I am shocked that gambling goes on here

Whose heart is having palpitations?

Open thread








Fuzzy Things Open Thread

Here’s 3/4ths of Badger, who was photographed recently while basking in the last sunbeams before nightfall:

I posted this on Twitter the other day, and a friend said Badger looks like he should have a martini and cigarette holder in his paws, which is true. He’s still a fuzzy boy, though — too young to drink or smoke!

There are all sorts of fuzzy things to look at in the swamp these days. I could swear I saw one of those adorable limpkin chicks I shared with y’all the other day achieve brief liftoff from its ground nest on a nearby island. Could be wrong though.

I keep trying to get a photo of a Sandhill crane pair and their two long-legged fuzzballs, but I can’t seem to catch the family at a time when I have a combination of my camera, good lighting and adequate cover so I don’t disturb them.

Moving to not-so-fuzzy critters, the frogs, cicadas, etc., were deafening last night. The weather was nice, so I had the windows open, and I almost shut everything down and turned the A/C on just to drown out the din of the frogs and insects.

The alligators are frisky too. Have you ever heard a gator mating call? It’ll make the hair on the back of your neck stand up if you happen to be outside in the dark when you hear it. Sounds like Satan’s drainpipe or something — hard to describe.

Anyhoo, all topics welcome in this open thread, even further re-hashing of Biden 2020. But talk of fuzzy things would be nice.








Biden Makes Me Sad

The whole Joe Biden announcement makes me sad. It’s just going to end so badly, he is never going to win*, and we’re just going to watch someone who is a shell of his former self ruin his entire legacy. It’s going to be like watching an aged Ali get totally trounced by Larry Holmes, although comparing Joe to Ali is in itself problematic, because Ali was a champion. Joe has run several times before and it has always ended badly.

When you look where he is on the issues, he’s just not where America or the Democratic party is right now. Middling centrism is most definitely not where the party is, and if you look at the totality of his record, including his war on drugs, his shepherding of the Bankruptcy Bill, the Anita Hill hearings, and so many other things, you can almost forget about the good he has done.

Again, it’s sad. Watching the video, he looks ok head on, if you can look past the hair plugs and the bulky crowns and the sucking sounds as he talks from his dentures. But his skin is thin, his cheeks are hollowed, and he looks old and tired, something that is obvious in non-staged photographs.

We all get old. I don’t know why so many of us can’t age more gracefully. He should be enjoying a well deserved retirement, spending time with his wife, his remaining kids, and his grandkids, doing the lecture circuit. But for some reason, and to his credit, he feels that he has to do this. But his good intentions and patrician feelings of obligation are not going to cut it.

The world has changed, and Joe Biden has not. He could have ridden off into the sunset, a hero for his past accomplishments and his popularity during the Obama years. But he is going to throw it all away, and it is going to be depressing to watch.

I just find it profoundly sad. It’s time for the kids to take over, Joe. You did your work. Let it go.

* And now he is guaranteed to win, what with me predicting his defeat.








Objectives and regulators’ choices

State insurance regulators are currently thinking about the 2020 individual market. Initial rate filings are due soon and regulators have to check to make sure that networks are adequate, policies are compliant, and premiums are justifiable. For some regulators, that is all that they will check. Other states will have regulators that can be more active in their decision making*.

Active regulators can shape the market.

The question then is what are they choosing to optimize?

In 2014, Kelly Krinn, Pinar Karaca-Mandic and Lynn Blewett looked at premium levels as a function of how active state regulators were as exemplified by whether or not the state had a clearinghouse model or an active buyer model and whether or not the state had its own exchange.**

They found in 2014 that state based marketplaces with a clearinghouse model (less active regulators) had lower premium levels than states with an active buyer model.

Lowest-cost silver plansSecond-lowest-cost silver plansLowest-cost gold plans
Lowest-cost bronze plans
ModelMean ($)p valueMean ($)p valueMean ($)p valueMean ($)pvalue
SBM-A179.490.008225.370.006245.27<0.001266.910.007
SBM-C157.53Ref196.92Ref205.3Ref233.96Ref
SPM182.510.004229.870.003242.720.001272.920.003
FFMS185.140.003224.020.019234.910.014268.970.012
FFM189.94<0.001233.16<0.001241.63<0.001277.35<0.001

This study was valuing the experience of the non-subsidized individuals’ experience. For them, levels matter a lot. Healthier individuals within this cohort are heavily weighing premium for their buy/no buy decision. For the question of how does the plan management characteristics impact upper middle class experience of value on exchange, the answer is that clearinghouses are probably better value than active buyer models.

However the single individual in the middle class or the family of four making six figures is not the only interested purchasing stakeholder group. The subsidized population earning between 100% to 400% Federal Poverty Level is a significant portion of the ACA individual market. For them, they care more about the spread than the level as the federal government has taken on premium level risk. Using the same data above, I’ve looked at the spreads instead:

Here state based marketplaces with an active buyer model seem to be optimizing for the premium experience of the subsidized buyer.  Bronze and the cheapest Silver plans are much less expensive than the benchmark plan in these states compared to everywhere else.  Gold plans are only less expensive relative to benchmark compared to everywhere else.

Regulators face choices.  In the ACA market, the first choice is whether or not to be an active regulator.  Conditional on the choice to be an active regulator, the second choice is what experience should be prioritized?  Should the exchange seek to prioritize on-exchange and subsidized buyers or should they seek to prioritize lower premium levels but tighter spreads that benefit non-subsidized buyers?  Should the exchange and regulators seek simplicity or complexity that may allow for multiple objectives to be addressed?

Any of those choices are valid choices that solve a real problem.  There are very few choices that will solve every problem.  Regulators who are active need to decide what their objective is and the trade-offs inherent in achieving that objective.

* Disclosure: I’ve talked to some state regulators regarding pricing tensions and choices in the ACA markets.

** doi/10.1377/hlthaff.2014.0627








Biden Makes It Official

Here’s the announcement video:

Here’s the opening tweet, which gives equal pride of place to both the candidate and a certain former president missed acutely by sane people worldwide:

Snazzy campaign logo! Read more








Thursday Morning Open Thread: #SheThePeople

Sounds like this was quite the EVENT!

Patrick Svitek, for the Texas Tribune:

Appearing at Texas Southern University, a historically black college, eight candidates made their pitches at a forum hosted by She the People, a national network of women of color. The three-hour event was one of the biggest gatherings of the Democratic primary candidates yet, let alone in Texas.

Taking questions from moderators and the audience, the candidates covered a range of issues that have already animated the primary — health care, criminal justice and voting rights — while sharpening their cases for how those issues impact women of color. The massive 2020 field is historically diverse, and most participants faced the same question at the end of their time onstage: Why should women of color choose you?…

For some candidates — particularly those who are neither women nor people of color — the forum at times appeared to be a humbling experience. The other hopeful from Texas, Beto O’Rourke, paused before answering why women of color should back him, acknowledging that their support is “not something that I’m owed, not something that I expect” but “something that I fully hope to earn by the work that I do on the campaign trail.” He cited a number of prominent black women in politics that he has learned from — including Houston U.S. Rep. Sheila Jackson Lee, a fellow Democrat who has a bill to study reparations that O’Rourke and several other candidates support…

Regardless, the day was a boon for Texas Democrats who increasingly view the state as a battleground. As he left the forum, state party Chairman Gilberto Hinojosa said the event — with its number of candidates and early timing in the primary — was unlike anything he has seen in his 35 years in Texas Democratic politics.

“One of the things that came out of this event today is a recognition — [one] that people who have been involved in politics have known about for a long time — that women of color deliver [a] large number of votes for the Democratic candidates in every election cycle,” Hinojosa said. “That number’s increasing significantly over the years. In the last election cycle, they delivered big time for Democratic candidates. They’re more energized, engaged and angry today than they’ve ever been before.”

Not surprisingly, one candidate started with an extra edge…


Read more








On The Road

Folks, due to family health stuff, nothing today or Friday. Surgery is scheduled for Friday morning and all is well but I’m otherwise occupied. Please understand.

Have a great morning and day!

Open thread,y’all








Late Night GOP Stupidity Open Thread: Economic Easing (Out the Side Door)

Prospective Federal Reserve Board member Stephen Moore may be forced, nay compelled, to sacrifice his own career dreams for the sake of his deep loyalty to The Party. (Mostly because it looks like he can’t count on enough votes from his fellow Republicans to sail through his confirmation.) Per The Hill:

Stephen Moore, President Trump’s controversial pick for the Federal Reserve Board, said Wednesday that he is “totally committed” to seeing the process through, but would bow out if he became a political liability to Republicans.

In a Thursday interview with The Wall Street Journal, the conservative economist and commentator said he would stick with the vetting process for a formal nomination unless it could damage the GOP’s standing in the 2020 election.

“I’m totally committed to it as long as the White House is totally committed to it,” Moore told the Journal, ceding that he would drop out, “if something I said or something I’ve done becomes a political problem.”…

Trump floated Moore, an adviser to his 2016 presidential campaign, for a spot on the Fed board last month, but has not yet formally nominated him…

While Moore has been a figure in Washington conservative circles for decades, several Republican senators expressed concerns about his close ties to Trump, who has repeatedly and harshly criticized the Fed for almost a year.

Moore has also been fiercely critical of the Fed and reportedly won Trump’s blessing for an appointment with an opinion piece blasting the independent central bank.

Moore has also come under scrutiny for old columns he authored opposing the presence of women in sports or sportscasting, which he said Wednesday that he regretted…

Stephen Moore has built a long career in and around conservative politics by repeatedly advocating for the government to cut taxes. He is not great at it, but it is a quirk of that job that he doesn’t really have to be great at it, or even good at it. He just needs to do exactly what’s expected of him, always. Moore’s first foray into actual politics didn’t end well—he co-founded the Club For Growth in 1999 with the aim of electing Republicans who would pledge to cut taxes, but mismanaged the organization such that it was forced to pay a $350,000 fine to the Federal Election Commission in 2004. He was forced out that same year, and has spent most of his time doing his Libertarian Teddy Ruxpin duties in various sinecures ever since.

Donald Trump wants to appoint Moore to the Federal Reserve Board because he’s seen Moore on TV—he’s on TV a lot, generally being “wrong all the time, about pretty basic things,” in the words of the Washington Post’s Catherine Rampell—and because Moore has spent the entirety of Trump’s administration flattering Trump in impossibly goofy ways
Read more








A Grim Realization

I was just reviewing some of my old posts and it occurred to me that in some respects this blog is like the Truman Show without cameras and the writing staff on drugs.

Speaking of cameras, what would be a low cost but effective way of having a live cam on the birds nest. Would that be doable?

Also, I should probably point out that Tammy told me that the first yellow was going to be way too bright but I didn’t listen. I never listen. She’s always right.








About That Shed Color

So I may have gone a touch too yellow with the shed color:

Fortunately, I only bought a gallon and the wood sucked up the paint, so I went and got two more gallons of something a little less retina burning:

The main reason for painting it was to protect it, but I did want to brighten it up, too, but I didn’t intend for it to be so fucking bright you could see it from the space station. Hopefullly “sunglow” will be better than the first color.

The paint never looks like the sample on paper they have at the store.








Hillary Clinton: It’s the National Security Threat, Stupid

Clinton published a must-read op-ed in Le Post this afternoon. Here are a couple of excerpts:

Our election was corrupted, our democracy assaulted, our sovereignty and security violated. This is the definitive conclusion of special counsel Robert S. Mueller III’s report. It documents a serious crime against the American people.

The debate about how to respond to Russia’s “sweeping and systemic” attack — and how to hold President Trump accountable for obstructing the investigation and possibly breaking the law — has been reduced to a false choice: immediate impeachment or nothing. History suggests there’s a better way to think about the choices ahead.

Obviously, this is personal for me, and some may say that I’m not the right messenger. But my perspective is not just that of a former candidate and target of the Russian plot. I am also a former senator and secretary of state who served during much of Vladi­mir Putin’s ascent, sat across the table from him and knows firsthand that he seeks to weaken our country.

Clinton urges Congress to hold hearings on the Mueller report findings, not jump straight into holding a vote on impeachment, citing the Watergate inquiry as a model. She notes that during Watergate, a Senate select committee held hearings that added to the facts of the case before an impeachment inquiry began and suggests that a committee could do something similar now by calling Mueller and McGahn to testify. Clinton doesn’t spell this out, exactly, but this would all have to be on the House side since the Republican-controlled Senate has demonstrated that it will do nothing.

Clinton calls out Trump in deservedly savage terms:

We have to get this right. The Mueller report isn’t just a reckoning about our recent history; it’s a warning about the future. Unless checked, the Russians will interfere again in 2020, and possibly other adversaries, such as China or North Korea, will as well. This is an urgent threat. Nobody but Americans should be able to decide America’s future. And, unless he’s held accountable, the president may show even more disregard for the laws of the land and the obligations of his office. He will likely redouble his efforts to advance Putin’s agenda, including rolling back sanctions, weakening NATO and undermining the European Union.

Clinton emphasizes a key point that Trump and the Republicans are determined to ignore: the Mueller report isn’t only or even primarily about Trump. It’s about an attack on our democracy by a hostile foreign power, and the report establishes that the attack happened unequivocally. That requires action. By making it solely about Trump and crowing about his supposed “exoneration,” Trump and the Republicans are derelict in their duty to protect the country.

Clinton is right, of course. But given that just today Trump signaled refusal to cooperate with any oversight at all because NO COLLUSION HOAX WITCH HUNT I WON, with the full support of his Republican toadies in Congress, impeachment might truly be the only way forward. Greg Sargent explains, outlining how stonewalling on requests for tax returns, urging former and current administration officials to disregard subpoenas and requests for committee appearances, etc., might force Democrats to use an impeachment inquiry to get anywhere at all:

Trump, in a new interview with The Post, just made it overwhelmingly clear that he will henceforth treat the House and its reasonable oversight efforts as fundamentally illegitimate.

“There is no reason to go any further, and especially in Congress where it’s very partisan — obviously very partisan,” Trump said, referring to the latest round of oversight requests House Democrats have made…

Perhaps Trump views an impeachment inquiry as a less bad outcome than releasing his tax returns. Or perhaps he hopes to run out the clock, gambling that Democrats won’t have the guts to pull the trigger.

If so, that creates a torturous dilemma. Democrats themselves say the full truth must be pursued, for the sake of the country. But if Trump blocks them from doing that, it would seem to force their hand and require an impeachment inquiry.

Clinton’s op-ed is a timely reminder that the stakes are much higher than the orange fart cloud’s presidency. Perhaps the House Democrats’ first move should be to get Mueller’s testimony about the true purpose of the report and underscore the national security implications, then proceed from there within that framing, explicitly pursuing impeachment if that’s the only way to get at the facts.

The op-ed also brushes back the notion voiced by some Democrats that we should close the book on the Mueller report and focus on removing Trump via the ballot box in 2020. What ballot box, if Putin or someone else decides to diddle our election again? Anyone who urges Democrats to move on has lost the plot — it’s not only about Trump, though holding a lawless president accountable is a Congressional duty; it’s the national security threat, stupid.








Social Media Open Thread: ‘President’ Grampa Has PROBLEMS!!! With You People…

In a statement, Twitter said the meeting — initiated by the president — focused on “protecting the health of the public conversation ahead of the 2020 U.S. elections and efforts underway to respond to the opioid crisis.” Twitter partners with the federal government on a program to encourage Americans to dispose of prescription drugs they no longer need to prevent against abuse.

In March, Trump accused Silicon Valley’s largest companies of harboring a “hatred” for “a certain group of people that happen to be in power, that happen to have won the election.” In doing so, Trump threatened potential regulation, telling reporters at a press conference that the government may “have to do something about it.”

Previously, Trump joined a chorus of Republicans in claiming that Twitter secretly limits the reach of conservatives, a tactic known as “shadow banning” that Twitter has vehemently denied. And the president regularly has raised fears about changes in his follower count. Twitter’s heightened crackdown against spam, however, long has affected both liberals and conservatives on the site.

In response, Twitter regularly has stressed its political neutrality. “Impartiality is our guiding principle,” Dorsey told lawmakers last year who grilled him over allegations that the site and its social-media peers exhibit bias against conservatives. Over the past year, Dorsey has sought to huddle with high-profile right-leaning pundits and political figures, hoping to assuage their concerns about censorship…

Dorsey long has faced pressure to curtail Trump’s tweets, as critics contend that the president regularly violates the site’s policies against harassment and abuse. Twitter has long maintained that it applies a different standard to prominent public figures, given that their comments — even offensive ones — remain in the public interest. But the company in March said it soon would adopt a new approach, labeling offensive tweets so users know why such content hasn’t been removed…


Read more








Three Cheers For WSAZ

WSAZ, the NBC affiliate for Huntington-Charleston, WV, had some guests on promoting the Queens Slay Cancer Drag Show at Marshall University, an event to raise money for cancer. Predictably, the Family Policy Council of West Virginia, affiliates of Focus on the Family, lost their shit.

Hats off to WSAZ’s Tim Irr for this public response:

The Family Policy Council of West Virginia took exception with one of our guests yesterday on First Look at Four. The young man was one of two guests being interviewed about upcoming events to raise money for the American Cancer Society.

The event in which he’s participating is the Queens Slay Cancer Drag Show at Marshall University, at 6 p.m. Friday, April 27. All the money raised at the event, and the other events discussed on our show yesterday, will go the American Cancer Society.

Our guests were not there to forward some type of political or social agenda. They were not promoting adherence to a certain lifestyle. They did not speak negatively about or demean anyone in any way. They simply promoted events meant to raise money to fight cancer.

Drag shows may not be your cup of tea. Undoubtedly, they have a somewhat limited, but very supportive target audience. You may not consider members of the LGBTQ community worthy of your friendship, or even your respect, which is rather sad from a humanity standpoint. Perhaps your religious beliefs put you at odds with something you see as immoral.

We all feel the need to pick our battles in life. There are plenty of people who believe they have a moral responsibility to stand up for their religious convictions, and how they would like to see those convictions applied to the rules of our society.

Conversely, there are plenty of people who see no redeeming value whatsoever in a society guided by what they perceive as religious intolerance. That battle will no doubt play out for many years to come at the ballot box, in the street, in our homes and on social media.

But dragging people down who are simply trying to raise money for something like cancer research — on their own time, in their own way… no matter how you may feel about it — just seems mean-spirited and very wrong. Perhaps the way we feel about the “other side” is best kept in our own thoughts, especially in a situation like this.

Fucking American Taliban.








Get mad, you sons of bitches

This is what I wrote a little while about the House probes and it is coming true.

The way to win in 2020 is through sheer, unbridled anger. I’m going to start fundraising in earnest soon. For now, I think nominee funds for the Senate, money for the Virginia races, and money to vulnerable House incumbents are the way to go. I’ll have a list for the last soon.

For now, here’s the Senate nominee fund (I chose the most vulnerable Republican incumbents, but you can pick and choose which exact states among those to give to)

Goal Thermometer

Give here to Virginia Democrats. Their state legislature elections this fall are the most important state elections on my radar.

Goal Thermometer

And don’t forget to vote your ass off in local elections this year if you have them.

Update.

Baby pictures.








Insurance incentive design in the tail

I am assuming that these are charges and not contracted rates. But my god, this is a lot of money. Even assuming a net 75% discount to the contracted rate, it is still a lot of money. And it is not the entire cost of the episode as professional fees that go to clinicians are a separate set of bills, outpatient rehab is a distinct set of claims and all the ancillary costs are elsewhere too.

This episode of care is an outlier at whatever contracted rate is applied. It is wicked expensive. And it destroys any cost sharing incentive designs. A deductible only model has the out of pocket maximum met in the first seventy seven seconds of the episode. A copay model that is heavily charges inpatient stays maxes out in a few days at the hospital. A coinsurance model of say 20% coinsurance on surgery charges is maxed out after two or three days in the ICU.

There is no benefit design structure that changes marginal costs or incentives. In this case, open heart surgery is most likely not a shoppable service, so it is irrelevant but there are enough other cases where something is both wicked expensive and somewhat shoppable. Someone with a cancer diagnosis in Chapel Hill can go to Duke or UNC hospitals. Right now the only insurance steering mechanism for that decision is network design. My personal insurance steers me to Duke Hospitals while some of the folks at my gym would be steered to UNC hospitals.

I think that the outlier cases are where the money is and rejiggering cost sharing and steering structures is a possible way to get a little more value and competition.