Been searching for so long

I normally hate big data wankery, but I find this shit fascinating: the share of google searches for a GOP candidate in NH on election day closely mirrored that candidate’s share of the vote.

Google-searches-NH

Strangely enough, Jeb is doing very (second place to Trump — EDIT: hopefully this new link is not paywalled) in google searches in South Carolina right now.



Horse drawn buggies and driverless cars

Kevin Drum is asking an interesting question and coming to a conclusion that I think is completely wrong:

But here’s a more interesting question: after driverless cars become widely available, how long will it be until human-driven cars are made illegal? I say ten years. It will vary state to state, of course, and there will likely be exceptions of various kinds (specific types of commercial vehicles, ATVs meant for fun, etc.). Still, without a special license they’ll become broadly illegal on streets in fairly short order. The proximate cause will be a chart something like the one on the right.

I think this is an interesting question, but when I went to visit my in-laws last month, there were still horse and buggies on the road.  And those have been technologically obsolete for a century now.

There are a few things that I think Kevin is getting wrong.  First, there is a massive distributional issue.  Driverless cars will by definition be new cars.  The first wave of driverless cars won’t be 100% adapted.  Some people will be technophobic, others will like driving sticks, others will be reluctant to put their life into the hands of a piece of software even if that software is statistically a much better driver than the average human (as we are all above average drivers in our own internal estimation it’s just those assholes who are honking at me that can’t drive).  And others will decide that they don’t want to spend the money.

Even assuming that there is a fairly rapid shift in the share of proportion of driver controlled and driverless vehicles sold over a couple of years so that in five or ten years from the first good autopilot to 90% of new cars being sold are driverless or driver minimized vehicles, there will be millions of new vehicles that require drivers on the road.

No state government is going to tell tens of thousands of middle class or better voters that they need to junk their $20,000, $30,000 or $40,000 capital investments for safety reasons.

Furthermore, the used car market lags the new car market.  My primary used car in high school was made several months before I could walk.  Factory fresh, it had sixty six horsepower and by the time I bought it for $50 it could just hit 65 MPH going down hill with a good tail wind.  It did not help my social life in high school but retrospectively that car kept me out of a lot of bad decisions simply because the car simply would not allow me to show off and be stupid.

The typical American car has at least a fifteen year lifepan.

There is no way any state government is going to successfully tell most of its working class voters that they need to scrap a $5,000 to $20,000 capital investment for a marginal safety improvement.

What is far more likely once there is good data on operational usage of driverless cars is that they will be treated like anti-lock brakes and skid-control features by the insurance companies.  Driverless cars will receive a massive insurance discount because they’ll be far less risky as they remove the most common source of error (human error) from the equation.  But driven cars will still be available and still be insurable but at a higher rate.



These were a few of my favorite things

Posts I liked this year:

Pareto proportions in healthcare

A small minority of people drive the vast majority of costs and utilizations. Conversely, most people are minimal users of healthcare services in any given year. This means there are two very distinct strategies that should promote good outcomes.

Reference Pricing tweak for Medicaid

Under my plan, the Medicaid beneficiary would receive a bonus check for a good choice. The check would be a portion of the difference between the bundled reference price and the regional average price

Distributional Impacts of different cost share methods

Deductible plans favor the sickest people as the low utilizers pay for almost all of their care via deductible cash. That means a comparatively high proportion of the pool’s individual responsibility amount is borne by healthy people.

Medicare 200: Medicare E

the desire to use Medicare as the basic structure of a national single payer system as it is a pre-exisiting program whose skeleton is strong enough to build on. However that skeleton has some odd deformities to it, and a lot of trade-offs have been built into Medicare that would need to be re-examined if we were to massively expand Medicare’s scope…. as Medicare E is not a matter of simply printing up new ID cards and mailing them to everyone in the country with a start date three months from the mail date

Why not charge more?

If the Finance and Accounting folks want Mayhew Insurance to increase profit margins by $5 PMPM (which is a massive increase for an increasingly low margin business), premium price increases are a low priority solution because they have significant costs. Instead we’ll see if we can craft a special narrow network which will be very attractive to people with very low utilization but we can charge a couple of extra bucks PMPM while still holding our relative Silver position, we’ll see if we can reduce mail expenses again by a dime PMPM, we’ll see if switching our preferred Hep-C cure to Harvoni instead of Solvadi reduces costs by a quarter PMPM, we’ll see if we really need a VP for Employee Morale (hookers and blow section),

Cash flow of rejecting free money

If we assume that the net federal spend per person who is Medicaid eligible is roughly the same plus or minus a reasonable amount, the net economic loss to a rejection state is “only” the amount of Medicaid spending that is available to cover people who make under 100% FPL as well as those people over 100% FPL but under 138% who would have signed up for Medicaid but did not sign up nor continue to pay their premiums for an Exchange policy.

That number is significantly smaller than Brad Delong’s .7% GDP, probably closer to 0.5% GDP.

Building networks

A wonky post on how provider networks are built

Competition, how does it work again

a symptom of the extremely dysfunctional nature of the individual insurance market before PPACA. It was a vampire that drank blood in quarts and very rarely paid benefits as it specialized in very high deductible policies with significant coverage limitations and short term contracts. The old business model was based on churn, it was based on cherry picking, and it was based on very low medical expense ratios

Lower costs but at what price

A summary of an NBER paper examining care costs after a switch to an HDHP. There were no big explosions of costs three years out. This is making rethink HDHP to some degree.

Wyden Waiver, New CSR Attachment Points

Currently, CSR is only attached to Silver plans. What if states decided to change their subsidy attachment point as part of the Wyden Waiver?

If a state decided to look at the total cost of providing the second lowest Silver in determining subsidy levels instead of just looking at the second lowest premium for Silver, average actuarial value would increase as choice space increases. The change in subsidy formula would be the sum of premium plus CSR subsidy cost minus the individual contribution = subsidy.

Healthcare 2.0 Breaking trusts and building markets

On the health insurance side, margins are already fairly low, and there is some fat left to cut, but not much. On the provider side of the equation, there is plenty of fat left to cut on the basis of international comparisons. The major areas where the Democratic Party can get a lot of money out of the US healthcare system is on high end provider payments, drug costs and hospital payments while also expanding the lower levels of basic but very valuable care. Right now the US health system has numerous guilds and other anti-competetive practices in place which protect small, concentrated and powerful groups’ incomes while screwing the broader society by ringing up much higher healthcare costs without delivering amazing value in return.



My greatest post of the year

Unquestionably this nugget.

[…] By Halloween the only way you still hear about Trump is if he takes his National Front fan base and runs third party.

polls

I guess that in the future everyone gets to be Dick Morris for fifteen minutes. Aside from Dick Morris of course, who has to be Dick Morris all the time. And Bill Kristol.

Do you have any least greatest hits of 2015 that you want to share? I could use some company.

Open thread.



Swift Round-up

From Batocchio:

Last call for a tradition started by Jon Swift/Al Weisel, the “Best Posts of the Year, Chosen by the Bloggers Themselves.” Jon/Al left behind some wonderful satire, but was also a nice guy and a strong supporter of small blogs. (Here’s Jon/Al’s 2007 and 2008 editions. Our revivals from 2010 through 2014 can be found here.)

If you’d like to participate, just reply to this e-mail or write to me (Batocchio9 AT yahoo DOT com) with your best post of the year before 12/25:

Blog Name
Title of Post
Link
Author of Post
Brief Description/Pitch of the Post (1-2 sentences)

(If it’s not a reply, adding “best post” in the subject line would also help.)

To modify Jon Swift’s 2008 solicitation:

I would be very honored if you would participate and send me a link to what you think was your best post of [2015], along with a short description of it. Please make the hard choice and send me only one link. I would like to post it before the end of the year, so if you could get it to me before Christmas, I would really appreciate it.

One submission per blog, please, otherwise things can get messy. Group bloggers can pick a piece among themselves, but are also welcome to submit their work via their individual blogs, if they have them.

Let me know what post(s) you think we should submit.








Lexicon and other updates

First I want to thank Alain for all of his good work around here.  The place is coming back together rather nicely.

Secondly, I added the phrase “Hookers and blow” to the Lexicon a few days ago.  I don’t like my working definition as it sounds like a grad school definition.

Hookers and Blow – What executives at regulated entities choose to consume in the form of social surplus gained through anti-competitive behaviors.

What should it be?

Third, John convinced Alain to retag all of my “wonkery” posts as “Insurance Below” and then using that tag to create a link in the secondary header.  I’ll be using Insurance Below as my healthcare post repository while my soccer and general WTF posts are still in the normal stream.

Is there a better naming convention for the healthcare post tag that makes it immediately obvious what it is?

 

Open thread



Dental Insurance primer at GOS

A diary at the Great Orange Satan has a great primer on dental insurance.  You should read it if you need to know more about how dental insurance works as I don’t have that knowledge base to give this subject justice.  Below are a few key take-aways:

 

First and foremost:  Stop thinking about dental insurance as “Insurance”.  It’s not.  It’s really a gift card that can be used for certain purchases for certain amounts.  The trick, as a consumer, is to figure out if you are going to spend more money on the gift card than you will actually use.

Dental plans break out services by category.  In general, these are:

  • Preventative and diagnostic :  Preventative cleanings, fluoride, sealents, exams, x-rays, sometimes periodontal maintenance cleanings
  • Basic:  Fillings, root canals, extractions, periodontal treatment
  • Major:  Crowns, bridges, dentures, implants

“Is purchasing insurance right for me?”  Here’s what you need to do to figure it out.  Call up your dental office.  Ask what a year’s worth of maintenance visit’s cost.  Do you have any work that’s needed?  What is it, and what is the cost.  Does your dental office offer any cost savings for patients paying cash (more offices are offering “in house” dental plans)?  Add up the costs of yearly maintenance, then factor in what the treatment cost is, and subtract any savings you might be offered by your dentist.  THEN, look at the plan that you are considering purchasing.  What is the yearly premium?  Is your dentist in the network?  If yes, ask the dental office what the fees are if you are going to be in that network.  What will your out of pocket cost be on work that needed, making sure to take into account what you will pay in deductibles and the maximum plan payment (provided, of course, the work can wait until any waiting periods are met….that may not be advisable).  Add that up.  Compare the two.

Just go and read an excellent explainer on yet another part of the arcane field of medical insurance.