Sunday Musings 12/29/13

And a Happy New Year to you.  I am going to try and shut this down for a week.

The New York Times summarized an exhaustive inquiry into the tragedy in Benghazi.  It was really too much for me to read.  Link to Article   But it has some great lines that summarize the difficulties of the U.S.A. pursuing the Neo-Con dream of the US military making the world look like the U.S. politically.

"It shows the risks of expecting American aid in a time of desperation to buy durable loyalty, and the difficulty of discerning friends from allies of convenience in a culture shaped by decades of anti-western sentiment."

On to why everyone needs Health Insurance

Milliman, an actuarial firm, tried to do a study of health care costs for the uninsured under age 65.  They found that even with the uninsured paying 30% more on average in billing than what the insurance companies pay (what an outrage that is), 50% of that population will pay $2,700 and less in any given year.  50% will obviously pay more and 5% will pay more than $47,300.  The upper limit is not defined.  I have never had a house burn, but I know I have hundreds of thousands of dollars of value in my home, so I have homeowners insurance.  I know that eventually I will need health care and I  know that I cannot predict when that will be.  That is why I purchase health insurance.  So I don't have to face the prospect of choosing between death and bankruptcy.  That is the point of insurance and why every individual needs health insurance, just as states require every driver to have car insurance.

The Power of Freedom and the Draw of a Capitalist Society

I recently saw Twelves Years a Slave, the true story of a free African male with a family in Saratoga, NY who made the mistake of traveling to Washington D.C. in 1841, where he was abducted and sold into slavery with no rights whatsoever, and only his innate intelligence to help him survive and eventually figure out a way to regain his freedom through then limited legal means available.

Today, reading the book reviews, I noticed a novel about "a runaway slave in pre-Civil War South" and another story about "a Revolutionary War veteran and his slave, put to work as a breeding stock."  These merged into my brain the lengths people will go escape miserable situations for a shot at working as a free person in a safe environment.  They will take exceptional risks because the upside is so much better than their existence or what will happen to them if they fail.

My initial thought was just how wrong these idiots on and the viewers of the reality show Duck Dynasty are in their idealizing their flawed memory of life in Jim Crow America.  But it is just Television, and eliminating flawed thinking in rural America is a very long term task that is beyond any one individual or cause.  I know, because my father had some views that I can only describe as worthy of both the Tea Party and Occupy Wall Street.  With my education, I could get him to acknowledge that he might be wrong, but it didn't change his views about Big Business. RIP Dad.

But where I really want to go with this is Immigration.  People are drawn to the U.S. because they want economic freedom and to be safe from corruption in all its forms.  People who are brave enough to get here by any means possible are not terrorists, they are the foundation on which the economy of this country is built.  They take minimum wage jobs, they perform horrendous tasks, and they want a better life for their children.  That is the commonality between runaway slaves and central americans who have walked across the Rio Grande.  The terrorists all flew into the US and overstayed their visas.  They were too soft to risk death coming across the desert. Sh*t, I am too soft to do that.  Thank goodness I was born here.

If there is anything I think the Republican Party believes in it is their origins as an anti-slavery party that believes in freedom for all individuals and respects every human life that resides in this country. There may have been laws non abided by, but no one was harmed by that violation, and now we need a plan for how these 11 mm undocumented workers are going to be brought into the system.  We cant' send them back because (i) it will shrink the labor force by 3% leading to a recession we cannot afford; (ii)  we probably cannot find them all; (iii) deportation is neither humane nor within the thinking of Judeo-Christian thought about kindness to others; and (iv) it is hardly pro-family to send the working father back from where he came while the rest of the family are U.S. citizens.

No one (Except those on Medicare) would every have kept the health insurance they had

The New Republic has a nice piece on the hubbub going on in certain circles of L.A. who's future health insurance will not cover stuff (except on a special needs basis) at Cedars-Sinai Hospital.  Never mind that other hospitals do a lot as well and even better than Cedars-Sinai and will be in the future health insurance network.  Reputation does not equal quality of care.

I now quote from Jonathan Cohn's article on the reality of all this.  This stuff was going to happen even without Obamacare.

"Even before Obamacare, employers and insurers were already moving in the direction of limiting networks and penalizing costly hospitals like Cedars.  Both the University of California and the City of Los Angeles aggressively limited provider networks affecting thousands of people without any reaction by the media or politicians.  Now, as more of this occurs, it is possible that Obamacare accelerated it, but it is also likely Obamacare gave the insurers the cover needed to do what they wanted to do to try and control costs."

"The only way to avoid this market driven attack on costs is to have the government do the job instead.  In other words, you need a single payer plan in which all hospitals accept everyone's insurance.   But that conversation never got past the phrase "government run medicine", and Americans chose to place their faith in market forces.  The insurers have adapted and so have the hospitals.  Now it is the consumer's turn, and that means relinquishing the idea that cachet always equals quality."

What irks me is not these changes, but that the GOP in their desire to destroy President Obama disown their own ideas on how to use the market place to control health care costs.  How are they ever going to implement this same stuff if they don't accept Obamacare as the starting place?

December Movie Reviews (V)

Stay tuned to this posting as I will update it as we see more this holiday season and I will change the Roman Numeral as I add to the list.

American Hustle:  A Great Story, well acted, good pace and lots of eye candy.  This is the best movie of the XMAS releases that I have seen.

Dallas Buyers Club:  A little late, we caught up with this November release and enjoyed it a great deal. A true story about mid-1980's AID's patients in Dallas trying to figure out what medicines will keep them alive, it is an uplifting story of individual growth and perseverance with great acting and a lot of eye candy along the way.

Wolf of Wall Street:  It is too long.  It was entertaining but not worthy of any rewards as it is not well edited.  You get the point, but they keep delivering it.  The eye candy here is off-the-charts.  At 3 hours, you either have to really want to see the movie and have nothing better to do with your time, or wait until you can stream it and get off the couch to refresh your beverage (maybe eat dinner too while you watch it).

Saving Mr. Banks:  No eye candy here except for some brief scenes with Rachel Griffiths.  And when I checked out the real story of how Mr. Disney got Ms. Travers to sign off on the movie rights to Mary Poppins,  I found the movie took a lot of literary license with family history.  Somehow pneumonia became raging alcoholism.  And this movie is a bit long as well coming in at 2:45 with all the previews.  I did shed a few tears watching it, so despite my criticism, I am glad that I went and was entertained while wondering what was going to happen in the past.

HER:  If you like personality revelation and growth in your movies, this is the one for you.  Add in some comedy and a sultry voice from a computer and you have the movie.  It is well done and entertaining.

Sole Survivor:  I read the book and know from the previews this one will be too tough for me to watch.  A true story about Navy Seals battling the Taliban, the title removes all suspense and all you are left with is the process.  Some reviews have called it the best military movie since Saving Private Ryan.

Philomena:  The true story of the discovery of Irish Nuns selling the illegitimate children of young pregnant girls who came into the Nuns care.  Judi Densch does a superb job with all the emotional variations of her character as she searches for her son.

So if you would like the summary:  American Hustle was the best (but Gravity is still my choice for best picture of the year),  then Dallas Buyers Club, Philomena, her, Saving Mr. Banks and Wolf of Wall Street.  I'm not going to Sole Survivor so I cannot rank it.

Twelves Years a Slave:  While not really an XMAS movie in NYC, it may be elsewhere.  This is a must see movie if you want to understand the meanness and abuses of slavery, and see in the personal story of someone wronged by slavery the absolute wrongness in any modern absolution of its perpetrators back then.  It is also a totally engrossing movie during which you will never look at your watch.  It is right behind Gravity as my best movie of the year.



As for the news today, we find that the GOP Senators are starting to try and build some GOP support for package of modifications to Heritage Foundation/Romney/Obamacare now that some 6,000,000 people who did not have health insurance under the old system will have health insurance on 1/1/14.

And what do these ideas contain?  Well, Surprise, they want to keep the no exclusion of pre-existing conditions and the Health Care Insurance Exchanges.  They want to add less expensive catastrophic options and modify malpractice insurance (no objections here on that).  And Paul Ryan wants to end employer provided health insurance and replace it with tax credits for individuals to buy health insurance on the exchanges.  (I support this, but it doesn't mean you can keep your health insurance if you like it, as almost every person with employer provided health insurance wants to keep it.)  And the Ryan plan would not require everybody to have health insurance, but everyone would be enrolled and have to opt out.  That all seems quite close to Obamacare making me wonder what all the fuss has been about.

This Joke is not getting enough hits. You will laugh.

I copied this from a comment to an article on safest driving states.  Vermont was the safest despite having a higher than average level of drunk driving arrests.

Sitting on the side of the highway waiting to catch speeding drivers, a State Police Officer see's a car puttering along at 22 MPH.

He thinks to himself, "This driver is just as dangerous as a speeder!"So he turns on his lights and pulls the driver over.

Approaching the car, he notices that there are five old ladies, two in the front seat and three in the back, wide eyed and white as ghosts.

The driver, obviously confused, says to him, "Officer, I don't understand, I was doing exactly the speed limit! What seems to be the problem?"

"Ma'am," the officer replies, "You weren't speeding, but you should know that driving slower than the speed limit can also be a danger to other drivers."

"Slower than the speed limit? No sir, I was doing the speed limit exactly twenty-two miles an hour!" the old woman says a bit proudly.

The State Police officer, trying to contain a chuckle explains to her that "22" was the route number, not the speed limit.

A bit embarrassed, the woman grinned and thanked the officer for pointing out her error.

"But before I let you go, Ma'am, I have to ask... Is everyone in this car OK? These women seem awfully shaken and they haven't muttered a single peep this whole time," the officer asks.

"Oh, they'll be all right in a minute officer. We just got off Route 142."

Sunday 12/22 Musings: Health Care Needs Serious Debate

Among other things.

Today is the shortest day of the year for sunlight in the Northern Hemisphere;  and for anyone whose personality swings around with the amount of sunlight in a day like my wife, the world is a better place for the next 270 days.

NY Sports teams are all hung up on the strategy of paying big bucks to older stars in the hope they all have near career years and bring a championship.  It's not working.  These basketball teams are unwatchable and boring.

In the Who Knew Category:  Only the Northeast calls sneakers, sneakers,  they are Tennis shows everywhere else.  And it is mainly the Northeast and mid-atlantic that call Tractor-trailers, tractor-trailers.  They are Semi's or 18 Wheelers elsewhere.  And garage sales are Yard Sales or tag sales in a lot of places.

RedStateVT commented yesterday that a family of 4 in New Hampshire, who make $100,000 a year, and will buy health insurance for $12,000 a year (plus co-pays/deductibles) were suffering because of Obamacare and would somehow have been better off under the old system.  I know RedStateVT's preferred management of this is to buy a $25,000 deductible for a relatively small amount of monthly premium.  And I also know RedStateVT has a family of 4 and the 1st or 2nd year on that plan, he met the $25,000 deductible.  How would that family in New Hampshire come up with that $25,000 plus other payments when they are complaining about $12,000. The answer in both cases is only with a great deal of pain and cutting back in the rest of their budget.

The real issue that all the hysterics about "Repeal" Obamacare obfuscate is that the old Fee for Service System generated a system where Healthcare represents 20% of GDP.  The European Single Payer plans are in the low teens.  But unless Republicans agree that a single payer plan is the solution it isn't going to happen.  Why, because the Health Care industry spends $500 million every year lobbying Congress to preserve the private sector involvement in the Heath Care industry.  I agree there are real reasons why that should be the case in many aspects of health care, but it also means we are not making progress on controlling this 20% of GDP, which some forecast will be 25% of GDP over the next 25 years as the Baby Boomers exit this world.

The GOP didn't even allow Medicare to negotiate bulk purchases of drugs when Pharmaceuticals were added to Medicare in Part D during the Bush II years.  That is the penultimate example of following the money.

For the system to work financially, the average person needs to pay 20% of their income for Health Insurance today or be subsidized by everyone else.  In addition, the cost of annual healthcare use/insurance for a couple over 50 is about $10,000 to $15,000 (without anything extraordinary).  You need to budget for that and, if you make too little, you need help.

Why can't we go back to the old system?  The old system created the problem.  Fee for Service and a belief that the government should not be involved created 50 mm uninsured using the system only too late and in too expensive a manner that the system passes on to the insured.  It also resulted in people who lose their jobs and have pre-existing conditions being unable to get insurance.  It also resulted in people who got sick losing their insurance upon renewal because they hit a lifetime cap or couldn't afford the repricing.  It resulted in a system where by a 77 year old Medicare patient gets surgery on both ankles for arthritis and the system pays $200,000 in NY and $40,000 in NH.

So, let's not pretend that repealing Obamacare is a good long term solution to the issue of controlling health care costs.  Obamacare contains incentives to pay for care, to bundle pay for fixing problems, and to try and undo the creativity in using fee for service to compensate hospitals enough to cover the uninsured.  In 1986, Ronald Reagan signed the COBRA legislation that passed in a bi-partisan manner, and included "Emergency Medical Treatment and Active Labor Act:  Wikipedia notes:  "Congress passed EMTALA to combat the practice of "patient dumping," i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs."

The law has been criticized as an unfunded mandate, but the hospitals found a way to get the insurance system to cover the costs which raises the costs to the insured.  And undoing the requirement either leaves people dying in gutters (which is what was happening before) and violating nearly 2400 years of Western morality.  Hippocrates wrote the Hippocratic oath late in the 5th Century BC.  Do the GOP really want to undo that in the United States?  I don't think so as there is not an ounce of compassion in advocating that.

The Hippocratic Oath essentially makes the providing of healthcare a national utility that needs to be paid for.  Everyone uses health care almost every year and multiple times over a lifetime.  You cannot predict when you will need care.  I nearly died in 1993 (age 40) and would have without health insurance because being that cheap I wouldn't have gone to the Dr's with the regularity I did and would certainly have waited longer to go to the hospital then happened because of the Dr's orders.

Despite the example of Heritage Foundation/Romney/Obamacare working well in Massachusetts, on a national level implementation is a much rockier path but it is difficult to discern who is upset for valid reasons of fairness and who is simply upset because they were being subsidized by the old system and that subsidy is now going elsewhere.  (Follow the money)  I am assuming the website issues will be fixed, although I note as a full payer shopper for an individual policy, both Aetna and Anthem told me to apply directly and not through the NY website, which is supposedly working well.

I have gone on too long.  I wish the GOP would focus on getting things into law that would help control healthcare costs, such as:  Medical Malpractice Reform (or even General Tort Reform), allowing Medicare to negotiate bulk purchases of drugs, and separate access to health insurance from employment.  I admit I cannot imagine how we would transition from Private Sector Health Insurance to a single payer plan when (a) it would create a labor transition for tens of thousands of people, and (b) Medicare through the Advantage Plans (which my wife selected) is using the Private Sector Health Insurance so how does undoing that work.  This could all be done, but politicians would have to be serious about negotiation and compromise instead of "Repeal Obamacare."

The World is a Complicated Place (again)

David Brooks on Israel's need to find a solution to its demographic realities while maintaining security.

Link to David Brook's wonderful analysis


This piece by Uwe Reinhardt really does a good job of summarizing the basis of how reality shapes the health care debate.  What the GOP really wants is death panel's or lack of insurance rationing the availability of health care for the poor so that Medicaid costs are controlled.  or would Sarah Palin/Grover Norquist actually provide the revenues to pay for such care?

An Economist Explains the Health Care Debate

Tom Egan on what motivates the GOP to reduce the social safety net.

Current GOP would have been right at Home in mid-19th century England

And last a commentary on the values of austerity economics vs. traditional Keynesian/Friedman counter cyclical economics.  Remember in the latter you run a budget surplus when the economy is doing well to pay down the debt you built up in the recession.  Something the GOP forgot during the last 30 years when they were in power.

Why Keynes/Friedman are correct

And last a word from the Tea Party.  Contrast the lack of facts and economic policy basis in this presentation vs the other posts.

Jenny Beth Martin States the Tea Party Way or No Way

More Proof that Stupidity is Widespread

Or perhaps it is delusion.

38% of the US population believes Obama is more responsible for the Great Recession than Bush II.

Thankfully, 50% recognize and remember that the Great Recession started in 2008 before Obama was elected President.