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    • The Torture Culture
      Ok, here’s the deal: Torture does not work to get information. Period. You do not torture people to get information, you torture people to send information, or rather, to send a message. What is that message? (Originally from Dec 16, 2010, but it seems worth re-upping for a new generation of readers – Ian.) We Torture People […]
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Team Players are always guys

If you are still under the illusion that Obama is some kind of feminist, even after Ron Suskind’s book Confidence Men showed otherwise, look no further than the rationalizations anonymous White House spokesmen are giving about why Janet Yellen is not favored to be appointed the next Fed Chairman.  This piece by Neil Irwin has gotten a lot of coverage for the past couple of days because it spells out exactly why women are not welcome in the Obama administration or anywhere else where the Obama fanboys have influence.  

But I told you exactly what the mentality of these sexist assholes was a couple of years ago.  That’s because women in the corporate world have been there.  And Obama hired these guys to run his show:   

The short story, it’s typical corporate under-the-radar discrimination.  The women staffers and cabinet members will no doubt be told that they are being too sensitive or paranoid but after their work fails to get the recognition it deserves or requires, she’s going to feel the stress of always being on the outside looking in and missing the crucial milestones necessary to get a promotion and exercise power.  When the crucial decision making meetings happen, she won’t be aware of them.  They might be impromptu, like during lunch at a table where few women are invited to join.  Or at golf games.  Or a meeting may be arranged where the scheduler has a propensity for the hierarchical and no juniors are invited, most of those juniors happening to be women.  Or the female staffer may need to gather information and sends out a survey email, which for some unknown reason, several more senior sycophants fail to respond to.  Or at a department meeting during your presentation, the guys talk over you or interrupt you or speed up your presentation or slow it down so they can ask you questions that were not in the scope of the presentation.  If you’ve been taking data, you’ll have realized by now that men rarely receive this kind of treatment, but it all contributes to making you look just a little bit unprepared or not quite knowing what’s really going on (because you weren’t there when they told the guys what was really going on).  Heck, you’re lucky you get a chance to present at all.  The stars get their 45 minutes of fame at every meeting while you have to book a slot months in advance.  That kind of stuff.

With the “She’s not a team player” rumors flying out there, Yellen is already doomed to be the least successful Fed Chairman ever appointed.  Team Player is code word for not one of us, i.e. male. The White House has already pre-approved the implicit bias treatment of Yellen.  She won’t know what’s going on when her subordinates meet and unless she’s got some plan to monitor their behavior, she won’t know when they’re ignoring her emails or dragging their feet.  If she raises her voice or expects results, they’ll call her “difficult to get along with”, which is code word for “bitch”.  Eventually, she’ll be called ineffective and the White House guys will have won.

We already know this.  Because many women have already lived it.  The landscape we survey in the Yellen- Summers competition is well known territory.  What’s so surprising is that the White House has absolutely no shame in putting it out there.  They are either so stupid they are unaware that they are admitting to implicit bias of a sexist nature or they are arrogant enough to think they can get away with it.  Well, the country has been letting them get away with sexist shit and rewarded them for it since 2008.  In neither case does it reflect well on Obama, his White House staff or his economic policy.  

Running the Fed well isn’t their point at all.  It’s getting their way, being in total control, winning.  It’s the dick waving thing again. Don’t expect Obama to come down on this kind of behavior.  Instead, he appears to be quite comfortable with it.  Well, it’s worked so well for him.  Sort of sums it all up, doesn’t it?  

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What the bankers are doing to Detroit is criminal

Go read No Banker Left Behind at the NYTimes.  Let us recap, shall we?

The bankers, who had all of their bonuses protected and bailed out with our federal tax dollars when they blew up the world because people like Larry Summers argued that it was unfair to violate their compensation contracts, are bearing down on Detroit to pay outrageous sums of money on ill-advised derivatives transactions that will result in innocent Detroit municipal employees forfeiting up to 90% of their pensions.

I blame Obama.  Yes, I do.  If he had come into office committed to holding responsible the people who lied, conned and irresponsibly gambled away our money, we might well be on the road to real recovery right now.  Instead, he had people like Larry Summers and Tim Geithner advising him to go easy on the bankers because shoring up the banks was THE most important thing.

Screw everyone else.

What I really regret is that so many former Democrats went off in a rabid frenzy over some stupid birth certificate issue instead of focussing on the real offenses of this White House.  So much time and energy wasted over citizenship red herrings and vacations.  I’m not sure which is worse.  Stupid conservative leaning Democrats or banker lackeys in the Oval Office.

Whichever it is, Detroit’s employees shouldn’t have their lives ruined over it and I have yet to see Obama step up and prevent this unfolding tragedy from taking place.  Which only means one thing to the rest of us: if our own pension plans go belly up because of some stupid merger or incompetent pension fund manager or predatory bankers, we’re all equally screwed.  No one is going to step up and protect your deferred compensation for all your years of work.

The White House is just going to let the bankers drink your milk shake.

I’d be a lot more sympathetic to these women…

if their “choices” didn’t make their attitudes towards everyone else so fricking smug.

Here’s the deal, ladies: you were such bitches during the 90s and naughties about how superior you were that you managed to obstruct the efforts of working mothers to get better after school child care and other things that you are now just realizing you desperately needed.

And you dissed the very people you now wish to become.

The rest of us slogged through the childrearing years as best we could with zero help from you and your holier-than-thou crowd showing up at school board meetings lording it over everyone else.  I was there.  We battled it out in corporate America and in the suburbs, where you couldn’t be bothered with us, but were always around to offer a generous dollop of guilt about how much volunteer work you did.  Hey, when you work a full time job, raise two kids, take classes in the evening and stay up until 1am arguing with a bunch of clueless libertarians over the construction of a new high school for three years, you tend to think that the Opt-out generation has got a lot of nerve criticizing the rest of us about chaperoning the class field trip.  (Did that too.)

Now, you want your old jobs back and are surprised that you can only make a fraction of your former paychecks and, geewillikers, it’s hard to take care of kids and work at the same time.  No shit, sherlocks.  What do you think we’ve been putting up with since we graduated from college?  What do you think the job market’s been like since the Little Depression when the economy came crashing in on our heads after your husbands blew up the world? Cry me a river and go tell it to the chaplain. You really owe us an apology first.

And here’s what they’ve been opting out of (from the same article):

Men, too, are feeling the crunch of excessively demanding work. They now report more work-life stress than women do, according to the Families and Work Institute. They also may be penalized more than women if they try to accommodate their work schedules to the needs of their children, as research appearing in the June issue of The Journal of Social Issues shows. It’s perhaps not surprising, then, that some husbands find themselves eyeing their wives’ lives at home with envy. “Men want to say we’re more than a paycheck,” Ted Mattox told me. “There has to be something more than going to work for 50 years and dying.”

Yes, but that’s the American Way where we work harder than any other developed country on earth and, unlike every other developed country on earthhave zero mandated paid vacation days.

If you don’t like the way this America works, you’ve got to change America.

Opting out is not an option.

PPACA Links: 2013-08-08

Readers, I’m sorry that Monday slipped into, er, very late Thursday, but I’ve been consumed with housepainting. –lambert

Is Choosing a Health Plan Like Buying a Car or Canned Goods? Trudy Leiberman, Prepared Patient Blog 2010-06-21

The hope is that patients will also become good consumers, always choosing the best options whether it’s a doctor, hospital, or an insurance policy. The danger is that if they don’t, and things go wrong, they will be blamed for the bad outcomes. An ethicist I heard speak recently was troubled by all the emphasis on health care choice which she called simplistic market rhetoric. The emphasis on choice blames the victim for not reading the fine print when they have made a wrong one, she said.
That brings me to the problem of Medicare Advantage plans and the apparent wrong decisions millions of seniors are making. The Centers for Medicare and Medicaid Services (CMS), which runs the Medicare program, rates Medicare Advantage plans using a star system’the more the better. The stars supposedly offer clues about plan quality including whether plan members get timely screenings and vaccinations and how how quickly they respond to complaints.
As someone who helped invent health plan ratings in a previous job, I’ve come to agree with that assessment, and that raises the fundamental question of how useful all these stars and bars are in the first place. To find out, I did a quick survey of the Medicare Advantage plans that are available in Manhattan where I live. There are 103 choices, way too many for the average senior to wade through and make an intelligent decision. Most people would throw up their hands and ask their best friends or run for the nearest insurance agent to help narrow the choices.
Once you make those decisions and start inspecting the stars, you run smack into another problem. Many of the plans have the same ratings. Looking at the stars that summarize all of the quality dimensions, I find that Aetna’s standard plan HMO rates three stars but so does its value plan HMO. So does GHI’s PPO II and Healthfirst’s 65 Plus Plan HMO. And how much better are these plans than the Fidelis Medicare Advantage Part B Reduction HMO-POS, or for that matter, Aetna’s standard plan PPO? They merit three and a half stars. Then there are a slew of plans for which there is too little information to rate.’ That would turn a shopper off right there.

Lambert here: This post is an oldie but goodie from 2010. It will be interesting to see if the ObamaCare Exchanges learned anything from the Medicare Advantage experience; I’m guessing no.

Medicare’s New Tactic—No Admission Affordable Care Act Review, 2013-07-30

In one of the most unique approaches to addressing Medicare payment issues, CMS issued a notice on July 26, 2013 that, in certain American counties, it was unilaterally suspending, effective July 30, 2013, the creation of new Medicare providers in ambulance services and home health agencies. The suspension is for a six (6) month period and may be unilaterally extended by CMS in six (6) month increments. To date, these moratoria are limited principally to Cook and Miami-Dade counties following decades of focus on the States of Illinois, New York, Florida, Texas and California as sites of Medicare and Medicaid fraud. Citing, among other provisions of the Affordable Care Act, Section 1866(j)(7) of the Act, CMS believes that it has the authority to make unilateral determinations of whether providers will be approved regardless of quality or financial strength. In pertinent part, CMS quotes from the Act that language that empowers the Secretary of HHS to impose the moratorium “if the Secretary determines such moratorium is necessary to prevent or combat fraud, waste, or abuse under either such program.” Exacerbating this announcement is the claim by CMS that rights of appeal will be extraordinarily limited.
In my 32 years of practice, I have never seen this tactic used before. … CMS may not be able to police its providers quickly enough for their own satisfaction. That failure should not be justification for federal determinations of whether a state has enough providers of a particular type.

Lambert here: I’ve been noticing a continuing story of “small fish” Medicare fraud indictments. Obama being Obama, I have to believe these are meant to lay the groundwork for a full-scale assault on the program. So this is a troubling precedent (and since Cook County is Rahm’s patch, you have to believe he knew about it). Will approval of other types of provider be unilaterally suspended? And catch the administration doing anything about “waste, fraud, and abuse” by banks!

The Unanticipated Consequences of Postponing the Employer Mandate NEJM, 2013-07-31

But the demise of the employer mandate has a potentially more important side effect: it removes incentives for employers to offer coverage to lower-income workers at low enough explicit premiums that they would choose job-based coverage over exchange coverage. The ACA sought high “target efficiency” — aiming subsidies only at lower-income uninsured people without a large-group insurance option and avoiding having subsidies claimed by people at the same income level who already have large-group insurance. This goal was buttressed politically by the view that employers should pay their “fair share” of the cost of coverage out of their profits (despite strong economic arguments that workers ultimately pay for mandated benefits through lower wages or job loss2,3). To restrain lower-income workers from swapping employer insurance for exchange insurance, the regulations required employers with at least 50 employees to offer coverage with low enough explicit premiums to keep the group alternative more attractive.
With that threat gone, it may make sense for employers and lower-wage workers to implicitly agree to a deal whereby such workers buy insurance through exchanges using government-financed subsidies and are “made whole” through higher wages. Higher-income workers could still choose group insurance, taking advantage of their larger tax break.

Lambert here: Show of hands: How many of you think employers will make the employees whole?

Wellpoint expects $20 billion PPACA windfall Benefits Pro, 2013-07-31

WellPoint trumpeted that good news during an analyst conference call last week to discuss second-quarter results. Not only did its quarterly results beat analysts’ expectations, but newly minted CEO Joseph Swedish said the company expects a windfall of sorts from the Patient Protection and Affordable Care Act — as much as $20 billion by 2016.

Lambert here: That shouldn’t be surprising; Wellpoint VP Liz Fowler wrote the bill when on secondment to Max Baucus’s office as chief of staff. Incidentally, since nobody can show what benefit insurance companies bring to any health care transaction, that $20 billion of rental extraction is pure waste.

Employers increasingly relying on wellness programs Health Reform Talk, 2013-07-31

Just 32 percent of companies that offer wellness programs said they have been able to determine the return on investment (ROI) of their companies’ programs.

Lambert here: Notice that the article doesn’t say what the ROI actually is.

Low-Socioeconomic-Status Enrollees In High-Deductible Plans Reduced High-Severity Emergency Care Health Affairs, August 2013

One-third of US workers now have high-deductible health plans, and those numbers are expected to grow in 2014 as implementation of the Affordable Care Act continues. There is concern that high-deductible health plans might cause enrollees of low socioeconomic status to forgo emergency care as a result of burdensome out-of-pocket costs. We analyzed emergency department (ED) visits and hospitalizations over two years among enrollees insured in high-deductible plans through small employers in Massachusetts. We found that plan members of low socioeconomic status experienced 25–30 percent reductions in high-severity ED visits over both years, while hospitalizations declined by 23 percent in year 1 but rose again in year 2. Similar trends were not found among high-deductible plan members of high socioeconomic status. Our findings suggest that plan members of low socioeconomic status at small firms responded inappropriately to high-deductible plans and that initial reductions in high-severity ED visits might have increased the need for subsequent hospitalizations.

Five Things To Know About Obamacare Premiums: A Guide For The Perplexed Kaiser Heath News 2013-08-01

[2] Premiums are just one part of the cost of health insurance. When considering a report on rates, ask which type of coverage was highlighted and how much the deductibles and co-payments are. Was it the low-cost bronze plan price, the slightly higher priced silver plans or the highest priced platinum or gold? Or some combined average? [3] Many of the estimates are based on averages, which really don’t reflect what any individual consumer will pay. Premium prices will vary based on a person’s age, where they live and the insurer they select. Generally, younger people – especially those few who are buying high-deductible coverage now — may see an increase in premiums, while older or less healthy people may see their rates go down.

Health Industry Price Inflation At Historical Low Heath Affairs Blog, 2013-08-01

According to [The Altarum Insitute’s] analysis, the health sector pricing trend ran at a 1.0 percent annual rate in May 2013, lowest since January of 1990. What is striking about Altarum’s health care pricing trendline is that it has declined for the last three years in spite of an alleged economic recovery. … Since the beginning of the recession, pricing has subsided from double the rate of the GDP deflator to parity, and it has closely tracked the deflator with only two deviations for more than eight years. Clearly, something more than the recession is at work here. … My economist friends point to rising consumer copayments as inhibiting price increases. … There is no actuarial roadmap to guide health insurance pricing in an environment where most traditional underwriting strategies have been outlawed by ACA. Guaranteed issue and guaranteed renewal, elimination of lifetime caps, prohibitions on pre-existing conditions restrictions, enrollment of children to age 26 on their parents’ policies all have costs that must be spread across insurers’ risk pools. Optimism about private insurer pricing in 2014 has given way to watchful waiting and anxiety. Yet the Altarum Report confirms that if one is to embark on an aggressive program of health insurance expansion and public subsidy, there could hardly be a more propitious time than right now. Sustained relief from rising health costs could help alleviate fiscal pressure on government budgets and on the broader economy.

Are doctors ethically obligated to sign patients up for Obamacare? KevinMD, 2013-08-02

Society expects much from physicians, much more than we expect from politicians. The medical profession rightly demands much of itself. I hope that even the most militantly anti-Obamacare doctors will recognize that their primary duty to their patients requires that they help them sign up for Obamacare coverage, even if they wish to continue to engage in the political process to get it changed or even repealed.

Obamacare foes shouldn’t obstruct personal coverage Bellingham Herald, 2013-08-04

One delusion of the refuse-to-enroll campaign was summed up recently by a tea party activist in Michigan.

“When you need help,” she told the Washington Post, “you should go to your neighbors and church. It’s the American way of doing charity.”

That’s a pretty thought. In the real world, people don’t go to their neighbors and churches when they fracture their skulls in motorcycle crashes or get pregnant unexpectedly. They go to emergency rooms. When the uninsured guy won’t or can’t pay, the hospital shifts the cost of his care to government and private insurers – which pass it on to the public in the form of higher taxes and premiums.

HHS is shielding Obamacare outreach from sequester cuts Sarah Kliff, WaPo 2013-08-05

“We’re going to do our best outreach to [young adults],” [HHS Secretary Kathleen Sebelius says. “We know a lot of young adults don’t have health insurance as their top priority and reaching that group is a challenge. I do know that the target population is front and center on insurance companies’ target lists.” Insurance plans want to sign up young adults for the same reason that the White House wants them to enroll: Their lower health care costs would likely lower the cost of premiums. Lower premiums, from an insurers’ perspective, means an easier sell.

Lambert here: Notice how ObamaCare (and what a misnomer “Care” is) isn’t prioritizing outreach to those who need care. Rather, it’s focusing on the actuarial sounds of the program, as if HHS were a private insurance company. This not only immoral, it’s cognitive regulatory capture of a very high order.

Obamacare Depends on Math of Matt Saniie From Campaign Data Cave Bloomberg, 2013-08-05

The success of President Barack Obama’s health-care plan depends on signing up millions of uninsured Americans, and Matt Saniie knows how to find them. Fresh out of the Obama re-election campaign “Data Cave,” the 31-year-old math whiz has gone from tracking likely voters in battleground states to honing a statistical model that can predict with 99 percent accuracy whether someone has insurance. Obama and his backers, facing a Republican move to disrupt the start of the insurance marketplaces that are at the core of the law, are adapting the techniques of his election wins. [Oh. I always thought that was the plan all along.] That includes cutting-edge data analysis, a heavy investment in personal canvassing and social media — and a bet that they can generate enthusiasm among young Americans. “The Obama people are not stupid: They know how to campaign and who to go after,” said Uwe Reinhardt, a health-economics professor at Princeton University in New Jersey. Because the government will offer billions of dollars in subsidies to help people buy insurance, he said, “There are enough young people with pretty low incomes that for them this is a pretty good bargain.” [T]his campaign is an all-out effort to get to 2.7 million — the number of healthy 18- to 34-year-olds that White House officials say they need to sign up when open enrollment begins on Oct. 1. … The model that Saniie developed, which scores the probability that anyone is covered by insurance on a 0 to 100 percent scale, helps Planned Parenthood and other groups promoting the insurance marketplaces target their efforts. … Enroll America already has deployed 80 salaried field organizers to 10 states to begin campaigns on insurance signup.

“We have volunteers who maybe have a couple hours on Saturdays to have conversations,” said Anne Filipic, 31, the group’s president, who ran Obama’s first statewide canvass in Iowa in 2007 and left a White House position to take on this mission. “The fact that we can double our efficiency or maybe more makes every aspect of our work more effective.”

Lambert here: This seems to be a follow-on to WaPo’s hagiography of David Simas, just with a different tech dude. I don’t get how this works. Aren’t we assuming the conversion rate for buying health insurance is the same as the conversion rate for voting for a political candidate? Why should that be true?

Criminal Charges for Providers Won’t Fix the NHS, Dr. Berwick The Health Care Blog, 2013-08-06

Don Berwick, who worked on the long fought for Obamacare provisions in the US, is director and co-founder of the Institute for Healthcare Improvement in Boston. He was called in by the government to reflect on the Francis report and on patient safety.
Berwick’s review makes ten recommendations including that sufficient staff are available to meet the NHS’s needs now and in the future – staff should be well-supported and able to ensure safe care at all times; quality and safety sciences and practices should be a part of the initial preparation and lifelong education of all health care professionals, including managers and executives; and leaders should create and support learning and subsequently change, at scale, within the NHS.
But most controversial is his final recommendation:

We support responsive regulation of organizations, with a hierarchy of responses. Recourse to criminal sanctions should be extremely rare, and should function primarily as a deterrent to willful or reckless neglect or mistreatment.

Berwick proposes the government creates a new general offence of “willful or reckless neglect”, applicable both to organisations and individuals. Organizational sanctions might involve removing leaders and disqualifying them from future leadership roles, public reprimand of the organization and, in extreme cases, financial sanctions – but only where that will not compromise patient care.

Lambert here: Oddly, or not, nobody in the Obama administration is proposing new forms of criminal sanction for banksters — or cops. So it’s quite clear which classes are privileged in this conversation, and which are not. Tin foil hat time: I can’t shake the feeling that there’s a concerted campaign against the NHS — one that will cheerfully put patients’ lives at risk — which will at some point cross the Atlantic and be used to attack Medicare and defend ObamaCare. Awarding a big contract to SERCO, a UK company, would chime with that; they would be potential beneficiaries of an NHS privatization scheme, and could use their ObamaCare contracting as a selling point.

WebMD launches online ObamaCare guide The Hill, 2013-08-06

WebMD on Tuesday announced its new “Health Care Reform Center,” which guides users through the basics of the Affordable Care Act and how to purchase health insurance on the new exchanges.

WebMD is part of a growing group of healthcare stakeholders working to educate the public before ObamaCare’s major provisions take effect on Jan. 1.

AARP on Monday launched two information sites on the reform, and Walgreens, CVS and the Blue Cross Blue Shield Association are working to promote the law’s benefits.

These efforts are likely to come as a relief to the Obama administration. Health and Human Services (HHS) Secretary Kathleen Sebelius lamented Monday that she does not have the resources she would like in order to promote the law.

Lambert here: Here is the WebMD site; here are the first and second AARP sites. If any of these sites convey to anyone that ObamaCare is going to like buying “a flat screen TV” send me a hat by surface mail, and I’ll eat it. (Obots not eligible.)

CVS Is Pushing Obamacare. Will it Backfire? Businessweek, 2008-08-06

CVS Caremark (CVS) recently announced that it would use its retail stores to promote the new health law to uninsured Americans who will be eligible to buy coverage through new online insurance marketplaces, starting on Oct. 1. Stores may host so-called “navigators,” who will be employed by states to act as advisers helping people enroll; this means that confused shoppers could walk into a CVS store armed with questions and walk out having figured out which health plan suits them best. Walgreen (WAG) last month made a similar announcement that it would help get the word out about Obamacare’s options online and in stores. … CVS operates 684 clinics in stores and plans to have nearly 800 by yearend. The company sees opportunity with so many new patients getting insurance and not enough primary care doctors to treat them. “Our longer term goal is to create a national primary care platform,” Chief Executive Larry Merlo said on the call today. Helping people sort through their health-plan choices just might be a natural fit.

Where Obamacare premiums will soar CNN, 2013-08-06

While many residents in New York and California may see sizable decreases in their premiums, Americans in many places could face significant increases if they buy insurance through state-based exchanges next year.

That’s because these people live in states where insurers were allowed to sell bare-bones plans and exclude the sick, which has kept costs down. Under Obamacare, insurers must offer a package of essential benefits — including maternity, mental health and medications — and must cover all who apply. But more comprehensive coverage may lead to more expensive insurance plans.

Under Obamacare, all Americans must have insurance coverage starting in 2014 or face penalties of $95 or 1% of family income, whichever is greater. Enrollment in the exchanges begins October 1, with coverage kicking in in January. Plans will come in four tiers, ranging from bronze to platinum.

Some lightly regulated states, including Indiana, Ohio, Florida and South Carolina, have recently released preliminary rate information highlighting steep price increases. Unlike the blue states of California and New York, these are Republican-led states that have strongly opposed the Affordable Care Act, as Obamacare is officially known.

Obamacare supporters are doing lots of door-knocking. It might not work. WaPo 2013-08-06

Last week, I wrote about Enroll America’s plan to go door-to-door to urge uninsured people to sign up for health insurance, in some cases returning a half-dozen times to convey the message. But will a knock on the door – or eight – be enough?

Maybe not, according to Stan Dorn, a senior fellow at the Urban Institute, whom I quoted in the piece and who is skeptical of such efforts. He thinks the only way to get large numbers of people signed up quickly is to actually do the signing up for them.

“It’s human nature not to complete forms or paperwork,” he said. “The initiatives that have succeeded in enrolling large numbers of people have eliminated the need for consumers to fill out paperwork.”

In our conversation, he cited a few studies to illustrate his point, including one from 2005 that examined company 401(k) plans. When workers had to fill out paperwork before the accounts were created, about 33 percent of workers participated, he said. But participation spiked to 90 percent when companies automatically established the accounts, with an option for workers to opt out.He also pointed to some experiments looking at H&R Block’s efforts to help their tax clients enroll in public benefits. In one, the tax preparation company filled out the paperwork for clients eligible for SNAP. As helpful as it was to simply fill out the forms, participation in the food assistance program was 80 percent higher when the company took the extra step of submitting the paperwork on the clients’ behalf.

Lambert here: Oh well. Still, even if Enroll America just ends up confirming addresses, that will be useful for Campaign 2014.

Preparations for Health Exchanges on Tight Schedule Online WSJ, 2013-08-07

With time running short before enrollment kicks off Oct. 1, the Obama administration last week cut back on training requirements for these “navigators.”
Grants to hire and train the workers aren’t expected to be released for another two weeks for the 34 states where the federal government is running all or part of the marketplaces, which will offer insurance to those who don’t get it on the job or from Medicare or Medicaid. That leaves just 32 business days to hire and train thousands of helpers in these states.
“It’s definitely a tight timeline, and there’s a lot to do before Oct. 1,” said Jen Bersdale, executive director of Missouri Healthcare for All, a nonprofit advocacy group helping coordinate outreach activities in the state. “I imagine some people will be working overtime to do it.”

The Affordable Care Act: A User’s Guide California Health Report, 2013-08-07

Our current system pays providers for specific services, for instance, but the industry is moving towards a system where providers are paid per patient instead. Under this system, doctors or practices receive bonuses when their patients do well, including going to follow-up appointments, avoiding the emergency room, and seeking appropriate care for chronic conditions. So far there have been mixed results for these pay for performance initiatives — sometimes they improve care but often they don’t. Accountable Care Organizations, which rely on a network of health professionals coordinating care to improve the health of their patients and reduce costs, aren’t working as expected either. Adjusting to new systems takes time, as long as five to six years, ACO organizations suggest, but that also means that reducing costs will take time too.

Lambert here: Medicare took a year to implement, back in the Age of Steam, when LBJ was president. So if Medicare for All had been passed in 2010, we would have saved $600 billion in 2011, and another $600 billion by the end of this year. All this crapola about bending the cost curve, and experimenting with different systems of health care delivery is code for one thing: Preserve the health insurance industry at all costs. Because we already know single payer works; it’s tested, tried, and true. So why are we even experimenting with ObamaCare?

A Conservative Re-Envisioning Of The Health Care Overhaul Kaiser Health News, 2013-08-07

[The new report,] discussed at an AEI forum Tuesday, would keep key elements of the 2010 health care law – its online marketplaces, or exchanges, where people purchase coverage, and its subsidies to help people buy coverage – but structure them differently. The AEI plan includes national or state run exchanges, but insurers would face far fewer restrictions governing how much they could charge for coverage. And while the health law provides subsidies for individuals and families with incomes up to 400 percent of the poverty level, the AEI plan would provide subsidies to individuals with extremely high medical costs up to 600 percent of the poverty level.

Unlike the health law, however, there would be no employer or individual mandates to provide or purchase coverage or pay a fine. And the AEI plan would scrap Medicaid, the federal-state health insurance plan, and instead provide coverage through the exchanges with generous subsidies for the poorest and sickest.

Lambert: So how long will it take for the Democrats to adopt this proposal and abolish Medicaid?

Obama to homeowners: I didn’t say it was your fault, I said we’re going to blame you

Well, actually, he is sort of saying that homeowners were at fault for the housing crisis.  Yes, yes, MOST of us were just responsible, law-abiding citizens, living within our means, paying mortgages on our modest little townhouses as we worked at jobs we loved.  Then the bankers saw an opportunity to lend money to millions of suckers, driving the cost of housing up.  Then they securitized those loans, sliced them up into pieces, sold them to unsuspecting pension and mutual funds and created a whole new financial instrument to insure speculators against risk.

When the bubble burst and people lost their jobs and the economy was taken to the brink of Armageddon because of all of the bankers’ wild speculations, the last people on earth who were asked to take a haircut were the bankers who refused to take any losses on the mortgages they expected to make money on in perpetuity.  It didn’t matter if those same homeowners no longer had jobs or were making less money.  No, they were not going to take a penny less than they expected.  So the government bailed them out and did nothing to help people stay in their homes.  We didn’t adjust mortgage rates or write down principal or stop anyone from being thrown into the street.  Because early on, THIS administration decided to bail out the bankers over everyone else.

And now, future homeowners will also suffer.  This administration has decided to get out of the housing business and let the private sector take over.  The cost of owning a house is expected to go up.

I love this piece of the article:

Previous generations of politicians created Fannie and Freddie as a means of providing those benefits while pretending the costs did not exist. The companies were declared to be private during the fat years, and their shareholders profited handsomely, even as everyone understood that the government would stand behind the companies during the lean years.

That strategy has probably been exhausted, as Washington appears to have lost its appetite for implicit guarantees.

That leaves an unpalatable choice between making the cost of the system an explicit government obligation, or making it harder for Americans to buy homes. Any reduction in government support for the mortgage market is likely to increase the cost of home borrowing.

Plans to revive private sources of financing for mortgage loans also need to be harmonized with the government’s countervailing efforts to reduce risk-taking by financial institutions. Some analysts are worried that new rules and regulations will limit the ability or willingness of the market to finance mortgage loans.

Alex J. Pollock, a fellow at the American Enterprise Institute, said he was confident that lenders would learn to operate within the rules — or learn to go around them — but he added that the effort required to do so would be billed to the borrowers.

“Enterprising companies are very able to figure out how to deal with these regulations, but that’s not free,” he said. “The loans will cost more.”

Well, at least I can say that I didn’t vote for him.  Twice.

Resident Trendspotter Recommendation: Convos with my 2 year old

My resident trendspotter, and up to the minute kid, introduced me to this YouTube hit from Canada.  (new episodes come out on Wednesday) Subscribe and enjoy!

The Confluence endorses Rush Holt for Senator of NJ

Rush Holt (NJ-12) for US Senate

I can do this because up until a few months ago, I lived adjacent to Holt’s district.  In fact, it’s a mystery why Hillsborough wasn’t *in* Holt’s district given our proximity to Princeton and how the shape of NJ-07 was drawn, dipping down in a weird way to trap the unfortunate residents of Hillsborough in a Republican district against their wills.

There are a few things the senate needs more of: women, African-Americans and scientists.  Let’s give it to the NYTimes for acknowledging that NJ has a male dominated political machine in BOTH parties.  There hasn’t been a single woman representative in the NJ Congressional House or Senate delegation for about 2 decades.  That’s disgraceful for a state that has as many people in it as NJ does.  It’s the densest state in the nation (in more ways than one) and over half of the population there has no representative in the House or Senate from either party.  NJ does not promote or mentor female politicians.  Just fugeddaboudit.  It’s not going to happen.

The US Senate doesn’t have enough African-Americans either and while they’re underrepresented, one would hope that the past African-American senators would prove to be more willing to step up and advocate vigorously for the needs of underrepresented groups.  Alas, this has not proven to be the case in recent history.  Cory Booker would be no exception to this rule.  Booker is a Democrat in the Barack Obama style.  His record in Newark might be admirable but in that case, his absence from NJ would be detrimental to that state.  Beats me why he didn’t run for Governor.  I blame Frank Lautenberg for his untimely demise.

Booker is Wall Street friendly and a happy corporate schmoozer.  Sure he’s done some super hero things during the recent hurricanes.  But he wouldn’t have to run into buildings and rescue people if his emergency services were running well.  If I recall correctly, his fire department refused to rescue a mother and her kids from rising flood waters during Sandy and Booker was nowhere to be found.  (Ah, wouldn’t you know, another news article that should be easy to find mysteriously disappeared.  Hmmmm…)That’s the problem with being a superhero.  There’s only one of you and you have to be everywhere at once.  What Booker has failed to learn is how to make his infrastructure run efficiently without him and how to delegate the rescuing to other people.  I mean, shouldn’t he have been in a central command center during Sandy directing things instead of riding around the city on fire trucks like some kind of department mascot??  There were whole sections of his city awash in flood waters, those sections still blighted by insufficient public services and poor infrastructure.  That wouldn’t have happened had Booker been as good with the poor as he is with the business community.

I’m going to venture a guess that Newark would have revitalized without Booker anyway.  Any politician with a sufficiently ingratiating attitude towards business could have done what he did.  Manhattan has finite real estate, housing and office space is expensive for businesses and people, and it was bound to expand. Newark is close and cheap.  It might as well be NYC’s sixth borough.  (Funny we’re not promoting the mayor of Hoboken who held it together during Sandy.  Oh, that’s right.  Dawn Zimmer is a girl.  Nevermind.) Amtrak, the PATH train and the NJ Transit NE Corridor train run right through it.  Sure, it has problems, and a history, and an educational system that needs help.  But gentrification was going to get there anyway.  All Booker had to do was get ahead of it slightly and take all the credit.

Enough about Booker.  He’s just another flashy aspirational candidate with a great Bonus Class funded PR campaign.  Besides, we don’t need Booker riding shotgun around DC putting out fires, walking little old ladies across the street and getting kitties out trees for little children.  We need a real Democrat in the Senate who will not be afraid of his own party’s platform and who will fight, vigorously, for it.  Even if that means pissing some people off.  Frankly, I can’t see Corey Booker doing that.

Now, for the scientist.  Rush Holt is a astrophysicist.  Presumably, he can think his way out of a paper bag.  That seems to be in short supply in the Senate these days.  Holt would be the only scientist in the Senate.

One of the reasons I like Holt is not just because his views on national security, single payer healthcare or the financial crisis make sense, though all of that is extremely important and his perspectives admirable.  He would be a credible successor to Lautenberg.  Holt’s stance to repeal the Patriot Act would put him ahead of Lautenberg.

No, the reason why I think Holt would be an important contribution to the Senate is because he was the author of H.R.5816 (112th): Voter Confidence and Increased Accessibility Act of 2011.  That bill would put an end to unaccountable, tamper prone electronic voting machines and would ensure ballot accountability.   In this respect, Holt is way ahead of his colleagues and is truly looking out for the only way that citizens have to change the status quo- their right to vote.  If you want single payer, privacy from intrusive government spying, protection of your 4th amendment rights, and punishment for the financiers who blew up the world, you have to be able to protect your sacred right to throw Bonus Class toe suckers out of office.

If you’ve ever voted on an electronic voting machine without a paper trail, or a punch card machine with hanging chads, or some butterfly ballot designed by nitwit, you know how important it is to protect your only real right.  Eventually, the bad guys are going to run out of Voting Rights Acts to destroy and they’ll start outright manipulation of the outcomes, if they haven’t already (I suspect that the Democratic presidential primary in Indiana in 2008 was a precursor of things to come)  I have to admire the guy who used logic and foresight to cut through all of the extraneous bullshit going on in government these days to realize that protecting the vote is THE most important thing ever.  If recent rulings from the Supreme Court and actions of state legislatures in Republican dominated states haven’t proven that point, I don’t know what will.  We need that kind of mind in the Senate.  Maybe he can tag team with Elizabeth Warren.

Since Holt is in the House, that bill is going nowhere.  Maybe he’ll have a better chance in the Senate.

Vote for Holt in the NJ Senate Primary.

You can learn more about Rush Holt and contribute to his campaign here.

AAAAAND, last but not least, in honor of Geek Week on YouTube, this is a Geek Out session with Rush from four days ago.  Dust off your Geek Speak and Enjoy!