ACA versus GOP plans side-by-side

This article from the LA Times by columnist Noam Levey links an update on earlier postings online that does a side-by-side comparison of ACA versus the GOP’s replacement AHCA plan. That posting provides the best concise overview I have seen of the latest GOP AHCA proposal. It will take 10 minutes to review/read. Randy

Here is the comparison

http://www.latimes.com/projects/la-na-pol-obamacare-repeal/

 

Here is the new article, which features specific effects.

http://www.latimes.com/la-na-pol-obamacare-repeal-chaos-20170625-story.html

 

From: Levey, Noam [mailto:Noam.Levey@latimes.com]
Sent: Sunday, June 25, 2017 9:44 PM
To: Levey, Noam
Subject: ICYMI: New article on the disruptive impact of the Senate repeal bill

Good day,

In case you missed it, I wanted to share my latest piece examining the potentially devastating impact of the recently released Senate legislation to roll back the Affordable Care Act.

The Republican architects of the bill, like their House counterparts, hail their legislation as a remedy for ills caused by the current law. But across the country, in physicians’ offices and medical centers, in state capitols and corporate offices, there is widespread fear the unprecedented cuts in the GOP bills would create even larger problems in the U.S. healthcare system, threatening to not only strip health coverage from millions, but also upend insurance markets, cripple state budgets and drive medical clinics and hospitals to the breaking point. As Tom Tom Priselac, chief executive of Cedars Sinai Health System in Los Angeles, told me: “These reductions are going to wreak havoc.”

Here is the link: http://www.latimes.com/la-na-pol-obamacare-repeal-chaos-20170625-story.html

I hope you find the piece interesting. Thank you, as always, for reading. All best,

-N

Noam N. Levey

National healthcare reporter

Los Angeles Times Washington Bureau

Tel: 202-824-8317

Cell: 202-247-0811

noam.levey@latimes.com

twitter: @NoamLevey

Performance Timer is excellent App

I was at a conference last week and learned about a terrific timer for my iPhone called Performance Timer. It counts down your specified time, and then changes from green to red as you go over.

What makes it superior to the default iPhone timer is its large font, there is no alarm when time is up, and your screen never goes blank, so you can read it for your entire talk. Really easy interface for the stressful time that you are setting it up. Or, if you are the timekeeper for someone else, they will be able to read it from 20 feet.

It is free in the Apple App store.  I looked but did not find the Android version.

Here is a review from the web.

Performance Timer on the App Store – iTunes – Apple

https://itunes.apple.com/us/app/performance-timer/id957648886?mt=8

Rating: 5 – ‎9 reviews – ‎Free – ‎iOS – ‎Utilities/Tools

Description

Performance Timer is a large-display countdown timer developed to be used to monitor the time remaining in a performance, presentation, etc. Performance Timer does not sound an alarm when the time runs out. Rather, when the timer reaches zero, the numbers turn red and the timer starts counting up so that you can see how long you’ve gone over your target time. The time can be set from 1 to 99 minutes.

Excellent articles about machine learning and replication

There is a wonderful article about Machine learning in the spring 2017 issue of the Journal of Economic Perspectives, and there is also a series of four fine articles in the AER May 2017. I decided to share as a BUHealth blog to all.

Whether you are curious, newly interested or an expert working in the area, I recommend the JEP one to you. The AER series is for more serious work. Here are the links (They should all be free to access, since they are all at the AEA.) Also see below for links on replication.

Machine Learning: An Applied Econometric Approach

Download Full Text PDF
(Complimentary)

 

Machine Learning in Econometrics (May, 2017)

Double/Debiased/Neyman Machine Learning of Treatment Effects

Victor Chernozhukov, Denis Chetverikov, Mert Demirer, Esther Duflo, Christian Hansen and Whitney Newey

(pp. 261-65)

Testing-Based Forward Model Selection

Damian Kozbur

(pp. 266-69)

Core Determining Class and Inequality Selection

Ye Luo and Hai Wang

(pp. 274-77)

Estimating Average Treatment Effects: Supplementary Analyses and Remaining Challenges

Susan Athey, Guido Imbens, Thai Pham and Stefan Wager

(pp. 278-81)

 

The series in the AER on Replication in microeconomics will also be of interest.  This article title speaks for itself.

A Preanalysis Plan to Replicate Sixty Economics Research Papers That Worked Half of the Time

Replication in Microeconomics

Assessing the Rate of Replication in Economics

James Berry, Lucas C. Coffman, Douglas Hanley, Rania Gihleb and Alistair J. Wilson

(pp. 27-31)

Replications in Development Economics

Sandip Sukhtankar

(pp. 32-36)

Replication in Labor Economics: Evidence from Data, and What It Suggests

Daniel S. Hamermesh

(pp. 37-40)

A Proposal to Organize and Promote Replications

Lucas C. Coffman, Muriel Niederle and Alistair J. Wilson

(pp. 41-45)

Replication and Ethics in Economics: Thirty Years after Dewald, Thursby, and Anderson

What Is Meant by “Replication” and Why Does It Encounter Resistance in Economics?

Maren Duvendack, Richard Palmer-Jones and W. Robert Reed

(pp. 46-51)

Replication and Economics Journal Policies

Jan H. Höffler

(pp. 52-55)

Replication, Meta-analysis, and Research Synthesis in Economics

Richard G. Anderson and Areerat Kichkha

(pp. 56-59)

A Preanalysis Plan to Replicate Sixty Economics Research Papers That Worked Half of the Time

Andrew C. Chang and Phillip Li

(pp. 60-64)

 

 

Congratulations to BU’s Class of 2017 Economics graduates!

Please celebrate the students who earned 556 degrees in Economics at Commencement this May!

This year the program honors:

14 Ph.D. recipients

215 Master’s degree recipients (MA, MAPE, MAEP, MAGDE MA/MBA, BA/MA)

327 BA recipients (including BA/MA)

This total of 556 degrees is up from 498  (12%) since 2016.

These numbers may undercount the total for the year since they may exclude some students who graduated in January.

In 2017 there were 14 PhDs, 215 Master’s degree recipients, and 327 BA recipients

In 2016 there were 22 PhDs, 203 Master’s degree recipients, and 273 BA recipients

In 2015 there were 22 PhDs, 155 Master’s degree recipients, and 305 BA recipients.

In 2014 there were 17 PhDs, 207 Master’s degree recipients, and 256 BA recipients.

Altogether 13 Ph.D. students obtained jobs this year (versus 24 last year).

To see the Ph.D. placements visit the web site linked here.

http://www.bu.edu/econ/gradprgms/phd/placements/

The department’s  website now lists 39 regular faculty (up one from last year) with titles of assistant, associate or full professors, a number which is one below the number of professors in 2012 (five years ago) listed on the commencement programs. Here are the recent counts of faculty.

2017: 39 tenured or tenure-track faculty, of which 3 are women (8%); 12 non-TT faculty, of which 3 are women (25%); 51 total faculty, of which 6 are women (12%)

2016: 38 tenured or tenure-track faculty, of which 5 are women (8%);  7 non-TT faculty, of which 1 are women (14%); 47 total faculty, of which 6 are women (12%)

2015: 40 tenured or tenure-track faculty, of which 5 are women (12%); 7 non-TT faculty, of which 2 are women (29%); 47 total faculty, of which 7 are women (15%)

2014: 41 tenured or tenure-track faculty, of which 6 are women (15%); 4 non-TT faculty, of which 1 is a woman (25%); 45 total faculty, of which 7 are women (16%)

http://www.bu.edu/econ/faculty-staff/faculty-profiles/

Congratulations to all!

Let the Children and Grandchildren Pay (More)

This blog revisits a posting from four years ago, in a series on Time to Change the Tax Discussion.

Whenever Congress (federal or state) proposes legislation that cuts taxes or increases net spending so that our national debt will increase, they should have to end every statement about why they favor their proposal with …

Because I want our children and grandchildren to pay for it.

Even if congress or the executive branch won’t say this, that is what they are doing.

The US House yesterday passed the American Health Care Act (AHCA) bill by a narrow margin that dramatically cuts taxes on the wealthy and raises burdens on the poor without even waiting for the CBO or others to calculate the impact on our total budget of this new trillion dollar proposal. The earlier AHCA bill was scored by the CBO as reducing the federal deficit, but doing so in a very painful, unfair way.

Since I have also urged people to think of bills in terms of their cost per household, not just in terms of billions and trillions of dollars, I present the numbers here as costs per US household (all 125 million of them).

The March 13, 2017 CBO scoring of the previous, kinder, version of the AHCA projected that the bill would cut taxes in the amount of $900 billion over ten years, which is $7200 per US household. This is a huge wealth transfer, the majority of which go to the wealthy. The CBO cites Urban Institute researchers in their estimate that 70.6% of the tax cuts go to the 6% of households with incomes over $200,000. These cuts largely arise from eliminating the Medicare payroll tax rate for high-income taxpayers, the surtax on those taxpayers’ net investment income, and the annual fees imposed on health insurers. These tax cuts have virtually no effect on health care spending or the delivery system, but are a give-away to high income Americans, imposing burdens on our children and grandchildren. They are the preamble to the much larger tax cuts that president Trump proposed on April 26 in his one-page tax cut “proposal”, which is a simplified version of his campaign proposal in 2015. Both tax cuts greatly increase the national debt by tens of thousands of dollars per household, yet have arguably received less attention in the media than the $2 per household cut in the Planned Parenthood budget (CBO, 2017 AHCA report, Table 2).

Offsetting these large tax cuts, the March 13 CBO rating of the AHCA projects that it will cut direct spending by $1,219 billion ($9,752 per household) over ten years. Unlike the tax cuts, which favor the wealthy, the spending cuts impact disproportionately the poor, the sick, and the old. The Urban Institute estimates that almost 77 percent of the federal funding losses come from families learning less than $30,000. So the bottom 36 percent of households is sacrificing $1000 of health support so that the top 6 percent of households can save an average of roughly $6,000 each.

Unlike the tax cuts for the wealthy, which will mostly increase savings and wealth, spending cuts on the poor directly affects their consumption spending, debt, and spending. The AHCA spending cuts will directly affect children since nearly half of them are close to poverty. We are not talking about making future children pay, but today’s children.

The following figure, based on data in the CBO report on the AHCA, show how different the tax cuts are from the benefit decreases. the forecast was made by the Urban Institute for 2022, hence reflects the fully phased in impact of the changes.

The AHCA is being sold to the public as promoting growth (implausible when it comes out of current consumption), lowering premiums (the opposite of the CBO projections), and avoiding the “catastrophe of the ACA” (not the consensus view).  Cutting the ACA subsidies and protections will force many not to buy health insurance, or to pay much more for their health care if they do. How can this stimulate the economy?

Taxes will never be attractive, but why should we LET THE CHILDREN AND GRANDCHILDREN PAY?

Economist article about end of life planning

One of my students today just sent me this link to an article in this week’s Economist about end-of-life planning.

How to have a better death

http://www.economist.com/news/leaders/21721371-death-inevitable-bad-death-not-how-have-better-death

It led me to also view its link about conversations about serious illness by one of my favorite authors.

“Serious Illness Conversation Guide” drawn up by Atul Gawande

I also found these slides targeting providers informative as well.

Using the Serious Illness Conversation Guide – HealthInsight

I found it informative that CMS (Medicare) created two new Advance Care Planning (ACP) codes. It will be interesting to see how often they are used.

Two new codes created in 2015, allowed for payment by Medicare in 2016.

  • 99497 ACP 30 minutes $85.99
  • 99498 ACP additional 30 minutes $74.88

CPT describes eligible services as being performed by a physician or “other qualified health professional” which means a physician, NP or PA.

We could save a lot of money and improve happiness and quality of life if more doctors, nurses, families and patients talked about these issues.

 

#stupideconomics and Healthcare Triage on the AHCA

Two interesting links related to the recent Republican health care proposal called the AHCA.

The first is a serious but also humorous Forbes article by my BU colleague Larry Kotlikoff in his series about Stupid Economics, this one targeting Tom Price and the AHCA bill. (A 3-minute read.)

Tom Price’s Liver And ‘The Coverage They Want’

The second is an excellent Youtube summary of the CBO forecasts (called “scoring”) of the effects of the AHCA by pediatrician Aaron Carroll.

Healthcare Triage: Results Are In! Congressional Budget Office Scores the American Health Care Act

Posted: 17 Mar 2017 06:09 AM PDT  Text of the report here.

(Broadcast is eight minutes.)

$147 Billion: The Economic Cost of Trump Racism

Bottom line:

Trump’s racism predicted to cost US households $147 billion in extra payments to the rest of the world.

Like many people, I am appalled by president Trump’s recent executive order banning refugees – and even US legal immigrants  – from seven predominantly Muslim countries from entering the country. In the process, Trump has also angered most of the world’s 1.6 billion Muslims, comprising about 23% of the global population. Many of these countries (e.g,. OPEC members) hold major financial assets in the US. President Trump has also been active about insulting Mexico and China, two other huge financial partners with the US.

Since Trump is a businessman, I am going to focus on why this racism is a really bad idea for the US economy.

According to US Treasury, US national debt held by the public as of last Friday, Jan 26, 2017 was 14.4 trillion dollars.  That is over $42,000 borrowed on your behalf per US resident. Last year (2016), the interest paid on that debt was $432 billion, or over $3,456 per American household  per year. (US census numbers estimate 125 million households currently). Of that total debt, about 34% is owned by international Investors, and we are paying them the interest on their holdings. So that is $1,175 per US household being paid out to foreigners last year before Trump became president.

Although my good colleague Larry Kotlikoff worries that this level of debt, particularly to foreigners, is not sustainable, that is not what I want to focus on here. I want to focus instead on the CHANGE in these debt payments to foreigners that can be attributed to scary Trump’s racism. According to the current US Treasury documents, the long term interest rate has increased by more than a half percentage point since Trump was elected. Look at the figure yourself. The increase when Trump was elected was immediate. Even faster than the stock market advance.

https://www.treasury.gov/resource-center/data-chart-center/interest-rates/Pages/Historic-LongTerm-Rate-Data-Visualization.aspx

Increasing the interest rate on the national debt from 2 percent to 2.5 percent costs Americans an extra $294 per household EVERY YEAR until our debt is paid off, which will probably be never.

Now imagine that OPEC, or the Chinese, or the Mexicans decide that they are not so happy with the US anymore and decide to start dumping their $6.8 trillion of US debt. We should all expect that  Trumps racist policies will cause federal interest rates to increase to 4% per year, up another 2% above its rates before Trump. This doubling of US debt interest rates will result in an additional $1,175 per US household per year being paid out to foreigners. Or another $147 billion in total interest paid out to the rest of the world for our debts.

That is my prediction of what will happen if Trump does not change his racist policies.

Notice that I did not have to do any calculations based on the effects of Trump’s racism on foreign tourism in the US ($168 billion in 2012), spending on US universities by foreigners ($30 billion in 2015), or US exports to China  ($113 billion in 2015) or Mexico ($267 billion in2015).  Trump’s tax cuts and deficit spending policies are also likely to increase interest rates. It would be easy for much larger estimates to be generated.

Take home lessons:

  • Racist policies are bad ethically and bad for our economy.
  • There is a real danger of serious interest rate increases that will cost everyone a lot of money.
  • Bond prices are likely to fall and long term bonds seem like a poor investment choice.
  • It helps with your arguments if you use facts and citations instead of making things up.
  • So far, instead of having Mexico pay for Trump’s Stupid Wall, Trump’s racist policies are making Americans pay more to Mexico and China and Iran and Saudi Arabia, and….

us-treasure-long-ten-year-interest-rates-2017-01-29

 

 

Read this posting on Stupid Economics

I invite you to read this Forbes posting on Stupid Economics by Laurence Kotlikoff.

 

I don’t always agree with my dear colleague, Larry Kotlikoff, but this posting at Forbes is one that I can really get behind.

Our president needs to start listening to serious economists instead of acting solo as an autocrat.

 

This article is a two minute read that will make you smile regardless of whether you agree with all of the sentiments.

 

Larry is a serious scholar, of course, and his credentials include not only nineteen books, but also a stint on the Council of Economic Advisors under president Reagan.

 

From: owner-faculty-econ-list@bu.edu [mailto:owner-faculty-econ-list@bu.edu] On Behalf Of Laurence Kotlikoff
Sent: Thursday, January 26, 2017 1:10 PM
To: faculty-econ-list; phd-econstudents-list
Subject: This may be of interest.

https://www.forbes.com/sites/kotlikoff/2017/01/26/stupid-economics/#61453f38e94f

 

 

Let me know if I’m being unfair. But I think it’s time to call this for what it is.

 

best, Larry

 

Laurence J. Kotlikoff

A William Fairfield Warren Professor, Boston University
Professor of Economics, Boston University
270 Bay State Rd.
Boston, MA 02215
www.kotlikoff.net

President, Economic Security Planning, Inc.

www.maximizemysocialsecurity.com

www.esplanner.com

www.economicsecurityplanning.com

kotlikoff@gmail.com
cell  617 834-2148
work 617 353-4002

The Ellis-Huber Christmas Poem 2016

The Raven                      The Ellis-Huber Christmas Poem 2016

Once upon a year so dreary, politics so wild and weary,
Arguments so quaint and curious, unfamiliar use of lore—
While I nodded, sometimes napping, suddenly there came a yapping,
As of candidates gently snapping, snapping as if t’were a war.
“’Tis only a primary,” I muttered, “yapping I have heard before—
Only this and nothing more.”

But the yapping became more noisy, as the prospects grew less rosy
Scared me—filled me with fantastic terrors never felt before;
So that now, to still the beating of my heart, I stood repeating
“’Tis only a primary entreating entrance at the White House door—
Some strange visitor entreating entrance at the mansion door;—
This it is and nothing more.”

Presently concern grew stronger; hesitating then no longer,
Words like “Sir” and “Madam”, scarce-used civil words appeared no more;
Soon the facts no longer mattered as emotions became more shattered,
Soon opinions grew more scattered, chattered just outside my door,
Not quite sure that I had heard it—here I opened wide the door;—
Darkness there and nothing more.

Ah, distinctly I remember it was in the bleak September;
And each separate dying ember wrought its ghost upon the floor.
Eagerly I tried to ignore it, even though I still deplored it
All my thoughts were filled with sorrow—sorrow for the lost true core—
Came the thought so sad and evil, worse time since the Wizard war—
Trump is our Lord Voldemort.

November came as we were fearing, long we stood there wondering, tearing,
Wishing undone, dreaming dreams no liberal dared to dream before;
But the silence was unbroken, and the election gave no token,
And the words e’er spoken were whispered words, “Lord Voldemort?”
This I whispered, and an echo murmured back, “Lord Voldemort.”—
Merely this and nothing more.

Now December, feeling bitter, as the trees begin to glitter,
Soon again I hear a twitter somewhat louder than before.
“Surely,” said I, “surely that is something at my window lattice;
Let me see, then, what the threat is, and this mystery explore—
I let my mind stop just a moment and this mystery explore;—
’Tis only Santa, nothing more!”

Santa saved us from our ruing, distracted us from all our stewing
Christmas tree our nightly viewing, ‘minding us of days of yore;
Now we pray for all united, keeping spirits undivided;
Wishing peace and love re-invited, mistletoe above your door—
Christmas prayers we do implore for elves and wizards, Dumbledore—
And Harry Potter, ever more!

(c) 2016 Randall P Ellis

Facts about Tom Price, HHS nominee

Health economists and every concerned citizen should disseminate the facts in this NEJM article about Donald Trump’s nominee of Tom Price to be the next secretary of HHS.
Coauthor Richard Frank is also a BU Ph.D. alum!

Randy Ellis

 

Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS

Sherry A. Glied, Ph.D., and Richard G. Frank, Ph.D.

New England Journal of Medicine

December 21, 2016DOI: 10.1056/NEJMp1615714

http://www.nejm.org/doi/full/10.1056/NEJMp1615714#t=article

 

Since there is no abstract, here are the first two paragraphs.

Representative Tom Price of Georgia, an orthopedic surgeon, will be President-elect Donald Trump’s nominee for secretary of health and human services (HHS). In the 63-year history of the HHS Department and its predecessor, the Department of Health, Education, and Welfare, only two previous secretaries have been physicians. Otis Bowen, President Ronald Reagan’s second HHS secretary, engineered the first major expansion of Medicare, championed comparative effectiveness research and, with Surgeon General C. Everett Koop, led the fight against HIV–AIDS.1 Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines,2 and introduced President Bush’s health insurance plan, which incorporated income-related tax credits3 and a system of risk adjustment. In their work at HHS, both men, serving in Republican administrations, drew on a long tradition of physicians as advocates for the most vulnerable, defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Tom Price represents a different tradition. Ostensibly, he emphasizes the importance of making our health care system “more responsive and affordable to meet the needs of America’s patients and those who care for them.”4 But as compared with his predecessors’ actions, Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.

Since the NEJM full article  requires a subscription, here is a summary what they document:

Price has sponsored legislation that

  • supports making armor-piercing bullets more accessible
  • opposes regulations on cigars
  • Repeals and replaces the ACA (see details below)

Voted  

  • Against the Affordable Care Act (ACA)
  • Against regulating tobacco as a drug
  • Against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act
  • Against funding for combating AIDS, malaria, and tuberculosis
  • Against expansion of the State Children’s Health Insurance Program
  • In favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments
  • Against reauthorization of the Violence Against Women Act
  • Against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people
  • Against enforcement of laws against anti-LGBT hate crimes.
  • Against expanding the NIH budget
  • Against the recently enacted 21st Century Cures Act

Price stated views:

  • Favors converting Medicare to a premium-support system
  • Favors changing the structure of Medicaid to a block grant program
  • Favors amending the Constitution to outlaw same-sex marriage
  • Opposes stem-cell research
  • Inconsistent in supporting investments in biomedical science.

His proposal for repealing and replacing the ACA is H.R. 2300, the Empowering Patients First Act,5 which would

  • Eliminate the ACA’s Medicaid expansion and
  • Replace ACA subsidies with flat tax credits based on age, not income
  • Be regressive, with larger subsidies for high than low incomes.
  • Credits would pay only about one third of the premium of a low-cost plan
  • Credits proposed are smaller than those proposed by President Bush in 1992, and will not be sufficient to get most people to buy health insurance
  • Eliminate the guaranteed-issue and community-rating requirements in the ACA, with ineffective substitutes.
  • Withdraw almost all the ACA’s federal consumer-protection regulations, including limits on insurer profits and requirements that plans cover essential health benefits.
  • Allow the sale of health insurance across state lines, effectively eliminating all state regulation of health insurance plans
  • Fund his plan by capping the tax exclusion for employer-sponsored health insurance at $8,000 per individual or $20,000 per family, caps that are lower than the unpopular Cadillac tax in the ACA, which Price himself has voted to repeal, and hence is unlikely to ever be approved
  • Directly advance physicians’ economic interests by permitting them to bill Medicare patients for amounts above those covered by the Medicare fee schedule and allowing them to join together and negotiate with insurance carriers without violating antitrust statutes.
  • Oppose strategies for value-based purchasing and guideline development,
  • Oppose the use of bundled payments for lower-extremity joint replacements and
  • Propose that physician specialty societies hold veto power over the release of comparative effectiveness findings.

Consider what you can do to make sure that these facts are widely known. Perhaps ask your legislators which of these views they support.

BU Grads Ranked among the World’s Most Employable

One more ranking in which BU rates very highly in the world.

BU Grads Ranked among the World’s Most Employable
11th worldwide, 7th in the nation in international survey

The employability of BU graduates was recently ranked 11th in the world and 7th in the nation in a report published in Times Higher Education. The Global University Employability Ranking 2016 was designed by French human resources company Emerging, which sent an online survey asking the opinions of thousands of recruiters at a management level and of managing directors of international companies.

The California Institute of Technology was ranked number one on the list, followed by the Massachusetts Institute of Technology, Harvard University, the University of Cambridge, and Stanford University.

“It’s very heartening that so many employers recognize that our graduates are very well-prepared in their fields and have the skills and habits to perform at a high level,” says President Robert A. Brown. “Helping to successfully launch the careers of our graduates is a focus of the University.”

Except is from Bostonia Magazine.

Wondering about 2.5%

I can’t help wondering how the election outcome would have been different if the headline that was prominently featured in the news for the last month had been the one we just received in the email message from the Boston University Human Resources Department that said:

  • Contribution rates for 2017 – we are pleased to inform you that the health plan rates are increasing by only 2.5% for 2017

This sure paints a different picture of the ACA than “it’s a disaster” and rates are going to increase at double digit rates.

And this is more typical of premium increases for the past four years.

Fact: The average real increase in per enrollee spending in the private sector from 2010 to 2014 was 1%, and it was negative for Medicare and Medicaid. (Obama, JAMA, 2016)

(This is my last blog on politics and health policy for a while. Too distracting.)

 

 

Did BU economics students vote in the 2016 general election?

In order to better understand what happened in last week’s US election, and perhaps also to encourage more students to both register and vote in the NEXT election, I created a very simple one-question survey using SurveyMonkey and arranged for it to be sent to all Economics students at Boston University. I first polled graduate (Ph.D. and MA) students, and then undergraduate majors and students in principles of economics courses. Among the first 515 respondents (which happened in four days) I found that among people eligible to vote, 76% of undergraduates and 81% of graduate students in the economics program voted. Reflecting the high fraction of people who are foreigners in our programs, 33% of undergraduates and 65% of graduate student respondents were not eligible to vote. Among those potentially eligible to vote, 4% of BU undergraduates reported that they had made some effort to try to register or vote, but were unable to. For example, their request for an absentee ballot was ignored or the ballot arrived too late, or they could not vote absentee the first time they were voting, or  some other specified reason.

This is of course not a random sample of all voters, but reflects those who replied to my request.

If you would like to implement the same poll at your university or college, please send me an email privately and I will send you a customized poll for your university that you can use at no cost.  The email I used to invite people to respond is below.

Surveymonkey will let you conduct a free poll with up to 50 responses, or get up to 1000 responses for only $26 for the first month. I would be happy to collaborate for free for the first ten collaborators at other universities or colleges.

Detailed BU Economics Poll results

BU Voting results 20161114

 

 

Hello,

 

 

 

Full text of inviting email:

Hello

I am a professor in the Economics Department at Boston University who is trying to better understand the recent election results.

I would appreciate it if you would answer this ONE QUESTION survey about the election which I am sending only to BU students.

Please answer it only once and do not forward it.

 

Once you respond, you will see the responses of other students at Boston University who have already replied. You do not need to be a US citizen or be eligible to vote to answer this survey. I do not ask you who you voted for.

 

The survey results are confidential: I am not tracking  the URLs of those who have responded.

 

https://www.surveymonkey.com/r/FFPWCZM

 

Thank you in advance for your participation.

 

In  a few days I will post a summary of the results on my blog which is linked here.

http://blogs.bu.edu/ellisrp/blogs/

 

Randy Ellis

 

Randall P. Ellis, Ph.D.

Professor, Department of Economics, Boston University

ellisrp@bu.edu     Off: +1 617-353-2741       http://blogs.bu.edu/ellisrp/

 

I am sorry

Dear BUHealth friends, alumni, students and colleagues.

Like most of the people I know, I am immensely saddened by the results of the US presidential elections, which have elected Donald Trump as president and elected republicans to run both houses of congress.

My view is that hate and party loyalty won out in the end over any reasoned comparisons of the two presidential candidates.

I hope to try harder to understand the views of the those who voted for Donald Trump and why they fell for such a clever salesman.

A good place to start is to reread the blogs I posted by and about Scott Adams who alone was consistently supporting and predicting the victory of Donald Trump for over a year. Sadly, Adams was right and the rest of us, driven by incorrect polling predictions, were wrong.

http://blogs.bu.edu/ellisrp/2016/09/why-trump-is-going-to-win-the-us-presidency/

Austin Frakt (at TheIncidentalEconomist.com) has already posted a very useful blog on what health reforms and directions are mostly likely under Donald Trump.  It is linked here if you are interested or if you are asked to discuss this with your family or colleagues..

The next health reform

http://theincidentaleconomist.com/wordpress/the-next-health-reform/

I am lucky that I live and work in a state and occupation that hopefully will not experience the brunt of the pain that I predict is ahead.

Some people may take solace in the fact that Marijuana was legalized for possession, home growing, and recreational use in Massachusetts starting this December 15 2016 (although not to be legally sold in dispensaries for another year).

I for one plan to try to add to our sadly lacking civility by calling him Donald Trump, or president-elect Trump, rather than simply Trump.

Randy

Recent Marketplace Premium Increases are No Big Deal

By Randall P. Ellis, Boston University, Department of Economics October 28, 2016

A great deal has been made recently about the large increases in certain Health Insurance Marketplace premiums  announced for 2017. I present here five arguments for why these increases are no big deal, and are not the right thing to focus on when evaluating the success of the 2010 Affordable Care Act (ACA).

Argument 1: The Marketplace exchanges in which premiums are increasing are very small part of the US Health Care Market. 97% of Americans are not in them. And 80% of the enrollees who are in the Marketplace get government subsidies for their premiums. (Thomas G. McGuire, unpublished figure).

TM US Market Composition 2014

Argument #2: When the ACA Marketplace was started in 2014, its premiums were unexpectedly low, not high, in most markets. Everyone commented on this. The same thing happened when Medicare Part D was introduced. Many economists believe this was because health plans were trying to capture market share by offering low premiums. Such low premiums were not sustainable. Two years into the Marketplace, plans are trying to catch up with the much higher employer sponsored premiums. This should not be treated as a failure of Obamacare.

Argument #3: Many health insurance markets in the US are already highly concentrated. For example Blue Cross Blue Shield of Alabama has a 90 percent market share. (kff.org, 2014)  We cannot expect competitive premium pricing with such market power. As I discuss in Ellis (2012): Leemore Dafny, Mark Duggan, and Subramaniam Ramanarayanan in the American Economic Review 2012, using data from the American Medical Association (AMA), show that 94% of 314 US market areas have “highly concentrated” insurance markets. This concentration cannot be blamed on the ACA, since it predated it.

Argument #4: The main goal and achievement of the ACA has been that it has reduced the number of uninsured. The data clearly show this, and the largest percentage increase has been in private insurance, not government insurance programs.

Recent Health Insurance coverage

Argument 5: The unexpected wonderful cost impact of the ACA has been favorable: lowering the average rate of increase in health care spending throughout the country. (Barack Obama, JAMA, 2016)

obamatrend2

This has been particularly true for the Medicare program. US government statistics (CBO and OMB) show enormous savings in Medicare since 2010.

2016_EllisMcGuire_UpdateonUS_RA_20161005_Page_09

While the ACA has not eliminated uninsurance or solved the US cost containment problem, it has made important improvements in both directions. Recent large premium increases in the Health Insurance Marketplace, which happen all the time in the employer sector without much attention, are part of a bigger problem still in need of solutions.

Why Trump is going to win the US presidency

Everyone can see that Trump is surging in the polls, but few understand why. Like most professionals, I am appalled at this possibility. Why do I now think it is almost inevitable that Trump wins?

Democrats have not figured out how to affect how Trump appeals to his supporters. As I blogged on June 3, 2016, and as Scott Adams (creator of Dilbert) so brilliantly foresaw a year ago, Trump is appealing to voters on an emotional level. Facts don’t matter if you relate to people’s fears and hopes, and that is what Trump is a master at: Fear and Persuasion.

We can call Trump a liar all we want, but Trump has already established his defense: berating crooked Hillary and the lying media. Throughout the country, campaigns are going on over which candidate is the bigger liar (I see the ads for the New Hampshire senate race). But the degree of honesty seems not to matter once you are both (called) liars.

Last April I purchased a red “Make America Great Again” hat as a prop for a faculty skit. This put me on the list of Trump supporters and gives me a glimpse into his campaign to his supporters.

I was initially surprised that it took two months for the Trump organization to use that contact information to make their first request for my money and support (in June). Now I know it was part of his clever strategy of not burning out his audience. I am getting emails every other day from Trump. I pasted in one of the recent messages below.  It looks pretty simple and convincing to me. Focused on broad fears and not facts or specifics.

I just revisited Scott Adams’ blog site, which I highly recommend to you. Here is the key text from his August 10 blog, when Hillary’s polls were at their peak. I pasted in below the eight possibilities he listed there.

“If nothing changes, Clinton will win in November. But things rarely stay the same. Here are several ways Trump could still win from behind.

  1. Voters discover that Clinton has been hiding a major health issue.
  2. Wikileaks releases something damaging.
  3. Trump over-performs at the first debate, showing the world that he is willing and able to master the issues.
  4. Trump makes the case that the Clinton Foundation is really about selling influence to foreign concerns.
  5. Trump gives a speech or interview that is so effective in its empathy that he no longer appears to be crazy and racist.
  6. A new surprise revelation about Clinton that no one sees coming.
  7. Terror attacks push everything else out of the headlines in the final months.
  8. Someone assassinates Clinton because of Trump’s 2nd Amendment joke.

Scott Adams Trump Prediction Update, August 10 blog

I see many of these themes already panning out. He himself calls them spooky in his Sept 18th blog, and I agree.

I also benefitted from reading Scott Adams’ assessment of the risk of Trump in his blog from this weekend.

http://blog.dilbert.com/post/150603095761/assessing-the-risk-of-trump

Adams makes some interesting points about Trump, less scary than most others, since Adams views trump as a smart, and highly successful businessman, which he is.

Is Trump’s success inevitable? (Recall that my opening paragraph said it was almost inevitable.) Maybe not.

The debates could go better for Hillary than expected.

It seems too  late, but conceivably efforts to register and get out the vote of students and minorities could mean the polls are wrong. (I am appalled by how little effort is going on at BU to get students to register. Apathy is winning out.)

Money won’t really matter. Hillary is outspending Trump in ads by 10-1, but still losing ground.

Factual errors and scandals about Trump’s past seem not to matter.

More endorsements for Hillary seem not to matter. Trump can still gather a large group of generals and veterans at will, and his rallies are bigger, and recently better behaved.

Adams thinks that to offset the persuasion skills of Trump the best hope is effective fear mongering by the democrats (e.g. nuclear war or a new middle east war). Maybe Hillary’s handlers can pull it off. But I am not so sure.

The parallel I use for this election is that Trump is an incredible used-car salesman, and the quality of the car does not matter if you are a good enough persuader. Hillary will lose the race since she is a terrible used car salesman. Until recently she has felt constrained to tell the truth about each car, and spends her time defending her honor and honesty. Who do you think can sell more cars?

Read a Trump direct email below for more insight.

 

Randall P. Ellis, Ph.D.
Professor, Department of Economics, Boston University
ellisrp@bu.edu     Off: +1-617-353-2741       http://blogs.bu.edu/ellisrp/
BU Ph.D. job candidates: http://www.bu.edu/econ/gradprgms/phd/phdcandidates/

 

From: Donald J. Trump [mailto:contact@email.donaldtrump.com]
Sent: Sunday, September 18, 2016 10:35 AM
To: Ellis, Randall P
Subject: listen

 

Donald Trump is listening to the voices of millions of Americans who want a new direction in Washington. Add your voice and guide his campaign to victory over the Obama-Clinton liberals. |

Friend-

The politicians and liberal elites have not been listening to you.

But I hear you loud and clear. That’s why I am the people’s candidate for president with a rising movement of pro-America voters ready to take back our country.

As one of my best and most loyal supporters, you can do a lot to help finish this race strong and send Crooked Hillary down to defeat.

Please take a minute right now to complete our Listening to America Survey so I can hear your voice at this important moment in the race.

You have my word I will take action on YOUR concerns and speak up for YOUR interests.

That’s what I’ve been doing this whole time.

When I said we should not be letting tens of thousands of Syrian refugees into our country if we don’t know who they are, the liberal elites screamed out against me, but they were not listening to you.

When I said we should build a real border wall because if you don’t have a border, you don’t have a country, they raged against me on TV, but they were not listening to you.

When I said China is ripping us off with all these stupid trade deals, the liberal elites screamed about their globalist economic theories, but they were not listening to you.

Well I have been listening to you, Friend. I have been taking you seriously. And I will not let you down.

So our campaign – our pro-America movement – is taking a new approach that hasn’t been tried before by the D.C. insiders. I am campaigning on a message that seeks to represent the American people only, NOT lobbyists, NOT the media, and NOT corporate elites. The reason I have surged in the polls from ‘day one’ of this race is because I have been listening to you – the great silent majority of Americans – and keeping you and other supporters engaged every step along the way.

With just two months to go before Election Day, I need you to stay engaged more than ever, so please complete our Listening to America Survey.

In addition to your valuable answers, I also hope I can count on you to make a special donation in support of our campaign at this critical time.

Crooked Hillary has tons of money from the liberal elites who have rigged everything against you. The media are in her corner too, and frankly I don’t think I’ve seen the media in this country behave in such a disgusting way as they have against me. So many lies!

So help me cut through the media nonsense and take our message right to the people. Complete our Listening to America Survey

Thank you,

Donald Trump

COMPLETE DONALD TRUMP’S LISTENING TO AMERICA SURVEY

 

Contributions to the Trump Make America Great Again Committee are not deductible for federal income tax purposes.
Paid for by Trump Make America Great Again Committee, a joint fundraising committee authorized by and composed of Donald J. Trump for President, Inc. and the Republican National Committee.

 

The US Should Ban or Heavily Tax Weapons Designed for Mass Shootings

Boston University Working Paper

Randall P. Ellis
Boston University,
Department of Economics
August 22, 2016
Abstract

This paper presents four arguments for why the US should ban or at least heavily tax the sale or transfer to civilians of weapons designed for mass shootings (WDMS), which would include most semi-automatic guns and weapons with large capacity magazines.

  1. The Supreme Court has repeatedly validated that second amendment protections of the right to bear arms do not apply to particularly dangerous weapons where protection of public safety overrides constitutional protections; this exclusion should apply to WDMS just as it does to machine guns and short-barreled shotguns.
  1. To make gun owners pay for the annual cost of deaths in the US due to guns, we should be taxing each gun owned at $1000 per year, or tax all gun sales (new or used) at $15,000 per gun sold. Given their higher killing power we should tax WDMS at $60,000 per gun sold. Or just ban them.
  1. In the last 36 months, there have been 5,399 people in the US killed or injured at mass shootings (where four or more people are shot, although not necessarily killed). Unless action is taken, the most recent trends suggest that there will be twice as many mass shootings in the US in five years.
  1. Current federal law for duck hunting bans the use of shotguns that hold more than three shells. If we care enough to ban four-bullet capacity guns to preserve ducks, then we should be willing to ban even higher capacity guns designed to kill people.

The full paper is linked here.

http://blogs.bu.edu/ellisrp/files/2016/08/Banning-or-heavily-taxing-WDMS-20160822.pdf

Obama’s JAMA article is a must read for all professionals

There is a very important  article in this week’s JAMA – Internal Medicine, written by Barach Obama.

It highlights the effects of the ACA/Obamacare.  It is free on-line.

United States Health Care Reform: Progress to Date and Next Steps

http://jama.jamanetwork.com/article.aspx?articleid=2533698

If you are short on time, then the following link to just the figures provides many of the key results.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

To me the highlights of the article are that it documents:

The decline in the uninsured (no surprise, but well presented) now down to 9.1 percent from over 16
Declines in teen smoking from 19.5% to 10.8% due to the Tobacco Control Act of 2009 (Wow)
Much slower rates of decline in the uninsured in states that refused the Medicaid expansion (no surprise)
The decline in the underinsured among privately insured as measured by the near disappeance of unlimited exposure (new to me)
Lower rates of individual debt sent to a collection agency (great to see)
Negative rates of real cost growth in Medicare and Medicaid since 2010, with drastically lower growth in privately Insured
Constant share of out of pocket spending as a fraction of total spending among the employer based insurance
(new to me, he cites increases in deductibles offset by decreases in copays and coinsurance.)
Forecast Medicare spending in 2019 is now 20% LOWER than when he took office.
Decline in Medicare 30 day, all hospital readmission rates as well as improvements in other measures.
This information is important to understand to counter the repeated false claims that Obamacare is a failure, or has increased health care spending, or is bankrupting the government, all of which are shown to be false in the evidence presented here.

Here is the link again.

http://jama.jamanetwork.com/article.aspx?articleid=2533698

Press Interviews and Quotes

Partly just to keep track of them for my BU annual report, this post links to my press interviews and quotes.

Meeting basic needs under Trump

Fed funds key for landlords, affordable tenants; Trump’s health secretary opposes Obamacare

Bay State Banner Jule Pattison-Gordon | 12/7/2016, 1:13 p.m.

Effects of Brexit on the world economy and Iran.

Tasnim News Agency Interview, Iran (translated into Persian), June 28, 2016.

Farm Animal Ballot Initiative.

posted on Youtube. By  Brittany Comak, BU School of Communication. November 29, 2015

Inspector General criticizes Red Sox, BRA deal

Massachusetts Inspector General Glenn Cunha criticized a 2013 deal by Boston Redevelopment Authority that granted the Boston […]

by · October 29, 2015 · 0 comments · City, News
According to a New England Economic Partnership report released Thursday, Massachusetts is creating jobs at the fastest pace in 15 years. GRAPHIC BY KATELYN PILLEY/DAILY FREE PRESS STAFF

Mass. experiencing economic boom, study finds

In the past year, Massachusetts has seen an economic boom unlike any since the 1990s, a […]

by · October 20, 2015 · 0 comments · City, News
Massachusetts Gov. Charlie Baker signed a bill Friday authorizing $200 million in transportation funds. PHOTO BY STUX/PIXABAY

$200 million in extra funding approved for infrastructure repairs

Massachusetts Gov. Charlie Baker approved an additional $200 million in funding for infrastructure contributing to a […]

by · April 14, 2015 · 0 comments · City, News
Massachusetts lawmakers announced their support Friday for a bill that would allow the legalization and taxation of marijuana. PHOTO BY SARAH SILBIGER/DAILY FREE PRESS STAFF

Mass. lawmakers support bill that would legalize and tax marijuana

Fifteen Massachusetts lawmakers are supporting a bill, pushed by the Marijuana Policy Project, that would regulate […]

by · March 18, 2015

MBTA late-night service threatened by lack of sponsorship Daily Free Press. by Paige Smith · January 27, 2015

Part time BU employees now eligible for health, dental benefits Daily Free Press. by Rachel Legon · October 30, 2014

Student loan report shows complaints, problems with private lenders Daily Free Press by Meiling Bedard · October 21, 2014

Greater Boston GDP declining, report finds Daily Free Press. by Mina Corpuz  September 18, 2014

Small businesses get extension for ACA in Massachusetts by Daily Free Press Admin · April 27, 2014

STUDY: Grad student loan debt on the rise. by Daily Free Press Admin · March 26, 2014 

College worthwhile investment, study suggests by Daily Free Press Admin · February 26, 2014

Bitcoin ATM installed in South Station by Daily Free Press Admin · February 23, 2014

Cost of student loan programs difficult for federal government to determine, study suggests  by Daily Free Press Admin · February 4, 2014

Universities see an increase in endowments, study suggests by Daily Free Press Admin · January 29, 2014

“South Shore Hospital, Partners HealthCare defend merger plan” The Patriot Ledger. by Christian Schiavone.  1/17/2014

“The Healing Begins for Healthcare.gov”  TechNewsWorld By Erika Morphy 12/04/13 4:12 PM PT

“Financial squeeze awaits W.Pa. hospitals”, TribLive. By Alex Nixon. Thursday, Oct. 24, 2013.

Wenermaar aan, Obamacare blijft“, Trouw Buitenlandredactie. (Article on ObamaCare in Dutch Newspaper) In Dutch. October 4. 2013

Menino plans to build about 30,000 housing units by 2020. Daily Free Press, Boston University, Sep 11, 2013

“Boston welcomes startups, entrepreneurship, despite study results” Daily Free Press, Boston University, Sep 11, 2013

Mass. residents driving less since 2004, study suggests. Daily Free Press, Boston University, Sept 4, 2013.

Medical Costs Register First Decline Since 1970s. Wall Street Journal Blog.  June 18, 2013,

Employers fear economic climate, fail to make hires, new study suggests. Daily Free Press, Boston University, April 24, 2013.

Outside spending in Senate race tops $1.25 million. Daily Free Press, Boston University, April 9, 2013.

New delayed-start loan repayment plan may help grads.Daily Free Press, Boston University, April 3, 2013.

Years after recession, Mass. job numbers finally bounce back. Daily Free Press, Boston University, April 2, 2013.

Popeye’s President Unconcerned About Obamacare, Says Health Insurance ‘Just Not Affordable’ Huffington Post. March 28th, 2013

Tax-based aid needs reform, report suggests. The Daily Free Press. Boston University. Feb 27, 2013.

Minimum wage-earners face hardship paying rent. The Daily Free Press, Boston University, Feb 5, 2013

Gas prices in Mass. shoot up 14 cents a gallon. The Daily Free Press, Boston University. Feb 5, 2013

Freshmen see college as necessary to riches, study suggests. The Daily Free Press, Boston University. Jan 30, 2013.

College debt high despite lower credit card, general debt. The Daily Free Press, Boston University. Dec 3, 2012

Government officials demand sales tax for items bought online. The Daily Free Press, Boston University. Nov 27, 2012

Interview with ASHEcon President Randy Ellis. American Society of Health Economists (ASHEcon) Newsletter Vol. 4 Fall 2010.