About This Afternoon

These messages, encountered on a foggy morning on the Venice (CA) boardwalk last week, seem on point:

Sorry for the soft focus — I had only time to grab a quick phone shot; these bearers of wisdom disappeared before I could unlimber some more sophisticated camera action.  But the point is made, I think.

I had a ten-day Flagyl imposed alcohol break, but that ended last night.  I plan to raise a cocktail tonight flavored with sweet, sweet wingnut tears.  La lucha continua, certainly.  But that doesn’t mean triumphs along the way can’t be savored. In fact the reverse.

Open thread, y’all.








I’m not tired of winning

Are you tired of winning? I’m not

Next fight is to make sure CMS and the Trump Administration do not sabotage the exchanges and avoids approving horrendous 1115 Medicaid waivers.

And yes, I am big footing Doug








It’s all over now








Soothing Balm of Nature (Open Thread)

As we wait for the Trumpcare vote to come down, here’s something lovely to look at — our white squirrel, Salt, hanging out in an oak tree:

Open thread!








Juliet was waiting with a safety net

Trumpcare isn’t dead yet. I won’t be surprised if the Freedom Caucus caves and votes for it this afternoon. If you live in a district with a Republican Congressional representative, get on the phone and tell them to vote against it pronto if you can. Try district offices as well as the DC office.

Things will get worse, not better, for Republicans if they pass this piece of shit onto the Senate. But there’s a real risk of this thing passing, becoming a law, and ruining millions of lives. So let’s kill it now while we can.

Update by Dave Anderson








Something Strange in the Greater DC Area: There Appears to be a Cluster of Missing African American and Latina Teen Girls

There is concern that there is a cluster or, perhaps, a spike in missing persons cases in the DC area where the missing person is either an African American or Latina teen girl.

The figure is startling — more than a dozen black and Latina teens have been reported missing in D.C. since March 1.

The apparent jump in the number of missing young people in the District has raised concern in neighborhoods and on social media.

Actually, what’s happening is D.C. police are now acknowledging a continuing problem.

https://twitter.com/DCPoliceDept/status/839886925632835584?ref_src=twsrc%5Etfw&ref_url=http%3A%2F%2Fwtop.com%2Fdc%2F2017%2F03%2Fdc-police-address-concerns-over-missing-teens%2F

As indicated by the social media response, DC authorities are taking the issue seriously.

Chanel Dickerson, who recently became commander of the D.C. police’s Youth and Family Services Division, said she was shocked by the number of missing children in the District. She said many of the cases involved runaways and she has pledged to publicize each case and provide equal service to all.

The 211 people who went missing in January did not reflect an increase in cases, Dickerson said, just better reporting by the families. While that may be true, it is far from reassuring. Few believe that the children are being snatched off the street in mass, but they do think that the children are endangered.

Sharece Crawford, a member of an Advisory Neighborhood Commission in Southeast Washington, said she believed that more black girls were getting involved with gangs and also being forced into prostitution.

“What we need is a citywide alert about the dangers out here and how parents can protect their children,” Crawford said. “Residents are very worried. They are wondering if the city is taking this seriously. They say things like, ‘If white girls were disappearing uptown, there would be a state of emergency.’ ”

The good news is that some of the missing teens are being found.

Amongst the teens missing, it’s been reported that 13-year-old Taylor Innis has been found in “good health.” Missing teen Antwan Jordan has been found safe.

Here’s the picture arrays with the pertinent information from one of the Essence authors/reporters.

As much as we are paying attention to a lot of important, fast moving things, it is equally important to pay attention to other equally important issues that impact people in different, but still important ways. It is important to remember that there are people at risk not because of anything the Federal, state, or local government may or may not be doing – though they may be at risk for things that should have long been done, but weren’t. Rather, people can be at risk just because of the reality of day to day life. It is important to keep in mind that as we focus on the big issues that we don’t lose sight of equally important things closer to home.



Why I Hate The NY Times, Part [n]*

This paragraph:

There is most likely a middle way. Republican lawmakers might be comfortable with a system that shifts more of the costs of care onto people who are sick, if it makes the average insurance plan less costly for the healthy. But making those choices would mean engaging in very real trade-offs, less simple than their talking point.

“Republican lawmakers might be comfortable…”  Think of the assuptions not in evidence required to write that phrase.  Think also of the cluelessness in what comes next:  those who buy insurance are seen here in the Republican frame, as two binary populations, the healthy and the sick.

That would be  the “virtuous”  healthy paid less than the molly-coddled, feckless sick.  That the same people might occupy both identities at different points of their lives seems not to have occured to this Times writer, Margot Sanger-Katz — whom I’ve noted before has an odd willingness to couch her Upshot explainers in weighted and coded language.

As seems to be hers and several Times-folk’s penchant, much of the story from which I extracted above is perfectly fine, an actual explainer of what Essential Health Benefits do and why they’re important. She even notes that in a system without a required benefit package–

…the meaning of “health insurance” can start to become a little murky.

Well, yeah, as it doesn’t actually insure against unanticipated risks.  I’d take issue with the meekness of her critique here, that is, but at least she suggests to the fragile sensibilities of her tender readers that perhaps a minor problem might result here.

Which makes the passage I quoted up top both weird and revealing: cheap insurance for the healthy and soak-the-sick policies for those with the misfortune to suffer the ails that impinge on just about every human being, sometime or other is a pretty damn good example of a murky notion of health insurance.

That is: the habit of mind, the reflexive and seemingly unconscious acceptance of a right wing tropes that lead both to conclusions unsupported by the evidence and an inability to grasp what one has actually just said.  This happens a lot at The New York Times. Happened a lot there too, over the crucial months of 2016.  Which goes a long way, IMHO, to accounting for the predicament we’re in now.

*Where [n] is an arbitrarily large number.x

Image:  Codex Aureus Epternacensis, Christ Cleansing Ten Lepers, c. 1035-1040.



I lay traps for troubadors

This is a sad story. I’m glad at least that this guy has come to his senses about Trump and I hope others do before more damage is inflicted on Americans, whether they voted for him or not:

Beginning in January 2016, Kraig Moss traveled to 45 rallies, belting out songs in support of Donald Trump and telling the story of his late son, Rob, who died three years ago from a heroin overdose. In this way, the musician earned the title of “the Trump Troubadour,” a true believer said to symbolize “the voice of unheard America.”

[….]

But this bill backed by the president “disgusted” him. He no longer sings songs about Trump, and he now wonders if any of his sacrifices were worth it.

[….]

“The one platform that I was just so genuinely involved in with my heart was the one thing that he just turned right around,” Moss said. “He’s turning his back on all of us.”








Whats going to happen today?

The short answer is mass chaos.

The longer answer is we will seeing some non-controversial bills come up under suspension rules this morning.  Around 10:00 AM, the Rules Committee will vote on the most recent set of changes that were placed in the bill overnight.     Those changes (stripping or punting EHB mainly) are probably going to cost a quarter of a trillion dollars and could lead to millions more not getting coverage but they are not waiting for a CBO score.  Once a special accelerated rule is voted on, the actual voting starts.

My opinion is that we are in good shape if there is an immediate blocking coalition of 23 Republican No votes in the first six or seven minutes.  At that point, the internal logic of the Republican caucus makes voting Yes and seeing the bill Fail become a no reward position so we could see a cascade towards No.  If we don’t see that, I would not be optimistic.

My gut feeling is that AHCA either passes by less than three votes or fails by more than fifteen. I can’t see the incentive structure for a narrow failure as the House leadership will hold the vote open for hours to arm twist a couple of hold-outs.

So call the House one last time.

Update 1:

He is from New Jersey, part of leadership and as of this morning he was in the New York Times Undecided/Unclear column. So him moving to a clear No is intriguing.



States defining EHBs are not a show-stopper

Nicholas Bagley at the Incidental Economist has a good piece on the chaos that punting the definition of Essential Health Benefits.  I think he gets it wrong in his conclusion though:

The amendment tells each state to define what counts as essential within the state. State-defined benefits will then set a floor on what insurers can offer, arresting the race to the bottom…..

However you feel about the policy, though, the manager’s amendment is troubling. Start with its irresponsibility. The new rule would apply as of January 1, 2018. But insurers have to create and price their health plans within the next few months in order to get them approved prior to the start of open enrollment. They don’t know which services their states will say are essential and they don’t have time to wait around while their states bicker about it. Insurers are likely to walk. All of them. The individual market in 2018 will be a ghost town.

He is right.  Insurers have to submit their 2018 plans for initial approval in late June.  They have spent years now learning by doing in the individual market.  Most insurers are making fairly modest tweaks to their benefit designs, their networks, their disease management strategies and their pricing.  At this point, submitting a mildly tweaked clone of a 2017 plan is not a back breaking amount of effort.

A brand new set of Essential Health Benefits is a massive change in the work effort. Networks would need significant additions if new benefits are included.  Networks would need to be examined to identify providers that could be dropped if the actuaries and analytics teams determine that they provide now non-essential benefits and are a magnet for adverse selection.  Actuaries would be re-running their pricing models to determine what types of deductibles and other cost sharing is needed to get to a sell-able product.  The disease management team would need to shift priorities and resources as the new EHBs will give them a new profile of diseases to manage.

When insurers were building out for the October 1, 2013 launch, exploratory efforts started in 2011 and 2012.  Significant building started in the fall of 2012.  I was locked into my unhappy place to do Exchange network design and provider configuration in the second week of January, 2013 and stayed there until November 2013.

I don’t think the work load would be as severe as launching the Exchange in the first place.  But I know it is more than a 10 week project.

However there is an easy punt.  States could legislate that for the 2018 Benefit Year, the essential health benefits for the state are the same as they were for 2017.  At that point, 2019 EHB’s could be debated with enough time for insurers to actually build something.








Friday Morning Open Thread: Some Well-Earned Schadenfreude

Anything is possible in this fallen world, so there’s still a chance that Ryan and Trump between them can bribe, charm, or bully enough Repub holdouts into voting for their “health care” “plan” (Trump air quotes). But the betting odds are against it, at least for today… and it’s always sweet to see such a bunch of grifters and cravens suffer.

Apart from cheering for more GOP defectors, what’s on the agenda as we wrap up another long week?
.



AHCA, HSA and incoherent policymaking

I am not a fan of HSA’s.  They are a good tax shelter to healthy people with high incomes.  They can be used to cushion a one-off shock of catastrophic medical events but they are useless in reducing the cost burden of either repeated catastrophic events or chronic conditions.  At best, in those cases, it is a back door subsidy through the tax code to slightly reduce out of pocket costs where the people who get the most help need it the least.

But there is a coherent theory of change with the use of HSA in both a single year and over a lifetime.  The single year theory of change is that high first dollar expenses will lead to lower utilization with minimal real health consequences.  The lifetime theory of change is that an HSA can be built up while an individual is young and healthy and spent when an individual is old and sick.  It prefunds some of the expected health cost obligations on an individual level.

In the original version of the AHCA, the subsidies were set up so that they could be split.  If a person found a policy that cost less than the subsidy, the remaining portion of the subsidy would be deposited into an HSA.  This makes a decent amount of mechanical sense.  The young and healthy people would buy dirt cheap policies and deposit a significant amount of the subsidy into an HSA.  Over time, the HSA would grow until the cohort of people who were once young, healthy and cheap to cover are no longer young, no longer healthy and no longer cheap to cover.  At that point, the savings they had accumulated in their HSA would be available to pay for either care or premiums.

There is a major issue of founder’s debt in this scheme but if we handwave away the problem that killed Social Security privatization in 2005,it is mechanically coherent.

The Monday Manager’s amendment took away the ability of a subsidy to be split between a premium and the HSA.  This was done to get more anti-abortion votes on board.  It will have two effects.  It will limit choice as insurers have no reason to price their products underneath the subsidy point. The second is that it completely destroys the mechanical theory of change for an HSA system.  People can’t use tax advantaged dollars to pay part of their first dollar expenses in the current year.  And more importantly, the young can not partially prefund their health care expenses when they become old as they can’t rollover a partial subsidy into their HSA.

There is no coherent policy thought here.  It is an absurdity








On The Road

Good Morning All,

This weekday feature is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.

So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are. By concentrating travel updates here, it’s easier for all to keep up-to-date on the adventures of our fellow Commentariat. And it makes finding some travel tips or ideas from 6 months ago so much easier to find…

Have at ’em, and have a safe day of travels!

Should you have any pictures (tasteful, relevant, etc….) you can email them to picstopost@balloon-juice.com or just use this nifty link to start an email: Start an Email to send a Picture to Post on Balloon Juice

Pictures after the fold

Read more



Late Night Open Thread: Nazi Pajama Games

The Repubs have soooo much respect for our military, they want to use it as a dumpster for all the fantasists and grifters who aren’t sharp enough for the business grifts:

Mattis was widely embraced on both sides of the aisle when President Donald Trump nominated him. Republicans and Democrats alike expressed hope that the retired four-star general would be a moderating force on the volatile commander in chief.

But Republican lawmakers and senior congressional aides said in recent interviews they’re running out of patience with Mattis’ staffing decisions, which have disappointed Republican members of the Senate Armed Services Committee hoping to see their ideological allies elevated to senior levels in the Defense Department. Others are grumbling about Mattis’ refusal to advocate a bigger increase in the defense budget, which defense hawks believe was gutted disastrously under President Barack Obama.

“He certainly has got a tough job, but it sometimes feels like he forgets that we won the election,” said one aide to a GOP senator on the Armed Services Committee, who declined to speak on the record for fear of publicly alienating the defense secretary.

“We’ve waited eight years for this, to be able to fill these posts with Republicans,” said another top GOP Hill staffer. “We know Trump isn’t part of the establishment and that it’s going to be a bit different, but it should go without saying that a Republican administration is expected to staff federal agencies with Republicans.”…

Defense Department veterans say the White House has put Mattis in a nearly impossible position given that a large swath of the Republican foreign-policy establishment was openly critical of Trump during the campaign. Some say that has left Mattis with little choice but to turn to Democrats and to those without a political background to fill senior posts.

“In picking Mattis, the president got someone who had bipartisan credibility and was seen as a tough national security official who wasn’t going to toe the White House or the GOP line,” said Jeremy Bash, a former Pentagon spokesman under Secretary Leon Panetta. “Independence is an important attribute in a SecDef. But when you get that, you get frustration from the political folks. When you’re not coming out of the establishment, you have the credibility to do bipartisan things. You’re just going to take incoming from Democrats and from Republicans from time to time.”…

There’s also a longwinded story about Mattis paying insufficient attention to Senators Cotton and Cruz and their Very Serious Military Theorists cosplay, and a sidebar that he’s not sympathetic to re-introducing GOP grifters into Pentagon budget planning.

… Others said it’s crucial that Mattis embrace the reality of navigating the Hill. “Everybody thinks very highly of him, but he doesn’t have any political sense, and he doesn’t think he needs any political sense,” said one former Bush administration Defense Department official. “But it’s quintessentially a political job.”

We don’t want capable people with experience! We want cushy berths for our grifters and ideologues!

Bonus watching, another Trump ‘terrorism expert’ gets Bee-burned..



This is One Important Reason Why We are Still Militarily Engaged in Iraq

I keep meaning to do a post on what is going on with the ongoing operations in Iraq and Syria – honest, but so much is going on I keep getting sidetracked.

Regardless, I just saw this and I think it is important to highlight it:

We in the US bear an incredibly large amount of the moral responsibility for what is going on in Iraq and Syria. It was the failure of American strategy, and in some cases just the actual lack of American strategy, in the post invasion phases of Operation Iraqi Freedom that set the conditions for the rise of al Qaeda in Iraq and its ultimate transformation into ISIL. Right now the US led coalition is pursuing a by, with, and through strategy with our Iraqi partners to drive ISIL from Mosul, and ultimately Iraq. By, with, and through is one of the key operational concepts of the US Army’s Green Berets, which has been borrowed and adapted by Combined Joint Task Force Operation Inherent Resolve. The Iraqi soldier who is saving that young Iraqi boy’s life in the video above is at the tip of the spear in the fight against ISIL. The US and our coalition partners are in support. Some of that support is training. Some of it is logistics. Some of it is air support. And some of it is direct and indirect fires. But day in and day out the Iraqi regular and irregular forces are at the forefront of fixing a problem created by the strategic malpractice of the US over the past fourteen years.

If you ever wonder what we’re still doing over there, that video is your answer. We’re providing support to the Iraqis that are risking their lives to protect each other in order to clean up a mess of our making.

We’re doing penance.