Donald “Racially Divisive” Trump: Oh Look There Is An Elephant in the Room!

The Grey Lady goes… as close to there as its recurrent fulminating BothSides fever will permit (and no sooner than time):

[A]mid gloom about Republican prospects in November, Mr. Trump may have endangered the party in a more lasting way: by forging a coalition of white voters driven primarily by themes of hard-right nationalism and cultural identity.

Republicans have wrestled for years with the push and pull of seeking to win over new groups of voters while tending to their overwhelmingly white and conservative base. Now, Mr. Trump’s candidacy may force them into making a fateful choice: whether to fully embrace the Trump model and become, effectively, a party of white identity politics, or to pursue a broader political coalition by repudiating Mr. Trump’s ideas — and many of the voters he has gathered behind his campaign.

In order to build a winning party again, some Republican leaders say, the party will have to disavow Mr. Trump’s exclusionary message, even at the price of driving away voters at the core of the Republican base — perhaps a third or more of the party.

This approach would amount to a highly risky lurch away from the faction that made Mr. Trump the Republican nominee, and toward a community of female, Latino and Asian voters who have never been reliable Republicans. Should the effort falter, and Republicans fail to win a second look from these Democratic-leaning groups, they could find themselves stranded with virtually no base at all.

If they are divided over the proper course forward, Republican leaders agree that a wrenching struggle is coming.

House Speaker Paul D. Ryan predicted that the aftermath of the election would bring “a fight for the soul of our party,” and said Republicans would have to reject the politics of racial resentment, which he called “a loser.”

“Our job is not to preach to a shrinking choir; it’s to win converts,” said Mr. Ryan, who has endorsed Mr. Trump but criticizes his pronouncements with regularity…

The appeal of a Trump-like message may go beyond even the share of primary voters that Mr. Trump captured: Exit polls found solid majorities of Republican primary voters supportive of his pledge to block Muslims from entering the country. In the general election, polls show most voters oppose that plan…

Mr. Trump’s approach is an alluring path to prominence on the right: Already, a handful of up-and-coming Republicans from the party’s conservative wing have moved to court his core voters. Some have argued his message could be more potent in the hands of a less flawed messenger.

Mr. Pence, who sharply criticized some of Mr. Trump’s proposals in the Republican primary race, campaigned hard to join his ticket in the general election.

Senator Tom Cotton of Arkansas, a first-term lawmaker who has taken steps toward a future presidential race, argued that the party should be prepared to go further than Mr. Trump and propose new restrictions on even legal immigration…

Speaking of Speaker Ryan:



Got to kill em to civilize em

Or asshole of the week award nomination:

Hmm, isn’t he supposed to be a conservative with a respect for institutions that work even if they don’t work well and a healthy suscipian of outsider experts smashing a system and imposing externally solutions that don’t have internal stakeholder buy-in.

Nope, just Col. Blimp at work.



Open Thread: Donald Trump, Still NeoNazi-Friendly

Short bursts, because that’s as close as a sane person wants to get. More serious arguments later in this thread…


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Convergence and Blue Cross and Blue Shield of Minnesota

The big health wonk news late last week was the decision by  Blue Cross and Blue Shield of Minnesota to drop their broad network PPO individual market plans and offer only narrow network HMO plans on and off Exchange.

Minnesota’s largest health insurer, Blue Cross and Blue Shield of Minnesota, has decided to stop selling health plans to individuals and families in Minnesota starting next year.

The insurance carrier’s parent company, which goes by the same name, will continue to sell a much more limited offering on the individual market through its Blue Plus HMO.

BCBS/MN was offering a broad network PPO plan on the Exchanges.  They lost a ton of money as the plan was priced high for three reasons.  First since the plan was a broad network, each unit of service was being paid out at either standard or near standard commercial rates.  Those rates are roughly 150% to 200% of standard Medicare rates.  Secondly, the people who signed up for those plans tended to be sicker as they were attracted to access to most of the hospitals in the upper Great Plains.  Finally, for the hospitals that were not in-network, since the plan is a PPO, the members had fairly decent out of network benefits that would allow them to travel nationally for care at high cost but no higher quality facilities than they had in network.  Broad access, commercial rate paying PPO plans are Exchange money sinks.

They are money sinks even in states where there is no very low cost competitor.  In Minnesota there is at least one Medicaid like managed care company, Health Partners offering plans on Exchange.  Their baseline Silver plan in the Twin Cities is a narrow network HMO where they pay low rates and mainly attract healthy people who need coverage.  They most likely pay a significant risk adjustment outflow but it works well enough.

BCBS/MN is converging their configuration on the plan designs that work well for the Minnesota market where the providers get paid a bit less than commercial rates.  They’ll probably end up getting paid near Medicare rates, and the networks are fairly narrow with significant gate keeping HMO functions.  These design features will knock off 10% to 15% of the premium cost and allow BCBS/MN to stay reasonably competitive once risk adjustment is taken into consideration.

And none of this should be surprising as some idiot on an almost Top-10,000 blog noted this market structure in June of 2014:

The Exchange and subsidy design create the first segment of the Silver market.  All subsidies on the Exchange are based onallowing an individual to buy the second cheapest Silver plan on the Exchange for a percentage of their income. …there is a strong incentive for insurers to offer at least a  Silver plan that is either the cheapest two Silvers or very close to the subsidy cut-off. …
This segment in a competitive market should see a cluster of plans that are at the subsidy line plus or minus a couple percentage points.  These plans are the first segment.  They tend to be very restrictive in all modifiable aspects.  HMO’s with gatekeeper and strict authorization processes are likely to be here while open access PPO networks are unlikely to be in this segment.  The networks will tend to be very narrow as the pricing model is Medicare plus a small kicker…and insurance companies are avoiding the high cost providers if they can.  These are the super narrow networks where the goal is to get a Silver plan that is either top 2 or really close to top 2 in pricing.  They are aimed at people who are getting subsidies are extremely aware of every additional dollar they have to spend on monthly premiums. …

These segments were haphazardly defined in 2014 as companies were mostly shooting blind on both what the risk pools looked like and what their competitors’ strategies are.  2014 is a successful beta testing year.  I think the Silver segmentation will be much clearer in 2015 and very obvious in 2016 as more data and experience comes into play.

I was off by a year, the convergence in configuration is happening in Minnesota in 2017 instead of 2016 when I thought it would have been obvious by mid-spring of 2015 of what was working and what was not working on Exchange.

 

 

 



Good news everybody

National healthcare spending is significantly (~10%) below 2010 projections:

And people are less stressed about being able to pay for a medical bill:

Why I was told that was Unpossible

Open thread



Internet Pile-On Open Thread: Frying French

Roy Edroso, of Alicublog, casts a cold eye on David French:

I have followed French’s career at National Review for years and will just quickly tell you that he’s not only against gay marriage, he’s also against Griswold v Connecticut, the decision that invalidated laws against contraception (“Is there a single legal doctrine that can stand against the quest for personal sexual fulfillment?” French thundered); that he denounced the widespread mourning of Prince’s death on the grounds that “Prince was ultimately just another talented and decadent voice in a hedonistic culture… notable mainly because he was particularly effective at communicating that decadence to an eager and willing audience”; that he has compared Kim Davis, that crazy clerk who refused to sign gay marriage licenses, to “men like Martin Luther, John Calvin, and John Knox — the men who first put the ‘protest’ in ‘Protestant'”; that he — well, I’m out of time for the moment, but you can peruse the archive for more if you can stand it. The point is, he makes Trump look like Eisenhower…

So, even if this brief moment of pixellated notoriety has faded by evening (the Washington Post has a dutiful synopsis on an interior page, while the NYTimes settled for reprinting a couple of paragraphs from Reuters), Mr. French seems to have earned his stint as a chew toy…

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Good news everybody

The interesting thing to me in this chart besides the final outcome is that the introduction and proliferation of government sponsored insurance after 1980 to 2010 basically was sufficient to replace 1:1 declining employer sponsored coverage and not expand coverage. Legacy Medicaid picked up more responsibility, Medicare picked up more members, CHIP was a brand new program that has covered a lot of kids. But all of those programs were effectively either status quo keepers on a population basis or slowed the rate of uninsurance growth.

There are three major challenges left.

  • Reduce uninsured rate to under 2% (Massachusetts is damn close to that now)
  • Increase the value of the coverage so that it is far more useful to more people
  • Continue to bend the cost curve so that total national healthcare costs grow at or under the rate of nominal economic growth.