A personal note on policy evaluation

I want to lay out one of my key heuristics for policy analysis and evaluation for the next four years. But first I need to go back a little in my life to two time periods.

1992 sucked for my family. I am one of five kids. My mom worked a retail job as she was mainly trying to get all of us going in the right direction while managing half a dozen minor chronic conditions between all of us. My dad was a union electrician. Construction is a pro-cyclical industry so when times were good, they were very good and when times are slow, they are really bad. The 80s were good as Boston boomed. The late 80s after the S&L crisis plus the overbuildout of Boston sucked. He was able to get the occasional side job and short term position as an electrician and had already started to work as a cabinet maker, a newspaper deliverer and half a dozen other side jobs and hustles to hold on. We were waiting for the Big Dig to really ramp up as that would clear a log jam on the job list at the union hall.

I remember crying in happiness one day when my parents decided to get me a treat of sweet canned corn instead of frozen corn. We had not had my favorite type of corn in so long as the extra thirty cents a pound was too much of a lift.

Now fast forward.

Mid-2008 my wife had gotten laid off as her organization got a new CEO who wanted to quickly leave their mark for decisiveness and wiped out several profitable but not exciting departments. She was pregnant with our daughter. I was working as a program evaluator for a behavioral health care coordination program. It was funded by a federal grant that was due to run out at the end of FY09. We were trying to transition our funding to local and foundation money. By mid-2009, my wife was working part time at a position far below her skill level, our daughter was happy making faces at her parents, and there was absolutely no local or foundation money as 51 mini-Hoovers were in effect for state level austerity. I got laid off. The next year I stayed home with our daughter as the combination of unemployment insurance and not paying for daycare that was the best solution possible.

Now fast forward.

The past six years have been great for my family. My career has taken off. My wife’s career has launched. We have two great kids. We have stability and we have a cushion. Yesterday the induction motor on the furnace failed after a good eighteen years of service. I was able to grumble and mumble as I wrote a check to the HVAC technician but writing that check had no impact on my family’s financial stability. We’re in good shape.

Some of this is a humble brag. But most of this is how my policy evaluation heuristic is formed. If a policy helps 2009 Me or 1992 Me out more than it helps present day me out, I’m most likelyfor it. If 2017 Me is advantaged over either 2009 or 1992 Me, I’m highly likely to be opposed to it.



Is this a valuable core competency?

I admit it, I can not figure out why Oscar is a media darling.  I might be an old fuddy duddy stuck to the ways of a dinosaur industry but I can’t figure out what they are doing that is so vastly superior to what my former co-workers (who work at a profitable entity by the way) do. And then I read this write-up on Oscar in BackChannel and I know what their core competency is; getting the tech press to write fawning write-ups.  Is that truly a market breaking and market making core competency with sustainable value?

I just want to pull out a few things that had me wait the weekend to write this as I just couldn’t go into an immediate critique.

(By the way, “members” is Oscar’s preferred term for its users — “customers” sounds too meretricious, and “patients” implies that they are sick. Oscar thinks of itself as a wellness machine.)

Members is fairly standard language at every health insurer I have ever talked to, worked for or been covered by.  If I am talking with actuaries or the finance department, I’ll hear the term covered lives as well.  Per Member Per Month (PMPM) is a nearly universal metric for first pass cost analysis.  Quora had an answer for PMPM from 2011.

The collaboration with Mount Sinai is part of Oscar’s new “narrow network” in New York City. This term refers to a tightly bounded but high quality set of medical services, and is a key component of Oscars full-stack approach.

Everyone is doing a narrow network these days.  My previous insurance was through an IDN’s narrow network.  My new job’s insurance is through a narrow network.  Smart insurers use narrow networks to drive both pricing down and quality up.  This would have been innovative in 2004.  Now it is normal.  Penn’s LDI has a great brief on the evolution of QHP narrow networks.  

The numbers on Schlosser’s screen marking Oscar’s subscribers don’t seem game changing— some thousands in each age group; the largest chunk in the 26 to 35 bracket. It’s not surprising that young adults are susceptible to a health care insurer with the vibe of an internet startup; after all, Oscar has been called the “Hipster Health Insurer.” But there are both older and younger signups as well, even some people over 65. “It’s exactly on target,’” says Schlosser of the mix, his English heavily accented by his native German. As for the numbers themselves, Oscar had about 120,000 members last year and may not (because it left two markets) have many more this year

What I see in this paragraph is massive risk adjustment outflows.   Read more



Prepping for the future

I’ll be downloading everything that I can from Healthcare.gov by January 15th.

I hope that I’m wasting my time but the cost benefit analysis is clear that downloading and archiving is a plausible choice. In the best case scenario, I waste my time. It is only two weeks on the clock while I build a deeper understanding of the entire data universe. I’ve wasted two weeks on projects that had no pay-off before and I know that I will be on projects that go nowhere at some point again in my life. I will have learned something and brought into local control useful data that I can bounce off of national data. Best case scenario, I incur minor costs that are slightly higher than minor benefits.

It is the worst case scenario where data just gets either locked down or yanked from the public and is only accessible via FOIA requests in non-user friendly formats that the pay-off is strong. Again it is two weeks of my life but it is access to years of research material that can fuel impactful analysis. It would be the creation of health policy wonk trading sub-culture that rivals show tapes of Deadheads — I’ll trade you a 2014 Rate PUF for a 2009 CBO public option report man….

And if you assume that this worst case scenario has more than a 1% chance of happening, that is a very good use of a few weeks and a few gigabytes worth of space.

I have to assume environmental and consumer protection focused folks are doing the same thing, just in case.



The GOP Does Love Their Safe Spaces

Hilarious:

safespaces

You’ll always have Rasmussen to lift your spirits, Republicans.








Please Proceed, Republicans

More of this please:

The scene on the floor was chaotic when the vote on the convention’s rules was called. The anti-Trump delegates, many of them clustered around the Virginia delegation, began chanting “Dump Trump,” only to be met by chants of “USA, USA.”

Sen. Mike Lee (R-UT) made a motion for a roll call vote, but it was announced that the movement had lost the three of the nine delegations it needed to force a vote. [via Tierney Sneed at TPM]

Jheronimus_Bosch_011

A little more detail from Hunter over at DKos:

After the initial uproar, the Colorado and Iowa delegations walking out, the chair left the podium for 5 or 10 minutes. Meanwhile, there was a lot of lobbying happening apparently. The Chair came back, declared that three of the 9 states that had petitioned for a roll call vote on the rules—their chance to basically “vote their conscience” on Trump—had withdrawn their petitions, and the minimum number of states is six. Sen. Mike Lee of Utah disputes that. He says he heard there are 10 or 11 states with petitions, so there should still be enough states to order the roll call.

 



Open Thread: Florida Woman, New NRA Poster Child

From that Jacksonville Ledger article:

[Jamie] Gilt, a 31-year-old Jacksonville resident, spoke to In-Gauge, a Winter Haven non-profit National Rifle Association training organization, Tuesday night about what happened to her on March 8 that made national news and sparked a conversation about gun safety…

Gilt said she left her Jacksonville home that day the same way she always does.

She grabbed her loaded .45-caliber handgun and brought her 4-year-old son, Lane, along with her to go look at a horse at her cousin’s home for her 10-year-old stepson.

She said she usually wore her gun in a holster on her hip, but that day she decided to put it under her driver’s seat…

While driving down the road, Gilt’s son had unbuckled himself to get a toy on the floorboard, Gilt said that is how he got his hands on the handgun.

Soon after, she heard a loud bang and saw something hit her windshield. It wasn’t until she looked down and saw herself covered in blood that she realized she had been shot.

Her son had picked up the handgun and shot through her seat, hitting her in the back…

Her name and what happened were all over the news, and she was condemned for being a, “bad mother,” she said.

“People post things and they absolutely destroy anyone they think is in the wrong,” she said. “And that’s what they did to me.”

But Gilt isn’t focused on that. She is focused on showing others how important it is to be safe with a gun…

Now, Gilt is on the road to becoming a NRA firearm instructor and will be certified at the end of this month. She plans to teach classes and show people that the unexpected can always happen…

Originally the Putnam County Sheriff’s Office considered charging Gilt with a second-degree misdemeanor, allowing a minor access to a firearm, but the State Attorney’s Office in Sanford offered her a deal.

She had to complete a gun safety course, install a mounted holster in her vehicle, provide proof of safe storage of her firearms in her home and give 10 speeches on the incident and what she learned from it.

Gilt said Tuesday night she had already completed her 10 required speeches and that she was speaking at In-Gauge because she wanted to…

When I was growing up, a lot of the little old Irish and Italian ladies in the neighborhood never went further than their mailboxes without their rosary beads, which provided them with a powerful feeling of spiritual protection and a focus for meditation during idle moments. But when those beads accidentally fell out of their purses in the grocery checkout lane, or got left behind on the bus, I don’t remember that the emergency services ever had to be called out.



Friday Morning Open Thread

President Obama began his scheduled meeting with the Presidents of the European Council and the European Commission — running some fifteen minutes late, at about 5:15am EDT — with a quick update on what little is known at the moment about the snipers at the peaceful protest in Dallas. Summary as I understand it: Right now all we know for certain is that five police officers have been killed, three suspects are in custody and a fourth one dead. Gonna be a busy, horrible day in another week whose chieftest virtue is that it’s almost over.

Apart from trying to ride the chaos rather than letting it ride us, what’s on the agenda for the day?
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