Come for the politics, stay for the snark.

Motto for the House: Flip 5 and lose none.

“Everybody’s entitled to be an idiot.”

You don’t get rid of your umbrella while it’s still raining.

Optimism opens the door to great things.

Come on, man.

It may be funny to you motherfucker, but it’s not funny to me.

Republicans don’t want a speaker to lead them; they want a hostage.

I was promised a recession.

Today’s GOP: why go just far enough when too far is right there?

Just because you believe it, that doesn’t make it true.

I really should read my own blog.

Too often we confuse noise with substance. too often we confuse setbacks with defeat.

Meanwhile over at truth Social, the former president is busy confessing to crimes.

Let’s delete this post and never speak of this again.

I like you, you’re my kind of trouble.

Being the leader of the world means to be the leader of peace.

Fuck these fucking interesting times.

We cannot abandon the truth and remain a free nation.

When someone says they “love freedom”, rest assured they don’t mean yours.

Republican obstruction dressed up as bipartisanship. Again.

Our job is not to persuade republicans but to defeat them.

If senate republicans had any shame, they’d die of it.

Sitting here in limbo waiting for the dice to roll

Hot air and ill-informed banter

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Archives for May 2014

Strippers and Blow Open Thread

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Nobody’s posted about Rob Ford yet. I’m not a specialist in Canadian politics, but pictures actually holding a crack pipe are probably at least another brick in the wall. as is saying you’d like to fuck your female political opponent, gay bashing, doing lines of coke, and this:

On March 15, an hour before he disappeared into a washroom at Muzik, Ford ran into pop star Justin Bieber in a common area of the exclusive nightclub near Toronto’s waterfront, according to witnesses. Ford tried to shake Bieber’s hand and became enraged when Bieber jokingly asked him, “Did you bring any crack to smoke?”

Security ushered Ford back to his party booth, where he was entertained, along with the four men, by three paid party hostesses. The Star has been unable to reach Bieber for comment.

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About that Express-Scripts data

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I just want to highlight and raise some data caveats about the Express Scripts data set concerning pharmacy/prescription costs for Exchange patients.  There are some interesting nuggets in the data.

Population inferences:

Our early analysis reveals that, in January and February, use of specialty medications was greater among Exchange enrollees versus patients enrolled in a commercial health plan. Approximately 1.1% of total prescriptions in Exchange plans were for specialty medications, compared to 0.75% in commercial health plans, a 47% difference.

 AND

More than six in every 1,000 prescriptions in the Exchange plans were for a medication to treat HIV. This proportion is nearly four times higher in Exchange plans than in commercial health plans.

AND

  • The proportion of contraceptives was 31% lower in Exchange plans

What can we infer from these data points?  There are a couple of inferences.  The first is that early Exchange population is sicker than the typical person covered in an employer sponsored health plan.  We can infer this from the higher use of specialty drugs, and the higher use of HIV drugs.  This was expected. 

The second is that the average age of the early Exchange utilization pool is older than the average age of the typical person covered by an employer sponsored health plan.  The tell here is the much lower use of contraceptives.  Contraceptives are heavily used by women between their late teens to early 40s.  Prescription contraceptive useage spikes in the twenties and steadily declines as women either have children, have permanent birth control, enter menopause or use barrier methods.  If prescription contraceptive usage has cliff-dived, it is probably because there are fewer 53 year olds who need or want to use it.

So what does this mean?

Does the data suggest a pharmaceutical death spiral?

No, as there is one other massive caveat in the dat set, and that is the population examined. 

The analysis is based on a national sample of more than 650,000 de-identified pharmacy claims from Jan. 1, 2014 through Feb. 28, 2014  [my emphasis] for patients enrolled in a Public Health Insurance Exchange

We know one critical thing about the population being analyzed.  

The people who were eligible for this analysis were the first adapters of Exchange insurance.  The January cohort being studied are  are the two million or so people who signed up on the Exchange in October, November and December.  They are the people who were so desperate and self-identifying as needing insurance that they were willing to keep on coming back again and again until the fucked up website worked well enough for them.  Of course, we should expect this group to have higher than expected claim utilization.  The February cohort is the January cohort plus the people who signed up on the Exchanges by January 15th.  This is another million or so individuals.  This cohort should be slightly healthier and slightly younger than the January only cohort. 

The Express Scripts data is reflecting a limited universe of claims utilization by people who self-identified as needing insurance now.  We know from enrollment data that January eligible individuals skewed old and skewed female.  We knowfrom  the February data the risk and utilization pool was slightly younger.  The March enrollment surge pushed the average age of the entire Exchange risk pool down further still, and the April extended blue box enrollment will probably reduce the average age again. 

Express Scripts data is confirming what the enrollment demographic data suggests.  The older and sicker signed up first and got care first.  The younger and healthier are coming in late.  This is not surprising.

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Early Morning Open Thread: Happy May Day

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It’s known as International Workers’ Day in much of the world, of course. But the traditions go back into Northern European prehistory, when Beltane was celebrated as the day when the cattle (among other mammals) were released from their winter imprisonment to go seeking after fresh pastures. From the Internet Book of Shadows:

… One of the most beautiful customs associated with this festival was “bringing in the May.” The young people of the villages and towns would go out into the fields and forests at Midnight on April 30th and gather flowers with which to bedeck themselves, their families and their homes. They would process back into the villages, stopping at each home to leave flowers and to receive the best of food and drink that the home had to offer… John Williamson, in his study “The Oak King, the Holly King and the Unicorn” writes: “These revelers were messengers of the renewal of vegetation, and they assumed the right to punish the niggardly, because avarice (as opposed to generosity) was dangerous to the community’s hope for the abundance of nature. At an important time like the coming of summer, food, the substance of life, must be ritually circulated generously within the community in order that the cosmic circuit of life’s substance may be kept in motion…”

Mr. Paine was no fan of ‘institutionalized religion’, but I do believe he would’ve approved the idea of celebrating communal generosity over plutocratic avarice.

Apart from celebrating, what’s on the agenda for the day?

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Late Night Open Thread

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Picked up my new glasses today and felt like I was having an acid flashback for a couple of hours while I got used to the new prescription. I tried them on in the shop and had them fitted, and said to myself “No fucking way I am driving home with these on.” I’d put off getting a new prescription when the last checkup I was told I would need bifocals, and probably waited too long for a new scrip. Everything seems clear and readable now. In other words, I am an asshole who fears doctors more than the repercussions. Film at 11.

Had a good laugh with the hot lady fitting me, because the only frames that fit me, and I shit you not, were called Fatheadz, and I pointed out that when I was in the Army they had to special order my hats because I was a size eight when I was 155 lbs. My running joke is that if I was a cowboy I would need a twelve gallon hat. Don’t even get me started on lacrosse helmets. The reason I had a mullet and wore a bandanna when I played was because if I didn’t, I would have lacerations on the back of my neck from hitting people (I played crease D) and the helmet was too small and cut my neck really bad.

Other than that, a very quiet night in the household. Shawn is now an official WV resident with WV tags and WV voter registration and WV license and we both high fived when he got his first piece of mail (Or maybe I may have said “Well, fuck, guess I am not getting rid of you now“). I told him it will be official that he is a resident when someone tries to drop off the complimentary broken washer and dryer in the back yard and hand him a basket of fresh pepperoni rolls and a WVU football sticker. He has a bunch of job leads but is waiting on the meeting with the VA rep on Friday, who will find him jobs that have a higher salary and less emphasis on healthcare, because as a combat vet he has the VA healthcare (which contrary to what Republicans say, is actually kind of great).

Quick Holly update- she is doing very, very well. With this kind of situation there are up and down days and moments, but from everything Greg is saying, she is rope a doping this whole aneurysm thing and showing positive signs every day, getting better and impressing her doctors, and taking the down moments in stride. This chick is a fighter. She is going to be ok, I just know it.

Dogs are on the lap, watching some boob tube, eating some popcorn (I have a new addiction- make popcorn and then instead of salt and pepper, just use Old Bay), and all is good. Hope all is well with you.

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