How Good Has Obama's Presidency Been?

Let's start by giving credit where it is due.

First: Obama has been a much better president than McCain would have been or than either Hilary or Trump will be.

Second: not rocking the boat is a highly under-appreciated achievement in politics.

Third: US politics is the most contentious and divisive it has been since the civil war, and while Obama hasn't visibly done much to fix this - and has arguably contributed to it - it is genuinely harder to achieve great things in politics than it has been in decades and centuries gone by.

With that said, I'll go over this list of "Obama's Top 10 Accomplishments - According to Obama".

10: A growing economy
It is definitely true that the US economy is stronger now that it was when he took charge. However, this is generally to be expected given that he was elected amid economic turmoil. By predicting a perfectly average recovery Bryan Caplan has won numerous bets, and by overseeing a perfectly average recovery Obama will pass on a healthy economic situation to his successor.

If I were more confident in my understanding of the situation, I'd compare the relative rates of recovery in 2009-10, when Democrats held all three branches of the federal government and were able to pass massive stimulus packages, to growth rates since 2011. I lack the requisite knowledge though, and in any case it's difficult to make this kind of comparison because you don't see the counterfactuals. Ultimately, I think this just falls into "not rocking the boat".

9: More Americans Getting Health Insurance Coverage
Obamacare was passed, and has survived various challenges at the Supreme Court. Let's take on face value his claims about how many people are now insured that weren't previously. Even so, Obamacare leaves a lot to be desired.

The single biggest problem in the US healthcare system is the way in which health insurance is tied to employment. This has its origins in the New Deal era when bosses were forbidden from competing on wages and so would attempt to attract workers with other working benefits, but continues to this day because income tax is charged on your wage - but not on your employer-provided healthcare. This has two major negative consequences: firstly, businesses buy one-size-fits-all healthcare packages for their employees, even when this is wildly inappropriate. Second, losing your job (because of a health condition?) tends to mean losing your insurance. Obamacare includes a band-aid for this latter problem, in that when you try to get a new policy you can't be charged more for having the condition which caused you to drop out of work, but overall it if anything reinforces the problem that health insurance is tied to employment.

There are smaller complaints we should have about Obamacare - for example, there is absolutely no reason why health insurance should cover contraception. The expense of contraception is entirely predictable and - more importantly - low variance, so requiring it to be included in employer-provided healthcare packages is wasteful (one-size-fits-all again) and creates easily-avoidable but expensive debates like the Hobby Lobby case.

I doubt American healthcare will be significantly worse after the ACA, perhaps it will be better. I don't know, and don't trust myself to judge fairly. But as reforms go, Obamacare is a remarkably sedate and unambitious one.

8: America's Global Leadership on Climate Change
There's been talk, there have been summits, there have been signed agreements. Wake me up when you have a global CO2 tax.

Sorry, that's an unfair and perhaps impossible expectation. But there have been lots of "commitments", both realistic and unrealistic. I'm going to judge results not by treaties signed but by actual reductions in CO2 emissions achieved. This is something we may be able to pass judgement on in a few years - the most recent figures I've seen are from 2011 - but in any case it wouldn't massively effect my assessment of Obama's presidency.

Quite simply, this is not something the US President has much power over. Obama may be the most powerful man on earth, but - despite what many European liberals might like to believe - he is not God.

7: US-Cuba relations
The opening up of trade and travel between the US and Cuba is indeed a great thing. Great for the US, but even more for the people of Cuba. Full credit here.

6: Iran Nuclear Deal
I have no idea how to assess how good this is, whether it would have happened anyway, or anything else relevant to this. Not being willing to spend the time to do the relevant research, I'll charitably assume it's good.

5: Standing Strong Against Terrorism
This is a very vague phrase. He is continuing to fight in the Middle East, although it's not clear whether that's a good thing. Domestic terrorism has continued to be a problem of extremely low significance but high salience; presumably were the Democrats in control of Congress he would be pushing some kind of gun control, but we can't assess presidents based on what they "might" have done.

4: The Trans-Pacific Partnership
Some of these claimed achievements I have avoided assessing because I have next to no knowledge about foreign policy. This policy I cannot assess because no-one knows what it actually is. In theory it's about securing free trade along with worker rights and environmental protection, as well as being a part of Obama's strategy to make friends with lots of countries near China. These are all laudable goals (although horrendous third-world sweatshops are highly underrated as an alternative to continued grinding poverty, which in practice is the alternative) but due to the secrecy surrounding the agreement, there's no way for me to have any idea how far it goes towards achieving these things.

3: Bipartisan education and budget deals
Well, the government "shut down" a couple of times in order for the budget deals to be achieved, and Obama - or more likely his underlings - deliberately made those shut-downs worse than they needed to be (for example: stopping people from using government websites, closing privately-operated national parks). I guess at least they may have improved health outcomes.


2: The legalisation of same-sex marriage
was indeed commanded by the Supreme Court, with not a finger to be lifted by Obama himself. Don't get we wrong, I'm very happy that same-sex couples are now able to get married - but the credit for this lies not with the president who eventually concluded that supporting it might not cost him votes, but rather with the activists who managed to take it to the Supreme Court - and win.



1: "The American People"
I have to quote this section in full so you can appreciate its utter vacuity:

"All of this progress is because of you -- because of workers rolling up their sleeves and getting the job done and entrepreneurs starting new businesses," Mr. Obama said Saturday. "Because of teachers and health workers and parents -- all of us taking care of each other. Because of our incredible men and women in uniform, serving to protect us all. Because, when we're united as Americans, there's nothing that we cannot do."

Um... well done, I guess? I have no idea what for, though...

Having looked at what Obama sees as his greatest achievements, we really ought to look at some of his failures. When you look up "Obama's greatest failures" articles online there tends to be a strong overlap with what are considered his greatest achievements (Obamacare, work on climate change, etc). I'm going to avoid discussing anything twice, but here are some things you might wish to criticise him for.

Failure to close Guantanamo Bay
It's true that he hasn't closed the base. But he has at least stopped anyone new being sent there, and given that he has limited political capital you can understand his decision to use it on other things.

Continuation of Bush-style militarism
He has surely been guilty of this. There was the cack-handed intervention in Libya (admittedly mostly the fault of Hilary Clinton), the bluster in Syria (where his reputation was saved, of all people, by Vladimir Putin), and the massive expansion of drone warfare.

I'm actually going to defend that last part. If you're going to war, then drones are a good way to do it. Sure there is significant collateral damage from drone strikes, but all war has collateral damage and drone warfare in fact has relatively little - I believe about one civilian per two combatants killed. Conventional wars typically involve around two civilian deaths for each single combatant death. Obviously all collateral damage is regrettable, but if you accept the case for war then you should accept the case for drones.

War on privacy and whistleblowers
The pursuit of whistleblowers - most famously Chelsea Manning and Edward Snowden - has been one of the more worrying trends of Obama's administration. As has often been remarked, it stands in particularly stark contrast to the platform he campaigned on. It's hard to quantify the harm caused by his policies here, and he hasn't been obviously worse than Bush Jr, but this is a definite black mark on his presidency.


Conclusion
The difficulty in assessing presidents lies in the absence of an obvious benchmark. I am not a fan of the average Obama policy, but the fact remains that had he not been president then his position would have been occupied by John McCain or Hilary Clinton - neither of whom would have been any better as a safeguard of domestic liberties or as an advocate of the free market, but both of whom would have been vastly more inclined towards ill-conceived military adventures in the Arab world. The best case to be made for Obama is that his presidency has been one of retrenchment, of healing after the trauma of his predecessor.

Perhaps the one thing I feel most willing to say is that Obama has ultimately been inconsequential. The US of 2016 is not so very different from the US of 2008 - slightly wealthier, a fair bit more polarised and distrustful, slightly freer in some ways and slightly less free in others - but ultimately there have been no grand schemes, no ambitious triumphs or follies. Obamacare is talked about a lot, but it did not change in any fundamental way the workings of the US health insurance system in the way that single-payer or taxability of employer-provided healthcare would. There have been new interventions but no new invasions, and past invasions (along with their spawn, such as Guantanamo) are being slowly but surely wound up. In time, Obama will be remembered as the first black president of the US, and nothing more or less than that. There are worse legacies.

Too much healthcare?

In one of my political philosophy tutorials last semester, I was asked to defend the libertarian position on healthcare - that it should be private with minimal if any government intervention. I immediately brought up the issue of overconsumption: that, when someone is not bearing the cost of their consumption, they will tend to consume more than the socially optimal amount. It failed to convince the people playing Rawlsian liberals and religious conservatives who were also in the debate, but it was at least a sensible argument that people of many different should take seriously. (I'd suggest it also gave the lie to the whole point of the exercise, which was to develop an Overlapping Consensus: that is, an agreement on policy between all "reasonable and rational" people. In order to attain this for healthcare, a Rawlsian would denigrate the libertarian position as "unreasonable", a word which here means "unwilling to consider the interests of others", despite the thoroughly reasonable nature of my argument).

The reason I bring this up is because I'm now wondering it the problem is actually far worse. I'll present a simplified theoretical model first, then show the things I have been reading which led to this chain of thought. I haven't done any independent empirical research and so would be wary of the conclusion, but it certainly seems plausible. The articles I have been reading all concern the US; my model would predict that the problem should be worse in the UK, so that's something that really needs to be investigated as a test of the theory.


In general in an economic model, we would assume consumers to be perfectly-informed, perfectly rational utility maximisers operating within a budget constraint. Within medicine, the budget constraint is very weak due to subsidies, nationalisation, insurance etc, and so we will treat it as non-existent. There is also very limited consumer information; in particular, I suspect that consumers will systematically overestimate the benefits of more healthcare. Furthermore, I model the actual utility of increasing healthcare increasing at first, but then actually falling. Essentially, I am rejecting the axiom of non-satiation: the marginal private benefit of consumption would look something like this:

Given the absence of a budget constraint, we would expect the consumer to consume up until the point where Marginal Private Benefit (better health and longevity) equals Marginal Private Cost (inconvenience of treatment, pain). However, this is where we introduce the problem of lack of information, by which I suggest consumers systematically overestimate the benefits of more healthcare.

We clearly see overconsumption here, even compared to what the individual would ideally choose in a post-scarcity economy. I'll add in another cost line to show the cost to society as a whole, given that individual is not bearing the financial cost of healthcare:

And to be fair, I should probably include a benefits line which takes account of positive externalities from healthcare - to concerned friends and family who have less to worry about, bosses who have less time off work to account for. These are likely to taper off with the higher levels of treatment, of course, since the increased treatment may restrict mobility and/or activity on the part of the patient.

The intersection labelled A is where, in an ideal world, consumption would occur. The intersection labelled B is where, in my model of the actual world, it will happen. Between these two points, the person subsidising the medical bill is largely paying for suffering to be inflicted upon the patient.

If I were aiming to provide an even better model of medical consumption, I would be likely to include a role for hyperbolic discounting. The effect of this would be to cause the consumer to underestimate the marginal private benefit of healthcare when young. However, my model is intended primarily as a model of healthcare among older people, where the effects are more immediate and so hyperbolic discounting plays less of a role.

In any case, is this such a problem? Some money is wasted on too much healthcare, antibiotics become that bit less effective - a pity, but surely it's far better to err on this side than to err on the side of underprovision?

This brings me to the reason I was thinking about the economics of healthcare. After reading Scott Alexander's half-hilarious-half-depressing parody of Piano Man by Billy Joel a couple of times, I went back to looking over some of his older posts on working in medicine. The first post I read at Slate Star Codex (as an actual follower of the blog, rather than merely as someone who followed a link from Marginal Revolution*) was Who by Slow Decay, which discusses the horrors which are to be found in hospitals. It links to an article entitled How Doctors Die, which talks about how most doctors would not go through the treatment to which their patients are subjected. From reading those, I would suspect that a substantial portion of healthcare spending on terminal patients is not even mere waste - rather, it is destructive. It puts people through painful, disgusting, repugnant deaths in an uncontrolled manner. Euthanasia would be a mercy, but even better would be to just stop f***ing CAUSING these horrible, miserable endings: let people die.

So how much of medical spending, then is not merely wasteful but actively damaging? Somewhere between a fifth and a quarter of lifetime medical expenses occur in the last year of life; of course, not all of this is on terminal patients and not all that is spent on terminal patients is destructive; that said, you don't need to be Robin Hanson to think a substantial portion of healthcare spending is counterproductive.


*Speaking of Robin Hanson, the MR link was to this article describing his talk on effective altruism. Reading over this again, I notice the following claim attributed to Hanson:

the real rate of return on investment has been higher than the growth rate for 3000 years and this pattern shows no signs of changing.

Robin argues that for this reason, it is better to save money and donate it all at the end of your life than to donate it immediately. There are rebuttals of this conclusion (e.g. opportunities for efficient charity dry up over time, we can do more good now than we will be able to do in future) but the quoted claim goes unchallenged. Compare to the current debate over Thomas Piketty's  Capital in the 21st Century, where right-wing and libertarian critics of the book have been eager to dispute the claim. There are many trained economists within the effective altruism movement, so surely the statement could have been challenged when Hanson made it? This leads me to suspect that challenges to the idea that r > g are frequently more about ideology than economics.