Friday, November 18, 2016

Does the Democratic Party even want to win?

Senate in session
Watching the post-election behavior of the Democratic Party, I’m left wondering if the party ever really wants to win. While it seems crazy to question Democrats’ desire to win, they are not at all behaving as one would expect a group to when faced with a seriously unfair system. They are sure not behaving like a party that lost solely because of arcane rules, even after winning the popular vote for President, House and Senate. There are numerous things the Democratic Party could do to fix this situation, but so far they haven’t even tried.

Electoral College
Twice in my modest lifetime, the arcane and idiotic electoral college has denied the presidency to the person that the most Americans voted for. Yet the Democrats have made no serious party commitment to eliminating this unpopular institution. Even though making the electoral college a relic of the past could probably be accomplished for less than 1/20 of what was just spent on the Clinton campaign, the party has yet to step up.

The growing urban-rural divide continues to push the Senate towards favoring the Republicans. One step could both address this imbalance and fix the injustice in the District of Columbia, where more than 600,000 people pay federal taxes without representation: granting D.C. statehood. Yet when faced with the opportunity to do just that in 2009, President Obama instead went out of his way to ignore the issue.

House of Representatives
The House is the branch of government which was specifically designed to most closely reflect the public, but in the past several elections it has failed terribly at this task. Thanks to the fact that Democratic voters are increasingly being packed into districts, the Republicans can win control of the House with dramatically fewer votes, which makes a mockery of our democracy. There are numerous ways to solve this problem with multi-member districts, but as of yet there is no real push in the Democratic Party for any of them.

Third Parties
Again, twice Democrats have complained that votes for third party candidates cost them an election (although I question the idea that Gary Johnson voters would have gone for Clinton). Yet the party has done almost nothing to fix the problem. The recent success of Maine’s Ranked Choice Voting Initiative shows there is real way to deal with it.

The future looks bleak for Democrats
Being a futurist is about looking past the current moment to try to predict how all big trends will fit together. Democrats have long comforted themselves with projections that a growing Hispanic population will secure their future, but they have ignored all the other trends going against them.

The reurbanization of America has created real problems for Democrats, and these problems are likely to grow. As more people live in large cities, it becomes easier to gerrymander districts to pack all of the Democrats into just a few districts. It means the Senate and the electoral college will continue to skew Republican. In the recent presidential election, Trump gained the most in the rural places where the population has been declining. If the trend continues, the gap between how people vote and who wins could grow much worse.

Structural reform may not seem like the sexiest issue, but pushing the fact that the system is rigged and unfair can truly galvanize people. It worked for Trump and the Republicans when they complained about “voter fraud,” even when it wasn’t real. If Democrats want to win, they need to advocate for what it takes to win, and so far they haven’t.

These rule changes would help Democrats in the mid-term, but they are not a guarantee of holding power forever. The pendulum of American politics will continue to swing; these changes would just mean that it wouldn’t take a massive swing the left to put Democrats in power. It would also force the GOP to eventually change their message to help address the needs of an increasingly urban population.

Monday, November 14, 2016

Donald Trump's Obamacare Replacement Plan: The least bad possible outcome

Donald Trump August 19, 2015 (cropped)
To be clear, this is not what I want to see happen to our nation's health care system; it is only what I think is the most optimistic possible outcome based on the current political climate and the statements Donald Trump has made. What I've laid out below is the best Obamacare replacement plan that I think would be politically feasible and still largely consistent with Trump's principles/statements. The one small silver lining is that Trump’s statements on health care have been consistently to the left of most top Republicans. 

1) Block grants Medicaid if states provide coverage for most everyone under 100-200% federal poverty line

Under this plan, states would have much wider latitude for how to design their Medicaid program and get federal funding as long as they provide some form of coverage to most of the people under the poverty line. This does two things. It allows Republicans to claim the moral victory that they went with a “state-based approach.” It also means they avoid the political problem of kicking people off their current insurance. The ACA's Medicaid expansion has been responsible for the bulk of the people who gained coverage from the ACA, and the insurance industry is not really interested in having these people as customers.

To sweeten the deal for the GOP, the plan could halt federal funding for K-12 education and instead use that money to pick up more Medicaid costs. This would give states more freedom to set up their own education policies. It would also allow the GOP to say they gutted the Department of Education and reduced federal meddling in education.

2) Create a program for the sickest and most expensive people outside the individual market

There are two easy ways to lower the cost of insurance on the individual market. One is to offer subsidies, like the ACA does, while the other is to remove the sickest (i.e., costliest) people from the market. A small percentage of the absolute sickest people account for most of the health care spending. There are a few ways to remove these people from the pool.

The Trump plan could place everyone with, say, the 10 most expensive conditions into a new, heavily subsidized, state-based “high risk pool” program. Or it could give these young, very sick people access to Medicare. There is precedent for this. Currently, regardless of your age, if you have kidney failure you can qualify for Medicare. Or the plan could say that if a person's total health care spending exceeds $X, they are “effectively poor” and thus eligible for Medicaid while getting to keep their current income. Alternatively, the Trump plan could offer a new government super-catastrophic program that would pay for anyone's medical bills once they go over $200,000 a year.

This might not save money overall, but it could if it moved the sickest people to cheaper government programs like Medicaid/Medicare that pay lower reimbursement rates. Mostly, though, it would reshuffle money that was being used for direct ACA subsidies into more indirect subsidies. The political benefit is that it would technically reduce the offical premiums on the individual market, giving the GOP a great talking point.

3) Allow insurance to be sold across state lines if they meet federal standards

The Trump administration could create minimum federal standards for what insurers must cover, and if they meet these standards they can sell in any state. The standards would likely be stingier than the ACA's, so this means worse plans but also lower premiums. Picture something like catastrophic coverage with HSA's. This will let the GOP claim they brought premiums down and created competition.

4) Tax credits

Rather than income-adjusted subsidies as they do now, everyone else on the individual market would get a flat tax credit to buy private insurance. These tax credits could only be used for plans that meet the new, more lax federal minimum standards.

5)  No more

The plan would also get rid of the site. People would just shop for health insurance like they do for homeowners or auto insurance. This would give the GOP a clear way to illustrate that they killed “Obamacare.” Replacing the highly structured ACA subsidies with a simpler flat tax credit will eliminate the main need for the website.

6) Replace the individual mandate with strong nudges

The individual mandate was the least popular part of the ACA, buts its function of encouraging healthy people to sign up for insurance can be replaced with other, less politically toxic options. One is automatic enrollment. The plan could automatically sign people up for the lowest price option in their area if they fail to choose a policy on their own. People could always choose to opt-out, but people are lazy.

The plan could also have a back-premium penalty. If you sign up after the open enrollment period or end up in the hospital without coverage, you'd be forced to pay several months of back-premiums to your chosen insurer.

Net result

The result of all of these policies would be a health care program similar enough to the ACA to prevent a broad political backlash of millions becoming uninsured. At the same time, it looks different than the ACA, appears more state-centric and friendlier to "free market" forces, potentially appeasing the Republican party.

You would see worse insurance policies on the individual market but also likely lower premiums. You might see slightly fewer people with what counts as “insurance” but not enough that it would be a major disruption resulting in thousands of bad headlines. Many people would probably end up with insurance they can’t really afford to use, but that is already a problem under the ACA.

This is, of course, the best case scenario. The worst case is the GOP destroys most of the ACA without any replacement, turning a bad system into a hopelessly crippled system dying under its own weight. The result would be millions losing Medicaid, millions losing insurance, and a market made into an even bigger mess.

Wednesday, November 9, 2016

My marijuana reform predictions are doing very well

Last night my predictions for the presidential election were way off (so were those of every data-driven election prognosticator), but my marijuana reform predictions have done very well. I wrote three years ago in my book After Legalization: Understanding the Future of Marijuana Policy:

2016 – This is the year the tidal wave is going to hit. If current polling trends hold, national support for marijuana legalization should rise to well over 60 percent by 2016. Marijuana reform groups are already planning to take advantage of this presidential election year to make their big push. There are likely to be ballot initiatives in Arizona, California, Maine, Massachusetts, and Nevada. If a well-crafted initiative makes the ballot in these states, they are almost guaranteed to pass. As of 2013, local polls showed there is already majority support for legalization in all five of these states, and support should continue to grow over the next three years.

Of these states, I suspect the biggest impact of legalizing marijuana will come in Massachusetts. California, Colorado, Washington, and Nevada all have relatively self-contained metro
areas—relatively few people commute daily across their borders. Massachusetts, on the other hand, borders five other states, all of which have significant populations close to the Massachusetts
state line. In about 30 minutes, you can drive from Manchester, N.H.; Providence, R.I.; Hartford, CT; Bennington, VT; or Albany, N.Y., to the Massachusetts border. The majority of people in New Hampshire and Rhode Island live less than an hour from the state. Legalizing marijuana in Massachusetts would make it foolish for the rest of New England to keep it illegal. All these other states have already decriminalized possession, so the real question they will face is whether they’ll
let the tax revenue flow to Massachusetts just to maintain an unpopular prohibition that has clearly failed.

With marijuana legalization on so many ballots during a presidential election year, including the potentially important swing state of Nevada, the major-party candidates will be forced to address the issue. I don’t expect a major presidential candidate to fully endorse legalization that year, but the politics of the situation will likely force them to publicly favor a hands-off approach by federal agencies. Neither party can risk pissing off young voters, and promising to leave states alone is very popular with both the Democratic and Republican base. This is the kind of half-solution, designed to try to please everyone without directly committing to anything, that politicians in tough elections are drawn to like moths to a flame.

National support for marijuana legalization hit exactly 60 percent in last month's Gallup poll.

Marijuana legalization initiatives were on the ballot in Arizona, California, Maine, Massachusetts, and Nevada. These legalization measures won in every state but Arizona.

In addition, neither Donald Trump nor Hillary Clinton endorsed marijuana legalization but both took a hands-off position when it comes to state legalization efforts. During the campaign, Trump said, "In terms of marijuana and legalization, I think that should be a state issue, state-by-state."

I also predicted that Canada would legalize marijuana in 2017 and that is looking increasingly likely.

Tuesday, November 1, 2016

The amazing way to predict this election

I'm going to make a decidedly cautious prediction for the 2016 election: the candidates currently ahead in the polling averages are going to win.

While I could do my own polling average, there is no need since RealClearPolitics has been putting together a great one for years. I predict Clinton will win the presidency with 304 electoral votes, and Democrats will end up with 49 Senate seats. So when I get over 90% of states right with this prediction, I want everyone to say how amazing my skills are like they have done for other election prognosticators that claim to use far more complex analytical models.

This post is not meant to simply knock places like 538 for repacking readily available data in a more interesting format. It's mainly to point out how great polling is. There is a reason polling is a multi-million dollar industry full of highly respected organizations and used by so many different industries. There is a reason every political campaign uses polling extensively.

Don't get me wrong -- places like 538 and The Upshot are going to be very accurate next week because polling is so accurate. It will be basically impossible to know if their more complex analyses are actually better because they will diverge so little from the basic polling averages. For example, in both 2008 and 2012 a basic polling average correctly predicted the presidential outcome in 49 out of 50 states.

I bring this up because I think it is relevant to futurism and all predictions. We shouldn't be focused on how the predictions are presented. We should focus on the real sources behind them.