Come for the politics, stay for the snark.

Incompetence, fear, or corruption? why not all three?

I was promised a recession.

Quote tweet friends, screenshot enemies.

Republican also-rans: four mules fighting over a turnip.

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

Give the craziest people you know everything they want and hope they don’t ask for more? Great plan.

There are more Russians standing up to Putin than Republicans.

Ron DeSantis, the grand wizard, oops, governor of FL.

Democrats have delivered the Square Deal, the New Deal, the Fair Deal, and now… the Big Joe Biden Deal.

… pundit janitors mopping up after the gop

An unpunished coup is a training exercise.

In my day, never was longer.

Fani Willis claps back at Trump chihuahua, Jim Jordan.

Narcissists are always shocked to discover other people have agency.

Fight for a just cause, love your fellow man, live a good life.

Biden: Oh no. We’ve upset Big Pharma again.

🎶 Those boots were made for mockin’ 🎵

The Supreme Court cannot be allowed to become the ultimate, unaccountable arbiter of everything.

It is possible to do the right thing without the promise of a cookie.

Pelosi: “He either is stupid, or he thinks the rest of us are.” Why not both?

Proof that we need a blogger ethics panel.

The choice is between normal and crazy.

We are aware of all internet traditions.

Red lights blinking on democracy’s dashboard

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Archives for April 2017

Cuteness Open Thread: Puppies!

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I don’t know about you, but my day needed some much welcome puppy relief today. So was glad to get a bunch of new photos from my friends and their foster brood.

My heart still belongs to Lolly. She had her checkup last week and besides being extremely underweight, a lot of her teeth are broken from gnawing at wood, wall board and other things while locked in the abandoned house. It looks like she’ll be with LFern until she’s ready to leave foster care, so I’ll get to see her again with any luck. She’ll be fully recovered and healthy in no time.

The puppies are all doing well and are 7 weeks old. They are weaned and four have gone on to another foster home so everyone gets lots of personal time in order to help them socialize. I know it was difficult for the Fern family, but important for puppy development, so they were happy to do what was best for them.

Again I couldn’t get the pup photos to just copy over here, so you’ll have to click here to see all the puppies.

Open thread.

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Good News for People Who Love Bad News

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And now for some more bad news via the New York Times reporting on the Centers for Disease Control:

One in 10 pregnant women in the continental United States with a confirmed Zika infection had a baby with brain damage or other serious birth defects, according to the most comprehensive report to date on American pregnancies during the Zika crisis….
Despite a C.D.C. recommendation that brain scans be performed on all babies born to women with possible Zika infection, only 25 percent of the babies in the study had brain imaging, so the actual number of impaired infants could be higher….

Birth defects, ranging from the condition of abnormally small heads, known as microcephaly, to neural tube defects and eye malformations, occurred in 5 percent, or 51, of those pregnancies, including 45 live births. Of the 250 cases where the presence of a Zika infection was confirmed with laboratory testing, 10 percent, or 24 pregnancies, resulted in birth defects, the report said.

All but eight of the 51 cases involved severe brain abnormalities such as microcephaly;

Why does this matter beyond the individual tragedy? Medicaid is the dominant payer for births in this country. Most Medicaid births are paid for by Legacy Medicaid funds where the states pay a significant portion of the cost. Almost all childhood Medicaid expenditures are also Legacy Medicaid expenditures where the states. We are having a policy debate that looks to significantly reduce Medicaid’s ability to respond to emerging public health crisises:

the current system where the Feds give the states an open ended funding stream that is a state specific multiple of the state contribution. The block grant removes the variability of the federal spending commitment. In the Ryan plans, it also shrinks in terms of real purchasing power over time so states either spend more money to maintain current level of enrollment and services or cuts to enrollment and services have to occur.

And here is where there is a problem. The capitated payments would be based on average expected costs in year 1 and then get weaker. States with disproportionate clustering of high cost conditions will be significantly worse off. Long run Zika neurological impairments will hit warmer states’ Medicaid budgets much harder and more dis-proportionally than Zika will hit cold weather states’ Medicaid budgets…. The block grant system fails unless there is a side payment of new federal funds. And given the political fights over natural disaster relief bills and the Zika bill, I have a hard time seeing Congress routinely providing multi-billion dollar cash infusions to a few states for new diseases or threatening epidemics.

Further more, the new CDC data indicates that severe birth defects are occurring more often than previously thought.

This is a case example of the problems with block granting with a shrinking real-dollar allocation. It can’t handle shocks.

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Actions Have Consequences: Lysistrata Edition

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I’ll just leave this here for your schadenfreude and viewing pleasure. Albo is quitting the Virginia House of Delegates.

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Steve Bannon Removed From National Security Council, Which is Reorganized

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From Bloomberg:

President Donald Trump reorganized his National Security Council on Wednesday, removing his chief strategist, Stephen Bannon, and downgrading the role of his Homeland Security Adviser, Tom Bossert, according to a person familiar with the decision and a regulatory filing.

National Security Adviser H.R. McMaster was given responsibility for setting the agenda for meetings of the NSC or the Homeland Security Council, and was authorized to delegate that authority to Bossert, at his discretion, according to the filing.

Under the move, the national intelligence director, Dan Coats, and the chairman of the Joint Chiefs of Staff, Marine Corps General Joseph Dunford, are again “regular attendees” of the NSC’s principals committee.

 

This is somewhat good news, I would think. Hopefully this is McMaster taking some more control and setting up some clear lines and authority. I know Adam will chip in or add his own expertise to this or a dedicated post, but this is important news to discuss.

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Open Thread: Social Notes from the Global Kleptocracy

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But since this is Lord Smallgloves’ court we’re talking about, things can always get more embarrassingly complicated. Per the NYTimes, “As Trump Meets Xi at Mar-a-Lago, There’s a ‘Wild Card’”:

… Mr. Guo Wengui is a Chinese property magnate who has been living outside the country for more than two years. In recent weeks, he has launched a broadside — in television interviews and on Twitter — criticizing the effectiveness of the Communist Party’s fight against corruption, all from the safety of financial capitals like London and New York. He is also a member at President Trump’s resort in Palm Beach, and posted photos of himself on the grounds last month with Mar-a-Lago’s managing director.

Mr. Guo’s newly public persona — more akin to a dissident Russian oligarch and highly unusual in Chinese politics — comes at an awkward time, just before China’s president, Xi Jinping, and Mr. Trump are to meet at the resort for their first summit meeting. The Chinese billionaire’s ties to the club are a new twist in how President Trump’s business interests can complicate diplomacy, in this case with arguably the world’s most important bilateral relationship…

At the very least, it would be embarrassing if Mr. Guo, who is also known as Miles Kwok, were to show up at the seaside resort during the meeting Thursday and Friday. At worst, his presence could incense Mr. Xi and the Chinese delegation. Mr. Guo left China during a corruption scandal linked to the jailing of his political patron, a top security official. Mr. Guo said his assets in China — he puts the figure at more than $17 billion — were seized…

Mr. Guo’s membership could be especially sensitive because of the lengths China’s leaders go to stamp out any political discussion that deviates from the Communist Party line, particularly remarks about the wealth of top leaders. Mr. Guo has leveled specific accusations against a former top party leader.

In two recent Chinese-language interviews and on Twitter, Mr. Guo, while highly critical of many current and former Chinese leaders, has praised Mr. Xi, or at least refrained from directly criticizing him…

China has more billionaires than any other country with the possible exception of the United States, but none as outspoken and flamboyant as Mr. Guo. He has a penchant for posting photos of himself in workout tights and camouflage, performing planks and other exercises. He sips vintage French wine in front of a picture of an aviator glasses-wearing, cigarette-smoking chimpanzee in his London office and likes to show off the private jets he uses for his frequent trans-Atlantic flights. One American who met with him described him as affable.

But Mr. Guo is anything but happy-go-lucky. He built a fortune in the Darwinian world of Chinese real estate, and people who crossed him soon rued the day. In 2006, he handed to the police a sex tape of a Beijing deputy mayor who had disputed one of his land deals. The official was imprisoned and Mr. Guo got the property, building the torch-shaped Pangu Plaza next to Beijing’s Olympic Green, a landmark during the 2008 Summer Games…

It’s like a Trollope novel, as written by John le Carre.
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More on Medicare for All

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I want to highlight two really good comments from yesterday’s post on Medicare for All as a means or as an end in and of itself:

First from Barbara:

What people like about Medicare is its “thereness.” You have it no matter what. That’s what it’s like in other countries. You just show the card and questions about insurance cease. That is a combination of eligibility plus the government’s ability to impose rules that private payers cannot by themselves. These include limits on balance billing and a significant weighting against providers for performing noncovered services without notice to the beneficiary (called the ABN rules).

What people who are not covered by Medicare don’t see, often enough: fragmentation, unlimited cost sharing, incentives to overutilize care for people who are unlikely to question the need for procedures, the need to get supplemental coverage and a separate prescription drug plan, both at additional cost, what seems like incessant arbitraging of reimbursement rules by providers to extract money from the system regardless of benefit to patient, and, importantly, almost no push back by the payer (Medicare program) to rein in these tactics.

There is great value in knowing that something will be taken care of. I see that, I acknowledge that, I value that. But here it is a question of means or ends. In my mind, the end is the knowledge that something will be taken care of, the “thereness”. I love this phrasing and insight. It just is, and problems are addressed. Barbara also points out how oddly designed Medicare is for people who have to deal with it for living or a living. Medicare FFS at the Centers for Medicare and Medicaid Services (CMS) level is a minimally involved payer. Once a claim meets minimum standards, it is going through quickly without systemic management or analysis of a case.

Rob brings up the practical impact of cost savings:

in order for us to see the cost savings Medicare for All can bring (spending more like 12-14% of GDP on healthcare rather than 18-19% now), we’d have to use it like a hammer to cram down on providers. Doctors. Hospitals. Nursing homes & other outpatient facilities. Medical device manufacturers. Pharma. All of them. Those groups of people are not without political power. They’ll fight.

Systemic waste is someone’s mortgage payment.

The most important thing to remember in health policy is that doctors and nurses are the most trusted professions in America while hospitals are often the largest employers in a district. On the other hand, insurers and Congress routinely strive to stay above chlamydia in the popularity rankings.

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You be the referee

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I’ve been reducing the amount of refereeing that I’ve been doing for a variety of reasons so I have been negligent on these threads. Let’s look at a few scenarios.

a) IFAB changed the rules this year. Fouls in the box committed mainly by the feet that deny an obvious goal scoring opportunity which do not rise on their own to be a red card offense are now only a yellow card and penalty kick instead of a red card and a penalty kick. What do you expect to happen?

b) Blue #22 is a beast. She is an elite player with national team exposure. If her knees hold up and she continues to hit the weight room she will at some point start for the USWNT squad. She has a history of playing a very physical, very strong, very aggressive but legal style. How do you as a referee approach the following situations:

b1: Of the 22 starting players on the field, 19 of them have D-1 scholarship offers and the other three are being scouted for D-1 offers.

b2: Of the 22 starting players on the field, no one else will even be scouted for a D-1 offer.

C) Back to Blue #22. She receives a pass from midfield 35 yards out from goal on the wing and proceeds to rapidly close the distance to goal. She jukes a defender. The defender, Gold #2, jumps on her back and piggy back rides Blue #22 into the box. Blue #22 spins off the center back, slamming Gold #2 into her teammate, and then Blue #22 launches a shot into the top left hand corner of the goal. What do you do with Gold #2?

D) You’re refereeing a men’s Open match. Gray just committed a simple tripping foul. Gray has committed the last six fouls. What are you thinking about Gray and their opponent, Red?

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