mindstalk: (Default)
Long article from EPI arguing that medical cost sharing is a terrible idea, just as you'd think. Also, I learned that EPI is a labor-affiliated think tank. Cool!

PDF of California's 2017 tiers. Look how high the out of pocket maximums are, or the deductibles in some cases.

Reader reminder: the US has 3 different "single-payer" systems (maybe four with the Indian health service.) VA, operating like the NHS. Medicare, for seniors, operating like traditional insurance with deductible and co-insurance[1]. Medicaid, for poor people, operating like a magic "we take care of you" ticket -- the user experience is much like the NHS, where you go in and get treated and walk out again, no billing. (Unless you need drugs, at like $4/month.)

[1] My mother had Medigap, which pays what Medicare doesn't, so her treatment turned into an avalanche of bills telling us what we didn't have to pay. Sort of Medicaid/NHS + lots of paper experience.

Drive-by doctoring

2014-Dec-17, Wednesday 18:21
mindstalk: (Default)
US healthcare: #1 in legalized medical fraud. "Drive-by doctoring" by out of network doctors, while you're lying there groggy on the operating table.

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html

Medicare for all now plz

US single payer

2014-Jun-04, Wednesday 17:16
mindstalk: (Mami)
65 million Americans are on Medicaid. (Precise number is in PDF linked by the article.)

49 million are on Medicare.

So 36% of us are on one of two socialized insurance plans already.

Edit to add: plus 9 million in the NHS-like VA system, bringing Americans on government-run or -paid health care up to 39%. Granted the VA has some recently infamous flaws. Could get some more by counting Indians (but they get screwed) or government employees (but that might be indirect enough to not count.) 2.7 million federal employees, that's about 0.85% of the population, though dependents might take that to 2% of Americans getting government health care that way.

Poli-econ links

2014-Jan-09, Thursday 00:26
mindstalk: (Default)
Consensus: minimum wage increases reduce poverty http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/04/economists-agree-raising-the-minimum-wage-reduces-poverty/?tid=up_next

Obama's failure, undercutting his own base
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/05/the-group-that-got-health-reform-passed-is-declaring-victory-and-going-home/?wprss=rss_ezra-klein&clsrd

Medicaid expansion most of Obamacare coverage
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/06/medicaid-is-obamacares-biggest-success-but-neither-side-wants-to-talk-about-it/?wprss=rss_ezra-klein&clsrd

ECB sabotaging eurozone
http://www.slate.com/blogs/moneybox/2014/01/07/eurozone_inflation_tumbling_does_the_ecb_care.html

US not best health care system infographic
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/07/think-america-has-the-worlds-best-health-care-system-you-wont-after-seeing-this-chart/?wprss=rss_ezra-klein&clsrd

unemployment facts
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/07/the-senate-is-debating-unemployment-benefits-here-are-seven-things-they-should-know/?tid=up_next

US poverty programs suck
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/07/obamacares-launch-was-bad-but-many-programs-for-the-poor-are-worse/?wprss=rss_ezra-klein&clsrd

book: Social Democratic America
http://www.slate.com/blogs/moneybox/2014/01/07/social_democratic_america_lane_kenworthy_s_book_is_great_but_it_s_not_about.html

Chris Christie closed road lanes in political retribution
http://www.nytimes.com/2014/01/09/nyregion/christie-aide-tied-to-bridge-lane-closings.html?hp&_r=1
Christie a bully
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/08/chris-christies-problem-is-that-hes-really-truly-a-bully/?wprss=rss_ezra-klein&clsrd
mindstalk: (Default)
Long article, but really interesting.
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

* Tylenol pills costing $1.50 each
* "Non-profit" hospitals that charge 11x what labwork costs them.
* "Chargemaster" tables of service charges that vary arbitrarily between hospitals -- I'm reminded of parking requirement laws -- and that the hospitals try to deny have any importance, but which determine what individuals pay.
* $21,000 bill for finding that chest pains were just heartburn. "The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm."
* Hospitals routinely charge 150% markup for some implantable devices. List price $19,000, patient billed $49,000
* As a quote says, hospitals claim their charity based on the amounts they bill, not the much lower amounts stuff costs them.
* It's not just pharm companies anymore: device companies pay off doctors, or are partially owned by them.
* Medicare costs are spiraling because of aging population, new treatmenets, and spiraling costs in general, but the bureaucracy does a fine job of determining actual costs and keeping payments in line with them -- payments which doctors and hospitals don't have to accept, but do. This despite Medicare's hands being tied in drug price negotiation or even determining which drugs are worth paying for; it's also forced to overpay for durable medical equipment. One the efficiency front, it's using electronic billing, bill checking, and payment.
* Author is enamored of co-pays and unduly skeptical of Medicare-for-all.

Quotes )

Healing America

2012-Jul-30, Monday 18:07
mindstalk: (atheist)
Wrapping up.

Read more... )

Standard principles are a unified system, with simple administration and single buying power; non-profit finance; and universal coverage. Obamacare doesn't live up to any of those, though comes closest on the third. 23 million people are predicted to still be uninsured in 2019; I don't know how much of that is voluntary non-compliance with the mandate. Insurers will still be for profit, and allowed to have 20% overhead (15% for the shrinking employer plans). The crazy quilt of Medicare, Medicaid, VA, Indian Health Bureau, and private insurers, with different payment systems, won't be simplified at all, so doctors will still have their own high overhead costs just to be paid.

So we've made a step forward. But compared to extending Medicare to all, or making insurers non-profit, price-regulated, and using a standard payment system, it's a very small step.

Note that a really unified system would mean either getting rid of Medicare and putting old people into regulated insurance, or getting rid of insurers (and Medicaid, and the VA) and putting everyone on Medicare. Both seem politically... difficult. (Putting everyone on VA? Ha ha!) So the US seems doomed to have wastefully expensive health care into the indefinite future.
mindstalk: (Default)
Misc notes
Some overlooked stuff before I move on.

One of my newer readers is from Japan, and goes back to Japan fairly frequently. She told me that Reid's tuition numbers are low -- did he ask his middle-aged doctors what they paid for tuition, without thinking about how that number would change over time? She says it'd be more like $6000/year at the elite and public National University. 6 years, + $3000 start fee, call it $39,000. Add in living expenses and you'd be looking at upward of $100,000, unless you were living with parents (likely?) or student housing is cheap. Against a GP income of $130,000 that seems non-trivial debt. At, if I understood her correctly, easier to get into but more expensive (like Phoenix U and other degree mills?) university, $100,000/year, which seems substantial for even a specialist

OTOH, she confirmed something I forgot to pass on: far from having waiting lists, the Japanese don't even seem to go in for appointments, expecting to be able to walk in off the street to see a specialist. (And without GP referral.) Waiting room, but not list.

Oddly, national insurance won't cover pregnancy or childbirth. "That's not a disease." (Assuming nothing goes wrong, I assume.) But local governments will step in with money for that.

French and German health payments are a fixed percentage of income. The French smart cards, carte vitale, were designed in the USA. But not for us!

Not part of the book, but Romney's latest gaffe leads to a brief description of Israel's health care system. Sounds like another Bismarck system, ironically enough, with about 8% of GDP spent. (My table says 8.7, that link says under 8.)

Canada

You know, what he calls National Health Insurance and I call Medicare was designed by Tommy Douglas, hero of Canada. Why isn't it called the Douglas movel, like the Bismarck and Beveridge models? I don't know if these are his own terms or standard in health economics. I guess he didn't design it from scratch; Henry Sigerist of John Hopkins told him him to gradually move to government payment of private medical bills, and Douglas cut the 'gradually'. Started with hospital care in 1947, in Saskatchewan, and it got copied by other provinces. In 1961 he launched Medicare, paying all bills; doctors went on strike for 23 days, then folded. A few years later the federal government got in on it, providing support and guidance for all the other provinces to do the same. Kind of like Romneycare turning into Obamacare, only without the same national public support. Douglas would later be rated the greatest Canadian of all time, beating A. G. Bell or Wayne Gretzky.

Huh, Romney could have had that kind of immortality, if he embraced and sold it rather than squirming away.

The system is called single-payer but that's true at a provincial level, so sort of 13-payer. Details vary: 100% payment, or small co-pays, or deductibles. Federal level sets a lot of rules and gives a lot of clout in negotiating drug prices, though you have to pay those unless you're poor, old, or chronically ill. Most Canadians have a private insurance too, to pay for dental, or nicer hospital rooms, or prescriptions. Since most of the actual medicine is paid for by Medicare, private insurance is cheap. (This pattern probably holds in the other countries too, just haven't gone into it much.)

Medical ecords are digital, and I infer accessible across the country. No filing cabinets.

A distinct feature is fear of a "two-tier" system where the rich get better care, so it is illegal to pay privately for procedures that Medicare will pay for. In a way that's more socialized than the UK, where specialists tend to be NHS employees but private medicine can exist in parallel.

Waiting lists

According to Reid, the US-conservative warning about dread waiting lists is true... for Canada. For France and Germany, it wasn't worth mentioning. For Japan, as above, they don't even make appointments. In the UK, his GP said a 2-3 month wait to see a specialist; that's comparable to the US. But in Canada he was told it'd be a year just to consult with an orthopedist, with another 6-8 months to schedule an operation after that.

(Oh yeah, I haven't mentioned that. Reid has a mildly bum shoulder -- limited movement, occasional pain -- so part of the book is his asking doctors around the world for help. So he has personal experience of how low-priority problems are treated. So that UK wait is to see an orthopedist about "my shoulder kind of hurts and we know why".)

A Canadian friend I told wasn't too surprised to hear that, especially in Saskatoon (population 260,000, in the middle of Saskatchewan.) Maybe Toronto would be better. I think he tended to live in more urban places in the other countries; I suspect Japan wouldn't look so cool in rural Hokkaido. And emergency times would be much better. But still.

OTOH, after an 18 month wait, he could get a free shoulder replacement. Beats the US, except for old people on our own Medicare. And the myth of Canadians flocking to the US for faster care is just that, a myth. (Never was plausible to me: how would most Canadians pay for US medical bills out of pocket? Especially when the exchange rate was worse for them?)

After an old man in pain had to wait 9 months and sued Quebec, the Supreme Court said in 2005 "no, you can't ban private care *and* have ridiculous waiting lists, that combination is unconstitutional", and the governments have been trying to cut down on waiting times. Still, it does seem a relative problem. And Canada already spends 10% of GDP on health care, so my usual answer to complaining Brits, "spend more you cheapskates", doesn't apply so well. (Though that 10% is after the decision, and might reflect increases in spending.)

Part of the problem is that in 1991, a commission recommended reducing the number of medical students. Reid calls the system underdoctored, and this agrees, with Canada having fewer doctors per capita then the US. (But Japan is said to have even fewer still. Odd.)

The doctor he talks to makes half as much as an American GP, but doesn't know how much malpractice costs since the provincial government pays it for him. Tuition costs for a medical degree run "half as much as they would be at a public university in the US", I'm not sure if Reid is comparing to public medical schools or to public undergraduate tuition.

And Canada looks poor only in comparison with other universal health countries, and at that does better than the UK in every simple metric except cost, let alone the US: longer life, lower infant mortality, much lower cost, people who really need care get it, and get it without going bankrupt.
mindstalk: (Witch)
Healing America continues!

Japan

Read more... )

Edit to add: doctors in both countries make house calls.

Healing America

2012-Jul-24, Tuesday 14:23
mindstalk: (atheist)
I'm reading this book by T. R. Reid, on his investigation into universal health care systems around the world. I think I've seen predecessor essays online. It's interesting, and may make you want to emigrate, if you're American.

Four basic health care models:

* Bismarck: heavily regulated private insurers, often tied to employers. It's what Obamacare wants to be when it grows up into a real system. Reid compares it to our existing system of employer provided insurance, but of course there are lots of differences. Insurers take everyone, everyone gets insurance, insurance rates are set by law (note different with Romney or Obamacare), insurers are non-profit (ditto.)

* Beveridge: "socialized medicine" at its purist, doctors as salaried government employees at government hospitals. Like the UK NHS, or US VA, or in the private market, Kaiser.

* "National Health Insurance", which for some reason he doesn't call by the much snappier name of "Medicare": Single-payer, a government insurance plan paying private doctors. Like, er, Medicare. (Or Medicaid). Or Candadian Medicare. Or Australian Medicare.

* Out of pocket: yeah, you know this one.

The US is, shall we say, uniquely complex in how we provide health care. And in having competing for-profit insurers, who are allowed to spend 20% of premium money on non-health care, compared to 2-5% elsewhere. Just changing that would save a couple percentage points of GDP!

Number of medical bill bankruptcies in other developed countries: allegedly zero "and how can you even ask?" Like asking how many flying saucers land in front of the courthouse. USA is the butt of health care economist meetings and the bogeyman of health care politics fights. "Grumble grumble." "At least we're not like America. You don't want us to become like America, do you?" "Oh god, no!'"

Hey, I just realized, it's like "socialism!" in America in reverse. We say "socialism!" to shut down debate, they say "like America!" Only with more justification, given that we spend twice as much to live not as long and to not treat many curable diseases.

Supposedly 20,000 Americans die in the prime of their life every year due to treatable diseases they couldn't afford to treat. That's like 7 9/11s a year.

Countries:

* France: Bismarck model. Rated #1 in the world. Only a few insurers, which you might stay with for life. France is into making you pay co-pays out of pocket unless you're destitute, even though you'll get most or all of that co-pay back from the insurer shortly; the ritual of actually paying seems to be valued. What you pay is set by the government, and there'll be a handy chart in the office telling you the prices. Contrast with the US, where the doctor may not know what something will cost. There are house calls, in fact there's extra compensation to the doctor for house calls. Everyone's covered, the "last 1%" got covered in 2000. Everyone has a smart card which contains all their medical records and facilitates electronic payments; no filing cabinets full of records, no complex or delayed payments. Go to any doctor, zip, they can see your whole medical history. Doctors make 1/3 of what US ones do (say, $60,000 for a GP), but have no college or med school loans, and pay 1/50th what US ones do in malpractice insurance premiums, while expected to never be sued. 11% of GDP.

* Germany: Origins of the Bismarck model, from the Iron Chancellor who wanted to cover workers without raising explicit taxes. (Sound familiar?) So they've been at it for 120+ years, through Kaiser, Weimar, Nazis, and postwar. After recent mergers, there are "only" 200 sickness funds, which you can shop around and change at short notice. Premiums are set by law, but what they pay doctors is negotiated with doctors' groups. You don't care, apart from a recently small quarterly co-pay you don't pay anything. They also have smart cards, though only since 2008; France beat them to it. Everyone's covered, even illegal immigrants, except for a 7% rich enough to be allowed to opt out. Otherwise similar to France, including making house calls. More doctors per capita in both countries than the US. One doctor mentions the new quarterly co-pays, and how Germans grumble, and an American quietly paid. Then, on his next visit, he tried to pay again! As if you had to pay every time you saw a doctor! Isn't that funny? 10.4% of GDP.

* Japan: Bismarck again, but I just started the chapter. Lots of advertising by the doctors. Lots and lots of doctor visits and longer stays in the hospital, but still really cheap.

PPACA/Obamacare

2012-Jun-28, Thursday 19:22
mindstalk: (squeee)
I've devoted a lot of attention to "Obamacare" and health care reform over the last couple years, the attention someone long interested in economics and who's at leisure can devote to something. So if you've got questions about how it will work, feel free to ask.

Free facts: 'will' is the right word; the interesting bits, especially the mandate, don't take effect until 2014. This is one reason you haven't noticed any really big changes; they haven't happened yet.

Major differences between Obamacare and Romneycare? None whatsoever. So yes, Romney has to somehow run against his own chief accomplishment as governor, without actually disavowing it. Fortunately for him Romney is willing to lie continuously.

How's Romneycare working out? Pretty well, thank you! I'm happy with it. State finances could be better but that's more about the Unnecessary Depression we're all in.

=====

Links about the ruling: what's up with the Medicaid expansion
http://www.slate.com/blogs/moneybox/2012/06/28/medicaid_what_s_the_deal_.html
http://elections.nytimes.com/2012/live-coverage/scotus-healthcare#sha=46a8dad46
(in short, Congress offered both carrot and stick, and Roberts removed the stick; some states may choose not to expand Medicaid to everyone under 133% of the federal poverty level (FPL), despite the Feds paying for 90% of the cost.

Senator Rand Paul (R-Gold) says SCOTUS isn't in charge of what's constitutional: http://www.dailykos.com/story/2012/06/28/1103965/-Sen-Rand-Paul-says-Supreme-Court-isn-t-the-boss-of-what-s-constitutional

Sip their tears or marvel at insanity:
http://www.buzzfeed.com/daves4/people-moving-to-canada-because-of-obamacare
http://mediamatters.org/blog/201206280004
http://livewire.talkingpointsmemo.com/entries/demint-obamacare-still-unconstitutional-states-should-refuse-to?ref=fpblg
impeach Roberts
http://www.politico.com/news/stories/0612/77947.html
fire my liberal employees
http://www.dailykos.com/story/2012/06/28/1103977/-Freeper-s-Response-to-SCOTUS-Ruling-Fire-his-Obama-supporting-employee


CNN fuckup
http://i.imgur.com/kHBVV.jpg
Obama Dewey moment
http://24.media.tumblr.com/tumblr_m6c3mtyrEA1qzs5cqo1_1280.jpg
mindstalk: (glee)
Solar zoning for cities, defining solar envelopes such that terraced buildings could be built to maximize solar access (for light and heating) while attaining high densities. High as in 100 1000-square foot apartments per acre in LA, which at 2 people per units maps to 128,000 people per square mile. Manhattan overall is 65,000/square mile. The idea of an even more environmentally friendly Manhattan justifies the icon.
http://www.theoildrum.com/node/9074
Long, originally published as 3 articles on Lowtechmagazine.

Which also informed me of the Chinese wheelbarrow, a highly efficient device for transporting loads (vs. the European wheelbarrow, which is convenient on a construction site.) Europe didn't have it, though a comment suggests Europe had enough waterways to not need it.

A Mormon flow chart is amusing. Lemba African Jews are interesting.

On the topic of cities, Jane Jacobs's 1958 essay on city design and streets vs. blocks.

Article from last year on health care systems around the world. Actually several linked articles, but I think you can figure it out. "Communist" China has totally fallen down on the health care front and is trying to reinvent universal health care. Oddly for once it's better to be rural.
http://www.guardian.co.uk/healthcare-network/2011/may/11/european-healthcare-services-belgium-france-germany-sweden


But not all links are awesome. On Israel Independence Date (don't save the date, it's set by the Jewish calendar), I learn of hunger striking prisoners being punished for their protest of indefinite detention without charge and ill treatment. Also, water cannon being turned on peaceful protest villagers. Which is probably a good thing for the overall cause, getting away from failed terrorism to the moral high ground. (Of course, I've been told one of the intifadas started out peaceful, until soldiers shot them.)

Someone's been leaking about Catholic church corruption. The Pope's response? Send in Opus Dei to hunt down the whistleblowers.


BTW, Pinker says pretty much every terrorist movement has failed to achieve its goals; the few exceptions had military or government targets, not civilian. (And if you have military targets, are you really terrorist?) Though he doesn't mention bin Laden wanting US troops out of Saudi Arabia, and didn't we eventually oblige?

links

2011-Feb-01, Tuesday 20:00
mindstalk: (Default)
government in the daily life of an American
http://www.governmentisgood.com/articles.php?aid=1

Ayn Rand took Medicare
http://www.boingboing.net/2011/01/28/ayn-rand-took-govern.html

Republican debt limit hypocrisy
http://www.nytimes.com/2011/02/01/opinion/01tue1.html
"They have passed new budget rules that allow taxes to be cut without
offsets to replace the lost revenue. The new rules also forbid raising
taxes to pay for major new spending, like Medicare expansions, requiring
instead that any such spending be offset by cutting other programs. That
is a recipe for fiscal irresponsibility. "

single payer moves forward in Vermont
http://socialistworker.org/2011/01/31/single-payer-in-vermont
http://www.wcax.com/Global/story.asp?S=13893471
http://www.singlepayeraction.org/blog/?p=2694

Read more... )

links

2010-Jun-10, Thursday 01:31
mindstalk: (lizqueen)
Aaagh I'm over a month behind.

Mostly Angry News
* Hunger growing in the US
* McCain denies rights, Lieberman strips citizenship, Glen Beck defends rights
* Muscovite reactions to woman in hijab. More discrimination in Arizona. McCain: immigrants "intentionally cause traffic accidents"
* GOP voter registration fraud
* Heath care reform tax debunking
* Corn syrup backlash. Hunt's is switching ketchup to sugar, but use is increasing in Mexico.
* What's the use of home security systems?
* Greek crisis rooted in massive tax evasion.
* Hallucinogen therapy research
* Opposition to a national power grid. States don't want a national power market.
* Arizona immigration, birthers, nativism, racism
* Racist expose of the BNP
* Adult learning and exercise.
* Charter schools show problems, their successes are hard to replicate, and they show need for strong government oversight. Callback to March's recanting by a school reformer. Houston dropout rates fraud.
* Church groups for women "addicted to porn".
* Mexican traffickers and prison gangs. It's almost as if something's wrong with our prisons.
* Somali pirate stock exchange.
* non-violent pregnant prisoner shackled during labor


* Insurance make doctors angry. How to appeal health insurance denials. "Balance bills".


Cheerful Media
* Incredible cloth and hair simulation. Coming soon to a MMO near you?
* Terry Pratchett on Doctor Who
* http://tvtropes.org/pmwiki/pmwiki.php/Main/CastOfSnowflakes
* Review of Mushi-shi, an anime I really liked.
* http://tvtropes.org/pmwiki/pmwiki.php/Main/MildlyMilitary lead to NOAA corps and US public health corps, uniformed auxiliary exploration and medical services where ensign is the lowest rank... real life Starfleet.
* Calvin's ultimate fate. (Warning: not so cheerful.)
* Nanoha Sound Stage transcripts

links

2010-Apr-26, Monday 01:28
mindstalk: (juggleface)
* Hubble Deep Field animation
* 538 on term limits being a bad idea
* Putin's alleged bombings and GQ's self-censorship
* Outsourcing government
* Palin's "death panels" wins political lie of the year.
* Lesson from Chile's quake: Seattle's in trouble
* Rising food fraud
* Interesting analysis of Azula
* Brief Objectivism cartoon
* Angkor destroyed by decades-long drought. Terraform the Earth!
* Obama team divided on anti-terror tactics, and trials
* Obama's progress on labor issues
* Onion: nation to save billions by cutting Senate
* gay animals
* NPR on health care reform myths. And rising health care reform scams
* Giant woodlouse
* Cory Doctorow vs. the iPad. EFF reveals constricting iPhone developer agreement
* A friend has the neat Alias 2 cell phone, that can flip keyboards
* There's a company devoted to fighting unemployment claims, i.e. keeping laid off workers from getting their compensation.
* Why the Taliban can't shoot.
* On the invisibility of most states and provinces.
* Measles in Zimbabwe
* Tom Coburn defends Pelosi, takes swipe at Fox News. And then backpedals as predicted, even though he was right the first time.
mindstalk: (Default)
Man, LJ seems slow the last couple of days. And I'm a paying member. Also, what's this big leaf doing at the top of my posting screen?

Link catchup:
Mercy cut )
mindstalk: (Enki)
A lot of people, including possible some state lawsuits, think there's something wrong in being forced to buy something, especially from private companies. At least by the feds; states and cities have mandated auto insurance (and in Mass., health insurance) or garbage collection services for quite a while. Let's work this through:

We have this Medicare system; taxes are collected, medical payments provided. It's been around for a while, the courts are cool with it, even Republicans were defending it strongly just now. So everyone likes it, at least for old people. There would surely be nothing unconstitutional in raising taxes and enrolling everyone in Medicare -- if we can do it for everyone over 65, we can do it for everyone, period.

Medicare pays doctors directly, but it doesn't have to; the gov't could collect taxes, then pay private insurers to do the decision making. In fact, we partially have this, with "Medicare Advantage"; seniors get to sign up with some private plan and the government pays the plan. I see nothing unconstitutional in the gov't using tax money to contract private businesses to provide a public service. Inefficient (why pay for someone's profits and advertising?) but not unconstitutional.

That means tax money is going to the IRS, then back out through HHS to an insurer. A mandate just cuts the government out of the loop, with people paying the insurer directly. Of course, taxes are (usually) progressive while a straight mandate would be highly regressive... but we've got a fix for that: there'll be income-adjusted subsidies (I think paid directly to the insurer, in fact, so the customer directly spends less), those subsidies being funded by progressive income tax and a new Medicare payroll tax.

Another difference would be that taxes have to be raised by Congress, while insurers seem like they can raise premiums at will. That is a big difference. It's also not entirely true, because long before the mandate happens, regulations on medical loss ratios and reviews of premium hikes will kick in. And again, the subsidies are keyed to premium-as-percentage-of-income, and one can evade the mandate without penalty if there are no plans available which cost less than a certain percentage of income, and that cap would have to be raised by Congress.

So it'll be a weird hybrid system, as in Massachusetts, basically a tax-funded private-provided service, but with some of the tax being levied as a mandatory premium sent directly to the private insurer, and partially raisable by a dance of insurer and regulator rather than by the legislature, but only up to a legislated cap. One could see it as a stealth weird income tax increase of up to around 9%, where you pay less tax if you can get qualified insurance for less, or if your income is small enough, and no tax at all if the tax won't be enough to purchase insurance.

Plus, of course, if you defy the mandate, the fine is only about 2% of income. Which I suspect is unsustainable, but at the moment the real tax increase is just that. If you choose to pay more, it's because you're getting insurance out of the deal.

Ironically, the most constitutionally dubious part of it is the most market oriented part; if Congress set the premiums, that'd be more government control of the industry, but less concern about having excessively delegated the power of taxation. And Medicare for All, a true government domination and displacement (not takeover: companies would get competed away, not taken over) of the health insurance market, would be unimpeachable.
mindstalk: (CrashMouse)
...stocks are up and Federal bond rates are down. Why are the markets blind to the fall of the Republic? Why?!

(Not that I put much, ahem, stock in stock-o-mancy. But people liked to use it against Obama when convenient, so I figure return digs are in order. All that New! Inflationary! Spending! yet important people with money are willing to lend it to the government at *lower* rates today.)
mindstalk: (robot)
Assuming the bill passes (edit: woot!)
One thing which might get more coverage later is that most of the big reforms don't kick in until 2014. AFAIK this is mostly for a stupid "who'se the biggest cheapskate?" reason: Obama in some speech had said a ten year cost less than $900 billion, said number being pulled out of thin air (or sounding less scary than the magic threshold of a trillion), and Congress took that as a hard cap for some reason. Despite the fact that the *net* cost is less than zero, since the bill has tax increases and cost containment measures to pay for itself. Somehow it became important that the size of outlays, even when paid for, be less than than $900 billion. And the only way to do that was to delay starting subsidies until 4 years into the 10-year period, so people will continue to risk death or medical bankruptcy so that some phantom of deficit hawks and fiscal conservatives can be satisfied.

http://www.kff.org/healthreform/sidebyside.cfm has lots of comparison options, most concisely http://www.kff.org/healthreform/upload/housesenatebill_final.pdf which I have just gone through for RPG.net to pick out the major elements and when they happen. Now I'll share them with you!

Employer mandate: Jan 1, 2014
Medicaid expansion (of eligibility to all adults with income <133% poverty level, and compensation increasing to Medicare levels): Jan 1, 2014
tax credit for small businesses (<25) providing insurance: starts in 2010 tax year
temporary reinsurance plan for age>55 employees: 90 days after enactment
tax for not having insurance: starts in 2014, scales up
increase in taxes funding Medicare (on high-income people): Jan 1, 2013

excise tax, on plans over $10,200 for individuals and $27,500 for families, said thresholds being increased for high-risk profession employees by $1650 and $3450, and possibly increasable for age/sex reasons: Jan 1, 2018. Yes, twenty-eighteen

tax on pharm companies: 2011
tax/fees on health insurance sector, increasing by rate of premium growth: 2014

guaranteed issue and community rating, the heart of individual insurance reform: Jan 1, 2014

Sick people get something though:
Establish a temporary national high-risk
pool to provide health coverage to individuals
with pre-existing medical conditions. U.S.
citizens and legal immigrants who have a
pre-existing medical condition and who have
been uninsured for at least six months will
be eligible to enroll in the high-risk pool and
receive subsidized premiums. Premiums for
the pool will be established for a standard
population and may vary by no more than
4 to 1 due to age; maximum cost-sharing
will be limited to the current law HSA limit
($5,950/individual and $11,900/family in 2010).
Appropriate $5 billion to finance the program.
(Effective within 90 days of enactment until
January 1, 2014)

medical loss ratio floors and rebate requirements: 2011
premium increase review process: 2010
dependent coverage up to age 26 for all policies: 6 months after enactment
no lifetime limits on coverage; no rescission except in case of fraud; no pre-existing condition exclusions for children: 6 months after enactment
no annual limits: 2014. Prior to 2014, annual limits "only as determined by the Secretary"

website for coverage options and standard policy information format: July 1, 2010; and 60 days after enactment


So the immediate or short-term help is no lifetime limits on coverage in any plan; no rescission in individual plans (unless they can spin your mistakes or withheld information as fraud); no exclusion for children; premium review and later loss ratio floors; a national pool for people with pre-existing conditions. Not sure what "a standard population" means for the pool: will premiums be set as for healthy people, with the difference being provided by the government, or will they be averaged over all the sick people in the pool?

Only immediate benefit for health individuals is that if they buy a plan, it'll presumably be harder to kick them off of it when they use it. And the premium review process might help too; not clear how much teeth it will have.


Edit: Newt Gingrich likens it to civil rights. So, in a less ironic way, does John Lewis:

"In a closed-door caucus for Democrats before the vote, Rep. John Lewis,
a Georgia Democrat and veteran of the civil rights movement who
reportedly faced racial epithets from protesters outside the Capitol on
Saturday, reminded his colleagues that they were acting on healthcare on
the 45th anniversary of the civil rights march from Selma to Montgomery
in Alabama. Lewis was beaten in an infamous confrontation with police
during the first of those marches."

wiki: The third march, which began on March 21 and lasted five
days, made it to Montgomery, 54 miles (87 km) away.
mindstalk: (juggleface)
I have a new font for the titles in my LJ style, Elegante, created by Juan Jose Marcos Garcia. It looks like this -- my pic, I couldn't find any samples online! God knows if anyone else will see it. I have some other cursivish fonts in there. I downloaded it among many fonts, after I upgraded Ubuntu to Karmic, which brought Firefox 3.5.8, which refuses to honor some fonts such as URW Chancery which I was using before. FF doesn't seem to have a concept of 'cursive', either. I also gave up on the steampunk theme for Firefox; the right-click menu was missing stuff more and more.

Otherwise the upgrade went well. Nothing else broke, and the laptop buttons controlling sound started working again!

Well, I've got one complaint; the Pidgin text alerts are different in annoying ways. Not worth describing.

Joke I read: "You know the old joke, who wants to live to be a 100? A 99 year old."

Links:
* If reform fails, expect more health care deterioration Plus busting the budget
* Women in open source
* World poverty stats
* Debunking mammal pheromones
* Unemployment Hits 10.8%, Presidential Approval Drops to 35% -- for Ronald Reagan. Obama's doing a lot better.
* Leading school reformer reverses course on charter schools and No Child Left Untested.
* More Republican confusion on Medicare and government health care
* We're going brooooke! Or not.

* Bujold debunks "Shards of Honor started as a Star Trek fanfic". You have to scroll down a bit or search.
* Speaking of fanfic: Jewish Arthuriana

Tea Party "kill the nigger" level crazy: 1, 2, 3

* Creationists join global warming denial
* Gay rights pulled from Canada's immigration guide.
* Couple sued for not having a lawn
* 95 year old man without records

This post brought to you by the PREVIEW BUTTON. You know who you are.
mindstalk: (Enki)
Random
* Terrorball
* Canadian PM Harper criticizes Parliament for interfering with government (line from James Nicoll)
* Deciphering monkey calls
* Google may stop censoring in China

Krugman

* Europe: social democracy works, and doesn't lead to stagnant economies. Column and blog; the latter looks at military spending as %age of GDP, to refute the common claim that the US can't afford social democracy because we're defending the free world.

Actually, it'd be fairer to say we can't afford social democracy because we're spending too much for health care (for which we get lower life expectancy, higher infant mortality, and lots of medical bankruptcies and economic distortion). Defense spendings are 1-3% of GDP... US might have drifted up to 4 or 5% what with the not-so-defensive wars. Health care spending is 8-10% for most developed countries, 15% in the US or maybe 17% by now. Obviously if you have an extra 9% of your economy handy, then it's easier to afford good schools and free child care and such, because you can have people doing useful things rather than treating prostate cancers that won't kill people or building yachts for doctors.
* Also (old), French family values. Less GDP/capita, a lot more vacation time. Something which is hard to negotiate with an employer for most people -- and even harder to negotiate on a coordinated basis, with the whole family or your friends getting vacation time.

* Europe may be okay, but the Euro currency may not be, which leads to the open question of how many currencies an area should have. He talks about closeness of trade and easy of labor mobility, and economic compensation between differently affected regions: the US is one country, the EU still isn't. Also, monetary and fiscal policy. I view it as a case of the problems that arise when levels aren't coordinated. One currency, one monetary policy, 20+ fiscal (though supposedly constrained) and employment policies, legally but not culturally or linguistically free movement. We have a different example in the US: the vaunted ability of the 50 states to experiment in undermined by free trade and travel mandates. Not that those are bad things, but they make the natural level of economic regulation and taxation be federal, not state.

* Quotes of economists denying the bubble even as it happened

Ezra Klein
* Racism and health care
* Technical: Combining the House and Senate bills, national vs. state Exchanges
* If reform is a windfall for insurers, why did they oppose it?
* The problem with Senators getting leverage by acting as if they'll oppose a bill: they convince their constituents it's a bad bill, and take blame for finally voting for it.
* How Wall Street drags down the economy
* Federal Reserve profits

Links from him:
* Mortgages are business contracts, not moral committments, and the penalties for non-payment are right there, surrendering the house. So feel free if you need to, businesses do all the time.
* Reid and color bias