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health costs vs GDP growth
Via Sarah Kliff
Sarah Kliff:
A four-year slowdown in health spending growth could be coming to an end.

Americans used more medical care in 2013 as the economy recovered, new reports show. Federal data suggests that health care spending is now growing just as quickly as it was prior to the recession.

"We're at the highest level of growth since the slowdown began," Paul Hughes-Cromwick, a senior health economist at the Altarum Institute, which tracks health spending. "You have to go back seven years to see growth like this."

More health spending can sometimes be a good thing: it might reflect more Americans gaining health insurance and seeking out needed medical care as the economy recovers.

But it also present challenges for the government. More than a quarter of the federal budget already goes towards health programs. That number could rise if health care costs started growing faster than the rest of the economy again.

Jonathan Bernstein:
Today, the biggest news about the Affordable Care Act probably is a Politico story that says insurance companies are becoming exchange optimists. It’s too early to predict, but it looks as though both large and smaller insurers are going to be more likely to jump into state exchanges than to leave them. That’s huge. The whole idea of the exchanges is to deliver the advantages of market mechanisms that were largely unavailable pre-reform. If this pans out, it would help bring down prices and encourage better insurance products.

Meanwhile, a lot of buzz is being generated by a Census Bureau plan to change the way it conducts its survey on health insurance, a change that will make it harder to make pre- and post-Obamacare comparisons. Sarah Kliff has more. And Jonathan Cohn explains the Census's move in the context of all the ways the government assesses who has health care and who doesn't (the change affects only one of those methods, so we should be careful not to overstate its importance). My favorite take on this is Kevin Drum’s conclusion that the Census probably gave change is likely to give plenty of grist for Fox News conspiracy theorists:

More politics and policy below the fold.


The U.S. Census Bureau's decision to change its annual survey -- reported Tuesday by the New York Times -- drew the ire of Republicans and some nonpartisan health policy scholars, who complained that it would make it harder to measure Obamacare's effects on the uninsured rate.

The fear was that the metric would change between 2013 and 2014, making it very difficult to discern the health care law's impact on insurance coverage. That would've been problematic. But the Census revisions, set for this fall, will measure data from 2013 onward. That means researchers will have a direct comparison from 2013 to 2014, the most critical period during which Obamacare's main coverage expansion took effect.

"We will still have an apples to apples comparison of 2013 vs. 2014 in the current [census]," Larry Levitt, vice president of the nonpartisan Kaiser Family Foundation, said in an email. He said the new Census questions are a more accurate indicator of insurance coverage.

According to the Times, internal tests involving the new survey suggested that the old survey was inflating the number of uninsured people in America.

What's sparking the change is worry about producing bad data. The change will likely spark outrage and gnashing of teeth from Republicans, because they see conspiracies behind every tree and bush, but there's not much you can do to change that. That's because grievance is a favorite tool for their fundraising.

Alex Seitz-Wald on Andrew Cuomo's growing problem with the Democratic base:

In the past month, liberal protesters outside Cuomo's office have dubbed him "Governor 1 Percent"; a prominent progressive activist has suggested that he run for reelection as a Republican; the head of a major labor union has called for someone to challenge the governor in the Democratic primary; and a series of behind-the-scenes feuds between Cuomo and other top Democratic officials have spilled out into public view.

The proximal cause for the infighting during an election year, when parties typically put aside their internal differences, is the state's recently concluded, highly contentious budget process, which ended many Democrats' hopes for sweeping ethics reforms this year. On fiscal policy, Cuomo aides insist the budget is "very progressive," but the labor-backed Working Families Party, which endorsed the governor in 2010, is reconsidering its support this year, saying that Cuomo "chose inequality over progress."

Behind the scenes, however, tensions have been building for years.

"This is not a minor shift, but it comes after a slow burn that started in 2010 ... and finally just exploded in the past week and a half," says Bill Samuels, a New York City Democratic fundraiser and activist. "There was probably no one who liked Andrew better than me.… He lost most of us permanently. And I mean permanently. I don't have one friend who is a Cuomo supporter."

USA Today:
The political action committee created by former congresswoman Gabrielle Giffords and her husband to try to reduce gun violence raised more than $2.5 million in the first three months of this year.

Americans for Responsible Solutions Political Action Committee had nearly $7.7 million in cash at the end of March heading into the election season, said Pia Carusone, executive director of the group.

The organization was created two years after the Jan. 8, 2011, mass shooting in Tucson that killed six people and wounded Giffords and 12 others at a Congress on Your Corner event.

NY Times:
Michael R. Bloomberg, making his first major political investment since leaving office, plans to spend $50 million this year building a nationwide grass-roots network to motivate voters who feel strongly about curbing gun violence, an organization he hopes can eventually outmuscle the National Rifle Association.

Mr. Bloomberg, the former mayor of New York, said gun control advocates need to learn from the N.R.A. and punish those politicians who fail to support their agenda — even Democrats whose positions otherwise align with his own.

“They say, ‘We don’t care. We’re going to go after you,’ ” he said of the N.R.A. “ ‘If you don’t vote with us we’re going to go after your kids and your grandkids and your great-grandkids. And we’re never going to stop.’ ”

He added: “We’ve got to make them afraid of us.”

Jonathan Capehart:
Folks, today is one of those days I despair of our political discourse. Sahil Kapur of Talking Points Memo had no choice but to introduce to the lexicon “shoe truthers.” These misguided folks actually believe that Hillary Rodham Clinton staged last Thursday’s infamous Las Vegas shoe-throwing incident.
Jay Rosen:
The Washington Post and the Guardian won the big prize: the Pulitzer for public service. There’s no prize for the network of journalists and newsrooms that brought the surveillance story forward.
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Comment Preferences

  •  new from Gallup (50+ / 0-)
    The uninsured rate among adults aged 18 and older in the states that have chosen to expand Medicaid and set up their own exchanges in the health insurance marketplace has declined significantly more this year than in the remaining states that have not done so. The uninsured rate, on average, declined 2.5 percentage points in the 21 states (plus the District of Columbia) that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

    The law is doing as intended.

    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

    by Greg Dworkin on Wed Apr 16, 2014 at 04:23:03 AM PDT

  •  ... (16+ / 0-)
    Also, most-read of the morning is @brianbeutler on race and Chait's argument:

    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

    by Greg Dworkin on Wed Apr 16, 2014 at 04:26:51 AM PDT

  •  I can't even get county-level stats on (3+ / 0-)
    Recommended by:
    Gentle Giant, Onomastic, Cadillac64

    Insured vs uninsured. I can make a wild regional guess based on Census data (for Maryland).

    So don't get  your Speedo twisted on this. The sad fact is that social areas and Census tracts don't always coincide very well.

    At the other end of the scale the numbers will always be estimates.

    Thump! Bang. Whack-boing. It's dub!

    by dadadata on Wed Apr 16, 2014 at 04:32:51 AM PDT

    •  expert opinion (11+ / 0-)
      See “CPS Controversy” section here:
      @haroldpollack @DemFromCT @larry_levitt Few surveys are designed to yield state representative estimates tho, which explains lack of ids
      Four thoughts about changes to the census survey and measuring the number of uninsured to follow.
      There’s consensus that the Current Population Survey (“census”) was never good at measuring the uninsured. (1 of 4)
      One big problem with the census was that it measured the uninsured in the prior year. So this year wasn’t going to tell us much. (2 of 4)
      The new census questions on the uninsured will be able to measure the change from 2013 to 2014. We just have to be patient. (3 of 4)
      The Health Interview Survey will show the change in the uninsured 2013-2014. Q1 results in September, Q2 results in December. (4 of 4)

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Wed Apr 16, 2014 at 04:41:49 AM PDT

      [ Parent ]

    •  too small a sample? (1+ / 0-)
      Recommended by:

      All the numbers are currently estimates, extrapolating from small samples.
      In order to have meaningful numbers at a county level, they would probably have to sample far more households than they currently do.

      If we want that level of detail -- and accuracy -- we would have to authorize the census bureau to access the NSA's database and correlate it with your credit report and your Medical Information Bureau account. IMO that's not a trade-off worth making.

      •  Probably. (1+ / 0-)
        Recommended by:

        The Maryland health exchange mapped the first 25000 accounts created, and then dropped it.

        Jerks. Next time Marty O'Malley brags about Statestat, ask him what's up with that.

        I understand the limits of sampling, but at the same time I'm not sure our statisticians are serving communities as they exist, versus convenient arbitrary slices (census tract, zip code, etc).

        Thump! Bang. Whack-boing. It's dub!

        by dadadata on Wed Apr 16, 2014 at 06:21:50 AM PDT

        [ Parent ]

  •  Thanks for the roundup this morning, Greg! (21+ / 0-)

    Has the film "Idiotocracy" come to life? This--

    Folks, today is one of those days I despair of our political discourse. Sahil Kapur of Talking Points Memo had no choice but to introduce to the lexicon “shoe truthers.” These misguided folks actually believe that Hillary Rodham Clinton staged last Thursday’s infamous Las Vegas shoe-throwing incident.
    --makes me think so. Dear Goddess, Faux News has ruined this country.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Wed Apr 16, 2014 at 04:38:34 AM PDT

  •  health Insurance (1+ / 0-)
    Recommended by:

    "Health Insurance" always the same story!

    I believe that love of beauty is taste and the creation of beauty is art:

    by deasiajohnathan on Wed Apr 16, 2014 at 04:42:06 AM PDT

  •  Under "What the hell?" comes (13+ / 0-)

    "Northern Virginia lurches to the right"! "Blue" NOVA? That 800 pound gorilla in statewide elections that can come in to turn a red tide purple to blue?

    Ah. We find the TP/GOP is lurching right in the 10th CD, which has long and intentionally rather creatively (Note those squid tentacles reaching into the suburbs from the mountains!) had a red tinge to protect Frank Wolf (R). And there, old GOP hack Barbara Comstock is among the

    half dozen Republicans vying to succeed the district’s longtime Republican representative, Frank Wolf, are engaged in a venomous primary contest to prove which of them is the most hard-line conservative. And it verges on the bizarre when the apparent front-runner, Del. Barbara Comstock (Fairfax), makes a truth-stretching attempt to wrap herself in the mantle of Rush Limbaugh.
    Yeah, this Barbara Comstock:
    Ms. Comstock is among the most conservative lawmakers in Richmond. A lawyer and prolific fundraiser, she represents thousands of commuters in a traffic-clogged district badly in need of road improvements; nonetheless, last year she voted against the first bill in more than a quarter century to provide fresh money for the state’s crumbling highways, even though it was backed by her own party’s top leaders.

    Ms. Comstock also supported legislation that would have required women seeking abortions to undergo transvaginal ultrasounds. She backed a measure intended to outlaw abortion by granting individual rights to an embryo from the moment of conception. She voted to repeal a law limiting handgun purchases to one per month. And she opposes expanding Medicaid, which would provide health coverage for up to 400,000 uninsured Virginians.

    The one that ousted a good solid Democrat in the 2010 idiocy where so many of our side sat the election out in either overconfidence or some sort of infantile snit that the top candidate wasn't "inspiring" and such to let our down ticket candidates get massacred.

    Oh well, from another article from April 10we learn Comstock is just

    a “D.C. establishment Republican” who is beholden to House Speaker John A. Boehner (Ohio) and House Majority Leader Eric Cantor (Va.), a theme that other candidates picked up during the debate.
    Among many interesting comments to that last article is one noting:
    She is the leading candidate and the moderate. Not saying you have to vote Democratic, but she has a track record against women, youth, minorities, gays, the elderly, supporters of reasonable firearm restrictions, and people that use state roads.
    Yep. Quite true. Is this the march of the Red Lemmings to suicide or something else?

    The only foes that threaten America are the enemies at home, and those are ignorance, superstition, and incompetence. [Elbert Hubbard]

    by pelagicray on Wed Apr 16, 2014 at 04:47:56 AM PDT

    •  The 10th district (7+ / 0-)

      is probably the best pickup opportunity that VA Dems have, and maybe one of the easiest GOP seats to switch in the whole country. Wasn't going to happen with Frank Wolf running, but this woman is a complete mismatch for the 10th district.

      It would be a shame to let her win the election by talking about "responsible governance" and other GOP claptrap, when what she really wants to do is close down the EPA and the Dept of Education, and eliminate free choice for women.

      You will not be punished for your anger. You will be punished by your anger.

      by mstep on Wed Apr 16, 2014 at 06:13:17 AM PDT

      [ Parent ]

      •  Almost purely dependent on turnout. Sit this one (6+ / 0-)

        out and the hard core red contingent will put her into the House. Turn out and it is indeed a pick up of a seat.

        The only foes that threaten America are the enemies at home, and those are ignorance, superstition, and incompetence. [Elbert Hubbard]

        by pelagicray on Wed Apr 16, 2014 at 06:49:21 AM PDT

        [ Parent ]

      •  Comstock is possibly the... (2+ / 0-)
        Recommended by:
        Stude Dude, Cadillac64

        ...least bad option the GOP has in VA-10. I suspect she and her team plan to get the nomination by whatever means it takes, then shake an Etch-a-Sketch and loudly assert that she is a NOVA GOP "moderate" in the tradition of Wolf. If she prevails in the nomination battle she'll receive plenty of cash to make that assertion, but as you point out she has a track record of votes that indicate who she really is. This seat can be won, but it won't be won easily.

        Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

        by Egalitare on Wed Apr 16, 2014 at 07:12:19 AM PDT

        [ Parent ]

        •  State Board of Election results for 2012 show why (0+ / 0-)

          if we don't turn out big time in "Blue" metro areas of the 10th she is a shoo-in for the House.

          November 6, 2012 General Election Official Results shows Romney won this district 186,650 (49.81%) to Obama's 182,432 (48.68%) with three other candidates and various write ins making the balance. That is Romney by just 4,218 votes. The voting summary page shows this district has 457,094 "Active Registered" voters of a registered 503,131 and the turnout that election was 376,216—82.31% of "Active Registered" voters,74.77% of registered voters.

          So, if our more "urban" women voters don't want to be represented by Congresswoman transvaginal ultrasound and people would really rather have some sensible firearms control not having another hard line opponent and on, and on, and on in that line . . .

          They'd damn well better not desert their posts at the polls this fall.

          The only foes that threaten America are the enemies at home, and those are ignorance, superstition, and incompetence. [Elbert Hubbard]

          by pelagicray on Wed Apr 16, 2014 at 08:05:14 AM PDT

          [ Parent ]

  •  shoe truthers!!??!! (10+ / 0-)

    Well you sure nailed it with this comment, Greg

    because they [Republicans] see conspiracies behind every tree and bush
    Even though your comment was directed at the Census Bureau story, it sure is applicable for a wide range of topics.

    As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them. John F. Kennedy

    by JaxDem on Wed Apr 16, 2014 at 04:49:16 AM PDT

  •  Jay Rosen & community of journalists on NSA story (7+ / 0-)

    excellent story about a group of international journalists working on the story with the help of the documents that Edward Snowden provided

    when Glenn Greenwald was asked after the Polk Award ceremony last Friday what was the biggest revelation from the story he said that the goal was to eliminate privacy for everyone on the globe.

    the global nature of the story and the participation of governments was well handled with local reporting

  •  ho hum on Sebelius departure (6+ / 0-)
    The impending departure of Health and Human Services Secretary Kathleen Sebelius is bringing forth a kind of shrug from her fellow Americans. They may not view her with much approval, a new HuffPost/YouGov poll finds, but they don't think her leaving will change how the Affordable Care Act works.

    Forty-one percent of Americans said they have an unfavorable opinion of Sebelius, while only 19 percent have a favorable opinion. But 39 percent said they weren't sure.

    Americans divided along party lines in how they judged Sebelius, but in an asymmetrical way.

    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

    by Greg Dworkin on Wed Apr 16, 2014 at 05:15:03 AM PDT

  •  Quirky question about that chart? (3+ / 0-)
    Recommended by:
    Gentle Giant, se portland, Cadillac64

    Why did medical costs spike while the economy was dipping in the early '00s?

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Wed Apr 16, 2014 at 05:23:38 AM PDT

    •  Possibly because medical profits have to remain (2+ / 0-)
      Recommended by:
      Stude Dude, Cadillac64

      high or investors move over to the commodities markets.  Energy markets in toto may be operating the same way.  Bobswern, here, would be a good source of info on this.  Perhaps he'll check in.

      Building a better America with activism, cooperation, ingenuity and snacks.

      by judyms9 on Wed Apr 16, 2014 at 05:30:36 AM PDT

      [ Parent ]

    •  Premium hikes? (4+ / 0-)
      Recommended by:
      skohayes, Stude Dude, salmo, Cadillac64

      As I read the graph, the "spike" was still less than a 10% annual increase. We know insurance premiums were going up often by 15-20% a year during the Bush-boom years.

      That doesn't mean actual medical care costs were going up, although they may have -- increase in number of CATs and MRIs, new more expensive drugs, whatever.

      And does this graph include the costs of severely injured troops coming home from Iraq and Afghanistan?

      I'd like to know a lot more about what's included in "health care costs." In other words, what are they measuring, and how?

    •  The price of everything skyrocketed (2+ / 0-)
      Recommended by:
      Stude Dude, Cadillac64

      With all the structural changes in the job market and stagnated wages, at least half of the current recovery is due to the slowing rise in energy, health care, and housing prices.

      I'm living in America, and in America you're on your own. America's not a country. It's just a business.

      by CFAmick on Wed Apr 16, 2014 at 07:12:08 AM PDT

      [ Parent ]

  •  Here's a curio (1+ / 0-)
    Recommended by:

    Somebody saying that Atheist Libertarians are part of the 1% problem. While I'm sympathetic to the idea, I feel that the author makes a too slight of a case.

    When I was young and had the religion, I was annoyed at a lot of Liberals and Libertarians because I felt that their Atheism was just easy hipster posturing. Now that I'm older and have lost the religion, I feel a lot of the same way, only from the other way around. They didn't earn it by suffering through a crisis of faith.

    Then again, going through a crisis of faith and losing your religion is horrible enough that I wouldn't wish it on anybody. Not even people I don't like.

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Wed Apr 16, 2014 at 06:03:27 AM PDT

    •  That's a great article (2+ / 0-)
      Recommended by:
      wintergreen8694, Stude Dude

      As far as atheism, I became an atheist back in high school, but it took me til I was almost 30 to admit it in public.
      It wasn't a crisis in faith, however, but a realization that I simply did not believe in anything that even resembled a god and organized religion was a scam to bilk the public out of money so that priests and cardinals (and Pat Robertson and Jerry Falwell and that ilk) could live like kings.
      Not a crisis, but a liberation.

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Wed Apr 16, 2014 at 06:14:26 AM PDT

      [ Parent ]

      •  I've decided this: (2+ / 0-)
        Recommended by:
        Stude Dude, skohayes

        You don't get an answer to the question "Do I believe in God?" unless I get an equity position in your organization. There's a lot money and power in my answer, and I won't give it away for free.

        I'm living in America, and in America you're on your own. America's not a country. It's just a business.

        by CFAmick on Wed Apr 16, 2014 at 07:14:50 AM PDT

        [ Parent ]

    •  I don't get it. (1+ / 0-)
      Recommended by:
      Stude Dude

      I see Libertarians as part of the 1% problem. I don't really see any reason why atheist libertarians are any worse than Christian (or Muslim or Jewish or any other theist) libertarians. In my experience the two aren't particularly connected. Certainly not all or even most athiests are libertarians, so why the focus on them?

      And I'm sorry I didn't suffer enough to earn my atheism. I was pretty much raised that way - or at least agnostic, about as close to without religion as you can be in the US. That doesn't make it "hipster posturing".

      The Empire never ended.

      by thejeff on Wed Apr 16, 2014 at 08:00:15 AM PDT

      [ Parent ]

  •  Another interesting bit to ponder: (9+ / 0-)

    Chris Hayes last night featured among the tax day items "Why ‘Tax Day’ could be so much easier" that noted the slush funds and lobbying of the tax preparation industry in making a fundamental government function—collecting taxes—expensive and difficult for so many.

    The story notes how an effort, "Ronald Reagan and Barack Obama both support a plan to allow the IRS to auto-prepare taxes - but industry advocates are standing in the way," would make things easier and entirely optional for the majority of taxpayers that have simple returns in which the IRS already pretty much knows what you owe because we don't have those "interesting" outside incomes that are not all covered by those withheld wages and interest payments reported to the IRS as made. As noted in the larger story, those are the people with a real interest in gutting the IRS' ability to look at returns because the rest of us are basically computer program fodder.

    Anyway, here in Virginia we have until the end of the month to file state taxes. Intuit and TurboTax among others try to sell state filing packages at a nice chunk of change. Until the 2009 TP/GOP sweep of our state's legislature and statewide offices we had iFile. It was available without "means testing," just an aid to the citizens and state itself in performing that basic, fundamental government operation of financing itself in the most efficient and pain free way possible. At the time I first used it I considered it perhaps the most elegant on line program of its type.

    One of the first things those champions of anti-government did in Richmond was gut the system, with the eager cheer leading of all the "tax preparation industry"! Now there is a "means tested" free option, through the "industry" or one can buy their products.

    Me? I went back out of sheer anger to a paper return and creating my own spreadsheet. Maybe I help keep some state employees employed too. Yep, I can still "do Virginia taxes" in under half an hour (spreadsheet needs  checking against instructions) and then use black ink and my old, arthritic scrawl on a paper return and use a stamp.

    The only foes that threaten America are the enemies at home, and those are ignorance, superstition, and incompetence. [Elbert Hubbard]

    by pelagicray on Wed Apr 16, 2014 at 06:08:56 AM PDT

  •  can they put feds onto the exchanges? (2+ / 0-)
    Recommended by:
    Cadillac64, Joe Bacon

    I don't care if the Fed Plans define Platinum, but i'd
    require all federal civil servants and the
    DoD TriCare to be on the Exchanges.

    It would help grow the exchange volume and it would establish a larger pool of people who understand them.

    I'd also put incentives to get all state workers into
    the exchanges.

  •  Good for Bloomburg (0+ / 0-)

    I may have not liked him when he was my Mayor... but if this is what he spends his time and money on, cheers to him!

    The threat to our way of life comes from corporations, and the solution is to shrink corporations while freeing government from corporate control.

    by gbaked on Wed Apr 16, 2014 at 08:19:42 AM PDT

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