Security Theater Open Thread: Wolverines! — Not the UM Kind

As ever, the brilliance of the Trump Administration: Getting a roomful of people with every reason to hate Islamic terrorists united in anger against… the Trump administration. Per the Detroit Free Press:

In a meeting today with Arab-Americans and Muslims in Dearborn, Department of Homeland Security Secretary John Kelly stood up at one point and threatened to leave after a community advocate accused the department of targeting their communities, according to meeting participants.

The tense exchange took place during a hour-long meeting at the Arab American National Museum in Dearborn, where Kelly met with several Arab-American and Muslim advocates as part of a visit to metro Detroit. At a separate earlier meeting with immigrant, Latino, and Chaldean advocates, some also criticized the department for allegedly targeting minority groups…

At the meeting, Nabih Ayad, an active civil rights leader and attorney who is founder of the Dearborn-based Arab American Civil Rights League, said he pressed Kelly about executive orders from his department that target six Muslim-majority nations.

He also mentioned alleged profiling of Arabs and Muslims at ports of entry. Ayad said he asked Kelly to create a record of who gets stopped for questioning at ports of entry so there can be data to see if there is disproportionate targeting of Arabs and Muslims.

“He stood up and walked away almost,” Ayad said. “He said, I’m leaving unless you decide to stop your questions and have someone else ask a question. … He actually got out his seat.”

Ayad said he then stopped his comments and another Arab-American advocate started to speak. Ayad’s account was confirmed by two other Arab-Americans who attended the meeting. U.S. Sens. Debbie Stabenow and Gary Peters, who had invited Kelly to Michigan, were also at the meeting…



Potentially good news everybody

Two ACA related stories from yesterday.

The first is from the Hill on the Cost Sharing Reduction subsidies:

Key House Republicans on healthcare say they want to find a way to fund ObamaCare payments that they previously sued the Obama administration over.

The payments, known as cost-sharing reductions, reimburse insurers for providing discounted deductibles for low-income ObamaCare enrollees. If the payments were canceled, insurers warn they could pull out of the market because of the hole left in their budgets, causing chaos….
top Republicans say they realize they need to fund the payments. Providing that funding would go a long way to stabilizing the market and removing a major source of insurer anxiety

If CSR is funded with 100% certainty, insurers will get into the market. Every other risk can be priced into the premiums that are to be submitted this summer. CSR cut-off risk effectively can not be priced into rate submissions. If CSR is cleanly funded, that would be an excellent indicator that the Trump Administration will at most clip the ankles of the ACA instead of making a studs up tackle straight into its knees.

And now onto Kansas:

Large but short of veto-reversing super-majorities in both houses of the Kansas legislature just voted for Medicaid expansion. Gov. Brownback will most likely veto the bill because of argle-bargle-cargle reasons. But there is a flurry of states that are pushing forward on Medicaid expansion. Georgia most likely will submit an Indiana style waiver, but Maine may try yet again to expand as they have a demonstrated legislative coalition to expand.








Wednesday Morning Open Thread: Stee-RIKE!


.

Apart from booing the Coward-in-Chief, what’s on the agenda for the day?

A trip to the mound for Donald J. Trump in the near future would be anything but ceremonial. It would mark the first time our president, who ran on the platform of American Toughness, showed his face in public since his inauguration. Over the last three months, Trump has been safely chauffeured from the White House to one of his hotels to his campaign rallies to his private club and back again, insulated by a gauzy cocoon of yes-men who tell him that any polls that show him to be unpopular are fake, and any people protesting against his agenda are paid. In the early days of his own presidency, Barack Obama participated in town halls, appeared on The Tonight Show, and sat courtside at an NBA game between the Wizards and the Bulls. Trump on the other hand was forced to cancel his only public appearance yet, a friendly trip to a Harley-Davidson factory in Milwaukee, out of fear that protesters would steal his headlines and undercut his populist narrative.

Potential booing aside, Trump would surely welcome a chance to show off his athletic prowess and Adonis-like physical form. After all, according to his personal physician, the soon-to-be-71-year-old is the “healthiest individual ever elected president”—George W. Bush’s six-minute miles and Barack Obama’s visible abdominal muscles be damned.

Trump has actually already thrown out a ceremonial first pitch once, as a civilian back in 2006 in honor of the Jimmy Fund (see photographic evidence here), so I know it’s possible. And with the baseball season rapidly approaching, I decided to sleuth it out myself….

[NSFB Warning: Do *not* click on that link during breakfast or while consuming fluids]



On The Road

Good Morning All,

This weekday feature is for Balloon Juicers who are on the road, travelling, etc. and wish to share notes, links, pictures, stories, etc. from their escapades. As the US mainland begins the end of the Earth day as we measure it, many of us rise to read about our friends and their transient locales.

So, please, speak up and share some of your adventures, observations, and sights as you explore, no matter where you are. By concentrating travel updates here, it’s easier for all to keep up-to-date on the adventures of our fellow Commentariat. And it makes finding some travel tips or ideas from 6 months ago so much easier to find…

Have at ’em, and have a safe day of travels!

Should you have any pictures (tasteful, relevant, etc….) you can email them to picstopost@balloon-juice.com or just use this nifty link to start an email: Start an Email to send a Picture to Post on Balloon Juice



Late Night Open Thread: Trumpcare, Not Dead Yet! (*Thunk*)

The NYTimes:

House Republican leaders and the White House, under extreme pressure from conservative activists, have restarted negotiations on legislation to repeal the Affordable Care Act, with House leaders declaring that Democrats were celebrating the law’s survival prematurely.

Just days after President Trump said he was moving on to other issues, senior White House officials are now saying they have hope that they can still score the kind of big legislative victory that has so far eluded Mr. Trump. Vice President Mike Pence was dispatched to Capitol Hill on Tuesday for lunchtime talks.

“We’re not going to retrench into our corners or put up dividing lines,” House Speaker Paul D. Ryan said after a meeting of House Republicans that was dominated by a discussion of how to restart the health negotiations. “There’s too much at stake to get bogged down in all of that.”…

Mr. Ryan declined to say what might be in the next version of the Republicans’ repeal bill, nor would he sketch any schedule for action. But he said Congress needed to act because insurers were developing the premiums and benefit packages for health plans they would offer in 2018, with review by federal and state officials beginning soon.

The new talks, which have been going on quietly this week, involve Stephen K. Bannon, the president’s chief strategist, and members of the two Republican factions that helped sink the bill last week, the hard-right Freedom Caucus and the more centrist Tuesday Group.

Any deal would require overcoming significant differences about how to rework a law that covers about one-fifth of the American economy, differences that were so sharp they led Mr. Trump and Mr. Ryan to pull the bill from consideration just as the House was scheduled to vote on Friday…

Meanwhile, per Politico:

Minority Leader Nancy Pelosi (D-Calif.) sent a letter to her caucus Tuesday, requesting members send their ideas to strengthen the law as soon as possible. Pelosi and ranking members of the committees with health care jurisdiction will discuss the proposals in a meeting Wednesday morning.

“After the collapse of TrumpCare, we must ensure that the Trump Administration does not sabotage the ACA out of spite,” Pelosi wrote. “Then, we can work to improve and update the Affordable Care Act and the health security it provides tens of millions of Americans.”

Pelosi ended the letter by calling last week’s repeal collapse, which stemmed from dwindling Republican support and unified Democratic opposition, a “thrilling success.” Democrats aren’t planning to introduce a full-scale alternative or even a comprehensive overhaul but are looking at specific areas within the 2010 health care law to target for improvement…

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The Maskirovka Slips XIII: A Few Thoughts

In the comments to the Maskirovka Slips XI post, PJ wrote:

Even a Putin critic like Masha Gessen has claimed that Russophobia is behind the allegations connecting Trump with the Russians, and that there’s nothing to see here, folks.

This is a good point to raise and something to keep in mind as everything continues to play out. My guess is that PJ was referencing this article by Gessen at The NY Review of Books. Gessen’s essential thesis is that:

Russia has become the universal rhetorical weapon of American politics. Calls for the release of Trump’s tax returns—which the group Citizens for Responsibility and Ethics in Washington (CREW) hopes to have subpoenaed as a result of its lawsuit alleging the violation of the Emoluments Clause—are now framed in terms of the need to reveal Trump’s financial ties to Russia. And the president himself is recapturing the campaign debate’s “No, you are the puppet” moment on Twitter, trying to smear Democratic politicians Charles Schumer and Nancy Pelosi with Russia.

The dream fueling the Russia frenzy is that it will eventually create a dark enough cloud of suspicion around Trump that Congress will find the will and the grounds to impeach him. If that happens, it will have resulted largely from a media campaign orchestrated by members of the intelligence community—setting a dangerous political precedent that will have corrupted the public sphere and promoted paranoia. And that is the best-case outcome.

And that this almost unrelenting focus is obscuring equally, if not more important matters:

Imagine if the same kind of attention could be trained and sustained on other issues—like it has been on the Muslim travel ban. It would not get rid of Trump, but it might mitigate the damage he is causing. Trump is doing nothing less than destroying American democratic institutions and principles by turning the presidency into a profit-making machine for his family, by poisoning political culture with hateful, mendacious, and subliterate rhetoric, by undermining the public sphere with attacks on the press and protesters, and by beginning the real work of dismantling every part of the federal government that exists for any purpose other than waging war. Russiagate is helping him—both by distracting from real, documentable, and documented issues, and by promoting a xenophobic conspiracy theory in the cause of removing a xenophobic conspiracy theorist from office.

Gessen has likely forgotten more about Putin and how he operates than most people will ever know, and I doubt she’s forgotten much if anything. And her concerns and caveats are important to keep in mind going forward. However, I think her concerns, as rooted in her excellent column on autocracy from November 2016, are also missing something: the overwhelming, open source reporting and documentation about the connection between the President, his business the Trump Organization, his children, and both senior and peripheral members of his campaign, his transition, and now his Administration with Russian government officials, Russians connected to Russian Intelligence – formally and informally, Russian oligarchs tied to Vladimir Putin, Ukrainian Oligarchs tied to Vladimir Putin, and people – Russian and non-Russian tied to Russian organized crime.

As I’ve been stating here, and Malcolm Nance has been tweeting and stating on a variety of news platforms:

And, to quote Ian Fleming, as many have:

Once is happenstance. Twice is coincidence. The third time is enemy action.

As Evan McMullin tweeted:

While I think it is important to keep Gessen’s concerns in mind, we have significant amounts of circumstantial evidence as a result of open source reporting and documentation. What we don’t have, what we don’t really know, is what the material that the Interagency Counterintelligence (CI) Task Force investigating all of this has. And here, I think, is where some of Gessen’s concerns begin to break down: a lot of the leaking hasn’t been anything that wasn’t either already known in the open source reporting and documentation for those that knew where to look or were looking and/or were intended as warning shots across various people’s bows. For instance, the leaks about Attorney General Sessions were the latter. They were intended to put him on notice that if he tried to muck about with the CI investigation the next shot wouldn’t be for range, it would be for effect. And to his credit, AG Sessions was smart enough to recognize this and recused himself.

As I’ve written here before, several times:

As a national security professional, what I would like to see is the President-elect address the now long standing and ongoing allegations regarding his connection to Russia. If the allegations are spurious, as he and his team have claimed every time they’ve come up, or if there is a straightforward and simple explanation that can be made, he needs to make it. I think a lot of the foreign, defense, and national security policy concerns that many across the political spectrum have with the President-elect’s longstanding policy preferences dating back to 1987 arise from all of the smoke around the claims of Russian connections and interference for Russia’s, not the US’s, not the President-elect’s, interests.

The sooner the President-elect and his team can either provide evidence for why the allegations and rumors are spurious or provide a simple and straightforward explanation for the seeming preference for Russia and the abandonment of the post WW II and post Cold War international order the better.

Unfortunately we’ve reached a point where I’m not sure a straightforward and simple explanation can be made. The circumstantial evidence we’re all able to review from the open source reporting and documentation seems to have obliterated that possibility. Yesterday several of the surviving members of the investigative reporting team that included the late Wayne Barrett provided even greater details and granularity into the Trump Organizations connections to Russian organized crime via Felix Sater and Sater’s ties to the Department of Justice and the FBI, specifically the New York Field Office. Today WNYC reported on some of Paul Manafort’s real estate transactions that appear to follow the same patterns as those done to launder money. These stories broke almost at the same time as Richard Engel’s reporting on Manafort’s financial dealings in Cyprus, USA Today‘s reporting on the Trump Organizations alleged ties to Russian and other state’s organized crime,* The New Yorker‘s multiple reports, and Michael Issikoff’s reporting on the ongoing mess that Congressman Nunes’ actions and statements have made of the House Permanent Select Committee on Intelligence. This includes functionally shutting the committee down so that the House of Representatives no longer conducts oversight of the US Intelligence Community given that all future business of the committee has now been postponed indefinitely.

For those of us that have been following these things for a while, a lot of this wasn’t new, surprising, or both. And that’s really why I think Gessen’s caveats and concerns are important to keep in mind, but that she is also missing the forest for the trees. There is just too much coincidence here. The US Intelligence Community does not form Interagency Counterintelligence investigations willy nilly. Nor do judges approve FISA warrants for spurious or frivolous reasons. I honestly have no idea where all this will lead. And I do agree with Gessen and others that even if these investigations ultimately demonstrate actual connections and collusions between the President’s campaign and the Russians which given how things have been intertwined under Putin basically includes the Russian government, Russian intelligence, Russian oligarchs, and Russian organized crime, we may not see the resolution that many are hoping for. These connections are all linked together, which also makes unravelling this ball of yarn difficult. Part of the problem going forward is exactly why we have been in a Constitutional crisis for months. It is unclear which, if any, of the institutional protections and remedies that the Constitution delineates actually could be used to resolve what we have been watching slowly unfold since last Summer when the leaks of hacked DNC, DSCC, DCC, and John Podesta emails began to trickle out. If there is nothing to see here, as Gessen attests, then there certainly is a whole lot of a very specific type of nothing** all around the President, his family, his business, his campaign, his transition, and his Administration.

* The Who, What, Why?USA Today, and WYNC reporting are not actually breaking news. They do provide substantially more details about things that have been previously reported, documented, and/or known.

** And this nothing doesn’t even get into financial ties between the President and PRC state owned banks, which are facially violations of the emoluments clause as a result of the President’s failure to properly and fully divest from his business.



I’ll remember April

American Urban Radio Network’s April Ryan isn’t having any of Spicey’s whiny bullshit.

On Tuesday he again showed his manipulative and churlish side in an exchange with April D. Ryan, the longtime White House correspondent and Washington bureau chief for American Urban Radio Networks. Ryan has been sitting through White House briefings since the second term of President Bill Clinton, and she had a big-picture question for Spicer after some rocky months for the Trump administration. “Two and a half months in, you’ve got this [Sally] Yates story today, you’ve got other things going on, you’ve got Russia, you’ve got wiretapping,” said Ryan, until Spicer cut her off.

[….]

After some more pushback from Ryan, Spicer said, “I appreciate your agenda here.” He said that people briefed on the Russia thing have reached the same conclusion about this matter. And as he unfurled his explanation, he snapped at Ryan: “I’m sorry that that disgusts you. You’re shaking your head. I appreciate it,” he said with sarcasm.

As a matter of fact, Ryan was displaying unimpeachable body language at that moment.








Greetings From My Underground Lair

I headed north on Sunday to visit ABC for a few days, and tomorrow I will be taking a megabus from Connecticut to Boston, where I will be for three days for work related things. I’m actually m ore excited about taking the megabus than I am the actual trip, but that’s just because I am a god damned weirdo.

At any rate, since I will be in the area, I was thinking of doing a potential Boston meetup. Or maybe not, as I am a fickle son of a bitch.

I DID BRING PANTS THOUGH!








Long Read: “A Post-presidency Like No Other”

Krissah Thompson and Juliet Eilperin, in the Washington Post:

So far, Obama is trying to approach his post-presidency in the same way as his cocktail-hosting duties — keeping things low-key, despite clamoring from Democrats for him to do more. “He is enjoying a lower profile where he can relax, reflect and enjoy his family and friends,” said his former senior adviser Valerie Jarrett.

But the unprecedented nature of this particular post-presidency means his respite could be brief. Even while taking downtime at a luxurious resort in the South Pacific last week, Obama put out a statement urging Republicans not to unilaterally dismantle his signature health-care law.

Not only are the Obamas still young and unusually popular for a post-White House couple, but their decision to stay in Washington while their younger daughter finishes high school has also combined with the compulsion of the new Trump administration to keep pulling them back into the spotlight…

He has attempted to stay above the fray, watching from the sidelines as Republicans have pressed to unravel a slew of his initiatives — and emphasizing the need for a new generation of political leaders to step up in his place.

And yet, while other recent ex-presidents have devoted their retirement years to apolitical, do-gooder causes, Obama is gearing up to throw himself into the wonky and highly partisan issue of redistricting, with the goal of reversing the electoral declines Democrats experienced under his watch…

For now, Obama is delegating political work to associates — notably former attorney general Eric Holder, whom he has tapped to lead the redistricting project that aims to help Democrats redraw legislative maps that many see as tilted toward the GOP. He also endorsed Tom Perez, his former secretary of labor, in a successful bid to become chairman of the Democratic National Committee. His first major speech as a private citizen will come in May, when he will be awarded a John F. Kennedy Profile in Courage Award as part of a celebration of Kennedy’s centennial.

Michelle Obama, who has a team of four staffers in the office, is spending more time than her husband in Washington, working on her own post-White House book while remaining focused on the home front.

“She’s got one daughter to get off to college, another is a [sophomore] in high school. All of that comes first,” said Tina Tchen, her White House chief of staff. “Now she will also be working on the book and still keeping up her engagement with the community as she always has.”…



Why the ACA Matters

Remember faithful reader cope, who occasionally shares lovely nature photos? Here’s a photo he took of some distressed flowers:

And also a story to go along with them, shared with cope’s permission (and with just a few alterations to protect his privacy):

Four weeks ago tonight, at about 9:15 (past bedtime here in copeville), we received a phone call from the Mayo Clinic that a donor liver had been found for my wife. She had been on Mayo’s liver donor list since December. Needless to say, within 30 minutes we were on our way. At about 7:45 the next morning, she was wheeled away for prep and transplant surgery and by 3:00 in the afternoon, she was back in her room.

After about 10 days at Mayo, she was transferred to [another hospital] for physical and occupational therapy and for treatment of fluid on her lungs. Throughout this time, my sister-in-law and I made a tag-team effort of being with her at all time, sleeping in her hospital room during the rare times when sleep was to be had. I am still working as a high school science teacher (but only 45 days away from retirement!) so I had weekend duty while SIL had the week days. Happily, spring break intervened… You can appreciate our utter and total joy at being told just 3 weeks and one day after surgery that we could come back to our house and our dogs. My wife is doing extremely well (we hit the local Michael’s for some retail therapy this afternoon) and this is the closest to “normal” our lives have been for months.

The fact that my wife even has health insurance, much less a sufficiently robust policy to absorb almost all of the costs of such a major procedure is entirely due to the Affordable Care Act. To be sure, since November’s election, we had not been particularly confident that she would still have coverage at the time a donor might be found (we expected to wait for months and months). Happily for us, we need not sweat the big stuff any more.

My wife worked for almost 35 years as an RN doing geriatrics, AIDS, cancer, burns, labor and delivery and finally, in her last chapter as a nurse, home health care. She has been universally loved by her patients and co-workers as she is one of those giving and loving and compassionate and empathetic people who fortunately walk this earth. She is even now loved by the nurses and techs who have been tending her for the last few weeks, many of whom she brings small gifts to when we make our frequent returns to Mayo. To have had to watch her waste away as her deteriorating liver tried (and failed) to kill her was a miserable, debilitating, depressing experience for all of us who love her. Our relief at having broken on through to the other side of these emotions cannot be expressed in words.

I chose this picture of a disheveled, sunlit flower against a background of dark, looming clouds as a pretty good visual metaphor for what our family experienced these past few months: the struggle to maintain a positive, sunny disposition in a dire and ominous situation.

See, sometimes, good things do happen.

Best jackal wishes to cope’s wife as she recovers. Her story is a great reminder about the stakes in Trump’s war on the ACA. The shitgibbon was dealt a defeat last week, but he and the other ghouls in the GOP will be back. For all its faults, the ACA does represent a huge top-down transfer of wealth, and Republicans will fight an insult like that to the last breath. We need to remain vigilant.

Open thread!



Tremendous cream

Years ago, James Carville said of the Paula Jones suit against Clinton, “If you drag a hundred-dollar bill through a trailer park, you never know what you’ll find.” At the time I thought it was funny, now I think it’s offensive and the antithesis of what liberals should say and think about lower-income Americans who live in mobile homes. The central point, however, that many of the people involved in this suit were being paid off by wealth wingers, is probably correct.

Here’s one thing that’s certainly true though: you put billions of rubles in front of grifters, you never know what you’ll get them to do. It looks like Manafort got upwards of $20 million from Putin cronies in total. Kushner’s family might have made half a billion in some shady deal with Russian banks. That’s real money. You know lots of people around Trump had their hands out. Russia would be willing to pay tens of billions of dollars to get sanctions lifted. You think there aren’t half a dozen people around Trump, including probably Trump himself, who are scheming for a way to get their cut?

That’s why even if there’s no collusion with the Wikileaks hacks (which is possible) and if Louise Mensch’s fever dreams are all wrong (which is likely), there’s plenty of nefarious doings here that the Republicans in Congress will want to cover up. So the cover ups will go on and on.








Swamps, All the Way Down

Good lord, this Trump-Russia thing is not necessarily developing to the shitgibbon’s advantage, is it? Here are three current WaPo headlines:

Trump administration sought to block Sally Yates from testifying to Congress on Russia

Nunes admits meeting with source of Trump surveillance documents on White House grounds

23 people ask the Justice Department to launch a criminal inquiry into its chief, Jeff Sessions

I’ve been out slogging through literal swamps for the past few days, so I’m catching up on the news, which tells of yet more swamps of the figurative variety. The craving for popcorn is damn near irresistible!

via GIPHY

Has there ever been anything like this cascading clusterfuck in the history of the republic? Sometimes it’s necessary to avert one’s eyes, hence the swamp trek. We’re gonna need a bigger boat…

Open thread!



Keep an eye on Cassidy

I’ve been banging the drum that Cassidy-Collins is a plausible framework of a deal since January.  It still is in play.

Let’s start with a statement from Senator Cassidy (R-LA) from last week:

“There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” he said, warning that to throw people off their insurance or make coverage unaffordable would only shift costs back to taxpayers by burdening emergency rooms. “If you want to be fiscally responsible, then coverage is better than no coverage.”

And then he was on CNN pitching Cassidy-Collins last night:

Cassidy-Collins as currently written needs a lot of work. People much smarter and more informed than me have told me that there are significant ERISA issues in Cassidy-Collins as currently written. But as a start of a discussion that could conceivably aim for 65 or more Senators getting on board, this is a vehicle which could entrench the expectation that everyone gets some decent if not great coverage.
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Collective action problems and races to the bottom

Insurers in a free, unregulated market with imperfect information and very expensive right hand tails of risk distribution will quickly converge to offering really bad coverage.  This is a sub-optimal for everyone involved.  It hurts people who need good coverage.  It hurts society in general as risk is not distributed efficiently.  It hurts hospitals as it guarantees more bad debt.  And it hurts insurers as they are giving up potentially profitable sales in order to protect themselves from a risk dump.

There will be some mathematical intuition required for this post.

Let’s imagine a world that does not involve insurance.  Let’s imagine Abe and Bob both sell furnaces to the same small town.  They both make a good living. Their products are fundamentally similar.  Bob’s furnaces start faster and warm the house quicker, Abe’s machines run quieter. Their current advertising budget is limited to a quarter page Yellow page ad and brightly painted work vans with their phone numbers on it.  The market for new furnaces in their region is effectively saturated and it is a steady business.

In the first year, both Abe and Bob make $100,000 in net profits.  In the second year Mark the Marketeer offers to sell $10,000 of advertising to Abe and Bob.  If one chooses to advertise and the other does not, the advertising furnace guy gets an additional $20,000 in profits but spends $10,000 in advertising.  If they both advertise, Mark gets $10,000 from each and there is a decrease in profits of $10,000 from each of Abe and Bob.  The pay-off matrix is below:

Let’s work through the decision tree. They start in green. Mark makes the pitch. If Abe advertises, his worst situation is $90,000 and his best is $110,000. If he does not advertise, his worst situation is $80,000 and his best is $100,000. If Bob advertises, his worst situation is $80,000 and his best is $90,000. The same applies in reverse to Bob.

If there is neither regulation nor collusion, both of them will advertise. They will see a decline in profits as Mark acts as middleman. Once advertising starts, the logic has both of them advertising frequently in order to protect their own marketshare. They are in a collective action problem.

Insurers are in a collective action problem. Bad benefits drive out good benefits. We talked about this with AIDS formulary design in the summer of 2014:

Once one plan in a market decides to make themselves as unattractive as possible, every other plan has to either follow suit in making themselves unattractive or be willing to take on massive health costs as they become the preferred plan for HIV positive individuals. At that point, there is a local death spiral as the attractive plan has to raise premiums to cover costs which drives them away from the Second Silver subsidy determination point, which then drives away cost sensitive but fairly healthy individuals from the plan. So a region will see either the “nice” plan become a “nasty” plan as a self-defense measure or that “nice” plan will leave the market so the new baseline is “nasty”. It is Gresham’s law for health insurance.

This problem is solvable. The unregulated equilibrium is for plans to be ugly and for plans to spend a lot of time and money on finding ways not to cover people. Regulation is the key. It sets a different set of parameters or at least it governs the depth of ugliness a plan is allowed to descend to. Essential Health Benefits and actuarial value floors limits how much socially counter-productive but firm specific rational behavior can occur.

And once those counter-productive cherry picking tendencies are curbed, a much larger market emerges. That market, once insurers figure out how to price it properly, can be profitable as hell even as it covers millions of more people.








Open Thread: Gimme Sanctuary

Cue the Malevolent Leprechaun, Jefferson Beauregard Sessions III :


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