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IN one of the most famous studies of health insurance, conducted across the 1970s, thousands of participants were divided into five groups, with each receiving a different amount of insurance coverage. The study, run by the RAND Corporation, tracked the medical care each group sought out, and not surprisingly found that people with more comprehensive coverage tended to make use of it, visiting the doctor and checking into the hospital more often than people with less generous insurance.

more expensive health insurance doesn’t necessarily lead to better health

the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement.

the Centers for Medicare and Medicaid Services of the Department of Health and Human Services delivered a giant spreadsheet on hospital charges and payments.

The spreadsheet has data in 65,536 rows and 12 columns. It covers, for each of more than 3,000 hospitals, charges and payments for the 100 most frequently billed inpatient cases, along with the average covered charges hypothetically billed by those hospitals for those cases.

it’s none too soon to begin asking the question: what have we learned about economic policy in this crash that should inform our thinking for the next downturn? 

Let’s start with the safety net since it’s a fixture of advanced economies and serves the critical function of catching (or not) the most economically vulnerable when the market fails

For many of today’s conservatives, the increased use of a safety-net program is proof that there’s something wrong with the user, not the underlying economy.

In most areas of the economy, free-market principles insure that products and services keep improving, and that consumers get better and better deals. But the free market, though it may be the best way of allocating new TVs and cars, falters when it comes to paying for bypass surgery or chemotherapy. The reasons for this were established nearly fifty years ago, by the economist Kenneth Arrow, in a classic article entitled “Uncertainty and the Welfare Economics of Medical Care.” Arrow showed that health care is distinctive in ways that limit the power of the market. Because people don’t have the expertise to evaluate doctors, hospitals, or treatments, it’s hard for them to comparison-shop. Because they can’t pay for major care out of pocket, they must rely on insurance, thereby often losing the final say in what to buy or how much to spend. More fundamentally, markets work only when consumers have the power to say no if the price isn’t right. Yet it’s very hard for people to say no in the case of things like end-of-life care or brain surgery.

the truth is that, despite the rhetoric, Romney’s main concern isn’t to bring down over-all health-care costs. In fact, he has regularly attacked one of the Affordable Care Act’s most aggressive cost-cutting measures—the independent board that can make binding recommendations on how to cut Medicare spending. What he wants is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney Administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding would lag behind the rise in health-care costs. And, if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country.

The real issue, come November 6th, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea of what government should do. ♦

Millions buying insurance outside exchanges amid ObamaCare woes

While premiums are set to rise by double digits on the ObamaCare exchanges, millions of Americans already have made the decision to abandon the markets altogether and shop for health care on their own

“If it is a bad year in the exchanges and the ship is sinking, people will figure out a way to find a life raft,” said Tom Miller, a resident fellow at the American Enterprise Institute.

"I've borrowed knowing that you can pay back with discounts," he told CNBC. "I would borrow knowing that if the economy crashed, you could make a deal.”

Trump has promised to make America great again. But a closer look his policy proposals, such as they are, suggests that within his first few years as president, he would more likely make American recessionary again.

Meanwhile, he has no plans to cut spending on Medicare, Medicaid, benefits for veterans, defense, or Social Security, which, along with mandatory payments on the debt,

A Commonwealth in Crisis

On Sunday, Puerto Rico will likely default again on some of its debts, which now total over $70 billion.

It is an entity that is often almost completely at the whim of Congress, the most dysfunctional body in national politics today.

while the Chief Justice is taking a lot of heat from the right, the way he handled the case might actually turn out to be a brilliant strategic move -- one that could very well define his judicial career, and could actually be the optimal outcome for Republicans.

the president was ready for the Court to break right or break left. But instead, Chief Justice Roberts juked. He agreed with the challengers that the mandate couldn't be justified under the Commerce Clause or even the Necessary and Proper Clause -- thereby reinforcing the narrative that the Democratic Congress overreached in passing the bill. His opinion -- though not the result -- may provide much help in the future to judicial conservatives, as it suggests that, with the dissent, five justices are in favor of a more aggressive role for the Court in policing the bounds of the Commerce Clause (and the Spending Clause, which was at issue in the Medicaid legislation). And while Roberts ultimately voted to uphold the Act, he did so on a ground that, for Obama, plays terribly: that it's a tax.

Third Way, the centrist Democratic think tank

The authors examined two categories of federal spending over the past 50 years, representing two of government’s fundamental missions. One was “investments,” which includes maintaining our national infrastructure, keeping our military equipped, helping assure that our work force is educated to a high standard, and underwriting the kind of basic scientific research that is too risky or long-term to attract private money. The report calls this the legacy of President Kennedy’s New Frontier, though the largest infrastructure project in our history, the interstate highway system, was Eisenhower’s baby, a reminder of the days when Republicans still believed in that stuff. The other category was “entitlements,” a catchall word for the safety-net programs that provide a measure of economic stability for the aging and poor: Social Security, Medicare, Medicaid, etc. You will not be surprised to hear that the red line tracking entitlements goes up while the blue line reflecting investments goes down.

In 1962, we were laying down the foundations of prosperity. About 32 cents of every federal dollar, excluding interest payments, was spent on investments, only 14 percent on entitlements. In the mid-70s the lines crossed. Today we spend less than 15 cents on investment and 46 cents on entitlements. And it gets worse. By 2030, when the last of us boomers have surged onto the Social Security rolls, entitlements will consume 61 cents of every federal dollar, starving our already neglected investment

France is a proud welfare state, where public spending accounts for 53 percent of GDP—the second-highest percentage in the developed world (only Sweden’s is higher). The U.S. is the third-lowest, at 36 percen

France’s health care system is a public/private hybrid: Everyone is covered to a certain extent by the government’s Assurance Maladie, but most people also have private insurance, called a mutuelle, that is either offered through their employer or bought on the private market. There’s a thriving private insurance market in France—one that the Affordable Care Act can only dream of.

my husband’s employers provided a choice of mutuelle; the top-of-the-line plan, which we signed up for, cost about 50 euros ($68) a month. By contrast, in the U.S., I’d been paying about $350 a month with an additional $50 co-pay for each doctor’s appointment.

a lot of Congressional Republicans are resistant to the more plausible conservative proposals  on health care precisely because they don’t want to find the money required to make any of them work — in some cases because they prefer the comforting illusion that the current system represents some sort of free market ideal that would be wrecked if we started providing tax credits to the currently-uninsured, and in other cases because they’re all-too-aware that some of that money would have to come from caps and cuts that affect groups that currently vote Republican.

right now, with the new health care law as-yet-unimplemented, we’re still in a world where the G.O.P.’s politicians and activists and interest groups think of themselves as working from a pre-Obamacare policy baseline. And this, in in turn, creates a strong political reluctance to propose alternatives that deviate from that baseline in ways that might negatively impact the groups — including, as Barro says, “the overwhelmingly insured Republican electorate” — that the party has tried to rally against the health care law from the beginning.

But the first moment when a Republican Congress might actually be able to pass a health care overhaul won’t arrive until February of 2017, at which point Obamacare will have been the baseline for two years

Republicans “turn from denouncing the health-care law for its lack of high-deductible insurance to denouncing the health-care law for its high-deductible insurance”:

The real difference between left and right now is the “other stuff” Obamacare does to the insurance market. And what’s that other stuff? It’s “guaranteed issue” and “community rating”—the requirements that insurers sell to anybody, regardless of pre-existing condition, with varying rates or benefits. It’s the creation of a minimum standard for coverage, so that all plans must cover at least 60 percent of the typical person’s medical bills and include a set of “essential health benefits” from hospitalization to mental health to rehabilitative services to maternity care. It’s the availability of generous tax credits, available to people with incomes as high as four times the poverty line and worth thousands of dollars a year in some cases. And it’s the individual mandate—the requirement that people pay a fine if they decline to get coverage when it is both available and affordable.

One option was for Republicans to build as many of their ideas into the Affordable Care Act and force Democrats to take partial responsibility for these hideously unpopular, but fairly reasonable, ideas. They didn’t do that. Then Democrats picked some of the ideas up anyway. So Republicans again had a chance to focus their fire on the parts of the law they hated — like the Medicaid expansion — in the hopes of moving the health-care system in the direction they prefer. Instead, they’re aiming at the least popular policies in the law — which just so happen to also be the exactly policies that they support.

a major new ranking of livability in 132 countries puts the United States in a sobering 16th place.

In the Social Progress Index, the United States excels in access to advanced education but ranks 70th in health, 69th in ecosystem sustainability, 39th in basic education, 34th in access to water and sanitation and 31st in personal safety. Even in access to cellphones and the Internet, the United States ranks a disappointing 23rd, partly

This Social Progress Index ranks New Zealand No. 1, followed by Switzerland, Iceland and the Netherlands. All are somewhat poorer than America per capita,

Every German resident must belong to a sickness fund, and in turn the funds must insure all comers. They’re also mandated to cover a standard set of benefits, which includes most procedures and medications. Workers pay half the cost of their sickness fund insurance, and employers pay the rest. The German government foots the bill for the unemployed and for children. There are also limits on out-of-pocket expenses, so it’s rare for a German to go into debt because of medical bills.

this is very similar to the health-insurance regime that Americans are now living under, now that the Affordable Care Act is four years old and a few days past its first enrollment deadline.

There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago

"He didn't have the majority that LBJ had," says Goodwin. Indeed, Johnson could count on 68 Democratic senators to pass Medicare, Medicaid and the Voting Rights Act. For his part, Franklin Roosevelt had the backing of 69 Senate Democrats when he passed Social Security in 1935. At its zenith, Obama's governing coalition in the Senate comprised 57 Democrats, a socialist, a Republican turncoat — and Joe Lieberman.

Compared to the opposition faced by the most transformative Democratic presidents, adds Wilentz, "it's a wholly different scale."

Despite such obstacles, Obama has succeeded in forging a progressive legacy that, anchored by health care reform, puts him "into the same conversation with FDR and LBJ," says Brinkley, "though those two accomplished more."

In 2010, the Citizens United decision by the Supreme Court effectively blew apart the McCain-Feingold restrictions on outside groups and their use of corporate and labor money in elections. That same year, a related ruling from a lower court made it easier for wealthy individuals to finance those groups to the bottom of their bank accounts if they so chose. What followed has been the most unbridled spending in elections since before Watergate. In 2000, outside groups spent $52 million on campaigns, according to the Center for Responsive Politics. By 2012, that number had increased to $1 billion.

The result was a massive power shift, from the party bosses to the rich individuals who ran the super PACs (as most of these new organizations came to be called). Almost overnight, traditional party functions — running TV commercials, setting up field operations, maintaining voter databases, even recruiting candidates — were being supplanted by outside groups.

With the advent of Citizens United, any players with the wherewithal, and there are surprisingly many of them, can start what are in essence their own political parties, built around pet causes or industries and backing politicians uniquely answerable to them. No longer do they have to buy into the system. Instead, they buy their own pieces of it outright, to use as they see fit. “Suddenly, we privatized politics,”