Open Thread.
This post is in: Open Threads
by David Anderson| 43 Comments
This post is in: Anderson On Health Insurance, Daydream Believers
The Incidental Economist is passing along an interesting study that looks at how people respond to co-pay changes for treatments of acute crisis:
A study just published in JAMA Pediatrics looked at how children with asthma obtained care under different levels of cost-sharing, and how much stress their families were under financially because of their child’s illness. It’s important to understand that children with asthma, by definition, require care.
We want them to use the health care system. With respect to asthma, prevention and maintenance are far better than trying to treat a child already suffering from an attack.
What we see from this study is that families with higher levels of cost-sharing were significantly more likely to delay or avoid going to the office or emergency room for their child’s asthma. They were more likely to have to borrow or cut back on necessities to afford care. They were more likely to avoid care.
This isn’t a good outcome. We’re talking about children with a completely manageable chronic condition who are being hampered by cost-sharing. That’s not what cost-sharing is supposed to do.
This is why I don’t think high deductible health plans or HSAs are a good policy solution. They work reasonably well as true insurance products. They are horrendous at the health maitenance component of health insurance. As I’ve said before, HSAs and HDHPs can be an appropriate health insurance offering for a small class of people:
If I was the health insurance dictator in this country, I would allow high deductible plans to be sold. They would only be sold to individuals and families who are reasonably young (age is a pre-exisiting condition) without any signifcant claims history. The policies would not be automatically renewed until the most recent claims and medical history was reviewed. Furthermore, the potential buyer pool would be limited to people who have the ability to absorb a one-time shock of several thousand dollars without it being a crisis. This sub-population is fairly small, and can absorb the risk shifting that is inherent in a high deductible plan design. Anyone with chronic conditions or recurring health maitenance problems should not be a plan designed like this
If we assume that there is a general public policy goal of promoting good health at reasonable cost, then the obvious solution is to redesign out healthcare delivery and financing systems to account for reality instead of theory. The obvious solution with plenty of real world comparables is some type of regulated public utility model of healthcare delivery plus social service enhancement plus collective single payer or regulated public utility payer systems mostly funded by general taxation. Every other OECD country can make it work better and cheaper, so there are easy gains available. However, I don’t think we’ll get to a national single payer or single payer-like system before my almost 2 year old can rent a car without surcharge, so I’ll be posting on a couple of second and third best kludges over the next week.
by $8 blue check mistermix| 69 Comments
This post is in: Open Threads
by $8 blue check mistermix| 39 Comments
This post is in: Republican Stupidity
You’ve probably seen this already, but I found it fascinating:
LOUISVILLE, Ky. (AP) — Senate Republican leader Mitch McConnell wants to repeal the Affordable Care Act, but he would not say Friday what that would mean for the 413,000 Kentuckians who have health insurance through the state’s health care exchange.
McConnell told reporters that the fate of Kynect – Kentucky’s state-run health insurance exchange – is not linked to the federal health care law. But the exchange would not exist if not for the federal law that created it.
Mitch figured he could just waltz into his home state, push out this turd of a lie, and the clueless press would let it sit out there, stinking, for a cycle or two. Then Alison Lundergan Grimes would call him a liar, and the he-said/she-said would go on for a few more cycles.
Instead, Adam Beam, who’s the “Kentucky Statehouse Correspondent” of the AP, dispatched Mitch’s bullshit in one sentence. Mitch is going to have to come up with some fresh new lie because this one just got shot to pieces.
This post is in: Garden Chats, Open Threads, Science & Technology
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No garden pics this week — I guess everybody else is out frantically transplanting / watering / mowing, too. So you get a TED talk, via Phil Plait, instead.
You are, of course, free to post your own gardening updates here. I need to get to the garden center again, pick up more potting mix (another dozen mail order tomatoes, several mail order rose bushes, two flats of lobelia and allysum), and hopefully a couple more sixpaks of annuals to fill in the remaining corners…
Apart from that, what’s on the agenda?
by John Cole| 66 Comments
This post is in: Open Threads
Got done shopping today, went out to load the groceries into the family truckster, and found this:
It was just so bad I couldn’t even get mad, so I took some shots. When I saw it was a Buick Century, I knew immediately it was a medicare sled, so I just loaded my groceries and sat on the back of the car on the trunk/bumper and waited (my car is not in the shots, but I could not get out until the car was moved), and after about ten minutes some 85-90 year old guy with a WWII veterans cap came out with his cart and looked at me sheepishly and grinned and said “How’d that happen” and I thought to myself “Old age, bro, but you keep on keeping on” but smiled back and took his grocery cart after he was done unloading his stuff and moved it to the place where they are supposed to go.
Funny stuff.
This post is in: Cooking, Open Threads, OLD MAN YELLS AT CLOUDS
Just a glorious day here- a touch of humidity for a spell but other than that 70-80 degrees, clear blue skies and pillowy clouds. Just perfect, and Shawn and I got a lot of yard stuff done and I got half the garden in. As always, I underestimated the amount of mulch and plants I needed, so we are headed out to the greenery tomorrow to get some more supplies.
A bunch of the fraternity boys are living here over the summer doing internships and working for Building and Grounds, so I have a couple of them down tonight and we are watching some hockey, then maybe a movie, and cooking fajitas. Quick Sidebar- five of the seven guys staying here are black, and all of them are working for B&G. I don’t know if this is just my delicate liberal sensitivity at work, but a number of times during the day all of them will be piled into the back of a pickup truck driving through town to go somewhere else on campus to weed-eat or mow or mulch, etc., but for some reason the sight of six black men (five of whom are my brothers) being driven around in a pick-up truck in my lily white town by their white boss just makes me stop and pause every time it happens. I was talking to Christion and asked him about the whole plantation vibe it gives me, and just told me “I feel you. We’ve talked about it.”
I know I showed you the picture of Christion getting loved on by Rosie, but he is one of my favorite kids and he spends a lot of time here because he is a lot like me. He can’t handle a lot of people talking all the time and sometimes just needs to be left the hell alone, so he comes down a lot and hangs out in the living room while I am working or out doing things. At any rate, whenever the fraternity boys are coming down for dinner for the last year or so, he comes down early and helps me with prep work and I have been teaching him how to cook. He’s a frighteningly quick study- I show him something once, and he can do it the very next time we cook it again -“I got this.”
He still doesn’t have a command of flavors and really doesn’t know how to handle vegetables and season them, but he is fine with most everything else. The one thing that is killing me is his knife skills. It’s just painful to watch. I have really heavy Viking knives and I have showed him how to just use his shoulder with them and use a rocking motion, and I have some Santoku knives and demonstrated how to use them and how you want more of a sawing motion, but every time he grabs any knife and starts to use it it’s like watching a Republican try to be funny or culturally hip. The only way I can accurately describe it is that every time he holds a knife, he holds it in contempt and fear, like the biggest homophobe on the planet being forced at gunpoint to grab another man’s erect penis. It’s just painful to watch.
I ask him why he is like that, and he tells me it is because the knives are so sharp, so they scare him, and I try to point out that dull knives are the dangerous ones, but it falls on deaf ears. Do any of you have any idea how I can teach him how to be comfortable with a knife in the kitchen?
At any rate, just a great day, plus when I went to the Post Office this morning, one of you generous souls had sent me a hand-crafted throw pillow- and that just made the day even though it was only 11:30. It’s beautiful, and thank you!
Hope you all have a good one. Off to watch the final period of the Kings and Blackhawks.