Let’s go, Ravens! Maybe there’s something we can salvage outta this shitty year!
A Hard Rain
I’m reading M Train right now — my way to push back on the news by diving into someone else’s struggle to live in the act of making work that cuts. Just now, with the luck of the ‘net, my YouTube bot popped this into my recommend list:
I am much moved by Smith’s break on stage and more so by her return.
The song is obviously on point, the setting is surreal, and Smith herself is a walking, talking, ain’t-bragging-if-you-can-do-it lesson on turning a life into its own artform — as that same life spins its art into the world through all the moil and misery (and those flashes of joy!) that go into walking this earth.
It’s not all Trump and evil out there. I strain to remember that every day, and some days are harder than others. (Yesterday! Worse than the chicken at Tresky’s.)
But it’s true, and I thank Patti Smith for the reminder.
Top of the evening open thread for all here — with a thick layer of improbable acts with oxidized farm implements to our enemies!
Monday Evening Open Thread: Show of Hands
@heathercampbell @ziyatong @McDonalds mittens pic.twitter.com/3nysv4LThY
— Andrew B. (@littlebitykitty) December 12, 2016
A generic silhouette of Holiday Cheer, made vulgar by the limitless imagination of American consumers. Because what use are mittens, without hands? [NSFW]
Monday Evening Open Thread: Show of HandsPost + Comments (206)
White House Enters the Fray
First, Trump’s idiotic tweet from earlier today:
Unless you catch "hackers" in the act, it is very hard to determine who was doing the hacking. Why wasn't this brought up before election?
— Donald J. Trump (@realDonaldTrump) December 12, 2016
Trump wouldn’t be able to locate a power source for a laptop if there were a glowing neon cord to follow, so I think it’s safe to dismiss his assessment of the difficulty of identifying hacker signatures. But his question about why it wasn’t brought up before the election makes me wonder if he’s cognitively impaired.
The Trickster God Is Toying With Us
There really can’t be any further doubt:
On Friday night, Mr. Trump’s transition team insulted the American intelligence community by saying that officers had misrepresented the threat of weapons of mass destruction ahead of the Iraq War, meaning that they should not be trusted with their conclusion of Russian meddling in the presidential election.
In a new twist, Mr. Trump will meet on Monday with Carly Fiorina, the former Hewlett-Packard chief executive, to discuss the job of director of national intelligence, a senior transition official said. [h/t TPM]
The sound you hear is every H-P veteran shrieking in shock and despair. This is screaming-of-the-lambs scale horror, Ph’nglui mglw’nafh Cthulhu R’lyeh wgah’nagl fhtagn madness.
Fiorina’s picture is in the dictionary next to “Fail Upward.”
To speak the obvious: she has, as far as I know, exactly zero professional intelligence training, and nothing in her work (or, for the last several years, unemployment) record suggests she’s mastered what you’d want America’s eyes on the secret world to possess. There’s no way to justify appointing Fiorina to this position unless you take Trump at his word and believe that he believes there’s simply no reason to bother with anything so frivolous as data, information, or knowledge of the world, our friends and adversaries alike.
Coyote is laughing…but at least this gives us all an excuse to revisit an old favorite:
ETA: I’m just hoping our Adam isn’t drowning himself in a butt of sack right now.
Image: H. P. Lovecraft, Cthulu sketch, 1934
Going where the money is: Essential health benefits
The Republican “Replace” plans make a big blather about reducing the scope of essential health benefits in order to dramatically lower premiums for healthy individuals. Let’s take a look at what is an Essential Health Benefit (EHB) and then do some analysis from there:
By law, they are in Section 1302 of the ACA:
(1)In generalSubject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:
(J)
Pediatric services, including oral and vision care.
The vast majority of the spending is on a combination of Hospitalization (C), Prescription Drugs (F) Ambulatory Patient Services (A) and Chronic Disease Management (I). Ambulatory patient services are sick visits to physicians. If those things are core services that need to be covered then it makes perfect sense that lab services (H) are covered as that fuels decision making and improves care. Well visits are fairly cheap as the screenings tend to be both fairly low cost and infrequent. At this point, Emergency Services (B) and Maternity/Newborn care (D) are the big money areas that could be cut from the essential benefits definition. However we run into the EMTALA problem that emergency services must be provided to the point of stabilization without regard to the patients’ ability to pay. Someone will pay.
Mental Health and substance abuse treatment services is the next “logical” spot to cut back as these run into the argument that mental health is a personal problem and not a disease (although that attitude is thankfully fading). But some money could be carved out of premiums. It might be a 5% savings on average with higher savings in regions that are getting hit hard by the opioid crisis. The trade-off is more dead people.
Finally, section J is vulnerable. Pediatric dental and vision are seen as add-ons. There is a good evidence base that kids who have good teeth and can see the chalkboard are better off than kids whose teeth hurt and can’t see if it is an “O” or a “U” on the board. The problem from a premium savings point of view is that there is almost no money here. Kids, once they can wipe their own butt, are dirt cheap to cover. Carving out pediatric dental/vision out of a risk pool that has relatively few kids makes the savings under $1 per member per month.
Realistically, the only way to have insurers spend significantly less money on essential health benefits is to institute usage limits. We do that to some degree with Rehabilitative services. It is not uncommon for states to decide that 25 or 30 Physical Therapy Visits at normal cost sharing is the essential service. Restricting covered days in the hospital like Medicare does would reduce insurance company spending and thus lower premiums. Restricting the number of brand name scrips or the number and type of diagnostic and labortory tests would also lower utilization and insurance company spending. But unless there are some standards we get a race to the bottom where healthy people get very weak insurance which is fine as long as nothing goes wrong and very sick people get comprehensive insurance that they can not afford because the subsidies being batted around are too damn small.
Going where the money is: Essential health benefitsPost + Comments (26)
Monday Morning Open Thread: Where’s the Clue-by-Four?
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Professor Krugman’s looking for one, in “Fast Food Damnation“:
… What I see a lot, both in general political discourse and in my own inbox, is a tremendous sense of resentment against people like Hillary Clinton or, well, me, that isn’t about policy. It boils down, instead, to something along the lines of “You people think you’re better than us.” And it has a lot to do with the way people live.
If populism were simply about income inequality, someone like Trump should be deeply resented by the working class. He has gold toilets! But he gets a pass, partly — I think — because his tastes seem in line with those of non-college-educated whites. That is, he lives the way they imagine they would if they had a lot of money.
Compare that with affluent liberals — say, my neighbors on the Upper West Side. They aren’t nearly as rich as the plutocrats that will stuff the Trump cabinet. What’s more, they vote for things that will raise their taxes and cost of living, while improving the lives of the very people who disdain them. Objectively, they’re on white workers’ side.
But they don’t eat much fast food, because they believe it’s unhealthy and they’re watching their weight. They don’t watch much reality TV, and do listen to a lot of books on tape — or even read books the old-fashioned way. if they’re rich enough to have a second home, it’s a shabby-chic country place, not Mar-a-Lago.
So there is a sense in which there’s a bigger cultural gulf between affluent liberals and the white working class than there is between Trumpkins and the WWC. Do the liberals sneer at the Joe Sixpacks? Actually, I’ve never heard it — the people I hang out with do understand that living the way they do takes a lot more money and time than hard-pressed Americans have, and aren’t especially judgmental about lifestyles. But it’s easy to see how the sense that liberals look down on regular folks might arise, and be fanned by right-wing media.
The question is, what do you do? Again, objectively those liberals are very much on workers’ side, while the characters who play on this perceived disdain are set to betray the white working class on a massive scale. Is there no way to get this across other than eating lots of burgers with fries?
Yes, a big chunk of the Trump/GOP’s appeal is old-fashioned all-American racism (and misogyny). But there are people of color (and plenty of women) who voted for Trump, under the rubric that he’d “shake things up” or similar. How does the Democratic sane Party appeal to voters who would rather punish themselves and their loved ones than be — in their minds — looked down on?
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Apart from that ongoing dilemma, what’s on the agenda as we start another week?
Monday Morning Open Thread: Where’s the Clue-by-Four?Post + Comments (312)