Come for the politics, stay for the snark.

This blog will pay for itself.

I showered with Rahm and all I got was this shitty blog.

Verified, but limited!

I thought we were promised Infrastructure Week

Not all heroes wear capes.

This is how realignments happen…

Consistently wrong since 2002

We Survived Breitbartpocalypse!

Yes we did.

Shock troops for the Unitarian Jihad.

I personally stopped the public option…

Hot Air and Ill Informed Banter

Wetsuit optional.

Dinky Hocker Shoots Smack!

Naturally gregarious and alpha

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Just a few bad apples.

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Word salad with all caps

Is it irresponsible to speculate? It is irresponsible not to.

And we’re all out of bubblegum.

Women: They Get Shit Done

A snarling mass of vitriolic vicious jackals

Han shot first.

Competition and Out of Pocket spreads

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Yesterday, we looked at the variation in the minimal out of pocket limit for Gold plans on Healthcare.gov in 2020.

Very different alloys of Gold are available on Healthcare.gov.

There are low maximum out of pocket gold plans in North Jersey, Arkansas, central Atlantic coast Florida, Kansas, Wisconsin and a couple of other spots where the lowest out of pocket limit for a Gold plan is under $3,500. Structurally, most of the cost-sharing in these plans will be in the form of a deductible and there will be few exemptions from cost-sharing.

On the other hand, most of Texas and Oklahoma as well as big chunks of North Carolina and Virginia only offer Gold plans that have the maximum allowable out of pocket limit. These plans tend to have smaller deductibles and more services that are no cost-sharing.

A colleague of mine asked if there was anything going on with market characteristics. I ran two sets of analysis looking at the difference between the lowest gold out of pocket limit and the lowest bronze out of pocket limit. The first was whether or not a monopoly mattered? The second was a broader question if the number of insurers mattered more than 1 or not 1. I’ve included for this quick and dirty analysis, the benchmark premium for a single forty year old.

Market structures matter.

The Monopoly Analysis:And the non-monopoly, insurer count model is here:

Difference between MOOP Gold and Bronze plans 2020 on Healthcare.gov (Monopoly Analysis)
Coefficients Standard Error t Stat P-value
Intercept -2793.93 107.20 -26.06 0.00
Monopoly 780.20 61.15 12.76 0.00
Benchmark Premium EHB 3.32 0.20 16.88 0.00

Here is the number of insurers analysis:

Difference between MOOP Gold and Bronze plans 2020 on Healthcare.gov (Number of insurers)
Coefficients Standard Error t Stat P-value
Intercept -1630.52 142.86 -11.41 0.00
Insurer Count -324.89 24.05 -13.51 0.00
Benchmark Premium EHB 2.91 0.20 14.24 0.00

In both cases, adding more insurers makes the spread between the lowest gold out of pocket limit and the lowest bronze out of pocket limit increase.  Gold becomes noticeably different than bronze and attractive to different populations when there are more insurers in a county.

A full-on model would be adding in state fixed effects to pull out state wide policy (like in New Jersey and states with standardized plan options) and look at several years worth of data.  But competition is probably related to making Gold plans more pragmatically valuable to individuals with high expected medical costs compared to counties where there is little to no competition.

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Tuesday Morning Open Thread: Keep Hope Alive

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Meanwhile:


(Yes, I too wish Harris was still in this race. We can dream… )

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On The Road – Auntie Anne – More England – Bath, Stonehenge, and Stratford

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Good morning everyone,

Today we return to a tour, already in progress!

Continuing on through my tour of southern England, this batch of photos is from Bath, Stonehenge, and Stratford.  It was overcast and drizzling the day we went to Bath, and the pictures reflect that, unfortunately.

As a reader of Regency romances in my youth, it was great to see Bath.  We visited the Fashion Museum there, which I highly recommend.  I also sipped the Bath waters, which were dreadful.  I just don’t get people drinking them for their health.

Stonehenge was one of the absolute highlights of the trip for me.  I’m fascinated by history; I could have spent hours visiting the nearby prehistoric sites.

Stratford was cute and very touristy, but I was most intrigued by the canal and the canal system in England.

On The Road - Auntie Anne - More England - Bath, Stonehenge, and Stratford 7
The Circus - Bath EnglandAugust 27, 2019

The Circus, originally called King’s Circus, was designed by the architect John Wood, the Elder. Convinced that Bath had been the principal cent of Druid activity in Britain,Wood surveyed Stonehenge, which has a diameter of 325 feet at the outer earth bank, and designed the Circus with a 318 feet diameter to mimic this.

The initial leases for the south west segment were granted in 1755–1767, for the south east segment in 1762–1766, and for the north segment in 1764–1766.

The Circus was part of John Wood the Elder’s grand vision to recreate a classical Palladian architectural landscape for the city.

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COVID-19 Coronavirus Update – Monday / Tuesday

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Despite appearances, Tom Cotton isn’t actually an illiterate moron — he just plays one, for career advancement. When he starts his ‘just raising the question’ spiel, you can see the Harvard Law training:

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Cold Grey Pre-Dawn Open Thread: Life or Death Issues

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Yes, I am a small & petty person. (Whose ancestors’ great saga was called The Cattle Raid of Coolan, so: biased across multiple axes.)


If the rest of us didn’t have to live in the aftermath, there’s be considerable entertainment value watching an all-out Sanders v. Trump campaign…

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Late Night Musical Interlude: Nancy Smash

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Cat Rescue Bleg – NYC

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Cat Rescue Bleg - NYC

From long-time lurker Deb S:

Hello Juicers. I’m a long-time lurker, from the days when B-J was on the Dkos blog-roll and John was still a republican.

My mom is in home hospice in Manhattan on the Upper East Side, and neither my brother nor I can take Shakespeare, her part Russian Blue mix. He is the best cat to ever own her. Typical Russian Blue personality, his goal in life is to be on a person. Vocal and loving, if he’s complaining either his food dish is empty or you need to SIT DOWN THIS MINUTE so he can jump into your lap. The picture is of him homing in on my lap like a heat-seeking missile.

My mom got Shakespeare about 10 years ago from a rescue connected with her vet’s office, after losing her prior cat to old age. He is at least 13, and maybe older.

He has a tilt to his head and is a bit asymmetrical, we think he might have been hit by a car or suffered some other traumatic injury before my mom got him. And he has a nervous habit of over-grooming and pulling out his own fur that has gotten worse as my mom’s condition worsened and she could no longer give him the attention he was used to.

He needs a lot of love and would probably do best with another shut-in, or a family with one or more older children who can dote on him and give him the affection he craves. He loved visits from the children who used to live next door. I don’t know how he would do with other pets but safest would be a home with none.

I will take him to the vet and get him caught up on his vaccinations before he is re-homed.

Steeplejack would probably attest — for someone who works from home, a senior cat can be the perfect pet.

If you’re interested, or know someone who might be, leave a comment or contact me via the link in the blogroll.

Cat Rescue Bleg - NYC 2
Deb S:It’s hard to get a good picture – if he’s awake and you’re near him he’s heading for your lap. In this pic he’s reaching for my hand because I’m not petting him as I should be.

Cat Rescue Bleg - NYC 1

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What is This Blog Coming To?

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I mean, it’s been almost a week since Ted Cruz whined about an Alabama “forced vasectomy” bill and nobody has posted to make fun of him. Sometimes I think we’re losing our touch. Anyway, the long and short of it (in Ted’s case, almost certainly, the short of it), is that an Alabama state rep, Rolanda Hollis, introduced a bill that would force men to have vasectomies when they reach age 50. This is the counterpart to a stupid Alabama anti-abortion bill that was struck down last Fall, as well as all the other stupid publicity stunt bills that Republican state legislators introduce all the time.

Why should Republicans have a lock on these stunts? The simple answer, as Ted’s news release that pushed this story into the our collective inboxes shows, is that they shouldn’t. Sometimes, when you fight stupid with stupid, you make your point, especially if an asshole like Ted picks up on it.

Wonkette has a good run down on the whole thing that’s worth a read as a pleasant diversion.

My only comment is that men are such weaklings about this little operation, and it doesn’t surprise me one bit that faux tough guy Cruz chose this stunt bill to whine about. Women, who already shoulder all the risks of a sometimes deadly act (reproduction), are expected to shoulder all the work and risk of birth control*, according to guys who are too chickenshit to have a short, low risk, at worst slightly painful procedure that is done under local anesthetic. Fuck those guys, really. Or if you’re a woman with one of them, don’t fuck ’em. (I actually knew a woman who did that to get her point across.)

Open thread.

* Yes, I know condoms exist. Still, are you going to tell me that Ted Cruz and his ilk would use one without whining like a pissy little baby? Damn right you’re not going to tell me that, because it isn’t fucking true.

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Election Year Guest Post: Report from the Ground in Nevada

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From commentor Schmendrick:

I promised to report back on my experience while early “voting” in the Nevada caucus, so here goes.

I arrived at the nearest early voting site at 11:00 am. It was scheduled to be open from 10:00 am to 6:00 pm. The line at 11:00 am appeared to have at least 200 people in it and I hadn’t moved more than a few feet after about five minutes. At that point I walked inside the school cafeteria and volunteered to help. About 8 hours later I was the final voter of the day at that voting site. In between I spent my time walking up and down the line counting people and telling them an estimate of the time it would take and explaining the process once they got to the registration table.

I have neither the time, nor the skill to weave a compelling story of my adventure, but I will list a few observations that might interest the jackaltariat.

Since this was the first ever early voting activity for a Nevada Democratic Party caucus, there are no previous turnout figures to compare with what happened yesterday. The person in charge of the voting site was competent and organized but he had a limited number of volunteers assigned. I believe he called in a few friends from previous campaigns at the last minute and a few of us volunteered spontaneously when we saw the long lines, so we ended up with about a dozen people helping throughout the day.

At the beginning of the day there was a bit of a learning process and about 75 to 90 voters per hour were completing the process. The bottleneck was the step of looking up the voter registration to verify that they would get the voting card for the correct precinct and to ensure that no one voted multiple times. By the end of the day voters were going through at a rate of about 125 an hour. I can estimate this pretty accurately because there were 128 people in line at 6:00pm when we closed the door and the last voter’s ballot (mine) went in the box at 7:02.

The longest waiting time was well over 3 hours for people who arrived in the late morning. Late afternoon arrivals probably averaged less than two. The total for this voting location was close to one thousand early votes cast.

I did not have any official information about what was happening at the other voting sites around town (Las Vegas), but there were individuals from several campaigns observing who were in touch with other campaigns volunteers at the other sites and the indirect report was that all of the other sites but one were also very busy. When the line was at its peak (about 350 people) I informed the people towards the back of this rumor and perhaps one or two dozen left to try there luck at the other site (about 7 miles away). A few people so disgruntled about the line that they called for their huff and departed in it, but it was striking to me how determined most people were to cast their vote and maintained good spirits.

During the day the party and some of the campaigns provided water and pizza and other snacks to the people waiting in line. There were a few very minor instances of asking campaign people to move a little further from the actual voting area, but from my perspective everyone was co-operative and the discussions were all in good faith. Since I was the one trying to ensure fairness, and the layout of the voting site included a sequence of gates and courtyards before the interior of the building there was room for debate about where the boundaries of the voting place were, there was some negotiation about where the campaign workers could be, but it seemed to me that there were no significant confrontations and the overall attitude was a very encouraging blend of enthusiasm for particular candidates leavened with a very healthy dose “Voting Blue, No Matter Who”.

My very unofficial assessment of people wearing buttons, shirts, hats or other indicia of preference is:

People with no outward sign of their preference more than 90%

Of the people with some sign of their preference, the most may have been Sanders, with Warren a close second. There were a few for Mayor Pete, and Biden.

In terms of campaign staff I think the largest contingent was the YangGang, followed by the Sanders and Warren people. The Biden campaign also had a representative their all day. I think the other campaigns may have been represented for part of the day, but I am not sure.

Finally, I had a celebrity sighting. I helped a certain famous Las Vegas magician update his voting registration so he could vote. He lives about a mile away from me but I had never met him in person before.

Now I need to get busy studying for my job at the caucus this Saturday.

Thank you for your service, and best luck on Saturday!

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Red, White and Barr

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Donald Ayer’s article in The Atlantic is making a splash today. The author is a former U.S. deputy attorney general under George H. W. Bush, and the piece is entitled: Bill Barr Must Resign. More than 1,100 former DOJ officials are also calling on Barr to resign.

Spoiler alert: Barr won’t resign and will almost certainly not be impeached, but Ayer’s piece is definitely worth one of your free monthly clicks, IMO. An excerpt:

Barr’s Federalist Society speech suggests that he is ready to say nearly anything in pursuit of his lifelong goal of a presidency with unchecked powers. As Napoleon is reputed to have said, the man who will say anything will do anything. That Barr has also repeatedly used his authority as attorney general to tailor the position of the United States, in court and in legal opinions, to empower such an unworthy incumbent as Donald Trump to do whatever he wants suggests that this is correct.

The benefit of the doubt that many were ready to extend to Barr a year ago—as among the best of a bad lot of nominees who had previously served in high office without disgrace—has now run out. He has told us in great detail who he is, what he believes, and where he would like to take us. For whatever twisted reasons, he believes that the president should be above the law, and he has as his foil in pursuit of that goal a president who, uniquely in our history, actually aspires to that status. And Barr has acted repeatedly on those beliefs in ways that are more damaging at every turn. Presently he is moving forward with active misuse of the criminal sanction, as one more tool of the president’s personal interests.

Bill Barr’s America is not a place that anyone, including Trump voters, should want to go. It is a banana republic where all are subject to the whims of a dictatorial president and his henchmen. To prevent that, we need a public uprising demanding that Bill Barr resign immediately, or failing that, be impeached.

All true, but here’s my question: why did any experienced legal analyst or past DOJ official give Barr the benefit of the doubt in the first place since, as Ayer points out, Barr has been peddling kooky theories about the imperial presidency since God was in knee pants? Barr’s Wikipedia page tells the story: he grew up in the right place and went to the right schools.

We really do have a “coastal elitists” problem in America, but it’s not city dwellers looking down on gun-fondling NASCAR fans. It’s benign assumptions about deranged and/or incompetent people if they emerge from centers of power. It’s a serious problem!

Ayer calls Barr “un-American,” an adjective I dislike because it usually implies that civic virtues are uniquely American and erases societal depravities that are all too American. But given that Barr is attempting to undo the American Revolution and restore a species of monarchy, the descriptor may be literally true in his case.

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Hurry Up and Fuck Up

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My God, this little tidbit from a story in Politico about the Nevada Caucus is the opposite of hallelujah (not linking to Politico, read it via LGM):

Party officials scrambled to streamline their vote reporting system — settling on Google forms accessible through a saved link on the iPads — after scrapping a pair of apps they’d been planning to use until a similar app caused the fiasco in Iowa two weeks ago.

Again, any process that runs once every four years is really hard to test, and therefore a major technological and human factors challenge. Add to that the fact that it is a new process that someone dreamed up in a couple of weeks, which has to be executed by harried, poorly trained volunteers, and you have a failure waiting to happen. At least they’re using iPads that they control, and Google Forms probably won’t shit the bed on caucus night, but other than that, Titanic II.

Some kind of verified (multiply witnessed) paper record, along with a process to call the results in to a phone bank, and a pre-stamped envelope to send that record to the party via certified/registered/whatever mail, is the right technology for a caucus. But that just avoids the obvious fact that the right solution for picking a candidate of a party is a fucking primary election.

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Election Year Redlining Open Thread: Warren v Bloomberg

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Anyone who hates the idea of President Bloomberg, remember — Mike promised he’d spend up to $2billion supporting whichever Democratic candidate triumphs in the primaries. If that turns out to be Elizabeth Warren, not only will we all be getting a better President, but it will viscerally hurt Mike Bloomberg.

(Yes, he and his vast fortune will be better off under President Warren than President Trump, but she’s been so meeeeean to him already!)

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Straight Outta Context

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Atrios posted this clip today and I decided to listen to it instead of relying on the summary. It’s somewhat out of context – it sounds like Bloomberg is in the middle of giving a short history of work, starting with farming, moving to the industrial revolution, and ending with the information age. His point was that most of the work done today requires a lot more skill than farming 300 years ago.

This is just bog-standard business conference stuff. Does he sound a little condescending? Yeah. Is this going to sink his battleship? Probably not.

Just as pure political strategy, I think attacking stuff like this for being “out of touch” is a political mistake. If you get this riff into context, Bloomberg probably has some solution that may or may not work to address the legitimate issue of what to do about an economy where a lot of people are locked out due to lack of technical skills. My guess is that his solution was unworkable, but he’s identifying a problem that resonates in “the heartland” — high tech skills and high tech jobs are few and far between in rural areas.

Frankly, the answer to this problem that is sometimes given by “moderate” Democrats’ – turning miners or assembly line workers into coders or network engineers – is just as vacuous as most of the conversations at business conferences. I spent a lot of time in “the heartland” last year, and the only “coder” I saw was when I looked into the mirror, because there are essentially no coding jobs in rural areas. What I did see was two paramedics in their late 50’s or early 60’s, men who had other jobs prior to retraining, who were now working in the only technical field in most rural areas, medicine. There were also a lot of nurses and aides, and home health care workers. Those home health care workers worked for agencies charging what, for that rural area, is a lot of money (like $25-35/hr), but I doubt that the aides saw a fraction of that. I also saw closed down nursing homes, and families struggling to take care of their elderly parents and grandparents at home when they really should have been in an assisted living facility or a nursing home.

A solution that really could help these rural areas is a huge infusion of money into Medicaid (which pays for most nursing home care, in the end), more assistance to pay for home health aides, and adding a requirement that aides and paraprofessionals be paid a much better wage. Then, retraining programs could be for medical jobs that actually exist in rural America, not IT jobs that exist in New York. But if you stand in front of a bunch of unemployed farmers or factory workers and tell them that, they’ll think you’re trying to sell them crappy jobs, because, today, those jobs don’t pay shit, and they’ve seen a lot of those jobs leave town.

The information economy is real, but so is the healthcare economy. The biggest employer in a lot of small towns is the hospital and/or nursing home — if they’re lucky enough to still have one or both of those facilities. That’s the reality in the heartland. Maybe Democrats could start addressing that if they want to win over a few voters in those places.

There’s plenty of other stuff that Bloomberg is terrible on – just attack him on that.

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14 and 24 carat Gold plans on the exchange

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Gold plans have become relatively much cheaper for subsidized buyers on the ACA exchanges since Cost Sharing Reduction subsidy payments were terminated in the fall of 2017.  Insurers have responded by placing the full cost of these subsidies onto only Silver plans.  This has upped the benchmark premiums and made the net of subsidy prices for non-Silver plans much cheaper.  Bronze plans have a target actuarial value of 60% and Gold plans have a target actuarial value of 80% while Silver has a target value of 70% and a silver loaded value in the mid-80s before risk adjustment does weird things to premiums.  Hundreds of counties on Healthcare.gov have at least one Gold plan that has a premium below the silver benchmark.

Insurers have an amazing latitude in designing their plans. A Gold plan in 2020 can’t have an out of pocket limit above $8,150 and it has to have an actuarial value between 76% and 82%.  Beyond that, insurers can do what they want basically whatever they want.  I am curious as to what the smallest maximum out of pocket amount is for Gold plans?

I am mapping the lowest maximum out of pocket maximum for a Gold plan in the map above.

 

 

 

Very different alloys of Gold are available on Healthcare.gov.

There are low maximum out of pocket gold plans in North Jersey, Arkansas, central Atlantic coast Florida, Kansas, Wisconsin and a couple of other spots where the lowest out of pocket limit for a Gold plan is under $3,500. Structurally, most of the cost-sharing in these plans will be in the form of a deductible and there will be few exemptions from cost-sharing.

On the other hand, most of Texas and Oklahoma as well as big chunks of North Carolina and Virginia only offer Gold plans that have the maximum allowable out of pocket limit. These plans tend to have smaller deductibles and more services that are no cost-sharing.

Both of these choices can produce benefits. Individuals who know that they are going to have very big claims in a year will prefer, for a given actuarial value, that most if not all of their cost sharing will be in deductibles. A deductible only or a deductible heavy plan means that the individuals who have fairly light healthcare expenditures will be paying a large share of their health expenditure in cost-sharing. As the healthy pay relatively more, the sick pay relatively less.

Plans that are light on deductible with many exemptions in the cost sharing are better (at a given actuarial value) for individuals with light healthcare utilization and low claims. The odds are that their utilization will either be in exempted categories or could be merely copay or coinsurance instead of full deductible coverage. However, individuals who have an expensive year will be paying through the nose in cost sharing. In many circumstances, the difference between a Bronze plan and a Gold plan for someone with $30,000 or $50,000 in claims will be monthly premiums (Bronze will be cheaper) and cash flow where Bronze might be all deductible so all cost-sharing is up-front while the Gold plan will spread out the cost sharing over several months.

Not all that glitters is truly gold.

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