Debunkery + Dog Spa Report

Among his many other excellent qualities, my husband, Mr. Not-Cracker, makes a great bellwether for how political stories are playing among people who don’t pay close attention to the daily campaign grind and media treatment thereof. He doesn’t read blogs or follow anyone’s Twitter feed. He’ll watch Rachel Maddow or Chris Hayes if I tune in but doesn’t pay close attention. He scans headlines and reads political articles only if they look entertaining.

Of course, he knows Trump is an appalling buffoon. He voted for Sanders in the primary and is looking forward to voting for Clinton in the general. But he’d never heard of Breitbart and had no idea that Trump had appointed a white nationalist as campaign chief until I mentioned it. And when he heard about the AP report on the Clinton Foundation on NPR, he thought it looked pretty bad but figured that’s how politics work: influence peddling is the norm.

So I was happy to be able to forward these pieces by Yglesias at Vox, the first of which ably demonstrates that the AP “exposé” on Clinton’s meetings with Foundation donors is a giant nothingburger, and the second of which explodes the AP’s feeble defense of its original reporting. If you know any non-political junkies who find the Clinton Foundation story troubling, I heartily recommend forwarding the Vox articles, which plainly indicate there is no “there” there.

On to the dog spa: A couple of days ago, I described a conundrum: Our vet recommended that we soak our dog’s injured paw in a medicated solution for 10 minutes twice a day, but I wasn’t sure how to get the dog to sit still for it. Here’s how:

IMG_0606

It turns out she’s willing to just sit there and allow the paw to soak…as long as I keep feeding her (and our auxiliary boxer dog — hind foot and tip of tail visible in the photo above) Goldfish crackers at 60-second intervals. Thanks for all the advice, though.

Open thread!



APTC Hacks – buggering the competitors

On the whole I want as many insurers and states to engage in a Silver Gap strategies.  However there are situations where it can be used offensively to bugger and beggar competitors.  Let’s walk though an example.

The scenario needs one insurer that actually wants to cover people in a county.  It also needs an insurer that for political/strategic/publicity reasons wants to be on Exchange while selling as few policies as possible.  I can think of at least one situation where that is an accurate assessment of the pricing configuration.  The way that a company stays on Exchange but does not sell many policies is to offer a plan design that meets minimum requirements but is a horrendous value proposition while being priced very high compared to its competing plans.

Silver Spamming strategies by the active insurer enable this sit out and wait strategy by the passive/avoiding insurer.  Mild Silver Gapping strategies where the active carrier offers a low price narrow network Silver and then a broader network plan priced 12% higher as the benchmark Silver when the passive Silver is priced 80% above the benchmark will also allow for a passive presence with low enrollment.

However if the active carrier decides that it wants to screw its competitor it can by embracing an extreme Silver Gap strategy.  It would offer its low cost narrow network plan only.  All of the sudden, the passive carrier’s Silver is now the #2 Benchmark Silver.  The #1 Silver by the active carrier has extremely low post-premium prices so it will suck in all of the healthy risk in the market.  The plan that was supposed to be a placeholder gets significant membership that the offering carrier was not anticipating and it is higher risk membership.

So in odd corner cases like this, the Silver Gap strategy can be deployed offensively.



Open Thread: Killed by Their Own Superbug

The Repubs created the Trump virus, a hardened iteration of every ugly racist misogynist xenophobic trope they’ve been doing their best to mainstream since at least 1965. And now the superbug might actually manage to destroy — or at least seriously weaken — its host incubator.

Could not happen to a more deserving bunch of scheming thugs.

Apart from our daily dose of schadenfreude, what’s on the agenda for the day?
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Late-Night “Yeah, We Knew It Was Coming” Open Thread: PIVOT!

JUST IN TIME FOR THE BIG ROLL-OUT!


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Late Evening Open Thread: Cats and Dogs Living Together…

Don’t look directly at the cuteness, it burns!!!!



Open Thread: Donald Trump Has A New Good-Luck Charm

UKIP founder Nigel Farage, the original “Mr. Brexit”. Per Politico:

The former head of the United Kingdom Independence Party will not offer an endorsement of Trump, a source close to Farage said, but will instead offer remarks on how to beat the odds and win an election.

“It came about after his visit to the Cleveland convention,” the source said. “He’s not here to endorse Trump but explain the Brexit story which has similar parallels to the current presidential race — he is going to be talking to grassroots activists about Brexit.”

The Trump campaign did not respond to requests for comment.

Farage was already in Mississippi Wednesday morning, where he did an in-studio radio interview. The source close to him said he will attend a private reception with Trump and 600 Republican donors Wednesday, where he will also be joined by Aaron Banks, a friend of Farage’s and a multimillionaire who bankrolled the U.K. Independence Party…

“Donald Trump dares to talk about things other people want to brush under the carpet,” Farage said in a CNN interview last June. “I think for the United Kingdom, I think Trump will be better for us than Barack Obama’s been. Of that, there is no doubt.”…

To quote NYMag‘s Jon Chait, “There’s Just One Flaw in Donald Trump’s New Plan to Show He’s Not Racist“:

The main difficulty Trump faces in dispelling the impression that he is a racist is that Trump is, in fact, a gigantic racist. His first appearance in the New York Times came in the context of his being caught refusing to rent apartments to African-Americans. A former Trump employee has detailed a series of private racist statements and acts — saying “laziness is a trait in blacks,” objecting to black people working for him in accounting, his staff shooing black people off the casino floor when he arrived. Trump has replied that the comments were “probably true,” but berated the person who made them as a “loser.” He has questioned the legitimacy of President Obama’s birth certificate, called him a “terrible student,” and implied he only made it into Harvard Law School due to affirmative action…



Back from Japan!

Back from Japan, Juicers! Wow, I’m only gone for two weeks and look at everything that’s been going on here! People have been buying homes, rescuing sweet dogs, getting shortlisted for major prizes, and cited by major newspapers. Great work everyone!

Here are some of my recent accomplishments:

1) Managed to NOT confuse the “flush” button with the “emergency” button in the toilet, as I did last year when accompanying my partner to a meeting at Doshisha University in Kyoto. (Nothing like exiting to the sounds of an alarm and into a concerned crowd!) Partly this was due to excellent signage, as per this on the Shikansen (bullet train):

toilet sign shikansen

In Doshisha everything was in Japanese, so I made my best guess, and guessed wrong.

2) Hung out in a Catbus. Happy to report that the Ghibli Museum (dedicated to the works of anime master Hayao Miyazaki), which has always had a Catbus for kids, now also one for adults. It’s fun! Even if all we boring adults did was sit sedately in it instead of crawl all over it. (Internet photo because you’re not allowed to photograph in Ghibli.)

3) Visited a coed onsen (spring-fed hot bath). Hey, even most Japanese women won’t do this! No pics, because what happens in the onsen stays in the onsen. However, let me just say that it’s amazing—at least to this insular American—how nonsexual a room full of naked, sweaty people can be.

4) Got to watch superb, nearly commercial-free, jingoism-free, and unobtrusively commentated Olympics coverage on the Japanese equivalent of PBS. (Which again raised the perennial expat/tourist-in-Japan question: “Why can’t we have such nice things back home?”) And, finally…

5) Remained blissfully removed from all things Trumpian—seriously, it was a downer to arrive at Narita airport for departure and see The Odious One on TV for the first time in weeks.

More to come…it was a successful vaca in that I wasn’t ready to return. But I did miss you all, and am happy to be back and posting!








I, For One, Welcome Our Lesbian Farmer Overlords

This one has been circulating through the fever swamps for a couple days not, and Jonathan Chait sums it all up:

Barack Obama is nearing the finish line of a presidency filled with accomplishments ranging from death panels to FEMA camps to the importation of Sharia law. Year eight is a natural time for Obama to unveil the most deviously brilliant plot of them all: mass lesbian infiltration of the agriculture sector. The Department of Agriculture has cleverly designed this scheme as an innocuous outreach summit to LGBT Americans living in rural areas. But Rush Limbaugh has exposed the administration’s true intentions, which are nothing less than a full-scale assault on the last bastion of red-state America.

Here’s how it works. “Rural America happens to be largely conservative. Rural America is made up of self-reliant, rugged individualist types,” explains Limbaugh. (Farmers are “self-reliant” because, even though their sector is technically the recipient of heavy federal subsidies, they are overwhelmingly white.) Obama has a plan to attack them:

They are trying to bust up one of the last geographically conservative regions in the country; that’s rural America … So here comes the Obama Regime with a bunch of federal money and they’re waving it around, and all you gotta do to get it is be a lesbian and want to be a farmer and they’ll set you up … apparently enough money it make it happen, and the objective here is to attack rural states.

As a resident of a member of a rural right-leaning state, I have done my due diligence and created a list of pros and cons:

PROS
1. Better farmers markets
2. everything will be organized, including you
3. new softball leagues
4. more organic everything
5. cleaner campsites
6. influx of animal rescue volunteers
7. locally owned restaurants featuring brunch
8. more liberal voters
9. instead of Fox news, all public televisions will be tuned to Ellen reruns or the Ovation network.

CONS
1. You will never get a good deal on a used Subaru wagon again.
2. Campsites and dog obedience schools will have to be reserved three years in advance.
3. Potential for uncomfortable discussions over whether any penetration makes you straight will increase dramatically.

This is not an exhaustive list, but I think the pros definitely outweigh the cons.








Random Afternoon Pet Musings

later

Let’s get the important shit out of the way. The duvet cover and pillow cases are light green and the sheets are a lavender cover. My tastes sucks/blah blah blah, whatever.

At any rate, I have noticed that my relationship with Steve has really changed this summer. He’s so much more affectionate than he used to be, and I wonder if he is finally ready to accept this as his forever home. He was never standoffish, but now he is approaching Tunchesque levels of being a good boy. Constantly on my lap when before he would only come at night, follows me around a great bit more when in the past he would do more of his own thing, and at night, when he used to sometimes come in and sleep for a while, he now comes running when I yell bedtime and is right behind Lily and Rosie, bitching so I don’t shut the door.

Then as I fall asleep, he is right by my left side, and grooms himself for a bit, then makes me pet him for a bit, and then he props his front paws on my chest and falls asleep (as Maine coons like to do because of their hips). It’s kind of sweet, and non pet owners (are there even any here at Balloon Juice) won’t understand, but I notice a big difference. Could it be the haircut, too? I hope it isn’t that, because then I will feel terrible that he felt so bad the last few summers.








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?