Small Site Updates, greennotGreen News

Folks,

I’ll be tweaking the sidebar a bit today and hope to add some nifty things to the comments either later today or tomorrow. Also, a rotating quote line is coming today!

On a more personal note, Terry, greennotGreen’s sister read the memorial thread and let me know how helpful it was:

Alain, I noticed the celebration thread up on BJ. Thanks so much. I’m actually going to use some of the quotations from Carol Ann for the memorial service. She would love the idea of writing part of it herself!

So there you go folks, well done!

 

Open thread!

 

ETA: OK, folks, exciting things just went live. Look below the comment form – there is now a comment help/tips section with lots of useful things (more to come, as things change).  And perhaps more importantly, a built-in pie filter. Use it to block annoying commenters and their comments. It’s harmless – enter a name or a comment number and all comments from that person will be turned into statements about pie. It works on a per-browser basis, storing your list in the browser’s site data.

All hail Major Major Major Major and cleek. Their help to convert the filter from something that you had to tack-on in a specific framework into a built-in function of the site was immense. Thanks guys, your help made this a better place for all.



Medicaid is getting sliced even more in the Senate

What is going on here?

Medicaid which was scheduled to take a 27% federal cut in spending under the House version of the AHCA, is getting cut even more in the Senate.

Why is this?

It is a function of reconciliation rules. The Senate bill has to reduce the deficit by at least as much as the House passed bill. Any dollar that is spent on beefing up opioid addiction spending or creating a multi-billion fund for NICU babies so that Senators can claim it passes the Kimmel test or slowing down the Medicaid expansion phase out from three years to seven years or anything else has to be paid for elsewhere in the bill.

There are three major sets of pay-fors in the AHCA. The first is reducing or slowing down tax cuts that accrue overwhelmingly to upper income individuals. The second is to cut funding for the individual market/Exchanges. The third is Medicaid.

The Republican Party has a strong revealed preference for tax cuts for upper income individuals above almost all else. That is the one policy plank that holds that party together. So pushing back the Medicare tax increment on investment income is unpossible within the political realities of the Republican caucus.

The Senate bill has been focused on taking off some of the most pointy edges of the individual market problems in the House bill, or at least sanding them down to avoid some attack ads in October 2018. So taking money out of there does not make sense within the internal logic of the Senate bill.

That leaves Medicaid as the sole pay for that does not have either strong and broad consensus support or immediate political logic. And here the power of compound interest comes into play. Switching to CPI-U instead of CPI-M or CPI-M+1 is a massive cut. Below is the difference in the CPI-U and CPI-M since 1/1/2000 with spending index at 100 for 1984.

What does this mean? May 2017 CPI-M had 2.7% growth from May 2016. CPI-U only had 1.9% Applying that to the $344 billion the Federal Government spent on Mediciad in 2015 (from the NHE fact sheets Table 03 Line 11), that is a difference of $2.75 billion dollars in the first year. And then it compounds. Over a ten year budget window, it is a $150 billion dollar or more in cuts adding to the current $800 billion dollars already scheduled to be cut. The Senate rumor has the change in formula not start until the end of the budget window so the total in-window cut may only be $20 or $30 billion dollars incrementally but the long run growth curve is incredibly compressed. It further shrinks the federal role for Medicaid finance over time. It is a slower shrinkage than the FY-18 budget proposal where by the end of the budget window, federal funding for Medicaid would be cut in half compared to present baseline but it will get to that point fairly quickly outside of the budget window.

Grabbing money out of Medicaid by lowering the index growth rate is a massive cut of future growth. It is also fairly subtle as I know the number of people whose eyes have not glazed over by now in this brief explanation can fit into a large booth at the local Cracker Barrel. It kicks Medicaid harder while allowing for attack ad insulation and large tax cuts.



greennotGreen: The Celebration

Folks,

As you know, a few weeks back we lost valued commenter and member of the community greennotGreen, whose real name was Carol Ann Bonner. I’ve been in touch with her sister as they try to cope with her loss while caring for their ailing mother. She was kind enough to respond to me a few weeks back as I passed on our love and well-wishes for the family.

This is a thread for the community to share memories of gnG and to suggest past threads that should be included in the extract of the site I’m going to send Terry. This will be the final chapter in the pdf I’ll build next week. Terry, Carol’s sister, assured me that they would love to read about what her online friends thought of her, when they are ready.

As you may know, her mother is also quite ill, and so the family is dealing with unbelievable pain and sadness. I don’t expect that they will read this post nor the book for months or more, but I felt it was important to share with her family how much she meant to the community, and what better way than letting them know how she touched us, and what you’ll remember about her.

As always, they can use your good thoughts, prayers, etc. They’ve got a lot of darkness to get through before the Light.

I am including greennotGreen’s obituary again, for those that may have missed it Tuesday.

Should you have something to spare, please consider supporting one of her preferred charities listed below.

Carol Ann Bonner, age 66 of Nashville, Tennessee passed away May 18, 2017 after a hard-fought battle against ovarian cancer, meeting her death with the grace and selflessness that defined her entire life.

Carol Ann was born in Little Rock, Arkansas but lived in Tennessee most of her life.  A brief time in Connecticut, where she graduated from high school, convinced her that Tennessee was her true home. She moved to Nashville to attend college and remained there. Vacations were often spent on the family farm in middle Tennessee. Carol Ann received her first Bachelor’s degree from Vanderbilt University and worked in a variety of jobs before a second degree led her to a career at the Vanderbilt Cell Imaging Shared Resource, a perfect blend of her scientific expertise and artistic ability. Carol Ann was passionate in all of her pursuits, including art, animal rescue, political activism, and gesneriad conservation. Her many interests and generous nature led her to have close friends all over the world.

Carol Ann was especially passionate about her family.  She was preceded in death by her father, but will be deeply missed by those who survive her, especially her mother, sister, brother-in-law, niece, and nephew.

A memorial service honoring Carol Ann’s life will be held at 2:00 P.M., June 24, 2017 at St. Augustine’s Chapel on the campus of Vanderbilt University.

In lieu of flowers, Carol Ann asked that donations be made to the Nashville chapter of the Cystic Fibrosis Foundation by visiting www.cff.org, the Avielle Foundation by visiting aviellefoundation.org or the American Cancer Society by visiting www.cancer.org.

You can leave a condolence via the website at http://www.nashvillecremationcenter.com/carol-ann-bonner/

 

So..let’s discuss greennotGreen and please do include links to threads and/or comments that you think should be part of the “memorial pdf”.








greennotGreen: The Obituary

Folks,

As you know, a few weeks back we lost valued commenter and member of the community greennotGreen, whose real name was Carol Ann Bonner. I’ve been in touch with her sister as they try to cope with her loss while caring for their ailing mother. She was kind enough to respond to me a few weeks back as I passed on our love and well-wishes for the family.

As you can imagine, it’s easy to procrastinate many tasks when in grief. But Terry was kind enough to send me the obituary yesterday, and so I wanted to share it with the community.

I have promised Terry that I will extract a collection of threads for her family to have. She assured me that the pain is too great now, but that she’d love to peruse it later, when the wound isn’t so fresh.

As a final tribute to greennotGreen, I am planning a final celebratory thread for this Friday at noon Eastern. This will be a meeting spot to reminisce, bring up old comments or stories, and to mention the ways that she helped make this a better community.  That thread will be the final chapter of the pdf that I create for the family, so please do come and share. It will also be the perfect venue for you to submit links to threads you think should be included in the extract.

Should you have something to spare, please consider supporting one of her preferred charities listed on the upper-right of the desktop site.

Carol Ann Bonner, age 66 of Nashville, Tennessee passed away May 18, 2017 after a hard-fought battle against ovarian cancer, meeting her death with the grace and selflessness that defined her entire life.

Carol Ann was born in Little Rock, Arkansas but lived in Tennessee most of her life.  A brief time in Connecticut, where she graduated from high school, convinced her that Tennessee was her true home. She moved to Nashville to attend college and remained there. Vacations were often spent on the family farm in middle Tennessee. Carol Ann received her first Bachelor’s degree from Vanderbilt University and worked in a variety of jobs before a second degree led her to a career at the Vanderbilt Cell Imaging Shared Resource, a perfect blend of her scientific expertise and artistic ability. Carol Ann was passionate in all of her pursuits, including art, animal rescue, political activism, and gesneriad conservation. Her many interests and generous nature led her to have close friends all over the world.

Carol Ann was especially passionate about her family.  She was preceded in death by her father, but will be deeply missed by those who survive her, especially her mother, sister, brother-in-law, niece, and nephew.

A memorial service honoring Carol Ann’s life will be held at 2:00 P.M., June 24, 2017 at St. Augustine’s Chapel on the campus of Vanderbilt University.

In lieu of flowers, Carol Ann asked that donations be made to the Nashville chapter of the Cystic Fibrosis Foundation by visiting www.cff.org, the Avielle Foundation by visiting aviellefoundation.org or the American Cancer Society by visiting www.cancer.org.

You can leave a condolence via the website at http://www.nashvillecremationcenter.com/carol-ann-bonner/








The 73rd Anniversary of D-Day

Today is the 73rd anniversary of D-Day.

Here is the lost, but now found, D-Day documentary:

 

From the Unwritten Record blog:

The First D-Day Documentary

This post was written by Steve Greene. Steve is the Special Media Holdings Coordinator for the Presidential Libraries System. Previously, he was the audiovisual archivist for the Nixon Presidential Materials.

Despite being cataloged, described, and housed at the National Archives for decades, the films created by the U.S. Military during World War II still hold unexpected surprises.

In a recent search for combat moving image footage to complement the Eisenhower Library’s commemoration of the 70th anniversary of the D-day landings, I identified four reels of a documentary on the landings prepared by the “SHAEF [Supreme Headquarter Allied Expeditionary Forces] Public Relations Division.”

These reels were assigned separate, nonsequential identifying numbers in the Army Signal Corps Film catalog, suggesting that the Army did not recognize them to be parts of single production. Rather than offering the perspective of a single combat photographer, the reels shifted perspective from the sea, to the air, to the beaches, suggesting careful editing to provide an overview. The 33 minutes of film were described on a shot card as “a compilation of some of the action that took place from D Day to Day Plus 3, 6-9 June 1944.” The production, with no ambient sound, music or effects, includes a single monotone narrator and gives the impression of a military briefing set to film.

This film is probably the first film documentary of the events of the first four days of the D-day assault, created within days of the invasion.

More at the link.

Here’s the US Army Europe’s Military Band playing at the 70th anniversary festivities:

Here’s a 70th anniversary air drop over France:

The President doesn’t seem to have made any formal remarks, but he did issue a commemorative tweet!

Here’s President Reagan’s 40th anniversary remarks:

And President Obama at the 70th anniversary:



Care costs money

The most important concept in health finance is simple; sick people are expensive to cover. Let’s keep that in mind for the rest of the post.

The Independent Journalism Review captures the reaction of Rep. Mark Meadows (R-NC), head of the House Freedom Caucus, to the CBO score.

When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.

“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter.

The CBO predicted:

“…the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

…..
The CBO analysis was likewise adamant that AHCA’s current high-risk pool funding isn’t enough to cover sick people if states use the mandate waivers.

After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.

Meadows, suddenly emotional, choked back tears and said, “Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

He continued:

“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”

There is a plausible high cost risk pool design that could theoretically work. It just costs a lot of money. The Urban Institute provides an updated floor to that type of design.

Government costs for the coverage and assistance typical of traditional high-risk pools would range from $25 billion to $30 billion in 2020 and from $359 to $427 billion over 10 years. (Figure 2)

I think this is a decent lower bound as they don’t look at very high cost but uncommon conditions like hematological defects, cystic fibrosis, major gastro-intestinal conditions, slow progressing cancers or hundreds of other things. But Urban’s estimates points us in the right direction. Taking care of sick people costs somewhere between expensive and very expensive.

This is not new knowledge. Anyone of any ideological stripe who is actively trying to be a good faith broker of information on health care finance has been shouting this basic insight for months. And yet, the Senate just invited actuaries to talk with them for the first time this week. And yet, the House voted on this bill without waiting for expert opinion. The bill was written without a public hearing. The product is a consequence of a process that deliberately excluded even friendly experts who were having a nervous breakdown when they looked at the cash flows much less incorporating the criticism of unfriendly but knowledgeable experts.

Healthcare for people with high needs is expensive.



Monday Morning Open Thread

Props to Google for reminding us that activism has a long tail!

What’s on the agenda as we buckle in for another week?
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Commentary for the time capsule — John Oliver’s always good, but this is particularly sharp: