Post

it’s even worse than this. Roberts cut a deal *with the liberals* to trade the exchanges for the mandatory Medicaid expansion, and they agreed to it because judges don’t know shit about policy or have any policy staff

mtsw@mtsw.bsky.social

probably the most heavily debated "policy" in my lifetime was Obamacare and the result of it was not that any of the debates got resolved, John Roberts just randomly took a meat clever and excised like half the stuff in it on a whim. Who cares if that's how actual policy gets made.

I think it was quite easy to predict! The idea that the main factor in people's decision on whether to purchase insurance is an accurate assessment of their expected future health care costs is just really dumb economics brain thinking.

well sure, but perhaps an indication of what type of thinking was dominant among policy thinkers who had the ear of Democratic officials from say 2007-2013 or so!

Since exchange subsidies are set at percent of income regardless of the actual premiums true death spiral was literally impossible. "Experts" were actively gaslighting everyone. Insane Obama team took a high risk strategy of arguing whole law should be thrown out if mandate was repealed.

That was the metaphor! And everyone used it. Krugman talked about it too. And in terms of direction of effect everyone was correct. It's the magnitudes that matter and that turned to be quite smol relative to other pushes/pulls.

I could have a whole rant here about how people are, on the whole, more risk-averse than Nash Equilibrium suggests. But I won't, because the mandate was still a better policy, and estimating the degree is so tricky that it makes NE a useful heuristic anyway.

This was basically known from when I was on the hill in ~2010 from people at CBO. Maybe the generalists but the healthcare folks knew it was a paper tiger once it was passed and the only real value was the initial nudge.

And back to the legal side what was wild was that no lower court came anywhere close to declaring the Medicaid expansion unconstitutional! Roberts just made a thing out of it to logroll with Breyer and Kagan, and turned out that was a wayyyyy more significant policy change than ending the mandate!

might be a stupid idea but I think the default approach for healthcare moving forward should just be utilizing emergency powers to lower the age of Medicare whenever possible. feel like that has more of a chance at success than negotiating some bill

Eventually, sure, but I think of it as asking for forgiveness instead of permission. Expand eligibility, let people opt in during "emergency" situations without a mandate and then put Republicans in the position of having to take it away from folks.

Yeah, it turned out adverse selection was blocked by the fact that the American medical payment system relies so much on overbilling and hoping the patient pays that a young healthy American still needs insurance as protection from overbilling.