Method agnosticism and funding

I’m fairly agnostic about what method the United States uses to provide healthcare and health insurance to our population as long as the objectives of providing decent care at affordable prices in an equitable manner are either met or worked towards.

If that means Medicaid expansion, great. If it is Medicare for All, fine.

If that means Exchange subsidy exploitation, wonderful.

If that means Medicare Advantage proliferation, I’m fine with that.

If it means it means segregating the risk pool into a general insurance market and a high cost/high risk chronic condition management market via a high cost risk pool that is adequately funded, I’m on-board with that.

Once a method is chosen, we should seek ways to use that method efficiently and wisely. There are lots of ways that coverage can be configured that if they are adequately funded AND constantly tweaked to avoid perverse and negative incentives, they would accomplish my objectives as a means to an end in and of themselves. I’m effectively method agnostic if the end is accomplished. And this method agnosticism means I’m okay with spending a bit more money to achieve the goal as most of my writing on Silver Gap subsidy manipulations will lead to higher federal expenditures than Silver Spam strategies.

TPM has a good piece on a problem that the Republicans have right now on trying to come up with a Repeal and Replace bill. They don’t share an end as worthy in and of itself of trying to get people reasonably covered. Instead their end is minimizing federal taxation which is constrained by electoral consequences. So their policy writing space is limited:

“On paper, high-risk pools could work to lower premiums for healthier people and provide adequate coverage to those with pre-existing conditions, it really comes down to the money,” Levitt said.

A number of states operated them before the ACA, but because they were so expensive, most states offered coverage on them to a very small portion of people on the individual market, much smaller than the percentage estimated to be barred from insurance without the ACA’s pre-existing conditions coverage requirements.

“The issue, of course, is the people in the high-risk pool are going to be very expensive, so you’re going to have to have some sort of funding mechanism to subsidize or otherwise pay for the coverage that they get,” said Yevgeniy Feyman, a health care policy expert at the right-leaning Manhattan Institute.

Estimates for the average annual cost for the federal government range from $15 billion to $178 billion, while Ryan’s “Better Way” heath care reform white paper reserved an average $2.5 billion per year to subsidize state risk pools.

The big problem is funding. A lot of different systems could work if funded reasonably well. It won’t be funded reasonably well.

“Money is so central to all of this. If a replacement spent comparable amounts to the ACA you could come up with all kinds approaches that could probably get the same level of coverage in a different way,” Levitt said. “But Republicans have generally been very clear that they want the federal government to spend less than what the ACA called for.”

There could be a bunch of designs that could work towards a liberal end if they were funded. That won’t be the case so agnosticism is useless on mechanism design.

Two great philosophers for the next four years

Okay, now it’s real so let us rely on two great philospophers for the next four years:

And it looks like America agrees with Ron Burgundy

CBS News:

It has been 10 weeks since Donald Trump was elected president, and more Americans disapprove (48 percent) than approve (37 percent) of the way he has handled his presidential transition. They are split on his cabinet picks. Views divide heavily along party lines.

Just days before his inauguration, Donald Trump’s favorable rating (32 percent) is the lowest of any president-elect in CBS News polling going back to Ronald Reagan in 1981, when CBS News began taking this measure.

Well we’ll have to survive being “governed” by the Brietbart comment section so we can either laugh or cry while we bang our heads into our desks today.

Wednesday Morning Open Thread: Blessed Solstice

So here in the Northern hemisphere the hinge of the year turns over — no sooner than time — and the days, however cold and dreary, grow infinitesimally longer every one.

All last week and bleeding into this, we had a team of plumbers in the basement installing a new heating system (the choosing of which was a three-year project for the Spousal Unit). For two days last week, there was another team of workers installing a new roof (that only took two years’ research, because the insurance company refused to renew our policy if the replacement wasn’t expedited). So our three little rescue dogs have been in various conditions of stranger-panic and noise-meltdown for the last ten days, and I never got more than three hours’ unbroken sleep at a time. There was also a flat tire (probably from a nail the roofers missed), plus a three-times-rescheduled eye exam and expensive new glasses for me. Not to mention the Spousal Unit’s (rescheduled by the doctor) outpatient surgery yesterday (which, thank Murphy the Trickster God, went off without incident and from which he seems to be recovering well). As a last straw, my flip phone bricked on Sunday, so after a hasty T-Mobile visit (do not visit a shopping mall the Monday before Xmas) I’m learning (not easily) to cope with my first (‘pre-owned’ Galaxy S6) smart phone. Never a good time when one’s first thought is, “Well, at least we’ve got enough slack on the credit cards… ”

Not to mention, all the political and geopolitical stuff. You know.

What I want from 2017 is NO MORE SURPRISES DAMMIT.

Apart from all that, Mrs. Lincoln, what’s on the agenda for the day?

Open Thread: Our Failed Media Experiment, (Up)Chuck Todd Edition

I first became aware of the rumors of a break between Comey’s FBI and the CIA when ex-CIA guy Evan McMullin stepped in to challenge Trump. How about you guys?

Friday Evening Open Thread: Working As Intended!

“Ambulatory cream cheese sculpture” Hewitt, not seeing a downside!


Apart from meditating on the never-ending revanchist urges of our GOP compatriots, what’s on the agenda for the evening?

Monday Evening Open Thread

That’s Kansas Secretary of State Kris Kobach, devout suppressor of non-Republican voters’ rights. They’re not even halfway competent authoritarians…

I don’t know whether that’s good news or bad, at this point.

Apart from facepalming, what’s on the agenda for the evening?

ETA: Via commentor Dog Dawg Damn, details from the Topeka Capital Journal:

A written plan for the Department of Homeland Security brought by Kansas Secretary of State Kris Kobach into his meeting with President-elect Donald Trump spells out a desire to question “high-risk” immigrants over support for Sharia law and the U.S. Constitution…

The document calls for updating and reintroducing the National Security Entry-Exit Registration System. The program was implemented in the wake of the Sept. 11, 2001, attacks, but largely suspended in 2011….

The document contains obscured references to the arrest and removal of illegal aliens, “386 miles of existing actual wall,” the post-Sept. 11 PATRIOT Act, and voter rolls. “Draft amendments to National Voter —” can also be seen, perhaps a reference to the National Voter Registration Act…

So maybe it wasn’t accidental — just another early warning.

Listen To Someone Who Knows Something About The Shitgibbon’s Mentor

Masha Gessen knows from vicious fascist dictators.  Here’s what she has to say under the headline “Autocracy: Rules for Survival“:

I have lived in autocracies most of my life, and have spent much of my career writing about Vladimir Putin’s Russia. I have learned a few rules for surviving in an autocracy and salvaging your sanity and self-respect. It might be worth considering them now:

Rule #1: Believe the autocrat. He means what he says….

Rule #2: Do not be taken in by small signs of normality.

[See Betty’s post below]

Rule #3: Institutions will not save you….

Rule #4: Be outraged

Rule #5: Don’t make compromises

Rule #6: Remember the future….


This is one of those read-the-whole-thing deals.  Masha has lived what she’s talking about here.  I have had the good fortune to spend some evenings talking with her, and she is at once one of the sharpest, most un-bull-shit-able political thinkers I know and among the most courageous people I’ve ever met.

If you don’t have time, or, like me, have only a finite tolerance for looking straight at the beast looking back at us, here’s the short form, as stated in Rule 4:

If you follow Rule #1 and believe what the autocrat-elect is saying, you will not be surprised. But in the face of the impulse to normalize, it is essential to maintain one’s capacity for shock. This will lead people to call you unreasonable and hysterical, and to accuse you of overreacting. It is no fun to be the only hysterical person in the room. Prepare yourself.

That leads to the logic of Rule 6:

Nothing lasts forever. Donald Trump certainly will not, and Trumpism, to the extent that it is centered on Trump’s persona, will not either. Failure to imagine the future may have lost the Democrats this election. They offered no vision of the future to counterbalance Trump’s all-too-familiar white-populist vision of an imaginary past. They had also long ignored the strange and outdated institutions of American democracy that call out for reform—like the electoral college, which has now cost the Democratic Party two elections in which Republicans won with the minority of the popular vote. That should not be normal. But resistance—stubborn, uncompromising, outraged—should be.

I expect we will lose most battles for years to come. Perhaps all of them.  ETA: Fuck that noise.  The comments below decrying defeatism are right.  We’re going to win a bunch.  Not everything, and people will get hurt, badly.  But Republicans are already over reaching.  They’re fuck-ups and we’ll be able to take advantage of the openings they provide.  See this from David Cole for a little hope.  Which is why I keep coming back to Masha’s conclusion — say no, and keep on saying it — and see it as a pocket-guide-for-the-perplexed.

I’ve more to say, as I think towards what specific forms my resistance may take, but none of that’s really formed yet, beyond giving some money to some of the most obvious targets.  More later.  In the meantime, what Gessen says:  Trump will not last forever, and resistance is many things — but not futile.

Image: the Ozymandias Colossus — Raames II, mistakenly identified as the mythical king Ozymandias.  This ruin inspired Percy Bysshe Shelly to write this.