Still I’m gonna miss you

Not sure why Dems are trying to stop Republicans from voting on health care tomorrow. I don’t always wish a motherfucker would hold a vote on destroying millions of people’s health care but there’s no way on earth this thing passes the Senate. I mean, look at these poll numbers:

Public sentiment is particularly lopsided in favor of an aspect of the current health-care law that blocks insurers from charging more or denying coverage to customers with medical conditions. About 8 in 10 Democrats, 7 in 10 independents and even a slight majority of Republicans say that should continue to be a national mandate, rather than an option for states to retain or drop.

These Tuesday group moderates, or whatever they’re calling themselves these days, are correct:

The latest changes, hammered out by Freedom Caucus Chair Mark Meadows (R-NC), and one of the moderates’ own, Tuesday Group co-chair Tom MacArthur (R-NJ), allows states to opt out of ACA insurer mandates in a way that would essentially gut its pre-existing conditions protections, the Holy Grail of the promises many Republicans made about their replacement.

“I spent the whole work period hearing from people pissed about pre-existing conditions,” one moderate lawmaker told CNN on Wednesday. “This isn’t helpful.”

Another moderate was overheard by the Hill telling a staffer: “If I vote for this healthcare bill it will be the end of my career.”

If these idiots walk the plank on this unpopular piece of shit…

Odds and Odds Without End

I miss the good old days (2008-2016) when a person could unplug for 12 hours and not find evidence of traitorous behavior in the highest levels of government and multiple instances of chief executive buffoonery upon reentering the media stream. Here are a few things that caught my eye:

This seems significant:

Former national security adviser Michael Flynn was warned by the Defense Intelligence Agency in 2014 against accepting foreign payments as he entered retirement, according to new documents obtained by the House oversight committee…

“These documents raise grave questions about why General Flynn concealed the payments he received from foreign sources after he was warned explicitly by the Pentagon,” said Rep. Elijah Cummings, the top Democrat on the House oversight committee, in a statement. “Our next step is to get the documents we are seeking from the White House so we can complete our investigation.

This stinks to high heaven, y’all. This specimen simply must be questioned under oath.

I’ve read a theory that Trump die-hards in the wingnut media are recognizing that this Russia business has the potential to bring the orange fart-sack down, so they’re creating an alternative narrative that, while the Trump campaign was thoroughly infested with Russian operators, he was personally clueless about it during the campaign but has now turned wily spy-hunter. That’s the line taken by tabloid trash purveyor David Pecker, Trump friend and aptly named publisher of the National Enquirer.

In another curious turnabout, Trump favorite and notorious Hillary-hater Judge Napolitano of Fox News published an op-ed questioning FBI Director Comey’s handling of the Russia investigation before the election:

How could Comey justify the public revelation of a criminal investigation and a summary of evidence of guilt about one candidate for president and remain silent about the existence of a criminal investigation of the campaign of another? How could he deny knowledge of surveillance that was well-known in the intelligence community, even among his own agents? Why would the FBI director inject his agents, who have prided themselves on professional political neutrality, into a bitterly contested campaign having been warned it might affect the outcome? Why did he reject the law’s just commands of silence in favor of putting his thumb on political scales?

I don’t know the answers to those questions. But the American public, and Hillary Clinton, is entitled to them.

Truth from an unlikely source. Will the fact that even Fox News bigwigs are questioning his precious integrity and impugning his self-cherished aura of bipartisan competence spur Comey to attempt to unshit the bed he so thoroughly shat in 2016? We’ll see.

It also appears that Trump got pantsed by Canada and Mexico after blustering about NAFTA yesterday. He’s agreed to “renegotiations” rather than following through on threats to unilaterally withdraw. Possibly Peña and Trudeau simply explained how the treaty works, just as President Xi held an impromptu “North Korea for Dummies” seminar at Trump’s private club, clueing Twitler in on the complexities of that situation.

Were I a citizen of Canada or Mexico, I’d be dancing with glee at the prospect of the upcoming negotiations with such an easily provoked, idiotic ass. The upside for us? Maybe we’ll get taco trucks on every corner after all, with a Tim Horton’s across the street!

There are at least half a dozen more news items that would be screaming headlines for weeks in a normal administration, such as Trump’s idea to break up the 9th Circuit Court because he doesn’t like its rulings. I didn’t need to read about that after watching the first three episodes of “A Handmaid’s Tale” yesterday.

Anyhoo, I miss the days when a tan suit could cause a media furor. Open thread!

Keep swimming, just keep swimming

Keep on swimming, keep on calling


Update 1
Keep on calling:

The vulnerable Republicans are getting squeezed hard, so time to pop them like a zit three days before prom.

Call Congress

Medicaid is the key. The AHCA is still cutting $800 billion plus from Medicaid over a decade and this is the point of resistance for the Tuesday Morning Group, a group of 40 to 50 less conservative Republicans who are likely to represent districts that are vulnerable in wave elections.

Let them know that this is important and that killing Medicaid kicks them out of a job in 2018.

With Chaffetz going out for surgery, Ryan can afford to lose 21 votes assuming every Democrat shows up. (Any Democrat who is not in the ICU or at the funeral of spouse and does not vote should be primaried). The House Freedom Caucus might still have two or three No Votes, Rep. Massie from Tennessee is still a NO vote. The Tuesday Morning Group needs to supply at least seventeen or eighteen No votes to defeat the legislation.

Call Congress and tell them what you think…

Double counting: reinsurance and risk adjustment

A friend of the blog raised a very interesting point about the current state reinsurance efforts. These efforts don’t modify risk adjustment coefficients. This leads to double counting of claims leading to risk based payments. This is a major problem with a couple of solutions.

We need to get deep into the weeds of chasing money like a rabbit at a greyhound track.

First, risk adjustment is zero sum at the state level. A dollar that Plan A receives is a dollar that Plan B gives up. Risk adjustment works by assigning a risk score to a collection of diagnoses. That risk score is then multiplied against average premium and a few standardization factors to calculate the individual’s risk value. The company’s risk values are summed and normalized against the state wide risk profile. If the company has less than state level risk, they pay into the risk adjustment fund which then pays their competitors who have more than state wide average risk.

Hemophilia receives a risk score of about 52 times average monthly premium to treat. In a state with an average premium of $500, that means this patient receives a risk value of $26,000 per month or $312,000 per year. A portion of that $312,000 covers ongoing maintenance medication that everyone receives. A portion covers catastrophic costs as a bad bleed can quickly run to a million dollar month.

Minnesota’s new reinsurance program pays a portion of claims that run from $50,000 to $250,000. That means a Hep-C cure will be paid for via risk adjustment and reinsurance. That means the maintenance prescriptions for a hemophiliac will be paid for by both risk adjustment and reinsurance. This means solid tumor cancers will be paid partially for by both risk adjustment and reinsurance.

Double counting is a problem on a market stabilization level and a political level. It needs to be fixed.

When I worked for UPMC Health Plan, the last three years had me focusing a significant chunk of my time on Medicaid risk adjustment. Pennsylvania Medicaid had revenue neutral risk adjustment like Exchange and a high cost risk sharing pool. These two elements of risk played nicely with each other. Risk adjustment was capped to be no more than approximately $75,000. Everything after $75,000 was put into a high cost risk sharing pool where money was spread around to cover unusually high expense cases. A dollar of spend was only ever going to be at risk for pool smoothing purposes once.

Minnesota or any other state that is thinking of using an aggressive reinsurance scheme to stabilize pricing needs to re-calibrate their risk adjustment co-coefficients to prevent double-dipping where the same dollar of spend will be credited to both risk adjustment values and reinsurance. They can also choose to apply risk adjustment corrections to the claims data that is used to trigger reinsurance payments. Both require local technical expertise, political will and time to implement.

As more states think about reinsurance, they also need to think about how they do risk adjustment. There are solutions, they just need to find the local solution that works.

Read more

Thursday Morning Open Thread: Turnabout, for Real Education

I much prefer this idea from Richard V. Reeves, at Quartz:

When the event was founded back in 1993 as Take Your Daughter to Work Day, the idea was to promote gender equality. It expanded to include sons 10 years later, and has since lost much of its animating purpose. It also remains a largely white-collar exercise: Sponsors of the foundation that advocates for the holiday include MetLife, HP, AOL, and Goldman Sachs…

But in practice, Take Our Daughters and Sons to Work Day hasn’t changed much. We need to turn it on its head. At Brookings we are trying to practice what we preach, and so this Friday we will be hosting over 100 high schoolers from DC Public Schools, as a result of a new partnership with two non-profit organizations—Build DC and the Latin American Youth Center—and DC Public Schools.

One of the biggest challenges the US is a lack of intergenerational social mobility. Too many children end up in similar positions to their parents on the social and economic ladder. Given this, the case for exposing disadvantaged kids to white-collar jobs is pretty clear. But there is something to be said for the other side of coin, too. Teenagers from affluent backgrounds often live in a bubble, surrounded by friends, neighbors and fellow students who share similar backgrounds. “Our kids are increasingly growing up with kids like them who have parents like us,” writes the Harvard social scientist Robert Putnam in his book Our Kids. He warns this represents “an incipient class apartheid.” It couldn’t hurt for upper-middle-class kids to step outside their bubble and spend a day in a working-class job…

Apart from tween-wrangling, what’s on the agenda for the day?

On The Road

Good Morning All,

This weekday feature is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.

So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are. By concentrating travel updates here, it’s easier for all to keep up-to-date on the adventures of our fellow Commentariat. And it makes finding some travel tips or ideas from 6 months ago so much easier to find…

Have at ’em, and have a safe day of travels!

Should you have any pictures (tasteful, relevant, etc….) you can email them to or just use this nifty link to start an email: Start an Email to send a Picture to Post on Balloon Juice

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Defining the True Progressive (Pt. II): Not An Intentional Joke, Apparently…

‘Our Revolution’, it appears, will be carefully curated:

The People’s Summit is a conference with a goal. To express a set of ideas, values and priorities that reflect our political vision. So instead of a ‘first come, first serve’ registration process, we’re deliberate about who we want to attend. With that in mind, we’ve crafted an application process that allows us to get to know you better before we seal the deal.

We’re looking for organizers and activists, thinkers and doers, grassroots and grasstops. And we know that simply opening the doors to whoever can buy a ticket will result in a space that is too white, too old, too local (also too Chicago and nearby areas), too many paid staffers, and too many consultants.

So we’re asking for personal information about people who want to come not to exclude anyone – but to make sure the balance reflects who we want to be. Our movement is leaderful, accessible, safe, and reflects the diversity of our country.
Read more

You know what to do

The Trump Administration in an attempt to otherize non-white people and scare the living bejesus out of the Republican marks base has set up a hotline to gather reports of crimes committed by aliens.

NASA has recently been finding planets that might be in the Goldilocks zones and evidently those inhabitants are causing a lot of trouble on earth. So if you see any strange people near Roswell jaywalking, give the hotline a call.

Who Defines the “True Progressives”? (Part I)

Senator Warren, still my idol. Here’s some more excerpts from the MassLive interview:

Q: Who is we? I hear progressives, and politicians in general, talk a lot about the middle class, but not much about people who live in poverty. Why is that?

Warren: One of the things I talk about is the way I divide the world. It’s the top ten percent who do very, very well; and the remaining ninety percent. And I talk about the interests of the ninety percent together, and make the argument that the investments in education, in infrastructure, in a robust economy, and in research are the things that benefit the ninety percent.

Q: So the breakfast waitress, and the dual-income double-professor family?

Warren: That’s right. Who are busting their rear ends but still can’t pull it all together. So that’s really the idea behind it. America once worked to build a lot of opportunity. And they called it the middle class; they filtered things through the middle class. But the truth was, opportunity was there for the middle class, for the working class, for the working poor, and for the poor poor. And you watch from about 1935 to about 1980, income goes up for everyone.

Q: Are you talking about Reagan; the 1980 mark?

Warren: Yes, that’s the 1980 mark. And African Americans talk about this as well. From the time we first started measuring, there was a black-white wealth gap; a big one. But we were hooked on the idea of opportunity. When the Civil Rights movement picks up steam in the 1960s and 70s, the black-white wealth gap shrinks by 30 percent. Then the shift to a trickle-down economy causes the black-white wealth gap to triple. So that’s the point. We can make a set of investments that work for all of us.

Q: You know some African-American political analysts say the progressive movement is tone-deaf when it comes to race. They say economic opportunity is all well and good, but it’s not going to make racism go away.

Warren: I talk about this in the book; about the economics of race. Which is a different point. It’s there in the first part of the story; how we built a middle class, and it’s there in the second part with trickle-down economics. But I also talk about it in terms of the politics of race. And the discussions around the Republicans; the dog-whistles on race, and then Donald Trump’s deliberate efforts to try to stir up bigotry…

That’s really an essential point — the Democratic Party’s problem is not that civil rights and women’s rights are somehow a distraction from “real” economic issues. It’s that, in our two-party system, some people who don’t want to call themselves Republicans are trying to turn the Democratic Party into a platform to talk about their issues (ECONOMIC JUSTICE! SINGLE PAYER NOW!) rather than the messy, open-ended coalition of “special interest groups” (urban activists, local machine politicians, immigrant workers, civil rights and women’s rights supporters) we’ve been at our best and most successful.

In fact, this is another nasty revival from the original Gilded Age, when Finley Peter Dunne mocked the Goo-Goos determined to purge American politics of ‘corrupt’ urban professional politicians (with the help of voter registration!) and replace them with clean-minded properly-educated white ‘native-born’ men. Just as it was more than a century ago, it’s always the people of color, immigrants, women — and working-class — voters who are expected to sacrifice themselves for True Progressivism.

(To be continued)

Today’s Word: Spicule

I had a long overdue dental appointment today, which was scheduled not because it was long overdue, but because I had a sore on my gum in the floor of my mouth down my my lower right molar on the gum underneath where my wisdom tooth used to be. It didn’t hurt that bad, as you all know I am pretty good with physical pain, but what actually forced me to go is that I am the world’s biggest hypochondriac when it comes to the unknown.

Basically, I can and am walking around with bone spurs in both shoulders and it doesn’t really bother me, but I cough twice and I convince myself I emphysema or lung cancer and so on. So, of course, I was convinced I had oral cancer, gum disease, herpes, HPV, scurvy, and everything else gum related I could find on WebMD.

Turns out it was none of those things. In 1991, while I was stationed in Fulda, I had my wisdom teeth extracted, and it was done with all the precision and care one might expect to receive from an Army dentist in a small barracks in a foreign land. Apparently, they left a shard of my tooth attached to a jaw, which is known as a “bone spicule,” and it took 26 years for it to work its way to the surface.

My doctor, whom I love (Jann Barber- Caring for People Not Just Teeth!) futzed around with that sharp hook-shaped device for a while and bled me, all the while apologizing and then jamming me again with it, told me what it was, and as we were scheduling an appointment to get a cavity filled and have that removed, I reached in, confident it was not cancer, gum disease, herpes, HPV, or scurvy and just a stupid piece of painful bone in my gum, and dug around for a while with my fingernail and pulled it out, saving us both some time and me some money. “Well, I’ve never had anyone do THAT before,” she stated. She’s pretty cool.

So I am pleased to report that I will not be dying of cancer, gum disease, herpes, HPV, scurvy, at least any time soon, and I have to report back to Dr. Jann in a few weeks to have a crown replaced (btw- Dr. Sasseen- that crown you put in in 1987 when I went through the windshield and bit a molar in half finally went bad, and Dr. Jann says she was impressed with your handiwork) and a cavity filled. I also went ahead and scheduled another cleaning in six months and now that I am an adult (WITH A HOUSE! And a GF!) I am going to start going to the dentist regularly like I should.

Unless I get scared and convince myself I have cancer, gum disease, herpes, HPV, scurvy, and then I will cancel my appointments and stay at home paralyzed with fear thinking I am going to die. Because that is how I roll.

Wednesday Evening Open Thread: Wheels Within Wheels

I was gonna use the ‘Not Normal’ tag… but after Nixon’s phlebitis and Reagan’s Alzheimers, “too ill to pay for his crimes, no point in examining things so closely” really *is* GOP-normal, isn’t it?

Apart from watching (probable) traitors scrabble after excuses, what’s on the agenda for the evening?

He’s Not a Scientist, But His Wife Did Stay in a Feriengasthof Ausdrucken

The NY Times, despite having an op-ed page that already hosts with Brooks, Dowd, Douthat, and Friedman and is a toxic waste dump of Oakeshittian wingnuttia and muddling centrism worthy of Superfund status, has decided to enrage those readers who still remain by hiring away the preternaturally smug Bret Stephens from the WSJ. Stephens has decided it is in his interest to do an “I’m not a science denier or moron, I’m just a fucking asshole” tour to deflect some of the criticism lobbed at him, and sat down for an interview with Vox. Lots of fabulous stuff (including downplaying campus rape by equating it the rape crisis in the Congo), but this is my fucking favorite:

My wife is German, so I know something about German energy policy.

With logic like that, I can see why the Times needed to hire him.

Here are some more excerpts:

“Look, at the risk of being incredibly politically incorrect, but I guess that’s my job — I think that all lives matter,” Stephens said. “Not least black lives.”


But if sexual assault rates in, let’s say, east Congo were about 20 percent, most people wouldn’t travel to those places. Because that is in fact — or, that would be, in fact, the risk of being violently sexually assaulted.

I am not for one second denying the reality of campus rape, or sexual assault, or behavior of the sort you saw from that swimmer at Stanford — that’s inexcusable and should be punished.

I’m taking issue with the claim that there is an epidemic based on statistics that, when looked at carefully, seem to have a very slim basis in reality. So what you’re transforming is horrendous, deplorable incidents into an epidemic — and that’s not altogether supported by reliable data.


Another example I took issue with is the idea that one in seven Americans are hungry. That’s not true. It’s not. It’s a problem because it’s not true.

Does this mean there aren’t hungry Americans? No. Does this mean we shouldn’t care about hunger in America? No. But when you have a campaign you see on subway billboards and elsewhere saying one in seven Americans is hungry, that’s false.

Here’s the problem with people like Bret Stephens (and I am not defending the stats he is attacking because, get this- I HAVEN’T FUCKING RESEARCHED THEM)- first, he knows full well what he is doing. He’s not plucking these statistics for disdain out of thin air. He attacks these specific statistics to allow breathing room for the deniers of problems that conservatives don’t like, don’t want to deal with, or would lose money if they had to address them.

Second, if you have a problem with statistics, the way you handle it is by demonstrating how the statistics are wrong. You show the flaws in the methodology, you run your own numbers and present them for peer review. What you don’t do is say “those numbers are bullshit because they give me a sad” or “there is not a crisis with sexual assault because the numbers seem too high” or “I see lots of fat people so how can all these people be hungry.”

What Stevens will now be doing, in the allegedly liberal NY Times, is going forward and farting through a megaphone into the public square, drowning out those people who have run the numbers and are trying to make evidence based cases that, unfortunately, are not as succinct as holding up a snowball in the well of the Senate or a bumpersticker that says “Stop Global Warming: Kill Yourself.”

Time to call the Senate

At this point, the AHCA as revised is on the knife’s edge to get out of the House. The Senate is where the highly anticipated battleground was always going to be. Time to light up their phones.

The great question on policy is Medicaid. There are a number of Republican senators (Portman, Heller are case examples) who represent Medicaid Expansion states whose Republican governors were not on board with the AHCA in March. These are the pressure points.

My read is if the AHCA gets out of the House it solely functions as a vehicle to get to conference committee with whatever the Senate wants to do. So let’s tell the Senate what you think.

Update 1

Call the Tuesday Morning Group and let them know what you think…


Via TPM, Axios, the landing pad for Politico rejects, transcribed Ivanka Trump’s latest women’s empowerment scheme:

I’m sure this is fine. It’s not like a fund that leverages political connections at the highest levels to buttonhole the rich and powerful worldwide would be seen as problematic during a political campaign — much less when operated from the White House by the president’s daughter, business partner and official adviser.

Crispy Cajun-fried Jeebus, I sure hope Hillary Clinton has a well-developed capacity for ironic amusement.