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Shallow, uninformed, and lacking identity

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Technically true, but collectively nonsense

‘Forty-two’ said Deep Thought, with infinite majesty and calm.

Wow, you are pre-disappointed. How surprising.

No offense, but this thread hasn’t been about you for quite a while.

Everybody saw this coming.

When I decide to be condescending, you won’t have to dream up a fantasy about it.

Let me eat cake. The rest of you could stand to lose some weight, frankly.

Reality always lies in wait for … Democrats.

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They fucked up the fucking up of the fuckup!

The revolution will be supervised.

Fuck these fucking interesting times.

Reality always wins in the end.

Tick tock motherfuckers! Tick fucking tock!

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A Modest Proposal

by Four Seasons Total Landscaping mistermix|  September 26, 20138:14 am| 67 Comments

This post is in: Open Threads

Washington Post  Breaking News  World  US  DC News   Analysis

Why pull the pin on a hand grenade when there’s a pile of dynamite, a fuse and some matches within reach?

A Modest ProposalPost + Comments (67)

I’m being oppressed and made better off

by David Anderson|  September 26, 20136:50 am| 73 Comments

This post is in: Anderson On Health Insurance, World's Best Healthcare (If You Can Afford It), All we want is life beyond the thunderdome, Assholes, Good News For Conservatives, Teabagger Stupidity, Technically True but Collectively Nonsense

Conservatives are having fun with stories like the following:

Ian Hodge, 62, is one of nearly 13,000 central and eastern Pennsylvanians who will soon need to shop for health insurance because Highmark Inc. is discontinuing their coverage at the end of the year.

Highmark has announced it is withdrawing five of its insurance plans that don’t comply with the Affordable Care Act, key parts of which take effect Jan. 1.

The hash-tag #TCOT is flinging poop under the quip “Obama lied, my health plan died”.
 
Let’s look at the details as to why Highmark is cancelling these plans:
 

The new regulations, for instance, prohibit insurers from denying coverage to applicants who have pre-existing health problems….

Highmark’s Classic Blue is a guaranteed-issue plan, meaning the Hodges and other customers were not required to inform Highmark of their health status to get coverage. But applicants couldn’t count on coverage for any pre-existing condition for their first 12 months under the plan….

Under the Affordable Care Act, beginning Jan. 1, all insurers must issue policies regardless of an applicant’s health history.

The guaranteed issue policies were Pennsylvania’s “solution” to some people with pre-exisiting conditions who fell through the cracks.  The individual insurance market in Pennsylvania is segregated (until Jan. 1, 2014) into two broad groups.  The first is medically underwritten individual insurance.  The risk pool for medically underwritten insurance is younger and healthier than typical.  The second group is the guaranteed issue group which has older and sicker individuals in it.  Jan. 1, 2014 changes this paradigm as all health insurance written on or after that date will be community rated so this distinction no longer serves any purpose.
 
Mr. Hodge from the article was paying $1041.85 per month for him and his wife for Highmark Classic Comprehensive Blue.
 
I only could easily find the 2012 product sheet for this plan.  It looks like the 2012 version at that rate for a married couple would have an in-network deductible of $3,000 with co-insurance above that at 80% on the next $30,000 for total family potential out of pocket of $9,000.  After $30,000 in medical expenses, the plan covers everything after that.  Pre-exisiting conditions are not covered for the first year.
 
That coverage is not too good.  It is inadequate and unaffordable coverage under Obamacare regulations.  Under Obamacare, the policy above is Catastrophic at best.
 
Looking back to yesterday’s data dump from HHS, the lowest Gold plan in Pennsylvania for a 27 year old is $205 per month.  Given that rates can not vary by age by more than a factor of 3, that Gold plan for Mr. and Mrs. Hodges can not be more than $615 per month per person.  Buying as a family will probably reduce that rate to be equal to what they are paying now.  This calculation does not include any tax subsidy.  Gold would be a massive improvement in coverage over what they have now.
 
Using the Kaiser Family Foundation Zip code specific calculator, Silver plans are available to a family of 2 in a random Lancaster County zip code for $5,070 under the typical case scenario,  total costs for the family of two without tax credits would be no more than $10040 before subsidy.  That is significantly less than the $13,000 in premiums the Hodges are currently paying.  Throw in the fact that the value of coverage has increased dramatically, the Hodges will be significantly better off.
 
Stop the oppression by improving the material condition of people….
 
 
 

 (updated a math error)

I’m being oppressed and made better offPost + Comments (73)

When I Say Jump, You Ask “How High,” Damnit

by John Cole|  September 25, 201311:38 pm| 103 Comments

This post is in: DC Press Corpse, Decline and Fall, Our Failed Media Experiment, Our Failed Political Establishment, Serenity Now!

Both sides. Liberal media. Oooga Boooga:

Sen. Ted Cruz has been speaking on the Senate floor for almost 19 hours, as of this post. The talk is not technically a filibuster — he can’t actually block the Senate from going about its business — but symbolically, it’s more or less the same thing. The point is to show one’s opposition to something through a demonstration of physical will.

Which is why you can forgive conservatives for being upset with the mainstream media’s coverage of the Cruz affair. When a Democrat like Texas state Sen. Wendy Davis filibusters against abortion restrictions, she is elevated to hero status, her tennis shoes become totems. When Cruz grandstands against Obamacare, he is a laughingstock in the eyes of many journalists on Twitter, an “embarrassment” in the eyes of The New York Times editorial board.

“Gee I wonder why NYT and WaPo and everyone else gave ecstatic coverage to Wendy Davis but not to Ted Cruz. I just can’t make sense of it!” John Podhoretz, the conservative columnist, tweeted on Wednesday morning.

The conservatives yell “BOO,” and the media flinches. No discussion of the differing circumstances. No discussion that Davis was trying to stop a law being passed under shady circumstances while Cruz is trying to backdoor invalidate a law passed by both houses, signed by the President, and deemed constitutional by the Supreme Court. Nope, none of that. Fuck you Dylan Byers.

Take it away, Mr. Pierce.

When I Say Jump, You Ask “How High,” DamnitPost + Comments (103)

Time to make the donuts

by David Anderson|  September 25, 201311:17 pm| 23 Comments

This post is in: Anderson On Health Insurance

The Donut Hole in Medicare Part D (the prescription drug benefit) is slowly going away.   Medicare Part D has four tiers of coverage.

Here is the 2013 benefit design:

  • Deductible phase where Medicare pays 0% (2013 $325)
  • Basic coverage where Medicare pays 75% ($325.01 to $2,970)
  • Donut hole where Medicare pays 2.5% ( $2,970.01 to $4,700) (Medicare has negotiated large discounts with providers)
  • Catastrophic coverage where Medicare pays 95% of costs ($4700.01 to infinity and beyond)

There is a reasonable non-spite rationale for this benefit design.  I don’t think the rationale works well as it was implemented as the donut hole was too high to discourage drug use that could be safely discouraged.

show full post on front page

The idea behind the donut hole in the benefit design was to discourage “over-use” of drugs by the medium to high intensity users while still providing help to people who are truly screwed.  This is fairly common benefit design in most health insurance plans.

However the problem is that the donut hole applies to people who most likely  suffer from chronic conditions.  The idea of a 97.5% coinsurance amount is that it will discourage people from buying unnecessary pills.  The problem is that people who are hitting that level of payments need those pills.  Discouraging people with chronic conditions from buying the drugs that they need leads to higher long run costs as manageable conditions become unmanaged acute crisis situations.

This is a significant problem with most deductible/co-pay/co-insurance plans.

The deductible/low co-insurance incentive structure makes sense for people like me and my family who are reasonably healthy and have no long term chronic conditions. We have the ability to absorb a one-off hit and we can anticipate that any hit is a one off, isolated event at this time in our lives.

It does not make sense for a college friend of mine.  She was/is manic-depressive and her manic-depression was smoothed out when she was taking her prescribed regimen.  She was, as most college students are, severely cash constrained.  Her insurance had a combined $100 a month co-pay for her medications.  Her solution to being flat broke was to stretch out her medication by either splitting pills in half (the more ‘successful’ system) or initially taking a full dose every other day.  These systems led to one involuntary mental health commitment and two voluntary mental health commitments.

After her second voluntary commitment, her case manager figured out that the government could have saved several thousand dollars a night if she was able to get her meds for free.  And amazingly, the case manager was right and fought like a tiger to get a modified care plan that got my friend her psych drugs at no cost share.  The last I heard, my former friend was in a pretty good place at the total cost of $1,200 per year instead of $2,500 a night.

Benefit designs that are good (enough) for most people fail miserably when insurance moves from covering unexpected events to managing chronic conditions.  People have relatively narrow time horizons and irrationally high discounts on the future in all cases.  People in situations of scarcity  are not optimizing complex multi-variate problems of life.  They are managing single satisficing solutions with minimal regard to interaction impacts.  Putting people who, systemically are costly, at the position to choose rent over needed medication is a good way to save money in year one but spend way more in year two.

 

 

 

Time to make the donutsPost + Comments (23)

Open Thread: GOP “Still Evil”, McMegan Still Wrong

by Anne Laurie|  September 25, 20138:43 pm| 124 Comments

This post is in: Excellent Links, Glibertarianism, Open Threads, Republican Venality, Pink Himalayan Salt

Jon Chait at NYMag finds McArgleBargle’s argument indefensible, because “Subsidizing Farmers But Not the Poor Still Evil“:

House Republicans are fighting to impose a $40 billion cut to the food-stamp program while also fighting to lock farm subsidies in place at a higher level than Democrats want. The combination of positions strikes me as indefensible. After all, farmers earn more than the average American, and there’s no rationale for handing government money to somebody just because they own a farm as opposed to a convenience store or a hot-dog stand.

Megan McArdle stands up to say the Republican position is perfectly defensible. McArdle doesn’t like farm subsidies but is even more outraged at disparagement of Republican fiscal priorities, urging, “It seems worth trying to answer the question, rather than merely marinating in our own moral and logical superiority.” The Republicans have a perfectly defensible basis for cutting benefits for poor people but giving them to farmers, she explains — reciprocity:

Here’s one reason Republicans might support farm subsidies, but not food stamps: the sense that you have to do something to get them… They’re not being given money just for breathing.

Actually, that’s not true. The Department of Agriculture does hand out money to people to do nothing. So, yes, they are being given money just for breathing. In fact, breathing is optional — millions of dollars in farm subsidies go to farmers who are dead. This underscores the fact that farm subsidies are a reward for people who own farmland, which they may well have inherited….

Bill “Always Wrong” Kristol better look to his laurels, because McMegan shows real determination to assume his Wingnut Wurlitzer crown for insistent plausibility at a 180-degree angle from the truth.

Open Thread: GOP “Still Evil”, McMegan Still WrongPost + Comments (124)

SATSQ- Gay Rights Edition

by John Cole|  September 25, 20135:28 pm| 180 Comments

This post is in: Gay Rights are Human Rights, Religious Nuts 2

No. Gay rights legislation is not trampling on freedom of religion.

SATSQ- Gay Rights EditionPost + Comments (180)

Wednesday Evening Open Thread: Tech. Dudes.

by Anne Laurie|  September 25, 20134:36 pm| 75 Comments

This post is in: Open Threads, Clown Shoes

Because I grew up with four younger brothers, I knew this was gonna happen. Via NYMag, Andrew Couts at Digital Trends tests out his iPhone 5S’s touch recognition system:

… Lastly, I went with the most secure body part I could think of – and all I will say is that I had to take off my pants. Unlike the knuckle and elbow, however, registering my nether region was a breeze. (It was quite chilly, in fact.) And not only did I successfully register this private part with relative ease, I was also able to use it to unlock the device. I think you can understand why there isn’t a video of this one.

Of course, using your junk to secure your iPhone isn’t just gross and absurd, it’s also impractical – you won’t be able to unlock your handset in public without drawing some unwanted attention, for example. But given that you leave your fingerprints everywhere, and that hackers have already broken through Touch ID’s defenses using a photocopy of a fingerprint and some wood glue, your manhood may be the most secure option you have.

Now, excuse me. I have to go buy some Purell.

Apart from finding the brain bleach, what’s on the agenda for the evening?

Wednesday Evening Open Thread: Tech. Dudes.Post + Comments (75)

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