You be the referee….

I have a busy week ahead of me.  The first half is full of refereeing.  During the second half of the week, my wife and I are going to a kidless undisclosed location with minimal internet connection (just enough to Skype Grandma and Grandpa once a day to make sure the kids are getting appropriately spoiled.)  So I am not sure how much interesting things I can write about this week.

Over the weekend, I worked a game with a referee who was telling me about an interesting situation he had earlier in the week.  What are your thoughts on this scenario?

Red and White don’t like each other.  They are both good scholarship driven programs.  Both are usually competing for one of the last bids into the NCAA play-offs.  They have a history of having ugly games.

In the fourth minute, Red #8 makes a very hard but legal challenge against White #2 in front of the White bench.  Red #8 hooks the ball behind his knee, trapped between his thigh and calf.  White #2 continues to go through the ball, and then goes airborne with an audible “SNAP”.

The referee stops play as White #2 writhes on the ground and calls in the trainer.  10 minutes of stoppage ensues as White #2 right leg is broken and he is prepped for transport.  After White is in the ambulance, the referee shows a yellow card to Red #8.  The card was written up as Unsporting Behavior.

One final piece of information, Red #8 completed the game and he was only fouled three times (once hard). The referee ended up giving three more cautions and no red cards.

What are your thoughts on this?  Are your thoughts different if the broken leg challenge happened in the 88th minute?  Are your thoughts different if the incident happened in the far corner 80 yards from the White bench?

My thoughts are below the fold.

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Network choice cheats

This is a continuation of the quasi-series of open-enrollment advice posts. A valued commenter and reader e-mailed me with a very interesting question:

I’m changing jobs, and have a choice between a PPO, an HMO, and Kaiser. (Kaiser is listed separately, and one has to ask about it; for whatever reason, it is discouraged by HR.) the cost difference between the PPO and the HMO are nominal – the difference in my cost is about $6/mo for just me.

Thanks to your blogging, I’m trying to pay attention to the depth of the networks, but it is hard to tell what is going on. The online directory they have (this is UnitedHealthCare) lists a bunch of doctors. Is there any reasonable way a mostly clueless-about-this-stuff person can get an idea of how sizable their network is?

This is a two layered process. The first layer is to make sure that if you value to keep seeing your doctors and facility services is to make sure that they are in the directory. If you want Dr. Brown to continue to treat you, you should be checking to see if Dr. Brown is in network. If he appears in the directory, then you’re good on this stage.

The second check is a cheat for narrow networks and gives you a good sense of the net that was cast.

Most narrow networks are primarily concerned about controlling what hospitals are being used as hospitals have high costs and more importantly, high variance in costs.  There will be exceptions as some networks will actively seek to exclude specific doctors but most narrow networks are premised on controlling hospital costs.

There are two basic flavors of narrow networks. The first flavor is the simple version of cost control. An insurer will offer X, and any hospital that will accept X or less is in network, while everyone else is out. A good check here is to see if the major academic medical centers in the central urban area of the region is in the network. If it is, the network is probably fairly broad.

If the major academic medical center has a split hospital structure where there are a few high end specialty hospitals (pediatrics, ob/gyn, trauma etc) and also general purpose hospitals, look at the general purpose hospitals.

The other type of narrow network is a business buggering thy competitors strategy.  This is more common when a region has an integrated payer provider system (like Geissenger, Steward, Sutter, Meridian etc) . If you are buying insurance through an integrated payer-provider, see if major hospital chains not owned by the insurance company are in the network. Outlying community hospitals that are independent or part of small local chains will probably be included in modestly narrow networks solely to give coverage, but chains have negoatiating power. If the non-owned chain is in, the network is probably fairly broad.

These are not perfect cheats, but they are 20 second checks as doctors usually follow hospitals when narrow networks are created.

Good news everybody

Via the US Census Bureau:

The Current Population Survey shows that the percentage of people with health insurance for all or part of 2014 was 89.6 percent, higher than the rate in 2013 (86.7 percent).

After several years of a relatively stable uninsured rate between 2008 and 2013 as measured by the American Community Survey, the percentage of the population who were uninsured dropped in 2014. This represents the largest percentage point decline in the uninsured rate during this period.

Now let’s get the rest of the Medicaid hold-out states on board accepting free federal money and then let’s start working on underinsurance.

Single payer and distribution

Kevin Drum is defending Bernie Sander against the Wall Street Journal but I think he is implying something at the end of his piece that is very wrong.  His logic would imply that Vermont would be getting ready to ramp up for single state single payer with a go-live date of 1/1/17.

Then there’s the $15 trillion price tag for universal health care. Is this a fair estimate? It’s probably in the ballpark. Private health insurance accounted for about $1 trillion in spending last year, and assuming reasonable growth that will probably come to around $15 trillion over the course of a decade…..But here’s the thing: this is money we already spend. Right now, employers and workers pay insurance companies $1 trillion for health care. Under Bernie’s plan, we’d instead pay that money to the federal government. Generally speaking, this would be invisible to most of us. Behind the scenes, our dollars would flow to a different place, and that’s about it….

You should think of the Sanders plan as costing about $3.4 trillion. You may or may not like the idea of universal health care, but it wouldn’t have much impact on how much money you actually take home each week.

Single payer benefits people who are currently uninsured.  It benefits people who have shitty insurance (including most Bronze plans) when the single payer benefit design is better than what they have, and it benefits people who pay a high percentage of their total compensation for healthcare.

Single payer, especially if it is based on Medicare which has an 82% to 84% actuarial value, also creates comparative losers. People who have very high actuarial value plans either lose their coverage or have to pay extra.  People who make a lot of money that is being taxed at a higher rate are worse off (as they have more money and tend to have high actuarial value plans).  Providers are worse off as they lose market power to dictate rates (From a societal POV, this is excellent as smashing rentiers is a good thing on net but sucks to be a rentier).

There are winners and losers in almost all policy proposals (there are very few truly Pareto improving policies that can survive contact with Congress).  Universal healthcare financed by general taxation produces winners and losers.  The losers are the well connected who will see less take-home pay unless an analyst uses heroicly absurd assumptions about segmented marginal propensity to consume taxation and public expenditure multipliers which creates an economic boom.

PPACA got around this problem by a comparatively very liberal Congress willing to lose its majority to accomplish a 100 year goal while also making most of the losers fundamentally unsympathetic people:

  • People earning over $250,000 per year in Modified Adjusted Gross Income who have employer sponsored health care or Medicare and are paying more in taxes
  • Young single males with absolutely no health problems, no relatives with health problems and incomes over 250% Federal Poverty Line that previously had a $42 a month, $25,000 deductible plans that did not cover maternity or mental health needs. Those policies got cancelled and they actually have to buy good insurance. Young guys making under $25,000 a year usually will get decent subsidies, past that, it is hard to be sympathetic to someone bitching that they (a member of a high accident group) have to buy decent insurance.

Single payer takes the same group of people of PPACA losers and makes them losers again. However this policy change would mobilize most if not all of the current coalition that wants to repeal, delay or shrink the Cadillac tax on high cost health plans would be included as losers, potential losers or perceived to be losers. The anti-Cadillac coalition is a blocking coalition unless some of its members can be bought off with significant policy goodies.

Game recap

Just a follow-up from this morning’s post about my game this evening.

TLDR: I did not fuck up.

Long version —   Good game but holy shit, those boys found new and interesting ways to hurt themselves.

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