On the Road and In Your Backyard

Good Morning All,

On The Road and In Your Backyard is a weekday feature spotlighting reader submissions. From the exotic to the familiar, please share your part of the world, whether you’re traveling or just in your locality. Share some photos and a narrative, let us see through your pictures and words. We’re so lucky each and every day to see and appreciate the world around us!

Submissions from commenters are welcome at tools.balloon-juice.com

Read more



Lighter than Freon Late-Night Open Thread: Cheeseball Decor for A Spray-Cheez ‘President’

Per the Washington Post:

… “This masterpiece is hanging at the White House,” Kimmel said, barely able to contain his laughter…

“There are only three living people in this painting,” he said. “Two of them hate Donald Trump. The other one is Donald Trump.” He added: “What a beautifully crafted piece of narcissism.”…

“It’s hard to figure out which piece of insanity to focus on,” Kimmel said, “the fact that Richard Nixon and Abraham Lincoln, in this scenario, are friends or that Donald Trump weighs less than 200 pounds in this painting.”…

“Ironic”, my flabby Irish arse, Vanity Fair. Trump’s got this print hanging where he and the rest of the world can see it because he likes it.

So what’s going on here? Why is President Trump, a man of taste, a man who would not do this without good reason, doing this? One word, two syllables: midterms. The midterms! He’s doing a thing where he pretends to be gauche and self-obsessed to expose all the snobs right before the midterms, and laughs and laughs, much like noted good-time guy Richard Nixon in this painting. He’s exposing all the snobby snobs as they come out of the woodwork to yell at the top of their blown gaskets, “It’s too easy! You’re making it too easy to laugh at you, and it’s actually exasperating at this point!”

It’s that, or President Trump thinks that the portrait depicts actual events, and so it’s a very important historical piece to have in his home. It’s a toss-up, really.

I’m sure the artist is a very nice man, but if Trump had the merest modicum of taste, he’d support the guy who created it, beyond hanging a cheap copy some fellow grifter gave him. I own art prints, and even collector plates, but if by some unimaginable catastrophe I end up with Oval Office privileges, you can be damn sure I’ll at least upgrade to a nice original… assuming I can’t persuade the artist into a commission!



GOP Voter Suppression in Georgia: Maybe If the Seniors Agreed to Ride in the Back of the Bus?…

The Suthrun Tradition revanchists are getting desperate. Let’s keep working to ensure these disgraceful antics will be summed up in the future as an extinction burst. From the Atlanta Journal-Constitution, “Black senior citizens ordered off Georgia bus taking them to vote”:

Government officials in an east Georgia county told about 40 African-American senior citizens to get off a bus taking them to vote Monday, leading to complaints of voter suppression.

The bus, run by the group Black Voters Matter, was preparing to depart from a senior center operated by Jefferson County when the center’s director said they needed to disembark, said LaTosha Brown, a co-founder of Black Voters Matter…

Jefferson County’s administrator said Tuesday that the county government considered the event at the senior center “political activity,” which isn’t allowed during county-sponsored events.

Black Voters Matter is a nonpartisan group encouraging African-Americans to vote in the election, but the county government considered the event political because Jefferson County Democratic Party Chairwoman Diane Evans helped organize it, County Administrator Adam Brett said in a statement…

Black Voters Matter had received permission in advance for the event at the senior center, Brown said. The event was originally intended to encourage seniors to vote, and when some of the seniors asked whether they could ride the bus to an early-voting location, Black Voters Matter agreed to take them.

But someone apparently saw the bus, painted with the words “The South is Rising Tour,” and called county government offices, Brown said. That led to the phone call from the county clerk to the senior center. When they were asked, the senior citizens agreed to leave the bus.

“It was discouraging that they weren’t able to vote,” said Evans, who was on the bus. “When they’re suppressing votes, they’re going to come up with any kind of excuse about what your problem is.”…

Despite the obstacles, the senior citizens will find a way to cast their ballots, Brown said.

“The seniors were so resolved. They said: ‘We’re going to vote. Nobody’s going to stop us,’ ” Brown said. “It wasn’t the first time someone has denied them or tried to prevent them from voting.”



John Bolton Is Worried About His War

Donald Trump says he told John Bolton when he hired him as National Security Advisor, “No, no wars.” But Bolton is a smart man who knows how to operate in the government to get his way. And his way is unabated hostility to the rest of the world. He has recently condemned the International Court of Justice. He supported the Iraq war. He is an advocate of preventive war against Iran and North Korea.

But the Jamal Khashoggi murder is standing in the way of a war against Iran. John Bolton must be sad. And, probably, working hard to find a way through this crisis. Read more



Texas Senate Debate: Congressman Beto O’Rourke Vs. Senator Ted Cruz

Here’s the live feed for tonight’s Texas Senate Debate at 9 PM EDT.

Open thread!



Bunnies Need Your Vote: Colorado House Rabbit Society (and Open Thread)

Bunny Yoga

I thought we could use a sweet distraction. What better than some rescue bunnies?

I received a request from a friend of mine (some of you met her at the first meet-up). She volunteers at the Colorado House Rabbit Society and also adopted a bonded pair of bunnies from them.

Seems there is a hay shortage in the country and it’s gotten very expensive. They entered a contest, we all wrote glowing essays and they are now a finalist.

They need votes!

Heide Sue (up for adoption)

So I said I’d give it a little boost here. Please vote if you are inclined. They do good works (as I’m sure all the bunny rescues do). They take in bunnies from all over the country, from shelters that have closed, from hoarders…and my favorite, this summer they were part of a cross-country caravan. They offered a rest stop where a hundred bunnies were fed, watered, brushed and cages cleaned. Took hours and a bunch of volunteers, but they sent them on their way refreshed.

We just got a bunch of bunnies from an out of state shelter that closed. We are stuffed with bunnies, all who need hay.  We are well over capacity right now. We need the hay!

If you’d like to help, just click here and vote for the Colorado House Rabbit Society (they are third row, center)

The bunnies thank you.  And if you’re in Colorado and looking for bunnies, they have plenty to choose from.

Open thread!








Money’s Great, but Your Time is More Valuable

It’s awesome how much money we’ve raised this year for candidates, but candidates also need people to put that money to good use. I’m down at the Wheeling HQ for the Ohio County Democratic Party, writing postcards for William Ihlenfeld, who is my candidate of choice this election for the State Senate. Ihlenfeld is battling a lot of dirty money that is backing his opponent, Ryan Ferns. And when I say dirty money, I mean literally:

Three years ago, a group of residents in West Virginia’s northern panhandle formed a new group, the Ohio Valley Jobs Alliance, and declared themselves a “voice for local jobs.”

A few months later, however, the group’s first major action was aimed not at creating jobs, but at blocking them.

In November 2015, the alliance, known as the OVJA, filed a legal appeal to challenge a key permit for construction of the Moundsville Power project, a natural gas-fired plant in Marshall County.

The move was puzzling. Backers of Moundsville Power said the project would be a significant boost for the area, providing 500 jobs annually during a three-year construction period and 30 permanent jobs once it was operational. Supporters said the project was a way for residents to capture more economic gains from West Virginia’s booming natural gas industry.

The legal action, it turns out, was funded by Murray Energy Corp., one of the nation’s largest coal producers, one of the group’s leaders testified in a deposition in the case. Murray Energy’s founder and CEO is Robert E. Murray, who is among the nation’s best-known advocates for reviving the coal industry and cutting regulations related to it.

Murray is the clown who was widely mocked by John Oliver and then sued him in response. At any rate, they are pumping a ton of money into a State Senate race, because, well, King Coal ain’t going down without a fight.

At any rate, if you can, get out and walk the streets, man the phone banks, staff the offices, write postcards, and if you just don’t want to even do that because you don’t like to be around people (which I totally get), maybe make them a lasagne or something healthful and drop it off at HQ so they don’t subsist on only fast food and cookies.








Give a little bit

Almost at our goal for More More More — split 47 ways among candidates recommended by you the readers. You can give to just one or two to avoid being on too many mailing lists.

Goal Thermometer

After this, I may go back to some Senate races. Or maybe go down into even lower tier House races. What do you think?








Worst couch surfer ever…

Speaking of flaming assholes, here’s a story via TPM:

The Ecuadorian government has had it up to here with Julian Assange.

The government has laid out strict house rules for Assange to follow or risk losing his diplomatic asylum, according to a Tuesday Guardian report.

They range from the important — don’t post political comments online — to the mundane — clean your bathroom and feed your cat.

“It’s virtually a prison regime,” Assange lawyer Carlos Poveda told the Guardian. “This new regime goes against his basic human dignity as an asylee.”

Poveda reportedly added that Assange could not understand the government’s directives, as they were written in Spanish, and currently does not have access to the internet.

Per the Guardian, the government also stated that come December, Assange will be on his own to pay for food and laundry.

So, that useless rat-faced ratfuck has been fed, clothed and housed by Ecuador for six years and still hasn’t learned Spanish! Throw his ass out, and give his cat to a better person.



So, this happened… (Open Thread)

We really are living in the dumbest goddamned timeline. Open thread!



Risk adjustment and market incentives

Market structure in revenue neutral risk adjustment should drive incremental coverage decisions.

Risk adjustment moves money to insurers that have a sicker than average population to cover.   There are two flavors of risk adjustment financing that have very different incentive structures for coding. Widget risk adjustment like Medicare Advantage has a central payer (the federal government) that pays a fee for each qualified diagnosis any insurer submits on a claim.  Revenue neutral risk adjustment has insurers with low population morbidity send money to insurers with higher than average medical burden.  A dollar that Insurer A gains is a dollar that Insurer B loses.  The ACA is risk adjusted in this manner.  Some state Medicaid managed care programs like Pennsylvania, where I used to work and optimized the risk adjustment search system for UPMC for You, also have revenue neutral risk adjustment.

Widget risk adjustment leads to upcoding.  Legitimate upcoding is the incentive for insurers to get their doctors to code everything that is medically defensible onto a claim.  Medicare Advantage patients will have more diagnosis categories than identical fee for service Medicare patients.  Medicare Advantage insurers will chase diagnosis codes that their data sets indicate should be credited but have not yet been credited.  The decision structure for any given insurer is simple: Chase every diagnosis until the incremental revenue gain is outweighed by the chase, hassle and piss off the providers costs.  It is not a strategic decision that has to incorporate other actors’ behaviors.

Revenue neutral risk adjustment can be a strategic decision depending on the market structure which will lead to very different chase incentives.  The ACA risk adjusts the metal plans in the individual market by state.

An insurer that has a state wide monopoly has no incentive to care about coding as a revenue enhancement measure.  Any coding concern should be relevant to either clinical treatment concerns, claims payment reasons or population health measures.  There is no money to be made or lost by chasing risk adjustment points.

States that have two insurers have a wide range of incentives. If there is a split market with a single dominant insurer (Insurer A) and an insurer that has minimal market power/enrollment (Insurer  B), Insurer A may be indifferent to chasing risk adjustment gains as the dollars at risk is a very small proportion of total revenue.  The rewards and costs for Insurer A are low.  Insurer B has strong incentives to optimize their risk adjustment.  A $1,000,000 risk adjustment swing is merely an accounting error for Insurer A and a company existence event for Company B.

If there are two more more insurers with decent market share in a state, we get a red queen’s race.  Insurers will have strong reasons to chase every defensible diagnosis ( and some that may not be defensible).  It won’t add to their revenue but it will prevent a competitor from getting undeserved revenue.  This is an expensive behind the scenes administrative arms race.

Why does this matter?

I think this is a good identification strategy for Hep-C dispensing incentives for insurers:

the ACA risk adjustment program is highly likely to overpay for Hep-C anti-viral prescriptions this year and next year due to list price reduction shocks.  The price that insurers pay will be significantly below the prices used to determine risk-adjustment co-efficients.

I think that insurers will be seeing too large of a risk adjustment score for the dispensing of a Hep-C anti-viral prescription.  Monopolistic insurers won’t have any risk adjustment incentives to change their behavior.  Insurers that are overwhelmingly dominant in a state will have very weak incentives to change their behavior.  Very small insurers will have bet the company incentives on increasing Hep-C prescriptions.  Insurers (regardless of enrollment) in competitive states will have strong incentives to increase their Hep-C anti-viral cures.








Never Let Your Opponent Set The Terms Of Debate

Last night, I told a friend that Elizabeth Warren’s DNA test was a strategic mistake. I haven’t wanted to say much about it, because I didn’t want to add fuel to the fire. But Democrats and others opposing Donald Trump have to get strategically smarter.

Never let your opponent set the terms of debate.

Never let your opponent set the terms of debate.

Never let your opponent set the terms of debate.

Apparently the lie about Warren’s using Native American heritage started in an earlier race. But Trump added the “Pocahontas” part, an obvious racial slur. He also added a challenge that he would pay $1 million dollars to a charity of Warren’s choice if she would take a DNA test.

Probably the way Warren’s people thought about this was: Take the DNA test, demand the $1 million, show Trump to be a piker.

WRONG

History shows that Trump is a piker. The $1 million challenge gives him an opportunity to continue the smear. And there was no way he would stop the “Pocahontas” thing in response to a DNA test. Negative commentary from Native Americans gave him more ammunition. All that was predictable.

Trump gets some things right, and his idea of hitting back hard is one of them. Warren should have, the first time Trump said “Pocahontas,” hit back hard by calling that for what it was.  RACISM. Say that her heritage, like everyone else’s, has nothing to do with her eligibility for office. Give the story of Pocahontas and show how the wrongs against her are perpetrated by Trump’s bigotry.

I don’t want to make a big thing out of this – we have more important points to make as we move toward the election. But please, please, Democrats get smart about this.

Never let your opponent set the terms of debate.



Tuesday Morning Open Thread: Getting Out the Vote

Meanwhile, on the Repub side…



On the Road and In Your Backyard

Good Morning All,

On The Road and In Your Backyard is a weekday feature spotlighting reader submissions. From the exotic to the familiar, please share your part of the world, whether you’re traveling or just in your locality. Share some photos and a narrative, let us see through your pictures and words. We’re so lucky each and every day to see and appreciate the world around us!

Submissions from commenters are welcome at tools.balloon-juice.com

Read more



Late Night Horrorshow Open Thread: Assassinating Journalist Not Perceived As Hoped by Saudi Arabia… or Donald Trump