Taking a Hatchet to healthcare (Pt. 1)

This will be a multi-parter on the P-Care proposal from Republicans.  I’m busy today.

Section 101: Repeal Obamacare
Standard Republican boilerplate with a lie in the first sentence as healthcare costs as a proportion of GDP actually decreased last year.

Section 201: Adopt Common-Sense Consumer Protections
Reinstate the popular to the employed middle class parts of Obamacare. Keep kids on parents’ insurance until the end of age 26, disallow life time limits. Tweak the age rating bands from a 3:1 ratio (Obamacare law) to 5:1 (pre-Obamacare usual and customary) despite that change having little acturial impact. The 3:1 ratio is roughly equal to the actual expected cost ratio for 21 to 64 year olds.
Guaranteed renewability is the Republican means of dealing with pre-exisiting conditions. However medical underwriting will now be allowed so the incentive will be for insurance companies to go do a very thorough record review to look for application ommissions such as failure to list acne as a pre-exisiting condition to deny cancer claims. It says there will be strong regulation, but really, how stupid are we to expect strong regulation from a Republican bill?
Section 202: Pre-exisiting conditions covered based on continious coverage
Continious coverage is the key here instead of the banning of medical underwriting. Basically, if someone is able to keep covered themselves insured, a new policy can’t be medically underwritten against them, they get general rates. The problem is people who have significant health problems AND significant income variation are highly likely to have months where they can not keep continous coverage. One bad stretch and a person is priced out of health insurance for life (although that life will be fairly short)
Section 203 – Empowering Small business and individuals
Basically allow for small business to pool resources together to reduce acturial variance and TAX CREDITS. Or we could just use the SHOP exchanges to do the same damn thing.

Refundable tax credits to individuals and families up to 300% Federal Poverty line. Obamacare has refundable tax credits up to 400% of FPL. Don’t allow those tax credits to be used for abortion (which basically would mean the individual health insurance market would offer very few if any policies covering abortion). Value of those credits are significantly reduced compared to Obamacare credits. For intsance a single 64 year old at 200% FPL would get a $3,720 Republican credit while s/he gets a $6,100 Obamacare subsidy. Two 64 year old non-smokers at 200% FPL would get $13,000 in subsidies from Obamacare or $8,800 from this Republican bill.

Oh yeah, since the Republicans have re-instated medical underwriting, those 64 year olds have the pre-exisiting condition of being OLD. They won’t get Obamacare rates, their rates for anything that provides decent coverage will destroy their subsidy in three or four months.
The idea behind the Republican bill’s smaller subsidy is that people have too much good insurance as it is, so a smaller subsidy will force more people to get catastrophic coverage only and then pay for day to day expenses out of pocket. The threat of destitution will make people extremely cost sensitive and thus extremely efficient shoppers.
Section 204 — More power to states
States can automatically enroll people into coverage equal to their subsidy value. I don’t have a problem with this. Given subsidy levels, these default plans will have deductibles in the $15,000 to $20,000 range. High risk pools will be formed again and be chronically underfunded. Interstate compacts are allowed (as they are now for regulation and selling of insurance, but the Georgia and Maine examples show that few companies really want to sell across state lines)
Section 205 Expand HSAs and Consumer Directed healthcare
Allow pre-tax dollars to pay for non-prescription and over the counter goods and services. Expand allowable uses of HSA dollars. Either of these proposals is worth talking about as they are fairly small bore.



Thursday Morning Open Thread: Who Watches the Watchmen?

Charlie Savage, in today’s NYTimes:

An independent federal privacy watchdog has concluded that the National Security Agency’s program to collect bulk phone call records has provided only “minimal” benefits in counterterrorism efforts, is illegal and should be shut down.

The findings are laid out in a 238-page report, scheduled for release by Thursday and obtained by The New York Times, that represent the first major public statement by the Privacy and Civil Liberties Oversight Board, which Congress made an independent agency in 2007 and only recently became fully operational.

The report is likely to inject a significant new voice into the debate over surveillance, underscoring that the issue was not settled by a high-profile speech President Obama gave last week. Mr. Obama consulted with the board, along with a separate review group that last month delivered its own report about surveillance policies. But while he said in his speech that he was tightening access to the data and declared his intention to find a way to end government collection of the bulk records, he said the program’s capabilities should be preserved…

The report also sheds light on the history of the once-secret bulk collection program. It contains the first official acknowledgment that the Foreign Intelligence Surveillance Court produced no judicial opinion detailing its legal rationale for the program until last August, even though it had been issuing orders to phone companies for the records and to the N.S.A. for how it could handle them since May 2006

Defenders of the program have argued that Congress acquiesced to that secret interpretation of the law by twice extending its expiration without changes. But the report rejects that idea as “both unsupported by legal precedent and unacceptable as a matter of democratic accountability.”

The report also scrutinizes in detail a handful of investigations in which the program was used, finding “no instance in which the program directly contributed to the discovery of a previously unknown terrorist plot or the disruption of a terrorist attack.” …

Ellen Nakashima, at the Washington Post, adds:

It rejects the reasoning of at least 15 federal surveillance court judges and the Justice Department in saying that the program cannot be grounded in Section 215. That statute requires that records sought by the government — in this case phone numbers dialed, call times and durations, but not call content — be relevant to an authorized investigation.

But the board found that it is impossible that all the records collected — billions daily — could be relevant to a single investigation “without redefining that word in a manner that is circular, unlimited in scope.” Moreover, instead of compelling phone companies to turn over records already in their possession, the program requires them to furnish newly generated call data on a daily basis. “This is an approach lacking foundation in the statute,” the report said…

And while we’re on the topic of getting value for money from our Security-Industrial Complex, a note from UPI:

The Justice Department accused the firm that conducted a background check of U.S. secrets leaker Edward Snowden of defrauding the nation of millions of dollars.

US Investigations Services LLC of Falls Church, Va., methodically filed more than 660,000 flawed background investigations in an alleged “dumping” practice that became the subject of internal jokes, prosecutors said in a civil complaint filed in U.S. District Court in Montgomery, Ala…

The firm — whose website tagline is “ensuring a safer future today” — is the largest private firm conducting security-clearance background checks for the federal government. The company, with 6,000 employees, handles 45 percent of federal background checks used by the Pentagon, Department of Homeland Security and more than 100 other federal agencies…

The Justice Department adds to the case, accusing top USIS executives who have since left the company of directing the alleged fraudulent scheme to secure nearly $12 million in bonuses from the federal government, which thought the company was providing checks that had gone through the full review process…



Wednesday Morning Open Thread: Wetware Failure

cool new workout stuff get fuzzy
(Get Fuzzy via GoComics.com)

Even in a murderous oligarchy, you just can’t get error-free tech minions:

(Reuters) – Human error likely caused a glitch in China’s Great Firewall that saw millions of Internet users ironically rerouted to the homepage of a U.S.-based company which helps people evade Beijing’s web censorship, sources told Reuters.

Hundreds of millions of people attempting to visit China’s most popular websites on Tuesday afternoon found themselves redirected to Dynamic Internet Technology (DIT), a company that sells anti-censorship web services tailored for Chinese users.

The official Xinhua news agency on Tuesday quoted experts as saying that the malfunction could have been the result of a hacking attack, and domestic media was full of speculation along those lines…

However, sources familiar with the Chinese government’s web management operations told Reuters that a hacking attack was not to blame for the malfunction. They declined to be identified due to the sensitivity of the matter.

They said the incident may have been the result of an engineering mistake made while making changes to the “Great Firewall” system the Communist Party uses to block websites it deems undesirable – such as the DIT site.

The state-run China Internet Network Information Center (CNNIC) said in a microblog post that the outage, which lasted for several hours, was due to a malfunction in China’s top-level domain name root servers.

These servers administrate the country’s Domain Name Service (DNS), which matches alphabetic domain names with a database of numeric IP addresses of computers hosting different websites, a sort of reference directory for the entire internet.

Instead of matching the names of popular Chinese websites with their proper IP addresses, Chinese DNS servers instead redirected users trying to access websites not ending with the “.cn” suffix to the IP address associated with DIT’s homepage…

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Apart from lamenting the universality of imperfection, what’s on the agenda for the day?



Honoring Dr. King

Got an email from my senior Senator today:

Each year, we honor the memory of the Reverend Dr. Martin Luther King, Jr. We honor his struggles and his triumphs. We honor his work to stand up to racial injustice and to help America move one step closer to her founding promise of equality.

But when Dr. King was taken from us, he was engaged in another struggle – a struggle that was no less challenging, a struggle that he believed was essential to America’s soul.

It was the struggle to end poverty. And it is a struggle that is still with us today.

For years now, we have heard the claim that America is broke, that we cannot afford to invest in our children and that we must tell our seniors to try to get by on less. We face a world in which those born in wealth will have plenty of opportunity, but those born in poverty have little chance to escape – a world in which people work their hearts out and barely hang on.

That is not the promise of American life. That was not the America of Dr. King’s dreams. And that must not be our American future.

In 1967, Dr. King told us what it would take to combat poverty. He said:

[W]e are called to play the good Samaritan on life’s roadside; but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life’s highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.

We are now engaged in a great debate over poverty and inequality. And as Dr. King argued, “true compassion is more than flinging a coin to a beggar.”

Our success as a community will be measured not by the riches of a few, but by the success of many. Read more



Friday Morning Open Thread: “The Joy of Unfollowing”

Best response I’ve seen yet to Bill & Emma Keller using their high-profile media platforms to sniff at a cancer patients’ tweets (Should there be boundaries in this kind of experience?”) comes from Maureen O’Connor at NYMag:

In the age of social media, when cell phones come with camera lenses optimized for selfies, that last question gets asked regularly. So I am going to answer it, once and for all: No. There is no such thing as TMI on the Internet. We are living in a post-TMI age, and everyone needs to deal with it. Preferably by using the “unfollow” button.

There is such a thing as too much information for you. There is such a thing as information the speaker will later regret. But if an audience is willingly and pleasurably consuming the information, then by definition, that is the right amount of information for them…. If you continually recoil at TMI, it’s because you lack the willpower to stop consuming (or foresight to avoid) the information in question. That’s your fault.

Modern media consumption — particularly digital media consumption — is personalized. This is sometimes to our detriment; it is very easy to surround yourself with the voices of only those who agree with you. As consumers of social media, we are all the programmers of our own personal line-ups, featuring a hand-selected set of soap operas, news sources, and other amusements. If a particular soap opera becomes boring, you click “unfollow” — or maybe you hate it so much that you block it. You can download browser extensions that will turn words you do not want to see into a big black bars, or prevent you from loading web pages that contain material that offends. For instance, if I never want to see or think about Bill or Emma Keller, I could install a content filter like Blocksi and set it to block or limit the amount of time I spend on web pages where the term Keller appears. Or I could set it simply to warn me about incoming Kellers, so that I can summon a third party to preview the material for me…

… In the age of micro-audience — when everyone is famous not for fifteen minutes, but to fifteen people — there is a consumer for everything. No exceptions….

My emphasis. I hadn’t realized there were so many tech-enabled ways to avoid seeing stuff I don’t like, but then, I find the scroll-down option sufficient for my unexacting needs.



A (Small) Win for Sensible Policy?

Via commentor Amir Khalid, from Reuters:

A U.S. judge on Tuesday sided with a woman challenging the federal government’s no-fly policy and ruled that existing procedures to correct mistakes on that list do not provide adequate due process protections.

U.S. District Judge William Alsup in San Francisco ruled on a lawsuit brought by Rahinah Ibrahim, a Malaysian citizen. The U.S. no-fly policy excludes individuals from commercial air travel if they are suspected of having ties to terrorism, but critics say it is practically impossible to be removed from the list once on it…

The no-fly list is the subject of multiple legal challenges. Ibrahim’s case is believed to have been the first to go to trial. The trial took place last month.

Ibrahim attended Stanford University on a student visa, according to court filings. In early 2005, she was detained for two hours at San Francisco’s airport because authorities believed she was on the no-fly list.

Eventually, she was allowed to travel to Malaysia. However, her U.S. visa was revoked under a legal provision relating to suspected terrorist activities, though she was not told the specific factual basis for that action. She has not been allowed to return to the United States.

Ibrahim petitioned U.S. authorities to clear her name but received a letter that did not say whether she was still on the no-fly list. She filed a lawsuit, claiming that her inability to return to the United States damaged her professionally…

In Tuesday’s ruling, Alsup said the government has conceded that Ibrahim is not a national security threat. She is entitled to be informed whether she is still on the no-fly list, Alsup wrote, and for any mistaken information about her to be corrected…

Ibrahim’s case proceeded amid continuous litigation over what information about the no-fly list could be made public, and the judge reviewed several pieces of evidence in private at the government’s request…

If my memory is correct, “Rahinah Ibrahim” is the Malaysian equivalent of “Elizabeth Johnson” — so it’s not impossible that Professor Ibrahim was originally flagged by a buggy program or an overzealous technician. Sure, we don’t want to let those sneaky Terrrists know that we’re on to their nefarious tricks, but “You can’t come in here, because security” seems a little overbroad.



Wednesday Evening Open Thread: Marketing


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What’s on the agenda for the evening that doesn’t suck?