Friday, April 28, 2017

Washington Post shoots down "my" reinsurance proposal for health care


The Washington Post writes that “Repeal and Replace Just Got Worse” in an editorial Friday morning, here.

It’s notable to me that the Post seems to reject the idea of reinsurance for excessive claims associated with pre-existing conditions.  Such a program could be left to the states, and some states would not be as generous as others.  Some states might refuse to allow reinsurance to work for “behavior-related” conditions, for example.  That might be bad for a lot of people with HIV, and it wouldn’t cover PrEP – but you don’t have the “right” to make others pay for it.

The Post speculates that federal contributions to such a fund would be inadequate.  Maybe so if most of it is left to states.  But it gives no detail.

This still comes back to “moral hazard”.

But if you value all human life, you have to decide how you will pay for it.  Taxes, or single payer?  The simplest, and most removed (and it comes with rationing and wait lists).  Making everybody pay much higher premiums?  Or goading people with GoFundMe campaigns.  But you have to pick an outcome.  It’s a multiple choice exam.

Politico has suggested a reinsurance system recently, at least according to my Starbucks reading.

Many Republicans favor letting states use their higher risk pools, with premium subsidies for low income policyholders. This way those could afford it would pay for their higher use of medical services.  But imagine the argument extended to Medicare.  You could make people who can afford it pay for more of their share of, say, coronary bypass surgeries.  People do pay for their own custodial care, though.

On the tax code reform – it’s too early to say, but raising the standard deduction could encourage more renting and less home buying, and less charitable contributions.  But it would make taxes take less time, for some of us.

Thursday, April 27, 2017

Trump wants to break up the Ninth Circuit


President Trump supports a GOP plan to break up the Ninth Circuit, which has been hostile to some of his policies, especially his travel bans, the Washington Examiner reports here.

Apparently Congress would create another circuit, that would include the state of Washington, which is generally more conservative than California (as well as Alaska, but Hawaii might be more liberal).
 
Trump still insists he was right on the travel bans and on opposing funding to sanctuary cities.  A federal judge stayed that plan earlier this week on 10th Amendment arguments, claiming the federal government perhaps cannot micromanage how states manage their own law enforcement priorities.

Along these lines, Wikipedia has useful article on unitary vs. federal sovereign countries.

Wednesday, April 19, 2017

US-born children of undocumented immigrants left stranded by Trump deportations


As more undocumented immigrants are deported, a disturbing question will be, what happens to their children, especially those born in the U.S. and therefore citizens by birthright.

The Phoenix New Times has a detailed story by Antonia Noori Farzan and Sean Holstege.

Sometimes older siblings or other relatives (who might be undocumented) have to raise them.  Sometimes they are put into foster care.



The Migration Policy Institute has a 2016 profile of children with undocumented parents here. Nearly 80% were born in the United States.

An Arizona group called LUCHA (“fught”) does organize fundraisers for affected families.

Tuesday, April 18, 2017

Yes, under Obamacare single individuals have to pay for coverages they could never use


One of the biggest controversies with Obamacare has been that even in the individual market, people have to pay for coverages that they have zero chance of needing personally.

The Christian Science Monitor had an explanation back in 2013 that still bears reading.  It’s about ending “discrimination” and enlarging the risk pool in the individual market.

When I was working for a long term employer (through the end of 2001), I had group coverage only for myself.  My premiums were about one-fourth of a family plan.  But I think they technically could have covered “pregnancy”.  It was not viewed as likely to increase claims substantially among workers.

One could ask, isn’t thus paying for “sin” – childbirth out of wedlock?  But you could turn it around and say, as a gay male, aren’t others paying for my presumably higher risk of HIV?  (In fact, I am HIV-).  In fact, now, as Obamacare comes under fire, paying for protease inhibitors or, particularly, PrEP could become controversial.

Obamacare’s own site lists the required coverages here.

There is also literature that says that for small employers, individual plans will be cheaper than group plans, because the individual plans are open to larger pools.

Obamacare allows insurers to set premiums higher for certain risks.  The most “important” is probably family coverage – spouse and dependents, which can keep adult children until age 26 (for most needs).  But it appears that individuals even without children must cover pediatric services.  States have some discretion, but some states (like New York) have required that pediatric dental coverage be embedded in all policies, and New York claims this is generally cheaper for everyone.

Much of the anger of Obamcare was that some policyholders seemed to be forced to pay a lot for services they didn’t need, after their older policies were canceled as substandard.  It’s not clear why some premiums rose so much. With health insurance, it is much more difficult to address the issue of "moral hazard" if, indeed, all lives matter.

My own case at ING was that I had inexpensive coverage that provided immediate first rate surgery when I had an accidental hip fracture in a convenience store.  The claim was subrogated against the liability policy for the company, but I wound up with fill salary and no deductibles in the end (after a brief fight over one issue).   But, again, I was “cherry picked” as a professional worker unlikely to cause claims.  Even so, ING was able to cover some disabled workers (or families with dependents with pre-existing conditions) fully without significant premium increases for everyone.  This seems much easier for large employers with professional work forces than for anyone else.

Monday, April 17, 2017

Conservative group in Minnesota provides complete analysis of healthcare problems in the state, and how Obamacare messed it up


When I lived in Minneapolis  (1997-2003) I sometimes went to forums held by the Center of the American Experiment, particularly those forums with a more libertarian focus.  The Cato Institute visited once, as did ABC libertarian-leaning journalist John Stossel.

Peter Nelson has a detailed article in the print version of “Thinking Minnesota” for Spring 2017, p. 44, “Anatomy of a Death Spiral: The loss of healthy enrollment leads to such an expensive risk pool that no one can afford to buy coverage, thus killing the market”.

I could not find the specific article online, but the writer has a huge page on the org’s website, with a video about getting away from employer-sponsored health insurance.

The article makes a case for state-sponsored higher risk pools for those with pre-existing conditions.  It also makes the case for older people paying more relative to younger people.  Indeed it makes the point that Obamacare tries to force younger and healthier people cover other people’s know pre-existing conditions with their own mandatory premiums, rather than rely on separating out the risk, which is what happens with other kinds of insurance (although one could wonder about the actuarial Anwisdom of the way some umbrella property and auto policies are set up).



Another article, on p. 34, “Disinherited”, by Diana Furchtgott-Roth, “explains how liberal policies betray America’s young”, criticizes Obamacare for forcing young adults to purchase coverage they don’t personally need, such as single men paying for maternity care or child care.  But this point as a moral backside, as I have often covered before.

Note the Rand video above, and “moral hazard”.

Note also Ezra Klein's article for Vox today, about the "real debate" among conservatives.

Sunday, April 16, 2017

Amateur journalism, pickets, and "the right to Life"


As I left the Lincoln Memorial area today after the Easter Sunrise service, I did encounter a small anti-abortion demonstration.


I guess I’m a watcher.


As I took pictures, a man approached me and asked, “Sir, am I right or wrong?”


I said, “I’m just a journalist.  I record what I see.”

Are journalists above "takings sides"?


Do I have a right to pretend to be “above” carrying pickets? 

Friday, April 07, 2017

Senate passes bill requiring women to register for Selective Service


A bill requiring women to register for Selective Service has passed the Senate, as reported here in “Military”.  When it would start is not yet clear,

Libertarian-leading Rand Paul had tried to introduce a bill abolishing Selective Service and was rebuffed.


 
Donald Trump has wanted to eliminate unneeded federal entities.  How does he feel about the Selective Service System?  Does he feel we could need a draft again?  He’s not even close to having served himself, for all his talk about strengthening the Armed Forces and helping veterans.

Thursday, April 06, 2017

GOP goes nuclear on SCOTUS confirmations, stacking the court; the hypothermic truck driver case


The Senate exercised its “nuclear option” on a stormy day in Washington (with a possible tornado 30 miles away) after the Democrats threatened a filibuster on the nomination of  Neil Gorsuch (New York Times account ).  That means that from now on, a simple majority will confirm Supreme Court appointments.  If Republicans (counting Trump) stay in power for the next year, it will be pretty easy for them to stack the court. 

I’m reasonably confident that the new nominees would regard marriage equality as settled law.  But they won’t bend over backwards to protect LGBTQ people fired from jobs (even with some federal funding) over “religious freedom”, even if such incidents are uncommon and extreme.  They probably will side with the 11th Circuit (rather than the 7th) on how Federal Civil Rights law is read with respect to some gender issues. They won’t help transgender people in states that don’t want to allow birth certificate changes.  And so on. 



Yet, I don’t join resistance movements over hopeless fights over appointments. 

Ezra Klein has a video on Vox supporting Democrats’ protesting one last time, and thinks the filibuster should disappear anyway.  I couldn’t find the right URL, so it’s on my Facebook book page right now, here

I agree, the Senate should only confirm moderate judges who represent the people, regardless of whose party is in control.  But, as Klein himself says, we have weak parties and strong partisanship. 
  
I personally that that “original meaning” of anything has to be interpreted in light of science or technology that has developed since (and this particularly true of the Internet).  
  
Elie Mystal has an article summarizing the case Trans Am Trucking v. Department of Labor, where Gorsuch dissented with a decision in favor of a truck driver who drove an unhitched cab instead of waiting for assistance in extreme cold, and was fired because company policy didn’t allow him to do that.  Gorsuch interpreted the law very literally, even given unusual life and death circumstances.     Franken grilled him on the confirmation hearings, and Democrats wanted to hang the disapproval on this case.  

The ”nuclear option” had been used in 2013 for lower court judge confirmations.  

Tuesday, April 04, 2017

Trump. after threatening to work with Dems on health care, returns to demands of conservatives on health care


While Trump has “threatened” to work with Democrats on health care and attacked the Freedom Caucus in his “own” party, now the White House seems to be supporting a revised “TrumpCare” bill that seems more conservative than the RyanCare bill that was defeated ten days ago.



The new bill might allow insurers more leeway in charging higher premiums to people with pre-existing conditions while not allowing them to be denied coverage altogether; and it might allow states to opt out of coverage requirements for some items, like drug addiction, mental illness or reproduction-related services.

Bloomberg has a story here.

NBC News has a recent detailed story with two videos, here.

Yet Trump, according to the New York Post, had credited himself for tripping up the GOP on the Ryan bill, story.


Saturday, April 01, 2017

CNN covers crowdfunding for families seeking to adopt children


CNN Saturday morning ran an interesting quick report on crowdfunding for personal adoptions.
 
A family explained that the cost of the actual adoption process, especially for overseas adoptions, constrains many families.



There are many sites that enable families to get to crowdfunded sources.  There are many articles about them.  Here is a typical article.  Here is another one.

Again, I’m rather miffed, as an older person, by the openness (I could call it brazenness) of appeals for money for personal projects, even if they are socially important.  I feel a little differently (and more supportive) about artistic projects to which I feel some personal connection because of my own history.

Thursday, March 30, 2017

Politico fixes Obamacare / Ryancare / Trumpcare: Reinsure the insurers


Politico Magazine seems to have taken me up on one of my ideas for reforming Obamacare (or RyanCare or TrumpCare, if some other replacement bill someday does pass).  That is, offer resinsurance to insurers, mostly dealing with pre-existing or perhaps lifestyle conditions.  That’s Point 2 of the “4 things” in the article by Michael Grunwald, March 27, here.

The Chicago Tribune has an article by Steve Chapman, “Why health care can’t be fixed”.   Except that the article really says that Obamacare is more or less working for most people, and that the steep premium rises are the exception, not the rule.


 
The  Republican governor Brownback of Kansas today denied Medicare expansion, which the hospitals want, for no good reason other than ideology (that is, providing tax dollars to Planned Parenthood).  .

Tuesday, March 28, 2017

Trump ready to issue EO to "obliterate" Obama's progress on climate change; will the free market really work? (natural gas can be clean)


The Washington Post reports that President Donald Trump will “obliterate” Barack Obama’s progress on climate change and environmental cleanup, with a new Executive Order today, in a detailed and illustrated (with photos) story by Juliet Eilperin and Brady Dennis, link.

Energy self-sufficiency (“autarky”, or “economic nationalism” indeed) may be admirable enough (remember the rhetoric during Jimmy Carter’s years and the post-Arab Embargo gas shortages of the 70s).  Free market incentives will lead the power industry to favor natural gas over coal anyway. It looks like the pipelines will get built as part of Bannon's infrastructure.

 Natural gas is cleaner and safer in most circumstances.  It can be made very clean.  And we have both the “Pickens Plan” of a few years ago, and the Taylor Wilson Plan (supported by Peter Thiel) which Trump ought to be paying attention to (just invite Thiel and Wilson to the White House).



Increased coal mining probably means more mountaintop removal, especially in the southern West Virginia area within 80 miles of Beckley, and over into eastern Kentucky and far SW Virginia, toward Cumberland Gap.  It probably doesn’t save many miners’ jobs.

But walking away from international climate change debate sounds, well, immoral. One precept of conservatism is that future generations matter.  Who is responsible for the refugees from low-lying poor countries thirty years from now?  Who is responsible for the super storms that may occur?  How about sudden methane release from northern permafrost?

I may be gone when a lot of this happens, but I may know about it anyway.  Maybe, like Celebrity Apprentice’s Schwarzenegger. “I’ll be back” after all.  The very idea that reincarnation may happen (there’s more evidence about this than we realize) changes the self-interest.



Update:

The EO has been issued.  Here is Vox's detailed rundown by Bard Plummer. Note the link to the interview with Harvard's Jody Freeman.

Here is the text of the Executive Order at the White House site.

Monday, March 27, 2017

How effective are AP courses?


I found a curious story in the Atlantic in October 2012, by John Tierney, “AP Classes are a Scam”,

I did get AP classes when I worked as a sub, and they were a pleasure to teach.  I took only one in my own high school, Enriched Chemistry in twelfth grade.

I wonder how science fair winner Jack Andraka would react to this article today (he won his prize for his pancreatic cancer test in 2013, and says that the idea for using carbon nanotubes the way he does in the test occurred to him in a class.

I have seen AP math classes that went as far as differential equations.  I remember giving a calculus test where the first part was without graphing calculators, and had to be turned in before the student could work the second part.


But I wonder how the calculators do today in the era of smart phones.  I found the TI device that bought kept losing power quickly.

You could make math and physics test problems about how high a batted baseball that barely clears the Green Monster in Fenway Park in Boston will reach before starting to descend, and how far it would travel beyond the wall to reach the ground.  A lot farther than 305 feet.

Wednesday, March 22, 2017

More about what "unmasking" means -- it could have happened to me, even


There is some more clarification of what “unmasking” by the NSA means.  If an American tried to contact Vladimir Putin or high Russian officials, the NSA would pick it up.  In the effort to identify foreign officials, a FISA court might allow the identification of American citizens.  This can be quite common.  It could be someone ordinary, even like me, or the citizen could be Donald Trump, or an official in the previous Obama administration.

When private citizens get classified tips sent to them, and authorities find out (as would happen in the four or five foreign tips I have shared sent to me over the years – one might have concerned a possible attack in Indonesia), something similar to “unmasking” happens.  It normally will not result in adverse action against the citizen.  (I have TSA pre-cleared flight status.)

All of this means that most of Trump’s complaints about Obama are pretty meaningless, but not without some remote foundation.

But it is possible that crimes might have been committed in the apparent connections between Putin and Trump’s campaigns, Vox,  Zack Beauchamp – but the “grand jury” is still some time away. .


Tuesday, March 21, 2017

Wiretaps, Russian hacking, and really existential foreign threats: this gets dangerous when truth is loss


I’m not sure what to make of Donald Trump's @POTUS Twitter storm yesterday as he apparently watched the hearings rather than doing his job.  

The Washington Post writes a Fact Checker, “President Trump’s terrible, horrible, no good, very bad Twitter day, here. I'm reminded of the really bad President's Day Blue Monday that Milo Yiannopoulos experienced recently. 
   
Trump seems to find in Comey’s statement about “unmasking” American citizens some sort of evidence backing up his fantasy that Obama wiretapped the Trump Tower.  But Comey denied right off the bat that there was any such evidence. 


No question, the US relations with Britain and Germany are already embarrassed, and Trump faces an accelerating and existential threat from North Korea that seems to have been kept on a back burner.  North Korea may be much closer to having ICBM’s that can reach the entire US than anyone had imagined, and it might have the ability to direct an EMP attack from a satellite.

No wonder the doomsday prepper crowd is (ironically) so active on Facebook.

The criminal investigation of the Russian activities with respect to last year’s election are becoming a side show..  Noubt, Vladimir Putin really did hate Hillary that much. 

FEE's Julian Adorney writes "The Media and Trump are both to blame for the death of truth". Truth. remember, is "the eternal feminine". 

Monday, March 20, 2017

Will private sources take up the slack on likely Trump-aka-GOP budget cuts for FY 2018?


If Congress slashes the civilian budgets the way Donald Trump wants, what will be the effect on ordinary Americans?

Well, very mixed.  On the arts, there is plenty of reason to believe that private sources can do a lot more to support PBS, the Smithsonian, and the like.  There are ways to set up “socially responsible investing”.  The non-profit world would grow, much of it around DC, and help take up some of the loss of federal jobs. The Washington Post has expressed a lot of concern over possible federal layoffs on the regional economy. 

Rick Sincere, connected to the Libertarian Party of Virginia and to GLIL (Gays and Lesbians for Individual Liberty) in the past, has written some articles on Virginia and the arts.  He argues that states subsidies for the arts help rich people out of state rather than poor Virginians (typical blog post – he has several; his posts look like mine). 

Tod Van Der Werff of Vox makes somewhat similar arguments and notes that rural areas will lose out – primarily because supporting public services in rural areas is generally less cost effective for the public as a whole – this goes for airlines service in smaller cities, too. All of that feeds the self-sufficiency, self-defense (NRA) culture of the “doomsday prepper” movement that I see on Facebook (ironically).

I stop and ponder this a moment.  Most of the time when I travel on my own, I’m staying in smaller towns at night (unless I go to NYC).


What about so many of the other cuts?  We hear a lot about the loss of funding to things like Meals on Wheels.  Some states will do more than others to pick up the slack.  But it is this delivery of personalized service to people that the private sector is best at.  That brings me back to another general comment – organizations that recruit many volunteers need to become much more transparent about what they will be asking for.  Meal delivery, for example, can mean driving in low-income neighborhoods and a bigger risk of exposure to crime. 
  

Yet, traditional conservatism still has a point:  part of the solution to the inequality problem is expecting more openness and less insularity from those who are better off (me).  

Here is the CBO's analysis of the 2017 budget. 



Update: March 21, 2017 

Peter Jamison has an article on how Trump's budget affects the District of Columbia, here.  I wonder if it could affect organizations like Whitman Walker and DC Center Global.  

Friday, March 10, 2017

Trump's idea of making a deal could be challenged by the next debt ceiling crisis (Beware the Ides of March)


Damian  Paletta has primed us to apprehend another debt ceiling fight this summer, in an article on p A6 of the Washington Post Friday, March 10, 2017, “Treasury calls on Congress to raise debt limit, begins steps to delay default.” 

Treasury Secretary Steve Mnunchin has started his “extraordinary measures” already, as Congress-passed immunity from the debt ceiling runs out on the Ides of March, that is, March 15, 2017. 
The possibility of a default could occur as soon as August. 

  
Trump, remember, has claimed he could “make a deal” and not raise the debt ceiling (story ).  He has also made statements that seem to suggest it could be OK to “default” (at least maybe on debts overseas like to China).  He does seem to be promising Social Security would never be interrupted (and maybe it wouldn’t be, for legal reasons we have covered before).

Here is CNBC’s article by john W. Schoen on Feb. 17.  CNBC continues the discussion (Jacob Pramul) with charts March 9. 
   
I can live with Parlor Timocracy, but not “t_Rump-ocracy”.  

But maybe the fact that Trump is nominally from the same party as Congress means there won't be the partisan bickering we saw in the summer of 2011.  (Trump had at one time tried to get the Reform Party nomination, in 2000, and wrecked the party, Jesse Ventura notwithstanding. 




Update: March 20

FEE has an article by Richard M/ Ebeling arguing against extending the debt ceiling, but fails to note the government would actually default on what it actually owes.  Whether current social security beneficiaries are actually owed is a good question (Flemming v Nestor) as I've covered, but the Trust Fund intermediary tends to protect beneficiaries. The writer seems to think a balanced budget alone would cover this, but it wouldn't. 

Monday, March 06, 2017

Obamacare 2.0 waffles into TrumpCare with little ideological accomplishment on anti-selection


Here’s a good explanation of the GOP draft of the Obamacare rework, by Sarah Kiff on Vox, link.

The main concept in dealing with the pre-existing condition problem is “continuous coverage”.  But older people are likely to be charged more than under Obamacare.

Also premium support supplements are largely replaced by tax credits.  For this idea to work for poor people, they would have to be given the money (almost like UBI).  The tax credits tend to be less than the support. If they are true tax credits, then it won't matter if people itemize or not, but we have to watch that.

Young adults pay less, older people pay more.  This may help young adults with student loan problems.   Trump does seem to be determined to cover someone like Connor Golden, who lost a leg to an explosion in Central Park properly.



Ezra Klein writes that the bill is a solution looking for a problem, or is a “compromise of a compromise …”.

The Washington Post calls the new proposal "reckless and heartless".

Here's the text of "The American Health Care Act", from Fox, of course.



Update: March 11

Julia Belluz of Vox explains how the "continuous coverage" concept in the GOP plan can fail people with long term medical conditions and job breaks.  I also wonder what happens if the insurer leaves Obamacare;  does the person have to find a new provider within 63 days?

March 13

The CBO says that 24 million people would keep coverage under the American Health Care Act/  Another issue is that consumers cannot comparison-shop for healthcare or know the prices when critically ill (although they could compare-shop for plans if there was enough competition).

March 14

Today, at a WH Press Briefing.  Sean Spicer made a point that Obamacare burdened a lot of people for making them buy coverage they didn't need (making 55 years olds cover other people's pregnancies); so it's about more than just pre-existing conditions.

Thursday, March 02, 2017

Visit to Smithsonian exhibit on WWII Japanese-American internment; a lesson for today's immigration debate?


Today, I made a brief visit to the small exhibit “Righting a Wrong: Japanese Americans and World War II”, at the Smithsonian American History Museum in Washington DC, link here.


Wikipedia gives the history of this episode   which started when president Franklin Roosevelt promulgated Executive Order 0966, in early 1942, shortly after Pearl Harbor.  Over 110,000 Japanese Americans (including second generation citizens born in the US of Japanese descent) were forced into camps (Nisei) and even their kids (sansei).  First generation immigrants were called issei.
 
Immigrants lost property, pretty much through theft and expropriation, as they were allowed to carry only what fit in a suitcase (shown in the museum).  Fear-driven propaganda morphed into racism, and comments on how different the orientals looked  (Some the same attitude would show up during the Vietnam era.)



I recall writing a term paper on “The Home Front During World War II” for social studies in eight grade (1957) and covering the Nisei issue.  In 2012, I did stop at Manzanar along US 395.


The history of the Japanese internment seems like a pertinent comparison to today’s aggressive attitude on immigration by Donald Trump and many on the political “right”.  There is a tendency to look for civilian scapegoats and group people into “us” and “them” when war occurs, and terrorism tries to get ordinary people to see things that way.


Interned men sometimes served in the Army.


Saturday, February 25, 2017

GOP Obamacare replacement "in situ" involves continuous coverage, risk pools, ending mandate, ending employer tax break


Vox has a detailed article on the “leaked” GOP plan to “replace” aka “repair” Obamacare, by Sarah Kiff, here.

There seem to be two key concepts in dealing with pre-existing conditions.  One of these ideas is allowing people with continuous coverage to keep plans at the standard rate.  That may help some.

 That means if you were covered before, then get cancer, and keep the same coverage even if you change jobs (the GOP wants you to), you don’t get charged higher premiums.

The other is helping states set up high-risk pools.

My personal belief that it is better to re-insure  claims from  certain conditions (or cover them the way we cover end-stage renal disease) rather than separate people and cover them differently. On the other hand, as a philosophical matter, it makes sense in the long run to privatize retirement (social security) and old age medical care (Medicare) because we will all get old and, from some starting point, should plan for it.



On the other hand, it seems wrong to require people to pay for other people’s known problems products they purchase from a market.  It sounds better to segregate the costs of these problems and fund their reimbursement publicly as necessary.

The GOP wants to end the tax break for employer plans, which tend to cherry pick healthier people.
States could allow plans to eliminate mandatory coverages – like maternity coverage for single men.
 
 The bill would also eliminate the individual mandate, which insurers maintain is necessary to counter anti-selection.

It also wants to reverse the expansion of Medicaid and change the whole thing into block grants to states (separate explainer).