I’m a bureaucrat at a health insurance company which most of you have never and will never hear about. My job is to be a subject matter expert on a fairly arcane set of knowledge. I have seen some posts and some great comment threads at Balloon Juice where great questions are being asked and basic mechanical knowledge would be very useful. I will be writing a series of posts over the next couple of weeks/months that attempts to explain why a profit seeking insurance company does what it does.
And yes, before I get started, I agree with the vast majority of the commenteriat here that absent massive path dependency and being able to make policy behind a veil of ignorance, I would not choose the US model or the modifications to the model that are being made by Obamacare. I would have chosen a far more comprehensive single payer system that is not a kludge of multiple previous kludges. However, that is not the world that we live in, so I am assuming profit seeking insurance companies will be around for a while.
I think that has stood up pretty well even as my life has changed dramatically over the course of 2,000 posts.
I’m no longer a mid-level bureaucrat at a regional insurer writing behind a pen name.
I’m an accidental academic working at Duke thinking about the ways payments are structured for care, behavioral choice eddies people get stuck in and over the past eight months, all sorts of things about infectious diseases and pandemic responses due to COVID.
I’ve written in the New York Times, JAMA-Internal Medicine, JAMA Forums, Health Affairs. I’ve been quoted in the LA Times, Washington Post, Politico and Axios. I’ve talked with senior policy makers, key staff and high profile policy entrepreneurs to pitch ideas and get policy moved in directions that I think are superior to other options. I’ve screamed my head off for years and have begun to build an academic career on the very simple point that price linked subsidy systems, especially oddly means tested price linked subsidy systems, do very weird things to pricing dynamics.
I’ve been able to help people through confusing and complex situations. I’ve talked to people who are facing immense pain and stress and hopefully was able to give some advice that made their life a little bit easier and clearer. I’ve been on conference calls with advocates to figure out what an actionable ask could be. I’ve pitched ideas that were useful and interesting and have gone nowhere.
Yet, except for the “next couple of weeks/months” part, I think my 2013 me would recognize in kind if not degree my 2020 me.
As I said last year, I love writing here and I want to keep writing for and at Balloon-Juice until one of the following happens:
- My wife tells me to stop.
- My boss tells me to stop.
- You all tell me to stop.
- I tell myself to stop as I don’t find joy in thinking and writing about these problems any more.
None of those things are likely to happen any time soon.
So, you guys are stuck with me for at least another year and a few more hundred exceedingly wonky, geeky and esoteric posts about the US healthcare finance and risk distribution systems.
Baud
That happened with your predecessor Richard Mayhew. Poor guy.
rikyrah
I can’t believe that it’s been 7 years.
Thanks for all the education about Healthcare, Mayhew ?
Sab
Thank you, thank you, thank you.
Sourmash
I don’t always understand your posts, but I sure do learn from them. Thanks for all your help in making sense of things!
Mike S (Now with a Democratic Congressperson!)
Thank you very, very much! With only MSM writings to guide me the last 7 years, I would have been totally confused anf misled about what was really happening with the ACA.
Cermet
Your posts are insightful, of course helpful and offer a rare place to understand the very dense and almost unintelligible healthcare system that we users are supposed to be able to navigate on our own – lol. Good example of the BS much of the thug leadership spew’s and now dumb their voters really are accepting this.
Viva BrisVegas
I’ve often wondered about that Mayhew character. Always seemed shifty to me. Could he have lifted his name from the protagonist in the Gaiman novel Neverwhere?
Anyway, DA is a far superior replacement.
DB in PA
I very much hope you continue to find posting worth your time, I learn a lot from them. Thanks for being so generous with your expertise.
Azelie
I’m mostly a lurker but I really appreciate your posts. There’s such an amazing community of bloggers and commenters here and you’re an important part of it.
Dorothy A. Winsor
Thanks for all the columns, Mayhew/Anderson. I always know where to go for reliable information and explanations.
SiubhanDuinne
No seven-year itch for you!
Happy anniversary, David. Thanks for all the wisdom and incisive knowledge you bring to this blog on a near-daily basis.
Gin & Tonic
@Viva BrisVegas: I think Mayhew had a better sense of humor. This Anderson dude is awfully dry.
arrieve
We’ll always have Mayhew. I appreciate the knowledge that you bring to this community.
Caphilldcne
Thank you for this. I work on public health issues in DC and your work has been invaluable to me in helping better understand the ACA and health care!
Bluegirlfromwyo
Happy to be stuck with you! I have learned so much from your posts. Keep them coming as long as you can stand it!
RedDirtGirl
Just echoing the other comments. Thank you for sharing your perspective.
evodevo
DON’T STOP!! There isn’t anywhere else other than wading through hundreds of pages a day to come up with the info I get here.
Cheryl Rofer
Thanks, Dave. I find your columns helpful too.
Mathguy
Thanks for bringing clarity and beneficial insights to a complete opaque subject. The complexity is daunting.
Spanky
A lot has happened to everybody over the course of those 2000 posts, and I doubt there’s any of us you haven’t helped.
Thank you.
randy khan
And we’re thrilled you’re here.
I know your posts have made me much smarter about health insurance.
Citizen Scientist
I dunno man, that Richard Mayhew guy was about 100 times better at this than you. ;)
Anyway, your posts are definitely appreciated. I’m more knowledgeable about how our healthcare system works thanks to you.
Tom Levenson
Congratulations on achieving a milestone that exhausts me just thinking about it.
Also…great news that you plan on continuing to make all of us at Balloon Juice smarter. Thanks!
Richard Guhl
And for your excellent analysis we shall always be grateful.
Billcoop4
It’s your posts which led me to this site.
BC
WV Blondie
You’ve been a great help to me. Now I’m wrestling with Medicare choices and how they’ll ripple through a host of other “life choices” (as if I have “choices” these days), and while I’m still overwhelmed, I’m not as confused. Progress, in baby steps …
Thanks, RM/DA – glad to hear you’ll keep it up!
BruceFromOhio
Your posts have enabled me to talk people down from ledges when having to face the exchanges. You’ve made the daunting and the byzantine far more accessible and attainable. Knowledge is power!
Thank you for your efforts and your contributions!
Another Scott
Happy anniversary!!
Thank you for all that you’re doing here and in real life. It’s important and greatly appreciated.
Cheers,
Scott.
Sab
@Tom Levenson: OT: When are we discussing your book? I have it but I am meanwhile lost in a Dorothy Dunnett historical series about 15th century Flemish merchants. Those guys were ruthless.
geg6
What you do here and elsewhere is invaluable. And you have taught me so much. Medicare is just a few years down the road for me and I dread it. But knowing you’ll be able to explain it here is a comfort. I know you’ve written about it before but it wasn’t a real thing yet. It’s creeping up now and I know now you’ll continue to write about health care in all its many complexities here at BJ where I might be able to ask questions. I’ll pay better attention to what you write about Medicare from here on. Thanks for all your wisdom all these years.
cope
Thank you for your tireless efforts. I started reading and searching your posts when my wife developed non-alcoholic fatty liver disease in 2016. At the time, she was working as a self-employed home health care RN and had no insurance. She was close to retirement age but still had three years to go. I was still working but as a teacher in Florida, my benefits pretty much sucked and it was hideously expensive. That’s when I dove into the matrix of the ACA system via your posts. You helped me figure enough of it to get her sufficient, affordable coverage to keep her alive and finally receive a new liver.
We eventually were able to get her SS disability but by the time we finally accomplished that, she had a new liver and was on the road to recovery.
I only scan your posts these days as we both are on Medicare (about which I am sure I could learn much more) but I will never forget how much help they gave me in some very dark days. Thank you.
Elizabelle
Seven lucky years for us, David. Happy Blogiversary.
Steppy
I appreciate and admire the way that you communicate the arcane with us. You are simply a wealth of knowledge. Amazing how many front-pagers here I can say that about.
I do miss the referee posts.
Mart
Much appreciated. Thanks for all your help.
PAM Dirac
Thanks for the many deep dives into the reality of the heath insurance world. However much it pains us, it is important to be reminded that reality isn’t always what we want it to be and if we are serious about making things better, we need to confront the messy, complicated details.
oldster
David, I am very, very grateful for your posts here, and I hope you will continue with them.
You give us insights into systems that we would never have otherwise. I do not know of any voice across the media ecosystem that is doing what you do (Charles Gaba, to some extent, but with far from total overlap).
So I think the BJ audience is very lucky to have you here. And it would not surprise me if you drew new audiences to BJ, just to read your health policy posts.
(I don’t know, maybe people who otherwise hate dogs and cats, but just need insights into insurance policy?)
I’m also really delighted to hear about your career trajectory. As a former academic, I think you made the right call in moving to Duke. Although when I read this:
“I’ve been able to help people through confusing and complex situations. I’ve talked to people who are facing immense pain and stress and hopefully was able to give some advice that made their life a little bit easier and clearer.”
I assumed that you were talking about the tenure process.
Anyhow, thank you, and please keep it up.
David Anderson
@WV Blondie: Choice fascinates me…. talking with a collaborator in 15 minutes on how to structure a grant to really dig into choice.
J.
Thank you for your service. :-)
David Anderson
@oldster: In academic life at Duke, I’ve been lucky that there is a group of mid-career folks who made dramatic life changes at about the same time as me. They all went back for PhDs in health policy between 2015-2018 at an age when backs and knees occassionally hurt just because the day ends in a “y”. So I have a good squad of folks who are blindly blundering forward with me in a new career environment and we offer mutual support and shared experiences of balancing research and kids.
Spanky
@David Anderson: I take it you’re pro-choice, then? :^)
David Anderson
@Spanky: Well curated and coherently structured choice where the really objectively dumb decisions are not on the choice menu pro-choice.
dnfree
Wasn’t it DJT who said something like “Nobody knew that health care could be so complicated”? Well, you did! And many of us did, but you’re actually doing something about it, and enlightening us on the way.
And for those contemplating Medicare decisions, plenty of people here seem to be old like me and we will also be glad to share personal experiences and insights gained.
zeecube
A “couple of weeks/months”, ha. Also, I enjoy reading your sports ball (soccer? football?) posts.
Ghost of Joe Liebling*s Dog
Medicare’s bewildering – starting with “what do I need to do about Medicare if I have health coverage through my job when I turn 65?” An array of choices with lifetime penalties attached to some of them, if I understand correctly. And I’m not even sure I do understand correctly.
Is there a good source for helping people decipher the choices and make decisions that have a reasonable chance of not sucking too badly? I’d be glad to know about it. I know I’ll need one.
WereBear
And… loving it. Thanks for all you do!
Raven
Your work here is tremendously valuable.
narya
Love your posts! And, if I may be so bold, a suggestion for your “free time”: a couple of Balloon Juice guides: what to think about when you are reaching Medicare age; what to think about when picking a health plan from the ACA; I’m sure there are other topics, but those are the two big ones that come to mind. I have sometimes found it useful to see decision trees that say, in effect, if A is more important to you, then go this way; if B is more important, go that way; C may override all other preferences because the choice structure works this way with regard to C
ETA: Kinda like requested above by Ghost. :-)
Leto
Balloon Juice doesn’t negotiate with terrorists!!!
Thanks for the valuable knowledge you bring with every post. You’re part of the professional contingent that make this place an invaluable resource for everything under the sun. Thanks!
sheila in nc
Thank you for being here and for the work you do. Your articles gave me an excellent way to explain to my friends what was happening in the health insurance market as the ACA was being implemented (and challenged). Also, you may have had a small effect on my daughter’s choice of career (she and I enjoy geeking out together over health policy.)
Oh no — now I have to worry about whether she will see this post.
Ripley
I read every post you write, David, and I believe we’re very fortunate to have someone with your background and experience here to break things down for us.
In re: the quote, I was a hard core liberal blogger, and worked in a “high value” division of a personal lines insurance brokerage, back in the day. Within a few days, post-Katrina, I found myself in the unenviable position of trying to explain to some very good people and hard core liberal bloggers why Big Insurance wasn’t paying NOLA residents’ flood damage claims.
I wasn’t defending Big Insurance; I was only trying to explain how basic Homeowner Policies were written and claims were executed. But I was told that I was “an insurance asshole who doesn’t care” and “a stooge for The Man”.
As much as we would love to wave our hands around and make everything amazing for everyone, we live with the policies and the industry norms of our present time. We can certainly work to make things better, but we are stuck with what we have in the very real Now.
I work in IT in the HealthCare industry now and things couldn’t be breezier. (Can they see me? I’m clapping. I’m clapping!!)
Mom Says I*m Handsome
Keep writing. You’re fucking great.
Meyerman
Agent Smith: In one life you’re David Anderson, program evaluator for a respectable insurance company. You have a social security number; you pay your taxes; and you (dramatic pause) help your landlady carry out her garbage. And then there is your rather troubling work with the jackals on Balloon Juice.
Thanks for sharing your insights for 7 years! (Though I do miss Mayhew’s posts on working as the center referee in football.)
BrianM
Thank you for all you’ve done.
RA
I have learned so much from your posts, even things I don’t want to know, and you have helped me so much. May you have a long prosperous life and career.
Penty
Thank you for sticking around, I’ve enjoyed an learned a lot from your articles.
MazeDancer
Lucky BJ!
Have to agree it doesn’t seem like 7 years since you were first introduced.
Time flies when you’re sharing smart stuff. Always grateful that you do.
There go two miscreants
I never commented back then, but I really appreciated your posts, and still do!
Mike Field
@Sab: Seconded! Thank you, David.
stinger
Don’t stop, David! The nature of many of your posts is such that most jackals won’t have much to say in comments. But in addition to the help you’ve provided specific individuals, all readers of Mayhew’s Musings come away better informed!
piratedan
waiting for the inevitable moment when you’re offered to speak to these issues in front of a Congressional committee and get to tell Louie Gohmert “with all due respect Congressman, you’re a fucking idiot”
frosty
@dnfree: “And for those contemplating Medicare decisions, plenty of people here seem to be old like me and we will also be glad to share personal experiences and insights gained.”
Quick insight: if you live on a border and your doctors are in a different state don’t bother looking at Medicare Advantage.
David: Thanks for sharing your knowledge in all 2,000 posts for the last (7!) years.
CaseyL
Happy Blogversary! 2000!posts is quite a milestone. Particularly in view of all the other things you’ve been up to and accomplished over the past seven years!
I’m delighted (and relieved) that you’re staying, because your posts are essential, invaluable sources of information.
Also, you’re cool :)
Thank you!
WV Blondie
@David Anderson: It irks me no end that there’s apparently no one place where I can compare the various drug and supplemental plans. Nor is there any easy way to find out how this will affect my husband’s coverage (and its cost!) – we’ve been covered together, but when I drop off our ACA plan I have to immediately get him re-enrolled by himself. Since we’re already operating at a huge financial deficit, I’m scared to death I’ll wind up spending 25 or 30% of our income on health insurance.
Any suggestions welcomed …
dnfree
@frosty: I went to an Advantage presentation and the salesperson actually said “IF you have pre-existing conditions and IF you can afford it, you’ll be better off with a supplement plan.” I met both criteria, so that’s what I did. To me, any senior is only a moment away from having a serious condition.
realbtl
Thanks for the info and more importantly your insights.
dnfree
@WV Blondie: we didn’t realize this at first, but there are two places to get comparisons by knowledgeable people. One is via your local senior center if you have one and if they have this service, but it’s staffed by volunteers. The other is through an insurance broker who specializes in Medicare. There is Medicare software you can use yourself to compare drug plans by entering your prescriptions, but this past year for some unfathomable reason the default selection was to optimize premium cost, not out-of-pocket counting drug cost. I’m sure that cost a lot of people. Professionals know how to navigate the software.
Also, sign up for part D when you turn 65 even if you don’t need prescriptions at that time. If you delay and later need drugs, you’ll pay a permanent monthly premium penalty.
StringOnAStick
I admired your courage by writing pseudonymously when you were in the industry, and cheered when you went to academia. Live long and prosper! Plus keep us updated on your niece, please if that’s ok with her parents.
David Anderson
@StringOnAStick: 4:00pm post already scheduled :)
rivers
Thank you so much, David. I have read your posts from the beginning and find them illuminating. Glad to hear you’re still enjoying yourself.
Mary G
When Mayhew first came along and explained that the reason some bad things happen to good people is that insurance executives needed their hookers and blow, I thought to myself “that guy’s a keeper.” I was right. How much has changed in the last seven years.
cursorial
Many thanks from another lurker. I don’t always understand your posts, but the effort you put into making complex topics accessible to those of us not in the field is always apparent, and very much appreciated.
Villago Delenda Est
David, keep on posting! This stuff is VERY esoteric, and you do the best you can do to explain this arcane shit.
MJG
Another DC health person here. I can’t thank you enough for your posts. Plus it is fun to send along a link to this blog (and try to explain what this blog is!) when referring other health policy folks to one of your articles . . .
Gus
Please don’t stop!
David Anderson
@MJG: Next time I’m in DC, lets get lemonade, caffeine or alcohol of your choice.
David Anderson
@MJG: Just say it is the place where all of this is true:
WV Blondie
@dnfree: Thanks for the advice re Part D; my understanding is that I’ve got two months after I start to make a decision? And as long as I opt for any plan, I can change it in the future, yes?
Also thanks for the advice about the senior center – I’ll call them. I’ve never even been there (still wrapping my head around how old I’ve gotten!), but I’ll see what they say.
Zelma
I think I’ve read every one of your posts. I don’t always understand all the content, but I always understand the ramifications. Balloon Juice is lucky to have you. I remember you’re telling us that when you applied for your Duke job, it actually helped when you admitted you were Richard Mayhew. And it was illuminating to learn you worked at UPMC. As an ex-Pittsburgher, I have a very mixed opinion of the octopus. Got great care the few times I needed it, but hated the organization. BTW, I’ve got two family members who are doctors at UPMC. They hate the organization too,.
TomatoQueen
WV Blondie’s post is exactly mine, with extra fluffings of Liebling’s doggie’s ears. Oh, and I turn 65 on December 31, which is inconvenient.
Here’s to at least 120 more years of the esoteric, the astonishing, the weird, the wonderful, the glory that is David Anderson.
MJG
@David Anderson: It’s a deal – I would love to!
currants
@Mary G: YESS!! Richard Mayhew and David Anderson added much to our information stores. With humor. I loved the soccer posts too, though I understand why we don’t get them anymore.
Common to both types, though, was the “use your noggin” feature, and I LOVE things that make me think (constructively).
Thank you, David!
MMM
Thank you for your time and sharing your expertise.
scott (the other one)
I’m not being hyperbolic or just blowing smoke when I say your work has made the country a less bad place, and in this day and age that’s truly something.