Recently in Politics Category

Where are all the error bars? I'm looking at you, CBO.

 
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Every estimate involves uncertainty, which creates error. When you present estimates, at least some mention of that error should be presented along with the estimates themselves. 

On graphs, you often represent error with error bars. When written out, you usually add a +/-. Yet pretty much every estimate I come across does not represent the error at all!

Case in point, the Congressional Budget Office (CBO), a bi-partisan agency chartered by Congress to provide economic data to them.

CBO's cost estimates were center-stage at the health summit today. That fact in and of itself is fine. A big part of the health care debate should center around cost. 

However, without knowing the error in their estimates, their predictions are useless. For example, suppose plan A is $500 million +/- $300 million and plan B is $400 million +/- $100 million. Can you really say plan A is more costly than plan B?

No, you can't. In some scenarios, plan A will be more costly, but in others it will not. That basic level of scrutiny is seemingly not being applied by Congress or the media.

I went to the CBO site to double check the possibility that they were accounting for error, but it just wasn't being picked up by the Congress or the media. I couldn't find any error bars or +/-s anywhere. Feel free to correct me if I missed them :).

75% of state budgets go to three things. Can you name them?

 
I was listening to C-SPAN radio this morning, and the governor of Montana was on. He said that governors wake up each morning thinking mainly of three things: education, medication, and incarceration. Overall, depending on how you count, these three things add up to about 75% of state budget expenditures.

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My post on Federal expenditures had a nice chart. So here is the equivalent state chart, which I got from here.

Health care is very understated because it encompasses a lot more than Medicaid alone, including health care benefits and pensions of current and former state employees. The note at the bottom bears this out a bit. It should be really about 25%.

Corrections is also quite understated, because it doesn't include law enforcement and the judicial system, both of which of course are involved in the entire process of incarceration. It should be really about 10%.

As the site where this came from points out, these are averages, and the %s can vary widely from state to state. From the site:

"For example, Alaska and West Virginia each spend 11 percent of their budgets on K-12 education, while Michigan, at the other end of the spectrum, spends 31 percent. Similarly, Medicaid makes up 10 percent or less of state budgets in Alabama, Hawaii, and Wyoming but more than 30 percent of the budgets in Maine, Missouri, and Pennsylvania."

80% of the US budget goes to five things. Can you name them?

 
Can you name the top five line items of the US federal budget? I think knowing this answer is a pre-requisite to seriously participating in the ongoing discussions/debates over what should be done about the US deficit/debt. That's because cuts will have to come from these items to be significant in the long term.

I've been asking this question of people for years because I personally think it is important for a wide range of issues, including thinking about who to elect for President. I think people are most shocked at how small education is (2%), and after that science/medical R&D (3%).

Last night I went searching for the best info-graphic explanation. The following is the best one I found, which I got from here.

WhereOurTaxDollarsGo_MostOfBudget.jpgDepending on what you count in"Safety Net Programs", interest payments can be 4th or 5th. I think that understates its importance, though, because of how fast it is currently growing. If unchecked, it will be 10-12% in only a few years.

We need a Modern Bill of Rights

 
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People are mad about the recent Supreme Court decision on the right of corporations to influence political campaigns. Lawrence Lessig is even calling for a convention to restore our democracy, which he insists is broken. The movement has even drafted a proposed constitutional amendment.

This pattern (court decision -> outrage -> proposed amendment) happens every few years. Well, I'm sure it happens more often than that, but it actually gains some traction every few years. The last one I recall was around eminent domain and the Kelo case.

In any case, I agree with Lessig that we should call a convention:

"If 2/3ds of the legislatures of the states demand it, Congress must call a convention. That convention then must meet and deliberate about amendments to the constitution. If it agrees, it then proposes amendments to the states. 3/4ths of the states must then ratify any amendment before becomes law. Thus, 12 states of 50 have the power to veto any change, meaning no change could happen unless it appealed to a solid group of Red States and a solid group of Blue."

However, I think the scope of that convention needs to be much bigger. Yes, we should call a convention, but it just shouldn't be about this one problem, one amendment.

If we're going to call a constitutional convention, we should really consider a host of amendments, i.e. a modern Bill of Rights.

The Bill of Rights was ratified, in part, because it was many amendments, not one. In the same way, proposing many together would actually give the movement legs, which other amendments have failed to capture by themselves.

A more substantive argument is that our Constitution is need of a lot of amendments to clarify things. Corporations' status as people/citizens and eminent domain are two good examples. 

Equally good (and popular) are finally spelling out the right to privacy, a right to eduction, and raising the standard of gender and ethnic equality to that of race and religion. Less popular but possibilities are a social security trust fund, no military draft, and direct election of the president. There are of course many other possibilities as well.

I think people dislike the Supreme Court so much because they think they just make stuff up. That's of course not true (read opinions), but there are a whole host of issues that the Constitution really doesn't have much to say about. In those cases, they do try to make strong logical arguments (mostly), but they aren't really backed up the way should be (with the Constitution). A modern Bill of Rights can help us get back that foundation.

Smaller bills are on the path towards bi-partisanship

 
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This is turning into a weekend of political posts. This morning I watched Meet the Press with David Axelrod and John Boehner. (I haven't watched that show in a while, really since Tim Russert died.)  Anyway, it got me thinking...

Republicans didn't actually vote no on everything in 2009. Obama highlighted a few of those instances in his Q&A on Friday, and Boehner made reference to some today, e.g. Afghanistan, extension of unemployment benefits, credit card reform, etc.

The votes we hear most about, however, are health care and stimulus. And on those they did vote no.

Now Boehner today again reiterated there is broad disagreement on health care, but there is some agreement too, e.g. offering plans across state lines, various types of insurance reform, etc. Obama said basically the same thing on Friday, asking to come together on at least those issues.

One of the problems though, is that these areas of agreement become embedded in these huge 1,000+ page bills that include massive areas of disagreement as well as all sorts of other unrelated things.

A seemingly feasible tactic on the path towards bi-partisanship would be to make smaller bills that are limited to areas of agreement.

This is a completely different process, and I realize that, as well as the trouble that comes along with it. You will have Democrats saying they want to do everything together or nothing at all, for example. However, if it really comes to a vote, I doubt they would vote against it.

And think for a second if Obama and the Democratic leadership had taken this approach over the past year. You might have had twenty different "bite-sized" stimulus and health care bills. Republicans would presumably have voted for some of them, and at the very least, we would have had both a) something accomplished (on health care) and b) both parties working together.

Obama, Ryan, bi-partisanship and changing Washington

 
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I watched Obama's Q&A at the House Republican retreat. It's very long, but really worth watching if you want some insight into bi-partisanship in Washington. (The Q&A piece starts around 20min in.) Here's my summary.

It's clear (at least to me) that Obama desires bi-partisanship in some form, but has gone about it to date in an extremely sub-optimal way. I think there are two general approaches.

The first approach, which Obama has done, is to say we're in charge, and to those of you not in charge, if you have ideas, we'll hear them out, and include them in our plans. He reiterated this approach multiple times in the State of the Union and again during the Q&A session.

It's not lip service. You can tell he has been listening to some of these ideas. He is clearly angry that even though some are in incorporated into Democratic bills, Republicans have been voting against these bills. He sees the bills as compromises. And to some extent they are--Democrats have adapted their bills in effort to get some Republican support.

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Yet consider the situation from the perspective of the Republican house member, Paul Ryan. Ryan had a completely sensible and constructive dialog with Obama in the Q&A session, which Obama acknowledged. 

Congressmen Ryan illustrates a group of Republicans who are willing to work with Democrats. I don't know how big this group is, but it does exist. I watched several committee sessions this year on C-SPAN where Ryan et. al. offered amendment after amendment that were all voted down on party lines. 

These were not all partisan amendments. Some were simply mechanical tweaks on bills, clearly thought out to help them operate more efficiently or provide better oversight opportunities for Congress. The message though was clear: we don't want any of your help constructing our bills; you Republicans will have to vote our bill up or down.

This brings me to the second approach to bi-partisanship: bring the other side into the bill construction process. Make them co-sponsors. Let them into the back rooms. Approve their amendments if they are reasonable. And instead of just letting them email their ideas into a black hole, let them work with you in real time to incorporate them (when appropriate).

Even if the end result is a very similar bill, you will have much more of a chance for Republican votes. Those Republicans willing to cross the isle and compromise like Ryan will have bought into the process and will have a real stake in it. More importantly, they will have something they can show their constituents. They can say this or that piece is mine--I worked with the majority party to get that for you.

The other approach just gives them a take it or leave it decision: an up or down vote on a bill they didn't help write, had no say in, and were actively denied participation in its construction. Even if their idea is in there in some form, it isn't really their idea anymore.

Back to Obama. I realize it's a hard thing as President to try to increase bi-partisanship in Congress, given that you aren't really in charge of it. However, it is clear there is a lot of indirect power.

Obama is now using that power to start to force the Congressional leaders of both parties to meet on a regular basis. And he himself is doing more things like this Q&A session. I think that is a great start. I still don't get why he didn't do this stuff from the get-go, but better late than never. 

So I'm hopeful. I hope he also puts more pressure on lower members of Congress.  In particular, I hope he helps Republicans with legitimate amendments to get those passed in committee.

I'm also a bit skeptical, though. In the Q&A, Obama kept going on about how both sides need to stop attacking each other and be constructive. The problem with this message is he keeps speaking to the audience (Republicans) as a solid block. I think that is his core mistake.

He is frustrated, and in his frustration he has written off the entire other side by retreating to his side entirely. Instead, he should pick off those people like Ryan willing to work together and promote them and their ideas.

Reaction to State of the Union

 
hero_bkgd_state_of_the_unio.pngPundits seem to think Obama's speech was partially aimed at independents, i.e. the center. As someone who sort of fits that bill, here were my reactions.

  • What if. I liked a lot of the proposals that I think were targeted at my political demographic, e.g. zero capital gains taxes, more nuclear power, small business credits, budget restraint, etc. However, I kept thinking why didn't all of these thing happen over the past year, when they arguably would have had a bigger impact on the economy.

    Then I got to thinking they are somewhat bi-partisan proposals, at least in recessionary times, so what would have happened if Obama had led with these last year? Of course it is an unanswerable question, but you have to wonder if he had done it would he had started off on a better footing and then would have been more able to achieve a real bi-partisan, or at least more bi-partisan health care reform outcome.

  • Too long. I realize most State of the Unions are super long, but it just seemed to drag on. I would love to see Obama or another president make a shorter, more themed speech as opposed to really ten different speeches on every major political topic. It seemed he was just trying to cover all the bases. The worst was at the end he threw in like three sentences on immigration with no proposals or anything. He might as well just said the word immigration, paused, and moved on.

  • Liked the casual parts. I really appreciated the parts where Obama's personality shone through. That is, you could tell some of it was his own words. It bothers me how speech writers are so prevalent.

  • Bi-partisan yet not at the same time. I thought the tone on partisanship was weird. He would call for bi-partisan effort and then 30 sec later attack people in a partisan way. And I thought some of his attacks were simplified to much in the same way he attacked the media for doing.

  • Supreme court thing was strange. The moment where he called out the Supreme Court and all of Congress basically jeered at them while they just sat there was strange, and I thought inappropriate. 

A moment for bi-partisanship has opened.

 
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The election of Scott Brown puts Democrats in a tough spot. Instead of finding a way to push health care through Congress, how about instead offering an olive branch to Republicans?

Bi-partisanship has largely been absent from the health care bills, which effectively fueled the recent election. I'm sure there is plenty of blame to go around, so let's not dwell on the past.

I think there is a moment right now where a real bi-partisan bill could be formed and passed. Both sides (and the American public) agree health care reform is necessary.

I think the way forward is those C-SPAN televised health negotiations. Obama and the Democratic leaders should now offer to do those open-door negotiations. It might seem at first like too little, too late, but if they actually carry through with them in a meaningful way, I think it would have a high probability of turning positive.

Of course, this strategy requires an actual willingness to compromise that will result in a scaled down bill with new stuff added in. That's the reality of bi-partisanship!

Health care policy: will we ration 5% cures?

 
Suppose you are terminally ill with few months to live if untreated. There is a new drug that has a 5% success rate that if successful, will leave you completely cured. But 95% of the time it won't work and you will get no benefit. Should the government pay for these 5% cures?

On the face of it, this is a case where pure cost/benefit analysis would most often return a big fat NO. This result occurs because 95% of the costs will be effectively wasted such that cost per unit of life extension will seem really high relative to other things under consideration. It gets even worse if the cure ends up being say a 3-year life extension on average because those patients end up dying from something else in that time frame due to their weakened initial state. Or if the cure rate was even lower, say 3% or even 1%.

At the same time, the cost to the person whose life is saved appears ~20x lower to them because they would not incur individually the costs for the other 19 people (on average). I don't pretend to have the answer to the question, and would be interested in your thoughts, but I think this is an interesting case that shows the complexities we will soon increasingly face as well as one potential pitfall of cost/benefit analysis that pundits love to push.

We ration health care already, both privately and publicly, so I'm not too interested in the question of will we ration care of not. I believe that debate to be a false one. What I am interested in, however, is how our rationing will change under proposed reforms. It seems that we are headed towards some sort of quasi-public body that will decide, at least for public options, what care will be approved for varying reimbursements. Of course, this is similar to what we do now, but this new body will presumably have more power and be trying a lot harder than we do now to squeeze costs out of the system.

No one really cares about unnecessary costs because they are by definition unnecessary, e.g. duplicate tests. And I suspect existing Medicare benefits will end up being frozen in time, i.e. no current benefits will be cut. Yet that is only a short term win since new drugs enter the market place all the time. It is around these new drugs where some interesting debate will occur, which brings me back to the case of what I'm calling the 5% cure. 

These cures pose additional problems beyond the initial cost/benefit debates. Suppose we stop covering 5% cures as a rule. Further suppose, and I don't know if this is the case but I suspect such, that a lot of great treatments that end up being 50% cures start out as 5% cures. By shutting down (or at least hampering) the 5% cure market we will be effectively telling pharma not to invest in these cutting edge treatments. From their perspective, what's the point? That could lead to less important disruptive innovation in health care, which is the very thing we want to encourage.

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