A different death spiral

This Forbes article is a helpful explanation of the complicated choices facing insurance companies as their customers embark on a completely different scheme of self-selection from the one that has driven actuarial planning up to now.  It seems that the ACA tried to guard against some kinds of self-selection and their resulting death-spiral dangers by requiring insurance companies to create one risk pool for all of their customers, regardless of whether they purchased their insurance on or off the exchange.  The law's architects did not take fully into account, however, how many insurers might decide to boycott the exchange altogether.  Boycotting insurers are free to price their products on the basis of their own pools.  If I understand the author's argument, this is likely for several reasons to result in a divergence of the risk profiles that will favor the competitive position of the non-exchange insurers even on their ACA-compliant products.

Pricing is only one aspect that may vary sharply between exchange and non-exchange products:  there is already considerable pressure on exchange products to shrink their provider networks and covered drug lists.  I've become interested in Assurant Health, an insurer that decided to boycott the exchanges.  Its prices for a Bronze plan are slightly higher than those of Blue Cross, but its network is the old-fashioned universal sort.  The article cites to a detailed brief on risk pools, including this explanation of why network shrinkage may be a more powerful cost-control issue than I realized:

Prohibiting [denial of coverage for pre-existing conditions] leaves insurers vulnerable to attracting a disproportionate share of patients with poor health risks. This vulnerability might cause them to leave the market or encourage them to use more covert or indirect means of risk avoidance, such as selective marketing or structuring their provider networks to exclude the doctors or hospitals preferred by higher risk patients.

It's not just that excellent hospitals like the Mayo Clinic or cancer centers charge high rates.  It's that they attract exactly the sort of patient that an insurer needs to avoid if it can't tie its prices to the health status of brand-new customers.

"I can't believe they let you do that"

Bill Whittle is terrific.  I can't seem to link directly to this video, so here's a basic PJTV link that, for now at least, takes you directly to his piece describing the pleasures of visiting Texas for Thanksgiving.

How many uninsured Americans are there, really?

Megan McArdle tries to get a handle on just how many people really were uninsured.  Is it more or less than the number of people who were insured before the PPACA hit them like a truck?

A third possibility is that we don’t have the uninsured problem we thought we had.  Most of the estimates we have for the uninsured population are really pretty crude.  For one thing, we tend to treat the U.S.'s roughly 48 million uninsured as if they were part of a discrete group, like Mormons or people who know how to play the tuba.  But in fact, people change insurance status all the time.  If you look at data from the Medical Expenditure Panel Survey, you’ll see that a lot of people are uninsured for at least a month, but if you look at who is uninsured for as long as two years, that number falls by two-thirds.  If you extend the reference period out to four years, just 7.6 percent of the population counts as “uninsured.”  That is not a negligible number, but it is less than half of the 48 million we think of as uninsured.  And it’s heavily skewed toward immigrants and the young. . . .

. . . and to all a good flight

Medieval Warfare, Lego-Style

No female Legos were harmed in the making of this documentary. At least, I assume not, since I didn't see any that were pink.

The one-way compromise ratchet

John Hinderaker at PowerLine wonders why budget "compromise" always results in higher spending.  The best conservatives ever seem to be able to get is decreases in the rate of increased spending.

A number of observers are praising today’s deal as a “compromise.”   Patty Murray set the tone: “‘Compromise has been a dirty word” in Washington, D.C., Murray complained in an evening news conference, but “we have broken through the partisanship and the gridlock.”  But wait! The 2011 Budget Control Act was itself a compromise.  The $967 billion discretionary spending limit was a compromise, just two years ago.  So why should a higher spending number now be lauded as a “compromise”?  How about if we reduce spending by another $50 billion, to $917 billion?  That would be a compromise too, wouldn’t it?  But somehow that isn’t the sort of compromise that is ever entertained in Washington.

Hinderaker also points out the soft underbelly of this and every other budget "deal"--the gambit Republicans fall for every single time:

Republicans did get something in exchange for increasing spending: notably, federal employees will have to increase their pension contributions.  But we can say goodbye to the $2.1 trillion in spending cuts that the GOP trumpeted following the 2011 Budget Control Act.  That is the real moral of the story–long-term budget agreements are meaningless.  Typically, minuscule spending cuts up front are augmented by major cuts in the out-years.  But the reality is that the out-years never come.  No Congress can bind a future Congress, and political will to reduce spending is always in short supply.  Consequently, any spending deal is meaningless, except insofar as it applies to the current year or next year’s spending.  Beyond that, all claims to have cut government spending are fatuous.

Wouldn't it be amazing to see a bipartisan compromise that imposed immediate spending cuts (not merely decelerations) in exchange for unspecified entitlement increases to be implemented in 2024?

Meritocracy

Those of us who are well into our curmudgeon years probably have to stop and laugh now and then at our growing tendency to deplore the errors of this new crop of whippersnappers.  It is a pleasure, therefore, occasionally to find evidence that a characteristic error of the age is falling out of favor with the Young Turks:

More than 70 percent of [unionized] teachers on the job less than a decade are interested in changing the traditional salary scale, which rewards educators for longevity rather than performance.  Just 41 percent of more veteran teachers back such reforms, according to a national survey last year by the organization Teach Plus.  The poll documented similar gulfs in opinion about revamping teacher evaluations and pensions.

Unions are under intense pressure from falling membership, in the wake of movements to make their dues-paying membership voluntary.  They're finding that they have to consider what their members think.

My hometown

This five-minute clip from "Good Morning, America" is a brief introduction to the small town we live near.  The accents are interesting.  Several speakers are local, but the mayor obviously is a winter Texan who stayed on.  This time of year the parking lots are full of license plates from Wisconsin and Michigan.

An Outlaw Interlude

Some of you doubtless know the Dallas Moore Band, which has been billed as everything from an heir of Outlaw Country to the torch-bearer for Lynyrd Skynyrd-style Southern Rock.

Whether or not you know the band, though, here's an anthem that you may find useful at times in the next few years.

Steampunk insect act

I like these.

The Pig Bang

From Rocket Science, a report on a pig farm manure pit explosion that killed 1,500 pigs and seriously injured a human worker.  The unusual explosion may or may not have something to do with experimental pig feed or antibiotics.  Kind of makes you wonder what's going on in your gut.  Or maybe it just makes me wonder that, given my curious obsession with the topic.  I have to go give a short talk to some teenagers about organic gardening, so I'm focused more than usual on poop, the cycle of life, and the storage and release of chemical energy.

Most transparent presidential psyche ever

Ace has up a good essay about the press's Hitchcockian treatment of Barack Obama.  Hitchcock's thrillers employed a device he called the MacGuffin: "The thing that the hero has to get, but the audience doesn't care what it is."  He was a skilled enough storyteller not to waste any superfluous exposition on where the MacGuffin came from, how it worked, or what it might do it if got loose.  The audience just wanted to watch the hero be disappointed, hurt, and ultimately successful.  In Nick Lowe's formulation, the MacGuffin is one of the plot coupons the hero has to save up so he can send off to the Author for an ending.

The other day I was participating in an argument that went off in a familiar direction:  my interlocutor demanded to know with what I would offer to replace the splendor that is the PPACA if it were repealed.  My response, as usual, was that there are a number of practical proposals anyone can look up if (as seems unlikely) he's genuinely interested, such as high deductibles combined with HSA's and tax breaks or outright subsidies.  But the immediate point is that the law is proving so obviously and concretely harmful that simple repeal would constitute an improvement without any regard to a replacement.  His entire response was, "Oh, I see. So it's 'Screw you, Obama.'"  Yes, I don't care about health insurance.  I'm just the Villain who places obstacles between the Hero and his MacGuffin.

For too many of Obama's followers, the story is about him, not about his policy or his countrymen.  They think they're in a "Raiders of the Lost MacGuffin" caper, but it's really a science fiction disaster movie in the "You're Meddling with Forces You Don't Understand" line.

Ace carries his theme further with a report on the breathless interest in Obama's reading list and what it reveals about the state of his internal journey.

Tullamore Dew

There are many blessings that come with dismissing television from your life; there are few sorrows. But I expect all of you have seen this before me.



It's a fine piece, especially if you have wasted so much of your life in pubs that you can't help but join in the final verse.

Just-in-time insurance

I've been assuming for months now that the problem with waiting until you get sick to buy the new guaranteed-issue health insurance was that you can sign up only once a year, which leaves you exposed to up to a year's worth of medical expenses before your new coverage kicks in.

I'm hearing now that that's true only if you plan to go through the exchange to buy your coverage, which is necessary only if you want to try to qualify for a premium subsidy.  To my utter amazement, it appears that you really will be able to go to an insurance company at any time and buy coverage, regardless of pre-existing conditions.  The only counterargument I'm finding on any official websites is "We'd really rather you didn't do that."  There's the penalty, of course, but anyone should be able to avoid a penalty simply by not overpaying taxes and putting himself in the position of needing to apply for a tax refund.

Who wrote this thing?  Were they high?  I know it's possible to rack up a big ICU bill in a few weeks, but come on.  What's easier, saving up against that one-time danger, or paying $10K a year in premiums year in and year out?

This is like guaranteed-issue fire insurance you can buy after you dial 911 and while you're waiting for the fire trucks to arrive.  If this is right the law has got to collapse under its own weight.

Shards of Narsil

Bill Whittle is meditating on the Lord of the Rings.

On Vaccines

I assume that most of you are not both (a) of an age to have young children, and (b) struggling with whether or not to vaccinate them. For any of you who are, however, my cousin in medicine writes to recommend this article. She is a young mother herself.

How To Fit In As A Marine Infantrywoman

The satirical Duffleblog is in rare form today.

After finishing check-in late Friday to Alpha Co, 1st Battalion 6th Marines wearing her dress blue uniform, Private First Class Rhonda “Thunderbeast” Williams went down to Honest Pierre’s Used Car Emporium and bought a hot pink Ford Mustang at 46 percent interest....

The final acceptance by the company came on Saturday night, when the entire unit went out in town. After consuming several dozen alcoholic beverages and getting a tattoo of ‘Death Before Dishonor’ on her entire back, Williams led her platoon into the Pink Flamingo, a local gentlemen’s club near the base. At the end of the evening she was seen leaving with a male waiter who she had been loudly hitting on all night.

On Monday, Williams had informed her chain of command she was getting married.

Heh.

The self-pay patient

This is an incredibly useful article about strategies for dealing with Obamacare without exposing your household to financial ruin.  I look forward to reading the guy's book when it comes out.  There is information about price transparency, cash discounts, exempt healthcare cost-sharing ministries (including for non-evangelicals), exceptions to tax penalties, affordable telemedicine for simple illnesses, and exempt short-term or limited-scope insurance policies.  This is exactly the sort of information I've been looking for from licensed health insurance brokers, two of whom have proved to know very little about the subject.

"Special Government Benefits"

Evil Hobby Lobby! Don't they realize how much they owe the government?

This corporation, which already takes advantage of special government benefits by incorporating as a private business in the first place (entitling Hobby Lobby to tax benefits and liability shelters to which individuals alone are not entitled), wants to use its government-created corporate status with the help of government-run courts not just to express its religion on a poster or what have you but to force its employees to comply with the supposed religion of the corporation’s founders. This is, plain and simple, a corporation trying to contort government to impose the religious views of some onto many. This is precisely what our nation was founded against.

I think the writer and I agree on the issue at stake, but disagree about the Constitutional principle entirely. The issue at stake is whether religious people can form corporations, or whether your ability to practice your religion must serve as a kind of severe economic penalty. If you can't form corporations to pursue economic activities, you are subject not to limited liability but to losing everything you own in the event that your business fails. What the author is calling "special government benefits" are, rather, an international feature of the corporate mode of organization that has made it so powerful in driving economic growth.

What the government wants to do here is to bar religious organizations from corporate status, so that religious people must either abandon their moral principles when they enter the market, or accept an uneven risk of personal financial destruction v. those without moral principles.

As for compelling employees to abide by its corporate religious principles, of course, Hobby Lobby makes no such claim. It doesn't claim any right, nor express any wish, to prevent employees from purchasing birth control. Its owners merely state that they are unwilling to buy and distribute birth control themselves, especially the kind that facilitates abortion.

Should they have to do so? Or exit the market? Or, at least, accept a disproportionate risk of personal financial destruction if they wish to run a business?

A Thoughtful Analysis of the Pope's Recent Writings

Via D29, "In the Spirit of John Chrysostom." The writer is a fan; but see what you think.