Health Care Law Projected to Cut the Labor Force
nytimes.com
nytimes.com
Hopefully it means that people who want to work will be able to back fill those jobs.
I think it's a good thing for the economy. It can't be a good thing to force individuals to work when they'd have the means to retire if they were able to purchase healthcare at the same rates as large companies.
Individuals have to buy insurance, because only a combination of them can form a (large enough) pool.
And I note that your analysis that this is good only holds in a situation like today, where there's a labor surplus. In the future it could be a very bad thing, especially if individuals in otherwise productive parts of their life don't work and therefore don't pay for the Baby Boomers' retirement promises like Social Security and Medicare.
ADDED: one thing we can be very sure about this law: there's going to be a bunch of "UNINTENDED consequences", and some of them will be bad. Some are likely to be very bad; one thing recently remarked on is that VCs are pulling back sharply from funding biomedical ventures, right now due to uncertainty, but things like the medical device tax are a component of that, and of well documented existing company retrenchment.
As an example, the entire Silicon Valley ecosystem started from the confluence of government programs, such as one where private investor dollars were matched by government dollars to create the very first valley VCs. I don't think anybody inside or outside of the government, projected the immensity of the impact of those programs.
Or y'know... about 90% of the stuff that spun out from NASA.
Anyway... I get it: you're a closed-minded ideologue and you weren't REALLY asking a question, you were just being snarky. So I'll stop pretending that I respect you now. And I'll stop pretending that we're having a conversation.
What's the NASA spinoff you allude to? I expect it's, again, what had been promised. Part of the plan was to bring about technological innovations. The development of velcro, or things like it, was part of the plan.
What I actually asked for is any example of what you claimed to be a certainty: a large, complex government program having unintended positive results.
I wasn't being snarky, I was trying to demonstrate that the record here is nearly, if not entirely, on the downside. History shows us governmental programs failing in a myriad of ways, but this isn't balanced on the upside. I honestly can't think of a counterexample within my parameters (large size and complexity, and having unintended positive results).
EDIT: A better way to state my question occurred to me. What I'm looking for is not quantitatively unexpected results, but qualitatively unexpected results, because I think that's what is implied in the above back-and-forth about these qualitatively unintended bad results versus a certainty of unintended good results.
You're pretending that if something good happens after a government action it was all intentional and thus there were never any unintended positive impacts of anything, ever. Because government is full of far-sighted individuals who totally grokked that ARPAnet would eventually be used for every conceivable form of communication, entertainment, and commerce.
The world is complex. Governmental programs aren't all good or all bad. Reality isn't compatible with your small-minded ideology. Deal with it.
I'll admit that I'm walking a dangerous line with the "no true Scotsman" fallacy. I stand by my judgment of the examples cited, but agree there is some room for debate.
I think the NASA example fails not because I'm being too narrow, but because the initial stated objectives were so fuzzy and broad. More importantly, these stated objectives were probably just secondary, a rationalization to enable the true objective - the nationalistic desire to win the "space race" against the Soviets. JFK, who initially got the whole ball rolling, actually wanted nothing to do with space exploration. His backing of it was really just a political ploy. (of course, in pointing this out, I'm making your point to a certain degree: JFK set out to score political points, and in the end he wound up bringing us velcro and ICBMs - yes, I'm being snarky there)
That said, you've also given me the best reply to my question: ARPAnet. While it wasn't large at the time, it was certainly complex (beyond my ability to understand all of its technology, anyway). And since it was developed for defense purposes, the end positive consequences are in a whole different ballpark than what was originally planned.
Anyway, what really drives my questioning here is a Megan McArdle post from yesterday [1] about a political science class at John Hopkins about policy failures. She quotes the prof. as talking about opening minds to critical thinking about the endless ways in which the best-laid plans can go awry.
[1] http://www.bloomberg.com/news/2014-02-04/learning-from-iraq-...
As I read it, it was part of the fight for the hearts and minds of the 3rd world, the "Western" 1st World's approach to things vs. the Communist's 2nd World approach. Eisenhower let the Soviets orbit the first satellite to de facto establish his Open Skies policy, which the Soviets were mightily objecting to (the principle that outer space overflights were beyond territorial claims like those for airspace) ... but that the usual internal infighting led to our being visibly behind the Soviets in the most visible form of high technology. Which severely weakened our sales proposition to the 3rd World....
One explicit objective that developed, especially after LBJ took over, was uplifting the South with high tech. The opportunity of spending an extra billion in Texas is why we didn't build any infrastructure in space....
Actors within government are generally aware that their actions have some negative consequences. They have a lot of smart people who tell them about problems that can (and will) occur, along with some likelihoods of the magnitude and frequencies of those problems. So under your classification scheme, there really aren't many unintended downsides of governmental action.
You seem to be conflating the public marketing of a policy (it will be sunshine and rainbows) with the internal understanding of a policy (it will solve a few problems, create a few different problems, and hopefully net positive).
Yes. I'm doing that consciously, because I think it's appropriate. The very nature of the question is that when it's presented to the public, only the public marketing is on display. At the time we're debating a policy, we can guess at the internal agenda but we never really know for sure until later (if at all).
So if we're trying to learn from history and apply it to today's policy debate, of what use is a history that separates the hidden agenda - a factor that we are unable to know and make use of at the time the decision is being made?
And it's almost comic that you're essentially pretending that nobody talked about potential problems and failure modes for various healthcare reforms prior to the passing of Obamacare.
It saddens me that you seem to be an otherwise intelligent person, but you're so blinded by your ideology that you don't realize what intellectually dishonest nonsense you're spewing.
It's true that I'm not impartial here, but there's every indication that you're not either, yet you're trying to pin it all on me.
Of course problems and potential failure modes were debated; that was part of the public marketing. But there clearly was a hidden agenda that we still don't know. Why else would they have worked so hard to pass something overnight -- as if it were an emergency -- and including language making it so far from what anyone wanted and containing provisions contradicting what had been promised (and with every indication that (at the outset, anyway) those promises were sincere?
But where in the debate do you see any discourse about the hidden agendas of either side? How in the world can we include this in today's discussion when even now it can only be speculation? And how can I be intellectually dishonest with it, then, if we can't know what it is?
Sidebar: The debate we had included raging dishonesty on both sides. On the pro side we had misdirection about the problems the bill was putatively intended to solve (preexisting conditions were already significantly addressed by HIPAA; uninsured could already get catastrophic care at hospitals, financed by the government) and funding (expenditure estimates were cooked by showing a runtime starting years before actual outlays began, in order to minimize the deficit impact). On the anti side we had hyperbole about "death panels" and about the government taking over the industry, etc.
No, you didn't. You simply asserted that you weren't committing that fallacy.
Similarly, you simply asserted that when evaluating unexpected positive and negative consequences of an action, it is acceptable to dismiss nearly all of the positive ones while including nearly all of the negative ones. This is obvious nonsense, but you couldn't see the problem because you're blinded by your ideology.
And after that you engaged in the always fun sport of moving the goalposts. You switched your argument from 'there are no unintended positive consequences' to a completely unrelated set of complaints about public discourse.
You were intellectually dishonest. If you can't see this, it is only because you do not wish to see it. Your cognitive dissonance will not change reality.
I respond poorly to people accusing me of intellectual dishonesty without demonstrating in what way I'm being dishonest.
Grow up.
I acknowledged that there was room for debate, yet you offered none. I explained why I thought that I was on the correct side of the line (because the NASA case had objectives too fuzzy to judge), despite it being a close call.
I also acknowledged that a further example you gave (ARPAnet) was, in fact, a pretty good response to my initial question. You didn't pursue this point, yet I think it demonstrates that I'm not dishonestly throwing out all counterarguments.
You accuse me of "purposefully conflating completely different arguments to try to score cheap political points." Yet in my remarks about JFK and the space race, which in the sequence of the conversation seems to be what you're referring to, I was quite explicit in admitting "in pointing this out, I'm making your point to a certain degree".
I don't believe that your claim that I'm moving the goalpost has merit. I was pretty explicit in that I was looking for positive results that were qualitatively unexpected. The examples cited to me (with the exception of ARPAnet) were positive ones, but they were quantitatively unexpected. Saying "that worked better than we thought" is very different from saying "that had benefits that we didn't foresee".
Turning this around, now, and looking back on your own claims... your initial statement was "One other thing we can be very sure about this law: there's going to be a bunch of 'unintended consequences'", i.e., with certainty there will be positive consequences that weren't intended. Based on the context (that we're discussing employment effects of a sort that I don't recall ever seeing discussed in the PPACA debating), and the connotations of the word "intended" (as contrasted to the word "expected"; to me, the latter might have referred to quantitative differences but this doesn't work so well for the former), I interpret this to mean that there is a certainty of positive consequences that were qualitatively unintended.
You were intellectually dishonest.
It seems to me that -- as you're accusing me -- you're making brash and unfounded ideological pronouncements. That's what I intended to challenge, because it sounds preposterous to me. If the outcome you promise is certain, then there must be such a laundry list of them from past endeavors that you'll be able to rattle off a list in no time. I couldn't think of a single one (although, as noted above, ARPAnet is one example). So I challenged for examples.
And only one of the examples met the conditions that I believe were implied by your original statement (or how I interpreted it, anyway), that is, positive qualitatively unintended consequences to a large, complex governmental program.
You may disagree with me, but I think the fact that we've only come up with a single example (in between the name-calling) pretty well shows that such outcomes are far from a certainty.
(I'll concede that it depends on what you want to measure, but it's hard to argue that cheap trucking has only been a negative)
Most basic research, whether in natural sciences, mathematics or the humanities.
The equation 'large-scale government endeavour = bad' is so simplistic, it is painful to hear otherwise smart people repeat it over and over. The real world is way to complex for this kind of black-and-white armchair economics.
Or how the "stimulus" produced a counter-reaction that's got the establishment utterly terrified, and using the full force of the state to repress. Which doesn't tend to end well, per Pareto "history is a graveyard of aristocracies".
With so many dropping into the clearly subsidized roles this will push the costs of the program up. With the guarantees to the insurance companies built into the law the public will end up footing an even larger bill which requires increase taxes and health care costs for those working putting a bigger drag on the economy.
Having more part time jobs which is what will happen when the employer side of this kick is not better that keeping full timers.
I actually worked with someone (who knows python, JavaScript, c#, t/sql, etc.) who had to work loading boxes at UPS on the night shift while he was between jobs because, while he could afford to quit and look for a new job, he couldn't afford a gap in his insurance. It's not that he was sucking down tons of services either - just having a gap would have been bad news.
Now I hear that jobs at Whole Foods and Starbucks are pretty good all around, but there are others that I think will rightly need to pay more going forward.
We had to move for other reasons than her job, but consider that there are many people doing work that other people do, who are motivated to do things like start a business, but who are otherwise unable to do so because of the US healthcare system.
Additionally, consider my parents, who are also working not because they need the income per se-- they could retire and live well-- except for the costs and difficulties of purchasing health insurance on a private market.
So it isn't the case that people are just universally "going on the dole"... making private insurance closer to the same cost to purchase health insurance regardless of your status as an employee shouldn't affect the overall bottom line of the leeches who provide insurance.
So, like about 1 in 4 folks in Texas, we went without.
This is a common misunderstanding. For most people in this situation, the laws on the books already took care of the problem. If she already had healthcare insurance at her previous employer, if she could show continuous coverage, she would be able to continue to purchase healthcare insurance privately, despite her preexisting condition.
Whether the private insurance would be affordable to you is a different question, but it's not true that a preexisting condition was, before Obamacare, a complete roadblock to acquiring coverage privately.
And you're right; I believe that there were options open to her, specifically our state's high risk pool, which wasn't a viable option due to price.
But, heck, if price isn't a factor, why do we need insurance at all :D ? I mean, we always have the option to just purchase healthcare directly; whether that will be financially feasible, is, of course, "a different question".
Under HIPAA, continuous coverage ensures acceptance into group health care plans (for instance, employer-provided coverage) regardless of preexisting conditions.
Further, continuous coverage ensures acceptance into some form of individual coverage, of a kind determined by the specific state you're in.
I do not believe it is the case that continuous coverage guarantees acceptance into individual health care plans.
In 19 years of working, and (more relevantly) 15 years of marriage, I have never had a lapse of health care coverage for myself or my family. When we started Matasano, I had just previously left a full-time, full-benefits job at a larger company where I'd been working for 4 years. I elected COBRA when I left, and started shopping for individual coverage.
We were unable to get family coverage at any price in Illinois because of preexisting condition concerns for two members of my family. In both cases, the rejection cause was a total surprise, because the "condition" wasn't an ongoing health problem, but rather a piece of medical trivia that caused underwriters concern that there might have been more significant issues down the road.
I shopped for insurance myself, and then with a professional broker who I paid to deal with the problem, and who could not find a way around it.
We solved the problem first by my wife taking a full-time job outside Matasano, which got us group coverage, and then by starting group coverage at Matasano.
I don't get it. If we are footing the bill, then it will make higher taxes, but if the insurance companies foot the bill then health care costs increase. There's no reason for both to rise (unless we subsidize the insurance companies through taxes on the insurance companies...)
The "visible foot of the government" is quite enough. 2,000 pages of unread "law" can force all sorts of negative changes, and then there's the electronic health record (EHR) requirements in the "stimulus" bill, including the single sentence on requiring "meaningful use" which expanded into 700 pages of regulations, a lot of well paid consulting, and what looks like so far worse medical care as healthcare workers have to focus on the computer instead of the patient to avoid losing their jobs.
There's also the host of taxes in Obamacare; just the medical device tax alone will obviously raise the cost of care.
Risk corridors by themselves, obviously not. Except if you ignore the fungibility of money aren't they ostensibly paid for by taxes on policies??
On the other hand "guarantees" will put less pressure on insurance companies to put pressure on suppliers of health care, resulting in less displacement to other customers.
"An earlier version of a headline accompanying this article on the home page was incorrect. The health law is projected to result in a voluntary reduction in the work force equal to 2.5 million full-time workers, according to the Congressional Budget Office, not two million fewer jobs."
You also have to consider the small business case. I can't tell you how many technology workers I know who have health issues and would otherwise be building a startup or working as a consultant, but before the ACA they could never dream of getting or keeping health insurance. I mean I'm a relatively healthy 20-something and was denied health insurance several times, and when I was approved, was paying ridiculous amounts per month because I was 10 pounds overweight.
Putting those prices back in line for most people and not tying health insurance to a full-time job is the whole point. I fail to see how this is government offering an incentive of any sort, unless that's what you meant and it was poorly phrased?
So you are saying you might produce less as a result of subsidies given to you if you choose not to have a full time job? You are agreeing with 300bps.
So, no, I do not agree with him.
You agree with his claims, just not his tone.
This statement is incredibly naive and shows a complete lack of knowledge of economics. When the government gives incentives for making less money, then they are giving an incentive to make less money. It's that simple, but let me explain.
To get a bronze family plan on healthcare.gov, I was quoted $12,000 per year with a $12,700 deductible. Basically, I'd be paying $24,000 per year for healthcare.
That's the list price, which is what I have to pay if my wife and I make more than $96,000 per year (1/4 of the income goes toward healthcare). The cost goes down the less I make below $96,000. This is government giving me an incentive to make less money.
Or at least report less income. I bet a lot of people will move into the shadow economy, and get paid in cash. Instead of getting a W2 with 50k on it, I can work a part time job and report 20k, and do some off books work for 30k. I would qualify for the subsidy, and get a chunk of cash that I don't pay taxes on.
"[...] under Obama the average annual number of tax crime prosecutions sought by the Justice Department has been 1,568, versus 1,303 under Bush."
Doesn't sound like that's going to strike fear in the hearts of many. Plus I suspect detecting small fry like in byoung2's example is rather difficult.
I'm sure there are lots of them, but I wonder if there are so many that it is something to worry about.
Given the audience of this site, web design would be the obvious choice. But here are some more:
http://livesafely.org/financial-freedom/67-jobs-that-pay-und...
I'm not arguing that cash jobs are rare or nonexistent. I'm wondering how prevalent "really good ones" actually are.
($30k being a real good cash job is just like my opinion, but whatever)
Elsewhere, well, look at e.g. Italy where I've read that the people don't view the central government as legitimate and evading taxes is said to be the national pastime. Read up on the tax police stopping cars in the industrial north and checking trunks.
Our current tax system is truly voluntary in a certain sense, and would seriously break down if we widely adopted such attitudes for whatever reasons.
And I have no clue what state you live in or your age obviously, but in Florida, which (previously) had some of the highest health care costs in the country, a family Bronze plan is only like $4k a year. I could get a Platinum plan with $0 deductible for about 30% than the price you're quoting. So, let's not act like those are normative numbers.
And beyond that, you have no idea what you're talking about. I just put in my exact family situation into healthcare.gov for Broward County in FL and it is $987 per month with a $12,000 deductible for every Bronze plan. I'm guessing you're entering a ridiculously low income and taking the subsidies into account. Or you're looking at the catastrophic plans and thinking it's bronze, which it's not.
This will be my last response; you are an incredibly naive person and it is not my job to educate you.
It's a big problem for our official poor, where there are wide ranges of income that cost them more in government benefits than they get in highly repressively taxed income.
And look at the results of supply side tax rate cuts, JFK's from 91%, Reagan's from 50% and 75% as I remember ("earned" and "unearned" (passive) income). Those had major effects, and while I'd gone to college a year before the latter's election I noticed how it changed my parent's economic behavior in ways that were good for the economy.
Note the rise from 25% to nearly 50% in the ~ $65K to ~ $85K income range, after which it plateaus to around that $96K threshold; add Obamacare subsidy losses and we're absolutely guaranteed a significant impact, unless people's economic behavior has radically changed since the '80s. Which is of course what the CBO is saying, among many other dire things (0.5% GDP loss, 6-7 million losing their employer health coverage, around the same number uninsured (although a lower percentage because of population growth)).
Note also the > 100% rates around $25K to $45K, and the steep climb that starts around $15K. That's the big effect I was talking about, except we generally don't count people or families in most parts of the country making $45K as "poor".
But, yeah, exactly what's going to happen at that income range is yet to be seen, and at this moment neither of our impressions can be stated to be right or wrong.
Making changes to a system that corresponds to one fifth of the annual economic output will obviously have massive consequences. However, it is hard to see how you could possible make the economics of US health care worse. ACA gives more people the ability to individually choose their health care insurance, thus increasing competition and hopefully giving the health care buy side more incentive to drive down prices.
The U.S. healthcare system is not set up to maximize outcomes. I guess I agree that is a problem, but it makes efficiency comparisons less interesting.
Further, it is not like they are getting health care due to an efficiency in the system. The government is taking resources from the productive (taxes) and giving it to the unproductive (subsidies) in order to purchase insurance. This will further erode economic productivity.
What they're expecting is that fewer people will be motivated to work (or to work a second job, perhaps). Imagine someone self-employed who also works part time to get medical insurance benefits; with PPACA he wouldn't need to do this any longer. On the other hand, imagine someone who was working just to supplement the spouse's income. With PPACA's subsidies, the extra income (within certain ranges) becomes a liability, and it makes more sense for that person to stay home without the earned income, enjoying the healthcare subsidy instead.
So this doesn't say anything about unemployment (as it's commonly defined).
They should also expect that some people will appear to reduce their hours or quit that second job, when in fact they trade it for some off the books work. For example, the musician who used to work part time at Applebees might just teach guitar lessons for cash in his spare time instead. The person supplementing the spouse's income is not going to just stay home and watch TV...they might run an unlicensed daycare or become a basement hairstylist or freelance web designer for cash.
In a way, the ACA is creating jobs. Or at the very least, it'll increase wages. That's a selling point.
EDIT: I thought I wrote the "increasing jobs" in a "wouldn't it be funny if this were true" sort of sense, guess I didn't.
As for the wage increase, Business insider seems to think so at least (http://www.businessinsider.com/the-buried-lede-in-the-cbo-re...).
Loss of working hours for businesses does not mean loss of jobs it means finally people can work decent hours and employers can't take advantage of them as easily.
A company needs to pay what that costs or their not worth being a company.
This is unclear to me. The company needs to pay what what costs? As far as I can see, they are indeed paying hourly workers for the hours that are worked, so this can't be what you're referring to. What is the cost that they're not paying?
According to the body, hours worked and full time employment will drop. This is a straightforward supply shock, along the same lines as the oil shortage of the 70's (assuming of course you believe in reducing the entire economy to 2 graphs, as the Keynesians often do).
Also, increasing wages in a recession is a big no-no if you believe in Keynesian economics. Assuming this effect is not taken into account by the CBO's headline number, it means there will be further job losses.
They're predicting a smaller labor force (non-institutionalized population of working age working or actively seeking work) resulting from the reduced health insecurity from the ACA, not fewer jobs. [1]
To see where that fits into the unemployment picture, understand that the unemployment rate is (1 - (Filled Jobs / Labor Force)).
> Also, increasing wages in a recession is a big no-no if you believe in Keynesian economics
We're not in a recession. We're in an expansion in which both wages and employment rates have recovered slower than normal -- which was also true in the last expansion between the 2001 recession and the Great Recession -- which is why it feels like we've been in a 13 year recession to many people who aren't major capitalists, though there have only been 26 months of official recession in that period.
[1] The ACA effect is described on p. 14 of the report [2], which is linked from the NYTimes article, in the section under the heading "Labor Force Participation" (heading on p. 13).
[2] https://www.cbo.gov/sites/default/files/cbofiles/attachments...
The unemployment rate you cite is correct, but it's just as you said - a rate, not an absolute total.
What the report states is that the total number of jobs will decrease. Together with the fact that we know that hours per job is not going to increase (and may actually be decreasing, thanks to other PPACA regulations), simple algebra tells us that there will be fewer hours worked overall.
Barring an external development that causes productivity per hour to increase, we can expect lower total production. Bottom line, then, is lower GDP as a result of this. That is the opposite of a good thing for the economy.
One argument for better healthcare is people end up less sick. These guys(http://www.forbes.com/sites/brucejapsen/2012/09/12/u-s-workf...) seem to think that productivity decreases in the US account for almost 10% of spending on salaries and whatnot. There are 120 million or so people in the workforce, so 2 million jobs is something like 1%.
So if we make people "10%" more health , it would end up with us saving the same 1% (thus on the long-term allowing more investment later). We could get people to do the same amount of work for less, thus we are more productive.
I do not vouch for the validity of the numbers, just for the idea behind it (healthier people means more productive people).
Indeed. Unfortunately, it is entirely unproven that Obamacare, which focuses on health insurance, is going to result in better health care.
For reasons we can go into if you want, Obamacare compliant polices tend to have extremely narrow networks of doctors and hospitals. E.g. look at all the fuss the Seattle Children's Hospital is raising, and there's a lot of individual cases where people are losing their doctors who've been treating their conditions for a long time, this is just the latest report to pop up: http://www.latimes.com/business/la-fi-obamacare-patients-201...
There's a reason Reagan got a lot of mileage with his joke "The nine most terrifying words in the English language are 'I'm from the government, and I'm here to help.'"
This is a good point.
The narrower networks can, I think, be expected to result in more time off work. I'll have to drive a farther distance to see my doctor, or I'll have to settle for an appointment in the middle of the day. Either way, it's a hit to my time that wouldn't exist under "traditional" schemes.
it is entirely unproven that Obamacare, which focuses on health insurance, is going to result in better health care.
So the fact that you're insured doesn't necessarily mean that you're going to get better faster. The doctor can't do anything for you if you've got a cold or the flu; you've just got to ride it out. I suspect that it's cases like this that make up the lion's share of health-related lost productivity.
And even when healthcare can have an impact on your health, I don't believe that the positive effects on worker productivity could be that great. Most employers already provide healthcare insurance, so there's no improvement to the situation there. The only positive effect will be toward those who are already employed but without health insurance, which is a minority.
According to the CBO, the difference between actual and potential GDP will decline to 0.5% by 2017. At that point (and possibly before) a reduced labor force is reduced jobs and (more importantly) reduced production.
It could result in reduced jobs/production even before that if workers who choose to reduce output are not interchangeable with unemployed [1] workers willing to take those jobs at the same wage.
We're not in a recession. We're in an expansion in which both wages and employment rates have recovered slower than normal
Either we need fiscal/monetary stimulus or not. If we need stimulus, increasing wages is a bad idea according to all mainstream economic theories (Keynesian, Monetarist, Structuralist). Which is it?
Here is the report, btw: https://www.cbo.gov/sites/default/files/cbofiles/attachments...
[1] Including discouraged, at least if employers can find the discouraged workers.
Sure, from the POV of much of the workforce the economic. car isn't going anywhere, but stimulus is like trying to give it a jump start when the engine is runnin but the transmission is in neutral.
If true, this is a good thing. We, as a society, don't need "jobs" or hours worked. We need stuff made. Voluntary attrition of the least productive 5-billion person-hours per year won't hurt us much, but that will cause wages to rise (which will, over time, improve what is produced).
We're already producing a lot of stuff. What we need now is a qualitative focus, serious consideration of sustainability and, above all, better leadership. Taking some pressure off the lower and middle classes (i.e. peeling back the wage serfdom that gives power to feudal strongmen) is a start.
There used to be a Fordist connection between general prosperity and the well-being of businesses, rippling up to the very rich. But the consumer credit boom killed that (sort of). Instead of letting wages rise or prices fall, the poors could be pumped full of loans they couldn't afford to repay. We saw, in 2008, how well that works out, but the fundamental structure of society hasn't changed.
Obama has made many tactical mistakes with the PPACA, and I wish he had started at single-payer to make public-option the compromise, but if "Obamacare" is bringing us back toward a more cooperative, progressive society, then that's a good thing.