Happy Friday

Just a few reasons why things are looking up for the U.S. Fiscal position (the largest single component of the American economy):

1) The economy is growing, jobs are being created, and tax receipts are growing as a result. Nearly 300,000 non-farm jobs were created in April. No one is saying employment levels are where they need to be, but they're trending in an encouraging direction. (http://www.bls.gov/news.release/empsit.nr0.htm)

2) Since February the federal government has been operating under Statutory Paygo, meaning any additional spending must be accompanied by an equal offset- it's the law. This combined with #1 will reduce the deficit. The President has also frozen all non-security discretionary spending for the next 3 years. This freeze is expected to reduce federal expenditures $1.1 trillion over the next 10 years. (http://www.whitehouse.gov/omb/budget/fy2011/assets/tables.pdf - Table 2 ; http://budget.house.gov/laws/CRS-stat-paygo.pdf)

3) Expiration of the Bush Tax Cuts. For individuals earning more than $200,000/year, rates will return to pre-cut rates- accounting for an estimated $678 billion over 10 years and further reducing the deficit gap. 39% of these cuts went to the 99th percentile of income earners, while the middle 20% of income earners recieved 8.5% (and under Obama will continue to). These cuts have caused the lowest level of federal tax collections as a share of GDP since 1950. When these temporary cuts are allowed to expire tax levels will not exceed those of the Reagan Administration. (http://www.cbpp.org/cms/index.cfm?fa=view&id=1811)

4) Healthcare reform. Officially this will reduce the deficit around $100 billion over the next decade of outyears and one $1 trillion the following decade (http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf). This is likely a very conservative scoring as it only accounts for direct cuts, not savings or efficiency gains, for example through the dozens of pilots it establishes to learn about cost control.

5) National Commission on Fiscal Responsibility and Reform (http://www.whitehouse.gov/the-press-office/executive-order-national-commission-fiscal-responsibility-and-reform). The President's Budget lays out a plan to cut the deficit in half by 2015, from 10% of GDP to 5%. The (very) long-term sustainable rate of deficit spending is equivalent to the economic growth rate, e.g. the ability to finance current borrowing with future growth in a non-zero sum fashion. The 50% reduction in the size of the deficit is an enormous accomplishment; the President's FY 2011 Budget released in February represented the largest reduction in the deficit in over 10 years. The previous Administration never proposed a budget that reduced the deficit, not one penny. Obama's budget reduces it over $2 trillion in the outyears, before throwing in the commission and likely the largest domestic policy reform in 50 years- healthcare.

Sit back and enjoy the show

There seemed to be at least two over-riding criticisms of the newly passed healthcare reform law:

1) It would not, contrary to official estimates, reduce the deficit, but rather add to it.

2) It would represent something more or less "un-American"- a significant expansion of government at the cost of free market choice and competition and a general ideological move towards socialism.

What I am perhaps most pleased about with this bill is that over the coming years, certainly the next 5-10 years, we can evaluate these claims with real world results and see who is right. We can test these claims, comparing Congressional estimates of cost with those of the Administration and the Wall Street Journal and Rush Limbaugh and the American Enterprise Institute and Brookings- and we can see who was most correct. Afterall, prejudging outcomes and assuming away complexity in favor of one sized fits all answers and ideology is anathema to science. So let's sit back and see the results of this experiment. These arguments will not linger abstractly out in the ether of public debate and controversy forever, with two sides eternally duking it out over fundamentally unproveable philosophical or moral questions (I'm sure more than a few come to mind). We will get hard data about how many more people get healthcare, on the rate of price growth, on the cost of these new mandatory government spending programs on the budget and tax rates, on the success and replicability of the 27 cost control and quality care pilots this bill establishes, on whether we remain a country of elections and predominantly privately produced and procured goods and services, or whether we become the new Venezuela. All of this, and much, much more, time will reveal.

For instance, the intent of these new pilots is to look for best practices, cost control measures, and general innovation in healthcare delivery. The point is to test new things for proof of concept, cutting funds for what doesn't work, and scaling up what does. Evidence based, pragmatic cost control measures are good ideas whether in corporate America or government. Many (potentially) good, cost-saving ideas are in this bill, and the potential savings weren't even priced into the budget estimates. Stuff like bundling payments across hospitals and outpatient services to reduce administrative costs and create greater negotiating leverage, paying hospitals with higher infection and readmission rates less, sending out undercover inspectors to look for waste and abuse, working on payment systems that reward quality of outcome and care over sheer volume (as is currently the case for the fee for service model) and clearly conveying the state of peer reviewed medical literature to practitioners in the field, so there is no ambiguity about the state of scientific knowledge on what works, and what is a waste, both of treatment and money. After all these assertions and claims that have been discussed the last 14 months during the genesis of this law, we will get to concretely see what savings and best practices come out of these 27 seperate case studies. For economists or researchers looking for good data sets and means to test null hypotheses, it's almost overwhelming to think of all the good analysis that could be done. Yet one thing is for sure, we know what healthcare costs today, we know how much waste there is, we know how many errors there are, we know how many people are covered- and now we are about to discover which way this law pushes all these indicators.

One could spend a great portion of her life reading criticisms and attacks of every aspect of this law (and even criticisms of things not in it!) from countless think tanks, research institutes, lobbies, and yes, gasbag bloggers such as myself. But what is so exciting about this historic piece of legislation, in addition to the potential to provide care for millions and root out inhumane abuses in the insurance industry and expand competition and choice- is that we will get to test these assertions very clearly. I just hope we keep score, and in 2020 if everyone takes for granted that kids can't be denied health coverage, or domestic abuse can't be classified as a preexisting condition, or a consumer isn't forced to buy into an oligopoly because the government now forces companies to post their plans side by side online to drive choice and innovation, or that healthcare costs are growing slightly above inflation rather than 250% of it- that we don't shrug this off as just the natural progression of things, as some inevitable outcome or industry innovation. No, like any good science experiment, we have been operating a good control scenario for about the last 50 years, and now we can compare it to the future. If these changes come about, we can make clear scientific arguments of attribution. Whichever side has it right, it will be a triumphant essay they pen in the National Review or Cato blog- an epic example of "told you so!" In other words, after 40 years of debate, it's finally down to the 4th quarter of a close contest, and we're getting closer to seeing who the winner is.

As a caveat, on the first two criticisms- deficit control and socialism- I would point out that this bill cuts $550 billion from Medicare in the next 10 years by eliminating 15 cents on the dollar of Medicare Part D (because it's 15% more expensive than public run plans and gets no better results). CEOs and turnaround private equity guys gets plaudits for this constantly, ruthelessly cutting waste and ineffeciency to force better results and make hard decisions. Oh, and in this case, it will also fulfill a promise the previous administration made to seniors about prescription drug coverage but didn't actually fund. But cutting medicare funding hardly seems like adding to the deficit to me, and curtailing the size of government payouts hardly seems like expanding government. Also, creating competitive transparent online exchanges, for customers to review and scrutinize plans, none of which will be government programs by the way, hardly seems like something that would be expected to increase prices, and hardly something that is socialist, in fact it seems like the essence of market based capitalism.

And from a behavioral economics standpoint, I've decided to take this new system for a spin, test out all my new government benefits by being a little clumsier here and there. JK