Da Weekend

Apr. 24th, 2017 08:24 am
hudebnik: (Default)
Saturday: [personal profile] shalmestere went to her vielle and viol lessons, while I did some yard work. Met her for lunch, came home for a nap, then drove to Poughkeepsie for a really good concert of 13th-14th-century music on the theme of Dante. Had a really good barbecue dinner in Poughkeepsie, then drove home and crashed in bed.

Sunday: woke late, made pancakes (for the first time on our new stove!), took Moongrrl for a walk in the park. [personal profile] shalmestere spent a few hours finding and/or arranging processional-sounding pieces to play on shawms for an upcoming SCA gig, while I did more yard work.

In a previous post, I lamented the finish of the new cabinets in our mid-renovation kitchen. Got an e-mail reply from the manufacturer, saying "the veneer is a multi-step process, and we don't recommend trying to change the finish." Which is exactly what one would expect them to say: they have nothing to gain, and considerable to lose, by "authorizing" us to refinish their cabinets. So the reply doesn't carry much informational content. However, I have some scraps of leftover cabinet material, and we experimented Sunday with sanding and staining it. Preliminary results: some of the pieces are made of real wood, and they stain reasonably well. Other pieces are plywood with a plasticky veneer, and neither sanding nor staining has much effect on them. Fortunately, most of the plywood parts are internal; the parts of the cabinets that face into the room are mostly real-wood.

Da Wall

Apr. 24th, 2017 07:28 am
hudebnik: (Default)
So Da Trump wants this week's continuing budget resolution to include billions of taxpayer dollars to build a wall on the Mexican border. The wall won't keep out illegal immigrants, won't keep out drugs, won't serve any useful purpose except to allow Donald Trump to say that he kept a campaign promise -- while conveniently ignoring the other half of that campaign promise, "Mexico's gonna pay for it." Trump says "Oh, Mexico will pay for it at a later date, but we need to get started on it now." Huh?

Let's put this in terms the President will understand, with a real estate analogy. Suppose you were working on a development project, courting two investors, V and M. You tell V that M is going to invest (despite M's repeated public statements that he has no intention of investing), and V somewhat dubiously signs onto your project. M continues saying publicly that he has no intention of investing. M has nothing to gain from the project, and you have no plan to entice or force M to invest that doesn't cost you more than it costs M. Would you put your own money into the project, on the assumption that M would eventually invest and you could reimburse yourself from M's contribution? Would you expect V to put more money into the project, promising V that M would eventually invest and you could reimburse V from M's contribution?

Wait -- that's not just an analogy. That's exactly how the President has actually been putting together real estate deals for decades: lie to one investor about another investor's commitment. As long as none of your own money is on the line, it's all good: if the project goes through, you get a cut of the profits, while if it doesn't, your investors are stuck with the losses. In either case, you go on with your life, find another gullible investor whom you haven't burned yet, and repeat the cycle with a new project.
hudebnik: (rant)
Just heard a news story on the radio, as President Trump sent his condolences to the people of Paris about "another terrible terrorist attack" yesterday. The attack in question involved a guy with a gun going to a public place, killing one person and wounding three others. Terrible, yes, by European standards... but the same attack in the U.S. wouldn't even make national news, because it happens LITERALLY EVERY DAY here, because we have more guns than people, with almost no controls on who can have one or carry it in public places.
hudebnik: (Default)
This article on Medium points out that the 2008 economic collapse, and lots of other recent economic failures, result from people conducting rational behavior within ground rules that encourage such things, and suggests that the rules have changed in that direction because, since about 1940, public policy issues are debated against a criterion of "is this good for economic productivity?" rather than, as before 1940, "is this good for democracy and civic society?" Ironically, the latter criterion seems to often produce better long-term economic productivity.

I need to follow some of the links in the article to the real academic research.
hudebnik: (Default)
The first phase of kitchen renovation has finished. The guy from the countertop company came on Thursday to measure the cabinets and make a template; now we wait two weeks for the "quartz" countertop to be made to order, after which they'll install the countertop, sink, dishwasher, and backsplash, apply finish paint to the window frames, door frame, and base molding, install a doorknob in the basement door, and various other minor things.

The bamboo floor is lovely. The ceiling (drywall rather than hung acoustical tile) is lovely. The wall paint (over the aforementioned five layers or so of various wallpapers) is lovely. The new oven, range, and microwave are nice (although I don't think we've actually used the new microwave yet). The light fixtures are lovely.

The new fridge has the same footprint as the old one and is six inches taller, so theoretically it should have more capacity. But I think it also has more insulation, hence less capacity. And it has different internal organization: no cheese drawer, one big fruit-and-vegetable drawer rather than two smaller ones, and the only place tall things can possibly fit is on the doors. (Since the fruit-and-vegetable drawer is full width, you can't open it without opening both doors.) We picked up some fridge-organizing bins at the Container Store yesterday, and are starting to move things into them in hopes of being able to find stuff. It has two pull-out freezer drawers rather than one big freezer door, which means ice trays have to be put on top of other (flat) things rather than having their own slide-in-from-the-front compartment. And, in a bit of bad design, things can easily fall off the back of a pulled-out freezer drawer: retrieving the fallen object requires reaching under the lip of the compartment above, over the back of the drawer, and down to wherever the object fell, and you won't be able to close the drawer until you retrieve the fallen object. We may need to buy a small trunk freezer and put it in the basement.

The cabinets appear to be sturdy, well-built, and well-installed, but the finishes look and feel more "faux-wood-grain" and plasticky than the sample we saw at the store. ([personal profile] shalmestere says it feels like living in a cheap motel room from the 1990's.) [personal profile] shalmestere did some asking on Facebook and some searching on the Web of How-To Videos, and concluded that we may be able to solve the problem by taking off the shine with 220-grit sandpaper or fine steel wool, then applying a coat of satin-finish (as opposed to glossy) Polyshades or something like that. Which I'm confident will work for the real-wood parts of the cabinets, but I'm not sure what effect it'll have on the veneer-over-plywood parts. I've written to the installers, and to the cabinet manufacturers, to ask.

We (mostly [personal profile] shalmestere) came up with a couple of boxes of clothes and seldom-used kitchen stuff to donate to the St Vincent de Paul thrift store yesterday. I dropped them off at their loading dock without sticking around to find out whether they were acceptable. We looked around the thrift store, but escaped without buying anything.

Went to the Greenmarket yesterday to acquire lamb for the Paschal feast, which in recent years has been a lamb-and-prune tagine inspired by Katniss Everdeen's favorite dish in the Capitol. Our preferred purveyor of lamb was out of boneless shoulder, and out of stew meat, so I ended up with leg steaks; still not sure whether we'll cut them up for stewing or cook them as steaks.

While I was there, I also picked up a couple of baby Thai-basil plants, which yesterday afternoon I put variously into raised boxes in the back yard, and the ground around the quince trees in the front yard. Also pulled up a bunch of weedy, stringy stuff from dead patches in the lawn, sprinkled grass seed over them, and watered them.

Today: Easter service, install a new motion-sensing lantern outside the front door, cook Easter dinner, consume mass quantities of chocolate, continue dusting and vacuuming after the kitchen reno, maybe mow the lawn, maybe do some more weeding, maybe visit the hardware store for more grass seed and refinishing supplies, maybe arrange rehearsal dates for a non-SCA loud band gig that is now less than five weeks away.
hudebnik: (rant)
After the first attempt to repeal and "replace" Obamacare failed in the House of Representatives, President Trump suggested he would sit back and watch Obamacare fail, after which Democrats would fall on their knees begging him to rescue it. That hasn't happened yet, so he's made more noises about it this week, making clear with the subtlety of Al Capone that "I don't want anyone to get hurt. What I think should happen and will happen is the Democrats will start calling me and negotiating."

As Paul Krugman points out, this strategy is not only cruel (to all the people who will "get hurt") but stupid, in that it's not likely to work.

Let's put it in terms of deal-making, something the President claims to know something about. He's written in the past how important it is, when going into a deal, to show that you're willing to walk away from it. The same goes for the Democrats in Congress: they won't accept any deal that is worse than walking away. In fact, they won't even come to the negotiating table unless they hope to get something better than if they don't.

What do the Democrats get if they don't negotiate with Trump and/or Ryan? Medicaid expansion continues to work, at least in the states that have accepted it (and I gather several more red states have been considering that in the past few months, presumably because it puts hundreds of millions of dollars into their local economies without politically benefitting Barack Obama). Healthcare.gov, which has actually been working pretty well since its bad first few months, will collapse for lack of maintenance and P.R, which can be blamed directly on the Trump administration. Fewer young and healthy people will buy health insurance because the individual mandate isn't enforced, and fewer poor people will buy health insurance because the cost-sharing reductions are cut off, so health insurance companies will either drop out of many states completely or raise their rates much faster than at any time in the past eight years. Those rate changes will probably apply not only to people in the exchanges, but also to people with private or employer-based insurance, which means about 90% of Americans will see their insurance premiums jump, again as a direct result of Trump administration actions. State-run exchanges will continue to run, theoretically, but there will be few or no plans in them, so millions of people will completely lose the insurance that Obamacare gave them for the first time in their lives. Every health insurance company in the country will sue the Administration for breach of contract (and those are some DEEP pockets!) It will be painfully clear that the situation was "not perfect, but pretty good" in the Obama administration, and now that Republicans control all branches of government, it's gotten rapidly and dramatically worse -- especially for the demographics that voted for Trump. Bad for the American people, but pretty rosy for the party out of power.

What do they get if they do negotiate with Trump and/or Ryan? Well, that depends on what "negotiate" means. Since Trump is trying to force Democrats to the negotiating table with threats rather than luring them there with promises, he probably has no intention of offering very much. The Medicaid expansion goes out the window. All the rules saying "you must cover these things in order to be called 'insurance'" go out the window. The pre-existing conditions rule will be kept in name, but eviscerated so that if you ever miss an insurance payment and have a pre-existing condition, you'll never get insurance again in your life -- at least, not insurance that covers that condition. And they get their Democratic names on this mess. All in all, a worse deal for the Dems than "walking away".

Congressional Democrats have no incentive to negotiate away anything that's in current law unless the Republicans can offer them something they see as better, and they have no intention of doing that.

Unless... Trump can negotiate with the Democrats a collection of minor tweaks that stabilize the markets and make the system work better, but which Trump with his genius at branding and P.R. can describe as "repeal and replace" (or even as "the Democrats blinked"). Such a deal, if it happened, would serve as evidence that, however incompetent he may be at most tasks one expects of a President, Trump really is good at making deals. The question is, would Democrats accept such a deal, knowing it would make Trump look good with mainstream America? (Not with the Tea Partiers, but he has little of their love left to lose.)

If the teams were reversed, there's no doubt that Congressional Republicans would turn it down: they've made abundantly clear over the past eight years that they're willing to hurt the American people (extend the recession, sabotage health care, etc.) if that's what it takes to hurt President Obama and the Democrats.

I don't know what the current Democratic leadership would do if they were offered a deal that repealed a few inessential aspects of Obamacare (say, the employer mandate) and improved others, on the condition that Trump gets to say he won the negotiation. I don't even know what I would want them to do in that situation: is it worth improving the health care system if it lends credibility to an administration that is so corrupt and so malevolent on so many other issues?

But I very much doubt they'll be faced with that choice.
hudebnik: (Default)
I spent the last two days at an academic conference upstate, which is (relatively) Trump Country. And I found myself talking to a security guard who was no big fan of either Hillary or Donald, and didn't say whom he had voted for, but told the following first-person story.

"I work mostly as an EMT; the security guard thing is on the side. And since Obamacare, it's been impossible to get paid. After we go on a call, we bill the patient's insurance company, and they just refuse to pay, because under Obamacare, they don't have to. Before Obamacare, they paid just like that <snap>."

Now, I have a hard time believing insurance companies ever "paid just like that <snap>", at least in recent decades. And I confess to knowing nothing about how EMT and paramedic services are now, or have ever been, funded. But for those of you who do know something about it, does the above make any sense? What aspect of Obamacare could have caused (perhaps indirectly) the above phenomenon?
hudebnik: (Default)
Mixed messages from Trump and Ryan. Some indication that Trump never really cared about health care except "repeal Obamacare" as a campaign slogan, and he would be delighted to never hear the words for the rest of his Presidency; also some indication of an interest in "working with Democrats". It's clear that the Republicans don't have enough of a unified vision to pass any health care bill on their own, so any change from here on will need to be bipartisan. What if he/they actually meant it? What improvements could be made that would get a significant number of both Democratic and Republican votes?

I wouldn't shed many tears if health insurance were divorced from employment, and most Americans got their health insurance through an individual market rather than through group deals worked by their employers. (This would make cases such as Hobby Lobby moot: if your employer doesn't pay for your health insurance, your employer doesn't get to choose what your health insurance covers based on their religious views.) This could be accomplished by gradually decreasing the amount of employee health-insurance expenses that an employer can tax-deduct, making it gradually less attractive for them to offer health insurance. The effect would be to move a lot more employed, reasonably-healthy people into individual markets (including, unless changed, the state Obamacare exchanges) and make those markets more stable and sustainable. And it would arguably be a "pro-free-market" move that would attract ideological Republicans.

One of the problems with Obamacare as it stands right now is that in some states most insurers have pulled out of the market. A public option would guarantee that there IS competition in every state, which should bring down premiums... but it's competition by a gummint entity (even though it's not taxpayer-funded), so Republicans won't go for it. Never mind.

Perhaps the biggest possibly-bipartisan improvement would be clarity and fairness in health care pricing. At present, most of the financial benefit of having health insurance isn't the amount of your health care costs the insurance company *pays*, but the amount that the insurance company *negotiates away in a puff of smoke*. Providers have to give deep discounts to big insurers, or they'll be out-of-network and will never get any customers from that insurer.

So here's how we change that. Require health-care providers to publish price lists of their services, and limit the ratio (gradually decreasing over a number of years) between the maximum and the minimum they charge different customers. (Might want to allow large discounts based on personal income, but not based on insurance.) This would make illegal a lot of insurance-company "negotiations" with providers, and mean that uninsured and insured people paid more-nearly the same prices for things. Health care providers would compete with one another on price and quality, rather than merely on which ones are in-network for your insurance company. The whole idea of in-network and out-of-network providers would become less important; consumers would have more choice of doctors, and maximum prices would come down as minimum prices rose. I suspect most doctors would love this, but insurance companies would hate it, so there would need to be some other sweetener to prevent the latter from blocking it. Perhaps the first idea above would please the insurance companies enough to balance this. And it's a free-market reform, so it should get a fair number of Republican votes (although not those who see ANY government regulation as evil, even government regulation to open the markets).
hudebnik: (Default)
Of course, the simplest way to have a large, reasonably healthy pool of people paying for health insurance is to have EVERYBODY paying for health insurance -- universal enrollment. But socialism, totalitarianism, Hitler, dark days of the war, Kenya, end of civilization as we know it. So never mind that.

People do cost/benefit calculations. For any given person, under any given life circumstances, there's a cost C of buying insurance, and a benefit (financial, psychological, etc.) B from having health insurance. It makes sense for you to buy health insurance if B > C.

What are the units of B and C? They're really about personal choices, so they have to be measured in what economists call "utility": one scenario has more utility than another if you would choose the former over the latter. It's tempting to measure them in dollars, but in fact any given number of dollars has more utility (it matters more in decision-making) to a poor person than to a rich person, so anything measured concretely in dollars will have utility that's a decreasing function of income.

Furthermore, poor people tend to be liquidity-constrained: even if they know something would be a good long-term investment, they're less likely to make that investment if it means being unable to pay the rent or buy food this month. In other words, they necessarily discount the future more heavily than rich people do; while everybody values a predictable dollar now or soon over a hypothetical future dollar, this effect is more pronounced for poor people. C is typically stated in concrete, predictable dollars/year, while B is partly hypothetical dollars and partly psychological; for both of these reasons, C is effectively a decreasing function of income. (At the very-rich level, B decreases with income too: if you could just write a check for a course of chemotherapy, you don't need health insurance. Let's leave the very-rich -- perhaps the top 1% of the income distribution -- out of this analysis.)

B is also an increasing function of health risk: the older and/or sicker you are, the more valuable health insurance is to you.

In the U.S., it's always been possible to buy insurance at different levels, ranging from cheap, bare-bones plans (B and C both small) to expensive, comprehensive plans (B and C both large). In other words, B and C are increasing functions of coverage; one assumes a given customer will choose a coverage level (possibly zero) to maximize B relative to C. If even the cheapest plan available costs more than it's worth to you, you'll choose no coverage at all.

So, to sum this up: regardless of the legal environment, B will be an increasing function of age, coverage, and sickness, while C is increasing in coverage and decreasing in income. Which means in general, health insurance makes more sense for old, sick, and rich people.

Laws about health care are intended to tweak the shapes of these curves. For example, a system of pure universal coverage removes the "no coverage at all" option, and indeed removes the notion of coverage level entirely, as everybody gets the same coverage (which is more valuable to you the older and sicker you are). In a pure laissez-faire system, C tends to be not only increasing in coverage and decreasing in income but increasing in age and sickness, essentially infinite for people with pre-existing conditions whom nobody wants to insure at all. Medicare was put in place to limit how high C can go at the high-age end, so old people (or moderately-old with long-term health problems) were more likely to have health insurance; their higher actuarial costs were shared by taxpayers so the insurance market didn't buckle under their weight. Medicaid was put in place to limit how high C (measured in utility) can go at the low-income end, so really-poor people were more likely to have health insurance.

Obamacare made several changes to this. It expanded Medicaid to apply to somewhat higher income levels as well as the poorest, making moderately-poor people more likely to have health insurance. It provided subsidies for people just above that level, making middle-income people more likely to have health insurance. It required insurers to cover already-sick people, at a cost not enormously higher than the cost for healthy people, getting rid of that vertical asymptote. And it removed the most "bare-bones" plans from the system entirely -- if your coverage doesn't meet certain minimum standards, your coverage is zero -- so below a certain level of coverage, B is zero, while C is the nonzero penalty P for being uninsured. The penalty is still less than the cost of buying insurance, so some liquidity-constrained people will still "choose" to be uninsured, but again the effect should be to make poor people more likely to have health insurance.

In particular, if you currently have health insurance and are contemplating dropping it, you know that you'll lose all your benefits B, but will save only C - P on costs, which makes you less likely to drop it. If you're currently uninsured and are contemplating entering the market, the reverse applies: you'll get benefits B, at a cost of only C - P. The larger P is, the more likely people are to stay insured, or become insured if they're not. Which is why one of the Republicans' first tactics in pushing Obamacare off a cliff was to reduce P.

Ryan/Trumpcare takes a different approach. There's no penalty for being uninsured, but there's a penalty of 30% of your first year's premiums for rejoining the market after being uninsured. So if you currently have health insurance and are contemplating dropping it, you know that you'll lose all your benefits B, while saving C immediately; if you rejoin the market later, you'll pay 0.3C for one year, but that's farther in the future so liquidity-constrained people will discount it more. In other words, poor people are more likely to drop out of the insurance market if they're in it, unless they're old enough or sick enough that B is still greater than C. If you're currently uninsured and are contemplating entering the market, you know that you'll gain B, while paying 1.3C immediately and C in the long run. The longer you go uncovered, the more money you save before paying that one-time 0.3C for a year to re-enter the market. In other words, those who re-enter the insurance market after a lapse will be those old enough and sick enough right now that B > 1.3C, and sufficiently liquid that they can handle the one-time penalty. So at both ends of a lapse, Ryan/Trumpcare encourages younger, healthier, and poorer people to go uncovered, leaving an older, sicker, richer pool of people in the system and inevitably higher average premiums. Pushing Obamacare off a cliff wasn't enough; they're pushing their own system off the cliff even harder.

At the same time, Ryan/Trumpcare decreases government cost-sharing and subsidies, making poor people less likely to participate in the system unless they're really sick. It makes those subsidies age-based rather than income-based; this brings a small advantage in reduced paperwork, but tends to encourage younger people to go uninsured unless they're really sick. At the same time, it increases what insurers can charge old people, thus encouraging old people to go uninsured unless they're really sick. (If you're sufficiently old, you can discount the one-time penalty to re-enter the market because you'll probably die before paying it.) And it largely dismantles the minimum standards of Obamacare -- the "bronze", "silver", "gold", and "platinum" levels -- effective 2019, thus encouraging people to buy cheaper coverage than is currently possible without a penalty, until and unless they get really sick. All in all, it gives us an insurance system for middle-aged people (probably near their earning peaks), fairly-rich people, and really sick people of all ages -- a recipe for skyrocketing premiums.
hudebnik: (rant)
He ran against politics and politicians. What's wrong with politicians? As anybody who's read a U.S. newspaper in the past 150 years knows, they promise the stars, and as soon as they're in office, they break all their campaign promises.

So he's not going to be like that: he's going to keep his campaign promises if it kills him us.

Problem is, most of his campaign promises weren't carefully thought out; they were just whatever got the most applause at rallies. Who knew he was going to win the election? Still, he's going to keep them, or find somebody else to blame when he can't.

He promised he would build a big, beautiful border wall, and make the Mexicans pay for it. There's been a delay in getting the Mexicans to pay for it, but at least he can keep the "build a wall" promise, and get around to making the Mexicans pay for it later. We'll spend at least 20 billion U.S. taxpayer dollars on a wall that won't keep anybody out, or make America safer, but it will demonstrate that Donald Trump keeps his promises. About the "making the Mexicans pay for it" part... he would totally do that if there weren't a bunch of politically-motivated international-law do-gooders who won't let him use his superb bullying negotiating skills.

He promised he would block all Moslems from entering the country "until our people can figure out what the hell is going on." He's tried twice so far, and he would totally do that if there weren't a bunch of politically-motivated Constitutional-do-gooder judges refusing to carry out his orders. For some reason the namby-pamby liberals have a problem with recognizing Moslems as the enemy. Weren't all of the 9/11 hijackers Moslem? Come on, people, use some common sense!

He promised he would institute "extreme vetting" for refugees. He didn't know exactly what was wrong with the existing system, but there would be time to figure that out later; at any rate, his was going to be much tougher and more extreme. He's tried twice so far, and again there are a bunch of politically-motivated Constitutional-do-gooder judges refusing to carry out his orders. And who knew he couldn't fire them for insubordination?

He promised he would scrap most of our existing deals with other countries and make much better ones. So far he's scrapped a couple of existing deals with other countries, and indicated his intention not to abide by others. About the "making much better ones" part, he would totally do that if there weren't a bunch of international-law do-gooders who want America to fail and won't let him use his superb bullying negotiating skills.

He promised he would repeal Obamacare and replace it with something much better and much cheaper. So far he's supporting the sort of wibbly-wobbly repealy-wheely stuff that Congress has come up with; he would totally come up with a much-better-and-much-cheaper replacement if there weren't a bunch of politically-motivated obstructionist Democrats in Congress who won't do what he says. And for some reason he can't fire them for insubordination either. And who knew health insurance was so complicated?

He promised he would "drain the swamp" of corrupt Washington insiders and bureaucrats. So far he's appointed non-Washington-insider people (indeed, people with no government experience at all) to run most of the government. As for getting rid of the rest of the Washington-insider bureaucrats, who knew the President can't just fire anybody he wishes? I mean, he's the President, isn't he?

He promised he would lock Hillary up. Who knew you can't do that without finding evidence that she committed a crime? What's the point of being the most powerful person on Earth if you can't lock people up?

He promised he would create lots of good American jobs in steel, coal, and heavy manufacturing. So far he's made a couple of phone calls, and several corporate CEO's have said they're going to create gazillions of U.S. jobs as a result. (OK, they actually announced those jobs before he was elected, and the last few times they said something similar, it fizzled.) But if the steel and coal companies don't have the gumption to hire hundreds of thousands of red-blooded American men the way they did fifty years ago, that's their problem; he can't do it himself.

He promised he would avoid conflicts of interest between his job as President and his job as boss of the Trump Organization. Of course, he could perfectly well run both at once, because he's a very smart guy, but just to keep people happy, he'll keep them separate. From his years running a corporation, he knows you're not supposed to trade on inside information, so he's removed himself from day-to-day operations of the Trump Organization to make sure he's not making company decisions based on secret President information. Problem solved; what other kind of "conflict of interest" could there possibly be?

He promised he would make America great again. How do you know a country is great? Because it wins all its wars. How do you win all your wars? By having a really big, powerful military. He's not quite sure what's wrong with the existing military, or what kinds of things the military needs to do, but his is going to be bigger and more powerful.
hudebnik: (Default)
The CBO says it'll put 14 million people into "uninsured" status almost immediately (i.e. 2018), and "24 million over the course of ten years." I'm not sure how to read that latter statement, but let's assume conservatively that the average number of people uninsured because of this bill in any given year is halfway in between those numbers, 19 million.

The bill also saves the Federal government $337 billion over ten years. That's $1774 per year per uninsured person. So the obvious question is, how much more will those 19 million people's health care cost as a result of their uninsuredness? This is tricky. One would like to know how much a typical person's health care costs in a year, how much a typical person spends on premiums and deductibles under ACA, how much a typical person gets in subsidies under ACA... but are these 19 million people at all "typical"?

One could argue (and I imagine Paul Ryan will) that most of these are young and healthy people who will choose not to carry health insurance because they feel they don't need it. But if you look at how the bill will affect various kinds of people, the ones most adversely affected are poor and/or old and/or sick, so one would expect a substantial number of the uninsured to be poor and/or old and/or sick people who feel they can no longer afford health insurance. Others will indeed be "young invincibles" who, in many cases, wouldn't have cost much in health care anyway. I'm going to assume, lacking evidence one way or the other, that the 19 million new uninsured are neither healthier nor sicker than the general population. I'm confident that they are poorer than the general population.

According to the NY Times, the majority of the newly-uninsured people -- 14 million of 24 million -- will become uninsured because of cuts and restrictions to Medicaid. Another 7 million will become uninsured because their employers no longer offer health insurance. (Far more people than this are expected to lose employer-sponsored insurance, but the CBO assumes reasonably that most of them will be able to buy insurance on the individual market; the 7 million are the ones who can't or won't.) The remaining 3 million, I assume, are currently on the individual market but will no longer buy insurance because either they don't think they need it or they can no longer afford it. I haven't read the CBO report itself yet.


As for deductibles, the right-wing Daily Signal and Freedom Partners say "an average medical deductible in 2016 for gold plans is $1,247, for silver plans $3,064 (up from $2,556), and $5,765 for bronze plans (up from $5,328)". The Freedom Partners numbers are quoted, mostly accurately, from a Kaiser study (Kaiser is fairly reputable), but I think they don't consider the "cost-sharing reductions" for people with incomes between 100-250% of the poverty level, which effectively turn a Silver plan into a Gold or Platinum plan with a much lower deductible; the Kaiser study discusses these cost-sharing reductions but doesn't quantify their impact. (I don't know where they got the $1,247 figure for gold plans; the Kaiser report doesn't give a specific number for gold or platinum plans.)

The left-wing Mother Jones says "The [enrollment-weighted median] deductible decreased from $900 to $850 in 2016.... it looks like nearly two-thirds of all enrollees had deductibles under $1,000. Only about a fifth had the horror-story $6,000+ deductibles that we hear so much about." These figures are quoted accurately from a Centers for Medicare and Medicaid Services study which says

"In 2016, among all consumers purchasing HealthCare.gov Marketplace coverage, the median individual deductible is $850. This is lower than the $900 median deductible for 2015....
These facts may seem surprising given anecdotes about Marketplace policies with very high cost sharing. However, those reports, which often focus on the highest-deductible plans in a market, ignore two important factors.

Financial assistance. The figures in this analysis account for the fact that about 60 percent of 2016 HealthCare.gov Marketplace consumers qualify for financial assistance that reduces their deductibles, out-of-pocket maximums, and other cost-sharing obligations....

Consumer choice. Rather than choosing bronze plans, which generally offer the lowest premiums, Marketplace consumers are overwhelmingly choosing silver plans, which generally have higher premiums, but lower cost sharing....

The net result of these factors is that about a third of HealthCare.gov Marketplace enrollees have deductibles less than or equal to $250, and over half have deductibles below $1000 in 2016."

This is going to take more work than I want to put into it right now :-)
hudebnik: (teacher-mode)
Conservative Republicans on Capitol Hill, Breitbart, the Kochs, etc. are outraged by Ryancare because it doesn't completely repeal Obamacare and it provides Federal subsidies (albeit age-based rather than income-based) to help people pay for health insurance.

What would they prefer? What's the ideologically-pure, conservative answer?

No Federal mandates about what needs to be in a health insurance plan, about who needs to buy health insurance, about who needs to offer health insurance, about who needs to be offered health insurance. Health insurance is strictly a matter between consumers and insurance companies, in a free and competitive market. (With some State regulation -- for some mysterious reason, many conservatives are willing to accept regulation at the State level that they wouldn't accept at the Federal or local level.)

Are insurance companies required to insure anybody who comes along? Certainly not at the Federal level; some states might enact such a requirement, but many won't, which means people with pre-existing, expensive medical conditions in red states simply won't be able to get insurance. They have several choices: (a) get all their care from emergency rooms without paying for it; (b) get lots of money from friends and family to pay for health care; (c) go bankrupt paying for health care; (d) die without health care. Competition won't solve this, because insurers don't want the business of people with pre-existing, expensive medical conditions; if anything, they'll compete for who can lock those people out the fastest.

So, young and healthy people can buy cheap, high-deductible insurance, or no insurance at all. Rich people can self-insure with HSA's, buying cheap, high-deductible insurance or no insurance at all. Old and sick people can buy no insurance at all. Since anybody who actually wants health insurance is unable to get it, the result is dismantling the health insurance industry.

What if conservatives compromised on the popular "pre-existing conditions" clause, but not the rest? Without an individual mandate and without government subsidies, young, healthy, and/or poor people won't buy insurance, leaving only old, sick people in the pool, so their premiums will go through the roof, so they won't be able to buy insurance either, again dismantling the health insurance industry.

Which is ironic, because "dismantling the health insurance industry" is also the result of the ideologically-pure liberal solutions (either single-payer or socialized medicine). The difference is that in the liberal solutions, everybody gets preventive care, rich and poor get the same health care, and nobody dies for inability to pay, while in the conservative solutions, poor people don't get preventive care and end up either in inefficient, expensive emergency rooms, or dying for inability to afford health care. Oh, and taxes are higher under the liberal solutions, but total spending on health care is higher under the conservative solutions.
hudebnik: (teacher-mode)
Paul Ryan actually said this yesterday (link with video):

The fatal conceit of Obamacare is that we’re just gonna make everybody buy our health insurance at the Federal government level. Young and healthy people are gonna pay for older, sicker people. So the young, healthy person is gonna be made to buy health care, and they’re gonna pay for the person, you know, who gets breast cancer in her forties, or gets heart disease in his fifties.

So take a look at this chart. The red slice here are what I would call “people with pre-existing conditions” — people who have real health care problems. The blue is the rest of the people in the individual market — that’s the market where people don’t get health insurance with their jobs, or they buy it themselves. The whole idea of Obamacare is the people in the blue side pay for the people in the red side. The people who are healthy pay for the people who are sick. It’s not working and that’s why it’s in a death spiral.

Here’s how we propose to tackle this problem. We want to have a system where we encourage states, with Federal funding, to set up risk pools and reinsurance mechanisms. For example, in Wisconsin, we had a great risk pool that actually worked, so that people with real high health costs and diseases, and pre-existing conditions, could still get affordable health care. Well, Obamacare repealed that. They had a great risk pool reinsurance system in Utah, a good one in Washington State… all those are gone under Obamacare.

Here’s how they work, and here’s how our system would work. We would directly support the people with pre-existing conditions. [Red slice removed from pie graph] Let me give you a sense of this. 1% of the people in these insurance markets drive 23% of the costs. 1% of the people in the individual insurance market drive 23% of the costs. So a reinsurance program is to cover more than just the 1%, to cover the people who have high health care costs. So by having state innovation funds to go to the states to set up these reinsurance programs, we would directly subsidize the people who have pre-existing conditions. Direct support for the people with pre-existing conditions so that everybody else has cheaper health insurance.

What you do when you do this is, the individual market, the people who don’t have pre-existing conditions, they have much more stable prices.

Oh. My. Gawd. As lots of people on Twitter have pointed out, "the people who are healthy pay for the people who are sick" is literally the definition of health insurance. More generally, "the people who are lucky pay for the people who are unlucky" is the definition of insurance -- fire, flood, burglary, health, life, etc. We've been discussing Obamacare and alternatives for eight years now, and the Republican Party's anointed policy wonk doesn't pretends not to know how insurance works.

Anyway, let's consider his alternative. We'll take the high-risk people out of the pool, leaving the low-risk majority of people buying their own cheaper health insurance -- and that's probably true. So what do we do with the rest? The Federal government gives the states money to set up "high-risk pools" and "reinsurance programs" that subsidize insurance companies to get them to cover those high-risk people without astronomical premiums. In other words, the money to cover the high-risk people, which was coming from low-risk people in the market, will now come from... Federal taxpayers! The leader of the anti-Federal-government, anti-tax Republicans in the House of Representatives is proposing that instead of paying for something through the free market, we pay for it with Federal taxes.

Mind you, nobody expects Ryan to raise Federal taxes to pay for this added expense -- indeed, the bill in the House cuts Federal taxes. Which leaves several alternatives:

(a) the Federal budget deficit goes through the roof (which is OK when Republicans do it), or

(b) high-risk people will get much less health care, die, and decrease the surplus population, or

(c) total costs will magically drop sharply because the money goes from Federal government to State governments to insurance companies to providers, rather than from Federal government to individuals to insurance companies to providers, or

(d) the Federal government will provide less money than it does now, and State governments will be expected to make up the difference by substantially raising their own taxes. Which California, New York, and Massachusetts might be willing and able to do, while high-risk people in Kansas and Utah (and pretty much any state that voted for Trump) are back to option (b).

I'm betting on (a) and (d).
hudebnik: (Default)
164.0 lbs
breakfast: grapefruit, yogurt, cereal, dried cranberries, strawberries
lunch: Thai
dinner: pasta, vodka sauce w/Italian [goat] sausage
bedtime: chocolate-avocado milkshake
hudebnik: (rant)
1) The world is divided into winners and losers. It's more fun to be a winner. In order for you to be a winner, somebody else has to be a loser. The more other people are losers, the more of a winner you are.

2) The appearance of being a winner or loser is self-fulfilling: calling yourself a winner and acting like a winner makes you a winner, and calling other people losers makes them losers.

3) Winners have the power to make what they say go. Whatever a winner says is (in practice) right.

4) Winner and loser status are not guaranteed to last: today's winner can be tomorrow's loser, and vice versa.

5) As a corollary, truth, morality, and justice are transient conditions: what's true or right today may be false or wrong tomorrow, when somebody different is on top.

6) Some people object loudly to that notion. This can be for two reasons: either they're making a hypocritical show of "objecting on principle" because they lost and you won, or they're so naive they don't understand how the real world works.

7) Since "rules" and "principles" are just whatever the guy currently on top says, they obviously don't apply to the guy on top. In choosing people to help you, it would be silly to choose them by their past adherence to somebody else's rules, because you can change those rules anyway; if you're on top, the most important criterion is their personal loyalty to you.

Some of this isn't specific to Donald Trump, but applies more broadly to Republicans (and neoconservative Democrats) in general: the notion that "it's a tough, dog-eat-dog world out there, and it calls for a tough man, not hobbled by rules and principles that nobody really believes in anyway."

See the recent Times op-ed, In Praise of Hypocrisy.
hudebnik: (rant)
Let's take the "pro-lifers" at their word and assume they (or a significant fraction of them) honestly believe that full human life begins at the moment an egg is fertilized. What happens if we insert that axiom into the rest of an ethical and legal system?

[Note: for purposes of this thought exercise, "woman" is defined in terms not of birth certificate or appearance or self-identification, but of the physical ability to get pregnant.]

A fetus, embryo, blastula, zygote, or fertilized egg is a full human being with the same rights as one who's already been born. Any intentional termination of the pregnancy, even days or hours after conception, is therefore murder. No "exceptions for rape or incest", because we wouldn't consider a child fair game for murder just because of its parentage or the circumstances of its conception. Likewise, no exceptions for crippling or life-threatening genetic defects, unless we as a society would be willing to actively kill a born child for having those defects. Even an "exception to save the life of the mother" is dubious: it amounts to choosing which of two human beings to kill. Terminating a pregnancy to save the life of the mother would be permissible only if the alternative was both mother and child dying; in that circumstance you're choosing to kill one person rather than two. In all these cases, it seems clear that both the mother and any medical personnel involved would be criminally liable.

What about unintentional termination or harm? It could be argued that conduct (e.g. strenuous exercise) that accidentally leads to the termination of a pregnancy is manslaughter or negligent homicide -- which typically get a lighter sentence but are still felonies. Conduct that leads, or could reasonably be expected to lead, to harm to the fetus, such as drinking alcohol while pregnant, is reckless endangerment of a minor, and could again be punished under the criminal code. Even allowing a spontaneous miscarriage without taking heroic measures to prevent it could be considered criminal medical malpractice -- negligently allowing a human to die who could have been saved.

Once you're pregnant, you no longer have full jurisdiction over your own body, because you share it with another human being who has the same rights as you, but no decision-making power. Indeed, if there's a realistic chance you might be pregnant, you should probably (to stay on the safe side) assume you are. In short, if you're a sexually active female of reproductive age, you have less autonomy than a sexually active male of the same age. Unfair, yes, but that's just the way the world is -- like menstruation.

A woman who has sex is giving up part of her autonomy for at least a few months until she's sure she isn't pregnant, and possibly for years to come. A man who has sex is not giving up anything unless it turns out she is pregnant and he's the father. So having sex is a much bigger decision for a woman than for a man. A woman who has sex "lightly" is therefore irresponsible and morally suspect, while a man who has sex "lightly" is normal.

If you're female and want to retain independence and autonomy, you need to avoid sex, at least any form of sex that could lead to pregnancy. Males, of course, don't face this dilemma -- indeed, they can express independence and autonomy through sex. Again, it's unfair, but it's just the way God made us: women have to choose between (hetero) sex and autonomy, while men get both at once. If you've chosen (or been forced) to live on the "sex" side of the divide rather than the "autonomy" side, your every action henceforth has to be assessed from your perspective as a growth medium.

If a woman is going to willingly risk her autonomy in order to have sex, she'd better get something in return, like financial security, so it is appropriate to consider most (hetero-)sexually active women as prostitutes, although the "respectable" ones get to call it "an advantageous marriage".

Which implies that in the natural order of things, there are two kinds of women: autonomous but (heterosexually) celibate ones, and sexually active ones financially supported by their male sex partner(s). Men can be autonomous, sexual, and financially independent, in any combination they wish, because these are orthogonal questions for them. If they don't want to take on the long-term financial responsibility for a wife and children (or if they get bored with their long-term partner), they can get their sex a la carte from short-term prostitutes and mistresses instead. Again: unfair, but that's just the way things are.

For women on the "sex" track, their main saleable assets (to be exchanged for financial security) are sex and physical attractiveness; a man's main saleable asset (to be exchanged for reliable access to sex) is his money-making ability. So it is entirely appropriate for women to be extremely concerned with physical appearance, and to spend whatever money (or eyelash-batting) they have on clothes, makeup, cosmetic surgery, etc, while it is entirely appropriate for men to concentrate their energy on their careers. Men earn money, men give it to women in exchange for sex, and women spend it on their appearance so they can keep getting paid for sex. That's the natural order of things; objecting to this model makes as much sense as objecting to the law of gravity.

And it's understandable that employers would be reluctant to hire women, or to promote women, or to pay them as much as a man: this particular woman might be on the "autonomy" track now, but both she and her employer know that she has another option, and could switch to the "sex" track at any time. Since she doesn't really depend on her job, you can expect her to take it less seriously than a man would, and her employer will accordingly take her less seriously.

In short, we can live in a society in which women have roughly the same rights and freedoms as men, or we can live in a society in which zygotes have roughly the same rights and freedoms as born children. We cannot have both.

Our new President and Vice President, in their different ways, have both made clear that they prefer the latter. The President has had three wives, whom he married at the fertile ages of 28, 30, and 35 respectively, and (I think) cheated publicly and repeatedly on all three of them, because he is just that oversexed. Their role was to be beautiful and fashionable and sexy and spend the money he made, as a sort of scoreboard to show off his supreme manliness (including, but not limited to, earning capacity). He's made abundantly clear that he values women primarily for physical attractiveness; the worst cut-down he can think of for a woman is to insult her appearance. Grown women are unimportant except as sex objects. Meanwhile, the Vice President has taken every opportunity in his career to assert the importance of unborn children from the moment of conception on, and to keep women in their rightful places as sex partners, housekeepers, and child-rearers. In short, zygotes are more important and have more rights than grown women.

Most of the conclusions I've drawn above aren't really about abortion: they're really about the equation of sex with pregnancy. Anything that breaks the "God-given" connection between sex and pregnancy -- whether abortion, contraception, or even homosexuality -- is a threat to an equally "God-given" social model built on the assumption that women can't have sex without risking their autonomy for months or years to come, and men can.
hudebnik: (Default)
President Obama took years after entering the White House to publish a paper in a refereed academic journal.

President Trump seems to be on his way after only two weeks, with an illuminating example of the Alternative Facts approach to mathematical proof.
hudebnik: (Default)
Somehow I got onto whitehouse.gov's e-mail list, and my first e-mail from the Trump administration asks me to sign a petition supporting Justice Gorsuch's nomination to the Supreme Court.

The e-mail includes this bit: "Judge Neil Gorsuch follows the same principled approach espoused by Justice Scalia. He carefully applies the statuary text and he follows the Constitution’s original meaning."

Seriously -- "statuary text"? I've heard of people viewing the law as an edifice, or as graven in stone, or as fixed and unmoving, but not literally as a statue.
hudebnik: (teacher-mode)
"clinamen", in this Politico piece.

Apparently it means an event that "just happens" for no particular reason. The term was originally used in connection with the classical Greek "atomic theory", which (in a curious prefiguring of Brownian motion) postulated that the atoms from which everything is made are constantly swirling unpredictably. So, for example, if by chance most of the atoms in a container are momentarily on the left side, thus exerting measurable pressure in that direction, the resulting pressure is a clinamen.

The author uses the term to suggest that in a complex system such as a U.S. Presidential campaign, actions have such unpredictable consequences that hidden conspiracies are unlikely to have much net effect distinguishable from background noise.
hudebnik: (rant)
So there were thousands of protesters for a Iannopoulos speech, all peaceful until about 150 masked protesters, dressed all in black, showed up and started setting things on fire, throwing Molotov cocktails, etc. The resulting TV images were exactly what Iannopoulos and his former boss at Breitbart wanted: intolerant, violent Leftists at the birthplace of the "Free Speech movement", suppressing free speech and turning an American city into the kind of war zone the President described in his inauguration speech. The President responded with a tweet threatening to cut off Berkeley's Federal funding, which coincidentally was what Iannopoulos's planned speech called for.

No arrests were made, despite lots of extra security called in for the event, so we have no idea who any of the masked, violent protesters actually were. A Trump supporter was pepper-sprayed on camera, and nobody was arrested.

I don't like to push wacky, paranoid conspiracy theories, but doesn't this look a little suspicious to you?

Mind you, I don't have any evidence that the guys in black were right-wing agents provocateurs, but neither is there any evidence that they were left-wing protesters. So we can't validly draw any conclusions about the behavior of either right-wingers or left-wingers, only that somebody behaved violently and didn't want to be identified.


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