This is as graphic a demonstration of the impact of climate change as is possible- click on the link to go to an interactive where you input your hometown and the year you were born and it will compare what the temps were like when you were born versus now.
Archives for August 2018
Spillover effects from MSSP
The Medicare Shared Savings Program (MSSP) is the delivery reform side of the ACA. It applies to Medicare Fee for Service (FFS) where provider entities of various flavors take on significant financial risk and financial upside to manage a defined Medicare FFS beneficiary population for a year for a given cost in an Accountable Care Organization (ACO). If the ACO spends less money than the target, the ACO keeps some of the gain. If they spend more money, in some models, the ACO loses money. In some ways, it can be cheekily described as Medicare Advantage incentives in FFS clothing.
So far, it looks like the most recent round of models is leading to small savings with increased quality. This is a win. There is a big methodological fight over what the appropriate counterfactual should be to assess savings. I am, at best, qualified to tell everyone in that seminar room that we need to get out now as someone has it reserved for a meeting starting in two minutes.
The CMS actuaries make a very good point in a recent rule (h/t Farzad Mostashari) that the savings which are currently being attributed to the MSSP program are ignoring a very real and growing source of secondary savings. Medicare FFS spending levels drive Medicare Advantage benchmark bids.
To the extent that proposed changes to the Shared Savings Program will result in net savings… In addition, because MA payment rates depend on the level of spending within traditional FFS Medicare, savings or costs arising from the proposed changes to the Shared Savings Program would result in corresponding adjustments to MA payment rates…. these secondary impacts has been included in
the analysis shown.
Let’s back that out a little bit. Medicare Advantage is bid out at the local cost of providing the traditional Medicare FFS benefit package. If the cost to provide FFS benefits are lower, than the Medicare Advantage bid is lower. That saves the federal government money to provide the same service at a slightly lower price.
Now this is where it gets interesting. We could plausibly see a virtuous interaction between Medicare Advantage and MSSP.
Medicare Advantage has been shown to have positive spillover effects on the cost of FFS Medicare. As more people are covered by Medicare Advantage, the average cost of FFS goes down. Austin Frakt has a good summary of the recent literature (up to mid-2016) on Medicare Advantage spillover effects. The theory is that Medicare Advantage payers more aggressively manage care than FFS Medicare. Once a certain threshold of revenue is met, providers (doctors and hospitals) are willing to change their care patterns for all patients and not just their Medicare Advantage patients. This leads to lower FFS costs which then restrains MA bid growth in the future.
Now, what I am thinking is that if MSSP also lowers FFS costs, MA bids need to be lower. It places a cycle where more and more of the entire Medicare population is being actively managed by some risk bearing entity that has at least partial gains from becoming more efficient.
It may not be a world changer, but this could be another one of those 1% solutions that pushes us in the right direction.
Friday Morning Open Thread: Another Infrastructure Week Already?!?
I think they're gonna wait for Miller's GJ testimony.
My money's on movement in the Butina case. https://t.co/lxShFn6iYI
— zeddy (@Zeddary) August 31, 2018
This is true and indeed deserves more emphasis, but there are also close variations on this scenario where the GOP does all of the below—except it results in them getting clobbered in 2020. https://t.co/FYiU9fjakc
— Nate Silver (@NateSilver538) August 30, 2018
If Dems won the popular vote for the House by the same margin (5.7%) that the GOP did in 2010, they'd be only ~even money to win the majority of House seats, and would probably *lose* a Senate seat or 2. So the GOP could easily misread a middling result as a mandate.
— Nate Silver (@NateSilver538) August 30, 2018
We should be pressing deeper in to traditionally Repub territory & putting all the resources we have in to maximize gains. It lays a foundation for 2020, & Dem takeovers of state governments can not only get us better maps in 2022-2030 we can do big things w power over government
— Dana Houle (@DanaHoule) August 30, 2018
Take MI, WI, & NV: if we get The trifectas, we should be able to overturn right to work in all three states. We can do things w voting rights, campaign finance, maybe even things about candidate transparency to get on the ballot (plus clean energy/climate, inequality, etc)
— Dana Houle (@DanaHoule) August 30, 2018
Deadlines for voter registration are coming up soon, but with a host of new restrictions and voter roll purges in place.
Find your state's deadline and register online here: https://t.co/Js2CrUbw0H
If you *think* you're registered, check to be sure: https://t.co/blofpcduRj
— Kevin M. Kruse (@KevinMKruse) August 30, 2018
Friday Morning Open Thread: Another Infrastructure Week <em>Already?!?</em>Post + Comments (152)
Predictable End of Summer Open Thread: The Wheels Are Coming Off Trump’s Wagon
I’m good with that. https://t.co/lrXaiWDFfo
— Daniel W. Drezner (@dandrezner) August 30, 2018
Someone nervous about the Woodward book? https://t.co/c23xzhmEK9
— Blake Hounshell (powered by blockchain) (@blakehounshell) August 30, 2018
If you are an elderly political cynic like me, you’ll remember the post-Watergate rumor that Bob Woodward was (still) an agent of the national intelligence community, assigned to remove an increasingly unhinged Nixon from the media spotlight before further investigation could expose just how badly compromised the “permanent, sane” Republican Party was. A rumor by which Carl Bernstein was labelled as a journalistic newbie who got played as a catspaw by more sophisticated outside agencies. Let’s just say that none of the news this week has debunked that old rumor…
Sounds like the florid pomposity you’d expect from Bannon or Gorka https://t.co/YfzaupaGkk
— Dana Houle (@DanaHoule) August 30, 2018
From the Washington Post, “Allies fear Trump isn’t prepared for gathering legal storm”:
… Within Trump’s orbit, there is consensus that his current legal team is not equipped to effectively navigate an onslaught of congressional demands, and there has been broad discussion about bringing on new lawyers experienced in white-collar defense and political scandals.
The president and some of his advisers have discussed possibly adding veteran defense attorney Abbe Lowell, who currently represents Trump son-in-law and senior adviser Jared Kushner, to Trump’s personal legal team if an impeachment battle or other fights with Congress emerge after the midterm elections, according to people familiar with the discussions.
Trump advisers also are discussing recruiting experienced legal firepower to the Office of White House Counsel, which is facing departures and has dwindled in size at a critical juncture. The office has about 25 lawyers now, down from roughly 35 earlier in the presidency, according to a White House official with direct knowledge.
Trump announced Wednesday that Donald McGahn will depart as White House counsel this fall, once the Senate confirms Supreme Court nominee Brett M. Kavanaugh. Three of McGahn’s deputies — Greg Katsas, Uttam Dhillon and Makan Delrahim — have departed, and a fourth, Stefan Passantino, will have his last day Friday. That leaves John Eisenberg, who handles national security, as the lone deputy counsel…
Still, Trump has not directed his lawyers or his political aides to prepare an action plan, leaving allies to fret that the president does not appreciate the magnitude of what could be in store next year…
If Democrats control the House, the oversight committees likely would use their subpoena power as a weapon to assail the administration, investigating with a vengeance. The committees could hold hearings about policies such as the travel ban affecting majority-Muslim countries and “zero tolerance” family separation, as well as on possible ethical misconduct throughout the administration or the Trump family’s private businesses.
White House officials defended Trump’s lack of preparation by saying he is focused squarely on helping Republicans preserve their majorities in the Nov. 6 midterm elections rather than, in the words of one senior official, “panicking about something that could happen.”
Any Democratic salvos would not happen until new members take office in January, which Trump advisers said seems like eons away in an administration juggling so many immediate problems. As a result, preparing for possible impeachment proceedings is not at the top of Trump’s to-do list…
Predictable End of Summer Open Thread: The Wheels Are Coming Off Trump’s WagonPost + Comments (53)
Bloomberg Report from the WH Bubble: “He Thinks It’s Impossible to Impeach A Successful President”
Trump says in Bloomberg interview that he will put out of the WTO "if they don't shape up".
Scoop from the Bloomberg @business @economics team just back from the White House.https://t.co/1BHAGuZpuy
— Shawn Donnan (@sdonnan) August 30, 2018
If you can’t see the five-minute clip at the top, it’s well worth clicking over to Bloomberg directly, because it’s a comprehensive (i.e., terrifying) review of what passes the Oval Office Occupant for “thoughts”. And provides, IMO, key insights to some of this week’s agitations among the ‘permanent’ GOP ‘leaders’…
…“If they don’t shape up, I would withdraw from the WTO,” Trump said Thursday in an Oval Office interview with Bloomberg News. Trump said the agreement establishing the body “was the single worst trade deal ever made.”
A U.S. withdrawal from the WTO potentially would be far more significant for the global economy than even Trump’s growing trade war with China, undermining the post-World War II system that the U.S. helped build…
“In the last year, we’re starting to win a lot,” he added. “You know why? Because they know if we don’t, I’m out of there.”
Countries that bring complaints to the WTO tend to prevail and defendants in trade disputes lose…
Since World War II, successive U.S. presidents have led efforts to establish and strengthen global trading rules, arguing that they would bring stability to the world economy.
The WTO was created in 1994 as part of a U.S.-led effort by major economies to create a forum for resolving trade disputes.
Things I noticed, apart from the WTO dick-swinging:
– “He sort of radiates a kind of confidence, which not everyone is going to agree with… but he’s got that sense that he’s winning all the various battles”
– “He still hasn’t stopped thinking up [ed: being spoon-fed by his donors] new big ideas — he’s thinking about the capital gains tax”
– Jeff Sessions’ job is safe “until November, after the midterms”… “I asked how many days after that, and he ignored the question… but I don’t think it’s just Trump, I think there’s a general noise out of the WH at the moment that Sessions is okay through to there.
“What Trump went on, quite a lot, about, was the idea that he wants Sessions to be looking at other things, especially [unclear] the Democrats, and not him. And he returned to the idea that he thinks it’s impossible to impeach a successful president — “
– “Is he aware of, does he understand, his interaction with the stock market? Do you get the sense that he feels omnipotent, in that way? “I think he sees himself… he looks at the stock market as one indicator of how well he’s doing… I think he’s a little bit mystified as to why he might get beaten in the midterms, given how well he sees the economy going…”
– Trump’s “backed off a bit” on attacking the Fed; “He talks a bit about how he wants to be accommodated — if you push him on that, he doesn’t want to step over the line — it looks as though the Fed has begun to win that battle” [again, my impression: He’s been called to heel by the Actually Rich People, his donors/props, who are the only ones he respects]
– “Talk a little bit more, as he says, you can’t impeach a sitting president — ” “No, he thinks it’s very hard to impeach a successful president, which is how, very much, he views himself… He remains, on the midterms, very wary — but he thinks that if the midterms were purely about him, he would do very well.”
***********
Ask President Bill Clinton how hard it was for the GOP to impeach a successful president — of course their manifold wasteful attempts failed to unseat Slick Willy, but you can’t say they didn’t give their and the national treasury’s best in the attempt.
But the general point remains: Trump assumes the world revolves around Trump, who is a Great (if underappreciated) Success, and that as long as he can browbeat his minions into propping up the stock market, he’s literally unimpeachable.
Those midterms, as ever, remain ours to win. And IMO it’s more clear than ever how crucially important — not just for Democrats, or Americans, but for the global financial markets — it is that we do!
Beat on the Brat, beat on the Brat, beat on the Brat with a baseball bat
The Postal Service said on Thursday that it “deeply regrets our mistake in inappropriately releasing” the official personnel file of Abigail Spanberger, a former C.I.A. operative now running as a Democratic candidate for Congress, and requested that a Republican-aligned super PAC return the documents.
[….]America Rising, the Republican-aligned research group, had requested Ms. Spanberger’s file under the Freedom of Information Act. After the Postal Service released the file, the group provided it to the Congressional Leadership Fund, a super PAC aligned with Speaker Paul D. Ryan, which then used some of the information about Ms. Spanberger’s employment history for political purposes.
Dave Brat is the piece of shit Republican incumbent benefitting from this Soviet-style corruption. Let’s send his sorry ass home in November. Give to Abigail Spanberger here.
Beat on the Brat, beat on the Brat, beat on the Brat with a baseball batPost + Comments (51)
Info Ops – Staying Alert
I said in a post last week that I’m going to try to keep you all current on what we know about information operations, as we approach November’s elections and the 2020 presidential election. I’ll post short summaries or longer commentaries if they are warranted. We’ve all got to stay alert for malign influencers.
The FBI has launched two websites, Protected Voices and Combating Foreign Influence. Protected Voices offers advice on cyberhygiene – they have a set of short videos on things like passwords, browser safety, wi-fi, and router hardening. Looks like they might be useful for internal corporation training or just anyone who has questions about the various topics. Combating Foreign Influence is newer and intends “to educate the public about the threats faced from disinformation campaigns, cyber attacks, and the overall impact of foreign influence on society.”
I’m a little dubious about government initiatives of this sort, but it was the FBI and others who went to President Obama in summer 2016 to tell him that the Russians were doing damage. So I’ll keep an eye on these sites. I also hope that the jackal computer nerds will chime in too.
BuzzFeed has a big article on Russian propaganda operations in the Baltic states. Three news outlets set up in Estonia, Latvia, and Lithuania to spread the Russian point of view without saying that’s what they were doing.
The websites presented themselves as independent news outlets, but in fact, editorial lines were dictated directly by Moscow.
The purpose was to turn Russian speakers in those three countries toward Russia and away from the countries they live in. The article is very detailed, working from Skype calls among the managers of the news outlets. I kept thinking about Fox News as something of an analogy in the United States.