx, Engels, and Plato

The Open Syllabus Project tracks over 100K college syllabuses to see which texts are used.

At number 3 is The Communist Manifesto by Karl Marx and Friedrich Engels (this is the shorter, more political than economic book, that is often paired with readings from the 3 volumes of Marx’ Capital).

WTF.

My guess is that this may be the primary exposure to economics that many students get.

An analogy would be if Paley was read by far more students than Darwin.

This is not to say that Marx wasn’t a great economist. He definitely recognized and discussed the big unsolved or unaddressed problems of his day. But that was half to 2/3 of the way back to Adam Smith. A lot has happened since then. That’s like contemporary chemists reading Priestley: old, seminal on some points, and woefully wrong and out of date on others.

And Marx’ labor theory of value, his core idea, was a failed attempt at explaining the paradox of value. An important aspect of why it failed is that he came up with an answer before others did, that was later shown to be flawed by the marginal revolution. In most fields, that would be called a valiant attempt, with emphasis on the attempt part.

And yet, I have never, ever, had an incoming student at any level who could explain why it was wrong. This makes me think that while # 3 is being covered a lot, an essential part of the story is being left out.

In context, Marx is best thought of as a low and thick branch on the tree of economics knowledge. It was a worthwhile direction to go as the field explored new directions. But when it didn’t work out, economics as we now understand the field to be, backed out of that branch and went down the others, and flourished.

At number 2 is Plato’s Republic. OK. I’ll give on this one. It’s a great and seminal piece of social thought. But I wonder how many students get through as much of it as they can and come out the backside understanding that it doesn’t have much to do with democracy, republics, and elections as they’ve come to understand them?

In an event, as an economist, I find this work to be blissfully unaware that decentralized exchange is important or worthwhile. And yet understanding of decentralized exchange is what economics is all about.

A case in point is the prisoners’ dilemma. It wasn’t until halfway through the 20th century that a couple of mathematicians hit on a fundamental problem for understanding economics: optimal choices do not always lead to optimal outcomes. Plato knew nothing of this when he considered the best government to be that of an all-wise and all-knowing philosopher king, who made nothing but optimal choices.

So why is macro so hard? Because these authors are blithering idiots on the subject of what we now call economics, or on the subject of economics as presented in the news every day. If this is informing students’ viewpoints on some topics, no wonder they find what we do difficult.

I’ll even update my analogy. Paley was at least talking about some of the same things as Darwin. Better yet would be Origen and Augustine, discussing diversity without any conception of the random part of random selection producing it. That’s what teaching Marx, Engels, and Plato is doing to college students.

Proposed Social Security Reform

It’s an opinion, but I feel that for 20 years or so, students have been fairly well-informed that Social Security is not sustainable in its current form. (Unfortunately, like the general public, they do not seem aware that Medicare, because it is both trending upwards and currently has no boundaries is the bigger long-term problem).

Having said that, most seem to lean towards the idea that social security will simply not be around, or won’t be a major contributor, to their retirements around mid-century.

In class, I’ve generally voiced the opinion that I thought it would be around, in much like its current form, and that it would be contributions from younger working people that would change. The big problem here is that older people vote with more frequency, and the politics is you don’t hurt the people who vote more.

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Reform proposals come and go, and the new one on the table is from the Democrats (here are some recent proposals from Republicans).

So, this is not a very specific criticism of Democrats or the proposal, but it will point out some of the design features adopted in this proposal that have been touched on in my macro classes over the years.

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What’s in the new proposal?

Increased taxes on working people. I hate to say I told you so, but …

Increased benefits for seniors. This is probably necessary to secure their support. It belies the fact that the wealthiest population segment in America is already seniors. On the bright side, it does increase social security payments to the poor by more than to the rich.

A particular bugbear of Democrats is the willingness to create additional tax brackets. The problem is the resulting complexity of the outcoming tax planning. This one is worse because it creates two tax bracket changes, one for the rich and one for the very rich, neither of which is indexed to inflation, making them more complex with the passage of time. This has been dubbed the “doughnut hole”. Do note that on top of this, the change in benefits from the previous paragraph is like creating an implicit third new tax bracket.

On a good note, the proposal does reduce the number of brackets that recipients in middle incomes face.

Probably most importantly, the reform would change the adjustment for inflation. We’ve known for about 25 years that using the CPI to adjust for inflation creates long-term problems because it overstates inflation rates. The new reform would make this worse by switching to a new measure of inflation known as CPI-E. This new measure actually results in higher inflation rates than the old one. So this is a sneaky way to amplify an old problem. This is pure politics again: if you choose a more accurate measure of inflation to use, because we’re too high that must be lower, benefits for seniors will grow at a slower rate. Lobbyists for seniors (like the powerful AARP) are the one who keep that sort of thing from going through, and they’ll love using the new index.

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Keep your eye on the ball here.

Social Security needs reform.

Reform will happen eventually. Both parties want to be the ones who get credit for it.

Each party proposes a set of compromises, looking for the set that will ultimately pass.

Those compromises will always have bad stuff in them, to get some good stuff too. This just happens to be the Democrats current bad stuff, and my honest opinion is, that increasing tax complexity and a preference for biased inflation adjustment are fairly normal for how they operate.

Why Is Macro So Hard? Don’t Measure What You Don’t Want Others to Find Out

Here is an example from Berkeley passing a sin tax on sugary sodas. The goal of these is allegedly to combat obesity. If so:

The problem with the way the soda tax is implemented, however, is that the city treats the policy as a settled issue rather than an experiment. It does not account for the possibility that the policy may fail. In fact the city’s decision-makers do not even bother to outline what they would consider a success for the soda tax in terms of reduced obesity. They have not announced any plans to track the tax’s impact on obesity rates. Thus, even if the policy fails to reduce obesity, the tax will likely continue.

Maybe the purpose of the tax isn’t really to combat obesity at all. Maybe it’s just to raise money. Cold Spring Shops (linking to this article, with more here and here) quotes that those two probably don’t go together

As with all sin taxes, there's a contradiction at the heart of California's proposed soda tax: the policy is supposed to both dissuade soda purchases and raise significant revenue from taxing them. To succeed on one metric is to fail on the other.

The reasoning is nothing if not obvious:

• If the tax is going to reduce obesity by discouraging people from buying sugary drinks, then their demand must be elastic. So little tax revenue will be collected.
• If the tax is going to raise revenue, it must do so because people will buy the sugary drinks in spite of the tax, because their demand is inelastic. So obesity won’t change much.

Ya’ can’t be elastic and inelastic at the same time.

Thing is, if they knew this, it would make sense to discourage collection of data.

It all makes sense now …

Some History of Government Backed Mortgage Lending

Any decent explanation of the financial crisis of 2006-9 needs to include the implicit backing of mortgages with taxpayer dollars. In the U.S., most mortgages are backed by GSE’s. Backing means that if those real estate purchases went well, the mortgagee/buyer keeps the gains, but if they do badly and the mortgagee/buyer walks away or declares bankruptcy, the holder of the mortgage covers the loss.

Note that I do not say mortgager. Most mortgages are offered/written and/or contracted by local financial institutions. The money to make those loans often comes from GSE’s. And the mortgages, once written, are often bought by GSE’s; they then receive the payments as their income to finance their operations, including making new loans.

And what’s a GSE? That’s short for Government Sponsored Enterprise. Basically, there is no private entity doing some thing (usually because it is a dumb idea that won’t make money). So the government creates/sponsors one. These then operate sorta’ like private corporations. Except: 1) they’re located in D.C. and report primarily to politicians and bureaucrats, and 2) if they go bankrupt it’s seen as something that must be prevented at all costs, so those politicians pony up tax revenues to keep them running. There are lots of GSE’s in the U.S., and in other countries too.

In the U.S., the big GSE’s involved in housing are the FHA (Federal Housing Administration, this one is actually part of the government), Fannie Mae (Federal National Mortgage Association), Freddie Mac (Federal Home Loan Mortgage Corporation), and Ginnie Mae (Government National Mortgage Association).

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N.B.

It is an urban myth that real estate is always good investment. That’s why they needed to create GSE’s: they wanted to jump start a type of investment that markets deemed unwise for most people.

The sense in which contemporary real estate purchases are a “good investment” is that you are allowed to make the purchase mostly with borrowed money, and the protections for the buyer if the investment goes bad are stronger than with other investments.

Basically, it’s heads you win, tails someone else loses … set up with an investment that is mediocre. That creates a moral hazard.

Financially, it also makes home purchases like buying a call option, with the attendant agency problems.

Here’s the thing (or two things). Our mythology of America is that the Great Depression was caused, in part, by people buying stocks with borrowed money. So Congress’ solution to that was to make that hard to do, but make it easy for people to buy houses the same way. Duh! And, most people are told to shy away from buying options, and yet they’re encouraged to buy homes as options without telling them that they now have an option. Double-duh!

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D.C. likes to tell us that reforms instituted after 2008 (including Dodd-Frank) cleaned up this mess.

Most economists do not find this credible. While Dodd-Frank did many things, it did not address the fundamental problem: there’s moral hazard involved in borrowing someone else’s money to buy a home. Further, homes are probably the last asset you’d like people to buy with borrowed money: they’re not very liquid, and you can’t shop them around to different locations in the hopes of finding buyers willing to pay more for them.

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All of this is a lead up to an informative blog post by Kevin Villani at Chicago Boyz. It turns out that Villani has way more expertise on this than most people. Here’s his bio:

Kevin Villani, chief economist of HUD during the Carter and Reagan Administrations and Freddie Mac from 1982 to 1985, is the author of Occupy Pennsylvania Avenue on the political origins of the sub-prime lending bubble and aftermath.

Here’s the history of these GSE’s, in a nutshell:

U.S. secondary markets evolved entirely in response to anachronistic political forces. FHA was created in 1936 to stimulate new construction jobs [not a bad idea during the Great Depression] subsequent to a huge housing construction boom [it worked]. Fannie Mae was created two years later to prop up flagging demand for FHA mortgages [investors didn’t have money for mortgages before, and they didn’t still when FHA marketed more of them]. Ginnie Mae was created in 1968 to liquidate Fannie Mae after prior privatization attempts failed … Rather than liquidate, the privatized Fannie turned to funding conventional mortgages for their mortgage banker clients. To protect their turf, portfolio lending savings and loans [S&L’s were a different type of bank, also created by legislation during the Great Depression, which have largely ceased to exist, except in name, when many of them crashed in the financial crisis of the late 1980’s] then demanded their own secondary market facility, Freddie Mac. It later privatized mainly to provide management incentives comparable to Fannie, particularly stock options.

They then morphed into massive public directed credit institutions, with profits from government subsidies privatized but otherwise lacking the benefits of market efficiency and discipline. About half of F&F subsidies were captured by shareholders, managers and politicians (my estimates) … [Bracketed comments are from me. Parenthetical comments are the authors].

Many presidential candidates, and much of Congress is interested in further reforms. Villani points out what we’ve learned so far:

• Private markets operate on one set of incentives and accountability, government on an entirely different set. Each has its problems and imperfect solutions.
• Private markets may inappropriately discriminate against qualified borrowers, for example, whereas public programs may fail to adequately discriminate.
• Public enterprises created to jump-start or complement private markets often miss the mark, with unintended consequences.
• Politicians much prefer to deliver subsidies through taxes (in this case tax exempt debt substituting for taxable equity) rather than expenditures – especially since the Budget Control Act of 1974 – and implicit off-budget credit guarantees that delay the reckoning.
• In spite of good intentions and design to get the best of both, privatized hybrid public-private systems inevitably embody the worst: public risk for private profit. Lacking both market and public discipline, they cause systemic failure that “nobody could have seen coming.”
• Political reform reflexively blames private market failure, doubling down on unaccountable and ineffective bureaucratic methods while providing opaque bailouts through greater tax and credit subsidies.
• Political reform starts with what is, not what should be, repeating the cycle.

Read the whole thing. Highly recommended.

Anyway, d’ya think mortgage finance is a big enough issue to be covered in macroeconomics classes? Yep.

And, it’s common for people to make the claim “no one told us this could happen”, but I can attest that the moral hazards of GSE’s in the housing market has been part of my macro classes for 30ish years.

Oh … and … student loans are financed the same way (through, you guessed it, Sallie Mae). Just sayin’ …

Wealth Taxing In the U.S.

Taxing wealth appears to be an issue for the 2020 election cycle. Democrats are pushing ideas for new ones, and we’ll probably see something along those lines if they defeat Trump.

I say “new ones” because, as Tyler Cowen points out, we already have important taxes on wealth. But people don’t seem to want to recognize them as such.

First, we have the capital gains tax, paid on many assets if the sale price exceeds the purchase price. Of course, assets are synonymous with wealth.

Further, the capital gains tax is not indexed to inflation. This means that when the nominal value of your asset goes up faster than your real value, you pay the tax on the nominal increase.

For example, if you bought an asset for 100, and its real value does not change, but there is 20%inflation, you would sell the asset for 120 and pay a tax on the nominal gain of 20 even though you’ve made no real gain. This isn’t a hypothetical: it’s fairly common on vacation homes and stock investments.

FWIW: Indexing capital gains taxes for inflation has been in the policy discussion mix for 40 years now. It doesn’t get passed because it is seen as a tax break for the rich, and as a likely reducer of tax revenue. It is very hard to get across that “break” might be the wrong word if you’re going from something unreasonable to something reasonable.

Capital gains tax revenue is not huge (it is part of federal individual income taxes, and varies from 6 to 12% of those, so between $100-200 B/yr).

But second, property taxes, mostly paid to state and local authorities run close to $700 B/yr. These are mostly paid on real estate. Interestingly, home owners pay the tax on the entire assessed (gross) value of the property, rather than the (net) equity which is their wealth.

Lastly, most people recognize taxes on inheritance as a tax on wealth, but in point of fact, these don’t actually collect that much revenue (about $20 B/yr). The primary reason for this is that low levels of inherited wealth are untaxed, and while high levels of wealth are taxed … there aren’t as many very rich people as most of think.

I think the Democrats should be held to some numbers here: if tax revenue across all jurisdictions is about $7,000 B, and wealth taxes are already 10-15% of that, should they be presenting their proposals as new ideas at all?

The Biggest Story In Economic History Continues

You should be hearing about macroeconomic news like this. All. The. Time.

It’s a testament to the low key awfulness of the legacy media and politicians that you don’t.

Anyway, the UN reported that India lifted 271 million people out of poverty between 2006 and 2016.

That’s almost as large as the population of the whole U.S.

And, India wasn’t the only country doing this.

The report said that in the 101 countries studied — 31 low income, 68 middle income and 2 high income - 1.3 billion people are “multidimensionally poor”, which means that poverty is defined not simply by income, but by a number of indicators, including poor health, poor quality of work and the threat of violence.

The report identifies 10 countries, with a combined population of around 2 billion people, to illustrate the level of poverty reduction, and all of them have shown statistically significant progress towards achieving Sustainable Development Goal 1, namely ending poverty “in all its forms, everywhere”.

The 10 countries are Bangladesh, Cambodia, Democratic Republic of Congo, Ethiopia, Haiti, India, Nigeria, Pakistan, Peru and Vietnam.

Due to its size, India was the biggest improver, but the rates of improvement are startling:

India reduced deprivation in nutrition from 44.3% in 2005-06 to 21.2% in 2015-16, child mortality dropped from 4.5% to 2.2%, people deprived of cooking fuel reduced from 52.9% to 26.2%, deprivation in sanitation from 50.4% to 24.6%, those deprived of drinking water reduced from 16.6% to 6.2 %.

Further more people gained access to electricity as deprivation was reduced from 29.1% to 8.6%, housing from 44.9% to 23.6% and assets deprivation from 37.6% to 9.5%.

I also should not have to teach these sorts of factoids to college-level students, but given the priorities of others I have to:

• All humans used to be desperately poor.
• The only sustained period of improvement in that condition is the current one (ongoing for about 350 years, or 7% of human history).
• This enrichment is associated with regions that practice market tested betterment.
• The improvement in China and India over the last 40 years are unprecedented improvements in the condition of humanity
• Those changes are associated with a shift in political, social, and legal culture away from other systems and towards one market tested betterment.

Central Banking by Lawyers

Ummm … this can’t be right (but it is):

With Lagarde at the ECB and Powell at the Fed, lawyers, not economists, will be running the world's two most important central banks.

I hope it ends well.

Mercator Adjustment

Two visualizations of correct sizes on a Mercator projection:

I have started using some maps in this class and its Handbook, so a visualization like this is a good thing to refer to once in a while.

From Visualcapitalist via bookofjoe.

Venezuela

Americans get a lot of misinformation about Venezuela. Here’s Tyler Cowen, author of prominent principles textbook, mega-blogger, in Bloomberg:

Republicans are labeling the country “socialist,” using Venezuelan problems as a weapon against more left-leaning Democrats. Commentators on the left, in contrast, are arguing that Venezuela is more of a failed petro-state with bad leadership, rather than a test of socialist ideals. Who is right?

If we look at government spending as a percentage of GDP, Venezuela seems far from socialism. In recent years government spending in Venezuela has been measured at about 40 percent of GDP …For the U.S., the corresponding figure is about 37 percent.

Yet emerging economies typically cannot afford the same government programs as wealthier countries, and they cannot run them with the same efficacy. …

Furthermore, rates of change are important. The Venezuelan figure of about 40 percent is up from about 28 percent in 2000, a very rapid increase. …

Or consider exports, which for most developing economies play an especially critical role. They bring in foreign exchange, provide contacts to foreign markets, and force parts of the economy to learn how to compete with the very best foreign companies. Yet over 90 percent of Venezuela’s exports are oil, and those resources are owned and controlled by the government.

People on the political left need to tread carefully here. Venezuela is a place the left used to be proud of:

Greg Grandin, writing in The Nation in 2013, offered a laudatory take on Chavez and suggested that Venezuela “might be the most democratic country in the Western hemisphere.” (He also argued, oddly enough, that Chavez “wasn’t authoritarian enough.”) Jeremy Corbyn, leader of the U.K.’s Labour Party, has also been a big Chavez fan, while Nobel laureate economist Joseph Stiglitz praised Venezuela’s economic policies in 2007 and declared that the risks of higher inflation were overrated.

Keep in mind that for all its faults, Venezuela used to be the richest country in Latin America. The political left has a lot of macroeconomic explaining to do on this one.

Interesting Healthcare Tidbit

The “expensive” healthcare in the U.S. has big box pharmacies with lower prices.

The “cheaper” healthcare in Europe has small, local, pharmacies, with higher prices. Oh, and it has rent-seekers out to defend the status quo.

I wonder whether or not this is included in most peoples’ assessment of the cost and value of healthcare.

FWIW: Backpacking around Europe in 1984, I found out that in Switzerland the only place you could buy shampoo was the local pharmacy. I still remember paying over $6 for a small bottle. That’s about $15 in 2019.

Oh … That Sneaky Republican Tax Reform

Last year I posted an 11 part series on the tax reform passed by the Republicans. I thought I had covered all the important parts. Not so.

“Democratic socialists”, led by Alexandria Ocasio-Cortez want to raise the marginal tax rate on high incomes to 70%. I’m not sure they have an economic motivation for this, it may simply be resentment.

Surprise, surprise … the Republicans already did this.

Actually, they did worse: the Republicans did raise the effective tax rate, Democrats are merely proposing to increase the marginal rate.

Here’s what the Republicans did: they instituted a new form double taxation of corporate officer incomes.

N.B. Double taxation means the same thing is taxed once, and then taxed again. It occurs all over (and some have argued that incomes in the U.S. are taxed up to 5 times).

After the tax reform, income paid to executives must be taken out of the corporate income statement below taxes (with after-tax profits) rather than above them (with costs). And then they’re taxed again at the personal income tax rate.

To be concrete, paying a corporate officer of a publicly traded New York company an extra $1 million will result in an additional $261,350 in federal and state corporate taxes, $370,000 in federal individual income tax, $38,000 in payroll tax, and $127,000 in New York State and New York City tax.

Since the $261,350 part would come out first, the corporation would actually be paying $1,261,350 and then subtracting the $261,350, on which an additional $535,000 in taxes would be paid. That works out to an effective marginal rate of 63% (i.e., 796,350/1,261,350).

Read the whole thing. This is from the Brookings Institution, which is not known for being sympathetic to Republicans (and which probably qualifies as part of Trump’s “swamp"). It’s entitled “Ocasio-Cortez wants to raise the tax rate on high earners. The Tax Cuts and Jobs Act already did”.

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Of course, AOC isn’t proposing this. She wants something even worse: to raise the marginal federal personal income tax rate on incomes this high from 37% to 70%. In the above calculation, that would mean an 89% effective marginal rate for the corporate officer..

It’s cynical, but all of this makes me think that “Democratic socialists” just say things they think will play well in the legacy media, without actually thinking about them very deeply. And then people repeat them loudly.This can be difficult to parse out: if 70% is proposed, but they’re already paying 63%, is 89% what you really want, and if not, what is??