Let’s make this Trump voter internet famous:
This nation has a serious mental health crisis. I guarantee this woman drives an SUV without using turn signals.
by John Cole| 91 Comments
This post is in: Assholes, Just Shut the Fuck Up
Let’s make this Trump voter internet famous:
This nation has a serious mental health crisis. I guarantee this woman drives an SUV without using turn signals.
by David Anderson| 22 Comments
This post is in: Anderson On Health Insurance
I’ve had two NBER papers that I am struggling to make sense with. These papers are critical health policy papers as they relate to high deductible health plans (HDHP). We’re going in that direction for a lot of health policy. My prior assumption is that high deductible health plans paired with a health savings account is appropriate for people with the means to save significant money and a reasonable expectation that they are insuring and saving against one time risk. As soon as those conditions are not met due to either low ability to save due to low income or known chronic conditions that would routinely incur costs at or above annual cost sharing limitations, high deductible health plans are massively inadequate. That is my prior.
So I just want to flag two papers that I’m struggling to make sense with together. They each make perfect sense on their own. I am struggling to put them together.
Haviland et al 2015 NBER 21031
Relative to control firms and the pre-offer years, firms offering a CDHP had an estimated 6.6, 4.3, 3.4 percent lower annual spending in the first three years respectively (p < 0.05 for each difference) (Table 3, column 1). In addition, the CDHP second pre-year trend coefficient is insignificant, supporting the assumption of a parallel trend in the absence of CDHP offer. In section 6.4 below, we discuss whether the post CDHP offer impact is changing over time controlling for differential composition of treatment firms over time.
Her team does a nifty piece of machine learning to balance covariates to address the possibility that the savings are merely an illusion of the covered population effect. I don’t have the statistical chops to say if their treatment makes sense but I’m glad that they are attempting to look at the case mixture. One of my big worries as we generalize HDHP learning from employer sponsored coverage is that ESI is a unique pool compared to public pools. ESI is younger than Medicare, wealthier than Medicaid and healthier than both. More importantly, ESI offers people with known high disease burden a lot of outs if the richness of their benefit package declines. They can get a new job. They can go on their spouse/domestic partner’s coverage. They can apply for Medicare and disability if sick enough. There are outs in ESI that are not present in other systems. This is my big worry about generalizing research.
And then the other paper:
Employees at the firm are relatively high income (median income $125,000-$150,000), an important fact to keep in mind when interpreting our analysis. In addition, post-switch there is no meaningful change in the relatively small rates of employee entry or exit from the firm. The required firm-wide change from free health care to high-deductible insurance constituted both a substantial increase in average employee cost-sharing and a meaningful change in the structure and complexity of that cost-sharing. We use this natural experiment, together with the detailed data described to assess several aspects of how consumers respond to this increased cost-sharing. First, we develop a causal framework to understand how spending changed, in aggregate and for heterogeneous groups and services. In doing so, we account for both medical spending trends and consumer spending in anticipation of the required plan switch.5 We find that the required switch to high-deductible care caused a spending reduction of between 11.09-15.42% for t0, with the bounds reflecting a range of assumptions on how much anticipatory spending at the end of t−1 would have been spent under higher marginal prices in t0. Spending was causally reduced by 12.48% for t1 relative to t−1, implying that this reduction persists in the second year post-switch….
We find no evidence of price shopping in the first year post switch. The effect is near zero and looks similar for the t−1 − t0 year pair (moving from pre- to post-change) as it does for earlier year pairs from t−4 to t−1. Second, we find no evidence of an increase in price shopping in the second year post-switch; consumers are not learning to shop based on price. Third, we find that essentially all spending reductions between t−1 and t0 are achieved through outright quantity reductions whereby consumer receive less medical care. From t−1 to t0 consumers reduce service quantities by 17.9%. Fourth, there is limited evidence that consumers substitute across types of procedures (substitution leads to a 2.2% spending reduction from t−1 − t0). Finally, fifth, we find that these quantity reductions persist in the second-year post switch, as the increase in quantities between t0 and t1 is only 0.7%, much lower than the pre-period trend in quantity growth. These results occur in the context of consistent (and low) provider price changes over the whole sample period.
The decline in expenditure is directly related to decline in utilization and not shopping. This applies to the sickest group of people who routinely would go over their deductible.
My brain crash on these two papers is the first paper is not seeing any catastrophic care costs bounce back in the out years while the second paper finds extremely inefficient and irrational consumption behaviors.
These are two papers I need to chew on.
This post is in: Grifters Gonna Grift, Hail to the Hairpiece, Open Threads, Republican Venality, Assholes
At last, a little uplift for the Balloon Juice commentariat! (And, yes, this front-pager, who just turned 61.)
The fact that 54% of those voting voted against Trump clearly has him unnerved. Let's remind him every day.
— Neera Tanden (@neeratanden) November 28, 2016
Speaking of long-range tactics, I think Dana Houle has a good point here:
After narcissism, it’s what was on TV, what the last person he spoke w told him, cruelty, racism/sexism, conflicting goals of his minions https://t.co/LLSOzZBDLD
— Dana Houle (@DanaHoule) November 28, 2016
And no, Trump is not a puppet of a cohesive team executing a plan. The Kushner/Bannon/Priebus triumvirate will be acrimonious & chaotic
— Dana Houle (@DanaHoule) November 28, 2016
Jared Kushner is a NYC businessman, heir to a convicted felon real estate developer. Reince Priebus is a leading product of the GOP political machine. Steve Bannon is a sociopath who sees the neo-Nazi, white-supremacist “alt right” as a tool for random social destruction, which he finds entertaining / useful for his private goals. (Bannon is acting as the third corner of the traditional GOP Golden Triangle, Business/Bureaucracy/’Church’, which is its own kind of weird American success story.) The three of them have converged, temporarily, to push an aging “celebrity” to the top of the American political pyramid. Their common interests started diverging immediately after Clinton’s concession speech… and the cracks are widening by the day.
Our strategy, as Democrats and citizens, must include encouraging the dissension between ‘good for the Trump/Kushner business conglomerate’ — ‘Good for the GOP party’ — ‘Good for the dank lulz’. Yes, it would be nice if the pivot weren’t Donald Smallgloves Trump, but then again, he’s not going to make life easier for the triumvirate, either.
***********
Apart from soldiering on, what’s on the agenda as we start another week?
On Monday I will introduce a resolution asking President-elect Trump to comply w/ Constitution regarding his assets. https://t.co/KFt4zPliVS
— Senator Ben Cardin (@SenatorCardin) November 22, 2016
Monday Morning Open Thread: Cold ComfortsPost + Comments (222)
by Adam L Silverman| 21 Comments
This post is in: Music, Open Threads
Here’s a shiny new post to get you all through the wee hours. Given the discussion in the comments to the previous thread, I reckon this is an appropriate musical choice.
This post is in: Election 2016, Hail to the Hairpiece, Open Threads, Republican Venality
Site Trump got his illegal voters lie from also says Giuliani blew up Building 7 soooooooo……
— Zeddonymous (@ZeddRebel) November 27, 2016
These tweets by Trump are a great example of the silliness of “don’t fall for his tweets, he’s trying to distract you.” This shit is serious
— Dana Houle (@DanaHoule) November 27, 2016
A responsible observer can do both!
President-elect Donald Trump falsely claims in bizarre tweets that "millions" voted illegally for Clinton: https://t.co/MtJjIWtdSi
— People Magazine (@people) November 27, 2016
Focus on Trump's business. Follow the money. Ignore the tweets. Focus on Trump's business. Follow the money. Ignore the tweets. Focus on Tru
— David M. Perry (@Lollardfish) November 27, 2016
Why do people posit this false choice? It’s like saying focus only on Nuremberg Laws but ignore Nuremberg rallies. https://t.co/JS2jcAj8qg
— Dana Houle (@DanaHoule) November 27, 2016
New Trump rule for press: When the president says something clearly false, the story isn't the lie he's saying but why he's lying.
— Schooley (@Rschooley) November 27, 2016
Open Thread: Walk <em>and</em> Chew AnklePost + Comments (182)
by Betty Cracker| 330 Comments
This post is in: Open Threads, Politics, Republican Stupidity, Assholes, General Stupidity
A small, delusional narcissist who can’t focus on the fact that he won the big prize but has to quibble over the implicit slights in his historic popular vote loss:
Never mind that alleging massive voter fraud hardly serves his cause — people are saying he was beaten by a girl! Outrage!
This is your president-elect, Trumpkins. You were taken in by a not-too-bright conman. That makes you an especially idiotic mark.
Had you only squandered your life sayings on a hard-sell shakedown disguised as a real estate course, it wouldn’t be any of my business, except perhaps as a concerned citizen who wants to shut down similar scams.
But with your vote, you made me and mine collateral damage to the con you signed up for, and second-class citizens into the bargain.
Wanted to “send a message,” did you? Well, message received, motherfucker: You don’t give a shit about this country that you’ve entrusted to a lunatic. Never dare to question my patriotism again.
So, he’s all yours, Trumpkins. Defend his petty vendettas at the cost of your soul. Or sack up and join the resistance.
This post is in: Election 2016
I don’t get excited too often when I read the news, but this piece got my blood pumping:
On Wednesday, she woke up inconsolable. On Thursday, angry. But on the Friday after the presidential election, as she prepared posters to join thousands in protesting Donald Trump’s victory, Mia Hernández came to a quiet realization: If she found her country’s direction intolerable, she would have to try to change it.
She would change it not just by signing petitions, or protesting, or calling her legislators. For the first time, she sketched out a plan to run for elected office.
In 2020, Hernández intends to make a bid for a seat on the San Jose City Council or the Santa Clara County Board of Supervisors. Her focus will be reproductive rights and community empowerment, she said.
“Everybody says organize, don’t mourn, make a change,” said Hernández, 22, a student at the University of California at Santa Cruz. “So I said to myself, ‘How am I going to be an active member in this? You know what, I need to run for office. I need to be a part of that decision-making. I need to make sure Trump’s voice is not the only voice out there.’ ”
Among young, liberal women who expected to see the country elect its first female president Nov. 8, Hernández is not alone; many are responding to Hillary Clinton’s defeat with a new sense of obligation to seek political power. After years of never imagining a career in the public eye or only vaguely entertaining the idea of working in politics, these women are determined to run for elected office.
YES! This is exactly what we need. We need it in every single county election, we need it in every single state election, and we need it in every national election. In my state alone, so many elections don’t even have two candidates. Not only is there no choice, there is no accountability.
Several extra thoughts:
1.) The local level is where people will feel the impact of positive governance most immediately. It actually has more of an impact on your daily lives than people realize.
2.) This can serve as the pipeline to higher office for candidates that Democrats desperately need. Republicans are always puking up bilious up an comers, and there seems to be no deep bench.
3.) The thing about organizing is it is exceptionally difficult when there is nothing to organize around. I started a grass roots group of fb for our area, got a lot of people in the group, we talked and talked, and then we did jack shit. Why? There were no candidates to support, no useful county organization, and so forth. Organization takes time and practice- they aren’t like a drag car that you run every now and then for 10 seconds at high speed, they much more resemble a diesel 18 wheeler that takes some time getting started and once you get the engine running performs best if it doesn’t stop.
Once you get some candidates around which you can organization, then the magic happens.
If This Is Hillary’s Legacy, It Will Be a Good OnePost + Comments (189)