Open Thread: Kiss Me As If It Were The Last Time

Looks like we could use an open thread…



1332 juiced up

Margot Sanger-Katz from the NY Times flags an interesting pre King vs. Burwell Republican plan that is actually interesting in a non-sarcastic manner.

Let’s look at it with the 53 page PDF here:

Section 101 is the three options a state has if the Supreme Court ruled in favor of the fabulist argument advanced in King. Option 1 would be to stay under PPACA and establish a state based exchange. Option 2 would be a complete withdrawal from PPACA with no subsidies. Option 3 would be to establish a HSA like equivilent of coverage with most of the regulator requirements, taxes and mandates of PPACA thrown out. This is actually interesting if the funding makes sense. The default assumption is a complete opt-out. States would have to to opt into either Option 1 or Option 3.

Section 102 talks about the state alternative with HSA. It wipes out mandates and federal regulation. Essential health benefits, minimal actuarial value coverage and other regulatory requirements of PPACA that define a qualified health plan also are junked in this section. 102-4-A authorizes an initial HSA grant and the rest of 102-4 describes the mechanics of that grant. 102-C establishes a public health block grant that is 2% of the eligible funds for the HSA.

Section 103 determines the size of the HSA subsidy. This is where the money matters. The HSA amount is age and geography adjusted which is very similar in function as the ACA benchmark Silver is determined by zip code and age of the recipient. Bingo — 103-1-B is good news.
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Fee Schedule

The Society of Actuaries commissioned Milliman to do a great review of the different payment methodologies and their risk profiles for a wide variety of stakeholders in 2015.  It is a great read (for the right definition of a great read).  One of the things that I want to pull out is the chart below.  It is a fairly standard commercial, employer sponsored insurance contract.  The number is the multiplier applied to the Medicare fee for service fee schedule.

Let’s follow the money to see what we actually value.

There are a couple of very useful things to pull out of this table. First, the topline number is that the same services for a commercial plan will cost 170% or more than what Medicare pays.  This is why one of the major goals of liberal health policy is to drive more services to pay providers rates closer to Medicare than Commercial.

The second most interesting thing to me is the payment for evaluation and management services.  E&M codes are the primary care physician codes.  These are codes that involve a good deal of time and talking and far less cutting and doing.  We pay people lots of money to either cut something or do something.  We don’t pay for talking as much.  So we get a lot of cutting and doing and not as much talking.








Wednesday Morning Open Thread: Smart Takes


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Apart from planning for the Women’s March / Sister Marches, what’s on the agenda for the day?

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I applaud Josh Marshall, on “The Case for Not Being Crybabies“:

Presidents don’t validate what is and isn’t news. If you’re expecting them to, you’re doing it wrong. Almost nothing that is truly important about the work of a free press is damaged by moving the press office across the street.

Don’t get me wrong. I’m not saying that these things are not important or that all these threats aren’t a very bad sign. It is vastly preferable to have a President who believes in or at least respects American and democratic values. But let’s get real: we don’t or won’t as of Friday. Trump is a would-be authoritarian and a bully. He’s surrounded by mediocrities who owe all to him and feel validated by enabling his endless transgressions. Of course, he’s doing these things. We know Trump’s MO. He will bully people until they’re cowed and humiliated and obedient. He’ll threaten to kick the reporters out of the White House and then either cut a ‘deal’ or make some big to-do about ‘allowing’ the reporters to stay. These are all threats and mind games meant not so much to cow the press as make them think Trump is continually taking things away from them and that they need to make him stop.

They don’t need to. That access isn’t necessary to do their jobs. And bargaining over baubles of access which are of little consequence is not compatible with doing their job. Access can provide insight and understanding. But it’s almost never where the good stuff comes from. Journalists unearth factual information and report it. If Trump wants to turn America into strong man state, journalists should cover that story rather than begging Trump not to be who he is. America isn’t Russia. And I don’t think he can change us into Russia. So unless and until we see publications shut down and journalists arrested or disappeared, let’s have a little more confidence in our values and our history and our country…

Trump wants to bully the press and profit off the presidency. He’s told us this clearly in his own words. We need to accept the reality of both. The press should cover him on that basis, as a coward and a crook. The big corporate media organizations may not be able to use those words, I understand, but they should employ that prism. The truth is that his threats against the press to date are ones it is best to laugh at. If Trump should take some un- or extra-constitutional actions, we will deal with that when it happens. I doubt he will or can. But I won’t obsess about it in advance. Journalists should be unbowed and aggressive and with a sense of humor until something happens to prevent them from doing so. Trump is a punk and a bully. People who don’t surrender up their dignity to him unhinge him…



Late Night Endless Smoke & Mirrors Open Thread: Anonymous Discusses Wikileaks


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Speaking of subverting the deep state — Commentor Magurakurin flagged this series of tweets a few days ago. Excerpts:

It’s never as simple as Four legs good, two legs bad. Or even Four legs good, two legs BETTER…



I Don’t Have to Outrun the Bull Alligator, I Just Have to Outrun You

This wee fellow was caught on video near Lakeland, FL yesterday.

That’s a big boy!



Open Thread: The Peasants Are Revolting!


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“Well, we don’t actually test it… See that little camera up there? The boss just likes to watch.”

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Apart from the obvious jokes (and the President-Asterisk is an endless source for those!), what’s on the agenda for the evening?



Time to not hate on Manchin

Senator Joe Manchin (D-WV) is in a horrendous political position of dead incumbent walking. He is a Democrat in West Virginia with an election coming up in 2018. West Virgnia has steadily been going Republican for a generation and it went heavily for Trump in 2016. It is also heavily dependent on Medicaid and the Exchanges because it is a state with a lot of very poor people in it with high health needs.

Earlier this month, Senator Manchin made his comments on the ACA:

Instead of repealing the Affordable Care Act, Congress should work together to fix the parts of the law that don’t work, Sen. Joe Manchin, D-W.Va., told reporters Wednesday.

Manchin said Congress should work on the law “piece by piece,” instead of repealing the entire thing….

He followed up earlier this week reiterating the “Repair” language with Jake Tapper.

This is straight out of the Mend don’t End messaging playbook and I think this also works with a general Democratic defense of the law. LGM has a good preview:

As with all other issues, the default position of the Democratic caucus should be “no.” Make it clear that there will be no initial negotiations on a replacement plan. Hope that the tensions within the Republican caucus either cause the effort to collapse on itself, or results in repeal-and-replace. The longer this drags out, the better the chances of preserving the ACA. Obstruct. Delay. Vote no.
If the Republicans were to offer cosmetic changes to the ACA — slightly less generous subsidies and more rentier skimming for Medicaid, say, but preserving the basic structure of the ACA and making it worse in ways that could be fairly easily fixed by the next Democratic Congress — this would be one of the few instances in which the bad politics of collaborating with Republicans would be substantively beneficial enough to be worth it. But I think this will be a moot point. This would be the smart political play for Republicans, and I suspect McConnell would go along — but I don’t think Ryan will.

The ACA needs a technical correction bill. If Manchin is on board with cosmetic changes that make the bill slightly worse (Copper plan for instance) while getting a host of technical corrections in place (family glitch is the big one) at the trade-off of more Health Savings Account tax breaks, that would be great. I don’t know if that is where Manchin wants to go. But if the most vulnerable Democratic incumbent is on the Repair rather than Repeal kicker, this is good news for caucus unity.



President Obama Commutes Chelsea Manning’s Sentence

I’m sure this will piss some of y’all off, but maybe it was the right thing to do. Manning seems like a lost soul, vulnerable to the manipulation of unscrupulous people (i.e., the scumbag Assange). She’ll get out next May instead of 2045. Via the NYT:

In recent days, the White House had signaled that Mr. Obama was seriously considering granting Ms. Manning’s commutation application, in contrast to a pardon application submitted on behalf of the other large ­scale leaker of the era, Edward J. Snowden, the former intelligence contractor who disclosed archives of top secret surveillance files and is living as a fugitive in Russia.

Asked about the two clemency applications on Friday, the White House spokesman, Joshua Earnest, discussed the “pretty stark difference” between Ms. Manning’s case for mercy with Mr. Snowden’s. While their offenses were similar, he said, there were “some important differences.”

“Chelsea Manning is somebody who went through the military criminal justice process, was exposed to due process, was found guilty, was sentenced for her crimes, and she acknowledged wrongdoing,” he said. “Mr. Snowden fled into the arms of an adversary, and has sought refuge in a country that most recently made a concerted effort to undermine confidence in our democracy.”

In other words, don’t hold yer breath, Eddie. What do y’all think?








REPOST: Women’s March On (Your City Here): Let’s Meet-Up

Artwork is attributed to Patrick Sean Farley (though I could not verify)

Reposting this  by request:

When Betty posted about attending  about attending the Women’s March on Washington, I saw there were a lot of people going to local marches. There is one in Denver:

Women’s March on Denver

January 21, 2017
9 am – 3 pm
Denver’s Civic Center Park
Marching in Solidarity for Human Rights…

Any Colorado folk want to do a meet-up for the march. Even if I can’t make it, I’ll help organize it.

Why don’t we use this thread to see if we there is any interest for meetups in other cities.

And I’m hoping Betty C and anyone else going to the marches will live blog/tweet their adventures – or at least provide photos after the fact.

If you have photos from your event, email them to me (whats4dinnersolutions at live dot com) and I’ll put together a post after the events.



Open Thread: Repeal and…. Uhhh…

(Jack Ohman via GoComics.com)
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It’s all fun and games, until your constituents realize they’ll be losing their insurance…

Of course, the GOP’s own President-Asterisk has been running his mouth without bothering to check on the Party Line — it’s HIS party now…


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He’s just fucking with us now…

It sorta looks like Putin is pushing back on opposition to the puppet he bought fair and square, but more likely, he’s just fucking with us. Via Bloomberg:

Russian President Vladimir Putin said he doesn’t believe that U.S. President-elect Donald Trump met with prostitutes in Russia, calling the accusations part of a campaign to undermine the election result.

Unsubstantiated allegations made against Trump are “obvious fabrications,” Putin told reporters in the Kremlin on Tuesday. “People who order fakes of the type now circulating against the U.S. president-elect, who concoct them and use them in a political battle, are worse than prostitutes because they don’t have any moral boundaries at all,” he said.

You guys — I think he just called Jeb Bush a sad, low-energy hooker! Moreover, the dead-eyed revanchist implied that Trump hardly needed to patronize Moscow sex workers since he owned all kinds of choice tail at the time:

The U.S. tycoon-turned-politician was last in Moscow in 2013 for the staging of the Miss Universe contest that he owned. He hoped unsuccessfully to meet Putin, tweeting in June that year about the possibility the Russian leader would attend the beauty pageant.

Trump is “a grown man, and secondly he’s someone who has been involved with beauty contests for many years and has met the most beautiful women in the world,” Putin said. “I find it hard to believe that he rushed to some hotel to meet girls of loose morals, although ours are undoubtedly the best in the world.”

My guess is the most low-rent, indiscriminate prostitute in all of Russia has more morals in her pinky toe than Putin, Trump, their entire families and wretched hangers-on put together and multiplied by infinity. But it’s easy to see from these statements why Trump formed a schoolgirl-on-Bieber-like crush on Putin. And it’s laughably plain that Putin knows how to play Trump like a fiddle.



The privilege behind bake sale and GoFundMe “insurance”

The grocery store near my old house has a set of jars out collecting change for a young girl with cancer.

GoFundMe has a huge numbers of campaigns for people who need help paying for care.

A Tweep and an occassional beer drinking buddy pointed the limitations of community charity based fundraising for care:

More importantly, let’s think about what a successful fundraising drive for $20,000 or more needs?

For a successful campaign a few things are needed.  First the beneficiary has to be sympathetic to the public.  An eight year boy who needs a lung transplant to play baseball is sympathetic.  A forty seven year old with Hep-C because of a bad series of decisions made in her twenties is not sympathetic.  We’ll also need to throw in considerations of broader sympathy for race, age, and disease type.  We quickly devolve into a discussion of the deserving versus non deserving poor.

After we have a sympathetic beneficiary, the fundraising drive needs a core nucleas of powerful, forceful advocates who can make the fundraising their primary activity and focus for months if not years on end.  This excludes people who are new to areas, it excludes people who have lost significant elements of their family (if my family had a need, my older sister is the natural point person to organize anything needed), it excludes general assholes and curmudgeons.

And once a sympathetic beneficiary is identified with a forceful advocate, they have to access a broad network of both tight and loose ties in order to actually raise money.  There are quite a few kickstarters and GoFundMes that fail misterably because the people who are pushing great ideas or truly needy projects either have no ability to connect to a wide network or can connect to a wide network that has minimal ability to give.

The Balloon Juice community has demonstrated the power of loose ties to raise significant sums of money for a sympathetic beneficiary (MARC animal shelter) with a strong advocate (John).

So the GoFundMe and bake sale method of health care financing is fraught with privilege and let’s remember that when we hear calls to rely on the charity of neighbors instead of systemic funding for a humane baseline of care via collective social action.








Tuesday Morning Open Thread: Encourage Dissent


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A note from commentor Lizzy L:

For those worried about ACA coverage for themselves and their families…. After hearing about the midnight repeal of the pre-existing conditions clause, a friend of mine called Senator Warren’s office. The woman she spoke to said they are being flooded with calls, as are the offices of Speakers Ryan and McConnell.

Senator Warren’s staff member told her that what would help the most would be to call the five Republican senators who have broken away from the GOP to demand a slow down of the repeal. Tell them how much you appreciate their efforts to stop this train wreck! If this issue affects you or someone you love, share your story with the staffer who answers the phone. (Remember the time difference when you call.)

The senators are:
Senator Bob Corker – (202) 224-3344
Senator Lisa Murkowski – (202) 224-6665
Senator Rob Portman – (202) 224-3353
Senator Susan Collins – (202) 224-2523
Senator Bill Cassidy – (202) 224-5824

if you call the number and get VM, one approach would be to leave an appreciative and encouraging message. I know people who prefer to do that, since calling a Representative’s office often means waiting on hold for a loooong time.

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Apart from encouragement — and resistance — what’s on the agenda for the day?
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Late Nightmare Open Thread: “Expertise” Is for LUZERS!!!

It’s not like I trust these particular individuals, but it would be nice if there was someone in the President-Asterisk’s office who knew that electrical outlets were not made for having forks stuck in them. And from what I know of corporate practices (in or out of government), we have to assume that if the top offices are being filled with newbies and know-nothings, then the bureaucratic middle ranks are now divided between nervous people busy shopping around their resumes, and time-servers/incompetents/fellow true believers…

From the company paper in the town whose monopoly industry is national politics, the Washington Post, “‘Never Trump’ national-security Republicans fear they have been blacklisted“:

They are some of the biggest names in the Republican national security firmament, veterans of past GOP administrations who say, if called upon by President-elect Donald Trump, they stand ready to serve their country again.

But their phones aren’t ringing. Their entreaties to Trump Tower in New York have mostly gone unanswered. In Trump world, these establishment all-stars say they are “PNG” — personae non gratae.

Their transgression was signing one or both of two public “Never Trump” letters during the campaign, declaring they would not vote for Trump and calling his candidacy a danger to the nation…

The president-elect has virtually no experience in national security and foreign policy, and his transition team could presumably benefit from the broadest pool of applicants for the influential appointive positions in the State Department, Pentagon and Department of Homeland Security.

But the purportedly blacklisted figures report to their jobs at Washington law firms and think tanks in a state of indefinite limbo as their colleagues, some working in the same offices, are flirting with potential administration jobs.

Last week, the Trump transition held a private briefing for secretary-of-state nominee Rex Tillerson to prepare him for his Senate confirmation hearing. One former Bush national security official who works at a Washington think tank said that some of his younger staff assistants were invited to participate but that he was not. He assumes it was because he signed the letter.

“It’s hostile,” said this person, who spoke on the condition of anonymity for fear of further retribution. “It’s not just that we’re frozen out. . . . I was told they said there was an enemies list.”

Among those who signed at least one of the letters are Tom Ridge and Michael Chertoff, the first two secretaries of the Department of Homeland Security; two former U.S. trade ambassadors, Carla Hills and Robert Zoellick; two former heads of U.S. intelligence agencies, John Negroponte and retired Air Force Gen. Michael V. Hayden; a former ambassador to NATO; and several former deputy secretaries of various U.S. government agencies.
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