President Obama: On Helping the Midwest, and Mozambique



Wednesday Morning Open Thread: Welcome the Worm Super Moon

Seriously. According to lore, it’s when the frozen ground softens enough for earthworms to emerge, thereby encouraging the return of the robins. Perhaps more importantly, the Spring Equinox arrives just before 6pm EDT… and I, for one, am ready for this winter to be over.

And speaking of spring, with the impulse for housecleaning it inspires, this is very sweet and also embarrassingly reminiscent of our whole house…

When I was a child, the grownup books in my house were arranged according to two principles. One of these, which governed the downstairs books, was instituted by my mother, and involved achieving a remarkable harmony—one that anyone who has ever tried to organize a home library would envy—among thematic, alphabetic, and aesthetic demands. The other, which governed the upstairs books, was instituted by my father, and was based on the conviction that it is very nice to have everything you’ve recently read near at hand, in case you get the urge to consult any of it again; and also that it is a pain in the neck to put those books away, especially when the shelves on which they belong are so exquisitely organized that returning one to its appropriate slot requires not only a card catalogue but a crowbar.

It was this pair of convictions that led to the development of the Stack. I can’t remember it in its early days, because in its early days it wasn’t memorable. I suppose back then it was just a modest little pile of stray books, the kind that many readers have lying around in the living room or next to the bed. But by the time I was in my early teens it was the case—and seemed by then to have always been the case—that my parents’ bedroom was home to the Mt. Kilimanjaro of books. Or perhaps more aptly the Mt. St. Helens of books, since it seemed possible that at any moment some subterranean shift in it might cause a cataclysm.

The Stack had started in a recessed space near my father’s half of the bed, bounded on one side by a wall and on the other by my parents’ dresser, a vertical behemoth taller than I would ever be. At some point in the Stack’s development, it had overtopped that piece of furniture, whereupon it met a second tower of books, which, at some slightly later point, had begun growing up along the dresser’s other side. For some reason, though, the Stack always looked to me as if it had defied gravity (or perhaps obeyed some other, more mysterious force) and grown down the far side of the dresser instead. At all events, the result was a kind of homemade Arc de Triomphe, extremely haphazard-looking but basically stable, made of some three or four hundred books…



Trembling on the Verge Open Thread: Preznit Idle Hands

He can’t stand to be alone with his memories — or his lack of them. Professional (character) assassin Olivia Nuzzi, for NYMag, “Trump’s Phone Friends May Be More Important Than His Staff. So Who’s He Calling?”:

Trump abides by what I call the “Groucho Marx Law of Fraternization,” meaning anyone choosing to be near him is suspect while everyone else gets points simply for existing elsewhere. “He always kind of wants what he doesn’t completely have,” the New York Times’ Maggie Haberman once said. “You are never more valuable to Donald Trump than when you’re walking away from him.”

What explains this social idiosyncrasy? Obvious answers, like self-loathing, don’t quite feel complete. But whatever the psychological cause, the effect is manifest in at least one thing: his compulsive phone habits. His Rolodex is a Greatest Hits and Deep Cuts composed of mostly friends, associates, media figures, and tycoons. Although Trump is known to call senior members of his staff at all hours, his informal advisers share a common attribute: They’re not there and, therefore, they can’t be blamed when things are falling apart. Their praise sounds less sycophantic and, therefore, more compelling; the president seems to grant the calls coming from outside the White House an inherent credibility. They are also a welcome distraction, a link to his old life in Trump Tower, when concepts such as “executive time,” a term used by aides to make it seem like the president is doing something productive when he’s fucking around and calling TV-show hosts to gossip about ratings (a subject of intense interest for him, even now), were irrelevant…

One person who has received late-night calls from the president told me this: “If you’re Trump, the last thing you want is a moment of self-reflection. That’s why he’s constantly on the phone at night. Everybody’s afraid of themselves. People fear silence because they don’t want to hear voices. But Trump really fears that.



Monopoly insurer strategies in 2019

In 2019, 1,058 counties had only a single insurer on Healthcare.gov. 1,056 of those counties had the insurer offer at least one Silver and one non-Silver plan. I am curious about what we can figure out about the monopoly insurer strategies. I’ve contended for years that a monopolistic insurer can effectively choose their enrollee pool by how they manipulate the spreads from the benchmark plan to the other plans.

Insurers can choose their risk pool by offering very low cost plans. The people who are on the cusp of buying insurance are price sensitive. The healthiest slice of the cohort will be the people who are flipping a coin between buying insurance and not buying insurance. The sickest slice of the cohort will be the people who look at a $1,500 monthly premium and are doing a happy dance as they know they are still getting a great deal. The risk pool will be, on average, healthier if the cheapest plan available costs $15 for the incremental buyer rather than $100.

Monopoly insurers get to choose their spreads**.

So this is very curious when I look at the difference between the Silver Spread which is the difference of the Benchmark Premium to the cheapest Silver premium and the Other Metal Spread which is the difference of the Benchmark Premium to the Cheapest Gold/Bronze premium for 2019.

There is wild variance. A few counties in Wisconsin and Ohio have no Bronze plans. Their cheapest not-Silver plan is significantly above the cheapest Silver plan.

Wyoming, on the other hand, is running a massive spread so that their cheapest Bronze plan has a significantly lower subsidized premium than the cheapest Silver plan.

One of the big things to note is that insurers that are operating as effectively a state wide individual market monopoly do not have to consider risk adjustment in their decisions. Insurers that are in a fragmented state wide market with only a county or regional monopoly may have risk adjustment concerns.

This risk adjustment concern leads me to scratch my head when I look at the different strategies that are evident in Mississippi and Wyoming. Both are single insurer states. Wyoming’s Exchange strategy creates very low premium for subsidized buyers who are flipping a coin. Lots of people earning between 100% to 400% federal poverty level are seeing Bronze and some Gold plans that will cost them and their families less than two medium three topping pizzas at a national delivery chain every month.

Mississippi is also a single insurer monopoly state. There is a different pricing strategy. The Gold plans are priced over the benchmark silvers as they broad load. The low cost Bronze plans are creating very few truly low premium plans.

I am confused as pure monopoly ACA insurers that have no risk adjustment concerns should be able to create their own risk pools for whatever purpose they so choose. They can choose a sick pool. They can choose a healthy pool. They can choose a small pool. They can choose a big pool. Wyoming’s pricing and plan offering strategy is a choice to pick a big and comparatively healthy pool. Mississippi’s sole insurer, Centene, is picking a comparatively small and comparatively unhealthy pool.

That just seems odd to me.

** I am using a single 40 year old non-smoker non-subsidized for all examples. For purposes of the blog, I am not looking into EHB percentage of premium which will slightly alter final numbers.



Open Thread: Pray for Nebraska

And if anyone has more concrete suggestions about helping, please leave a comment!

Commentor Jay Noble, last night:

Haven’t seen it mentioned here but Nebraska took a beating from Mother Nature this week. From Central NE to the Missouri river has become an archipelago due to failed dams, levees and washed out bridges and roads. Over 60,000 people evacuated, 53 of 93 counties declared disaster areas, 2 fatalities so far. Right now, many are venting that MSM is ignoring them because “fly over country” and “Trump deplorables”.

This does need a some more coverage because it’s all headed down stream both literally and figuratively. Literally all that stuff – inculding at least one fair-sized sewage treatment plant – will go into the Missouri River and thus into the Mississippi. If the Keystone Pipeline had been built . . . Figuratively, it will be hitting pocket books at the supermarket. Most of that area is corn and soybeans. While planting season is still a little ways off, whole farms worth of tractors and trucks and tools got swept away. And this is calving season with calves at theirs most vunerable…


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