I'm reminded of some of the things that I hated most about college, namely the preponderance of self-absorbed, entitled douchebags. Man, I really disliked being in college (thanks for the memories, NYT). And apparently I wouldn't enjoy
Friday, April 30, 2010
Lifestyles of the Well-Connected
I have to say, I walked away from this Times puff piece about the Obama administration's 20-something staffers feeling annoyed.
I'm reminded of some of the things that I hated most about college, namely the preponderance of self-absorbed, entitled douchebags. Man, I really disliked being in college (thanks for the memories, NYT). And apparently I wouldn't enjoythe O.C. D.C. much, either.
I'm reminded of some of the things that I hated most about college, namely the preponderance of self-absorbed, entitled douchebags. Man, I really disliked being in college (thanks for the memories, NYT). And apparently I wouldn't enjoy
Sunday, April 4, 2010
The Basketball of Health Care Reform
With the Cavs set to take on the Celtics in Boston in a little while, I'll pose a question that may be interesting to some of you: what does the NBA have to teach us about the mechanics of the new health care law?
The NBA has a salary cap ($57.7 million for this season) to keep the big market teams from buying up all the talent, a la the Yankees in major league baseball. But the NBA's cap is a soft cap, meaning teams can go over it. But if a team pulls in two big-money stars and their team payroll exceeds the cap by a certain amount, they have to pay the luxury tax (although there are enough exemptions and special cases to make the IRS blush). For this season, the luxury tax kicks in $69.92 million. If your payroll hits that, you have to pay the league a tax on every dollar above the salary cap you've gone. That money then gets distributed to teams whose payrolls come in below the cap. A little bit of redistribution to achieve an extra degree of parity between high-revenue and low-revenue teams.
What does this have to do with health care? The new law institutes the very same principle for health insurance companies. Starting in 2014, insurance companies will be subject to guaranteed issue and community rating rules. This means they can't turn people away (as in, for pre-existing conditions) and, except for certain exceptions, they can't charge people more for things that are out of their control, like gender or medical history. That's all well and good for the consumer but suppose you're an insurance company that by sheer luck of the draw ends up getting a disproportionate share of the less healthy, more expensive customers? You can't turn them away and you generally can't charge them more to make them help cover the added expense of covering them.
Never fear. The new law contains risk adjustment mechanisms, to be implemented by the states. Insurance plans with lower than average actuarial risk--that is, a healthier and cheaper than average pool--have to pay a fee. This then gets distributed to insurance plans that have a higher than average actuarial risk--the disproportionately unhealthy, more expensive pools. So no insurer gets unduly penalized for accepting sicker people into its pool.
If lower than average actuarial risk plans were NBA teams, they'd be the ones that luck out and get multiple superstars on their team, hitting the luxury tax threshold. Of course, in the world of health insurance that translates into fewer sick people drawing benefits. Higher than average actuarial risk plans are those teams whose payrolls check in under the cap, garnering them luxury tax payments.
All right, it's tip-off. Go Cavs.
The NBA has a salary cap ($57.7 million for this season) to keep the big market teams from buying up all the talent, a la the Yankees in major league baseball. But the NBA's cap is a soft cap, meaning teams can go over it. But if a team pulls in two big-money stars and their team payroll exceeds the cap by a certain amount, they have to pay the luxury tax (although there are enough exemptions and special cases to make the IRS blush). For this season, the luxury tax kicks in $69.92 million. If your payroll hits that, you have to pay the league a tax on every dollar above the salary cap you've gone. That money then gets distributed to teams whose payrolls come in below the cap. A little bit of redistribution to achieve an extra degree of parity between high-revenue and low-revenue teams.
What does this have to do with health care? The new law institutes the very same principle for health insurance companies. Starting in 2014, insurance companies will be subject to guaranteed issue and community rating rules. This means they can't turn people away (as in, for pre-existing conditions) and, except for certain exceptions, they can't charge people more for things that are out of their control, like gender or medical history. That's all well and good for the consumer but suppose you're an insurance company that by sheer luck of the draw ends up getting a disproportionate share of the less healthy, more expensive customers? You can't turn them away and you generally can't charge them more to make them help cover the added expense of covering them.
Never fear. The new law contains risk adjustment mechanisms, to be implemented by the states. Insurance plans with lower than average actuarial risk--that is, a healthier and cheaper than average pool--have to pay a fee. This then gets distributed to insurance plans that have a higher than average actuarial risk--the disproportionately unhealthy, more expensive pools. So no insurer gets unduly penalized for accepting sicker people into its pool.
If lower than average actuarial risk plans were NBA teams, they'd be the ones that luck out and get multiple superstars on their team, hitting the luxury tax threshold. Of course, in the world of health insurance that translates into fewer sick people drawing benefits. Higher than average actuarial risk plans are those teams whose payrolls check in under the cap, garnering them luxury tax payments.
All right, it's tip-off. Go Cavs.
Saturday, April 3, 2010
Friday, April 2, 2010
Counting
You may have heard that certain "Tea Party" types--and even a U.S. Congress(wo)man or two--are deathly afraid of the attack on liberty known as the U.S. Census. They're convinced that questions about, say, race are not something the government has any reason to ask and thus it must be unconstitutional (generally defined among that crowd as "something with which I disagree). The question of where in the Constitution it says the government can ask your race in the Census came up today. And, in fairness, it's an interesting question.
But as anyone who's taken some basic U.S. history or government classes knows, the Constitution did explicitly require that race be reported to it. Why? Because we didn't originally count everybody the same way:
If the government didn't know your race for the first 70-odd years of its existence, it might've had to round upwards and count people of every race as a whole human being. Clearly that wouldn't do so they had (and were empowered by the Constitution) to include race in the count.
"But," you might protest, "that language was stripped out after the War of Northern Aggression!" Certainly, but the second section of the Fourteen Amendment merely takes away the necessity (for taxation and apportionment purposes) of asking your race. It doesn't now forbid the government from asking. And since the precedent was already set that they can and did ask demographic questions, one would think an amendment taking away that power would have to do so explicitly.
What's the moral? Merely that I suspect many of these Patriots are not nearly as familiar with history or the Constitution as they'd have you believe.
Also, don't forget to return your Census forms.
But as anyone who's taken some basic U.S. history or government classes knows, the Constitution did explicitly require that race be reported to it. Why? Because we didn't originally count everybody the same way:
Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons. The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct.
If the government didn't know your race for the first 70-odd years of its existence, it might've had to round upwards and count people of every race as a whole human being. Clearly that wouldn't do so they had (and were empowered by the Constitution) to include race in the count.
"But," you might protest, "that language was stripped out after the War of Northern Aggression!" Certainly, but the second section of the Fourteen Amendment merely takes away the necessity (for taxation and apportionment purposes) of asking your race. It doesn't now forbid the government from asking. And since the precedent was already set that they can and did ask demographic questions, one would think an amendment taking away that power would have to do so explicitly.
What's the moral? Merely that I suspect many of these Patriots are not nearly as familiar with history or the Constitution as they'd have you believe.
Also, don't forget to return your Census forms.
Saturday, March 27, 2010
That Wizard's Just a Crazy Old Man
I don't know why, but at this moment I'm finding Uncle Owen's line about Ben Kenobi to be absolutely hilarious.
Saturday, February 20, 2010
Déjà vu all over again
Update: Today the Kaiser News Network has released a table that encapsulates most of this post. So check that out.
Some time ago, in trying to explain a bit of the philosophy behind public policy, I identified a certain brand of thinking I call political nihilism:
I think it's time to present an example of what I'm talking about.
I've been reading various alternative health care bills lately to see if I can identify one that has some potential for bipartisan support (there's actually a current Republican proposal I rather like that I'll post about sometime). Yesterday, I came across a doozy. But first I want to offer a little background on the current Democratic proposals that passed out of the House and the Senate late last year. So let's walk through some of the key elements.
● Insurance market reforms and the individual mandate. The Democratic bills institute guaranteed issue and adjusted community rating rules in U.S. health insurance markets. This means that insurers can't turn someone away based on medical history or pre-existing conditions and they can only vary rates in the insurance pool based on age, geographic location, and familial status (and even then there are limits to the allowed variation). These kinds of reforms are popular among the public and with good reason: the ability of insurance companies to cherrypick their pools by turning people away or charging women, the sick, or the elderly significantly more than they charge others strikes most people as unfair.
But medical underwriting (the practice of deciding whether to accept somebody into your insurance pool and, if so, whether to charge them more than everybody else) serves a purpose, even if it seems douchey on the surface. It helps to mute the influence of what economists call adverse selection, a process by which the composition of health insurance pools could disproportionately contain sick people, threatening their financial viability. If insurance companies have to accept you when you go to them and they can't charge you more than anybody else once you're in their insurance pool, why pay premiums every month when you're healthy? If you get sick, you can always go buy insurance without fear of being turned away or punished financially for your irresponsibility. It's actually a pretty great scam. But it means that these high-minded, popular limits on the abilities of those evil insurance companies to play their medical underwriting games actually threatens to destroy (or at least make exorbitantly expensive) health insurance itself.
So we need another piece of the puzzle. Some way to keep people from dropping out of insurance pools until they need to draw resources from them. Some way to head off the obvious scam that most of us healthy people would be tempted to run. That's where the individual mandate comes in. You incentivize people to enter (or stay in) insurance by threatening them with a tax penalty if they go without insurance. Make it so that it's not cheaper to be uninsured and there's no reason for people to go without health insurance. Then healthy people pay premiums and health insurance pools stay solvent. The only issue is that libertarians freak the fuck out.
● Financial assistance to low-income people. The only problem with mandating that everyone buy health insurance is that a number of people are uninsured because they can't afford to buy insurance (that's part of the problem we're trying to address here, right?). So you have to provide financial assistance to help low-income families pay their premiums. That, of course, is where the costs of the Democratic bills stem from and why you'll hear conservatives weeping that the bills cost almost $1 trillion over the next decade. But this assistance, along with the insurance market reforms, pushes us close to universal coverage. The House bill, by the way, contains a mandate on employers to provide insurance to their employees.
● State-based health insurance exchanges. Right now there are a few different health insurance markets. There's the large group market for big employers. Large companies either self-insure (they have enough people to make their own health insurance pool) or, if they do go to an insurance company, have a great deal of leverage in bargaining for decent plans because they can offer the insurance company thousands of new customers. There's the small group market, in which small employers (like mine) go to insurance companies and try to get some kind of deal but have considerably less bargaining power than big employers. And then there's the individual market for people who don't get coverage through their employer. This last one is expensive, opaque, confusing, and just difficult to navigate.
The Democratic bills create health insurance exchanges in each state. In addition to being governed by the ground rules we covered above (guaranteed issue and community rating rules), they are meant to be a more transparent, competitive marketplace than the individual insurance market currently is. These exchanges are envisioned as being a bit like the market in which federal employees choose their plans (the Federal Employees Health Benefits Plan). Check out the website. Click your state, get a brochure for all available plans, along with the rates. Easy, transparent, one-stop shopping. As time goes on, the Democratic bills allow small employers of larger and larger sizes to enter the health insurance exchanges with their employees. This effectively gives these small employers bigger pools with which to bargain with insurance companies because a transparent marketplace with a level-playing field is a competitive marketplace.
In addition to the ground rules for insurance companies operating in the new health insurance exchanges, insurers will face benefit standards (i.e. they have to offer at least a minimum package of benefits). The House bill sets up a panel of experts to determine what kinds of things should be included in minimum benefits packages.
● Taxes. The Democratic bills cost north of $900 billion over the next decade, yet they're actually projected by the nonpartisan Congressional Budget Office to reduce the deficit. They do this, of course, by coming up with revenue streams to pay for their spending (and then some). The House bill does this through a progressive income tax on millionaires. Every dollar you make in excess of $1 million gets a nickel taken out of it. And poor people get to stay alive. The Senate bill goes a different route. Instead of an income tax, it relies primarily on a tax on "Cadillac" insurance plans. That means if you have a very expensive insurance plan (costing more than $9,000 if you're a single guy or more than $24,000 if it's a family plan), you'll pay a 40% tax on it above that threshold. So if you have an individual plan costing $10,000 a year, you'll pay a 40% tax on that excess $1,000 (i.e. you'll pay $400).
● Miscellaneous. As you may have heard, these bills are a bit long. That's because they contain lots and lots and lots of things. Additional money to fight waste, fraud, and abuse in federal health programs. Additional money to encourage medical students (I'm looking at you, Jim!) to go into primary care; this includes things like extra loan forgiveness and resources to create more residency programs, etc. Efforts to improve Medicare, including an end to the practice of subsidizing private companies to do things the government is doing more cheaply. Efforts to emphasis wellness programs to help shift the focus from treating sickness to maintaining health. A focus on collecting and compiling data to encourage comparative effectiveness research that will help doctors choose the most effective (in terms of health and cost) treatments. Numerous delivery system reforms that plant the seeds for the kind of fundamental changes that will ultimately help us control costs by changing the way we deliver care. Even incentive payments to states that come up with novel ways of reforming their medical liability laws (yes, Virginia, that's a flavor of tort reform).
That, in a nutshell, is what's in the Democratic bills that have consumed the national policy debate for the past eight months. These are the bills that were on the verge of being signed into law and which would've, obviously, led to an ultra-liberal dystopia in which freedom as we know it no longer exists and the government is in total control of 1/6 of the U.S. economy. At least, that's what one party told me would happen.
But let's rewind to the last Great Health Care Reform Debate: Bill Clinton's ill-fated 1993 reform effort. As we all know, "HillaryCare" went down in flames. At the time, Senate Republicans took the initiative in drawing up a bipartisan, centrist plan to counter President Clinton's proposal. In addition to having several Democratic co-sponsors, this bill (introduced by Republican John Chafee) counted Republican Senate Minority leader Bob Dole among its co-sponsors, as well as several Republican Senators who still serve today (Kit Bond, Bob Bennett, Orrin Hatch, Dick Lugar, and Chuck Grassley). I want to list some of the key provisions of this bill, the Health Equity and Access Reform Today Act of 1993:
● Universal access to health insurance coverage, in part through premium assistance to low-income individuals who don't quality for Medicaid (ultimately up to 240% of the federal poverty line)
● An individual mandate requiring all citizens to be covered by a health plan
● A mandate on employers to provide health insurance plans to employees
● Requirements for qualified heath plans to meet standards of: guaranteed eligibility, availability, and renewability of health insurance coverage; nondiscrimination based on health status (i.e. eliminating pre-existing conditions); benefits offered; insurer financial solvency; enrollment process; premium rating limitations (allowing variation in premiums based only on age and family); risk adjustment; and consumer protection
● The formation of individual and small employer purchasing groups
● Requirements that the Secretary of Health and Human Services, in consultation with the Secretary of Labor, establish standards for large employer plans similar to requirements applicable to small employer plans
● Formation of a Benefits Commission to develop a standard (minimum) benefits package that any qualified health benefits plan must offer
● Enumeration of state responsibilities in implementing state insurance market reforms
● Certain alterations to tax law, including an excise tax for excess contributions to medical care savings accounts and a tax on employee contributions to health care plans in excess of a certain "applicable dollar amount"
● Quality assurance programs, including the creation of a national health data system
● Medical liability reform, including a requirement that states adopt an alternative dispute resolution method for the resolution of health care malpractice claims
● Efforts to fight fraud and abuse in federal health programs
● Efforts to bolster the primary care workforce
Sound like any other proposals you've heard recently? Maybe some other one described in this very post? Premium assistance to the poor, insurance market reforms, new purchasing groups for individuals and small employers (a pre-cursor to the idea of the health insurance exchange), individual and employer mandates, even a tax on excess spending on health plans (think of it as a tax on Cadillac plans, except with a much lower threshold).
For ideological purposes, it's the same fucking plan. Proposed by Republicans 15 years ago and co-sponsored by 5 Republicans who are still sitting in the Senate and who all voted against the Democratic bills last year. An idea that Republicans now attack so viciously that President Obama correctly pointed out: "But if you were to listen to the debate, and, frankly, how some of you went after this bill, you'd think that this thing was some Bolshevik plot."
This, boys and girls, is political nihilism.
Some time ago, in trying to explain a bit of the philosophy behind public policy, I identified a certain brand of thinking I call political nihilism:
A participant in the policy process who becomes unmoored from ideological preferences and personal passions finds himself in a dire situation. The loss of faith leaves him with only the cold embrace of cynicism. He can be little more than a "hired gun," choosing a side and playing to win by any means necessary. Politics and policy-making become solely about the acquisition of power or a simple love of the game. The notion of identifying desirable social goals and using policy to launch us in the direction of the Utopian's dream becomes quaint and, if anything, simply a tool in the political manipulator's arsenal. This sense of purposelessly drifting through the political landscape is what I'll call political nihilism (a usage of the phrase that differs a bit from what Wiki tells me is usual). It isn't any more endemic to society than is religious agnosticism but I suspect--as with religious agnostics--there are many adherents among us.
I think it's time to present an example of what I'm talking about.
I've been reading various alternative health care bills lately to see if I can identify one that has some potential for bipartisan support (there's actually a current Republican proposal I rather like that I'll post about sometime). Yesterday, I came across a doozy. But first I want to offer a little background on the current Democratic proposals that passed out of the House and the Senate late last year. So let's walk through some of the key elements.
● Insurance market reforms and the individual mandate. The Democratic bills institute guaranteed issue and adjusted community rating rules in U.S. health insurance markets. This means that insurers can't turn someone away based on medical history or pre-existing conditions and they can only vary rates in the insurance pool based on age, geographic location, and familial status (and even then there are limits to the allowed variation). These kinds of reforms are popular among the public and with good reason: the ability of insurance companies to cherrypick their pools by turning people away or charging women, the sick, or the elderly significantly more than they charge others strikes most people as unfair.
But medical underwriting (the practice of deciding whether to accept somebody into your insurance pool and, if so, whether to charge them more than everybody else) serves a purpose, even if it seems douchey on the surface. It helps to mute the influence of what economists call adverse selection, a process by which the composition of health insurance pools could disproportionately contain sick people, threatening their financial viability. If insurance companies have to accept you when you go to them and they can't charge you more than anybody else once you're in their insurance pool, why pay premiums every month when you're healthy? If you get sick, you can always go buy insurance without fear of being turned away or punished financially for your irresponsibility. It's actually a pretty great scam. But it means that these high-minded, popular limits on the abilities of those evil insurance companies to play their medical underwriting games actually threatens to destroy (or at least make exorbitantly expensive) health insurance itself.
So we need another piece of the puzzle. Some way to keep people from dropping out of insurance pools until they need to draw resources from them. Some way to head off the obvious scam that most of us healthy people would be tempted to run. That's where the individual mandate comes in. You incentivize people to enter (or stay in) insurance by threatening them with a tax penalty if they go without insurance. Make it so that it's not cheaper to be uninsured and there's no reason for people to go without health insurance. Then healthy people pay premiums and health insurance pools stay solvent. The only issue is that libertarians freak the fuck out.
● Financial assistance to low-income people. The only problem with mandating that everyone buy health insurance is that a number of people are uninsured because they can't afford to buy insurance (that's part of the problem we're trying to address here, right?). So you have to provide financial assistance to help low-income families pay their premiums. That, of course, is where the costs of the Democratic bills stem from and why you'll hear conservatives weeping that the bills cost almost $1 trillion over the next decade. But this assistance, along with the insurance market reforms, pushes us close to universal coverage. The House bill, by the way, contains a mandate on employers to provide insurance to their employees.
● State-based health insurance exchanges. Right now there are a few different health insurance markets. There's the large group market for big employers. Large companies either self-insure (they have enough people to make their own health insurance pool) or, if they do go to an insurance company, have a great deal of leverage in bargaining for decent plans because they can offer the insurance company thousands of new customers. There's the small group market, in which small employers (like mine) go to insurance companies and try to get some kind of deal but have considerably less bargaining power than big employers. And then there's the individual market for people who don't get coverage through their employer. This last one is expensive, opaque, confusing, and just difficult to navigate.
The Democratic bills create health insurance exchanges in each state. In addition to being governed by the ground rules we covered above (guaranteed issue and community rating rules), they are meant to be a more transparent, competitive marketplace than the individual insurance market currently is. These exchanges are envisioned as being a bit like the market in which federal employees choose their plans (the Federal Employees Health Benefits Plan). Check out the website. Click your state, get a brochure for all available plans, along with the rates. Easy, transparent, one-stop shopping. As time goes on, the Democratic bills allow small employers of larger and larger sizes to enter the health insurance exchanges with their employees. This effectively gives these small employers bigger pools with which to bargain with insurance companies because a transparent marketplace with a level-playing field is a competitive marketplace.
In addition to the ground rules for insurance companies operating in the new health insurance exchanges, insurers will face benefit standards (i.e. they have to offer at least a minimum package of benefits). The House bill sets up a panel of experts to determine what kinds of things should be included in minimum benefits packages.
● Taxes. The Democratic bills cost north of $900 billion over the next decade, yet they're actually projected by the nonpartisan Congressional Budget Office to reduce the deficit. They do this, of course, by coming up with revenue streams to pay for their spending (and then some). The House bill does this through a progressive income tax on millionaires. Every dollar you make in excess of $1 million gets a nickel taken out of it. And poor people get to stay alive. The Senate bill goes a different route. Instead of an income tax, it relies primarily on a tax on "Cadillac" insurance plans. That means if you have a very expensive insurance plan (costing more than $9,000 if you're a single guy or more than $24,000 if it's a family plan), you'll pay a 40% tax on it above that threshold. So if you have an individual plan costing $10,000 a year, you'll pay a 40% tax on that excess $1,000 (i.e. you'll pay $400).
● Miscellaneous. As you may have heard, these bills are a bit long. That's because they contain lots and lots and lots of things. Additional money to fight waste, fraud, and abuse in federal health programs. Additional money to encourage medical students (I'm looking at you, Jim!) to go into primary care; this includes things like extra loan forgiveness and resources to create more residency programs, etc. Efforts to improve Medicare, including an end to the practice of subsidizing private companies to do things the government is doing more cheaply. Efforts to emphasis wellness programs to help shift the focus from treating sickness to maintaining health. A focus on collecting and compiling data to encourage comparative effectiveness research that will help doctors choose the most effective (in terms of health and cost) treatments. Numerous delivery system reforms that plant the seeds for the kind of fundamental changes that will ultimately help us control costs by changing the way we deliver care. Even incentive payments to states that come up with novel ways of reforming their medical liability laws (yes, Virginia, that's a flavor of tort reform).
That, in a nutshell, is what's in the Democratic bills that have consumed the national policy debate for the past eight months. These are the bills that were on the verge of being signed into law and which would've, obviously, led to an ultra-liberal dystopia in which freedom as we know it no longer exists and the government is in total control of 1/6 of the U.S. economy. At least, that's what one party told me would happen.
But let's rewind to the last Great Health Care Reform Debate: Bill Clinton's ill-fated 1993 reform effort. As we all know, "HillaryCare" went down in flames. At the time, Senate Republicans took the initiative in drawing up a bipartisan, centrist plan to counter President Clinton's proposal. In addition to having several Democratic co-sponsors, this bill (introduced by Republican John Chafee) counted Republican Senate Minority leader Bob Dole among its co-sponsors, as well as several Republican Senators who still serve today (Kit Bond, Bob Bennett, Orrin Hatch, Dick Lugar, and Chuck Grassley). I want to list some of the key provisions of this bill, the Health Equity and Access Reform Today Act of 1993:
● Universal access to health insurance coverage, in part through premium assistance to low-income individuals who don't quality for Medicaid (ultimately up to 240% of the federal poverty line)
● An individual mandate requiring all citizens to be covered by a health plan
● A mandate on employers to provide health insurance plans to employees
● Requirements for qualified heath plans to meet standards of: guaranteed eligibility, availability, and renewability of health insurance coverage; nondiscrimination based on health status (i.e. eliminating pre-existing conditions); benefits offered; insurer financial solvency; enrollment process; premium rating limitations (allowing variation in premiums based only on age and family); risk adjustment; and consumer protection
● The formation of individual and small employer purchasing groups
● Requirements that the Secretary of Health and Human Services, in consultation with the Secretary of Labor, establish standards for large employer plans similar to requirements applicable to small employer plans
● Formation of a Benefits Commission to develop a standard (minimum) benefits package that any qualified health benefits plan must offer
● Enumeration of state responsibilities in implementing state insurance market reforms
● Certain alterations to tax law, including an excise tax for excess contributions to medical care savings accounts and a tax on employee contributions to health care plans in excess of a certain "applicable dollar amount"
● Quality assurance programs, including the creation of a national health data system
● Medical liability reform, including a requirement that states adopt an alternative dispute resolution method for the resolution of health care malpractice claims
● Efforts to fight fraud and abuse in federal health programs
● Efforts to bolster the primary care workforce
Sound like any other proposals you've heard recently? Maybe some other one described in this very post? Premium assistance to the poor, insurance market reforms, new purchasing groups for individuals and small employers (a pre-cursor to the idea of the health insurance exchange), individual and employer mandates, even a tax on excess spending on health plans (think of it as a tax on Cadillac plans, except with a much lower threshold).
For ideological purposes, it's the same fucking plan. Proposed by Republicans 15 years ago and co-sponsored by 5 Republicans who are still sitting in the Senate and who all voted against the Democratic bills last year. An idea that Republicans now attack so viciously that President Obama correctly pointed out: "But if you were to listen to the debate, and, frankly, how some of you went after this bill, you'd think that this thing was some Bolshevik plot."
This, boys and girls, is political nihilism.
Tuesday, February 2, 2010
A nod's as good as a wink to a blind bat!
Remember the smiley face in Moon? Well check this out...
The nod is one of the most important signals a person can send. When made at the right time, it means “I am engaged in what you are saying” or “I understand”. For computer programs and robots that are designed to interact with people, being able to notice nods and respond with nods of their own (through an on-screen avatar in the case of a computer, and with actual nods in the case of robots) would be a boon. Unfortunately, nobody has yet been able to get it right.
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