Month: March 2013

Dr. Rob Lamberts recently left his old practice to experiment with an insurance-less, subscription-based practice of his own. After his first month, he is surprised by the response:

We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending.  The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. …

[And] as the enthusiasm for my new type of practice grows in the community, it may spur a boom in cash-paying patients.  Why?  One of the provisions in the Accountable Care Act (ACA) is that small businesses (with over 50 employees) who want to avoid the penalty for not having insurance can opt to contract with a direct-care physician like myself in conjunction with a high-deductible health care plan.  Even though I have made no effort to attract such interest, I’ve already been approached by 2 businesses of 100 employees to make such an arrangement.

He’s also been contacted by specialists interested in partnering with him to take advantage of this model:

This seems quite ironic to me – a sort of “trickle-up economics,” where I am spreading the benefit of offering discounted care in exchange for cash to the higher-paid specialists.  It is a win-win-win arrangement, though, as the specialists benefit from reducing their overhead while getting guaranteed payment, I benefit by increasing the value of my type of practice even more to my patients, and the patient benefits by getting cheaper care.  This, of course, raises the likelihood that more businesses will opt for this payment model, and the movement gains momentum. Who loses?  The “increased overhead” comes in the form of the front-office staff doing billing, coding, and collections.  This is the staff my simple-minded approach to finances has heretofore avoided, and hopes to continue avoiding.

Commenting on Clinton’s reversal, Richard Socarides explains why the Democratic president signed DOMA in the first place:

Inside the White House, there was a genuine belief that if the President vetoed the Defense of Marriage Act, his reëlection could be in jeopardy. There was a heated debate about whether this was a realistic assessment, but it became clear that the President’s chief political advisers were not willing to take any chances. Some in the White House pointed out that DOMA, once enacted, would have no immediate practical effect on anyone—there were no state-sanctioned same-sex marriages then for the federal government to ignore. I remember a Presidential adviser saying that he was not about to risk a second term on a veto, however noble, that wouldn’t change a single thing nor make a single person’s life better.

What we didn’t fully comprehend was that, sooner than anyone imagined, there would be thousands of families who would be harmed by DOMA—denied federal benefits, recognition, and security, or kept apart by immigration laws.

They didn’t fully comprehend that the federal law would do … exactly what it said it would do. Blogger, please. That’s like Stephanopoulos taking me out to dinner at the time to persuade me that Don’t Ask Don’t Tell was going to reduce the number of discharges of gay servicemembers – when it did the very opposite. And Socarides won’t mention Dick Morris, who was the real force behind this move and who once actually told me (probably disingenuously) that his one regret in the Clinton years was DOMA.

But Socarides’ point – once you get past his ludicrous excuse that they were shocked, shocked that gay people would be affected by the law – is honest enough. They wanted votes. They thought signing a pro-marriage law would help elect Bob Dole. They had the eager backing of the gay liberal establishment, like the Human Rights Campaign, who wanted a place at the DNC money table and if gay equality hurt that, then gay equality would have to wait.

But was Bob Dole really a threat so great it was worth becoming the most substantively anti-gay president in history?

DOMA was signed in September 1996. At no point in the entire campaign had Bob Dole even come close to beating Clinton in the polls. When DOMA was introduced by Bob Barr (now also an apostate on the question) in May 1996, Clinton led Dole in the polls by 14 points. When Clinton signed the bill, in mid-September, he was up by 12 points. Dole never broke 40 percent in the polling all year. The reason DOMA was signed was because Dick Morris saw it as a key to re-establishing Clinton as a good ol’ boy. Socarides’ job was to sell this to his fellow gays. You can read his memo on how to snow the rest of us here. Here was his pitch:

The president believes that raising this issue now is divisive and unnecessary and is calculated only to score political points at the expense of this community. The president believes it is an attempt to divert the American people from the urgent need to confront our challenges together… the President does not believe that the federal government should recognize gay marriage [and] he does not believe it is appropriate for scarce federal resources to be devoted to providing spousal benefits for partners in gay and lesbian relationships.

So it was also about saving money! Look: there was profound cynicism and opportunism in the GOP on this. They bear primary responsibility. But they didn’t sign the law – and no president has to. And he doesn’t have to run ads in the South bragging about it later (something the former president and perjurer understandably omits in his new op-ed). Clinton, instead, insisted to the Advocate:

I remain opposed to same-sex marriage. I believe marriage is an institution for the union of a man and a woman. This has been my long-standing position, and it is not being reviewed or reconsidered.

He sister-souljahed us – but, unlike the hip-hop artist, we were not celebrating the murder of cops, but seeking core civil rights. Kornacki sets Clinton’s opportunism and Socarides’ lack of principle straight:

If Clinton’s goal was to get reelected and to get gay marriage off the table without a constitutional amendment entering the equation, he succeeded. At the same time, he reinforced the assumption that no politician with national aspirations was safe going anywhere near gay marriage. And the law he signed had destructive consequences for same-sex couples for years to come.

It’s been a nightmare for countless human beings. I welcome president Clinton’s change of heart, just as I welcomed Barack Obama’s and Bob Barr’s. But I am not going to white-wash his or Richard Socarides’ records. The core test of a defense of civil rights is when they are unpopular – not when they have reached widespread acceptance. On that measure, Clinton failed. And Socarides failed too.

Their failures had victims. And neither will still actually, you know, apologize.

(Photo: Bill Clinton laughs October 7, 1996 in Manchester, New Hampshire, not long after signing DOMA. By Dirck Halstead/Liaison/Getty. )

The economy added 236,000 jobs last month and the unemployment rate ticked down to 7.7%. Derek Thompson calls this “the most optimistic jobs report of the recovery”:

We added more construction jobs in February than any month since the Recession. If the numbers hold up — big if, you might say, but I’m just going off today’s stats — it will be the single best month for construction jobs added since March of 2007 and the third best month since 2006! The housing market is sort of (fingers crossed) on a roll. When it comes to recoveries, not all industries are created equal. A retail recovery is nice to have, a food services recovery is nothing to sneeze at, but when housing comes back, a recovery starts to really look like a recovery.

Jared Bernstein thinks “it’s too soon for the sequester to be seen in these numbers”:

The question is not whether the sequester will hurt—it’s likely to reduce growth by about half-a-percent and kill a bunch of jobs too.  The question is “off of what base?”  If the economy can strengthen such that it’s growing 2.5-3% this year then 0.5% slower growth still means at least slowly declining unemployment.  But if underlying GDP growth is 1.5%-2%, the impact of the sequester could be such that we’ll longingly look back on reports like today’s.

What Neil Irwin is hearing:

Robert Dye, chief economist of Comerica bank noted that auto sales and home sales data are both pointing toward economic growth, suggesting the private sector is so far powering through despite tighter fiscal policy. “If we can keep the labor market momentum up for the next few critical months, as fiscal tightening continues, many other good things will happen,” Dye said in a research note. “Solid hiring is the antidote to fiscal tightening. We got a dose of the antidote in February. More is needed.”

Floyd Norris notes that the government still isn’t adding jobs:

For the 31st consecutive month, the number of government jobs in February was less than it had been a year earlier. There is an employment recovery, but it is confined to the private sector. The only comparable period in government data, which goes back to 1939, came after World War II, when the government was shrinking for a very good reason. The year-over-year string of declines ended in December 1947 at 30 months. So we have a new record here — a record being set largely because governments, particularly local ones, have been squeezed by a dearth of tax revenues.

Yglesias picks up on the same trend:

[I]n my opinion the story of the recovery continues to be the “rebalancing” of the American economy toward more people working in the private sector and fewer people working for the government. This months 236,000 new jobs turns out to have included 246,000 new private sector jobs and a loss of 10,000 public sector jobs. Most months the overall numbers have been worse than that, but the general pattern is the same. You hear about this some from liberals who wish the federal government were doing more to bolster state and local governments, but I wish we’d hear about it more from conservatives. This is, presumably, the outcome they want. Are we laying the foundation for supercharged growth in years to come through this rebalancing?

Ryan Avent wonders whether the good news will continue:

The biggest uncertainty concerns whether improvement will continue. The American economy has been here before, after all. Indeed, hiring early in 2012 was considerably stronger than it is now. Despite the relatively strong run of employment growth since November, year-on-year employment gains are well below the best performances of the recovery to date. For employment increases to continue, economic growth must pick up. In the past half year, GDP growth has been only mildly positive. And while the payroll tax increase seems not to have slowed consumers too much, there is time yet for the spending cuts in the sequester to do damage (and there are more budget battles ahead). When all is said and done, fiscal tightening in 2012 will prove substantial, making it hard for hiring to generate much momentum.

Felix Salmon throws some cold water:

All is not entirely sweetness and light, though, as Brad DeLong and many others have noted. The number of multiple jobholders rose by 340,000 this month, to 7.26 million — a rise larger than the headline rise in payrolls. Which means that one way of looking at this report is to say that all of the new jobs created were second or third jobs, going to people who were already employed elsewhere. Meanwhile, the number of people unemployed for six months or longer went up by 89,000 people this month, to 4.8 million, and the average duration of unemployment also rose, to 36.9 weeks from 35.3 weeks.

And Daniel Gross is more upbeat:

Compared with a year ago, there are 1.966 million more people with payroll jobs. They’re working about the same number of hours but at slightly higher wages, up 2.1 percent from February 2012. These gains aren’t nearly good enough to recover the losses suffered from the Great Recession, but they represent real progress.

(Chart from Calculated Risk.)