Sarah returns from New Zealand in time to reflect with Matt on the year in policy. White paper: Uniform Pricing in US Retail Chains
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hello welcome to another episode of the weeds on the box media podcast network. I met him glace. Yes, this is Friday, but we are doing it more like a Tuesday We got Sarah Cliff here I back from the interposed really Y yeah. That's what he's got New Zealand that you're in the results of that look it up. Man, hey, wait. I've come around your theory that New Zealand is actually very elaborate seat. She I because it's it's tuna- is to be real it's legit somewhere! It's it's a lot of smoke and mirrors Derek. In Ohio, which I think is is an all too real place, we will be back with us next week we wanted to do. A little urine and I think there has not been a lot of news over the past several days. God bless
and you must reflect on stories that we think maybe did not get as much attention as day as they deserved it in the course of twenty seventy and are not what he thinks here yeah. So about my under covered story, which I think it's it's a few years go together, but it basically the regulatory dismantling of a lot of the Obama legacy by the Trump administration. So I think a lot of times. We have a tendency as reporters as policymakers, to focus on what is happening in Congress because It's much more visible, there's just one kind, Press, unlike the agencies, of which there are many and what kind of track very easily what's happening. Bills are made public. You can follow the process with the tax bell at the Healthcare Bell, but one Savings even happening that hasn't gotten enough attention, but is quite consequential, is that true
Administration need across different agencies, taking really big steps to change the way our country, works through regulation, which is a lot less sexy. A lot less covered a lot harder to cover. It say as a journalist, because there is much less a schedule, you don't really know when things are coming out. The regulations are very long and very boring, but actually very consequential also to to pull this back a little bit. People me you, you were parted from from the helm more than I have, but like the Porter literally like stand around and the whole guys, and you like see the members yes, and you can ask them right leg. If you're in Congress and like I want to know, question about the healthcare bell, I can lead we, like, I know good times, to go, find I don't know like Susan Collins and ask her a question about like where she's in Healthcare Bell or like what she thinks about the individual mandate. Portions. That's not an option with federal agencies. You can't around the halls of eighty just they will ask you to.
if you need a visitor pass, you didn't escort to be there. You can't go up to the bureau at writing the regulations in like hey where's, this issue going to land. It's more closed off, just logistically like you're, saying then than congresses, so I mean that's just it's important because I think Wiedersheim don't always know, but it's like there's a reporters and Capitol Hill, because I mean, because the stories are important, but also because sending them there. They come back with stories whereas if we said like why don't you just just hang out at the Interior Department and like ask reigns and Keys General Council, some good questions. It wouldn't work net, ride, silly That's why we don't do it. It's not that, like editors are like dumb to see that there's interesting stories in the agencies, but it's like it's hard to generate, like the journalist,
anything? It's harder to see the interesting juries, because their often buried on the page, five, twenty two of some regulation. So I want to talk about one particular exam just a kind of make. This little more cunning even though I know there's a bunch bang on an EPA other places. They cover H, H us the most. I want to talk about this part of Ababa care that doesn't get much attention, which is this move to pay doctors for value instead of volume. So instead of lake rewarding people for doing a dozen tests that people- don't you, actually pay them more when they provide really cost effective care. and the Obama administration was. The all in on this idea there are a lot of experiments and affordable care act in the last years, the administration They set a goal of getting to fifty percent pay for value by twenty eighteen, so by twenty eighteen, fifty percent of the payment to the programmes they run, things like Medicare, Medical
it wouldn't somewhere reward doctors when they provide better care. There are a lot of requirements. The doctors adopted new payment models in the trumpet administration through regulation, has halted a lot of this work and really set the country and a very for, of course, so one concrete example: that's kind of easy to think through of organisation. They want to pay Medicare, doctors a bundle, the payment when they did a hip replacement. So, instead of you paying for like this screw in the hip and a screw in that procedure in the recovery. They want to say, like here's, how much we're going to give you for hip replacement and like you're, going to have to work within that budget, which would give you a reason to try and provide more. Cost effective healthcare, and there was a lot of you, especially from orthopedic surgeon, a lot of complaining that this is when we bad for them that they don't want to do this
but the whole idea was to get people to think about. Ok, I just get this lump sum payments. How can I do care in that in that particular amount of money and the trouble administration has essentially rolled back This programme is the kind of one of the bigger Obama efforts to paper. Value Obama I've made it mandatory and sixty seven geographic areas, the Trump Administration has cut that in half and a lot of its now voluntary participation, A lot of this was actually led by former ETA just Secretary Tom Price. A former. orthopedic, surgeon and now former Asia just secretary after we learned about as penchant for private plans and the old Obama straighten wanted to make a lot of this matter. the Tory and require the Trump administration is essentially sending doctors, the message, You can do this if you want to, but you don't have to go, and it's really a big shift and one that's been happening through. regulation and one that I don't think that's my
tension, but actually is really going to shape. The way healthcare is delivered in. This is one example of what numerous regulations that are changing the way America works in a very low key but important way, and I think it's really good. Exam. I hadn't really turned about this, except from you, it's under cover, there's so much. Why would do is get covered on? The regulatory friend tends to be stories that fit two very simple ideological sort of frame right, like under Obama. The EPA took really skeptical, look at toxic chemicals and was like inclined to ban a lot of under Trump, is inclined to take a really skeptical. Look regulation and, like companies, do what they want and there's this event ways you can phrase it it's like it's like a tug of war between, like liberal think, there's not enough regulation and conservatives think there's too much regulation. You see that with its, neutrality, the consumer, financial,
Texan bureau are a lot of things like that, but this Medicare stuff, like it's a government programme, rarely get doesn't question here of like regulating cordon quote like like a private business. It's like the government has a pot of Medicare money and it's like how should we spend it and Obama had this idea, which, once upon a time this was always controversial, but it was an idiot logically contentious. Yes right, there was like there were some people who thought that you could make Medicare more efficient. By doing this, the payments. It was not like up be like left or right. There's a large ideological disagreement about like should we spend so much money on the social safety net but like How should we spend the money is really up
It is actually a lot of by partisan support for this kind of approach to health care. It doesn't fall long. Normally, there had been writing like before Obama became president the thing a smart conservative might say to criticise the big government programme. Better care is, look they just paying all these doctors fee for service, like the more screws you put in the head, the more money you get like that's done, Lol bureaucrats are stupid right and so Obama was like. Ok, let's make the bureaucrats less stupid. Let's make it harder for doctors to like game this, stem, let's make sure we're only spending money if we're getting something valuable and what Trump is doing is no, you know like doctors are like which business guys hospital they just like they don't want to have to deliver value and so he's how business out with what it wants, which is just like a spigot of money that they can dip into
Anne and you see the same in the in the for profit colleges sector, but you Bobby Administration have really crackdown on seeing again like you're playing with the government's money here. The demand that you like try harder to show your actually doing something useful Betsy divorce has like really just been like now, just like. Go. Do whatever Cypriot in Congress like there will be a debate like should we just cuts to loan funding maybe someday Paul Ryan, will revive the idea of cutting Medicare spending, but like as long as it was going to be spent. The Obama idea was to like try to make the money be well spent and the Trump idea is like right, and I mean in the case of others, Medicare stuff- attribute a lot more of this to Tom Price than to Trump. So it's possible. This is something that changes yet every isn't those following. I like I deny those living like Tom Price, the former orthopedic surgeon who, when you
Congress using outspoken opponent of these programmes and seems very much like something specific to him, but I think these things are really going to matter alot. Another regulation that came out of Asia just this year that didn't get much attention but is actually and regulation is a statement from the Medicare director seem of Irma Kind of an outline of their vision is, one of things are also talking about, is allowing net here. Doctors to contract directly with patients would what essentially thou Medicare doctors to charge higher rates if they are working things out with the patient. You know right now: Medicare has a feast schedule, that's When I give you a physical, you know this, isn't that right, Amber back. You know I get paid fifty dollars by the government. There idea of allowing Medicare doctors to contract directly with patience you could see. You know a doctor and a fancy New York neighbourhood, saying I'm a very and demand doctor, and you can work with me directly and I'll, get you in the door earlier. If you know you're willing to pay me a hundred dollars for that physic
and this is an idea that hasn't really come up a lot in policy making, and this is quite an, violation. This is more a kind of vision statement outlined that eighty just put out earlier this but I think it's another signal towards where they want to go. And again these are ones where It's really challenging to keep on top of the different things that are going on and it- is not going to be, is well covered, as far as the process on where's. I think one other thing that's very different about covering regulation than covering com grace in Congress. You you knew it in a way. You see things develop in real time like you got to watch the evolution of the taxpayer from a hustler and ascended Bell, you see provisions fall in and out. You know it's not completely opened but you're, seeing in real time different policies get added and subtracted and keeping up with what it looks like, with regulation, a kind of just comes out
and you know there is usually the way it works. As you have a preliminary regulation there's a comment period and then you got a final regulation too. There is a little bit of development between, but it's it's a lot less there's a lot fewer stage, were employed and for evaluation, and I think that makes a lot of the regulatory work almost stamp You know another. The big thing that happened. Deregulation this year was the roll back of the Obamacare birth Control mandate, which was a pretty soon, again deal end either. You just have waited for this thing to come out and those kind of the final word It was out there wasn't as much time or space for debate, our discussion, this was basically what was going to happen, which is another reason why I think these regulatory stories are pretty important to be thinking about. I n a wider another thing and make some weird is that there is then a post game of litigation. so like one thing they did happen this week, is a federal courts ordered the EPA to promulgate
New regulations about lead paint within ninety days, and what has happened is that the the Obama administration originally had. I don't know Kennedy swayed big pains over there by research, but apparently they had sway because they ask for six years to study the problem of lead lead in current paint. how much would be allowed- and it doesn't seem like a six year issue, and so did the six year spanning one of exceeding the life of the Obama administration, and then Scott poet had like asked for by said, no, what we need for six years, till I do this over again and the night Circa, just rejected them Argument I mean basically making the case that, legally speaking, at least the EPA just, ten used to exist from the Obama years to the Trump years, and it's not like just because its new president, the science all changes under you, so they supposed to go forward fast hook.
As I am out of my say, who cares is important issues. I doubt this the kind of issue that the Trump Administration is gonna like litigate? To that the mattresses unison, this baby, the end of it and some new will come out. But, but you have this kind of thing- over and over again, one of the most important things that happened to in Georgia, be bushes presidency, is that the Supreme Court ultimately ruled that the EPA had to regulate greenhouse gas emissions weight, which was not like a thing. the Bush administration wanted to do, it's us are not actually something they didn't do, but the the legal wrangle a round? The regulatory process becomes very important and like even harder to cover right, like the EU, cannot at all like skulk around the Dc Circuit and like, the judges like. So how do you they followed the administrative procedure act when they were coming. Like I mean they won't tell you read like that's no works like members of Congress.
Some of them are gonna be like claimed, on any given day but, like somebody always wants to tell you something about. What's going on and like judges really don't but the litigation super important. I mean a lot of stuff. Obama did in his second term wound of getting held up by by the judiciary. Ok! Well, that was my under covered story and I think we are going to die about math, but first were grinned, took a very important break. Do you? feel like you're paying a lot for crappy quality at Everley that doesn't, you can upgrade go to tools. Add your style, like everyone's classics, your new favorites, this nothing worse than overpaying something not only to see it fall apart and an ever leave that doesn't they. Make premium essentials finest materials withheld traditional markets, and they tell you the real cause. You know you're, not overpaying, you're, not getting scoop. They want you to know what you're for, and why your pain for their radically transparent about every step in a process for mature, I used the ethical factors they work where they sell directly to you, which means that prices are
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I felt a little sheepish about calling this an undercover story because it it has been covered and I've. But I I've been looking over the past couple weeks at the opium, Lloyd overdoses issue in the United States. and I do think that it is under cover it. I mean, I think, not, because journalists are making a mistake. I think a number of great reporters and editors round? The country are really trying to push this topic onto the public agenda, but will we to talk about is like we talk about policy issues that are the subject of political controversy, and for whatever reason, this topic has not like made it to like bubble up to be something that famous important politician are arguing about, and he saw was a difference right. There was a moment during the Obama CARE repeal debate when a topic, concern for a number of Senate Republicans became that they wanted. Kind of state opiate funding model in there and then like TAT,
of stories got written about that request and like how inadequate it was in the comparison to Medicaid and because it was like a big, interesting political story, but he hears the basic. You know. Might my sort of baseline out on this issue people. People know this has gone on. People know it's a big deal. People may even have read last week that in the twenty sixteen final dad it showed so much oboloi deaths that life expectancy dropped, drop for second year in a row, you drop for two years and well for the first time since the early nineteen sixty is then look at the the preliminary dad. I came out four January to me. The first six months of the year and have you made up of twenty seventy right and so in the young? In the first half of the year deaths assertions I appeared as all drug overdose despotism. It's mostly opiates. It right ten percent year on year Right- and so this is what I dont think people quite under
damn that, like you, ve, been reading, probably for years sort of like sporadic feature reporting about somehow and that's like racked by avoids. But the problem is getting worse. Like a lot works at a fairly dramatic speed, I mean a ten percent year on year. Increase in deaths is a lot from what was already like last year. It was high enough to push national ethics lay down and its ten percent higher for the first six months. We don't know, I mean we don't have the count for last six months, but like what I have no, I but what would cause it to slow down right, like nothing at all, has been and nobody is even considering doing anything. It seems too. I think a thief I mean the under cover part of the story. I think that is the point you are making is that
We don't really have a plan like we have a lot of stories that, like this is happening right but like there doesn't seem in the open crisis its changing in a lot of ways? We are talking about this yesterday, just in the autumn, ass. How one of the things you are seeing? Witches hopeful sign is. Doctors are certainly pursue our changing their prescribing habits, I think, have been made exceptional unclear to american doctors that there is a woman prescribing opium for long term, chronic pain that people should not be getting a mass amount of tells after surgery. I think that certainly changing in the medical community. But dont know that that's actually leading to things getting better one of the things you ve seen as as I mean I've taught. We will have been through this situation, whereas access to opium prescription, tell us becomes less available than you see a lot of people turning to heroin and heroin
available in a lot of the parts of the country where it just wasn't a drug. You would have seen like on ten years ago, or so SAM can Yonah sue. I believe you read valet Times you had a wonderful buckled dreamland that everyone's interestin understand story, I would highly recommend and was by one of the best books they re I've read in the past few years, where he said how these heroin networks kind of spread in these areas that had really high prescription Doug prescribe opium prescribing rates, and that I think, would not getting as much coverage face averted like what is driving the crisis is changing. Its changing different drugs is changing, the heroin is changing, the sentinel and that those things can be more more deadly and we're not getting a while on the one hand, the the path right I mean so the Obama administration. What when her mom Lopez was, was on with me what we talked about uploads and
He said that the Obama administration understood when they started cracking, impel mills that in the shower term this was going to push the like stock of acts into deadlier substances, but they thought that it was. It was worth that they had to cut off that the news by anything, but we ve seen over the past year or two years, is that it didn't work that the kind of heroin dealing networks way. That have become established autonomously. So it's no longer the case that a person needs to become hooked on prescription painkillers visa. Some kind of poor medical product yes and then they become addicted to help your aids, and then they switch to ST legal drugs that there is just like a big heroin problem. Now in America, and a lot of places have a health problem. I should say: actually I am lobbyist for the pharmaceutical industry was yelling at me about this and
they want to clarify that what is actually skyrocketing is heroin and send to know overdoses that overdoses of prescription We always have sort of levelled off this a high level right, I mean if you were reading in twenty thirteen. Oh operator boosts as reached dramatic new level like it still at that dramatically of all, but that the spike in debt, so we ve seen over the past three years, is almost all Heroin and found no, it's not you. It's not pills at all That's the problem that we don't have, and not only is the politics Pakistan and pity in a weird way. I think the media coverage is excessively silo right. So what another thing that I have read a lot of stories on is the murdering right, which M and went up in twenty fifty,
and went up again and twenty sixty and there's some indication than may go down and twenty seventeen, but we don't really know at crime statistics report with a terrible lag and most of that reporting has been sort of hooked. to the police, violence Spock lives Matter story frame. So there have been stories saying: oh we're, seeing a Ferguson effect right where you know poor relations of communities, as is reducing policing or receive people touting New York, where the murder rate is falling and stop in France can saying? No. You know this. Despite asthmatic campaigners is working but which Rosenfeld criminologist in Missouri. He wrote a piece couple weeks ago, making the point that, as far as we can tell Huge share of the increase in the murder rate. Has white perpetrators and white victims, its conceivable that that has thing to do with policing at african american
communities. But it's hard to see why that would be right. Zander, say there's also been some objects and in african american communities, but it's not a racially specific dynamic, and so his point was that it seems like we should probably be looking at a howling connection. He right that we know when crack addiction boomed that led to a lot of trouble, related violence and that we should be considering the possibility that this spike in here deaths and the spike in murderers is connected to the drug trade. And yet I haven't seen that, like wine being drawn really right, you have like tat. passes. Emma's thirteen hang up Sanctuary city use. You know liberals have their there things about police procedure, but like we're not taking seriously the idea that this, like unprecedentedly large wave of illegal drug addiction, is like actually the driving force behind a lot of the big
social trends that that were see where one thing you do wonder about like as the as the roots of this shift from prescription drugs, to abuse of illegal drugs is whether we thinking about it differently and whether we start thinking about opium users is different sorts of people. When you know they aren't someone who's, I'm guessing Weed generally take a more sympathetic stance to someone who who got prescribed guess who we know took them for three weeks after a car accident and all of a sudden find themselves, you know, wanting more. They reveal the prescription and kind of tumble inches and prescription pill Sean versus someone who tries heroin and turns out they like heroin and becomes a heroine act ends I'm cool and maybe a bit worried about How how that changes, how we respond and think about the operating at actual wait. We ve talked about on the palm cast before about the politics
deserving Nestlike, who deserves help end. I don't know we ve covered much like what and when these sources of the opium crisis change like how we think about those people and what we should do with them, because I think you know remind your mentioning earlier. Our colleague he wrote a piece kind of because he's been reporting and operate crisis all year about, what are you learned in this full year of reporting? Any rights about this idea We still seem to have of addiction as this moral failure that people have. You aren't straw, nothin and that really all the science of it cuts against that idea. But when you switch from abuse of illegal drugs to abuse of illegal drugs are lens on it changes a little bit and I that changes our response to it. Even it worries me that the response to it could change, even as it seems like the crisis is getting much worse because we decided. those people well, you know their drug addicts or not the ones. We need
am, I think, we're going to see this play into these sort of much rumour, twenty eighteen cortical welfare reforms in Sweden, already. You see some state level efforts to imply more drug testing to snap. At a said, thing into medicate right and I think you could see a big federal pushed to that right to say too I to draw the narrative that, like the social safety net, is in fact being used by like parasitical drug addicts, and we need to have a poet bag. For that regard, and that's going to lead to the probable this even more deaths among the addictive I mean who knows but do not believe. I fundamentally do not believe that if you yank some heroin attics Medicaid coverage from them that that's gonna be the thing that causes them to like wake up and be like all right. I'm gonna get clean and stay clean tomorrow, like it's just going to mean more people die, but this has been one
weirdest stories that took hold this year. That I am this argument who is me, king it M this argument that medicate expansion cause the opium trade overturned You remember where that I a creature arguments, but I worry illegally. Idea actually took decent hold this rambles Healy, worried, because the idea I mean conservatives had this sort of prior it meant to statistical evidence that they think proves that medicate is harmful to people and I think they never had like a plausible explanation of how that would work, seven. This idea that Medicaid let people become prescription, drug addicts, sort of stuff. floating around end has never. I am I never seen him even the eagerly rigorous effort. to demonstrate this. Would they appear you have shown successfully is that poor states had more opiate addiction and let me
teens, which and more medicated right re revel. That's what I like a honest I feel like a lot of concern discourse on medicated like this, like bottomless pit of bad faith, but but we're gonna see this concept applied more more broadly ready, and I think that I mean use. You talked a lot about deserving or undeserving poor, and I think that it's gonna be tough politically to say that, like a person, who is down on his luck, not because the unemployment rate is nine percent for the unemployed. Four percent is be three point. Eight three point: nine that he's down on his luck, because he's addicted heroin That's why he needs public assistance like I believe the deck. I should get public assistance, but I think that that is gonna be a tough poetic. I'll, sell, particularly for state governments, said face. You know: they're gonna, funding, colleges. They got a fund long term health care for
elderly, like there's a lot of pressures on state budgets, and I think you know as addiction increases along with the labour market, improving, I think you can see more and more the use of addiction as a kind of like political tool. Tat to dismantle safety net programmes, I says we take a break and get them some. Absolute and of your news as break I'm here to tell you about. The secret were well groomed guy, it's the art of shame company was found your can. Ninety ninety six, they ve been helping guys look their best for over twenty years. They ve a total routine covered, whether shaving beard maintenance here scheme, embody fragrance the award winning products are familiar with the highest quality. Botanical ingredients features pure central points, safeguards they called the four elements of the perfect chick until smooth result. Everyday. There hasn't weren't, you prep your skin, but the signal appreciate loyal. Then you, credit, thick formula either. What shaving cream that your private shave brush shave than Europe
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of care news, so we found out that Obamacare enrollment accident decent. Well this year that it almost remained steady with last year. So eight point: eight people signed up recovered through healthcare, doc of that, when a million Therefore, point eight prison really itself waiting, Milly, hidden, spurred immediate visitin, armoury of being a point, eight million both signed up for health care through healthcare archives, that's just the thirty four states that use the federal market, there's the so the states run their own marketplaces, them have longer and roman periods are still waiting on those numbers. But to give you a bit of apples and tackles comparison last year. It was nine point, two million people and rolling through health care of so a drop of four hundred thousand, but actually really solid. When you think of everything that has happened in the past few months. I mean from not been passed
year from the attempts to dismantle the affordable care act. The discussion happening during open Romans about individual mandate, repeal the advertising budget getting caught. Ninety percent and the outreach assistance budget getting cut forty percent Andy enrollment period being cut in half so the past few years it's been a twelve weeks sign a period this year, is only a six week sign a period, so people had half as much time to sign up for bridge, but you only saw coverage, loss of foreign, two thousand people. You really saw pressingly robust sign up and a kind of I mean I think we could talk about is kind of like what Obamacare looks like in the age of twelve. We saw a new Paul come out earlier this week that found that forty four percent of our publicans believe that Ababa care has been repealed. At the same time, we have a bomb, a careless, doing decently. Well, people are signing up for medicate expansion for sure the marketplace.
Element is a little bit down, but pretty steady, and it could have raises the sure of whether Obamacare the Obama care Cars can end with it living in this, like hybrid state of, like Republicans, believing they ve done enough to repeal it by getting rid of the individual men and even President Trump saying in an interview with the New York Times today, like I repealed Obamacare, and you're, still giving our benefits and liberals and Democrats thing. But this is greatly. People are getting Obama care. that is the deterrent event where Obamacare. So tests, but the president and many of his supporters think it's repealed and that's the world where it can have just scoots I notice that are now. I mean this The universe in which I wish Donald Trump were a better present twice I think a lot of us the second one was me. Twelve.
to go six months ago I used to have these were current fantasies that Donald Trump, who, whatever you may think of him. He is not a fanatical libertarian right. He has not like spent his days. Reading Michael Cannons Health policy briefs clear that when journalists let him with that, he believes the government should do something that causes people to have health in. Scot Free trade that like that is an idea that is in Donald Trump Head is that public policy should give people health insurance cover jostling? He said many times over the course of years. It's in all of his books. It is a thing that he believes. He also clearly hates Barack Obama. He hates Obama care. He is a republic. and he wants to see that he were peeled. Obamacare. My dream and, like you know, like Jared General Kelly,
like, if you were out there. Other guys who, like Trump, are disconnected from like the institutional Republican Party, is like make this work like, keep saying that you have already repealed Obamacare and then like say it say it all day all night. Every time you get a chance but get on the phone with you know what David Cutler or seek a manual like with some people who are smart and work with them on ideas that will make health insurance work better for people. I think clear that repealing the individual mandate does not eradicate the whole Obamacare Programme and they things that could be done to make it work better and that, like Donald Trump, should in his own self interested way to make in line with his medical self interest, his stated ideals like he should do that stuff. You should try to make it work. He should say that he were peeled Obamacare any put selling better in its place, but I think what we ve seen from Trump consists:
for the for the past twelve years. Twelve months is that he does not have the discipline the like mental fortitude, two like actually see his way through to these kind of solution, that he will sometimes say in a meeting which action were Nancy policy that he wants to do a deal on the dreamers, but Stephen Miller, will lead him back to a hardline position right and that the twenty ministries is mostly populated, with far right wing Republicans white and the cheapest have I have no idea what John Kelly thinks about domestic policy issues, but he appears to be. Extremely comfortable with the idea that you know. Paul Ryan should just be in the driver's seat on everything and then what he cares about is foreign policy and immigrants. right and like that is how they are doing it. It's not like it's not good for trial.
Like there's a reason. Donald Trump is the least popular president. This that has ever been at the end of its first year He desperately needs till I get out of this shell and just like talk to some, but He must know some guys who, like own hospitals or something you don't just like, speak to somebody. Don't talk about Obamacare like just talk about healthcare like how can we It was the manual you was taking a few meetings that the way to earlier this year. I mean you do legs going to your ear trump dreams. This is what trim said in an interview with the New York Times at him today. He said with essentially got it and ended Obamacare. So, like second of speaks to o the cure really brilliant, let him have let him have it and, like I pickets also be interesting to see how, like liberals and Democrats reacting if they, are going to say no, no, you haven't, like nine million people just signed up for this Obamacare like is thriving or
going to Lincoln Braces. That is a strategy and say, like you know what fight like I'll stop attacking at. You can say its repeal that we don't have to fight this battle anymore, because I think there is a c urge on the liberal scientific tout how zillion to non gazing, Obamacare isn't like you tried to Sab, but it still is try being and people are still signing up and Obamacare is better than ever, and I think it also plays that you are talking about the strategy a how this could get screwed up bomb, unified Trump dumping and great didn't I think, there's also strategy things happening on the liberal side where they have this, desire to to talk about this. that arm. Doing so. Well, I think one of the places You might see a lot of this tested out some now that the but your mandate has been repealed is if there's some kind of crisis and sprang where a lot of insurance companies decide like we don't want to Obama care. You know we're out,
are skyrocketing some places. You know, there's zero insurance carriers. You can actually buy bomber care so It's either going in the direction like you're, saying, Worthertrouble Buick, although we got rid of Obama, care and Veto Congress, would come up with some thanks to slide into that, and you talk to the command. You only talk to some hospital ceos or it's just bad legged. Fleet is Obamacare, repeal nine people aren't people to get help You can't have the stasis where Obamacare exists. Republican say doesn't exist that actually the individual mandate causes such a collapse. Where you know it's not all of Obamacare, I think Bobby, cares becomes shorthand for the insurance market places like we're, setting Medicaid and even the payment stuff. I talked about earlier aside, I don't know feels really unknown to me like what things look like. In the spring and like if this, if Obama care
I don't know how much of Obamacare is repealed. I guess that's what I'm saying I don't know how much repealing the individual mandate dismantles. Obamacare because we haven't really seen the results of that We also know what state governments are gonna, do so like California could- and I think probably should pass a law saying that in the state of California, you need to either have a qualifying health insurance plan, or else you need to pay now, whenever the stupid Obamacare fee was you wanna go higher, but yeah like I feel for Marilyn Dc Washington state are already talking about their own mandate, sway did they they should say you know you gotta pay, two thousand dollars or apply for ship waiver or show that you have insurance and they should do some of the employer mandate. Stuff have to say if you're are employing whatever five people in California. You have to give them in like that. They should think they should just do the same. There's been a lot of this, like
being ahead too, like maybe we're gonna have Medicare for all a ram and California and like maybe they well liked by all means, go work had at that, but like in the next, like twelve weeks, like blue states that one people to have health insurance. She just do the right thing because challenge for us level universal Healthcare programme is about getting the money and Trump did not repeal that part of allowing right like people. If you deuce people to sign up for these plans. They are eligible fully eligible for the federal subsidies. So that's the part, that's hard. First, a government to do but it's easy for a state government to do is to like make people get the subsidies that they are eligible for, unlike they should just frankly, red states into a too, but they won't because their crazy but like if you have a democratic legislature like,
It is a no brainer like the federal government stands at the ready to like cut checks to huge quantities of people but you gotta like make sure they have some kind of shove to actually sign up and an you're like healthy affluent people who were mostly not signing up. Despite the mandate, you really should make those people sign up for healthcare like they wrote this for many should put my cards on the table, but in that light in game of a character like a year, long process where they were like, we to diversify the risk posed by making everyone sign up. They like wiped out at the end and like had like a really really low fine. But if you for ways in rich right if it. If I dont know why you're making seven hundred fifty thousand dollars a year and also don't have twenty behaviour of Silicon Valley. I dont know why. Auditors, that that is you, you should pay giant fine. If you don't go by health insurance, because you should just by the fucking health insurance, I could find a big deal. Nobody would actually pay
Two hundred thousand off, if I might just get the health insurance to engines, dollar. If really know what I mean is it should be goal should be to set the fire. I'm so high that you have no fine revenue on this fisheries is another like bear. Is Obamacare peel the one future you see. Isabel Obamacare is repealed in in red, stay spot in blue states. It essentially stays how it is. So you would see this like West Coast northeast where they pass. I think once ones does this you're gonna see a ping pong around a bunch of other states, I know Washington state as in a bit of a jam because they have an income tax, so they're trying to figure out like how do we do this, but the rest of them? I think, like it's a pretty, as others have an income to five they could get in there they have a blue legislators who that's the solution, but one future that
could also happen. Our lot of disparities between states, where you see a collapse in like the south and in some western states and oh essentially going on ask as this now in the states that support it, which has been putting already a little bet you seen this this year with the states that run their own marketplaces, as you know about it, doesn't states that support a care they ve other advertising, they ve been doing their longer and roman period there trying to keep things exactly as they were last year, but I think the into mandate, is more crucial peace, but again it's really on time, territory. There is a lot of guessing right now, ranging from subsidies are the most important part. It doesn't matter that the individual mandates appealed to the markets will collapse. Individual mandate. Nobody knows, never taken a health insurance about like protein like Obama, care and ended. The requirement to buy Sharon's. Nobody
whose, where that leads, and like that eight point, eight million number we do I have no idea right now like if there will be four million next year. If really be eight point, six million its completely unpredictable and one of the reasons it sound, predictable, Eliza Lot on private actors relies a lot on insurance companies making to say, and about whether they want to sound that and people, and they probably don't know at this point whether they want to art and place. I just want to emphasise that, like to extend like political actors, control their own destinies, he rightly even more public and stage, should try to not destroy their insurance markets. State governments have the authority to do his taxing if they want to from administration could reach into the bag of Republican, like ways I mandate ideas and like bright. In a continuous coverage. Raw, unlike probable,
They won't like republican state legislature, could do that. Yes, right, a we body should like a dozen have to be an individual mandate. It could be a continuous covered requirement because you're in Kentucky and you camp as an individual man, too exactly, and I would just like urge everyone till I don't don't just like watch this freight train like come hit your stuff, and then be like. I wonder how I'm gonna to when it comes like. Do some right like if you, if you're comfortable with the mandate, do that you're not come from the mandate like phone up somehow economists and they won't sketch out alternative strategies they to give me a cup of shore and cause they're reed. Frankly, this had been covered extensively invokes outcome, but if you, if you need some pointers, you know emo us and we will, we will hook you up time for a last white paper here, but first a break before we get to it.
It was an amazing sponsor, I'm so glad to have them, because this is an organisation that really does a lot of good in the world. I mean what could be a better resolution than to give more the people around you to people in need, give your money more actively. That's we'll get well, as is all about by this how is it upon thousands upon thousands of causes out there in and they all sound, like good causes that you know you want to do the most good that you can with your money and to do that you really need to know not just like what's a good cause, but what are the best constitutes one of the best charitable organizations out there there's a lot of charity evaluators out there and they mostly use frankly really shoddy method and give well. Is this it seriously research programmes to help. You understand, which are the most cost effective. In terms of you know, if I gave a hundred dollars what's going on the most people's lives. What's gonna do the mouse to boost incomes for the neediest people in the world so like one,
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This is a little bit of a non policy bit of economic research that that I haven't. You think what was interesting done by us to find a dove, India and Matthew against cow in there. Looking at the fact that we have a lot of chain stores in America, Red Let's see, vs is a lotta right. Aids, alot of supermarket chains. Walmart things like that, and so you have, exactly a store owned by the same company and they operate. lots of different towns and lots of different neighborhoods but we know that neighborhoods are different from one another, I mean you have just in. If you looked at sea vs is in Washington. Dc ride like of them are really rich. Neighborhoods in some of them are really poor, neighborhoods in it, stands to reason that, like the optimal price strategy first or should have something to do with where it is right, which people could probably charge them more money, poor people you probably charged unless,
honey, I mean not just to be nice, but like actual business sense and what they find is that companies don't do this the day. To some extent, sir themselves so you'll be like a fancy chain that mostly exists in fancy neighborhoods, but they don't really alter their pricing basin her characteristics and when they do alter their pricing is based on a very broad kinds of things. Right, like there's taxes here and not I'm instantly seated in a will have to a model in which you, you know prized optimally. They're, giving up about seven per cent of profit compared to what you could be making. If your optimist everything and also am ease, significantly increase the price paid by poor households, a relative to rich households It reduces the responsiveness of prices to economic shocks. Wide sounds like when the fact
Three in town shuts down like the prices at the local drugstore dont decline like even a little bit, even though it would make more sense to have legs. Many of them please try to ask why this is, and you know it's it's not. really clear, but they find the most evidence for what they call managerial, fixed costs, which, at I think a layman might say it's like the ditch privileges, too lazy and defend heavy good. I think it would be. navigate to mount of work like let's say you're like like and like, unlike you want to, like do this adjustment. I think it's like a fair question to ask whether it's worth the work involved, a gesture prices to get that extra, seven percent It is. I think, that's of our committee's raises a question about the efficiency of moving to the chain model in the first place right, because emanate used a pattern of seamen.
that he used to be this way. But, like you think of it, is being like. Ok, you have your neighborhood store right, you're low. There were a lot more independent drugstores like forty thirty years ago. Exactly and indefinitely in supermarkets has been consolidation right. Civil Margaret was always like a chain industry, but it used to be more localize chains and now even a lot of things. You know it's like you stop and shop in New England, but it's all part of the same giant, multinational dutch conglomerate that all sorts giant and everything else and so the question is what is lost when you do that right and were saying One thing that is lost is that the manager the big chains don't appear to have like the bandwidth to like pay attention to wear their stores are and what is actually happening there and to set prices It right and inlets on something that has been concern: necessarily appropriately in merger analysis and in competition policy. What's are there any
chains that are doing this because you think, if I give this is away till I get ahead of your competition This was like a wage like this. This is free money sitting on a table born. I think, like any change. go to like target best like going across different segments. I would be very surprised to like notice, like I went to the target a few miles, my house and all of a sudden all the prices were different. I mean either. I guess restaurants doing this to some extent they are much less SAM Kane based, but they don't think Mcdonald. I do know that exact on on, for example, is a daily. The avian flu in the in the in the fast food industry, you do see at a local price differentials, and I I that the reason for that is that labour costs are much higher share of you know what chain restaurants, are burying made. So I get it. I mean obviously like Walmart pays people to work there, but like the me component of the price of like many fridge
Walmart is that they need to buy the refrigerator from supply somewhere. I where's like that. The food costs it Mcdonald's, really really small, your mostly paying for the cooks and labour, It was really varied from from place to place and also went at so you ve gotTa Mcdonald's in Manhattan. It's a lot more than Mcdonald's. In Texas, and that's why you generally can't look up prices on restaurant websites. I also wonder some of it has to do with that. Guy franchise model verses a chain modern because they give Europe franchising a subway I don't know I have not franchise- does her way, If you have any control over the praise, presumably like if you're going to convince me to Franchises Subway in Manhattan like you're, going to have to give me the ability to charge those higher prices verses. Like Subway is running all of these and you know what, if they're Manhattan loses eleven money in their taxes. Store, makes money They can deal with that internally by wonder if the franchise, also
leads to more of this one. Is those the managerial fixed costs white their pushing the decision making down? We know it's like the same subway everywhere, the actual. the Jews more and more localised It is interesting to me from just an urban policy perspective thou because it eat it highlights one of the just sort of infinite, like weird and obscure way, is that you can be a kind of screwed for being poor. D like it there should be at least is what I mean is always better to have more money, rather than less than one potential advantage to living in a whole community. Full of people who don't have much money is that, like It should be bringing more discount goods into your environment, because people have less ability to pay and that should provide some like resiliency and ten t, even things out we ride like there would be lower cost of living to move into the lower income neighbourhood, which might encourage middle income people.
I want to do their break up patterns of segregation of the night but we're seeing some sort of fundamental reasons: the business environment. Why that doesn't happen? like. No there's. No like. Nobody here has any money discount about anybody, even though you know I mean not just like it charity there should be, but just like out of cold business logic, there ought to be a little bit more sir, give in areas where people don't have the money to spend, but their peers too, you know basically not be, mysterious, where I still think it's that must. I don't know I don't find it that mysterious that, like Walmart chooses a price for its many for it, that you are saying that the lot of the price is the actual costs of the many fridge and the many fridge doesn't varied. Pending on where you find it in c I don't know, I guess, because I think like this like chain big chain. I do. I do that. Extra seven percent- I don't know if that's ever going to be worth the price of, I think like it's fixed and important,
You have my seven percent. Where do you get seven percent rays think about what you are doing I ve got a lot of times like. as we see more chains Macy like local businesses, leaving there's like this kind of a gamble- No reaction, like I dont Walmart, that go on my like local store This actually suggests that an economic reason for why you might want to apply, who's, that those kind of like bigger, Baxter, yeah. That's what I'm saying. I always used to think that the people who opposed by exchange for progress and that that was dumb and would Stewart those about get out. The myriad ways in which big companies are secretly better, for example, they pay higher wages, but now it's like, I have to rethink everything. turns out. Mom and pop actually know whether or not the factory has closed and Papa CBS doesn't care and assistance charge people. This is the first she's, not gonna, sell anything
I'm going to know why or be curious at all. It makes me sad. Here's a sad story, twenty eight, but what makes me happy is vocs media, podcast network poker, You should listen to all of them, but especially the weeds, but also our and you should you- should join the weeds Facebook group near you should not sign up for the weeds newsletter because we're like me sending those anymore it might come back someday. Batman January beyond that lived for us next week, exciting predictions for the new year s fresh new white paper. Start things off Gonna be amazing things from producer Lunnon thanks several for listening. Therefore, having sat on the Friday, she also have a new year's new year.
Transcript generated on 2021-09-12.