This Is Complete Bullshit

burkini

This is offensive, obnoxious, anti-liberal, anti-freedom, and probably will be the one thing the French do that wingnuts will want to adopt:

Photographs have emerged of armed French police confronting a woman on a beach and making her remove some of her clothing as part of a controversial ban on the burkini.

Authorities in several French towns have implemented bans on the burkini, which covers the body and head, citing concerns about religious clothing in the wake of recent terrorist killings in the country.

The images of police confronting the woman in Nice on Tuesday show at least four police officers standing over a woman who was resting on the shore at the town’s Promenade des Anglais, the scene of last month’s Bastille Day lorry attack.

After they arrive, she appears to remove a blue long-sleeved tunic, although one of the officers appears to take notes or issue an on-the-spot fine.

The photographs emerged as a mother of two also told on Tuesday how she had been fined on the beach in nearby Cannes wearing leggings, a tunic and a headscarf.

Her ticket, seen by French news agency AFP, read that she was not wearing “an outfit respecting good morals and secularism”.

How would you feel if armed police were patrolling the beach telling your loved ones they are wearing too much clothing? Whatever happened to letting people wear what they fucking want?

Not to mention, I went to the beach in Maine during the summers when all the Canadian autoworkers had their vacation, and I saw enough burly men in banana hammocks to scar me for life. They should have been forced to wear a burkini.








So fucking stupid

The Atlantic has gotten so bad it makes me long for the days of Douthat, McArdle, and Sully:

It’s 2020, four years from now.

[….]

As the presidential primaries unfold, Kanye West is leading a fractured field of Democrats. The Republican front-runner is Phil Robertson, of Duck Dynasty fame. Elected governor of Louisiana only a few months ago, he is promising to defy the Washington establishment by never trimming his beard. Party elders have given up all pretense of being more than spectators, and most of the candidates have given up all pretense of party loyalty. On the debate stages, and everywhere else, anything goes.

I could continue, but you get the gist. Yes, the political future I’ve described is unreal. But it is also a linear extrapolation of several trends on vivid display right now.

What possible purpose could this kind of sub-Borowtiz material serve?

Yes, our political system has gone crazy but someday it may be sane, and Jonathan Rauch will still be a pompous idiot.



Oscar lays off their underpants gnomes

February:

Oscar is able to get young and healthy people on an expensive network and high risk adjustment payments.  I can’t figure out their business model past the buzzwords.

March:

Oscar is incurring losses of roughly $145 Per Member Per Month (PMPM) in its biggest market.  It is charging roughly $190 PMPM in net premiums.  Some of the loss is due to risk adjustment (~$20 PMPM) as Oscar’s entire business strategy is to cater to tech savvy individuals who tend to be young and healthy…

I think there are two take-aways.  First, I still can’t figure out Oscar’s business model.

Secondly, setting up an insurance company or expanding an incumbent carrier into new lines of business and new areas is tough.

 May:

Oscar’s strategy has been to use their web/mobile technology platforms to be the hip/cool/disruptive insurer for the next generation.

The market segment that both of these plans seem to be aiming for are people who are fairly young, active, technologically savvy and very healthy….

Assuming a hypothetical individual could be covered by both insurers for the same treatment, Centene is paying significantly less per service than Harken because Centene’s basing its provider contracts on Medicaid rates instead of commercial or Medicare rates.

Centene and other Medicaid like Exchange providers are targeting roughly the same type of population but since they are much cheaper post subsidy, they are probably getting a far larger population to amortize their fixed costs over plus any service that they do need to pay for, they are paying for at a lower rate.

From here, I am having a hard time seeing how plans that have a “lifestyle” component can compete against Medicaid like Exchange providers.  Maybe it is different off-Exchange where everyone is paying full premium and “cheapness” is not a strong selling point.

June

I’ve been skeptical about Oscar as I can’t figure out their business model besides build a cool app and then profit???

Ohhh… no one has ever thought about medical management and early chronic care intervention.  My cube wall mate spends 90% of her time working on our algorithms to identify members who are likely to be expensive before they become expensive so that we can intervene. …

Oscar is trying to go narrow network or quasi-TPA support for health systems that want to run a home host insurance product that should allow them to control costs. But those strategies are common.  That is what I spent most of 2013 working on building hyper narrow networks for both Exchange and Commercial ESI.  That is what my 11:30 meeting tomorrow is about.

And August from Bloomberg:

Oscar, which pitches itself as a tech-savvy alternative to traditional health insurers, plans to end sales of Affordable Care Act plans in Dallas, a market it entered this year, and New Jersey. It’s part of a more conservative approach by the New York-based company as it plans to introduce insurance products for businesses next year….

The company said it’s quitting New Jersey mainly because its network of doctors, hospitals and other health providers isn’t a “narrow network” — a relatively closed, but lower cost, group of providers that many in the industry see as a way to keep expenses down….

In the interview, Schlosser said the company’s new plans focus more on Oscar’s strengths, particularly narrow networks. Along with lower costs, using more narrow networks gives the company a larger role in coordinating the care of its customers…

By the end of next year, Oscar wants to begin offering health plans for larger employers, Schlosser said.

I have not been able to figure out Oscar’s business model.  It was always a flashy app/front end with loads of good marketing and Venture Capital buzzword bingo, handwaving about disrupting the marketplace and then PROFIT!!!

The little bit about Oscar trying to go to the large group market segment is interesting as in some ways that is the easiest segment to operate.  Bills get paid on time, there is no risk adjustment payment flows to worry about and the population is comparatively health with comparatively low variance.  It is also a segment that is most inclined to want big networks and is the least price sensitive.  It is a hard market to get into but a fairly easy market to set up the plumbing for.

But as the reality that being an insurer is HARD sinks in, let us all have a moment of silence for all of the now laid off underpants gnomes who have nothing to do between deploying cool frontward facing tech and PROFIT.  They have a rough life so let us appreciate those gnomes.



Lines On the Map: The Human Geography of the US’s Southern Border

ghmap

(Map 1: US Borders Prior to the Treaty of Guadalupe Hidalgo*)

With all the discussion, both in the current election cycle and year in and year out, about immigration to the US, as well as how to secure the US’s southern border, what often gets ignored is how the US got its southern border. Specifically the human geography of the southwestern US and their relationship to its border. After the conclusion of the Mexican War, in February 1848, the US and Mexico completed the negotiation of the Treaty of Guadalupe Hidalgo. The Treaty of Guadalupe Hidalgo did several things, but among them it moved the US’s southern and western borders to roughly where they are now. Basically we moved the line on the map. As was, and still is, the case when borders are drawn the people living on either side of the old and/or new borders do not always pay a lot of attention to that border in their daily lives. This can be seen in kinship maps of various parts of the world where borders were drawn, often by people far from where the borders were or would be, that subdivided or bisected members of kinship groups into separate states regardless of the reality on the ground. You can see this on ethnic maps throughout Africa, the Middle East, Central Asia, and other parts of the world.

This is also the reality with the US’s southern border. The Treaty of Guadalupe Hidalgo officially moved the lines on the map, but the day to day experience – the pattern of human settlement and the human geography of the region did not really change. Sure, more of what we now call non-Hispanic whites moved into New Mexico and west Texas and Arizona and Southern California, but the overall human geography – the people, places, and things that make up that pattern of human settlement didn’t change all that much. If you look at the pattern of settlement, based on 2010 Census data, you’ll see that where Hispanics and Latinos were living in the southern US hasn’t changed a lot. The highest density areas are still in the southwest.

hispanic

(Map 2: Hispanic or Latino Population of the US**)

You’ll notice that on both the map prepared for the negotiations of the Treaty of Guadalupe Hidalgo and the Rural Health Information’s map of Hispanic or Latino population of the US based on the 2010 Census that the area that the US would get from Mexico in 1848 is still where the largest percentage of the Hispanic or Latino population of the US live. This doesn’t count south Florida, which has a different historic pattern of Hispanic settlement. What the patterns of settlement shown on the maps show us is that the border was moved on the map, but the pattern of settlement remained largely unchanged.

And off and on for almost a hundred years that border was open. People went back and forth for familial reasons, for economic reasons, for social reasons, and for political reasons (don’t forget the Mormon exodus to Mexico in the late 19th Century and their return to the US in the early 20th Century). At different times throughout the 20th Century there have been attempts to seal the southern border for security reasons, which were sometimes/often conflated with xenophobia and anti-immigration sentiment. There were also attempts by the Mexican government to police their northern border to prevent (accused) criminals from crossing into the US illegally to escape justice. And all of these, over the course of a decade in the 1940s into the 1950s culminated with Operation Wetback – the last, named operation to deal with the issue at that point in time. These efforts to regulate the southern border also included guest worker programs, like the early 1940s Bracero Program. In the 1980s the Reagan Administration pushed the Immigration and Reform Act of 1986 that included a pathway to citizenship. Later, in the 1990s, there was Operation Gatekeeper, the Clinton Administration attempt to secure the southern border. And there was also the disastrous impact of NAFTA and the war on drugs on Mexico’s economy, driving millions north in search of work to support themselves and their relatives at home. And through it all the pattern of settlement in the southwestern US has not changed very much. Until this reality – that the border may have been moved in 1848, but not the demographics of the population – is acknowledged in the debate on what to do with the migration across the US’s southern border, then it will not be possible to formulate feasible, acceptable, and suitable policies for immigration into the US across the southern border and how to best regulate and regularize it.

* Map found here.

** Map found here.



APTC Hacks, BHP and 1332 Waivers

The ACA has two non-Exchange means of significantly expanding and configuring coverage.  The Basic Health Plan (BHP) allocated 95% of the combined funding of the Advanced Premium Tax Credit (APTC) and Cost-Sharing Reduction (CSR) subsidies of a state that would have been paid to cover people earning between 138% and 200% of the Federal Poverty Level (FPL).  Those funds are then used to create a low cost network (usually paying provider Medicaid plus something rates) to offer high actuarial value coverage.  New York and Minnesota and currently the only states offering BHPs.

The other method a state can use to rejigger their coverage arrangements is through a 1332 State Innovation Waiver.  These waivers allow states to re-arrange minimal acceptable coverage, eligible populations, subsidies and most other ACA requirements as long as the end result covers at least as many at least as well for no more federal cost than the traditional Exchange based methodology.

Right now, most of the 1332’s (with the exception of a potential Colorado single payer 1332) that are being proposed are fairly technical back-end fixes.  For instance, Massachusetts wants to re-align merged risk pool provisions for the small group market.  That is valuable.  It is not a system transformation effort.

Both of these alternative pathways have strong budget constraints.  The BHP program must cost the federal government no more than 95% of the traditional effort.  The 1332 process must be budget neutral.

States that want to engage in large scale systemic experimentation with either the BHP or 1332 waiver processes need to be aware of what strategies carriers are offering in their market.  If a state’s markets are dominated by Silver Spam strategies, the budget flexibility to engage in large scale reform will be severely constrained.  Silver Gap strategies will give states significantly more budgetary resources to use for BHP and 1332 demonstration projects.

Let’s go below the fold to explore why.

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Wednesday Morning Open Thread: Wonky Works

Apart from committing to GOTV, what’s on the agenda for the day?



Magnitude 6.1 Earthquake hits Umbria, Italy

100px-Amatrice-Stemma

(Coat of Arms; Amatrice, Italy)

Early this morning (local time) a magnitude 6.1 earthquake hit the Province of Rieti in central Italy.

250px-Rieti_in_Italy.svg

(Map of Rieti Province of Italy)

The town of Amatrice in the neighboring region of Umbria was especially hard it. The mayor has stated that:

says residents are buried under the debris of collapsed buildings and that “the town isn’t here anymore.”

As with any news of this type, expect the information to form up over the next 24-72 hours.








Late-Night Open Thread: ‘Our’ Revolution Will Not Be Well-Organized

Jeff Weaver seems to have trouble making new friends. From Alex Seitz-Wald’s comprehensive NBC.com article:

As Bernie Sanders prepares to launch an organization meant to carry on his presidential campaign’s political revolution, it’s been jolted by legal questions, abrupt leadership changes and mass resignations.

The group, dubbed Our Revolution, is set to debut Wednesday evening. But eight of the group’s 13 or so staffers resigned over the weekend after former campaign manager Jeff Weaver was brought in to run the group. The remaining staffers, some of whom stayed for personal reasons, all sent letters to Sanders expressing concerns with Weaver and solidarity with those who quit.

The departures were first reported by Politico and BuzzFeed, but new details uncovered by NBC News from multiple sources close to matter reveal the depth of the turmoil inside the organization that controls Sanders’ lucrative email fundraising list and which many progressives hope will become a powerful force on the left wing of the Democratic Party…
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Open Thread: Hard-Earned Pushback

Even the Ragin’ Cajun, per Politico:

“Somebody is going to hell” over the political attacks on the Clinton Foundation, longtime Clinton confidant James Carville declared Tuesday, denouncing the recent scrutiny and criticism of the charitable organization.

If the Clinton Foundation had decided not to accept foreign donations while Hillary Clinton was secretary of state, as it has recently announced it would do if she is elected president, Carville said on MSNBC’s “Morning Joe” that the “good” thing would be that the organization would not be part of the political discussion.

“The bad would be you’d be out hundreds of millions of dollars that are doing good. What the Clinton Foundation does, it takes money from rich people and gives it to poor people. Most people think that’s a pretty good idea,” Carville said…

“I wish I could say the word I want to say. I’ll just say that’s BS,” Scarborough remarked. “You know the fact is if it’s a great charity and it’s a five-star rated charity, guess what, other people can raise the money. It doesn’t have to be Bill Clinton calling somebody up making people think, if I give him money it could help me out. If it’s a great charity, it can stand on its own and other people can raise money for it. It’s not a zero-sum game. It’s not having Bill Clinton raise money while his wife is running for president or else we’re all going to hell and little kids are going to die across the planet.”

“They’re gonna,” Carville shot back. “The other thing is, Bill Clinton has more charm and people around the world have an enormous amount of faith in him. I’ve traveled with him. I’ve seen it myself. There are not many people that have the relationships and are held in the affection around the world as Bill Clinton.”

But Joe Scarborough and his fellow Media Village Idiots are never gonna meet any of the people the Clinton Foundation has helped at a Beltway cocktail party, so who cares what happens to them?



Tuesday Evening Open Thread: Ban Sidhe

Ask me, I’d say he was undergoing advanced hair repair therapy, because in press photos from the weekend his latest dye job was matching offputtingly well with the fluorescent-lime bracelets and trinkets in the audience. (Dude: Use some of the cash you’re grifting from the RNC to pay a skilled wig crafter, and save us all a lot of ugliness, okay?)

But maybe he is feeling a cold trickle of electoral doom down his spine…

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


(via NYMag — yes those are Kara Walker shadow puppets!)



Wait, WHAT?

daisy_che

Okay, so as I mentioned a while back, my dog Daisy badly cut the pad of her right paw. It is healing nicely, but there’s one spot where her claw rubs up against the wound, and it’s not altogether healed.

The vet recommended that we soak her paw in a medicated solution for 10 minutes twice a day. Is there a way to get a dog to soak a foot without hog-tying the dog? I could put her in a washtub and soak all four feet, but that seems wasteful.

Feasible, non-cruel suggestions gratefully considered. Thanks! And open thread!








Ladies Who Lunch (Open Thread)

This looks like a Norman Rockwell painting:

2016-08-23

The photo is one of a series of 1940s-era color photos taken by Farm Security Administration workers and reprinted in the Washington Post today.

The women pictured above were employed as “wipers” (whatever that is) in the “roundhouse” (whatever that is) at the Chicago and Northwestern Railroad in Clinton, Iowa, in April 1943. Photo credit: Jack Delano/Courtesy of Taschen

Open thread!








Remember, Catfish are Bottomfeeders

This election gets weirder and weirder:

Steven Wessel is a convicted con man with a Big Apple flair, feigning connections to Ronald Reagan and pretending to be an Oxford man while bilking rich Manhattanites of $750,000. But his last scam before heading to prison this spring targeted a very different kind of mark: Republican operatives opposed to Donald Trump.

And now those operatives are wondering who put Wessel up to it.

Assuming a variety of fake online identities, including that of a female solicitor in England, Wessel gushed in emails, phone calls and Twitter messages about (made-up) extramarital affairs with the likes of the late Lee Atwater, showered marks with gift cards to the swanky Mandarin Oriental, and invited them to go pheasant-hunting in Scotland — all in an apparent attempt to glean more about the operatives and their intentions regarding Trump. That was until federal prosecutors learned of the activity and a judge revoked Wessel’s bail in April, sending him to prison to begin serving a 55-month sentence ahead of schedule.

In a campaign season marked by the mind-bending, the — until now unreported —caper of Wessel’s months-long “catfishing” of operatives Rick Wilson, Liz Mair and Cheri Jacobus ranks among more bizarre episodes. It could get more bizarre still. The targets of the scheme do not believe that Wessel, described by his own lawyer as mentally ill, was acting alone. This month Jacobus, who said she believes Wessel was working in concert with allies of Trump, renewed her efforts to get the FBI to investigate the scheme.

Read the whole thing.








Open Thread: It’s A Grift, All the Way Down



APTC Hacks, Non subsidized plans and choice revelation

Advanced Premium Tax Credits (APTC) are only relevant for people who buy policies on the Exchanges.  However the subsidized universe is only about half of the entire individual market.  The non-subsidized and off-Exchange universes will help us determine how carriers embark on their Silver pricing strategies.

If an individual would have qualified for an APTC but buys an off-Exchange policy for whatever reason, they do not get any subsidy to help offset the premium.  They pay full price.  There are some non-subsidized buyers on the Exchanges.  A common case will be people with variable incomes who are not sure if they are subsidy eligible.  They may overestimate their income so they don’t have to pay the APTC back but if they have a bad year, they can collect the Premium Tax Credit the following year when they file for their tax refund.  People who know that they can not qualify for the Exchange have no reason to shop on Exchange.  Indeed, they have a mild incentive to look off-Exchange.

Policies that are sold on Exchange must be offered off-Exchange.  However carriers can offer policy and plan designs off-Exchange that they do not offer on Exchange.  Mayhew Insurance did that in 2014 with an experimental product as we needed data to see if our hunch was right (we weren’t).  Carriers can decide to only participate off-Exchange if they wish to do so.  The advantage of selling off-Exchange is that the population is a bit higher income and that tends to correlate with two things; better health and more stability in paying bills.  Even though policies are offered off Exchange, the on and off-Exchange policies in a single metal band in a state are in a common risk pool for risk adjustment purposes.

Off Exchange has a typical policy buying decision maker earning over 400% Federal Poverty Level (FPL).  On Exchange, subsidized buyers have a median policy decision maker earning around 200% FPL.  These are very different market segments.  And those differences can feed some insight into why a carrier that has the ability to capture the #1 and #2 Silver positions would engage in either a Silver Spamming or Silver Gapping strategy.

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