Wednesday, October 30, 2013

Over/Under on When Latest NSA Statement Proven Wrong?

From Politico:

...a report in The Washington Post — based on documents leaked by Edward Snowden — that the NSA secretly mined the connection between Google’s and Yahoo’s data hubs. The project, code named MUSCULAR and targeting data centers located around the world, granted the NSA access to hundreds of millions of accounts, including those owned by Americans, the Post indicated.

The NSA, of course, denies even knowing of such a thing.

The leader of the National Security Agency on Wednesday aired skepticism about a new report that the U.S. government had infiltrated the links between Google’s and Yahoo’s data centers.
“I don’t know what the report is,” said Gen. Keith Alexander when asked at a cybersecurity summit, adding the NSA is “not authorized” to access companies’ data centers and instead must “go through a court process” to obtain such content. “Not to my knowledge,” the general said when asked whether the NSA tapped the data centers
 It seems like all NSA denials are ultimately retracted, ("Least untruthful answer" ring a bell?) the only question is when.  I'll put the over/under as Tuesday November 5th, Noon.


PS. Thank God the President and Diane Feinstein think Angela Merkel's phone shouldn't be tapped. If only they would extend the same courtesy to me.

If You Like Your Doctor, You Can Keep Your Doctor?

It is already patently obvious the promise of keeping your insurance plan if you like your insurance plan is untrue for millions of Americans. One of the other foundational promises of the Affordable Care Act is, "If you like your doctor, you can keep your doctor." Critics have contended for years that isn't true either. In response supporters of the law have branded the critics  extremists, racists, deniers, lunatics, and heartless neanderthals whose only goal in life was keeping poor people from receiving medical care. Oy.

From the NY Post.
New York doctors are treating ObamaCare like the plague, a new survey reveals.
A poll conducted by the New York State Medical Society finds that 44 percent of MDs said they are not participating in the nation’s new health-care plan.
Another 33 percent say they’re still not sure whether to become ObamaCare providers.
Only 23 percent of the 409 physicians queried said they’re taking patients who signed up through health exchanges.
Apologists of the "If you like your insurance you can keep your insurance" broken promise claim the policies being cancelled are inadequate. Will they make the same claims about doctors?


Tuesday, October 29, 2013

So Why Didn't the Dems Go with Single Payer When They Had the Chance?

Why didn't the Dems push single payer in 2009? They had the House, Senate and Presidency. The Republicans were not going to have any part of the Affordable Care Act. So why not go for it all?

Robert Reich, who I think is one of the sillier commentators for the Left, had this to say about it:
Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler, and more widely accepted by the public.
So again, why didn't they? Don't blame the Republicans. The Democrats had 60 in the Senate and an overwhelming majority in the House.

The hypothesis put forward most often, as best I can tell, is the Democrats decided instead to propose a Republican version of universal health insurance courtesy of Mitt Romney. But why do that? The Republicans in Congress were opposed. Why spend so much time and effort on a plan the Democrats really didn't like and the Republicans wouldn't vote for, no matter if they used to like it or not?

I don't have an answer, only a couple of guesses. My first guess is Democrats weren't united on single payer. Makes sense. If your party controls the Legislative and Executive branches a reason you wouldn't do something is because your party is divided.

Another guess, which I think there is some evidence to support. The voters didn't want single payer. The shellacking the Democrats took in 2010 is (in my opinion) strong evidence voters didn't want single payer. The result of Blue Dogs voting for the Affordable Care Act (ACA) was the extinction of the Blue Dogs and the lurch left of the Democrats and lurch right for the Republicans. Oops.

I think there is another reason some Democrats wouldn't support single payer and why other Democrats supported the ACA: Going to a single payer system would result in sharply higher taxes and/or sharply higher deficits. If the Federal Government is going to be the single payer the money has to come from somewhere, and the thought of going to voters and saying, "Guess what, Taxes are going up a lot...." would result in voters taking up pitchforks. With ACA it was a step towards single payer without the pain of sharply higher taxes.

I also think the Blue Dogs wouldn't go for single payer because Medicare and Medicaid have massive unfunded liabilities already. Adding ALL of America to a system that was already in need of significant tax increases to maintain long-term financial viability was not going to happen.

But there is not such thing as a free lunch. Messing with market prices has consequences and we are starting to see the consequences of that interference. When health insurance (or any commodity) is under-priced, too much is demanded. When health insurance (or any commodity) is over-priced, too little is demanded. The ACA over-prices insurance by mandating minimum coverage levels. It over-prices insurance for the young and healthy. It under-prices insurance for the old, the sick and the poor. In its (laudable) goal of helping the poor and sick it has created a system that will likely hurt everyone. The young and healthy will try their best to not consume a product they find unattractive. Taxes will go up as the government scrambles to meet the promises it has made. It will try to lower payments to doctors, drug companies and hospitals to keep the budget from careening out of control. That under-pricing will result in withdrawal by those providers and on it goes. None of this is a surprise. All of this was foreseen.

To misquote Herb Stein, When a trend is unsustainable, it stops. This will stop. I don't know when, nor how. I doubt the remedy is single payer, but who knows, maybe it is. I doubt it's a Libertarian free market solution; we are too pregnant with government interference in the health insurance market for that to happen. I don't know enough about web sites to know if it can be "fixed" by the end of November. I doubt it. But I didn't think there would be massive incompetence in rolling out v1.0 either. Doesn't matter if it works or doesn't by November. The real issues are rearing their heads.


Friday, October 25, 2013

It Breaks Your Heart, this Game of Baseball


Doug Glanville the marvelous occasional baseball commentator for the Times writes;

"In our young minds, baseball has a permanence. We embrace it as a near certainty, one that rises in spring and sets in the fall as our lives revolve around it. Yet each larger-than-life player from our baseball childhood who walks out the clubhouse door for the last time forces us kicking and screaming into an uncomfortable maturity. We wonder where our childhood has gone. We are shocked into understanding that our favorite players are aging, and that we must be aging, too".

Carl Yastremski, who threw the ball out Wednesday Night to inaugurate this year's World Series, sports a full head of snow white hair. The greatest living Red Sox is 74 years old. He's had bypass surgery. He's lost a son not much younger than me.

It can't be. The 12 year old (1967) can still see him paroling left field at Fenway like a cop on his beat, daring baserunners to try and advance.  The 21 year old college kid raises his arms in triumph as Yaz singlehandedly demolishes Oakland in the playoffs ('75). Alone on South Racine in front of an old black and white TV, my 24 year old medical student self still fights back tears as Captain Carl pops out to Nettles (1978), in what, please G-d, will always remain my most heartbreaking baseball memory.

But Glanville, who played, and loved this game like those before and those to follow, elegantly reminds us that yes, it must be so.

"But when the final game is played, when the winners celebrate and the ticker tape falls, again there is silence. And in the quiet corners of baseball’s historic order, some players are taking off their uniforms for the last time. And inevitably, some of those now-former players defined post-season baseball, and made us love the game because of how they stood in the batter’s box, or the music that played each time they danced to the mound."


Monday, October 21, 2013

Single Payer Health Insurance


We have single payer health insurance in the US. It's called Medicare, among the the most successful and popular government programs ever established.  As with the ACA, conservatives, including, famously, Ronald Reagan, decried it as socialism, and predicted it would destroy the country. Like the ACA, it had an awful roll out. Finally like the ACA, it's a program in which the young and healthy subsidize the old and sick Along with Social Security, it dramatically reduced poverty among the elderly. It is far more efficient than private insurance.

Now, you're welcome to criticize Medicare on conservative or libertarian or philosophical grounds. You're even more welcome to agree with me that Medicare is unsustainable in its present form and as such in deep need of reform. But I would caution you about the politics of being against Medicare. As even the most "conservative" (or is it actually hypocritical?) Republican legislators understand, Medicare is as sacrosanct to Tea Party members as it is to liberal Democrats.

Maybe that's why the Right so loathes Obamacare. It just might Medicare.


Sunday, October 20, 2013

Obamacare to Putin: Please Help!

It is ironic the GOP decided to have a fight over Obamacare the same day the Obamacare exchanges opened. After all, how could they possibly know there would be significant issues? Gosh, I don't know:

Major insurers, state health-care officials and Democratic allies repeatedly warned the Obama administration in recent months that the new federal health-insurance exchange had significant problems, according to people familiar with the conversations.
then there was this from Henry Chao, at the Centers for Medicaid and Medicare Services
The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” Henry Chao, an official at the Centers for Medicaid and Medicare Services who is overseeing the technology of the exchanges said at a recent conference. “Let’s just make sure it’s not a third-world experience.

Well when the administration was in a tight spot with Syria a few weeks ago, the Secretary of State made some offhand comment, and before you know it Putin takes it seriously, and rides to the rescue. That's what the Obamacare needs now, a Hail Mary pass to Vladimir Putin.

The notion the exchanges problem was the overwhelming traffic was suspicious from the start. When a person can't save his security questions, that's not a traffic issue, that's a coding issue. There are many examples of web site behavior that suggest some deeper flaw other than overwhelming demand. And coding issues can be, don't have to be, but can be, tough. Time will tell if  "putting on a brave face" or "whistling past the graveyard" is the more appropriate metaphor to describe the supporters defense of the law these opening weeks.

Software and web sites can be fixed but there are much deeper issues starting to become evident. The system needs young people to sign up for insurance. The young subsidize the old in Obamacare. Without young people the insurance market could enter a death spiral. That is, insurers raise rates to make up for the losses incurred by having too many old, sick people in the pool. That results in even more of the young, healthy dropping out, losses increase and so it goes. All systems that rely on community rating face this risk, so this is a risk that will remain for as long as the program relies on this feature. The big problem for Obamacare is this: Many young people don't get insurance because it's not typically a good deal. Even the supporters of Obamacare admit this. The challenge will be to convince young people they should buy insurance they have demonstrated they don't really want. Plus, since children can stay on their parent's health care plans until they are 26, it reduces the number of young healthy there are to subsidize the old.

Parenthetically, the wife and I have been trying to watch Aaron Sorkin's "Newsroom." We both find it, most of all, boring. It masquerades as impartial and moderate in its political leanings. The amount of misinformation is distressing and it's really a liberal's fantasy of what a conservative should look like. But mostly, it's boring. Anyway the show loves to bash the Tea Party and in a throw-away line criticizes Tea Partiers as voting against their interest. It's a remark I've heard often, and is said without any apparent self-awareness that a key aspect of Obamacare assumes young people will buy something against their interest. Oh well.

The rates on the exchange are also causing some distress for those who bought insurance on the individual market. The problem is, Obamacare mandates certain levels of insurance that in some cases exceeds what consumers want to buy. Rate shock is the result. The administration admits this obliquely by crowing that rates on the exchange are lower than what was estimated or that rates in NY are lower. Well, the rates overall are still higher, and sometimes much higher than what consumers were paying. Supporters will point out the higher prices reflect better insurance. That may be the case. But it's probably small consolation to consumers no longer able to buy a policy they wanted because someone decided consumers really shouldn't be given the opportunity to buy what they want. 

There are also perverse work incentives. Casey Mulligan has articulated these in great detail and I recommend his articles in the New York Times, his blog and his book, The Redistribution Recession. He can be challenging to follow but it's worth the effort.Mr. Mulligan points out the Obamacare subsidies can be analyzed as marginal tax rates. Huh? Consumers may receive a subsidy to purchase insurance. The subsidy depends on income. The lower the income, the higher the subsidy. The more you earn the lower the subsidy. So your after-tax income increases at a slower pace than your gross income. One of the more interesting examples looks at a family of five in California. At at income of $110,280, there is no taxpayer subsidy. However, at an income of $110,279, a family could receive a subsidy of $8,100. So a family that earns an extra (marginal) dollar of income, sees its after tax income decline by $8,099. I suppose supporters of the law will say normal people don't think that way, or it doesn't affect that many people. I disagree. This is from SFGate.

People whose 2014 income will be a little too high to get subsidized health insurance from Covered California next year should start thinking now about ways to lower it to increase their odds of getting the valuable tax subsidy.
"If they can adjust (their income), they should," says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. "It's not cheating, it's allowed."
Mulligan estimates Obamacare adds almost 5% to marginal tax rates overall.

There are also incentives on the employer side to reduce employment. Part time workers do not need to be covered, so companies are moving to lower hours. Small companies avoid the mandate, and I suspect we will see companies near the cliff separating companies required to offer insurance, try to figure out how to grow carefully around that limit. 

It's almost as if the supporters of a single payer system came up with an evil plan: "Let's create a really awful idea. Then when it fails, as it must, we can push for a single payer system." Of course what they'll have to explain is why they are going to be better at devising a single payer system any more competently than Obamacare has been designed. I'm sure they'll come up with something.


You Can Tell a Yale Man, But You Can't Tell Him Much

Dan Kahan at Yale Law School discovers, much to his surprise:

It turns out that there is about as strong a correlation between scores on the science comprehension scale and identifying with the Tea Party as there is between scores on the science comprehension scale and Conservrepub. 
Did this change Dan's views? Thankfully no.

Of course, I still subscribe to my various political and moral assessments--all very negative-- of what I understand the "Tea Party movement" to stand for. I just no longer assume that the people who happen to hold those values are less likely than people who share my political outlooks to have acquired the sorts of knowledge and dispositions that a decent science comprehension scale measures.

Phew, that's a relief. And where does Dan get his understanding of what the Tea Party movement is? Here's the one I really liked:

I don't know a single person who identifies with the Tea Party.  All my impressions come from watching cable tv -- & I don't watch Fox News very often -- and reading the "paper" (New York Times daily, plus a variety of politics-focused internet sites like Huffington Post & Politico). 


Thursday, October 10, 2013

An Extremist Gets to Vote Also

To whom it may concern on the Left:

By the definition of the Left, I may be an extremist, or an economic terrorist, or an extortionist, or a kidnapper, or willing to watch the US go down in flames. By their lights I guess I am in the pocket of the Koch Brothers, or Big Oil, or Big Finance. It seems, in their view, I'm stupid, insane, nuts, a neanderthal (that's my favorite. Thanks Mr. Vice-President) and given the smirks, and shrugs I see when they are on TV, I'm beyond condescension. And, let's not forget, because I disagree with the President on policy issues, I am almost certainly racist in their eyes.

And yes, I do recognize the Right is guilty of this as well. But those I read on the right, or listen to, don't talk that way. Simply because when they do talk that way, I stop listening. But sure, I'm certain there are those on the right just as guilty of this lack of civility.

I just have two points to make regarding this rhetoric.

First, it is highly unlikely you'll will convince me of anything if first you call me stupid, or evil. If you accuse me of all sorts of malevolent behavior, berate me and try to discredit me and my views, and then demand I agree with you, the chances of you achieving your objective, are low.

Second, and this is the more important one. I vote, and my vote counts just as much as yours. Evil though I may be, my vote counts just as much as yours. Calling me a neanderthal, an extortionist, a terrorist, a tea bagger, a hostage taker, and stupid may make you feel better, but it won't result in me changing my vote or withholding my vote. Rather, it makes it more likely I work to persuade others (not berate others) into seeing what I see.


Wednesday, October 9, 2013

Obamacare Implementation: It Would Be Funny If It Weren't So Serious

But this one is really funny:

If you want to browse the Connect for Health Colorado insurance marketplace, you have to create an account to find out what’s in it. Having trouble setting up an account? Just download a not-so-handy PDF complaint form and upload it using your (nonexistent) C4HCO account!

Back in the 80's Sprint had a huge problem with its billing system. The problem? They didn't send out bills. When it did, customers were getting bills for hundreds of dollars for services rendered over the past few months. It took years to fix.

All technology issues can be fixed. But it will take time, maybe a lot of time. With elections coming in about a year, the supporters of Obamacare may not have the time they need.


Tuesday, October 8, 2013

The Market for Medicine Can Not Work. Righhhhhhhhhhhhhhhhhhhht. (corrected)

One of the big myths about health care is the market can't/won't work.  
MCMINNVILLE, Ore. – Next item on the auction block: A brand new colonoscopy.

Doctors across the country are using bid-for-care websites like to attract business and save customers money.

"A lot of procedures are a lot more affordable than big insurance companies want us to think they are,” Medibid CEO Ralph Weber told KATU. “If someone chooses to be uninsured next year, the individual penalty is $95 or up to 1% of your income. I think some people will choose to remain uninsured and shop for care as they go."

The penalty Weber is talking about comes from Obamacare’s individual mandate to buy health insurance by the end of 2013.

But people like George Law say insurance just isn’t affordable.

"I do not have health insurance. I'm one of the many who don't. It's not because I don't want it, I just can't afford it,” Law said.

Law, from Chicago, requested a colonoscopy on Medibid, and doctors around the country “bid” to perform it.

The winner: Dr. Scott Gibson, practicing half a country away here in Oregon.

Gibson charges cash customers about $800 for a colonoscopy, a bargain compared to the $3,500 price tags Law was finding around Chicago.

"You might say come on, you can actually travel from Chicago to Oregon, rent a car, stay in a hotel and pay for your medical services? Not only did I come out ahead, it was less than half the price [of having the procedure done in Chicago]," Law said.

Why the huge difference in price?

“I think it has to do with where it’s done,” Gibson said. “Hospitals have high overheads, so they tend to charge more.

Medibid claims it saves the average customer 50 percent

Free Health Care

My favorite line from this San Jose Mercury News story "Obamacare's winners and loser in the Bay area," is from Cindy Vinson,"of San Jose," who "will pay $1,800 more a year for an individual policy,"
"Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally."

To quote Steve Mariucci, "Bummer." Or to quote Milton Friedman, "There is no such thing as a free lunch."


Saturday, October 5, 2013

National Park Service Tries to Close Mt. Vernon Parking Lots

Only one problem,

The Federal government may be shut down, but Washington’s home remains open. Mount Vernon has remained a private non-profit for more than 150 years.

So why was the National Park Service trying to close parking lots? No one has said. And why would the government need to close an unmanned parking lot anyway? No one has said.

There are lots of reports of the National Park Service engaging in mean-spirited, nasty behavior, I suppose to make a point. I don't know what point they are trying to make, but the point I get is they are rectal orifices.

Full story on Mt. Vernon here.

And don't miss this one.

And some people wonder why respect for Government is low.


Friday, October 4, 2013

Assassinations, Targeted Killings and the NSA

When I tell friends and family the purpose of the NSA spying is to kill people, most indulge me or roll their eyes. Don't.

Michael Hayden, a former director of the National Security Agency, defended the government's use of targeted killings on Thursday.

"Yes, we do targeted killings, and I certainly hope they make full use of the capacities of the National Security Agency when we do that," Hayden said at a Washington Post panel discussion on cybersecurity.
Hayden later joked:
"I must admit in my darker moment over the past several months, I'd also thought of nominating Mr. Snowden, but it was for a different list," Hayden said.
The Government has already killed US citizens with drones. The Obama administration defends its "right" to do so. Given the lies that come out of the NSA and its defenders every day, I'm not convinced putting Snowden on the kill list is a joke.


Thursday, October 3, 2013

Would Someone in the Democratic Party Please Primary Diane Feinstein?

At a Senate Judiciary Committee hearing Wednesday, Chairman Patrick Leahy (D-Vt.) said he will push legislation to end the NSA's controversial program to collect records on all U.S. phone calls. He argued that the program invades Americans' privacy rights while doing little to thwart terrorist attacks.

But Sen. Dianne Feinstein (D-Calif.), the chairwoman of the Senate Intelligence Committee, argued that the phone data program is critical for protecting national security.


Today Senator Feinstein stated that the NSA phone metadata program that collects records on the telephone calls of American citizens includes location information.

Previously, head of the NSA, General Keith B. Alexander, stated that the NSA was not currently collecting call location data under the authority of Section 215 of the Patriot Act. It was left open that other authorization could allow for, and be currently used to, collect location data. It was revealed today that in the past a program at least tried to collect this data.
They should really coordinate their lies, because right now they are just looking dumb. And dangerous.