Five years now

Five years ago, I made a serious miscalculation.

I was a low level bureaucrat trying to get Exchange networks to work for UPMC Health Plan.

I was exhausted that first fall as we were scrambling with interim solutions for several months after the ACA individual market went live.  We then had to go crazy to ramp up HealthyPA, a convoluted Medicaid expansion waiver program in Pennsylvania.

I was in Pittsburgh living an anonymous life.

I thought I would only have a couple dozen health insurance related posts spanning twenty or thirty thousand words in me.

Now I’m in Durham.

I’m now at 1,550 + Mayhew on Insurance posts and several hundred other general purpose posts.  My health policy word count is closer to a million words than half a million words.  There is a mostly written book somewhere in these posts and I will sooner or later need to convince myself that I can write a book on health policy.


Then, I could never be quoted nor would anyone want to hear what I wanted to say besides a couple of co-workers as we slammed espresso shots before another analysis run cycle.  Now, I’m part of the usual quotable suspects when major ACA news breaks out.

Writing here at Balloon Juice has been and continues to be an amazing experience.  I get to play with ideas that fascinate me, and John gives me the keys to write to an audience.

One of the big changes since I’ve come to Duke, beyond saying good bye to the persona of Richard Mayhew, is that I’ve changed my writing targets.  When I was Richard Mayhew, I had to write at Balloon Juice.  I could and would poke a few people here and there that something big was coming down the pipe but I was limited.  Now, the audience is sometimes all jackals.  Other days, the intended audience is a few score of geeks and policy professionals who need to know about some esoteric corner case.  I apologize when I take over the blog for those purposes as I feel like I am hijacking your attention to pay the cost of entry into conversations that I want to be in.

As I have been drafting this post over several days, I’ve talked to reporters from local and national general interest press, I talked to a reporter from the trade press, I submitted a pair of long and very technical pieces to Health Affairs, and a revise and resubmit just went back to the editors of a good peer reviewed journal.  If you spend enough time reading Balloon Juice, you could figure out 85% of the article excluding some of the regression based analysis.

I feel guilty about this at times.

Last week, was a good example.  I wrote a Medicare shared savings post that I was aiming at a few dozen academics and several dozen think tankers, journalists and very targeted policy wonks. It is a very specific, nerdy, and incomplete idea.  It was not worth an op-ed as it it too geeky. It was not a Health Affairs blog or a journal perspective piece as the idea was not polished enough for that purpose, so I went Balloon Juice. And that post got three comments.  And I was fine with that as this was not a general purpose post but a very small part of a very different conversation that I participate in.

I’ve moved away from some general purpose health insurance and ACA blogging and at times over the past year, I’ve chased personal shiny objects down rabbit holes.  And you guys put up with that. And for that I am greatly appreciative as I love writing here at Balloon Juice.  I have a scratch pad and a place to get first drafts (seldom second drafts as you see my grammar and spelling) of reactions and thoughts.  I can dig into something that fascinates me on my own time and my own schedule until it makes sense to me.  I hope that this is not pointless intellectual public indecency as this entire creative process is extraordinarily valuable for me.

Balloon Juice is a very different form of writing than writing a journal article.  Under the best case scenario, a fast journal timeline from “umm, that is a cool question” to publication is a year or more.  It is very different writing than a multi-author Health Affairs blog where commas can become fighting marks while the critical point that I want to make might be the lead melody or become subsumed as a backing bass line.  It is a very different writing process than pumping out a New York Times op-ed where I first truly appreciated the value of a wonderful editor.  That process makes me sound a whole lot smarter by the end.  The final 750 words are a tight 750 words instead of a 5 post, 3,000 word series here.  But I was worn out both times I went through that process.  This is a fun place to write  and it allows me to get into awesome conversations of a variety of stripes.

But mainly, I just want to thank all of the jackals, the front-pagers and John for a community where I can nerd out on something that I find fascinating.  I’ll figure out what Year Six looks like, but the first five have been wonderful.


74 replies
  1. 1
    debbie says:

    Thank you for all your clarity. Nerdy is excellent, especially when it’s presented in understandable language.

  2. 2
    Jim says:

    And I’ve appreciated having your perspectives, David. Followed your posts from the very beginning. No, I don’t read all of them — especially the really wonky ones — but yours is one of the few places I can trust to get a straightforward discussion of what’s going on with the ACA/TrumpCare (formerly known as ObamaCare). Thanks!

  3. 3
    rikyrah says:

    Thank you so much. The information you have given language that we can understand… INVALUABLE.

  4. 4
    Haroldo says:

    Mr. Anderson-Mayhew,

    Thanks for these 6 years of posting (has it been that long?). Your writing is one of those things that I appreciate but do not use all the time – akin to having a first class art museum in easy traveling distance. I am thankful for their existence.

  5. 5
    frosty says:

    Aha! That explains why I sometimes skip some of your posts. I won’t feel so guilty about it any more!

    More seriously, thanks for writing here – I’ve learned a lot.

  6. 6
    DavidC says:

    Lurker, but I enjoy your posts and celebrate the fact that you (and other) have a platform here at BJ. So many people with specialized knowledge. Is this a great blog or what?

  7. 7
    batguano says:

    Thank you. Most of your posts are far out of my depth, but I am much more knowledgeable about healthcare delivery for them. I usually feel that I lack the knowledge and understanding to comment constructively to your posts. I share what I can with friends and family, and have been able to improve opinions about both the ACA and universal healthcare by providing counter arguments a lot of the nonsense that is spewed into the ether by our political class.

  8. 8
    Baud says:

    I’m glad to hear we didn’t torpedo your career.

    Congrats on all the success, DA.

  9. 9
    OzarkHillbilly says:

    But mainly, I just want to thank all of the jackals, the frontpagers and John for a community where I can nerd out on something that I find fascinating.

    I don’t always comment but I always read, even the truly wonky ones get read at least until my eyes glaze over. I learn from your posts and for that I say, “Thank you.”

    ps: I especially like the referee posts as they open up a world I had never even considered the existence of before you came here.

  10. 10
    RedDirtGirl says:

    Happy anniversary! You really class up this joint! (Not that there’s anything wrong with that!)

  11. 11
    satby says:

    You’ve helped me personally with deciphering insurance matters and I know I’m not the only one. As Ozark said, I don’t always comment but I always read your posts. And I am grateful you’ve been here to shed some light on a truly murky subject for most of us.
    Thanks David!

  12. 12
    MazeDancer says:

    Please write your book. Mention Balloon Juice somewhere in the author’s pages. Bring in more smart stuff chatters.

    Always enjoy seeing what you have to say. Even if I don’t understand it all. Feels like some insider guy is keeping us informed.

  13. 13
    Haroldo says:

    @Haroldo: Errr….5 years. (Read much, Haroldo?)

  14. 14
    Lee says:

    Thanks for the excellent posts on health insurance. I’ve directed several friends (both RL & FB) here to read your posts.

  15. 15
    Edmund dantes says:

    Don’t feel bad at all.

    I always enjoy your posts, and even if I don’t always find a reason or need to post a comment. They are all given me some new piece of information or a better understanding of healthcare (i.e. insurance unfortunately) in the USA.

  16. 16
    dnfree says:

    I second all these comments. I always read, usually don’t comment, but appreciate the insights and am glad you’re here. Having a few experts in different areas makes this blog a must-read. And it was exciting when you moved to Duke and changed your name!

  17. 17

    @Baud: I do tell people who are interested in working with me to google the phrase “Skull fuck a kitten” to see the #1 result as a means of fast due diligence.

    Without Balloon-Juice, I’m spending this morning prepping a code review of a risk adjustment run for Medicaid. I was good at that, but just that, only good. I am really, really good at what I’m doing now and that is only because I had Balloon Juice to get my foot into this world’s door.

  18. 18
    Gelfling 545 says:

    Phew! That started to sound a bit like a Dear Jackals letter. I’m glad it’s not. Looking forward to more informative posts.

  19. 19
    Gin & Tonic says:

    So this is a place for you to jerk off before you put your pants back on and go out in public, in other words.

    Not that there’s anything wrong with that, of course.

  20. 20
    pluky says:

    There is definitely a book in there. And if you write it, a spot should be found on the Group Track exam syllabus. I’ve found your posts (especially those on the game theory of metal band pricing) more useful than 99% of the what is presented at SoA meetings. If only I could get CE credits for it!

  21. 21
    Jim Bales says:


    Thank you for explaining healthcare policy and insurance in ways that this physicist can understand. Throughout the debate and run up and implementation of the ACA, your blog posts were my number one source of insight and analysis.

    As was mentioned earlier, I read everything you post, until my eyes glaze over. The latter is happened a little more often now, and I don’t mind that in the least.

    Also, a reminder that you and yours are welcome to a tour of the Edgerton lab should you be up in the Boston area.


  22. 22

    @Gelfling 545: Nope, I try to do a retrospective piece on major milestones (anniversaries, 1000 posts etc)

    I’m lucky as fuck in being able to write here, and I want to acknowledge that as well as look to see how I’ve changed in the course of writing.

  23. 23

    @Jim Bales: I will be taking you up on that offer!

  24. 24

    Five years! Your explanations are very helpful. Health insurance is a difficult subject, but we all need to know about it until some kind of universal coverage is passed. And we’ll need you for that process to evaluate the options.

    All your old friends are very proud of you!

  25. 25
    Walker says:

    Just because we don’t comment does not mean we don’t read.

  26. 26
    Gin & Tonic says:

    @Jim Bales: You’ve mentioned that before, and I need to bookmark this, because I couldn’t recall your name/nym. I took 6.163 mumble-mumble years ago. Still have some negatives somewhere in the basement.

  27. 27
    Manyakitty says:

    Like the others, I always read your posts, even though I rarely comment. I’ve directed others here so they can get a clue, too. Glad to hear you’re sticking around, and even gladder that you’re finding success!

  28. 28
    MomSense says:

    You’ve helped a lot of us over the years as we try to navigate health insurance options. You helped my friend figure out insurance and Medicaid that saved her family financial ruin. They have enough to do just grieving.

  29. 29
    pinacacci says:

    We love you to bits. Thank you for sharing your knowledge!

  30. 30
    Cheryl from Maryland says:

    Thank you so much for your contributions. I read all of your posts even though I seldom comment. We are informed and enriched by your postings.

  31. 31
    Spanky says:

    Well, on the whole I suspect you get the fewest “fucks” in your comments than any other front pager, which is more than the NYT op-ed page can say.

    I always felt a little sorry for you when your early AM posts had so few comments, so thanks for relieving me of that! Like so any others, I always read but rarely commented, hoping I could figure out what the adults were saying. Not always successful at it, but thank you for giving me the opportunity!

  32. 32
    Ukko says:

    Another thank you for all this writing, it has been invaluable to me and mine. I have parroted many of your points back to my family over the years. Because of your explanations I could actually explain the “why” of things instead of just some party line platitudes.

    Also the ultra technical wonky stuff is super interesting to see, even if only on an anthropological level.

  33. 33
    WaterGirl says:

    What does one get someone for their 5-year blog-iversary? Is there a list somewhere on the internet?

    In the meantime, thank you, Richard, um, I mean David, and congratulations!

  34. 34
    JPL says:

    @David Anderson: I still smile when you sent out your initial job search under your Mayhew name. Thank you for all your posts. Like others I always read, but seldom comment.

  35. 35
    Burt Hutt says:

    Dedicated lurker here, but chiming in to say that I am glad this was not a swan song. I’ve appreciated the depth and detail of your analyses and posts in general, even when the comments are in single digits. Please keep writing another million plus words here. Where else can you get intelligent military, healthcare, and legal advice alongside recipes and pet stories?

  36. 36
    Steppy says:

    @Gelfling 545: Same here. Thank goodness you love writing here, because we love reading you here.

    Also, I can’t believe we’ve gotten this far in the comments before someone (me) says that I miss the refereeing posts, now that you aren’t working games so much.

  37. 37
    Mike S says:

    I read all, but your wonkiest posts (I skim the 1st paragraph of those and glance at the graphs), but your post are the ONLY reason I’ve felt that I had any real idea of how the ACA works. Thank you! I’m really glad your invaluable posts here have worked out so well for you!

  38. 38
    RobertDSC-Mac Mini says:

    You’re the best. Every post is informative and appreciated, even if I have a hard time following the details.

  39. 39

    Five years ALREADY?
    We seriously need to get you a cake, Mr. Anderson. Something to do worth celebrating, because you’ve been the honest SOB on healthcare we needed all these years.

  40. 40
    Luthe says:

    If messing around on BJ brought you fame and fortune and continues to give you a place to bring ideas to the attention of the big boys, then I think we can live with early morning posts of varying wonkitude.

  41. 41
    evodevo says:

    What everybody said. Seconded, thirded, etc. Your analyses of ACA helped me tremendously.

  42. 42
    Susanne says:

    I also initially thought this was a swan song. You’re a natural at deconstructing. Congrats on your new position especially since you’re batshit crazy over it.
    You’ve made clear the insurance constructs, etc., regardless of their purposeful difficulty. Thank you.

  43. 43

    @Susanne: Nope I’m here until one of three things happens:

    1) My wife tells me to stop
    2) My boss tells me to stop
    3) FYWP

  44. 44
    JPL says:

    @David Anderson: If one or two happens, will they accept bribes?

  45. 45
    p.a. says:

    Keep on keepin’ on.
    Maybe some day we will live in a world where we don’t need someone to explain the difference between Silver Gapping and Silver Spamming, but that world’s not here yet. As for the in the weeds, esoteric oddball corners of the ACA: moar graphs.

  46. 46
    Yutsano says:

    I also freely admit to almost never commenting although I read every single column you write. It really tells me this shit is a lot harder than it really needs to be!

  47. 47
    japa21 says:

    Back then I was able to contribute to a small degree to your posts in the comments as I worked in the field contracting providers for an insurance company.

    Now I am retired and out of touch. If anything, I depend more on your expertise now.

    You have been a valued contributor here and are representative of the expertise this blog provides. I know of no other blog that provides such a wide range of experts in their fields.

    So I thank you and most of all thank John for his great ability to bring on people who really know what they are talking about.

    Now if he could just arrange for my nym to automatically appear.

  48. 48
    Odie Hugh Manatee says:

    I think I’ve read every single post you’ve made here because you break things down to a point that someone like me can understand what the hell is going on. I’ve referred several friends to posts of yours too.

    I may not say much here but I don’t miss what you have to say on health care and issues that surround it. Thanks! :)

  49. 49
    J. says:

    I may comment infrequently, but I read or skim most (if not all) of your posts. And I bet there are many other loyal readers who do the same. Keep up the great work — and thank you.

  50. 50
    narya says:

    Count me as another reader! I work for an FQHC, so I care a lot about these issues–the people we serve are the ones who are greatly affected by the ACA, and I have some wonk in me as well, so i greatly appreciate your approach.

  51. 51
    geg6 says:

    I may not comment much on your posts, David, but I appreciate all the information you give us. It is so helpful to me and to the people with whom I discuss these issues. I’m always the most informed! Which is amazing! Because I often feel like an idiot when I read your stuff as it’s so out of my own comfort zone.

    I can’t thank you enough for all of your blogging here. This Jackal, for one, is thrilled to have you around.

  52. 52
    JaneE says:

    I, for one, am very glad you post here. I have learned more about the “other” side of health insurance than any other subject in the last few years. Academic journals we are not, and you have made some fairly complicated issues understandable. It is really good to have some one tell me “why in the hell did they do THAT?”.
    Thank you.

  53. 53
    Barbara says:

    Well, I always glance at what you write and I am very glad to be able to participate and comment a little, within the bounds of what I feel able to do. A lot of times I just get tired of the Sisyphean effort associated with trying to make health care better so I just read and move on. Also, OT but thought you might like to know that I have nothing but nice things to say about UPMC based on my recent experience there.

  54. 54
    J R in WV says:

    Dear David,

    When I try to describe Balloon-Juice to friends when I tell them what I spend my retirement time on, there are so many valuable people on the list, from the MIT wonk, the Arms Control wonk, the International Strategic Affairs wonk, the Founder, and the Health Care Stats Wonk, who probably saved the most lives by helping people understand the purposefully opaque insurance scam inflicted upon the American people.

    Like many others who have commented, I quickly became afraid you were resigning or retiring your column here, only to be relieved to learn that it was merely an anniversary celebration rather then a swan song. Thanks for reupping.

    And thanks for the depth of knowledge and the careful analytical thought you put in to every piece you write. Even the Football Ref pieces you used to write. Sorry you don’t have time to do that sports work anymore, but glad you don’t need to for extra income now that you’re at Duke. To imagine that writing freeform here at B-J got you a highly respected position at a major University!

    And keep up the good work — America needs you, even if some of it doesn’t know that.

    Thanks again!

    JR in WV

  55. 55
    JAFD says:

    Congratulations on five years as a front-pager here, and Thank You Very Much !
    ‘Tis said that in the glory years of _Life_ magazine, hung prominently on walls was this motto:
    “Never underestimate the intelligence of your readers
    Never overestimate how much they already know.”
    Certainly you’ve been an exemplar of that.
    One request. At some point, we jackals and the folk we ask to join us could _really_ use a Balloon Juice Health Policy and Insurance Lexicon. Beginners here sometimes puzzled, think ‘Silver Spread’ refers to randy senior citizens ;-)

  56. 56
    Aurona says:

    To the insurance guy formerly known as Dick Mayhew;
    Thanks for the past memories. In the 70-80s, I worked for the Blues: Blue Cross in Southern California and Blue Shield/CPIC in San Francisco. I was not a technical wonk, I was the office administrator/executive assistant. However, I think Mayhew Insurance would have been a great help back to me back in those days. Please, by all means, keep up the great work because you never know who will find that it saved a life. May your alter ego continue on the current
    grand adventure.

  57. 57
    The Moar You Know says:

    I don’t comment because the entire insurance industry is well outside my wheelhouse of competence. But I do read. And you have been extremely education, so please do continue!

  58. 58
    Hubbgold says:

    Thank you for all the insight and knowledge you have shared. I, too, hardly ever comment but I read all your posts and continue to learn so much from them. It’s been exciting to follow your move into full-time health policy work — now I get to read your articles at the Health Affairs blog as well as here!

  59. 59
    J R in WV says:

    OMG — I left out ALL the political wonks! The pet wonks, the COOKING wonks.

    Sorry guys!!

    Forgive me? Please!


  60. 60
    Miss Bianca says:


    Thank you. Most of your posts are far out of my depth, but I am much more knowledgeable about healthcare delivery for them.

    I’m with you. I usually only understand about one in five of David’s posts, but I too am much, much more knowledgeable about healthcare and healthcare delivery in this country – and skeptical, as a result, of “easy fix” answers like “single payer!” We are so lucky to have the front pagers here that we do!

    And David, if Balloon Juice has jumped up your professional cred and career, I say, “Yay!” You deserve it!

  61. 61

    @J R in WV: Your first paragraph is what differentiates this place from pretty much anywhere else. I am perpetually amazed (while being a massive beneficiary) at John’s ability to first find serious SMEs on really interesting things and then keep the community humming along.

  62. 62
    feebog says:

    @David Anderson:

    I don’t read your posts every morning, but several times a week you snag me with something and I end up reading both the post and the comments. I know more about health insurance than I ever wanted to due to your posts, and that’s a good thing. Congrats on five years, keep the posts coming.

  63. 63
    Fair Economist says:

    I don’t often comment on your posts because I don’t have much to say on your detailed topics and because you already say things so well there is little to add or disagree with. Your knowledge is a great add to BJ and I am grateful for all the education you have given me.

  64. 64
    Kelly says:

    Thank You David for your clear and timely posts. Your posts are a huge help to pick our health insurance plan every new enrollment season. Your posts on the politics, where the votes are at, the background behind policy proposals are the best anywhere.

  65. 65
    Caroline Abbott says:

    I rarely comment on any of the wonderful posts here, but yours almost always fuel a lot of thinking long after I’ve left the page. Thank you for countless sleepless nights as I try to use the light you shed to illuminate my clients’ way through health care access and then attempt to advocate for systemic improvement.

  66. 66
    Mary G says:

    I can’t believe that no one has mentioned that most succinct phrase you used to explain the situation in the first years – “the executive suite wants the money for hookers and blow.” You had me at hello. Also your cheerleading for calling and writing and marching for the ACA got me to keep doing it when I was sure the effort was doomed. I also follow a lot of people who you referred to, like Charles Gaba, Andy Slavitt, and Topher Spiro. So like everyone else, I rarely comment but highly value getting to read you here.

  67. 67
    SC54HI says:

    Thank you, David. I can’t always understand everything but have really appreciated what I do get!

  68. 68
    Mom Says I*m Handsome says:

    If there’s one thing I’ve learned from reading this series of posts, it’s that health insurance in the USandA is unbelievably complicated. Your expositions of various cases gives me an appreciation for the value of expertise. I’m looking forward to the day when we can return our fragile union to the hands of faceless bureaucrats who do, in fact, know better than Joe the Fucking Plumber.

    Oh, and bee tee dubs: Is the Richard Mayhew moniker lifted from Neil Gaiman’s “Neverwhere”? I picked that up in response to an Ask Dr Google query (“If I liked Game of Thrones, what else should I read?”) and enjoyed the book immensely.

  69. 69
    tybee says:

    many of us read your posts but don’t comment. you shouldn’t think that a low number of replies signifies a disinterest in what you write.

  70. 70

    @Mom Says I*m Handsome: Yes, Richard Mayhew was directly ripped out of ‘NEVERWHERE’

    The book was on my bedside the night before I started to write here. I had finished re-reading it a few weeks previously and I thought that Richard Mayhew, a finance analyst who had to go fight the mythical Beast under London, would be a great name to hide behind.

    @tybee: I am very well aware that comments /= interest

  71. 71
    NA says:

    Your posts have been invaluable! I can’t always follow the details, but you do a fantastic job at also providing the big picture. I hope to continue to learn from you.

  72. 72
    Barbara says:

    @Mary G: I would like to endorse what Mary said. Your posts in the thick of the ACA repeal effort made me much more active in advocating against Republican efforts, and it also made me a lot more active in posting materials (including some of yours) that I thought explained the value of Medicaid expansion and the various “replace” proposals in ways that were comprehensible to the non-specialist, especially, who would get hurt. My FB page is still a trove of those resources, and really, I have never been all that active on FB otherwise.

  73. 73
    Mart says:

    I really enjoy your posts, whether I get all of the content or not. Please keep it coming.

  74. 74
    Joy in FL says:

    I want to thank for all I learn from your posts.

Comments are closed.