Wednesday, March 31, 2010

Saturday, March 27, 2010

a clean bill of health continued.

i started this bit with a simple question... "but seriously folks, what the hell is in the health care bill anyway?"

dreday posted this little gem yesterday, and so here is a nice clean summary of the health care act, and here is a nice clean summary of the health care bill that was signed into law (which includes the financial aid overhaul as well).

now heres another bit... my analysis in pros and cons.


im pretty sure this bills biggest plus is that it largely resolves adverse selection, aka people who wait until the day before expensive medical diagnoses/treatments to sign up for insurance coverage, or people who only sign up for coverage because they know they are at high-risk for illness. since theyre getting coverage from a plan they never paid into, this drives up premiums for all the other poor saps that have been paying while healthy.

but seriously folks, signing up as late as possible or only when feeling generally unhealthy was the skewed incentive prior to this bill, and the solution was to try boot people who had pre-existing conditions. the problem was: theres no way to tell between those who honestly didnt know they had a condition and those who were consciously gaming the system, so they both got booted.

another one of the pluses for this bill is solving this... before the reform, paying health care recipients eventually ended up paying for people who couldnt afford emergency care (which includes shitbags like this) either through higher insurance premiums or higher emergency care costs (if you dont have insurance).

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, [...] increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care. There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated. When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. In the first decade of EMTALA, such cost-shifting amounted to a hidden tax levied by providers. For example, it has been estimated that this cost shifting amounted to $455 per individual or $1,186 per family in California each year.

Financial pressures on hospitals in the 20 years since EMTALA's passage have caused them to consolidate and close facilities, contributing to emergency room overcrowding. According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Ambulances are frequently diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances were diverted over a half a million times.

i always have to correct people who are up in arms about reform because they dont want to pay for other peoples healthcare and explain to them that prior to reform, they did in fact already pay for others care, either explicitly through medicare or medicaid, or implicitly through the aforementioned emergency care cost-shifting. in some ways, this reform is simply making some of the implicit costs explicit by expanding medicaid to cover the would-be unpaying emergency room visitors.

another pro is health exchanges, which is essentially a competitive insurance market with consistent minimum benefits, allowing for more coherent comparisons of different plans with standardized options.

and finally if youre into equity, it takes huge steps to provide access to healthcare by fully subsidizing (through medicaid) those with incomes up to 133% of the poverty level ($14,404 individual / $29,327 family of four) and partially subsidizing (through subsidies and tax credits) those with incomes from 133% to 400% of the poverty level ($29,327 to $88,200 for a family of four).


now heres the catch, if the bill is going to be deficit-neutral (which it definitely should be), the money for these subsidies will of course have to come from taxes in some form or another to the tune of about $700 billion (including the possibilities of higher taxes or budget cuts elsewhere, hopefully the latter). while it appears those with incomes up to $43,420 (individual) or $88,200 (family of four) are getting a subsidy, at some break-even point approaching but below these higher income levels, people are essentially only getting back as health care subsidies and tax credits what theyve already paid in as taxes.

(some stats...)
$700 billion / 140 million taxpayers = about $5,000 per taxpayer (coincidentally about the same as the bailout)

below 133% the poverty level, it is indeed free healthcare financed by medicaid (note: "in some states medicaid beneficiaries are required to pay a small fee [co-payment] for medical services.") from 133% the poverty level to the break-even point, its increasingly forcing people and employers to buy health insurance with their own money. above the break-even point its forcing people and employers to buy their own health insurance as well as healthcare for others and fining them if they dont comply.

dont get it twisted to mean im railing against the bill, all taxes "force" spending in some form or another... im just saying that wherever that break-even point lies is where the equity/efficiency trade-off begins, producing access for those below it at the expense of coercion for those above.

another downside: the bill also increases moral hazard. since insurers cant deny or charge more based on health status, americans can be as fat and unhealthy as they like and expect everyone to share their health care bill (no pun intended). since america is one of the only countries (the only country?) where the poor are actually fatter than the rich, poor unhealthy fatties are the most likely to be subsidized.

(some more stats...)
less than $25,000: 32.5% obese
$25,000-$40,000: 31.3% obese
$40,000-$60,000: 30.3% obese
more than $60,000: 26.8% obese

pro or co(r)n...

which leads me to my final point, everything here is an estimate or projection, including the benefits of health exchanges and the $700 billion cbo price tag. if anything, my bit about moral hazard is really an argument that the price tag may be overly optimistic, as the government is still essentially spending to fatten people up with corn feed (through agricultural subsidies) and then spending to try keep these obese people healthy (through health care subsidies). and its doing it all with borrowed money.

so thats my caveat... we should always be open to the possibility of unintended consequences.

sanitas boner, bitches! (ahem, sanitas bona.)

Friday, March 26, 2010

Sunday, March 21, 2010

a clean bill of health.

but seriously folks, what the hell is in the health care bill anyway?

edit: dreday posted this little gem yesterday... here is a nice clean summary of the health care act, and here is a nice clean summary of the health care bill that was signed into law (which includes the financial aid overhaul as well).

those preclude the need to read the either partys biased summaries, but if youre looking to compare and contrast... here is a nice clean summary with plenty of room for bias, and here is less clean section-by-section summary with less room for bias.

im willing to bet a beverage that most of the people protesting have never read a single summary. im sure theyre content to fit the bill into their worldview as containing one word: socialism.

all in favor of socialism say aye. (aye!) socialism passes. (gavel.)

not that everyone in the opposition is delusional. the gop counter-proposal is actually pretty reasonable. here is an obviously biased summary, and here is a less biased section-by-section summary.

if you can ignore the creepy picture in the header, nancy pelosi's website has a nice collection of health care related links.

ps... im willing to bet a second beverage that some of the people protesting have never even read a book. just sayin...

happy nowruz!

et la reponse...

edit... omfg watch this with the transcribe audio captions on...

Wednesday, March 17, 2010

rip smashkan's sauce bucket.

smashkan's sauce bucket is reborn as smashkanistan... wise fwom your gwave!

also, this is the last post thatll be imported as a facebook note. im gonna be using twitterfeed from now on. learn to love it.

welcome to smashkanistan, population: me.

ayad allawi.

yallah allawi!

update: omfg, hes ahead! after a week of polls showing maliki would win, hes a-fucking-head! only by the thinnest of margins, but get this...

"results from refugee voters outside iraq, and special pre-election voting by iraqi security forces have still to be announced, and they could dramatically affect the outcome of the parliamentary poll."

and by that i mean... those votes are likely to heavily favor allawi. quick- everyone take off your pants! (how weird would it be if somewhere in the world that worked?)

ps... this is exciting.

Friday, March 12, 2010

rip apcs.

my apc jeans handed down by mike green have finally met their tragic end in a bike accident earlier today. (ouch.)

this is actually really cool in 2038.

note to friends: beyond belvidere, the sidewalks on franklin might as well be stairs. (also, just cuz its spring break, dont mean you can ride on the sidewalks... oops.)

Thursday, March 4, 2010

paul krugman.

"there was this kind of platonic beauty to the whole thing. i remember going through the two-by-two-by-two model—two goods, two countries, two factors of production. the way all these pieces fitted together into a swiss-watch-like mechanism was beautiful. i loved it." -paul krugman

the new taliban.

oh what?


Wednesday, March 3, 2010

iraq the vote.

its that time again... time for our favorite american experiment in nation-building to get out that purple ink and vote! so get caught up and pick your poison. so far im extremely optimistic, because either everyone in iraq has been reading my blog, or the damage done by sectarian politics is gruesomely self-evident. (probably the former.)

this election is a huge shift away from iraqs retardedly sectarian politics to a not-so-retarded revolutionary kind of politics where the sanity and competency of both parties and individual politicians (thanks to the open list system) actually matters. i think there might even be the faint flowery smell of secular liberalism in the air. oh no, wait- sorry, thats my tide with citrus febreze. god that smells good.

and praise allah, cuz its about time iraqis woke up and smelled the awakening council. you know, because god is obviously responsible for the political maneuverings of increasingly secular cross-sectarian politicians, right?

and hey, speaking of god controlling everything- hats off to sistani for so many reasons, not least of which is providing the most authoritative refutation of the islamic republics legitimacy aside from montazeri (rip). but more relevant to iraq, after making the mistake of supporting the mostly islamist and shi'i sectarian united iraqi alliance in the last elections, i think even sistani realized the futility of sectarian politics and he has refused to support any political party or parliamentary list this time around.

and another, bigger hats off to nouri al-maliki. ever since the iraqi armys assault on the militias in 2008, maliki has been growing on me. a man after my own heart, maliki took one of iraqs biggest steps towards national reconciliation and political prosperity when he and his dawa party ditched the united iraqi list and finally reached across the aisle- er, religion... or... ethnicity... no- sect... or whatever... to form the new state of law coalition.

for the first time, it looks like "the headdresses of tribal leaders significantly outnumber the turbans of clerics, a significant shift, given the religious and sectarian roots of mr. maliki’s own party, dawa." although it wouldve been more attractive if it had the firm support of the awakening councils, the state of law coalition is better than anything i wouldve expected from either maliki or iraqi politics.

but maliki is no saint... its completely absurd and hypocritical that jamal jafaar mohammed sits as a legislator for maliki's dawa party while mutlaq is barred from running. if maliki really wants to lead a cross-sectarian political renaissance, he has to drop his support for the blacklist, which includes dozens of candidates from the coss-sectarian iraqiya and iraqi unity lists. those lists are set to do well anyway, which i think is good news for iraq.

speaking of what i think is good for iraq, heres a few tidbits on my loyalties...

1. if i were voting, i would be voting for the iraqiya list. ive always supported allawis iraqi national accord party, and this is essentially their list. national accord has always stood out as iraqs most viable consistently secular liberal political party in post-saddam iraq. i would have no reason to divide my loyalties any further if they couldve claimed the support of the awakening councils, but for whatever reason the talks failed. which brings me to the next list...

2. the iraqi unity list. although malikis state of law coalition did manage to woo the anbar salvation front, the real heft the awakening movement lies with its founders brother, ahmad abu risha, and his awakening council of iraq. the awakening movement is the antithesis of sunni islamism, and you can always count on me to support the man who "threatened to turn anbar into 'a graveyard for the iraqi islamic party and its agents.'"

3. then comes the projected winner, maliki's state of law coalition. i think ive pretty much already covered this one... maliki is getting smarter and seemingly more secular, but i still dont think i trust him completely. dawa is still officially islamist, and therefore still officially not cool.

4. finally, theres the kurds. theyre awesome. enough said. ok well ill say one more thing... back in the day, i couldnt imagine putting the kurds last on my list, but voting along ethnic lines is so 2005.

everyone else is either ideologically repulsive, like the islamist iraqi national alliance, or too small to matter.

my far flung hope is that iraqiya and unity get enough votes to form a coalition government on their own, but thats pretty wildly far-fetched since polls show them getting about 27% of the vote. that said, iraqiyas 22% wouldve been unthinkable in 2005, especially considering that iraqiya and unitys 27% is just a mullahs whisker away from the next best alternative, the state of law coalition with a plurality of about 30%. realistically my hope is that state of law will form a coalition with either or both iraqiya and unity, who in turn will ensure maliki maintains a cross-sectarian secular government. that would effectively marginalize the islamists and is definitely not that far-fetched.

an easy majority for iraqs post-sectarian and secular lists certainly points to a new generation in iraqi politics, and with any luck, the political renaissance is just beginning.