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.