Come for the politics, stay for the snark.

I might just take the rest of the day off and do even more nothing than usual.

Be a wild strawberry.

How any woman could possibly vote for this smug smarmy piece of misogynistic crap is beyond understanding.

Usually wrong but never in doubt

Republicans: slavery is when you own me. freedom is when I own you.

To the privileged, equality seems like oppression.

Shallow, uninformed, and lacking identity

They traffic in fear. it is their only currency. if we are fearful, they are winning.

When do we start airlifting the women and children out of Texas?

One of our two political parties is a cult whose leader admires Vladimir Putin.

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

We know you aren’t a Democrat but since you seem confused let me help you.

America is going up in flames. The NYTimes fawns over MAGA celebrities. No longer a real newspaper.

The “burn-it-down” people are good with that until they become part of the kindling.

Relentless negativity is not a sign that you are more realistic.

The real work of an opposition party is to oppose.

Jack Smith: “Why did you start campaigning in the middle of my investigation?!”

Marge, god is saying you’re stupid.

Not all heroes wear capes.

If you are still in the gop, you are either an extremist yourself, or in bed with those who are.

You don’t get to peddle hatred on saturday and offer condolences on sunday.

Is it negotiation when the other party actually wants to shoot the hostage?

They spent the last eight months firing professionals and replacing them with ideologues.

Something needs to be done about our bogus SCOTUS.

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Archives for 2014

The NFL Isn’t The Only Profession With A Domestic Abuse Problem

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As of late, domestic violence and the NFL seem to go together like peanut butter and jelly. But there’s another profession that has a much higher incidence of domestic abuse. And that profession? Police officers:

Several studies have found that the romantic partners of police officers suffer domestic abuse at rates significantly higher than the general population. … As the National Center for Women and Policing noted in a heavily footnoted information sheet, “Two studies have found that at least 40 percent of police officer families experience domestic violence, in contrast to 10 percent of families in the general population. 

But what’s even more upsetting is that the abusers are rarely disciplined. According to a New York Times article, police officers are more likely to be fired for a positive marijuana test than abusing a significant other. And with a track record like that, how are people supposed to feel that their own domestic abuse cases will be handled properly?

Team Blackness also discussed the decline of Stop-and-Frisk in New York City, the trials and tribulations of dating, and how much money it takes to be considered part of the top 1% for wealth in your state.

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Sometimes I Get One Right

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These guys are jackasses:

The nude photo leak threat targeting Emma Watson earlier this week turned out to be a viral marketing stunt by Rantic Marketing to shut down the website 4chan.

The website surrounding the false leaks, EmmaYouAreNext.com, threatened to release nude photographs of the 24-year-old actress and included a clock counting down to Saturday at midnight ET. The person who posted the website said it was in retaliation for Watson’s well-received speech that she gave at the United Nations on Sept. 20.

However, by midnight on Wednesday, the URL redirected to Rantic Marketing’s website. Watson’s face and the countdown clock has been replaced with a banner that says, “#shutdown4chan” and an open letter to President Barack Obama that claims celebrity publicists hired the marketing company to popularize a call for Internet censorship and the end of 4chan.

Even a blind squirrel…

*** Update ***

It gets even weirder. This was all an elaborate rickroll.

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Insurance companies as countervailing forces

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The Incidental Economist’s Nicholas Bagley has a good set of comments on the New York Times great article on drive-by doctoring for massive out of network charges. First he looks at the current legal dynamics of contracts of adhesion for individuals and providers.  There is probably a theoretical course of corrective action for massive billing objections, the practical course of action is that it is usually cheaper for the individual to get extorted.

One of those terms is typically that the patient agrees to pay for all medically necessary care in connection with her treatment….As with any take-it-or-leave-it contract full of boilerplate terms—what’s called a “contract of adhesion”—the courts won’t enforce a treatment contract to the extent that it deviates from a signer’s reasonable expectations…just imagine how hard it would be to win such a case. The plaintiff would have to prove either that it wasn’t medically necessary to call in the drive-by physician or that the physician’s fees were so out of line as to be unreasonable. That, in turn, would require expert testimony and intensive discovery—and all for the unlikely prospect, after a delay of several years, of convincing a judge to supersede a physician’s professional judgment.

Doctors are one of the two or three most trusted professions in the country. Lawyers are slightly more popular than cockroaches and Congress. A doctor saying that his smart, intelligent colleague Dr. Smith was the BEST CHOICE at $100,000 for an afternoon’s worth of work for Mr. Doe’s surgery will sway far more juries than lawyers and experts arguing over what is appropriate care.   This is especially true when any claim that reaches the court room is a one-off event without vast statistical profiling.

Now the alternative as Mr. Bagley advances is for laws like New York’s reasonable expectations law:

New York’s law puts insurers on the hook for covering the patient’s out-of-network charges, which are then passed along to the rest of us in the form of inflated premiums. Disputes between insurers and out-of-network providers will be resolved in arbitration, and let’s hope that arbitrators won’t let providers get away with charging exorbitant fees. It’s possible, however, that New York’s law will just shift the costs of drive-by doctoring from patients to insurers.

I think this type of law is far more likely to reduce drive by assistant doctoring than individual litigation for a very simple reason. I know my company’s legal department. They are absolute assholes at softball. They also enjoy big, complex, multi-year litigation. They have spent twice as much on a case than they recovered/avoided in pay-outs to make a point. A suit to avoid outrageous charges is right up their alley.

In a Galbraithian sense, an insurance company acts as a countervailing pressure against concentrated medical power and the legal department is the sledgehammer in this function. An insurance company can look at statistical measures of patient quality and outcomes and show that keeping care in network at reasonable rates is no worse or significantly better than getting an out of network assistant surgeon. They can engage in extensive pre-trial discovery. More importantly, they can kick out of the networks abusers of assistant surgeon/drive by doctor assignments. It won’t stop it, but it will trim the outliers.

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Tools to detect bullshit

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At work, we received a response to a request for proposals that was incredible and fantastic.  I don’t mean that the proposal would save money, reduce confusion, reduce false denials and holds on services or even give a senior executive a suite full of nubile young women whose virtue had already been negoatiated.  I truly mean it was incredible along the lines of the product shitting cupcakes out a unicorn’s ass incredible.  However, on the first read of the response, it looks really good.  The second read is when the bullshit started to become obvious.  My boss knew it was bullshit but could not quite put her finger on why it was bullshit, so I spent the past two days deconstructing the proposal and thinking bullshit. 

There are a couple obvious sign-posts of bullshit in an argument that I think are relevant to general policy analysis.  If you start to see the following signs, you are either engaging with a sophomore in college who just learned something really cool in an introductory class but has neither the advanced classes in the field nor the experience to know better or you are seeing bullshit.  These two categories are not mutually exclusive.

The units of analysis make no sense

Avik Roy’s “study” of sticker shock in 2014 based on average prices per county had the unit of analysis as the county.  A county is a reasonable first unit of analysis as most state regulators regulate plans at a county level.  However, it is a shitty final unit of analysis as there are 3,144 counties in the US.  8 counties contain slightly more than 10% of the US population, and the largest county in the US, Los Angeles County, is roughly 120,000 times larger than the least populated, Loving County, Texas.  In his “analysis”, these two counties count the same. 

The comparisons are wildly bizarre

Again, Avik Roy compares community rated insurance with a fairly rich benefit package to underwritten insurance with significant exclusions of coverage.  As I showed last year, this study included plans that excluded mental health coverage, excluded maternity coverage and included plans that rejected outright a quarter of the individuals who applied for coverage.  It is real easy for an insurance company to offer low prices when it is statistically unlikely to pay big claims due to a screening of the risk pool.  So any comparison between underwritten policies and community rated policies have to be taken with extreme caution.  It can be done, but straight up comparisons can’t be made.

The claims are incredible

Timothy Jost looked at Avik Roy’s Obamacare replacement plan and made a note about an incredible set of claims that the free market/Universal Exchange would shit cupcakes out of its ass:

He claims it would increase access to providers by 4 percent (98 percent for Medicaid recipients) and average health outcomes by 21 percent,  [my bold] while reducing the federal budget deficit by $29 billion over the first 10 years and $8 trillion over 30 years. It would, he claims, reduce average commercial premiums by 17 percent for individuals and 4 percent for families by 2023.

These claims are based on analysis of the proposal conducted by Stephen Parente, an American Enterprise Institute Scholar. I can find, however, no description of the methodology, or for that matter of the inputs, applied in this analysis. In particular, how Parente and Roy modeled an improvement in health outcomes, something the CBO never attempts, is a complete mystery.

The bolded part, increasing average health outcomes by 21% is an incredible claim that flies in the face of most evidence that suggests access to great medical care is a 10% to 15% determinant of health status.  A 21% improvement in health status is an incredible claim.  It should have incredible evidence to support it.  The evidence should be made public.  However it is not disclosed nor has anyone with significant credibility and the charge to conduct that type of analysis ever published anything similar to that model.  It could happen, but the support for that number is extraordinarily weak.

The underpants gnomes dominate the theory of change

As we all know, the underpants gnomes have a simple business model/theory of change to get rich:

1) Steal underpants

2) ????

3) Get rich

When the underpants gnomes have to do the heavy lifting in a theory of change, it is either a first draft that needs to be fleshed out, an affinity scam, or bullshit.  Congressman Ryan (R-Wis) wants to use dynamic scoring to get around the fact that he is making two incompatible promises — lower tax rates, especially on the wealthy, and revenue neutrality.  Dynamic scoring  is step two of the theory of change. 

Don’t look at past predictions

Be extremely skeptical of people who don’t audit their past predictions.  Jonathan Chait ripped Reason magazine’s Peter Suderman apart on his Obamacare predictions:

The latter study comes in for criticism by Peter Suderman, Reason’s indefatigable health-care analyst. Like the entire right-wing media, Suderman’s coverage of Obamacare has furnished an endless supply of mockery of the law’s endless failures and imminent collapse. While some of his points have validity, it’s fair to say that the broader narrative conveyed by his work, which certainly lies on the sophisticated end of the anti-Obamacare industry, has utterly failed to prepare his libertarian readers for the possibility that the hated health-care law will actually work more or less as intended.

And yet, in another way, the conservative media has provided a useful lagging indicator of Obamacare’s progress. The message of every individual story is that the law is failing, the administration is lying, and so on. The substance, when viewed as a whole, tells a different story. Here is how Suderman, to take just one example, has described the continuous advancement of the law’s coverage goals:

People get things wrong all the time.  That is fine.  It is not fine when their is no evaluation of the process that produces wrongness as that guarantees the continuation of the Garbage In-Garbage Out loop.

 

There are plenty of other high quality bullshit detection tools that are useful in policy analysis, but the above tools can be safely applied by anyone with some curiousity and interest in a subject.

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Wednesday Morning Open Thread: Notorious RBG

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Guess I’ll have to check out the fashion section at the local B&N newstand:

Supreme Court Justice Ruth Bader Ginsburg: I’m Not Going Anywhere
… In a rare interview—featured exclusively in the October issue of ELLE—she speaks frankly with Jessica Weisberg about everything from riding an elephant with Antonin Scalia to why people who want her to resign so President Obama can appoint another progressive justice are nuts.

… What do you make of the term activist judge?

Depends on whose ox is being gored. You think of activism, Congress is supposed to make the laws. So, it passed a campaign finance law. This court says, “No, Congress, you can’t do that.” This court is labeled conservative, but it has held invalid more statutes than most courts. That’s why I say that activism is like “beauty is in the eye of the beholder.” So the answer to the question: If a judge is called an activist, you know the person saying that doesn’t like the decision…

Does it make a difference having three women justices?

Yes, an enormous difference….When Sandra left, I was all alone…. Now Kagan is on my left, and Sotomayor is on my right. So we look like we’re really part of the court and we’re here to stay. Also, both of them are very active in oral arguments. They’re not shrinking violets. It’s very good for the schoolchildren who parade in and out of the court to see…

Lots more goodies at the link, including RBG’s salute to her late husband Martin Ginsburg and a life-long romance.

In other social news, the Washington Post notes RBG just accepted the Institute for Education‘s 2014 Cultural Diplomacy Award.
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Apart from honoring our warriors, what’s on the agenda for the day?

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Ebola Epidemic: A Few Modern Heroes

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From the NYTimes, Dr. Mosoka Fallah:

… Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts…

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

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