… Wanting to help victims of a massive disaster is a human instinct that should be lauded. But unfortunately, well-meaning people repeatedly get it wrong. And this time around it seems that some are already responding in unsuitable ways. Updates have begun littering my Facebook wall from well-intentioned Americans: “On the way to local Filipino Market. With clothes and food … Come on, go through your closets and make a stop at your market. They need food, detergent, canned goods, soap. They need flip flops. Any old shoes you don’t want.”…
After the tsunami, similarly well-intentioned people cleaned out their closets, sending boxes of “any old shoes” and other clothing to the countries. I was there after the tsunami and saw what happened to these clothes: Heaps of them were left lying on the side of the road. Cattle began picking at them and getting sick. Civil servants had to divert their limited time to eliminating the unwanted clothes… Boxes filled with Santa costumes, 4-inch high heels, and cocktail dresses landed in tsunami-affected areas. In some places, open tubes of Neosporin, Preparation H, and Viagra showed up. The aid community has coined a term for these items that get shipped from people’s closets and medicine cabinets as SWEDOW—Stuff We Don’t Want.
Right now, access to people affected by the disaster is a major challenge facing the aid community in the Philippines. According to the most recent U.N. Situation Report, resources to deliver relief goods are extremely limited. Roundtrip travel on the 11-kilometer road which connects the airport to the city of Tacloban currently takes about six hours; it is the only cleared road, according the U.N. The airport’s air traffic control and fuel storage facility were damaged. Consider what happens when plane full of unwanted donations is competing for runway space with planes carrying needed medicines and food items. Someone has to unload those donations, someone needs to sort through them for customs, someone needs to truck them to affected areas which are hard to reach anyway and where there’s a limited supply of fuel. When old shoes and clothes are sent from the U.S., they just waste people’s time and slow down getting lifesaving medicines and food to affected people….
The Philippines has a highly developed civil society sector and effective government disaster response authority. Although Typhoon Haiyan has overwhelmed local capacity for now, their local efforts should be supported. The Philippines Red Cross has already worked to rescue individuals and deliver lifesaving goods to people in hard-to-reach places. Other Philippine-based organizations such as Community and Family Services International and the Philippine Red Cross will know the local needs and how best to respond…
"Let he who has not smoked crack and threatened to rip his political opponents' throats out cast the first stone…" pic.twitter.com/AHmI52OdtP
— billmon (@billmon1) November 10, 2013
Apart from the whole ‘impulse control’question, what’s on the agenda for the evening?
Networks are a key feature of all insurance plans as every provider has a network. A network is a group of providers who have contracted with an insurer to get paid a certain set of rates for a certain set of services performed on the people who are insured by the company. Networks can be manipulated for positive public gains and for evil.
Networks are regulated at the state level for most insurance products and have some federal guidance for Medicare, Medicaid and Exchange products. The regulations are rather loose. In PPPACA, the networks for the Exchange must have significant concentration of providers in a wide variety of specialties so that residents of a county where a network is sold has “reasonable” access. This is a very soft definition because assembling a rule that makes sense for Loving County, Texas and Cook County in Illinois is extremely difficult. States will define network adequacy differently. Most states will have multiple standards depending on population density as urban areas will require more providers that are closer to the average resident while rural areas will allow long drives.
When networks are working for the public good, they provide a means of cost control as an insurance company will include in a network a provider who will take 120% of Medicare while it may exclude a provider who wants 220% of Medicare. This works because an insurance company can guarantee volume of patients at the lower rate. Networks are also a quality control metric. For instance, insurance companies may refuse to contract with providers who are not board certified or who have multiple large malpractice settlements against them in the past ten years. Contracts can be terminated for the loss of licensure or large malpractice settlements as well.
However, networks can be used against the public interest as well.
Mark Rank, in the NYTimes:
… Contrary to popular belief, the percentage of the population that directly encounters poverty is exceedingly high. My research indicates that nearly 40 percent of Americans between the ages of 25 and 60 will experience at least one year below the official poverty line during that period ($23,492 for a family of four), and 54 percent will spend a year in poverty or near poverty (below 150 percent of the poverty line).
Even more astounding, if we add in related conditions like welfare use, near-poverty and unemployment, four out of five Americans will encounter one or more of these events.
In addition, half of all American children will at some point during their childhood reside in a household that uses food stamps for a period of time.
Put simply, poverty is a mainstream event experienced by a majority of Americans. For most of us, the question is not whether we will experience poverty, but when…
The typical pattern is for an individual to experience poverty for a year or two, get above the poverty line for an extended period of time, and then perhaps encounter another spell at some later point. Events like losing a job, having work hours cut back, experiencing a family split or developing a serious medical problem all have the potential to throw households into poverty.
Just as poverty is widely dispersed with respect to time, it is also widely dispersed with respect to place. Only approximately 10 percent of those in poverty live in extremely poor urban neighborhoods. Households in poverty can be found throughout a variety of urban and suburban landscapes, as well as in small towns and communities across rural America. This dispersion of poverty has been increasing over the past 20 years, particularly within suburban areas…
We currently expend among the fewest resources within the industrialized countries in terms of pulling families out of poverty and protecting them from falling into it. And the United States is one of the few developed nations that does not provide universal health care, affordable child care, or reasonably priced low-income housing. As a result, our poverty rate is approximately twice the European average.
Whether we examine childhood poverty, poverty among working-age adults, poverty within single-parent families or overall rates of poverty, the story is much the same — the United States has exceedingly high levels of impoverishment. The many who find themselves in poverty are often shocked at how little assistance the government actually provides to help them through tough times…
The solutions to poverty are to be found in what is important for the health of any family — having a job that pays a decent wage, having the support of good health and child care and having access to a first-rate education. Yet these policies will become a reality only when we begin to truly understand that poverty is an issue of us, rather than an issue of them.
Stigmatizing poverty as a personal failure is hardly an American invention, but refining and reinforcing the “self-made man in the land of opportunity” trope has been a major success for the One Percenters. Accusing someone of having been poor is like accusing a pre-Kinsley American of sexual deviancy — even if they were unimpeachably a victim (a child forced into pornography, or the use of food stamps) it’s a slur against one’s character.
Most people are minimally impacted by Obamacare as they already get their insurance through an employer, through the government or have solid individual coverage. The next largest group of Americans are impacted by Obamacare as they’ll be gaining access to coverage. They’re better off. Then there are two small groups. The first is a group who has decent individual coverage but may or may not be better off with the improved coverage mandates of Obamacare. These situations will vary by individual income and thus subsidy status, state and health status. The other group are the clear losers of the policy changes. They have individual coverage that is being cancelled and Exchange coverage is more expensive.