A Good News Summary

(from The Incidental Economist)

This is simply the best! Cheerful, energetic presentation of lots of things that are going right!

Some Predictions for 2014

It's that time of year, the time to make some predictions for the year coming up. So here are my predictions for 2014:

1. Obamacare - 3/31/14 enrollment: 5MM private, 7.5MM Medicaid. Under 35s' signup: 30% or more. 2015 premium increase average: less than 5%. Effect of 7/1/14 Employer Mandate startup: modest/under 500,000 workers estimated to be dropped in 2015. Total people with employer-sponsored insurance - 2014 vs. 2013: no change, or slight increase. 9/1/14 Obamacare approval: 50%
2. Debt Ceiling - GOP calls for negotiations. Obama refuses. GOP backs down, before we enter "full crisis mode".
3. Immigration - Boehner allows a vote on the Senate bill, after primary deadlines passed. Bill passes and is signed into law by Labor Day.
4. NSA Surveillance - President agrees to substantive changes to surveillance policy.
5. Healthcare Costs - No excess cost growth (growth in excess of GDP per capita) for fifth year in a row. CBO further trims long term healthcare forecasts, but not quite enough to stabilize long term debt/GDP picture. Becomes clear that the ACA has significantly impacted healthcare costs, and if the trend continues, the US does not have a debt, or an entitlement problem.
6. Global Warming - No legislation, but significant EPA action tightening up CO2 emission standards for existing and new utility plants.
7. Economy - Strong growth - 3% or more for GDP. 10/1/14 unemployment: 6.5%. Inflation and interest rates stay low. Best developed economy's performance, matched only by Japan. Europe stays almost flat. China slows down to 5% growth. Austerity economics starts losing supporters.
8. Iran - Agreement is reached to control and inspect Iran's nuclear program, upending the calculus for Middle East power dynamics.
9. Syria - Peace agreement is reached, with Iran's help. Assad forced to step down. International peacekeepers put in place to oversea an unstable peace agreement.
10. Obama Job Approval on 9/1/14 - 50%
11. Senate Midterms - Dems hold the Senate.
12. House Midterms - Dems pick up 5 seats.

A successful winter and spring for Obamacare is what underpins my political forecasts. Think the Iran deal will happen because both sides want an agreement. The Syria deal will happen, because Iran will help. The Sleeper: a possible Israeli-Palestinian peace deal.

A Profile in Courage

(from Nancy LeTourneau - "2013 Most Memorable Moments")

The above picture is of Antoinette Tuff who talked down a solo gunman with an AK-47 in a Georgia school this last August. I can't embed the video Nancy links to in her blog, so here's the link to the video. If you have the time, listen to it - an extraordinary profile in courage.

What do you hear? Here's what I hear:

• Antoinette tells us she was terrified, though you can't sense this in the calm, strong-voiced way she tells her story.
• She "anchors herself" in her sense of God, using the words of her preacher as guide. In other words, she directs her attention and energy to something strong and transcendent, leaving little room in her consciousness for fear or felt helplessness.
• She also grounds herself in Love - for the 800 "babies" in the school.
• The gunman is not the "enemy"; he is a sad and wounded soul. She shares her own story of despair and then recovery, telling him repeatedly that this same hope can be his too. Her words are not from some Emergency Procedures Manual. Nor are they a lecture. They come from her place of pain, felt very recently, so they ring true to the gunman. They are her words, but because they are "real", they are also his.
• In this connection, they recognize each other as brother and sister.

Are you capable of such courage? Yes, if you -

• are fully responsible for your emotions and where you choose to place your attention
• love others and honor yourself
• can embrace your own pain and also see it in others
• can stop thinking and be present

Another "self-test", this one in poetic form, is the call to authenticity embedded in the following poem:

SELF-PORTRAIT

It doesn’t interest me if there is one God

or many gods.

I want to know if you belong or feel

abandoned.

If you know despair or can see it in others.

I want to know

if you are prepared to live in the world

with is harsh need

to change you. If you can look back

with firm eyes

saying this is where I stand. I want to know

if you know

how to melt into that fierce heat of living

falling toward

the center of your longing. I want to know

if you are willing

to live, day by day, with the consequence of love

and the bitter

unwanted passion of your sure defeat.

I have been told, in that fierce embrace, even

the gods speak of God.

By David Whyte

From Fire in the Earth

If you can live "in that fierce embrace", with true authenticity, you will always have the courage you need.

Perspectives on the Birth

(Rembrandt, Adoration of the Shepherds)

On Saturday, Ross Douthat (a writer with whom I rarely agree) put up a splendid column in the New York Times titled "Ideas from a Manger". I will quote from it at length:

PAUSE for a moment, in the last leg of your holiday shopping, to glance at one of the manger scenes you pass along the way. Cast your eyes across the shepherds and animals, the infant and the kings. Then try to see the scene this way: not just as a pious set-piece, but as a complete world picture — intimate, miniature and comprehensive.

Because that’s what the Christmas story really is — an entire worldview in a compact narrative, a depiction of how human beings relate to the universe and to one another. It’s about the vertical link between God and man — the angels, the star, the creator stooping to enter his creation. But it’s also about the horizontal relationships of society, because it locates transcendence in the ordinary, the commonplace, the low.

Many Americans still take everything: They accept the New Testament as factual, believe God came in the flesh, and endorse the creeds that explain how and why that happened. And then alongside traditional Christians, there are observant Jews and Muslims who believe the same God revealed himself directly in some other historical and binding form.

But this biblical world picture is increasingly losing market share to what you might call the spiritual world picture, which keeps the theological outlines suggested by the manger scene — the divine is active in human affairs, every person is precious in God’s sight — but doesn’t sweat the details.

Then, finally, there’s the secular world picture, relatively rare among the general public but dominant within the intelligentsia. This worldview keeps the horizontal message of the Christmas story but eliminates the vertical entirely. The stars and angels disappear: There is no God, no miracles, no incarnation. But the egalitarian message — the common person as the center of creation’s drama — remains intact, and with it the doctrines of liberty, fraternity and human rights.

ACA is Reaching Solid Ground

(from http://obamacaresignups.net)

Accelerating progress. If you go to obamacaresignups.net, you can click back to prior forecasts, so you can get a sense of the acceleration factor. With 43.4% of the time between October 1 and March 31 elapsed, some states (with their own Exchanges and reporting systems) are just behind, right on, or ahead of pace for private insurance enrollments:

• California - 397K enrollments, 29% of 1.3MM target
• Colorado - 25K enrollments, 25% of target
• Connecticut - 23K enrollments, 71% of target
• Kentucky - 25K enrollments, 11% of target
• Minnesota - 30K enrollments, 44% of target
• New York - 117K enrollments, 54% of target
• Vermont - 23K enrollments, 41% of target
• Washington - 93K enrollments, 27% of target

My forecast has been: 5MM private, 7.5MM Medicaid. If the current pace continues, I could be low on both.

So what enrollment numbers would be generally acceptable to a broad range of the media? My guess is that any number below the 7MM private enrollment CBO forecast will be flagged as a miss by many in the media; though it's possible a "big win" in the Medicaid number would offset the miss narrative for all but the most conservative media. 9MM was the original Medicaid target, but that included all states: the 25 states not accepting the Medicaid expansion accounted for about half that forecast. So if Medicaid hits 8MM, which it might, that might offset a private forecast miss. Minimum private enrollment needed to record ACA a success in most major media? My guess: 5MM. And I think we'll hit that.

And how about the possibility of a premium "death spiral", caused by too few "young invincibles" signing up? This is the core conservative argument as to why Obamacare will "collapse of its own weight": the ACA, according to this argument, is based on a faulty model - the mandate penalties are too low to compel performance by the young, so they will not sign up and the program will eventually break down. The "death spiral" argument is, I am certain, groundless:

• Larry Levitt et al., from the Kaiser Foundation, recently published a paper showing that very significant drops in the rate of under-35 signups, below the 40% target, would affect premiums only modestly.
• Almost all analysts have missed the point (covered in Levitt's paper) that the risk pool combines Exchange signups with those continuing to buy non-group coverage off the Exchange, as long as those policies are ACA-compliant. All ACA-compliant policies sold on or off the Exchange form a single risk pool. In other words, every canceled policy that is converted to an ACA policy counts in the risk pool. I called Levitt last Friday to discuss this. He said that the off-Exchange, ACA-compliant policies could be 2MM early in 2014 and 4MM by year end. Since these folks most likely were reasonably recent entrants into the non group insurance market, and since they have been carefully screened to weed out health risks in the original application process, this 2-4MM group most likely represents a clear strengthening of the overall risk pool. 
• There isn't much demographic data yet, but it looks like California and Kentucky are getting under-35 year old turnout that is reflective of this group's share of the state population as a whole.

And finally, what about the employer-sponsored insurance market? Any chance of a wholesale dumping of people into the Exchanges to avoid ACA-related problems? The Right is pushing this meme big time, saying we will see this as we approach the July 1 date when the delayed employer mandate kicks in. My response: Quite simply, it won't happen. Providing quality benefits is too important to employers to just give it up.

The ACA is reaching solid ground. It will not be derailed. Will the strengths of the program emerge before the November, 2014 elections? They might, and they might not. To some extent it will depend on how effectively Democratic candidates present the evidence. By 2016, I am confident the benefits of this bill will be understood and this will contribute to what I am certain will be a Republican shellacking.

Why So Many Cannot See Obama

(Obama and Clinton just post-Benghazi)

Why can't people see this man? Nancy LeTourneau, aka Smartypants, has just completed a three-part blog series very ably addressing this question (Part I,  Part II, and Part III). She looks at three "lenses" that cloud the perception of many:

• The Patriarchal Lens - The Daddy versus the Mommy Party. Independent, get-it-done, aggressive male versus communal, nurturing, working-in-support position female. Authority and hierarchy versus shared leadership and communion-in-circle-space. Dominator versus partnership as leadership models. Using this lens you can "see" Obama when he kills Bin Laden or clobbers Republicans by refusing to negotiate in a Government Shutdown; but most of the time he is simply "invisible". "Leading from behind" is utter nonsense to this lens or viewpoint. Multivariate but still linear Chess works for this lens; the more fluid, slow, emergent, intuitive game of Go is nearly impossible to master. Nuance and complexity must be eliminated. Paradoxes must be "solved" or fixed, never engaged as Teacher.
• The Racial Lens - Few of us are able to acknowledge our Racial Lens; and because we can't, we endlessly generalize about the strengths and weaknesses of another ethnic group or race. We may even think we really like Blacks, or Asians, or Latinos, but as long as the ethnic character of the individual is what we see first, then we look through a Racial Lens. It's not a Person we see first; it's a Black....person. If we can admit to ourselves that we do wear, albeit unconsciously, a Racial Lens, we can then notice what generalizations spring unproven from this lens. The two Nancy points to are competence and luck. Obama is always demonstrating incompetence, or he's about to. And when a success is achieved, it's luck. There are a few people who credit the Syrian CW success with foresight and strategy (WaPo's David Ignatius), but only a few. And watch closely as the ACA proves to be a huge success over the next three years, and the evidence becomes incontestable that the Healthcare delivery system has undergone a transformation, due to the ACA; that the cost curve has been bent, and we no longer have an entitlement or debt problem in this country. The GOP will have enormous trouble seeing this because it would require both Obama and the Government to be judged as "competent", and the scale of the system change is simply too large to call it "luck".
• The Cultural Lens - Traditional media are in the process of splintering and transforming. Truth has lost its luster in the mass media. Ratings, polls and profits rule. Our media has become as polarized as our politics - each contributing to the developing extremism of the other. There are no wise men any more; no true arbiters; no revered institution seen to be "objective", above the fray. Even science has lost its credibility. Everything is up for questioning. All we can possibly tell for sure is who won and who lost; and even that is subject to question. The story with the strongest link bait - the explosive, possibly prurient innuendo that calls us back, like addicts, to the conversation - is the story that carries the day. This is a strange new world, where street fighters and celebrities are the ones talked about and admired; where our attention span has shrunk to nearly zero; and where the sensationalism has dulled our senses and we yearn for larger and bloodier spectacles. If we put this lens on, we will never pick up or see this man Obama, the long game player, the "no drama Obama", who leads from behind, is relentlessly decent and kind, and never strikes out in anger.

The Medicaid Tragedy

The following charts are all taken from a Kaiser Family Foundation report on The Coverage Gap, outlining state-by-state (all 25 are GOP-controlled states) how 4.8 million at or below the Federal Poverty Level ($11,490 for a single person) will be denied healthcare coverage that residents of other states will be getting, starting in 2014. This all makes me a bit angry and a bit ill.

In reading the KFF report, I found out some things about Medicaid I hadn't known:

• Did you know that adults without children have not (up until the ACA) been able to get Medicaid?
• Did you know that in the 25 red states the cutoff point for getting Medicaid is one half what it is in the mostly blue states? In other words, if you earn more than 48% of the FPL, you are cut off?

Take a look. The Medicaid-expanding states will provide Medicaid for everyone, including adults without children, up to 138% of FPL. In the 25 red states, nothing. Medicaid will remain available only for parents and only up to 47% of FPL. A bloody tragedy, to my mind.

In the pre-ACA system, all states had gaps (shown by the people in grey and areas without a solid colored umbrella). Poor adults without children were not covered. In red states, you were thrown off Medicaid if your earnings went above a certain number. The ACA fixed all that: everyone under 138% FPL was covered. And the Feds would carry the full load for three years, with the states picking up 10% in 2020. Red states not accepting the Medicaid expansion are leaving large numbers of their citizens uncovered, where folks in other states, at similar income levels, will be getting full coverage under Medicaid.

Look at Texas: over 1 million people who qualify for coverage under the terms of the ACA will be out in the cold, while the poor in neighboring states will be covered. A travesty, which I hope will not be allowed to stand for long.

The chart below shows the small percentage of poor that get coverage in the non-expansion-accepting red states. Wisconsin has put through legislation that replaces Medicaid with a state program, thus providing coverage to all the poor.

The waste of this makes me weep. And the downright meanness.