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Assessing the Trump Cabinet — and Exploring How Recessions Affect Health


Sarah and Matt take a deep dive into what Trump's cabinet picks say about how he will govern, with a particular focus on HHS Secretary-designate Tom Price. Also: an exciting white paper on recessions and health outcomes!

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This. We support is also sponsored by Nature Box, gotta, nature, Baxter, Comstock, weeds for fifty percent off your first order. The following podcast contains explicit language. Again, hang up, home Come to another observer, the weeds boxes, policy, podcast independently, apparently, network Matthew, the joined in studio by Sarah Cliff, who has brought the Seattle rain. it's disgusting efforts in the sunlight and like two weeks, its growth, it sucks its is especially bed with toddlers who like to go outside and Azra has left us from New Orleans. Outta here is very sunny yeah, it's just the two of us now, just the two of us. It's is grim. Conditions are grim, but we owing to a soldier thrill. Keep keep keep hope alive with this pod cast
We're going to we're reach into into the White Paper archives later to talk about something that that I've been thinking about in light of recent results were going to talk about an Obamacare replacement plan, which I know will be at a radical change of pace. Coverage, but but I wanted to start out with a kind of like, like a broader view of what we ve seen in the news from Donald Trump. he's now rolled out a lot of cabinet appointments. We have been Carson at hide. We have Betsy devotes, add education. We have Wilbur ROS at commerce. We have Nicky Hayley as you and Ambassador, which is going to be maintaining its cabinet rank. We have lain chow, pulling Chow it Transportation Tom Price, for health human services and Treasury most. We lay Steve Manichaean. I am not. My sources disagree. A little bit on how you pronounce his name
Have you no, please tell us the highest ranking current Treasury Department official, who have discussed this with, says it's manoeuvre, and what's the other options are I'm going? I've heard nuke in manoeuvre in this thing Question about how you pronounce the M in his question about whether the sea age is a check or why we have to wait for an announcement to make so here I am anyway, there's there's a lot of calves. I saw him on CNBC this morning, but it was sound off Santa subtitles. I, where I should I should have tried to try to get the idea we cabinet shaping I am committed to shaping up, and one thing that's interesting about it is that it's not that interesting. It's when we had the very first sort of Trump announcements ride. It was like. Ok, we'll have rents previous as chief of staff. so like. Ok, that's like a bridge to the party, don't have Steve Ban in whose, like this crazy, bright barred editor as a senior counselor, we have Michael
Lehne, who it seems like everyone in the government hates as national security adviser and wish him you'd, be a little bit of alike. Woe Trump administration. Would you be a little expected because terms, Camp in, has been like a word, but is we ve moved into the cabinet officials? Oh of course, Jeff sessions just as yours was over the bridge between these errors be conjectures real outlier in the Republican Party on the issues, the Justice Department overseas? He is a much more strident. Anti immigration person has a very staunch record of scepticism of civil rights law. Think things like that, but he's also its United States senator he's not like who's this guy right like easy and fun. So We keep seeing people who I would tromp is a little less focused on the idea that he wants cabinet secretaries who have experience in the
federal bureaucracy or managing comparable state agency is then we ve, seen from from most presidents like that bit Betsy Devoe set education seems typical. Does this to me that the last few patients secretaries than the current one Arnie Duncan his predecessor, both of their choices under George W Bush were people who had run public school system, and so now they were gonna be education sector. Betsy divorce is not like that. She is a heiress and donor to conservative political cause. Is primarily focused on education policy, so she's not like a veteran administrator but she's a paid up. Member of the republican Party. She was a major soft money donor in the soft money daisies into super pack. She duds education policy. She has,
slightly extreme conservative views, uncontrolled education, but not recognisable ones. I mean that nothing is vouchers. Charter schools, nothing you haven't, before and on down the line. They are basically like that their see my pretty normal conservative Republic right leg, it feels it gets going more in the rights previous like. If you think of Steve, but for those who do the first staff members travelling ugandan rights, friends previous and that they fit more into the rights previous. But I will say the one thing that feels a different which you mentioned is that There is less of an emphasis on like this federal experience. The granting of the cabinet that Obama most recently put together a lot of the prominent names and that our people, who had been in the government in one way or another, we recognised, but in a way as we are
talking a little bit about before you start taping like you, you had Hillary Clinton. Secretary of state was not someone who is like a super experienced diplomat by, but someone you kind of within democratic politics, and you actually kind of see a similar. A similar cabinet shaping up from Trump? I think one of things will be interesting missing. This group of people who are there is an exception and second detente price at it. His wine Alain Chow, with total inside our marriage, married to the Senate Majority leader, but a lot of people who are coming into federal bureaucracy for the first time it'll be. I will be interested to watch how that goes, unlike what that looks like in terms of agencies round like what changes. What doesn't change when you have a lot of people who haven't any really been these agencies are working in these agencies before so I feel that there is a slight The swamp tend to it. But it's not like I don't it's like these people are divorced from these issues and
in their market, but a meal. On the one hand there not like divorced me issues than I know. There were some concern right that, like Trump would pick Treasury secretary, who didn't actually know anything about financial markets and maybe some crazy design what would well out I'm a neutron who is at a veteran Goldman Sachs Sky. Then had his own hedge fund He like knows this terrain, he doesn't know the Treasury department and will probably, if he's smart, need to pick some assistant secretaries, who may be worked in the Bush administration in our or work in the Federal Reserve. System somewhere, who can help him like understand what how things actually work in the department, but he's gonna knowledgeable about financial markets. So that's all good. On the other hand, a big part of the promised during the swarm I mean I think about this, particularly in Treasury, right like when tromp was in his final battles with TED crews. He explicitly
called out the fact that TED cruises wife worked Goldman Sachs when he was running against Hillary Clinton. He explicitly called out the idea that Goldman Sachs, I'm in his words, were totally controls. Court, unquote, Hillary Clinton he put in his final tv ad, like ominous looking photo of Hillary Clinton standing with wide blank fine, he now has a Goldman Sachs Guy running the Treasury department. Pillar. Couldn't would not have done that there would have been intense pressure if she tried to do it Senate. progress will not have stood for it. There was no way that Hillary Clinton was going to literally put Goldman Sachs alumni in charge of the government from is doing that be a viable ban in whose kind of political outside We are now Goldman Sachs, veteran admonition, who was a Mitt Romney bundle. A sort of conservative guy got Commons exit alumnus. So to that extent
If you imagine this whole Donald Trump thing. This had happened right and, like some Republican had run against Hillary Clinton. Most people would have said. Hillary Clinton is not the most leftwing Democrat in the universe, but that by and large the Republican Party as it has been since eighteen, sixty or so is like more. The party of big business interests than the Democratic Party is, and that's just part of how politics is Trump seem to up in that in various ways, and now that he is taking office is really not appending right leg. It's not like the populist the net if you are going like full populism. This is not the cabinet. You would expect to see Bible question for you, mathematics, love it off topic the Mckenna, poverty pronounce Gauthier pronunciation. How do you think about what that means for TAT I know that just came out last night, even a ton of time to read up on ethnic walk me through how you think about him running touch her it's a little puzzling. Simply
because a lot of sort of finance guys who get interested in politics and government, one where the other start expressing views, federal public policy question. which he has really not dine. There was an interesting Bloomberg profile of him. I should note is that this I think, was like a really odd media failing in the campaign, but he was the financed chair of Donald Trump campaign. He was always the guy who was like rumoured to be the leading candidate for Treasury secretary, so be it new that, like people who covered the department- and we will cover wall Street- were aware of this fact, but that fact never like my greeted into like mainstream political coverage of Trump and Hillary Clinton, arguing about bank regulation in in an odd way, but back during that time, when minutiae was being covered, third, it like an assignment noses, good Bloomberg profile of them. Where you know they mention that, like
oddity of it is that he didn't have any particular stated opinions about Donald Trump or american politics, but they have a quote for him where he's like. Well, when I get a big job in the administration, people are going. Ask me why I was supporting Donald Trump. However, you mentioned this last week idea. That's insane quote as a weird thing to say, so you know cause. I mean I don't know, but just to set a normal baseline, which you would have expected him to say with something like I think, Donald Trump has the right vision to do x and why, which will be good because a and b- and he didn't say that he was on CNBC this morning he was his. His big idea was that we were going to have a cut in the corporate income tax rate that was gonna help companies move cash back on shore and boost economic growth. This is like the,
generic will embody thing. I can imagine a person saying, like literally you could have copy and paste this from my Calvin Coolidge or with anyone who has ever Public and lower corporate income tax rate- that's that's what they're all about! You would think that a guy from the hedge fund sector would not be in favour of the recent steps the Obama administration has taken to do more oversight of the hedge fund sector. He hasn't said that that's what he thinks exactly theirs planning Congress to like rollback, Dodd Frank Donald Trump gave a speech where he said he wants to roll back down Frank seems like a banker guy from Wall Street would agree with that, but he hasn't. He hasn't said much about it. This bringing cash back from overseas. I should mention it's only. The technical term, for it is, is bullshit
Why? What happens? Is that you're supposed to pay taxes on your profits as as a corporation in the United States, regardless of where there are earned? But you don't need to pay taxes on the foreign profits until you, rather, if, if you have a subsidiary ride, so apple, has this irish subsidiary Apple, Ireland, an Apple Ireland, thanks to some fancy legal work? Is this incredibly profitable juggernaut because, like every computer, every I found that apple cells in Europe, they, like apple juice, These subsidiary makes no money off of it because they have to pay enormous patent licensing fees to Apple Ireland, which Ireland is this like profit making gender not because they dont have a corporate income acts. So then, this money sets people say often on the business press that it's off shore, but it's actually control date. It's in Nevada is where apples, financial management
and so they don't pay taxes on their money because its owned by the irish subsidiary, and so they can, but they can do whatever they want with it rightly give apple, had a desire to like build a factory. They could get that money, it's not like walled off somewhere in. They wouldn't need to pay taxes on it, which is crucial because it not a profit, if you're recycling it into investment, the only reason they would need to pay taxes on it is if they wanted to do a dividend or stock buyback. So what what minute is talking about war, Republicans of atonement for years is we should let companies bring that money back tax, free or at a discount rate, and then pay it out to shareholders, which is great, if you like, a major apple shareholder, which maybe he is maybe Donald Trump is we have no idea but has nothing to do with the ECB,
me, so that's his idea, so that feels a rug using the very generic republic into meat, which I could see like a lot of people who write. Listen, the show a lot of liberals or could be like. I don't like that idea, but is also a good idea. That makes sense if you have a conservative, administration anything adjust its work. More similar to what the marker, Ruby, rise again was I do aids than you might think. As I look for good or bad right as I look at the cabinet, it feels like less massive threat to democracy and there are like, like, as you have written like, there is still citizens pretty significant threats, allowed the conflict of interest up you ve been covering, but then, when I look at the Cabinet feels like a little off from like what Marco Rubio would have done, but like a cabinet that does not sound some crazy or like a treasury secretary that, like the if Marco Rubio had picked him like wooden I like off the wall in a way like trump often often was and the republican
Mary, where he had like. I know, particularly in health in others bases he had quite different views. Often from Ma Am, but it is true that there are often different views in history, mention, then you actually look at his like policy papers and they kind of seem dyke this game of telephone republican proposals like someone who told someone that, like something or other, and then you end up with that no state lines and like these very vague things, look sort of like health care proposals, but but at least in a lot of the statements, making during the campaign he felt quite out of place in Europe and in part and now we are looking at a cabinet that seems quite at home in the Republican Party I feel accessions is kind of the one that you are saying. Outlook he's been rejected for for confirmation before our duty, somebody's is there anything. I say I wrote a peace that that I think will be interesting, but it did the tunnel. The peace was like it turns out. We should have taken from literally, and you know, if you look not at like what
on trumps, twitter, feed or like what did he say in alive television interview, We say when he was feeling flustered in a debate but like what did his white papers set and they were pretty conventional republican white papers, except on immigration, where his book, missiles were not like on working, there was an issue on which the Republican Party has had significant divides for years and which trumps white paper view we strongly sided with the Jeff Sessions faction of the party, which has traditionally been a minority groups in the party. It's not like a coincidence are mystery. Why that is its? The white paper is written by guys used to work for Jeff sessions and adjust sessions is, can be attorney general, so you see an area in which he
If thing, certainly shifting from how George W Bush approach immigration and you have areas like taxes and regulation, where his seeming very similar to two- how George W Bush was going- or just congressional Republicans writ large, but in all cases its closer to this sort of vague into the vague statements the website then to the kind of maniacal right statements. I warrant a lot of them, so they felt like big guy. They were easier, ignore when you're, they cover Clinton at these massive white papers, super detailed policies and then the ones at least I've looked at the Trump ones are usually like less than a page like super. Brief, but there are generally in line with party see, I dont think and the given about this performance, but that those policies guy one weird thing is that by not going into detail trouble was made. It troubles seem to give reporters a path uncovering announcing over these serious policies. You need to do.
This may words to them. I think I fell into that trap at some point and I did cover his his policies, but they are just harder to cover because there is so much less there. But now we are seeing those being one page outlines get fleshed out into actual policy on your right that those are the things is that are mattering a lot more than the things trump setting a debate Earl accepted a twitter account Tito understanding? I should have taken more seriously station that that I had with the sort of senior Ab Senate Senate Republican Guy- and you know it a man like you know, tromp than like. What's what's goin on, you know he was clearly not thrilled with the idea of Donald Trump, as the Republican Party nominee or trying to sell me on the idea that Donald Trump was can be like an amazing president, but he's You know he doesn't seem that interested in the details of public policy, so we gear he's gonna come in he's gonna get like some of our
a yellow, guys, we're going to our bills and he's gonna sign onto them, and maybe he'll have a signature issuer too, and I think that take right d, like orthodox conservative, the the people who are least covered in the whole campaign, we're like we were Publican Party elected officials who were not going like never trump, who also warrant like doing the like embarrassed. saying Rudy Giuliani, Chris Christie trumps surrogate thing, but we're just like they were supporting from there weren't Convince people that, like nominating tromp, was an amazing idea, but they thought it was an ok idea and they thought he would be an ok president, because I thought he would be of republican president, who would appoint republican people to jobs and sign often republican policy ideas, and I mean
we're still like what negative six weeks into the tramp administration, but it seems to be worth weak. The correct I mean there's a space where things you're normal. That feels like more the legislative process and pursuing these policies. Conservatives have the part that still feels very abnormal the conflict of interests and like Our international relations seem like they are going to become very annoying. But then, when I look at the legislative side, the covering the Obamacare fight like that that feels that gets proceeding as it would with anywhere public. wait any idea. Why don't you say, there's something like odd about tromp or in some ways alarming, but like there were some takes during the election season, someone vocs, maybe even one or two by me, but it like some really good ones by by Lee drop men about like a A realignment of the ideological configuration of american politics with, like Republicans, may be really like embodying a like white working class politics and Democrats, Willie leaning into like Cosmo.
but in his arm and globalization, and like I just don't see India any sign of that. That, like Trump, is odd in various ways
maybe just ways that are entertaining maybe ways that are alarming but, like the horror policy agenda is pursuing, is a very recognisable variant of like american conservative politics. If you're anything like me, you know sometimes you wanna snack end if what's allowed snack on his junk food, you gonna eat junk food and it is not great. So if you want a short and live a healthier life, he did start snacking healthier with nature box. It makes next that actually taste great and their better for you to create with high potty ingredients that are free from artificial colors flavors of sweeteners. She can feel ok about snacking. I like some their dried fruit staff, the great apples, a great pairs. They also have some in a study, more indulgent, principally things in their that that I also ask for- and they recently made this service even better. You can order as much as you want, as often as you want with no minimum perched required anythin cancelling anytime I so it's really simple, you gonna nature by
calm. You check out their snapped catalogue. There were hundreds next to choose from there always adding new stuff. You choose what you want. They deliver read your door, it's easy, but nature max! You never get. Bored is new stuff there, each month, it's inspired by real customer feedback and for some reason something comes you don't like it. They will replace it for free, that's a good opportunity to try something new, I'm so right, now, you're, safe, even more because nature boxes offering offence fifty percent off your first order. If you got a nature box, dot com, slash, weeds, she's, gonna, nature, box, tat, complex weeds that we get credit you get. Fifty percent of the first order, Nature box, dot, com, slash, and with that I mean I think I think it would be good to look at one particular nominees Tom Price coming in his other human services secretary, who does not
experience, particularly with that agency, but has been chairing the relevant committee and that in the house- and so I know you know, has a: u you written about it, but like he has a detailed, specific legislative framework for american healthcare policy. Yes, I think Tom Price is the guy you pack, quite serious, about dismantling Obama care like that really seems to be where prices legislative interests lie. he's done some work on medical medicate? That's mostly as budgetary! So we ever see budget process? He makes these different proposals to change medical. medicated in ways that really cut the programme, but but those are seem to be kind of a hold over from Paul Ryan who at the position beforehand, where he has focused most of his legislative efforts, are like thinking through one, the logistics of how do you repeal Obamacare, so here Is the lead author of the reconciliation repeal Bell that past about a year ago, so he was the one who worked through how you can use this reconciliation.
process to pass repeal by simple majority instead of the sixty member filibuster proof majority and to replace it with. So he is the author of. I think I am right on this. The longest Obamacare replacement Bell in Congress. It SAM Two hundred forty two pages long, it's pretty detail that does not replace Obama CARE, but it offers a framework for what would what would come in and what would replace it's it's worth. Having dwelling on a little bit just like, because one thing that sometimes you know has been known to come up with people like they haven't even read the bill and end the reason. People only read the Bell is like bills are super long. super unreadable and policy broken Those normally take the form of like maybe a detailed positive proposal would be like at twenty six age ready. I like going around like Paul, Ryan's Obamacare placement, which is quite similar to prices. That's like twenty nine page,
white paper and then, but it leaves out so many important details like how big the subsidies you nowhere. how much do spend on Medicaid, whereas when you move to legislative language, you actually have to put those detail, falls into the plan, and then you get a much better sense of what exactly will look and cohesion price has done. More work on this. Yes, then say, One in the Obama administration had done on drafting Obama care at this Well, I mean Democrats had a kind of rough and ready framework of what they were doing but like they had to, I mean not per se the judge, S department, big Macs, Bokkis and those guys they intellects start writing bills in the winter right price has already yes, there's starting and it's kind of thinking about this this morning. That gets probably this bill that, Tom praise. In all honesty, just expected to cultivate, hang out on a shelf.
however long and all of a sudden, it's actually quite useful document for Republicans two halves there like. Quite similar to warehouse leader Brian, as Ryan, put out his better way, Obamacare replacement, which is much less detailed. That price bill is called empowering patients and it takes a lot from that bells if they really have a framework for what comes next ended, something I am therefore likely changeful I'd say it's like a bill like that It has a lot of things. Republicans wants but may not be able to pass, for example, it wants to cap and player tax exclusion, which is something like every economists than ever. two things: a great idea and all the hundred fifty million people with employers sponsored ensuring think is a terrible idea because it will increase their costs. So that's one that, like a it's in there, it's on the wish list I don't think it's moving forward and then, on the other in terms of our impatience like water, like some big did
How will it empowers Rio? Where am I gonna I need my my premiums to be subsidizing. Like ladies birth control, anymore. Yes, you will have your on the individual market. You ought to pay, for others annoying pregnancies that women keep having. I agree that Mary empowering so it's I mean it's a very it's a very different insurance market that the price of Bell envisions. It is one where you can charge sick people more again so, and this is like a place. I want to dwell on just a little bit because I think the rhetoric grounded is going to become very confusing. So you hear politicians like Trump like price say we're gonna, outlaw preexisting conditions that no insurance company can deny you coverage
and that is true in prices Bell. It does require insurance companies to accept everybody, so sure I'll cover you right, we're a million dollar. So the catch is that if you dont maintained, continuous coverage of you at some point lose insurance for a few months couldn't afford it forgot to get around to it whatever insurance companies did. You have to offer to you, but they can charge you, however much they like to charge. You and you have to maintain under the price bell. Eighteen months of continuous coverage before you can get back to the standard non sick person and the price, but exactly the most detailed on this. It says that if you have your breakin coverage, insurance companies can charge you a hundred and fifty percent of the regular price, which could be quite a large increase by. I think that's something important to keep in mind. As we're gonna hear a lot about pre existing conditions. There is a huge difference between telling insurance companies they have to accept everybody and tying insurance companies have to charge everyone the same amount, the republican bells they do. The first
they do not do? The second tell us that they would in? This is a replacement for the individual mandate. This continuous coverage provision instead of charging you a fee for not having coverage, they basically say if you don't keep your coverage or you're going to get locked out of the cheap rates going forward. So it's it's a policy. You need it's probably a policy if they could leave out of the bill, they would because it will be unpopular but to send you need the individual mandate. You need some kind of motivation to get people on the market. I think there's some reasons You think this is an especially harsh penalty, one that could affect people for years. After you know they make a decision to go and covered for a little bit, but it it'll go empower you'd! Think a lot about em about making sure maintain your health gotta have let it happen if I got it like Medicaid am I can really my I'm gonna, make me empowered I'd, say it's it's! So the praise spill does nothing to replace medicate expansion, and this is another place where
really do Saigon, poor and I'm currently enjoying free recovery free healthcare, you gotta, be empowered you'll, be empowered to not to see the doctor what you're late you're in your mid been thirties. I think you gotta get twelve hundred dollar tax credit to buy a vendible tax credits. You know when we use of all but twelve hundred dollar tax credit to buy coverage, which is probably a lot less. Then the price of insurance, and if I don't get cover you dont get However it and then I went back so then you end up in this manual coverage right, isn't that there will be they do those areas that need you propose these high risk pools where people who end up in that situation, but the details, even in the price planner like soup, vague the funding who knows how much will be spent on it Tom prizes. specially skimpy and the high risk pools. He proposes.
Three billion dollars over three years, Paul Ryan's at twenty five billion over ten years, but basically in Tom prices plan you have high risk posed for three years. I guess you presume everyone gets covered in those three years than you: don't need them anymore, but but the medicate part I I think the Republican Party has shifted a little bit on Medicaid. Since price wrote his plan, we'd have a vice premier. Under an incoming vice president who expanded Medicaid, Ryan Plan envisions. Keeping a very. Then, of medical expansion, which is not is not nearly as generous as what exists now but it is an option for states to keep it too. I think that's one place where the party has evolved since price wrote his plan and I think they are going to have to go back and revisit Fifteen million people have joined, barricade, sense, Obamacare started, and I think that is a space where I would expect them to try and do like something if not saving the entire thing. But
lay with the planned as I do that the very ok, ok, ok, be nice. If someone else say say I'm like I'm healthy, no major illnesses and I'm and I've got like a good job and I'm above four hundred percent of the poverty line. So I'm not getting any amount of care subsidy our guy see no one ever make yadda yadda yadda pregnant shores. Rapid, I don't. I don't want birth control us as great as it does. He empower me twelve hundred tax credits is it so I bought a won't help me because Obama feels this. Is I'm not sick or poor? You know I shouldn't really get healthcare money from the government but Tom prices can empower Tom price. You know, like I said the gear in your mid thirties, regardless of what you aren't so that the whale balmy care works is their income. a tax credits, the less you are in the more you get, the idea being. You need more help to buy insurance. When you are less money, in the end. This is across the board nor republican plans, except for one the tax credits become aged ages.
So, depending on how old you are that determines how much you get so bill gates, for example, who is a network of three billion dollars, he actually qualifies for the most generous tax credit under the price planet. I know he is in the oldest oldest age bracket. So forget eggs, I think, was a three thousand dollar credit for this goal gates, so use impact so but so bill gates. Media is getting this tax cried and he's probably super thrilled about that, because it will be obvious insurance, the Gates Foundation, but you have a lot of these. You know Bridge Silicon Valley, tech, folks, who are not getting employers sponsored insurance. Maybe so it's a good plan if you are wretch, if you are, if you are healthy, for example, if you want- and this has been a constant grape republicans not the affordable care act. They argue that it mandates to many benefits, and I think this is a totally fair. You no argument to have about the structure of health insurance that mandates coverage of maternity care.
Lot of free preventative services and there's ten list of ten essential benefits that data that are required, which so How could you not have to back there's a fair there's, an argument. I get on the conservative from conservatives that the idea of insurance is sick, insure against the things you do not expect happening. to ensure to finance its not really about health. It's about financial protection that, if you get hit by a bus or whatever you don't wanna, go bankrupt from that and would disagree with the idea of offering these preventative. The expected benefits that everyone here, so we want to make health insurance more like. I don't know why homeowners, yes, where right like. If something terrible happens. Yes, you get financial assets, hence but like if you just like many Julie, you're no story like that's just
and they want. I don't think they envision onshore, like that. They want that to be an option on the table in a way Obamacare really doesn't offer. They do allow catastrophic plans for people up to thirty, but after that you can't buy into these cattle. Plans so, but so I merely Obamacare vision its words it because it's not like he was this everyone would like free Obama from scratch like the idea. I mean- I don't know whether you people bait may agree with. It are not right, but the idea is that health care is just something that is useful to have when you are desperately ill, but that routine preventive medicine like is good and promotes population health. So we should be pushing it on people and we will get in the long run like a healthier set rife citizens if we encourage them to do that right at whereas there
the price vision is different. It yes ends. So we hear his vision of a very good if you're somebody's healthy, who doesn't want all those benefits, would rather kind of take your chances on having less coverage. That thing or bombing here does Zeb requires new everyone on the market to by all these benefits, and that makes it didn't fleets the price. As for young people, it deviates the prices for old people and it makes it affordable for their older people buying on the marketing of coverage, because all of us, even if we're not going to you if it's quite unlikely, we're going to use these benefits, were all paying for them. The idea of the priest bill is it mandates fewer benefits. It allows people to kind of take more of a chance to say I just want to have much skimpy or coverage and I'll take my chances on ongoing without those prevent an event visits. I want to pay less for doing that.
that's good of your young and healthy, it's probably quite bad. If you're, older and sector, one of the other big changes the price bill makes is right. Now, a bomb care has something called an age band where it says you can only charge old people three times as much as the youngest Obama. Current role in that kind of artificially constrains the premiums for the people, who are all this to typically have healthcare costs five times the youngest people. The postal gets rid of that age. Bandits as you can charge old people, young people just like charged whenever you want charge that, like the old people, much as you think, it's fair to charge an old version, healthcare costs. So again, another way? You know if you're older, the price plan very much disadvantages, But if your younger, I mean the premiums are probably decline quite significantly below
insurance companies can start pray saying plans for how much they actually expect to health, insurance or Cassio. So there's a particular irony here that I do think it's noting. Is it if we think about the recent demographic structure of american politics, you will find that people under the age of thirty five or so were super enthusiastic about Bronco Burma a little bit less enthusiastic about Hillary Clinton, but really hated dumb tromp. Whereas, if you think about like a really stereotypical like like who won this, four tramp like whose swung away from the Democrats older working as you have all too often in community, is we don't know so much about their individual level. Health, but we know that the community level, health in area, that swung card from Trump has been has been not so high, exert a classic thing. We will talk about. You know which at which, I think
True, is that you know in the long run like the economy we balances, but if you're like a fifty four year old factory worker who lost his job due to chinese import competition, you're not really gonna, like retrain as an app developer. You now probably stuck in a lower paid service sector type job and you really screwed under this Yanks. It's a weird way where I see political full, like policies, views kind of at odds with demographics, where I think Republicans generally, believed that we would be better off if we had a health insurance system that mandated fewer benefits that are cheaper premiums. The kind of release health insurance more like homeowners, insurance, politically and they took quite strong about those policy of years. It doesn't help the people who support them in thick, exactly
the democratic side. Where Democrats really believe that health insurance should be a safety net, that it should help people get healthier and that we really care about providing that prevented benefits and again that helps the exact people and we and we do not vote, will you go further left as actually even more extreme right that I Obamacare was, relatively speaking, better for older and sicker people worse for young, healthier people, but like we care even better, would very likely even more like young. Healthy people would be getting health free health benefits they wouldn't use and sick people would be getting a lot of other say that's a little different because it presumably be bad for the Wretch rack structure of it. Well, but it right. Yes, I mean that we will be, very bad for me, just in terms of in terms of the philosophy of like what is the health insurance Cherub rank the further right, you,
the more geared not trying to like level health and aged spare visions, and just in some kind of like pure ensure its function and how bout, younger and and healthier people so they're not shouldering the cost of other people's health care and, as you move after you get more and more into like total pooling of rest Scrite, unlike through the tax code, people who are not going to see the doctor very much are paying for everyone else's Braddock, your vs right. and in the structure of american politics like interpreters. Who is that his eyes at that time for a white paper in our white paper? Why I think, we're actor and be are finally are I got. This is like a horse is only a favour, but history is from twenty fifteen a visit. They all paper from from twenty fifteen by Christopher Room or may be wrong, but I think room and it's called health effects
economic crises? It's like I've been thinking about a lot since the election as people have been interested in knowing what went on in the economy in health and The room is building on a larger literature in which he has been a participant which shows that recessions are good for health outcomes, so orchestra I was thinking so I'd have. It seems you there was like, like the old view, was that sessions are bad. Health outcomes causes bad to be poor, which makes a certain amount of sense, but it turns out that when people have jobs, one thing they do is they drive to work is a good way to die. They also have more money in their pockets and selling people like to do when they have more money in the pockets is smoke cigarettes and drink alcohol, which is bad for you
then the other thing they tend to do is get like busy and stressed out, which is not good for you. When people become unemployed, they tend to cut back on drinking and smoking. They cut back on driving, they increase the biggest thing they increase is television watching, which is why we tend to have a negative effect towards the idea of unemployment. But people do sleep more: they do more housework and childcare, which are both more physical activities. They exercise more, they socialize more. So all of these things right that the tv is like the biggest chunk and it's like neither are there, but many of our jobs are similar to watching tv say just stare disagrees. Aren't you staring at me? driving you boys forget but is like incredibly deadly. So young people people talk more to their friends and family there, size, a more they sleep, better, they drink land,
they smoke last. It is true that in recessions, more people kill themselves, so there is a real negative impact there, but it is outweighed by the positive benefits. There's a pretty robust, find across. U S, Recessions studies of Germany's studies of Spain, unemployment not just but like general impact instrument, not poverty, em- and I should say you don't know, overstated but like when everything unemployment rate they eat, mostly unimportant, but to some extent it's like just like you, know, cut by having less money in your pocket like it's all good, and so what we want. to check was like. Likewise, ok is a different when we have like a giant cataclysmic recession like like we had recently and he goes through, you know the depths of the recession and he finds no big recession. Is a small recession, but even more so like
even more suicides, but even more benefits and on the other side and the If it's do, they outweigh the increase in the do they got that the same celebrate here, it's it's just as best we could tell like you just. Else like it's, it's just the same as a small recession by bigger, so like nothing, interesting so I was interested in this paper because I think one interesting thing that started happening in twenty fifteen and twenty. Sixteen is that, as as most indicators of the economy indicated that the economy was getting better than it had been, is that two groups of people write like one like the hardest core trump next, like the kind of people voted for Trump in the primary and then all
so the hardest core, like Bernie Sanders people, the people wonder like radical political change, had a tendency to insist that no actually the economy like was still doing terror and then from won the election? He got less votes than Hillary Clinton, but he won the election anyway that like lead to an increase in the sort of like social status, of the view that, like actually, the economy was in more terrible shape, and so one thing people would point too, for that was a number of very bleak sort of health indicators that are happening, particularly in the sort of most trump friendly tag. Demographics and while this paper doesn't speak directly to that, it's a reminder of the fact that in a developed country like the United States, how often income growth are just not that closely correlate know if you have a community which is
as a skyrocketing death rate. There is clearly something going badly wrong there, but this no particular reason to believe that the that is going wrong is economic deprivation per se. communities that are being devastated by opiate addiction. Example may really just be devastated by opiate addiction. You know like how I don't know like Hurricane Sandy wiped out some very affluent tat. Hans ride like it was like the the thing was really the thing you know and in some ways the economic recovery may have exacerbated some kinds of population, health problems that exist and in every certain certain areas and in certain community is, I think one thing. That's where things I wonder about kind of an put this paper. This whole body of research is an
It definitely seems to be quite true that there was a positive health effects. Recessions for all the reasons you mentioned at the same time, I don't know what actually feels that way to people, and I think this like ties to like the suicide rates, that I think you can have both improvements in mortality. And mental health declines. Where you know you're you're not going to eat your driving out. The positive and maybe you're spending more time socializing with friends, but you're feeling like very separate from your community here at home, you're feeling bad about yourself. You know you're you're, playing for jobs, you're, getting rejected that you're quite isolated and like that social fabric, you have around youth created by claimant kind of goes away. You're spending a lot of time on like menial household tax here things you don't don't enjoy to so one thing I wonder about it, is you don't feel you don't see around? Oh, how exuberant driving and like it seems like a lot more people are living and, like I feel good about this down
turn like I imagine, you still feel kind of shitty about the downturn, even as This mortality am even as it you're having as mortality effects that are quite population of only quite hard to actually here, one I do think. Obviously, the causal attribution of suicides versus car accidents is going to be. You are obviously different right if you hear that your cousin lost his job and in five months later he had found a new one and he killed himself you're, not going to say like what everybody who loses their job kills themselves, but you're obviously going to draw the line between to avenge where's, your cousin John just gets in a car crash and gets a job, and then five months later dies in a car crash. You're, not gonna, think oh man,
if you hadn't gotten their job you'd still be alive. Today is probably true right, but that's not how we think about things, because employment for people of the appropriate age is just like considered the norm and commuting to your job in a car is also consider. norm, so the fact that a certain number of people die in any given weak driving their cars around it's not like. It's only mentally, socially or politically processed as like deaths, because people had jobs, even though, like an literal sense, that's what's that's what's going on So you know, unlike the exercise and and stuff like that, is a little bit vaguer. It's like it's like small scale stuff, whereas, like people are sad, people become depressed. Some of those depressed people kill themselves. Some of the depressed people become drugs acts that, like really ways on you, as like economic problems, are leading to better outcomes. Yeah,
So did you see, I think, it's easier to feel the negatives of animal, even if we have this academic body of reserve rat. If you look on the more micro level, That is a lot easier to identify the the negatives of of the doubt You ve heard of downturn, and I M kind of see those much more clearly than that. Like some someone, you didn't die grab driving to work. I do think it is important to keep in mind not so much because you know The next item is a recession. Don't they would make sense to go on being an asshole Who's gonna live longer, but did you know the United States is a fairly wealthy country overall? I think you know Luxembourg and Cutter and ahead of us, but we're not a country without problems
and one problem we particularly have is a much lower life expectancy than a number of other advanced developed countries and its interest. It's worth recalling I mean, I think, particularly for for people on the left right for people, were for people who really didn't like it when Hillary Clinton said Dynamic because already great, I think those people- people whose instinct is too was to react negatively to that message. I think, should should hold fast to their negative reaction because they know their these serious problems in the United States, but should recognise that many of those problems are not like economic per se at this very little reason to believe that increasing the employment rate in the United States would fix that. act that we have a much lower life expectancy than than most other countries is not even
much reason to believe that the you know like the problems of a bomb care premiums as up while very real sort of those are money problems much more than like health outcome problems right. That, like Americans, appear to be compared to other people and in developed countries less physically active, eat less healthily and that those kinds of things to you know they need to be like addressed more true. We also mark accidents yeah, we will, I mean we drive more drive more per person and our roads are not the safest on a permanent basis. So, like one thing, if America is going to be the dry vs country in the world and so one of the richest countries in the world, maybe what really invest in making our driving unusually safe, which we have not done it's about average in its dangerousness and any other countries, roads safer
what changes are really make speed limits like this literal physical have met his eye. since, as I said, the design of the cars I saw our caught wherein on arms race towards heavier and heavier cars which, on the toll, makes them more lethal. There's things you can do, but It always just to say that, like opiate addiction seems bad, car crashes seems really had, obesity diabetes like there's a lot of bad things going on out there and its also true that we recently had a big recession, and it's sort of tempting to like draw straight line between those things. But it is, he seems like that is not correct. So how do you think? about two. We know that these areas that are quite sick and in poor health are bigger trump supporters. A cut of this paper
is changes you think about those areas. Are I mean you think about this place? Is in the country? I think AEGIS reinforces that, whatever, like the most serious social, again. There are some people in United were living below the poverty line in court is states at times of extreme material deprivation, and they could probably best be helped with with more money, but I think that if we're looking at communities that are specifically experiencing public health crises, I'm not like an expert and thus like- I know more about economics but like what the economics are telling us is that economics is not. What the problem is exactly that. Employment is an idea that lack of employment opportunities is not the issue. what do you mean? It is money that was it. There was another reason paper that maybe we should talk about Sunday, but it, but it it tried to look at like lower income people and when they get more money, do they eat healthy food because that's like one. We know that, like richer people,
eat healthier food than poorer people, but a different question is is like: if you give the poorer people like twenty more dollars, did they go out and buy something healthy with it? And no, is it really gotten bike soda, which is which is bad and is similar to when people lose their jobs. They cut back on boot right and you know frankly I mean I, I enjoy soda and boots and and other unhealthy things, but you know it's like that right. It's like people who have unhealthy consumption habits and that leads to poor health outcomes. If we want to fix that or help them without her. I don't know how you want to put it, but, like you need to do something. Force kind of forceful into rat what sort of taxes are now all the rage? I mean, though, that may be eighty that weren't island semi, there's more things you might meet me me but we need to like DR trucks fellow broccoli up those houses I feel like. I unusually unhealthy lifestyle for an urban yuppie. So honestly, I have noted
but who is right, and this is one respect in which in which Donald Trump is a true working class avatar is You know what you know. I mean he's super Reggie lives in a gold condo, but here, is made a big deal in the campaign, at least, but I think- So in reality of, like you know his love of like Mcdonald's, french fries and an sloping sodas, and tackle oh yeah. His talk about- and you know I think there is a good- indication that firm, like most people who are eating unhealthy food, if they are more money, what they would do as by more I've healthy food with it because they buy that because they like it
Every has to say, because its grey right, I mean that's, that's what I mean I mean we're Trump is as an alcohol abstained, which is which is very healthy and not not that legitimately working class, but the issue that, but we need to confront and some level is that, like America is already, I don't know if we want to say that America's already great but America is already quite which so like what problems we have are probably not going to be solved by just increasing aggregate amount of money that people have. I think that offers that said, if you do have an ounce of money that you might spend, I'm like our sponsored products, be amazing or you can just help us. By recommending the weeds two friends Tom to subscribe Itunes subscribe on Itunes, just just talking about in person, email them tweet Facebook snapchat do all the staff to other snapshots
so thanks to our producers from Shapiro thanks to panoply, thanks to you, the listeners, and we will be back next week, except not with Ezra, etc so have to come up with a tent unto it's a mystery. Now, sir Thank you see seen Exley.
Transcript generated on 2021-09-14.