Flat Rejection Open Thread: There Are *NOT* Two Sides to This Argument

I know, I know — overkill. But this is 2017, and we’re trying to explain to the guy currently squatting in the Oval Office, in this very timeline, that Nazis are wrong. It feels like we have to make some kind of record…


Read more



Open Thread: At the Trump White House, It’s Always Worse Than You Expected…

Whoever invented the game of RISK has a lot to answer for…


Read more



50% of income is a wonderful choice

I was laid off from a program evaluation job in September 2009. I had been working at a grant funded pediatric behavioral and mental health care coordination demonstration project. It was a service that was more expensive up front but usually saved Medicaid money in a few years and social services/criminal justice costs very quickly. We had good results that had been backed up by an external program evaluation.

Our funding when I was on this project was overwhelmingly federal grant pilot funding with a small local match. We needed to transition to regular program funding. That meant we needed a Medicaid waiver for the service that we offered. There was absolutely no discretionary local money in 2009 so we did not receive a waiver. The nerds were let go in order to stretch operational funding. We wanted the kids to be served for as long as possible until a smooth hand-off could be arranged.

Thankfully I lived in Pennsylvania so I had a decent unemployment check. I was eligible for about $1,600 a month. My wife was working part time at the time and earning $1,000 a month and my daughter was nine months old and being very silly and adorable. I received an offer to COBRA our health coverage. We had a $2,500 high deductible health plan for $1,275 a month premium as the risk pool at my former employer was sick as hell. Half of our income would have had to go to just the premium. We were lucky, as part of the stimulus, there was a program that paid for 65% of the COBRA premium. That meant our premium was “only” 16% of our income.

We tried to make that work and we did until January when we switched my daughter to CHIP for $25 a month. CHIP was the best insurance I have ever had. My wife and I got a cheap underwritten policy that offered $500,000 in benefits after a $7,500 deductible with severe coverage limitations. We were getting it to give us some protection if the other person got hit by a bus.

Half of our income for a policy with a deductible equal to our entire monthly income is not an actual choice for insurance. We were trying to stay current on the mortgage, keep diapers on our daughter, and not fall too far behind. And we mostly were able to manage. Once we were both working full time, it took us two years to dig out of the hole that my lay-off placed us in. And that was only because we got lucky. We got lucky that we stayed healthy. We got lucky that we both could find decent enough jobs with decent pay and better advancement opportunities. We got lucky in that we were going to be okay if nothing else happened and nothing else actually happened.

Your money or your life is not a choice.



A personal note on patient-doctor openness

This morning I went to my new primary care physician for the first time. I am at an age where I am still pretty healthy but I am almost at the point where I can be legitimately accused of being middle aged. Given what I do for both a living and for fun, I know the actuarial tables indicate that I will need to spend increasing time with my PCP in the next decade than I have in the previous decade.

As part of the intake process, I had to complete a form of my medical history and relevant history of family members. Duke Primary Care made it easy to do that online so I did that pre-visit as I drank my morning coffee. And then I came to a question of “Anything else relevant….”

I have a high probability of a genetic pre-disposition of certain types of GI tract cancers running in my family. A younger siblings had a screening colonoscopy this year. They found and snipped several polyps.

I’m entering an age band where if I have that genetic variant, I am likely to be at significantly increased risk. I might have it, I might not. I should get a genetic test to confirm whether or not I really need bi-annual colonoscopies at this point in my life.

If I have that gene, it is one hell of a pre-existing condition. I’m fairly confident that I’ll be in the employer sponsored insurance world regulated by ERISA throughout the time that I am at an increased risk. But I am not sure.

I thought for a second, and then wrote it down the pre-existing condition. I’m betting that I don’t have to worry about coverage for that condition in case I actually do have it. But this is the second time in five years where I have had a PCP visit on the same day there was a risk of losing guaranteed issued insurance (NFIB v. Burwell SCOTUS day). Each time, I had to weigh whether or not I needed to be fully open to my doctor or hope that a pre-ex condition would not be a life time anchor against me.

At the end of the visit, the doc wanted me back next week for some labs and we scheduled a colonoscopy for sometime this fall.



Wednesday Morning Open Thread: Mitch McConnell, Cartoon Villain

(Drew Sheneman via GoComics.com)

.

Terrible excuse for a human being, and not nearly as skilled a legislator as he was reputed to be — but a genuine gift to political cartoonists, that Senator McConnell.

Apart from mocking the infinitely mockable, what’s on the agenda for the day?

(Tom Toles via GoComics.com)

Read more



Mitch McConnell Will Not Hesitate to Abuse People with Disabilities

Literally. As long as he doesn’t have to show his face on camera, of course.

I doubt McConnell does think he’s a good guy, actually; he figures he’s defending his cushy “leadership” job, and whatever it takes to accomplish that is just fine by him.



Open Thread: As American As… A(nother) Mass Shooting

Mr. Pierce, at Esquire:

How can this happen here? Because this is the United States of America in 2017, kids. It Can Happen anywhere. The suburbs are not sanctuaries. The ballfields are not sanctuaries. There is no big beautiful wall with big beautiful doors that will keep this kind of thing out, and keep all the Right People safe. There are no Right People who get shot. There are no Wrong People who get shot. Stop trying to convince us that there are. There are just victims and potential victims. And there are guns, too damn many guns too easily obtained…

… Violence doesn’t “intrude” on everyday life in America. Violence is a part of everyday life in America. A little more than a week ago, five people were shot to death in warehouse in Orlando. Is a warehouse in Orlando less innocent than a Virginia ballfield? Is a disgruntled worker taking his mad vengeance less of a demonstration of a country unhinged than a home-inspection specialist who fried his brain over politics? Is somebody who wounds over politics a worse murderer than someone who kills because he got fired? I admire the ability of anyone who can make that measured a moral choice.

On the whole, people shouldn’t get shot. They shouldn’t get shot in the streets. They shouldn’t get shot in school. They shouldn’t get shot in the workplace. They shouldn’t get shot while carrying snack food in the “wrong” neighborhood, and they shouldn’t get shot while they’re trying to surrender. They shouldn’t get shot while dancing in a nightclub. And they shouldn’t get shot on the ballfield on a spring morning.

In the main, one victim is not more “innocent”—and, thus, of more value—than any other one. Their occupation shouldn’t matter. Their politics shouldn’t matter. There is a violence inherent in the country’s history and there is a wildness present in its soul and, on occasion, both of these surface more clearly than is usual. Technology has made the violence more lethal and the wildness more general. The uniquely American conflation of innocence with hubris is a luxury we can no longer afford.

I don’t drink, not because of some philosophical commitment to sobriety, but because my family has a history of terrible things happening when we demonstrate just how much we can (can’t) handle our booze. Maybe Americans should consider that, given our history, a little judicious self-restraint in the firearms area might be a lifestyle improvement…