Open Thread: Happy Pride Month!

C.R.E.A.M. Open Thread: Guacamole Lovers, Rejoice!

Mexico broke into its Strategic Superlatives stockpile, so — as of 6:15am EDT — our imported avocados remain affordable…

For some reason, Democrats (and other sane people) fail to be overawed by the Squatter-in-Chief’s “accomplishment”!

Dangerous Moron Open Thread: Brad Parscale Has Been Fed A New ‘Idea’

Like the old crack about a guy who thinks he’s a genius because he was standing outside with a bucket when it started raining soup, Brad ‘GRU Conduit’ Parscale thinks Trump’s promotion to the Oval Office makes Brad a political trendsetter. Trump is gonna give up his YOOOOGH instant-gratification Twitter platform about the same time my rescue bitch stops trying to get at the cat’s food — if that were ever to happen, I’d know if for a brink-of-death indicator. But, hey, here’s hoping the publicity puts this Parler platform under all the bright regulatory lights…

Donald Trump’s beef with social-media giants is well-documented—just last month, he brought Twitter C.E.O. Jack Dorsey to the White House to whine about the dip in his following that’s supposedly due to anti-conservative bias. Yet despite his gripes, and the gripes of his far-right allies over the de-platforming of people like Alex Jones, Twitter has remained the president’s megaphone of choice. That’s in part because no platform rivals the reach of Twitter, where Trump can broadcast his every thought to millions of people in seconds. But a new report suggests the president’s aides are pushing him to lend his online clout to a Twitter competitor, raising the specter of a social-media ecosystem that’s even more deeply polarized.
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Capping Medicare Part D

A couple of weeks ago, the Hill reported that there is interest in the Senate to change the Medicare Part D drug benefit so that is actually functions as catastrophic insurance.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) is working on a bipartisan plan to cap seniors’ expenses for prescription drugs in Medicare as part of a broader effort to lower drug prices.

Grassley told The Hill on Wednesday that one idea he is working on with Sen. Ron Wyden (Ore.), the top Democrat on the panel, is “some sort of maximum amount that one person would have to pay” for drugs…
Capping Medicare Part D enrollees’ out-of-pocket costs has long been a priority for Wyden, who previously proposed legislation to limit seniors’ costs to around $2,650 a year. More than 1 million seniors in 2015 paid more than $3,000 for their Medicare drugs, according to Wyden’s office.

Medicare Part D has a complex benefit design. There is an initial deductible, then an area where the beneficiary pays 25% coinsurance, then depending on whether or not the drug is brand or generic, another layer of coinsurance. Finally, once drug costs are over a threshold ($8,140 in 2019), the individual beneficiary has a 5% co-insurance. There is currently no out of pocket limit to a patient’s total cash costs.

This is a problem. Dr. Stacie Dusetzina is one of America’s leading drug pricing experts and she made this comment about helping her dad choose a Medicare plan that stuck with me:

5% is much better than 90% or 100% but for drugs that routinely cost $100,000 or more per year, it is still a massive fiscal barrier to care.

Medicare Part D’s design has never provided true catastrophic protection. It did not provide that protection in 2006 when the number of six figure drugs was far lower, and it does not provide that protection now as an increasing number of six and (potentially) seven figure drugs for a lifetime are on the market and in the pipeline.

Policy makers have a number of choices that they can make. They can institute an out of pocket cap which increases the actuarial value of Medicare Part D without any other changes. They can hold actuarial value constant by increasing the deductible while also instituting an out of pocket cap. They can change how rebates flow. They can encourage more competition to hopefully hold prices lower than they otherwise would be.

The basic choice of whether or not to hold the actuarial value of Medicare Part D constant and then rejigger the benefit design is one that will test the ability of Congress to make non-Pareto improvements. Someone will benefit and a lot more people will be mildly hurt. The other choice is to turn on another firehose of federal money. That is the easier choice to make politically.

Repub Stupidity Open Thread: Hey, Remember That Jerk Stephen Moore?…

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