Open Thread

The willow tree is too close to the cat.

Why, one might ask, is the cat basking under the willow tree in chilly 44 degree weather?

The answer is A.) he is wearing a fur coat and B.) because someone filled the bird feeders this morning.








The Bullying Swagger

May I modestly point out my second article in Pakistan Politico? The print edition was published last week, and the online edition went live today.

America First seems to mean breaking earlier agreements and imposing unilateral demands. There are no explicit statements of what happens if those demands are not met, and, in the case of North Korea, the demands have been fading as North Korea ignores them. So bluster and swagger are a big part of America First.

Let’s see how swagger and America First work out for the Khashoggi affair. I wrote the piece before that happened. Click over and read the whole thing.



Going through my choice structure

Between the Medicare open enrollment period and the Exchanges opening up for enrollment in a few weeks, a lot of people will be making a lot of tough, and hard to fully describe choices for their health insurance.  I, personally, have a much easier choice set but I want to go through my decision process on how I chose the insurance for 2019 for my family last night.

    1. Grab a beer (I recommend 21st Amendment Blood Orange)
    2. List probable future medical utilization
      1. Flu shots
      2. 2 Pediatric well child (docs @ Duke)
        1. Several PCP visits for school age crud
      3. 1 or 2 adult wellness visits  (my doc is @ Duke)
        1. 1 or 2 urgent care visits for random stuff
      4. 1 OB-Gyn well visit (no relationship established)
      5. Possible surgery to clean up a broken ankle if it does not heal right
    3.  Expected Pharmacy Utilization
      1. Asthma crisis medications (generic nebulizer and brand name blue inhaler)
      2. Asthma maintenance medications (brand name orange inhaler)
    4. Confirm Pharmacy benefit is the same across all plans
    5. Eliminate the nationwide PPO and the North Carolina wide HMO network plans as they are too expensive.  The less expensive narrow network choices are built around Duke owned facilities.  If one of us has something weird, we’re likely going to Duke anyways as  Duke handles a good chunk of the complex/weird cases.
    6. Choices are now restricted to a no deductible/co-pay only Plan A.  It has a higher premium coming out of my paycheck compared to Plan B which has a $600 deductible/$2,000 individual  maximum out of pocket or $1,800 family deductible/$6,000 family maximum out of pocket plan.

Before I go further, I just want to state that this is damn good insurance.  The low AV plan is low platinum level coverage and the no deductible plan is high platinum coverage.  This is damn good coverage.

I had to figure out which would cost the family the least.  My son’s asthma medications are a constant cost, so they are analytically irrelevant.  My wife has a broken ankle.  So far she is healing well.  The orthopedic surgeon has told her that in similar cases, he frequently will need to go in and install screws/plates if everything does not heal up right after several months of light activity and supportive stabilization.  This is our big question mark.

Assuming that she needs surgery, we figure it is at at least a $5,000 operation with at least a dozen physical therapy sessions afterwards.  Under Plan A we would pay a $600 hospital admission co-pay and then $240 in PT co-pays.  Under Plan B, she would max out her deductible of $600 and run up most of her out of pocket limit through PT co-pays and coinsurance for the surgery.

If she needs surgery, Plan A is the better choice as the higher monthly premiums buy out the deductible and it has much lower co-pays.  Conditional on my wife needing ankle surgery, Plan A has us coming out ahead by about $1,000 for the year.  If she does not need surgery, Plan B is a better value by $1,500 or so for the year.

We don’t know if she needs surgery yet. We don’t have a good way to estimate our probabilities beyond the vague information from her orthopedist that he “frequently” needs to go in.  I don’t know what “frequently” means.  Is  it 20% of the time, or  50% of the time or does he slice and dice  85% of the time?  I don’t know.

At this point in the analysis, it was no longer analytical.  It had to become a discussion about tolerances and values.  I grabbed a beer for my wife, and she turned on The Good Place before we talked about our risk tolerances and our ability to take a hit on bad outcomes arrived through a good process.  This is mostly a values questions.  It reflects our risk tolerance at this point in our lives is not a perfectly rational loss/reward frontier.  We decided that we would stick with Plan B as we can afford an incremental $1,000 hit if she needs surgery although we’ll grumble about it.  But we would regret the extra $1,500 in spending if she does not need surgery.

This is how we made our insurance decision for next year. And this was a very easy set of choices.  We started with four choices with significant elements constant across all possibilities (the prescription drug benefit).  We eliminated from consideration the two expensive broad network options. We then primarily focused on one possibility. We excluded from consideration unusual and very high cost events as both plans will be good enough for a cancer diagnosis or similar events.   And even with that simplification, we’re gambling on imperfect information on what we need.  I think we will have satisfied minimal criteria but I know we are not optimizing our decision making.

This is the easy case. 

Some Medicare Advantage buyers will look at forty or more plans in 2019.  Some ACA Exchange buyers will see over 100 plans offered in their county in 2018. The language used to described the same element will vary wildly between insurers and the prescription drug benefits will also have significant confusion introduced by variation.  This is a tough choice.  And it is a choice where I think most people need to go into the decision matrix knowing that they won’t get the optimal choice but if they lay out a series of minimally acceptable criteria, that they can get a good enough choice.








Thursday Morning Open Thread: Excellent Arguments

Especially for Betty, Adam, and the other FL jackals…



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 ‘News of the Weird’ Open Thread


 
Let’s be fair: The programmers behind this stunt are, statistically, liable to be lousy dancers themselves. We won’t even discuss their concept of ‘popular music’…



Foreign Affairs Horrorshow Open Thread: Jamal Kashoggi Is Dead. Donald Trump Remains A Liar


 
Word from the (Republican) Chairman of the Senate’s Committee on Foreign Relations:


… Before or after the midterms? Because this sounds like one more really good reason to elect as many Democrats as possible, and turf out these useless GOP enablers.



Best Dog

Long day. Work stuff, then stopped by Team Kendra HQ in Morgantown. I got there when it was not open, and it was all grey and industrial and blah so I went back later with some mums, some water, a couple dozen apples, some bananas, grapes, and other stuff.

Twenty days to go. What are you doing to take back our country?

Also, if you are so inclined, they can still use the cash:

Goal Thermometer

If we get a couple hundred in the kitty I will hunt down Steve and post a picture of him. See what I did there? Kitty. Steve.

I think I am delerious.








Open Thread: It’s Almost As Though the Media Villagers Like Having Open Bigots to Showcase


 
Meanwhile, speaking of ‘white nationalists’…



Just a reminder of the stakes

Go vote early if your state allows you to do so.

Open thread



“A Natural Instinct for Science”

Here is a real thing Trump said during an AP interview when asked about the recent climate change report that suggests humans have 10 years to get our shit together or we’ll reach the point of no return:

Some say that and some say differently. I mean, you have scientists on both sides of it. My uncle was a great professor at MIT for many years. Dr. John Trump. And I didn’t talk to him about this particular subject, but I have a natural instinct for science, and I will say that you have scientists on both sides of the picture.

If I could pick up one of the many dead fish a recent algae bloom deposited on nearby beaches and use it to club each and every Trump voter (including my father, aunts, uncles, cousins, etc.) over their stupid fucking heads, I would gladly do so. And I’d select the largest, stinkiest mackerel I could find.

The first order of business in addressing climate change is to get that eugenics-believing moron out of the fucking White House. At this point, I wouldn’t blame the governments of sane countries for banding together to effect regime change. Unlike the late Saddam Hussein, Trump represents a clear and present danger to the entire planet.

ETA: In case you’re wondering, the AP interviewer just moved on to the next topic after that incredibly idiotic response rather than laughing in Trump’s stupid orange face and saying “eat my WHOLE butt” or pointing out that only crackpots deny that human activity contributes to climate change, etc. This is part of the problem.



Everything’s coming up roses

This is the first really solid evidence I’ve seen that Dems are going to do well on election day. It’s also a sign that Democrats should double down on #MeToo.

Polls and 538 predictions are one thing but betting against Megan McArdle is a sure thing.

People wanted more chances to give money to Senate races. You can give here to Jacky Rosen (NV) and Kyrsten Sinema (AZ).

Goal Thermometer

Send some postcards here.








Wednesday Gratitude Post: One Good Thing

What I’m grateful for, this week — and believe me, there ain’t much — is that THE SUMMER FROM HELL IS FINALLY OVER. Autumn is always my favorite season, but waiting for the last of the days that felt like a warm, wet blanket had been wrapped around the whole godsdamned planet has been a new level of torture. I can hardly wait for the first killing frost, just so I’ll have an excuse to tear up the extremely unproductive (yet flourishing!) tomato plants. And maybe get started on cleaning up the even-more-flourishing weeds that have taken over the yard while I was too HHH-stunned to fight them…

What one good thing are you grateful for, this week?



The Truth Is Out There

According to a report in Bloomberg today, shortly after the midterm elections, Special Counsel Robert Mueller will release findings on whether the Trump campaign colluded with Russia to swing the 2016 election and whether Trump himself obstructed justice:

Special Counsel Robert Mueller is expected to issue findings on core aspects of his Russia probe soon after the November midterm elections as he faces intensifying pressure to produce more indictments or shut down his investigation, according to two U.S. officials.

Specifically, Mueller is close to rendering judgment on two of the most explosive aspects of his inquiry: whether there were clear incidents of collusion between Russia and Donald Trump’s 2016 campaign, and whether the president took any actions that constitute obstruction of justice, according to one of the officials, who asked not to be identified speaking about the investigation.

That doesn’t necessarily mean Mueller’s findings would be made public if he doesn’t secure unsealed indictments. The regulations governing Mueller’s probe stipulate that he can present his findings only to his boss, who is currently Deputy Attorney General Rod Rosenstein. The regulations give a special counsel’s supervisor some discretion in deciding what is relayed to Congress and what is publicly released.

The thing I want to believe referenced by the image above isn’t that the Trump campaign colluded and that Trump obstructed justice; I am 95% sure the Trump campaign conspired with Russia because we have hard evidence that they were slobberingly eager to do so — all that’s needed is proof that they followed through on that intent. I am 100% certain that Trump obstructed justice because he confessed it on camera to Lester Holt and has publicly tampered with witnesses and interfered with the investigation ever since.

No, the thing I want to believe is that justice is possible even though the Republicans have insisted that only Republicans can investigate Republicans and that Republicans control what the public can know about the findings. If such a scenario were unfolding in a foreign country, we’d label it a Banana Republic and expect a white wash. I want to believe we will eventually know the truth about a hostile foreign power’s attack on our election, and in America circa 2018, that feels a little like believing in alien abductions.



Medicare Advantage and the public option

The Kaiser Family Foundation is recapping the Medicare Advantage landscape files for 2019.  The recap differs in details but is similar to previous years as Medicare Advantage is a well functioning program that seems to be delivering good value to both beneficiaries and the federal government.

Medicare Advantage are plans that are offered by private insurers to replace the traditional Medicare benefit package.  People can buy a Medicare Advantage plan or they can stay in traditional Medicare with the option of buying a supplemental plan to provide catastrophic risk protection.  Medicare Advantage is growing in popularity.

However it is not offered everywhere

No Medicare Advantage plans will be offered in 115 counties in 2019, down from 149 counties in 2018; these counties account for one percent of beneficiaries, most of whom live in relatively rural areas in California. Eight other states also have counties in which no Medicare Advantage plans will be offered in 2019 (AK, CO, IA, ID, NE, NV, VA, and WA).

And even where it is is offered, there may be low competition as a “plan” is only a single policy like a Gold $2,500 deductible narrow network is a single plan from a single insurer.  A one plan county is a single insurer county.

And very few people care.

Indifference is rational as everyone who is Medicare eligible has access to baseline coverage through traditional Medicare. It is the public option of the system that acts as a backstop to the added-on layer of Medicare Advantage.  It is the default that is everywhere for everyone.  Some people opt out of the default but it is always there no matter strategic decisions an insurer makes due to policy, actuarial or political pressures.