Beautiful!

(from theobamadiary.com)

This knocks me over. Strong. Clear. Fully grounded. Inspiring. Full of Light. Generative.

If these are qualities you admire and are touched by, be sure to visit theobamadiary.com every day! TOD's site reminds me of a favorite quote, from a book I read 50 years ago:

"The lover of beauty finds it everywhere around him. The vein of gold in the basest of ores. And he takes the collector's joy in finding the fragmentary masterpiece that is commonly passed by."

Memoirs of Hadrian

by Marguerite Yourcenar

TOD is a lover of beauty. And she has deeply enriched my life by finding a great many fragmentary masterpieces I would never have found or seen.

Maya Angelou Celebrates Mandela

Watch this. Extraordinary.

Budget Aikido

Not many people understand the game - the long game - of Budget Aikido that President Obama has been playing. It's not easy to describe. Let's start with some highlights:

• Obama decided early that he had to support deficit reduction in a smart, but aggressive way to absorb, transform and redirect the quite hysterical energy the GOP was channeling on deficit worry and fear of debt collapse. This is the essential aikido method: absorb and transform the energy of your opponent so that, in essence, he defeats himself.
• Obama commissioned Simpson-Bowles in early 2010 to come up with a deficit reduction plan. The plan was released on December 1, 2010, and called for $4 trillion in deficit reduction over 10 years (combination of budget cuts and new tax revenues).
• Obama was mostly mum on the Commission's report, saying later that he needed a negotiating partner to work out a deal. But in an April speech, he fully accepted the target of $4 trillion. And in early summer, he began his negotiations with Speaker Boehner, working to put together a tax and spending deal, totaling $4 trillion over 10 years. The deal failed, after seemingly coming very close to agreement.
• The Budget Control Act followed the failed negotiations, running right up to the debt ceiling deadline before the bill was signed. The BCA put budget caps on discretionary spending, and set up a $1.2 trillion ten year sequester program, to start in January of 2012 (later moved to March 1, 2012), if a Budget Supercomittee failed to reach agreement on a similar sized deficit deal. The Supercommittee, predictably, failed to reach agreement.
• Both Defense and Non-Defense Discretionary budgets would suffer across-the-board cuts, beginning in 2013, as compared to the CBO baseline. In the first two years, the cuts would be year to year reductions; after that each category would rise, but stay well under the Baseline. Non-Defense took almost the total year-over-year drop in 2013; but Defense was set up to drop over two years - about $20 billion a year. And that brings us to the current problem. Both sides yelled and screamed last year (i.e., Democrats looking to Non-Defense Discretionary and GOP (especially the hawks) looking to Defense). But this year Dems lose little; GOP/Defense loses $20 billion. So GOP hawks are more concerned than Dems; meanwhile Tea Party Conservatives don't want to budge off the sequester levels, counting this their single big win over Obama.

Obamacare Enrollment Update

(from http://acasignups.net)

The pace is picking up!

ACA's Cost Control Protects Medicare

(from Council of Economic Advisers Analysis of ACA)

Conservatives attack Obamacare for creating a large group of injured parties - those people whose policies are being cancelled; who are being told they have to buy an ACA-approved Essential Benefits policy (even though they don't personally need all the benefits offered); and who have to pay more than before, so they can be counted as part of a large and balanced risk pool that will benefit the sick and the elderly. Many hurt; few helped - this seems to be the argument.

What few realize is that the cost curve-bending effects of the ACA is having a dramatic effect on two programs (Medicare and Medicaid) that benefit 100 million Americans, a much larger group than the 5 million or so who may be losing their current policies.

The above chart shows how the Medicare/Medicaid spending projection line has moved down and to the right in the last three years. The above graph lines were put together by the CBO in their four most recent 10 year budget forecasts. The "gap" between the August 2010 and the May 2013 lines represents reductions in estimates of what the Medicare/Medicaid programs will cost going forward. The next chart (CBO/Doug Elmendorf ACA Cost Control Presentation) shows the magnitude of the savings.

Healthcare Costs (Again)

(from Council of Economic Advisers Report)

I'm a real bear about healthcare costs. I read whatever I can find. You will find me blogging about this repeatedly. Why am I so obsessed? Quite simply: almost no one gets the full implications of what's happening. Here's a Tuesday New York Times article that talks about the cost slowdown and how it will lower ACA's total cost; but the explanation for the slowdown is primarily the impact of the recession, slowing down demand for medical services. And the article quotes a conservative source saying there is no cost slowdown, and talk of such is just another piece of the Administration's misinformation campaign.

So I was really happy when the Council of Economic Advisers put out the above report, doing a thorough presentation of the academic research on the healthcare cost slowdown, showing that one group (The Kaiser Family Foundation) argues that the recession is the primary cause; but other researchers have concluded that structural factors are at play, representing a possible seismic shift in how healthcare is delivered, moving from payment only for quantity of service, to more payment for quality delivered (see particularly CBO Working Paper, August, 2013).

CBO's ACA Enrollment Forecast and Current Status

(from CBO Enrollment Forecast)

The above chart is the "holy grail" CBO forecast for Obamacare. Key points:

• In 2014, 9 million will sign up for expanded Medicaid (this was before 25 states decided to refuse the Medicaid expansion), 7 million will sign up for private insurance on the Exchanges, of which 2 million will come from the prior non group market. Total reduction in uninsured: 14 million.
• Most everybody on the Exchanges will receive subsidies. Only 1 million out of 7 million will not be subsidized in 2014.
• Employment-based coverage will stay flat in 2014, drop 2 million in 2015, and a further 6 million in 2016.
• By the end of 2016, 25 million formerly uninsured will have coverage.

And here's where we are today:

Points to highlight:

• A straightline extension of the Medicaid number (1.7 million enrolled with 34% of the time gone) would give us 5 million signups by March 31 - right on target, if the nonparticipating states are factored out.
• Similarly, a straight-line extension for the private insurance signups would give us about 1 million, well under the 7 million target.

So what's your guess? Here's mine:

• Medicaid - 7.5 million
• Exchange - 5.0 million

Considering the horrible start, not too bad. Am convinced there will be a big surge at the end that will be handled mostly well by the website's front end and pretty well by the backend (the part that links to the insurance companies). The system will be seen to be working, to be self-correcting, and most experts will be predicting a smooth open enrollment, when October 2014 comes around. Further: employers will not be planning a wholesale dumping of employees into the Exchanges for 2015 and 2015 premiums will be coming in with only small increases over 2014.

If this is the picture next summer, what will the GOP argument be? Mostly unchanged. They will focus on whatever problems are present; they will argue that employers will begin dumping next year, and that premiums will surely start skyrocketing soon, etc.

Will the public begin to see the true picture? I think so, but I'm not sure. It's possible the MSM will start holding the GOP accountable for making predictions that don't pan out, but I won't count on it.

The sleeper might be healthcare costs overall. If they stay moderate for another full year, and more research analysis points to the ACA as a key factor in the cost slowdown, this could tip the analysis towards a conclusion that the ACA is a strong net plus, and that GOP resistance has been political, not based on sound policy estimates. If this is the tenor of the public conversation, the House will be in play.