I’m 100 percent on board with Jon Chait’s argument that there’s no reason to think that abandoning the Affordable Care Act would have improved Democrats’ political standing heading into the midterms. Insofar as ACA is unpopular, that’s largely a consequence of the general decline in public esteem for the party currently overseeing a grinding recession. The specific subject of health care is, along with the environment, one of two topics on which Americans currently say they trust Democrats more than Republicans:

As Chait says, the more interesting idea is that perhaps they “should never have taken up health care in the first place, and used their time pushing some kind of economic stimulus issue.” I think assessing that depends really on what you mean by “the Democrats” and “should.” If it’s actually the case that by agreeing to not pursue the ACA in the 111th Congress, Barack Obama could have persuaded the legislative pivot points to embrace a much larger and more effective stimulus then I think that, yes, he should have done that. But I don’t see any plausible argument that this would have worked.

But here’s a more plausible tactical counterfactual. The administration decided, as a matter of political strategy, that it was not only crucial for the bill to “bend the cost curve” over the long-term and reduce the long-term deficit, but also to score as deficit-reducing within the 10-year CBO scoring window. Given that the law is largely structured such that its main components don’t even phase in until 2014, the 10-year score is basically irrelevant on the merits, it’s just a kind of political talking point. If the administration had not been committed to a strategy built in part around this talking point, then it strikes me as plausible that ACA could have been written so as to be a vehicle for substantial short-term stimulus, primarily by doing something with Medicaid funding. As best I can tell, however, nothing along these lines was seriously contemplated on either the congressional or presidential end. Instead, there was near-universal agreement on the dubious proposition that the deficit talking point was of critical value.

(cc photo by Oskay)

When it comes to barbers, I’m happy to let a free market blossom. A bad haircut is not a big deal. When it comes to more sensitive services, the case for more restrictive regulation of entry seems a lot stronger. But the question still remains of “how restrictive?” Clearly in an abstract sense, making it tougher to become a dentist will probably make dental services more expensive but the hope would be that you’re also increasing quality. Since regulation is done on a state-by-state basis, it’s possible to observe variance in licensing stringency and then assess the impact on cost and outcomes.

Morris Kleiner and Robert Kudrle did just that in “Does Regulation Affect Economic Outcomes? The Case of Dentistry” by looking at data from Air Force recruits:

This study examines the role of variations in occupational licensing policies in improving the quality of services provided to consumers and the effect of restrictive regulations on the prices of certain services and on the earnings of practitioners. Theory suggests that more restrictive licensing may raise prices, but that it may also raise demand by reducing uncertainty about the quality of the services. This paper uses unique data on the dental health of incoming Air Force personnel to analyze empirically the effects of varying licensing stringency among the states. We find that tougher licensing does not improve outcomes, but it does raise prices and earnings of practitioners. Our results cast doubt on the principal public interest argument in favor of more stringent state licensing practices.

That’s not to say we should totally unregulate this sphere of activity. But we should resist efforts to make existing regulations more stringent and unusually stringent states should get laxer. Then hopefully we can see where that leaves us.

I keep harping on this stuff because in the long-run the only way to ensure affordable high-quality health care services to everyone is to reform the manner in which health care services are provided so as to prevent costs from increasing much more rapidly than quality. It’s precisely because the prima facie case for regulation of the health care industry is strong that this sector has become a hotbed of cartelization and nonsensical barriers to entry that require scrutiny.

Lydia DePillis has a fantastic cover story in the Washington City Paper about Dave Alpert how the Greater Greater Washington blog he started has become a key node in a politically influential community. There are sort of two different threads here, one about policy and one about politics, and since I always bore everyone with my “parking, density, blah blah blah” stuff lets talk instead about politics.

Political power stems, fundamentally, from an ability to produce organization. Hence the clout of the dread “special interest groups.” The neat thing about the internet is that alongside interest groups it creates communities of interest. There’s a whole group of Dune fans who’ve gone and built a Dunepedia. In principle, these communities can be mobilized to engage with political issues that touch on their concerns. That’s probably not going to be Dune fans, but you can easily see how people interested in music or technology can be drawn into political discussions about intellectual property. Or about how residents of a given city who like playing around with made-up subway maps can get involved in local debates.

The internet is still a very new technology, so at the moment most things done on it still have a classic “early adopter” demographic skew—male, white, educated, few senior citizens—that to an extent undermines the progressive, egalitarian potential of this trend. But I think it’s a very hopeful phenomenon for the longer term.