Come for the politics, stay for the snark.
Watch Laura Ingraham practically throw a chair over Democrats organizing black voters. Gerrymandering gives Republicans thin margins by design so it goes to hell when turnout patterns change. Go change them.
Smug when they riot, panicked when they votePost + Comments (60)
The Robert Woods Johnson Foundation has published some interesting data on the utilization of hospital services for the first half of 2014. The basic story that the data is telling is the one that we expected.
Hospital utilization in the group market overall declined considerably, with a median decrease in both admissions and patient days of 7 and 6 percent, respectively….
The group/employer sponsored insurance market is relatively healthy. Some of the changes are probably quirks in the data set and the group composition, but a good chunk is probably real and a result of better care management. The goal of almost all care management programs is to minimize the number of admissions and the number of days in the hospital. Hospital days are insanely expensive. The more interesting chunk of data concerns the individual market.
In the non-group market, the median admissions per 1,000 members increased between 2013 and 2014 from 9.6 to 9.8, but many of the national, publicly traded corporations show decreases (Aetna, United, HCSC), although WellPoint posted an increase. Among the Blues, results are mixed, with some (Alabama, Florida, Minnesota, and Vermont) showing large increases, while others (Arizona, South Carolina, and Massachusetts) report lower hospital utilization in 2014. Independence Blue Cross, which adopted a very narrow network, showed considerable decline in hospital utilization. Molina Healthcare, which has Medicaid and QHP plans, reported an increase in hospital utilization in 2014, yet at levels which are considerably below the median. Wellcare, a privately traded company with Medicaid plans in a number of states, reported a high level of hospital utilization in 2014. Many, but not all, of the new entrants in 2014 post high levels of hospital utilization
There are a couple of very interesting nuggets. First, as expected utilization within the individual market segment went up. The individual market segment until December 31,2013 was often a comprehensively underwritten product. Underwriting, in most states, was designed to keep the people who are most likely to use hospital services out of the product. On January 1, 2014, the individual market became a minimally underwritten product as no one could be turned down and rates were based on age, location and smoking status only. Unshockingly, the risk pools got sicker and insurerss in the individual market paid for more services as the pools were sicker in January, and February 2014 than they were in the same months in 2013. As the enrollment surged in March, the risk pools probably got to look more similar to 2013 risk pools.
The next interesting nugget is Independence Blue Cross with a narrow network structure showed large utilization declines. I am speculating wildly out of my ass now. There are two plausible stories that would explain this utilization decline. The first is the narrow network scared away people who know that they are highly likely to be admitted to a hospital. Those visits were shifted from Independence Blue Cross to another carrier. That is good news for the bonus pool at IBC but either neutral or slightly bad news for society as a whole. The other story is that the narrow network had minimal scare-off attributes, but it cut out providers and hospitals that liked to over-admit and over-stay patients. I can’t tell which story is plausible, or more likely, which story has more weight over the other story.
The third nugget of interest to me is that the new entries had high levels of utilization. This was expected for a couple of reasons. The first is purely compositional. A new entry, by definition, had no grandfathered plans and it had no grandmothered (if you like it, you can keep it kludge plans), so therefore they had no underwritten membership that would help balance their numbers. Secondly, the co-ops and other new players were often making a pitch to underserved and expensive to cover populations. They were looking for the medically needy. Finally, setting up effective care and case management is partially a relationship building experience, and relationships take time to build between case manager and member, case manager and the nurse at the doctor’s office, and case manager and the admitting doc. I would bet a nickel to the RNC that 2nd half of 2014 results will see a normalization and decline of utilization as case management gets better at the new entries.
Overall, the big takeaways are utilization as a whole is going down which should lead to flat or low cost increases, and the exchanges are not deviating too far from aggregate insurance industry expecations.
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Professor Krugman, “Three Roads to Hard Money“:
So, a hedge fund manager, a right-wing politician, and a freshwater economist walk into a restaurant and order wine. No, this isn’t the setup for a joke — it’s a real story. We don’t actually know what they talked about, but all three have been prominent in warning that the Fed is embarked on a dangerously inflationary path. And as I have written many many times, this inflation paranoia has proved remarkably resilient, enduring despite five-plus years of utter empirical failure. Why?
What strikes me here is that we have three seemingly different stories about the roots of hard-money mania, which happen to be embodied in the persons of the three diners. One is that the wealthy hate monetary expansion because they fear that it will reduce their returns and erode their wealth, and money buys influence. One is that movement conservatism has become a closed intellectual space, within which leading political figures can and do imagine that the truth about economics can be found in Atlas Shrugged. And one stresses the internal evolution (or devolution) of the economics profession, in which the rise of rational expectations led to a great forgetting of even the most basic macroeconomic concepts….
“People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.” — Adam Smith
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Apart from that, Mrs. Lincoln, what’s on the agenda today?
Wednesday Morning Open Thread: Suspicious MindsPost + Comments (80)
One wonders how this one passed completely under the radar, per the NYTimes:
… I binged on the first six episodes of the ABC series “The Quest,” which began on July 31 and is at least trying to find new places to take the reality competition genre. It’s set in a fictional kingdom called Everealm, but it actually takes place in the Land of LARP: live-action role playing, a type of fantasy game in which participants physically take on the role of a particular character.
“The Quest” is an ambitious effort to merge LARP sensibility with a traditional one-elimination-per-week competition show. Some parts of the experiment work better than others, but it’s always intriguing. It’s also mindlessly addictive, even if you’re not the World of Warcraft type.
The show began with 12 contestants who all professed a fondness for fantasy role-playing of one sort or another. Call them nerds or geeks if you want; some called themselves that. In any case, they were transported to a real castle in Austria, where a medieval world had been created, populated by actors who guide them through a semi-scripted story full of challenges that most nerds can only dream of trying. Several involved archery. One required proficiency with a battering ram; another, performing feats of agility on horseback…
Funny, there doesn’t seem to be a category tag for “Insufficiently Popular Culture”…
Late Night TV Open Thread: Survivor, LARPing EditionPost + Comments (25)
Boy, this "autonomous billionaires as the saviors of American journalism" idea sure is working out swell!
https://t.co/hK0Y0IZob8
— Billmon (@billmon1) September 2, 2014
The Washington Post: From "Pravda on the Potomac" to "Chamber of Commerce chew toy" in less than 20 years. Quite a ride.
— Billmon (@billmon1) September 2, 2014
Jim Newell at Salon reports “Ronald Reagan’s No. 1 superfan now runs the Washington Post“:
The Washington Post has been a much more ambitious beast since Amazon.com founder and CEO Jeff Bezos bought the paper last year. Since it’s been in private control, and no longer subject to public shareholder pressure, the paper has invested in hiring dozens and dozens of new staffers with all sorts of cutting-edge “online experience,” writers who understand that the journalism of the future will involve getting lots of people to click on lots of stuff. No word yet on when/how this all becomes profitable. But that’s for the suits to worry about….
… Fred Ryan, who’s just been named the Post’s new publisher, is among the more Reagan-y people to ever walk the earth — somewhat less Reagan-y than Ronald Reagan himself, but probably more Reagan-y than Nancy Reagan or other members of the Reagan family.
“Ryan’s background in Republican politics,” the Post’s own write-up of the leadership switch notes, “also is certain to raise questions about the direction of The Post’s editorial page, among the most influential in the nation.” Make what you will of that “most influential in the nation” business. But as for the part about how it’s certain to “raise questions about the direction of The Post’s editorial age” — well, yeah! This Fred Ryan cranks the Reaganmeter dangerously into the red…
More at the link. I’m sure you all have strong opinions about this.
From the LA Times, “China complains SAT may impose American values on its best students“:
Chinese students have shown an insatiable appetite for attending U.S. colleges — last year alone, more than 235,000 were enrolled at American institutions of higher education. But now, some in China are grousing that the SAT may impose American values on its best and brightest, who in preparation for the exam might be studying the Declaration of Independence and the Bill of Rights instead of “The Selected Works of Mao Tse-tung.”…
The U.S. College Board in March announced plans to redesign the SAT to include key U.S. historical documents in one portion of the test, known as the Evidence-Based Reading and Writing, by spring 2016.
“The vital issues central to these documents — freedom, justice, and human dignity among them — have motivated numerous people in the United States and around the globe,” the College Board said in a statement.
But those are the exact values that the Chinese Communist Party has deemed as threatening to its rule; Chinese activists who have tried to promote such values have been silenced or jailed. Human rights advocate Xu Zhiyong, who initiated the New Citizens Movement to promote such values, was sentenced in January to four years in prison….
Meanwhile, in another place, James R. Grossman in the NYTimes on “The New History Wars“:
… Last month, the College Board released a revised “curriculum framework” to help high school teachers prepare students for the Advanced Placement test in United States history. Like the college courses the test is supposed to mirror, the A.P. course calls for a dialogue with the past — learning how to ask historical questions, interpret documents and reflect both appreciatively and critically on history.
Navigating the tension between patriotic inspiration and historical thinking, between respectful veneration and critical engagement, is an especially difficult task, made even more complicated by a marked shift in the very composition of “we the people.” This fall, whites will constitute a minority of public-school students in the United States. “Our” past is now more diverse than we once thought, whether we like it or not.
It turns out that some Americans don’t like it. A member of the Texas State Board of Education has accused the College Board of “promoting among our students a disdain for American principles and a lack of knowledge of major American achievements,” like those of the founding fathers and of the generals who fought in the Civil War and World War II. The Republican National Committee says the framework offers “a radically revisionist view” that “emphasizes negative aspects of our nation’s history.” Stanley Kurtz, in National Review, called it “an attempt to hijack the teaching of U.S. history on behalf of a leftist political and ideological perspective.”…
They Might As Well Adopt Them, We’re Barely Using Them OurselvesPost + Comments (123)