Friday Morning Open Thread

What’s on the agenda as we wrap up another busy week?

Also, Kay alert! —



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.



Open Thread: When Someone Tells You What They Are…



Go long popcorn, go long butter

The Senate Intelligence Committee will be hearing testimony by fired former FBI Director after Memorial Day.

Remember, the White House is not disputing that they believe that firing Comey would make their lives easier regarding the Russia investigation.

So go long on popcorn, go long on butter… things are getting real



Wikileaks Jumps In

In an unexpected coincidence, Wikileaks releases something about FBI Director Mueller delivering highly enriched uranium to Russia. And it’s secret! Scary, right?

This is pretty standard procedure for sensitive material: Make sure the Russian Federation is ready for the flight; make sure US chain of custody is in order; check that the Russians will pick it up. Keep it secret to avoid alerting troublemakers. The only question is why the FBI director would be carrying it rather than a courier. One of my followers (a BJ-er?) supplied the answer.

The material was seized in a nuclear smuggling case in Georgia (the country), and the Russian Federation wanted to analyze the material to double-check where it may have come from. A law-enforcement matter, and it’s likely the US wanted to make a point to Russia that it’s serious. You don’t get more serious in law enforcement than the head of the FBI.

Many thanks to Stacy! I’m posting this now to head off the questions that will arise.

 

Cross-posted at Nuclear Diner.



Friday Morning Open Thread: All the President’s [Expletive Deleted]

A little retro humor, for my fellow olds.

Apart from waiting for the Friday Damages Dump, what’s on the agenda as we wrap up another hectic week?
.

If somebody should happen to be considering a 2020 presidential run, this would be a good start…



He’s Not a Scientist, But His Wife Did Stay in a Feriengasthof Ausdrucken

The NY Times, despite having an op-ed page that already hosts with Brooks, Dowd, Douthat, and Friedman and is a toxic waste dump of Oakeshittian wingnuttia and muddling centrism worthy of Superfund status, has decided to enrage those readers who still remain by hiring away the preternaturally smug Bret Stephens from the WSJ. Stephens has decided it is in his interest to do an “I’m not a science denier or moron, I’m just a fucking asshole” tour to deflect some of the criticism lobbed at him, and sat down for an interview with Vox. Lots of fabulous stuff (including downplaying campus rape by equating it the rape crisis in the Congo), but this is my fucking favorite:

My wife is German, so I know something about German energy policy.

With logic like that, I can see why the Times needed to hire him.

Here are some more excerpts:

“Look, at the risk of being incredibly politically incorrect, but I guess that’s my job — I think that all lives matter,” Stephens said. “Not least black lives.”

***

But if sexual assault rates in, let’s say, east Congo were about 20 percent, most people wouldn’t travel to those places. Because that is in fact — or, that would be, in fact, the risk of being violently sexually assaulted.

I am not for one second denying the reality of campus rape, or sexual assault, or behavior of the sort you saw from that swimmer at Stanford — that’s inexcusable and should be punished.

I’m taking issue with the claim that there is an epidemic based on statistics that, when looked at carefully, seem to have a very slim basis in reality. So what you’re transforming is horrendous, deplorable incidents into an epidemic — and that’s not altogether supported by reliable data.

***

Another example I took issue with is the idea that one in seven Americans are hungry. That’s not true. It’s not. It’s a problem because it’s not true.

Does this mean there aren’t hungry Americans? No. Does this mean we shouldn’t care about hunger in America? No. But when you have a campaign you see on subway billboards and elsewhere saying one in seven Americans is hungry, that’s false.

Here’s the problem with people like Bret Stephens (and I am not defending the stats he is attacking because, get this- I HAVEN’T FUCKING RESEARCHED THEM)- first, he knows full well what he is doing. He’s not plucking these statistics for disdain out of thin air. He attacks these specific statistics to allow breathing room for the deniers of problems that conservatives don’t like, don’t want to deal with, or would lose money if they had to address them.

Second, if you have a problem with statistics, the way you handle it is by demonstrating how the statistics are wrong. You show the flaws in the methodology, you run your own numbers and present them for peer review. What you don’t do is say “those numbers are bullshit because they give me a sad” or “there is not a crisis with sexual assault because the numbers seem too high” or “I see lots of fat people so how can all these people be hungry.”

What Stevens will now be doing, in the allegedly liberal NY Times, is going forward and farting through a megaphone into the public square, drowning out those people who have run the numbers and are trying to make evidence based cases that, unfortunately, are not as succinct as holding up a snowball in the well of the Senate or a bumpersticker that says “Stop Global Warming: Kill Yourself.”