Better MLS referees in 2019

I am a bad soccer player but a pretty good referee. 

Last night, I was working a high school game with a former MLS official and an up and coming USSF-5 who has a plausible path to the MLS, on my lines.  I set the tone early with a caution for a dive in the box at the sixty third second.  The players just played for the rest of the match.  After the game, the ref crew stopped for a burger and a beer.

We talked through the first caution (ballsy but right) and a second caution for a crap tackle as well as a few other situations.  And then we talked about a major tournament two time zones away.  Both of the other guys had been invited to officiate.  The former MLS guy had been invited as a “senior mentor” while the young guy had been invited as part of the US Soccer Federation (USSF) identification/winnowing process.  I’ll never be a part of this process, I am slightly too old and more than slightly too slow, but it fascinates me. 

Right now there are roughly 200 referees who are theoretically MLS eligible (Grade 4 or higher), of which roughly a third will get an MLS game this year, and third will never see an MLS preseason camp much less a game because they either blew their opportunities at one level below MLS or have other circumstances going on.  The rest are either working towards the MLS or retired from the MLS.  There are another 500 or so officials (Grade-6 States, Grade-5 States, Grade-5 National Candidates etc)  who have been identified as potential top flight referees with appropriate seasoning/mentoring/opportunities. 

The screening process is extremely steep with very high attrition rates.  The intake phase, which is where my younger buddy is, basically has the USSF telling candidates to jump.  He has been sent to Dallas, Phoenix, Orlando, Chicago, Minneapolis, Portland and Denver this year.  Some of those tournaments pay, others cover expenses and nothing more.  He has been called to cover a semi-pro game six hours away eight hours before kick-off.  If getting to the MLS is a goal as a referee, refereeing is a full time job. Refereeing full time at the sub-MLS level is a better than poverty level gig but it is below first job out of college gig.   He can do this because refereeing is his primary source of income, but he has a small sideline gig as a web designer and is on his mom’s insurance for another year.

Frequent and active refereeing hurts.  In the past three years I’ve had a hip flexor injury, turf toe, bursistis and a couple of bone bruises from reffing.  Quite a few refs remove themselves from consideration because they can not afford to take the risks.    If health insurance is available to the cohort of potential future MLS at a price of one or two decent game fees a month, the MLS pipeline won’t be artifically restricted to guys who are both good and can afford to take the risk of running naked without health insurance. 

We won’t see on field results for another five years as the refs who are halfway through the pipeline have already passed (on average) the point of deciding whether or not reffing without insurance is a tolerable risk.  But the refs in the next few years who are just starting the pipeline won’t be forced through the chokepoint of health insurance risk.  They’ll be included or excluded based on skill on the field. 

 








Notes from day 1

Just a few notes from Day 1 of the Exchanges and what they mean:

From Business Insider:

About 2.8 million people visited healthcare.gov – the main website for the 36 state exchanges being run by the federal government – between midnight and mid-afternoon, theU.S. Department of Health and Human Services said….

Kentucky’s exchange, kynect, saw 57,625 unique visitors from its midnight launch until 2:30 p.m., according to the Kentucky governor’s office. Nearly 2,000 applications had been started, with 1,235 completed. The kynect contact center fielded 3,243 calls and 110 e-mails. The average visitor stayed on the site for 11 minutes….

Between the Federal and the State exchanges there were ten million web hits.  The financing and actuarial tables work out if roughly seven million people sign up for insurnance.  The first day conversion rate in Kentucky and other states are fairly low.  That is expected as buying health insurance is a big deal with a lot of options.  Pricing, networks, benefit configurations are being released for the first time in a comprehensive manner.  People should take time to look at their options, figure out what two or three really meet their needs and then think about trade-offs. My company has been modelling a repeated shopping experience for months now and that is probably what we will get.  People will come in, look around, narrow their choices, and leave.  Then they’ll come back a couple more times until they choose.  I expect spikes in enrollment around the 15th and 30th of the month as well as another spike right after Thanksgiving as people sign up for coverage that can go into effect on Jan. 1.

USA Today:

 huge interest and balky technology that led to a series of glitches, delays and even crashes that marred the first hours of the centerpiece of President Obama’s health law.

Responding to mistermix — this system was load tested — the load was just more than anticipated and was more active than anticipated.  Thankfully servers are reasonably scalable, and fixes were going into play by mid-afternoon.

The big takeaway is that people are interested, and the technology side of the equation should be quickly patched. 

Seven million new people are needed to sign up for the Exchanges including a little more than 2 million young people.  I think we’ll hit that by Thanksgiving if yesterday is an indicator.  As a side note, it is seven million covered lives, not seven million contracts.  This is a slight difference.  If I insured my family on Exchange, we would be one contract but four covered lives.  I think it is safe to say that of the 10 million hits, those hits represent at least and probably a good deal more than 10 million potentially covered lives.  Having enrollment in Exchange go over 7 million would be a very good problem to have. 

 

 








Wave around the Waiver

In the previous post, there were a couple of good questions about the Arkansas Medicaid “private option” waiver.  The big one is would the Bronze plans on the Exchange be effectively useless to someone making 75% of FPL as they could not even look at the co-insurance and deductible as plausible payments.

Here is a bit more news on the Arkansas waiver (amazing what happens when one read’s the application!)

Arkansas will be submitting a SPA in addition to the submission of waiver requests for this Demonstration which includes eligibility limits for the newly covered population, updated cost-sharing requirements and the state’s selection of an ABP. Consumer cost-sharing obligations under the Demonstration will be identical to those under the State Plan for all individuals receiving the ABP. The SPA describing the ABP will include the cost-sharing design for all individuals receiving the ABP. As will be described in the SPA, Private Option beneficiaries with incomes below 100% FPL will not have cost-sharing obligations in year one of the Demonstration; Arkansas plans to submit amendments to the waiver to implement cost-sharing for Demonstration participants with incomes from 50-100% FPL to be effective in years two and three of the Demonstration. Individuals with incomes of 100-138% FPL will be responsible for cost-sharing in amounts consistent with both the State Plan and with the cost-sharing rules applicable to individuals with comparable incomes in the Marketplace. . For individuals with income between 100-138% FPL, aggregate annual cost-sharing will be capped at 5% of 100% FPL ($604 for 2014). Providers will collect all applicable co-payments at the point of care. QHPs will monitor Private Option beneficiaries’ aggregate amount of co-payments to ensure that they do not exceed the annual limit.

Let’s break it down.

  • Year 1, people under poverty line won’t have any cost-sharing.
  • Year 2 and 3 people under poverty line will have some cost sharing.
  • People over poverty line but MA eligible will have cost sharing up to 5% of federal poverty line. 

§ 1902(a)(17): To permit the State to provide different delivery systems for different populations of Medicaid beneficiaries. The State is not requesting a waiver of comparability with respect to benefits, eligibility, or cost-sharing.

Earlier in the waiver, Arkansas is making a big deal about dealing with churn as its justification for the “private option:”

Continuity of coverage – For households with members eligible for coverage under Title XIX and Marketplace coverage as well as those who have income fluctuations that cause their eligibility to change year-to-year, the Demonstration will create continuity of health plans and provider networks. Households can stay enrolled in the same plan regardless of whether their coverage is subsidized through Medicaid, CHIP (after year one), or Advanced Premium Tax Credits.

I think this is a good policy justification for this option.  We know that income variance is high at the bottom of the economic scale.  Some people could have a good couple weeks of overtime at working that knock them out of one program to another, or someone who had just missed qualifying by $22 a week now qualifies after they lost the Thursday morning shift.  People shifting between dissimilar plans and dissimilar networks and different providers are a problem because the continuity of their care (to use a highly technical term) sucks. 

 








Arkansas waiver news

CMS approved a waiver for Arkansas for Medicaid expansion. Instead of doing the mechanically simple thing of just expanding Arkansas Medicaid for individuals up to 133% of poverty line, Arkansas will engage in premium support. Individuals who are newly qualified for Medicaid in Arkansas will get a voucher to buy a policy on the Exchange.

The Hill blog:

Under the waiver, Arkansas will expand Medicaid to cover individuals whose income is less than 133 percent of the federal poverty line — the expansion contained in the Affordable Care Act.

But rather than placing those newly eligible residents on traditional Medicaid, Arkansas will offer them private coverage. Residents will be able to buy the private healthcare plans offered in the state’s insurance exchange — the other half of ObamaCare’s coverage expansion.

Iowa, following Arkansas’s lead, has already proposed a similar waiver, and state officials have said Arkansas’s plan could serve as a broader model.

This is big news with a couple of levels if implications:







I aint got no Satisficing

Satisficing is one of my favorite concepts and words. Yes, my name is Richard Mayhew and I am a nerd of unusual size.

And in a just world, satisficing and the related concept of bounded rationality would have made Milton Friedman a very smart, very interesting thinker who had some excellent things to say about the world around us and not the economic intellectual father of the current socio-political superstructure that is around us today.

Wikipedia has a good definition and example:

Satisficing, a portmanteau of satisfy and suffice,[1] is a decision-making strategy that attempts to meet an acceptability threshold. This is contrasted with optimal decision-making, an approach that specifically attempts to find the best option available. A satisficing strategy may often be (near) optimal if the costs of the decision-making process itself, such as the cost of obtaining complete information, are considered in the outcome calculation.

The word satisfice was given its current meaning by Herbert A. Simon in 1956,[2] although the idea “was first posited in Administrative Behavior, published in 1947.”[3][4] He pointed out that human beings lack the cognitive resources to optimize: we usually do not know the relevant probabilities of outcomes, we can rarely evaluate all outcomes with sufficient precision, and our memories are weak and unreliable. A more realistic approach to rationality takes into account these limitations: This is called bounded rationality.

And here is a good example:

Example: A task is to sew a patch onto a pair of jeans. The best needle to do the threading is a 4 inch long needle with a 3 millimeter eye. This needle is hidden in a haystack along with 1000 other needles varying in size from 1 inch to 6 inches. Satisficing claims that the first needle that can sew on the patch is the one that should be used. Spending time searching for that one specific needle in the haystack is a waste of energy and resources.
 

Another useful example is thinking about picking up an attractive person to hook up with as graphed against time at the bar.  Early in the night, individuals may be attempting to optimize the matching process and hook-up with the most attractive person who is willing to say yes to them.  As the night goes on and failure to score with the 10, the decision process changes until at last call, the decision is to hook up with whomever is willing to say yes.  This is slightly different than the decision process described in A Beautiful Mind bar scene, although all of the men in that scene were engaged in satisficing decision making.