Thursday, July 20, 2017

Climate Change Will (Probably) Not Destroy the Global Economy but That Doesn't Mean We are Out of the Woods

Climate change is on course to do a lot of harm to our planet. That is why concerned economists like myself advocate measures that would at least slow the pace of damage and give us more time to adapt. Paradoxically, though, economists rarely discuss what global warming is likely to do to the economy itself. Will climate change destroy the global economy as it raises sea levels, intensifies extreme weather, and kills our crops? The answer turns out to be more complex than you might think.

It is certainly not as simple as David Wallace-Wells endeavors to make it in his widely read New York Magazine article. In it, Wells describes an uninhabitable earth and a devastated global economy by the end of the century. Here is how he explains the economic consequences of climate change:
The most exciting research on the economics of warming has also come from [Solomon] Hsiang and his colleagues, who are not historians of fossil capitalism but who offer some very bleak analysis of their own: Every degree Celsius of warming costs, on average, 1.2 percent of GDP (an enormous number, considering we count growth in the low single digits as “strong”). This is the sterling work in the field, and their median projection is for a 23 percent loss in per capita earning globally by the end of this century (resulting from changes in agriculture, crime, storms, energy, mortality, and labor.)

Tracing the shape of the probability curve is even scarier: There is a 12 percent chance that climate change will reduce global output by more than 50 percent by 2100, they say, and a 51 percent chance that it lowers per capita GDP by 20 percent or more by then, unless emissions decline. By comparison, the Great Recession lowered global GDP by about 6 percent, in a one-time shock; Hsiang and his colleagues estimate a one-in-eight chance of an ongoing and irreversible effect by the end of the century that is eight times worse.

The scale of that economic devastation is hard to comprehend, but you can start by imagining what the world would look like today with an economy half as big, which would produce only half as much value, generating only half as much to offer the workers of the world.
The problem, however, is that the paper to which Wallace-Wells refers says nothing of the sort. The paper was written by Marshall Burke, Solomon Hsiang, and Edward Miguel, and published in Nature in 2015. The authors do not say that climate change will make the world economy of the future smaller than it is now, but rather, smaller than it would be without climate change. Here is a quote:
[U]nmitigated warming is expected to reshape the global economy by reducing average global incomes roughly 23% by 2100 and widening global income inequality, relative to scenarios without climate change. [Emphasis added.]

Friday, July 14, 2017

Latest Senate Healthcare Bill is a Step Toward Universal Coverage but Not Bold Enough

 Universal health care access is coming to America. As I wrote a few weeks ago, it is time to stop fighting it and make it work. In principle, Republicans agree. After all, from the very start of the repeal-and-replace debate, they have explicitly promised “coverage protections and peace of mind for all Americans.”

The latest version of the Better Care Reconciliation Act (BCRA) takes new steps toward universal access, but it is not yet bold enough. If our Senators only had the courage, they could build on these ideas to craft a plan that would satisfy both conservatives and moderates in their own ranks. Furthermore, it could become a way for the GOP to work together with Democrats, which polls say is what the public wants.  Here is how it could be done.

Thursday, July 13, 2017

How Conservatives Could Design a Fair and Efficient Healthcare System if they Took their Time

Senate Republicans fell short in their first attempt to attract fifty votes for their healthcare bill. Small wonder. The Better Care Reconciliation Act (BCRA), as it is called, is remarkable in many ways, but perhaps remarkably of all, it fails  to draw on a large body of conservative reform proposals. As a result, it gives the false impression that only liberals have given any thought to how to design a fair and efficient healthcare system.

Now the Senate’s Republican leaders have a second chance. Instead of rushing something out that isn't much of an improvement, they could use the extra two weeks they’ve given themselves in August for open hearings on healthcare reform. If they did so, they would have a chance to hear day after day of testimony from conservative scholars and policymakers. Here are some key points that testimony would make, if it had a chance to be heard.

Some of that testimony would focus on the top end of the spending curve. As the chart below shows (based on data from the National Institute for Health Care Management Foundation), just 1 percent of the population accounts for 20 percent of all personal healthcare spending, and the top 5 percent of population for half of all spending. Many people in that range suffer from one or more chronic conditions like diabetes, kidney failure, or AIDS that require expensive treatment year after year. Their medical needs are literally uninsurable by traditional standards. They are not just at high risk of needing care, they are certain to need it. And even if an insurer could be persuaded to cover them, an actuarially fair premium would exceed the annual income of all but the very wealthiest among the 
chronically ill.

Saturday, July 8, 2017

Unintended Consequences of Healthcare Decentralization

All economic policies have unintended consequences. The decentralization of healthcare finance and policy proposed by congressional Republicans is no exception.

The Better Care Reconciliation Act (BCRA) pending in the Senate would sharply shift responsibility for healthcare toward the states. Some of the biggest changes would come in Medicaid. would sharply cut federal spending, leaving states with the choice of responding by increasing their own contributions to maintain current enrollments, or by reducing coverage. Aside from Medicaid, they would gain the right to redefine the essential services insurance must cover, to experiment with high risk pools, and to change policies toward pre-existing conditions.

A group of GOP senators skeptical of the BCRA have offered a different proposal that would permit even greater diversity in state healthcare policy. The Patient Freedom Act sponsored by Senators Susan Collins (R-ME), Bill Cassidy, MD (R-LA), Shelley Moore Capito (R-WV) and Johnny Isakson (R-GA) would give states three choices: Keep the existing framework of the ACA with most of its federal subsidies, sign up for a new market-oriented system centered on direct contributions to health savings accounts for each individual, or design a new system of their own, with federal approval.