Come for the politics, stay for the snark.
This post is in: Hail to the Hairpiece, Music, Open Threads
Contemplating the pain Trump’s going to lay on the most vulnerable among us (and yeah, some of them voted for him, but hurt is hurt), I found this song, imagined as being addressed directly to the Shitgibbon, a perfect expression of my mood:
(Buried deep in the lyrics Reed talks of the Trumps being ordained. But the real tell is when he sings “They say the President’s dead/But no one can find his head.” That last line is truer than he ever knew. Man was a prophet.)
Open thread.
by David Anderson| 101 Comments
This post is in: Anderson On Health Insurance, Free Markets Solve Everything, Fuck The Middle-Class, Fuck The Poor, All we want is life beyond the thunderdome, Bring On The Meteor
Now that we know Rep. Tom Price (R-GA) will be the next Secretary of Health and Human Services, it would be a good idea to look at the mechanics of his Obamacare Repeal and Replace bill. We did this in 2015 for HR2300 and I am reprinting the post on distributional impacts below. The mechanics of the plan are described in this post:
TLDR: The plan is good if you are healthy and wealthy as there are a ton of tax breaks and tax shelter expansions through HSA expansions. If you are chronically ill or poor, you are significantly worse off. And now for the moldy oldie:
Distributional Impacts of Price Plan (Reprise)Post + Comments (101)
by David Anderson| 30 Comments
This post is in: Anderson On Health Insurance, Election 2016
Proposition 61 was an interesting attempt to get better pricing for California’s state government for prescription drugs that it buys or directly reimburses for. It failed by eight points this November but I think there is something interesting here.
First, let’s look at how the LA Times described it:
The measure would essentially prohibit the state from paying more for a drug than the U.S. Department of Veteran Affairs does. The VA typically pays the lowest price for prescription drugs of any public or private entity, because federal law ensures the agency gets a 24% discount off a drug’s list price right off the bat. And officials there often negotiate even steeper discounts on a drug-by-drug basis.
It would apply when the state directly purchases drugs (as it does for prison inmates) and also when the state is the “ultimate payer” for those drugs, such as when it reimburses pharmacies for medicine provided to Californians who are covered under certain state programs. If passed, all state agencies would need to comply by July 1, 2017…
Opponents of the measure say about 12% of Californians, or an estimated 4.4 million people, would be covered. That includes low-income patients covered by Medi-Cal’s Fee for Service program, inmates in state prisons, state employees and retirees, and employees and teachers at UC and CSU campuses. Proponents of the measure have said they believe the figure is higher, around 5 million to 7 million Californians.
The basic thrust of the proposition would be to effectively make the VA the proxy price negotiator for a significant chunk of California’s prescription drug budget. California could probably get away with this because it is a huge market and it has the ability to significantly move stock prices if it shifted all purchases in one category to a single company instead of seven manufacturers. It actually has some market power. That market power is why the Pharma industry opposed the measure. Pharma probably would not have spent $100 million dollars to oppose a similar initiative in Wyoming.
We have to ask ourselves why does the VA get such good pricing on their drugs?
They have decent size although there are several pharmacy benefit managers with much larger patient pools.
They benefit from the federal law that mandates a list price discount but that does not explain their superior pricing to Medicare’s drugs.
The VA gets good drug pricing because they say no. I want to highlight one of my favorite 2011 Incidental Economist pieces (again) as Austin Frakt looked at the savings of a VA like formulary for Medicare Part D:
It’s worth asking, why are Part D formularies so generous? The reason is that a minimum of two drugs in each class must be included on formularies and six classes must include “all or substantially all” drugs on the market. Because of this, providing Medicare the authority to negotiate directly with manufacturers would not lead to price reductions on its own. To achieve savings, Medicare or its participating plans would also need the ability to exclude drugs from its formulary. This ability to tighten formularies would provide the leverage to bargain for lower prices.
Medicare’s inability to negotiate program-wide prices and tighten plan formularies is in stark contrast to the VA, which negotiates directly with drug manufacturers and is not bound by the same formulary rules as Part D plans. That’s why the VA has been able to implement a national formulary more restrictive than those of Medicare plans and obtains lower drug prices. If Medicare plans could implement VA-like formularies and obtain commensurately lower prices, our paper shows that enough could be saved to compensate beneficiaries for the loss of choice, with savings to spare.
To repeat, the key findings are:
The VA pays 40% less than Medicare plans for prescription drugs.
Medicare plans cover about 85% of the most popular 200 drugs on average (ranging from a low of 68% to a high of 93%).
The VA’s national formulary includes 59% of the most popular 200 drugs.
The initiative would have put into place a massive implicit system of NO. That NO would create a significant set of diffused winners (California tax payers), a small set of concentrated winners (California funded beneficiaries who currently take drugs that would be on the narrow formulary at lower prices), a large set of somewhat diffuse losers (beneficiaries who would either have to change drugs or pay higher co-insurance for current drugs) and a narrow set of concentrated losers (Pharma as they won’t extract as much money from California in economic and intellectual property rents). That is a nasty political balance of power that implies a close election which is what we got.
Is this an experiment that other states could push forward on? I think it is. The biggest challenge may be getting the VA to be the lead negotiator for drug classes that their population does not use or does not use in large quantities even as the states’ impacted population uses those drugs in large numbers. I am not a clinician but I would think some pediatric drugs would fit into this category of concern. The VA might be willing to take on this role as it could significantly increase the market power of the VA negoatiators as they would have millions of more covered lives to credibly threaten to move to a different drugmaker unless they get a better deal.
This is something that should be pushed again with any locally relevant tweaks and lessons learned from 2016. I think it could help the drug pricing problem.
This post is in: Don't Mourn, Organize, Open Threads, Daydream Believers
Important note from commentor Burnspbesq:
Speaking of memberships, some anonymous patriot has offered to match up to a half million bucks of year-end contributions to the ACLU.
So if you’ve got a little spare cash from a year-end bonus, or need a gift for that hard-to-buy-for friend…
Apart from seasonal charity, what’s on the agenda for the day?
***********
Jared Bernstein and Ben Spielberg, at the Washington Post:
The Fight for $15 has been incredibly successful since 100 fast-food workers first went on strike on Nov. 29, 2012, in New York City. The movement they helped create went 5-for-5 during the most recent election, winning ballot initiatives in Arizona, Colorado, Maine and Washington, while defeating a subminimum wage law for teenagers in South Dakota. And with the anniversary of its original strike approaching, that movement is only gaining steam.
As Bryce Covert of the news site ThinkProgress recently reported, workers in more than 340 cities will go on strike again on Tuesday, while “fast food employees, airport workers, childcare and home care providers, and university graduate students” will engage in “civil disobedience at McDonald’s and 20 of the nation’s largest airports.” The workers have also upped the ante: In addition to their calls for minimum wage increases, they’re “demanding no deportations of undocumented immigrants, an end to police violence against black people, and the protection of health care coverage.”…
Raising the wage floor would clearly be good policy, too. Decades of research show that minimum-wage increases more substantial than those Republicans are proposing have their intended effects of helping low-wage workers without much in the way of unintended job loss effects. While the labor market effects of the boldest Democratic proposals are harder to predict, as they lie outside the range of prior research, such proposals still phase in over several years to give businesses time to adjust and are worthy of Republicans’ consideration.
That they should do the right thing doesn’t mean these politicians will do it willingly, of course. Their feet will need to be held to the fire. But that’s precisely where the Fight for $15 has been so successful over the past four years, and low-wage workers’ resolve appears to be as strong as ever…
This post is in: Hail to the Hairpiece, Open Threads, Republican Venality, Trump Crime Cartel, Assholes, Decline and Fall, Romney of the Uncanny Valley
Kellyanne is acting like Mitt is hiding that one last Dalmation puppy needed to finish the marvelous coat before inauguration day.
— John Weaver (@JWGOP) November 27, 2016
… Except, y’know, the silly bastid is willfully submitting himself to this shiteshow. Per AP:
… Vice President-elect Mike Pence, who is heading the transition effort, teased “a number of very important announcements tomorrow” as he exited Trump Tower Monday night.
Pence is said to be among those backing Romney for State. Romney was fiercely critical of Trump throughout the campaign but is interested in the Cabinet position, and they discussed it during a lengthy meeting earlier this month.
Other top Trump allies, notably campaign manager Kellyanne Conway, have launched a highly unusual public campaign to warn the president-elect that nominating Romney would be seen as a betrayal by his supporters. Conway’s comments stirred speculation that she is seeking to either force Trump’s hand or give him cover for ultimately passing over Romney.
Three people close to the transition team said Trump had been aware that Conway planned to voice her opinion, both on Twitter and in television interviews. They disputed reports that Trump was furious at her and suggested his decision to consider additional candidates instead highlighted her influence…
Trump was also considering former New York City Mayor Rudy Giuliani for Homeland Security secretary, according to those close to the transition process. Giuliani was initially the front-runner for State and is still in the mix. But questions about his overseas business dealings, as well as the mayor’s public campaigning for the job, have given Trump pause…
Report: Mitt Romney must apologize to Donald Trump if he wants to be his secretary of state https://t.co/YkSIXR34Tf pic.twitter.com/qCUtqnJhSB
— Washington Examiner (@dcexaminer) November 26, 2016
Yeah, among the many things I hold against Trump is that he’s made Willard ‘Mitt’ Romney look like the good, sane alternative for a powerful political office. Mitt’s certainly touched some nerves among the Trump Crime Cartel, though…
BREAKING – Sources: Trump 'furious' over Conway comments about Romney https://t.co/Sd4kogEPGz
— Morning Joe (@Morning_Joe) November 28, 2016
I kinda like Josh Barro’s theory…
Whose power are Trump's loyalists worried SecState Romney would dilute — Trump's, or their own? https://t.co/C4y4oHrCR4
— Josh Barro (@jbarro) November 28, 2016
… Remember the calculus for the C-listers who signed up with Trump early.
They debased themselves by signing up with a candidate who was widely considered ridiculous and unacceptable by Republican insiders. In exchange, they would line up — in the unlikely event Trump won — for administration jobs for which they would otherwise be considered laughably unsuitable.
This calculus seems to have worked out for Michael Flynn and perhaps Ben Carson. But a Romney appointment would be a severe threat to the dynamic the Trump sycophants depend on.
If a consummate party establishmentarian who did not support Trump — indeed, one who said Trump was “playing the American public for suckers” — can be forgiven and given a top job, what role would be left for Rudy Giuliani or Mike Huckabee?…
@jbarro Trump shorting his contractors yet again
— Modeled Behavior (@ModeledBehavior) November 28, 2016
Late Night Open Thread: One Could <em>Almost</em> Feel Sorry for RomneyPost + Comments (58)
by John Cole| 60 Comments
This post is in: Open Threads
All I want for Christmas is for this house renovation to be over. I am so tired of thinking about it and stressing.
by Adam L Silverman| 122 Comments
This post is in: America, Domestic Politics, Election 2016, Open Threads, Politics, Silverman on Security
As we go to the judges scorecard it is important to remember we are scoring on a 10 point must system. The judges are looking for clean punching, effective aggression, and good ring generalship!
https://twitter.com/marceelias/status/803396435593011201
What does this mean?
https://twitter.com/marceelias/status/803403008742739968
https://twitter.com/marceelias/status/803403089025843200
Now we have to see if Governor McCrory tries some other tactic to maintain power despite the outcome of the North Carolina gubernatorial election.
Here’s the North Carolina State Board of Elections Statement:
STATE OF NORTH CAROLINA WAKE COUNTY BEFORE THE STATE BOARD OF ELECTIONS IN THE MATTER OF: CONSIDERATION OF CERTAIN LEGAL QUESTIONS AFFECTING THE AUTHENTICATION OF THE 2016 GENERAL ELECTION ) ) ) ) ORDER THIS MATTER CAME BEFORE THE STATE BOARD OF ELECTIONS (“State Board”) during a public meeting held November 22, 2016, upon the State Board’s own motion to consider certain legal questions affecting procedures and practices in the authentication of the 2016 general election. The State Board received briefing and heard oral argument from the Republican Party of North Carolina and Pat McCrory Committee, represented by Roger Knight, John Branch, and Brian LiVecchi; the North Carolina Democratic Party and Cooper for North Carolina Committee, represented by Kevin Hamilton (appearing pro hac vice); and the Southern Coalition for Social Justice, represented by Allison Riggs. After hearing from the parties, reviewing written briefs and public comment, and having reviewed relevant statutes and authorities, the State Board hereby orders the following pursuant to its authority under G.S. §§ 163-22(a) and 182.12:
1. The uniform application of law is necessary to ensure fundamental fairness in the administration of elections and to preserve due process for each voter.
2. Article 8 of Chapter 163 of the General Statutes (“Article 8”) provides the means by which one voter may challenge the eligibility of another voter. No voter challenge may be entered after the deadline or made indiscriminately. A timely challenge properly sustained against a voter who has cast an absentee ballot will result in the exclusion of that ballot from the canvassed results.
3. Article 15A of Chapter 163 of the General Statutes (“Article 15A”) provides the means by which a voter may protest an election. A successful protest must prove the occurrence of an outcome-determinative violation of election law, irregularity, or misconduct. If a county board of elections (“county board”) finds a violation occurred affecting votes sufficient in number to change the outcome of a single-county contest, the county board must retrieve the ballots improperly cast and note the deduction in the abstract. If a county board finds a violation occurred that did not affect enough ballots to change the outcome of any single-county contest, the county board must forward its findings to the State Board. The State Board shall determine whether all ballots improperly cast are sufficient to change the outcome of any multi-county contest. If so, the State Board will order county boards to retrieve and discount affected ballots and revise its canvass.
4. A protest alleging the occurrence of an election law violation that affected votes sufficient in number to change the outcome of a single-county contest concerns the manner in which votes were counted or tabulated, and therefore such protest must be resolved prior to county canvass as required by G.S. § 163-182.10(a)(2). A protest that does not allege an election law violation regarding a sufficient number of votes to change the outcome of a single-county contest shall not delay the county canvass procedures since the county may not retrieve and discount such ballots. In no case shall the county board delay the timely hearing and decision on a protest timely filed.
5. A protest of election brought under Article 15A may not merely dispute the eligibility of a voter. Such a claim must be brought timely as a challenge under Article 8. Rather, a protest of election may include claims regarding the eligibility of certain voters only as evidence that an outcome-determinative violation of election law, irregularity, or misconduct has occurred.
6. The county board of elections shall dismiss a protest of election that merely disputes the eligibility of a voter. The county board shall instead consider the claim as a voter challenge brought under Article 8 after the election.
7. No county board may retrieve and discount a ballot cast by an unqualified voter unless a challenge was timely brought under Article 8, or the State Board or a county board has found that ineligible voters participated in numbers sufficient to change the outcome of the election. The latter finding may be based on a protest timely brought under Article 15A or pursuant to complaint or directive of the State Board under G.S. §§ 163-22(a) and 182.12.
8. County boards of election must preserve the due process rights of all voters, including adequate notice and a meaningful opportunity to be heard. If a protest brought under Article 15A includes claims regarding the eligibility of certain voters, the county board must provide notice of the protest reasonably calculated to apprise such voters of the pendency of the protest and afford them an opportunity to present their objections. Due process in the context of time-sensitive post-election protests may mean that county boards expedite notice mailings or reach out to affected voters by other means not ordinarily required under Article 8. At a minimum, county boards must provide written notice to affected voters by expedited delivery service, such that notice is received at least three days ahead of any such hearing.
9. If any county board of elections has retrieved and discounted any ballot in a manner inconsistent with this Order in its canvass of the 2016 general election, the county board shall amend its canvass to include the vote. No such re-canvass shall reset any statutory deadline otherwise associated with the canvass of votes.
10. Counties shall proceed to the canvassing of the 2016 general election consistent with this Order, which shall govern future elections unless otherwise directed by this Board.
This the twenty-eighth day of November, 2016.
_______________________________
A. Grant Whitney, Jr.,
Chair State Board of Elections
North Carolina Finally Limps Across the Gubernatorial Election Finish LinePost + Comments (122)