I'm going to start writing again. Yes, it'll still be mostly about health care (but other stuff, too!). Who know if anyone, even my co-bloggers, still reads this place but I'm back to write again.
My only regret is bumping TJ's excellent Beatles album rankings off the top slot.
Thursday, November 6, 2014
Tuesday, April 29, 2014
Ranking Beatles albums
Awhile ago, Stanek wrote a post ranking the Trek films. Around that time, I had been reading through a special Rolling Stone edition titled "The Beatles: The Ultimate Album-by-Album Guide" and I got to thinking I would do a similar idea ranking the Beatles albums. And now, two years later, I finally got around to writing the post.
Why did it take me so long? Partially because I kept forgetting or delaying. But I also honestly agonized over this. I thought it would be fun, but then it started feeling more and more like I was trying to pick my all-time favorite Futurama episode (which is obviously the benchmark for tough decisions).
So a few disclaimers that I have to say or else I'll seriously feel guilty about writing this. First of all, a relatively poor ranking does not in any way mean I hate the album. Even the worst album is still awesome in its own way. It's all pretty subjective and based on my personal opinion, so since I generally like the middle-period the most it shouldn't be surprising those do relatively better. I tried to make the categories fairly broad in range. "Album layout" is based on the CD version, which I realize is different from how they incorporated it onto a record, but to me it was a useful way to quantify how all the songs sort of work together. "Overall enjoyability" is my way of comparing the albums to one another, since again even the poorly ranked albums I thoroughly enjoy (and since I enjoy them all so much, generally even the lower-ranked albums get a 5 or 6 in that category). And "Rock and Roll factor" does not necessarily mean "hard rock", as we typically imagine it meaning today; so I would still consider a softer or acoustic song like "All I've Got to Do" or "Norwegian Wood" pretty solid rock and roll. The "Shout Out" song from each album is either because I feel it's greatness is often overlooked or because it's simply an amazing song.
I tried to be stingy with the 10s, and afterwards I went back through my list and made myself dock each album more points in order to create some more variance. Interestingly, even with all of that there ended up being groupings of albums that naturally organized into tiers. It wasn't intentional, but I decided to include the tiers anyway. In the end, I was somewhat surprised where some of the albums ended up when I actually score them based on categories rather than just my gut feeling.
So, after that rather long introduction, here are my personal rankings starting with the worst tier, which is...
4th Tier: Something is Missing...
13. Yellow Submarine
Originality: 7
Re-playability: 2
Rock and Roll Factor: 3
Album Layout: 1
Impact/Longevity: 1
Overall Enjoyability: 2
Total: 16
No surprise here. It's not really a fair fight to begin with honestly: only six Beatles songs, two of which were already released. The other side is the classical music soundtrack for the film, not exactly what I would consider Beatles music. Originality is certainly not lacking, especially considering George wrote 1/3 of the songs (which admittedly amounts to 2 of them). However, the album was cobbled together and it really shows. Re-playability is a 2 only because it is so short, and the rock and roll factor was saved primarily by "Hey Bulldog" and George's two songs. Ironically, "Hey Bulldog" has always been one of their most "rockin'" tunes for me. It's a shame it was stashed away on such a weak album.
Shout Out: "Hey Bulldog"
12. Let it Be
Originality: 6
Re-playability: 2
Rock and Roll Factor: 6
Album Layout: 3
Impact/Longevity:3
Overall Enjoyability: 3
Total: 23
This score didn't surprise me all that much either. Let it Be is hurt a bit by the fact that it was basically cobbled together like Yellow Submarine, albeit with a little more care. I guess they were going for a live sound, but it makes a lot of the songs sound sloppy. And the odd half-songs like "Maggie Mae" and "Dig It" hurt the album layout and make it tough for me to really care, especially with "Dig It" since I think it would have been a decent song had they completed it. And "The Long and Winding Road" is a little too much for me, although in Paul's defense I guess it was intended to be much more toned down than what the producer Phil Spector made it out to be and in that way I think it could have been a fine song. Both re-playability and the album's impact are very personalized scores, because I listen to the album comparatively rarely and hence its impact on me is limited. I should maybe note that I'm referring to the original album, not the Let it Be... Naked version, which apparently cleans a lot of that stuff up. In the end, it wouldn't change its order in the rankings, though. When you consider all the fighting between the band and that it was their last released album (though much of it was actually recorded earlier than Abbey Road) it's a rather sad way for the Beatles discography to end (ignoring all the compilations and oddball Christmas albums, etc.).
Note: after writing this, I bought a copy of Let it Be... Naked. It is remarkably better, but overall the album would remain at #12. Still though - much improved.
Shout Out: "Dig A Pony"
11. A Hard Day's Night
Originality: 8
Re-playability: 3
Rock and Roll Factor: 3
Album Layout: 6
Impact/Longevity: 4
Overall Enjoyability: 6
Total: 30
This album has always been something of a mystery for me: for no particular reason, I've always struggled to really get into it like I do the other albums. It's a fine record, but something about it has never quite worked for me. The originality is pretty solid, considering it was their first album devoid of cover songs. But on the other hand, there isn't a whole lot of variability with the songs. There's a lot of acoustic stuff, and while I said that doesn't necessarily hurt the rock and roll factor, it kind of does when it permeates the album so much. That being said, some really great softer or acoustic songs appear on this album, such as "I Should Have Known Better" and "And I Love Her". In the end, it's an album that's at something of a crossroads in Beatles history and you can definitely see the maturation of their song-writing.
Shout Out: "Things We Said Today"
3rd Tier: Pretty Awesome
10. Magical Mystery Tour
Originality: 7
Re-playability: 2
Rock and Roll Factor: 4
Album Layout: 5
Impact/Longevity: 8
Overall Enjoyability: 5
Total: 31
Well, there are unquestionably a lot of unique songs, that's for sure: an instrumental ("Flying"), a song written to deliberately confuse people obsessing over the meaning of lyrics ("I Am the Walrus"), and even a song that borders on show tunes ("Your Mother Should Know"). In a way, though, that is what interrupts the flow of the album for me: the opposite of A Hard Days Night, there are so many different styles of music on one album. I know most stoner-rock fans would object to its rock and roll factor being 4, and I am sort of torn in that regard, but some of the songs really do stray from rock and roll and just enter into "weird" territory. That's not necessarily bad, but it's hard for me to get in a rock-and-roll mood that way, especially on a fairly short record. There's a lot of Paul on this album, and as a result sometimes that makes the album end up more bubblegum or pop-ish; hence you get songs like "Penny Lane" and "Your Mother Should Know". Some of these songs are great, but they make the record seem disjointed.
Shout Out: "Magical Mystery Tour" (this could be a stretch, but to me this song could be an early example of ska music).
9. Please Please Me
Originality: 4
Re-playability: 6
Rock and Roll Factor: 6
Album layout: 8
Impact/Longevity: 3
Overall Enjoyability: 6
Total: 33
As a kid Please Please Me was always sort of forgettable, but for some reason the older I get the more I love this album. The history itself is pretty impressive: recorded in a single day, over the course of a 10-hour session where the band actually practiced and planned songs during their lunch. Please Please Me is essentially the group's live show and has become a way for me to imagine hearing them play at the Cavern during their early days. It has that raw, classic rock and roll feel and always seems like the Beatles at their purest. The re-playability is pretty good because it's such a fast-paced album, but it's hurt a bit by its lack of longevity to me: I was introduced to the album a lot later than most of the others so it took longer to appreciate it, and to me songs like "Chains" and "Boys" work a lot better in a more chaotic, live show setting than on a recording.
Adding to the impressive history of the album, John had a cold during the recording sessions. You can hear it pretty easily in the shout out.
Shout Out: "Anna (Go to Him)"
8. The Beatles (The White Album)
Originality: 8
Re-playability: 3
Rock and Roll Factor: 10
Album Layout: 4
Impact/Longevity: 5
Overall Enjoyability: 6
Total: 36
If I had to sum up the White Album in one word it would be "chaos". That's not a bad thing, the album is definitely fun to listen to, but in the end it's what hurts the overall enjoyability for me, because my God the weird songs are distracting. It also affects how I view the album layout (I also took an extra point off simply for their decision to keep the junk song "Wild Honey Pie" on there). It's just hard to get into the album when you go from "Revolution 1" to "Honey Pie." The length of the album keeps the rock and roll factor high for me: there's so many songs that they cancel out the throwaways like "Why Don't We Do It in the Road" and "Good Night". On the other hand, while I'll gladly listen to some of the songs over again, I almost never play the whole album a second time through due to the length. All the negatives aside, this album has some amazing songs on it, like "Birthday", "Glass Onion", and "I Will". It was tough choosing a shout out.
Shout Out: "Savoy Truffle"
7. Beatles For Sale
Originality: 7
Re-playability: 9
Rock and Roll Factor: 6
Album Layout: 7
Impact/Longevity: 3
Overall Enjoyability: 8
Total: 40
Beatles for Sale has always been solidly in the middle for me. It's only weakness is that it doesn't quite have the impact that other albums have had, although it has to be their most underrated record. All the songs on it are pretty great, with the exception of "Mr. Moonlight", and it has a good mix of classic rock and love songs, with some new songs that made a bigger leap in originality than the previous A Hard Day's Night, in my opinion. There are covers again, but apparently they were rushed during the recording so that can be excused (that sounds like I don't like the cover songs, which isn't the case. I just meant as far as originality is concerned). Also, the cover songs have a bigger Beatles "twist" to them. I also get this sense that the softer songs are more soft rock than A Hard Days Night as well, but that's pretty subjective I guess. I could re-rank the albums again in 10 years and see a lot of variability, but Beatles For Sale would most likely still be solidly in the middle. It's a great album.
Shout Out: "Baby's in Black"
2nd Tier: Solid Though-and-Through
6. Sgt. Pepper's Lonely Hearts Club Band
Originality:10
Re-playability: 4
Rock and Roll Factor: 5
Album Layout: 10
Impact/Longevity: 9
Overall Enjoyability: 6
Total: 44
If this blog was read by people outside of our circle, this is where I would expect to get some flak and claims that I simply don't know The Beatles. I love the album, but similar to Magical Mystery Tour it's just sort of all over the place. That's great, and the theme style is pretty original, but I always feel like the album is slightly distracting. I'm flexible about what is "rock" music, but it's tough to call the whole middle of the album rock and roll, with songs like "She's Leaving Home" and "Within You Without You". I've said it a million times already, but: both of those songs are amazing and really add to the originality of The Beatles as a whole, but you can't really put them on as background music at a party or something. And while I can and do listen to songs like "Lovely Rita", "Good Morning Good Morning", and "A Day in the Life" over and over, as an entire album usually once through is enough for me. One minor aside, here: say what you want about the movie Across the Universe, but after seeing it I suddenly found myself enjoying "With a Little Help From My Friends" a whole lot more. Ultimately, this album knocked my socks off the first time I heard it and it ranks ahead of the majority of the pack. In hindsight, I would have liked to see more John and George on the album, though. (Paul has lead vocals on 7 of the 13 songs).
Shout Out: "Lovely Rita"
5. With the Beatles
Originality: 5
Re-playability: 6
Rock and Roll Factor: 8
Album Layout: 10
Impact/Longevity: 8
Overall Enjoyability: 7
Total: 44
With the Beatles is similar to Please Please Me in that it comes close to a live show and displays the band at their purest, but everything seems up a notch from their first record. It comes off as thoroughly more rock and roll, albeit very classic rock and roll as opposed to their later records. Both have the same amount of cover songs, but the original tracks are more developed and advanced. To me the re-playability and overall enjoyability are linked, and that's one of the main strengths of this record: whether I'm attentively listening to each song or have it on in the background, I can replay With the Beatles quite a few times and still get excited when a song like "It Won't Be Long" or "Don't Bother Me" comes up next. And although it's tied with Sgt. Pepper, I gave With the Beatles the edge due to overall enjoyability. This was one of the first full Beatles albums I was introduced to as a kid, so it has some personal impact for me, but historically it was pretty huge as well. With the Beatles and Beatles for Sale are the two strongest arguments against people who claim the group's early stuff isn't any good (although I've found that often times the people who say that are stubbornly going to resist anything you say anyway). As for the shout out song, a hat tip to Rolling Stone's "The Beatles: The Ultimate Album-by-Album Guide" for this: "With the Beatles... leans heavily on double-tracked lead vocals. It isn't easy to do: The singer must record a second vocal track that is, ideally, a mirror image of the first. All of the Beatles were proficient at it, but on this cover of an obscure song by the Donays, Harrison is positively astounding." Listen to the pre-chorus. I couldn't have said it better.
Shout Out: "Devil in Her Heart"
4. Abbey Road
Originality:10
Re-playability: 6
Rock and Rock Factor: 10
Album Layout:6
Impact/Longevity: 8
Overall Enjoyability: 7
Total: 47
It might seem odd that Abbey Road and Meet the Beatles are ranked so close together, but to me that just illustrates how varied and amazing their styles of music were. The originality is pretty outstanding here: very little that seems forced (unlike The White Album), a rare song written by Ringo, a medley at the end, and my favorite Beatle, George, really shining with possibly the two best songs on the album, including my #1 song - "Something". Some may wonder why the album layout isn't higher considering the medley, and perhaps I was a bit harsh but the category took a huge hit with the song "Maxwell's Silver Hammer". Putting it on the album was bad enough, but placing it right after a brilliant song like "Something" is like having an obnoxious alarm jolt you awake from a perfect dream. Lastly, I feel like "Octopus's Garden" is somewhat underrated. It isn't the greatest song ever, and I used to dislike it a lot myself, but the more I listen to it the more I find myself enjoying it. The guitar solo is catchy and the lyrics are simple, in a good way. Sometimes you need a meaningful song like Lennon's "Give Peace a Chance", and sometimes you need something more lighthearted like "Octopus's Garden".
The shout-out would have been "Something", but since I already built it up enough I'll go with a more "under-the-radar" song:
Shout Out: "Oh! Darling"
1st Tier: Knock Your Socks Off
3. Revolver
Originality: 10
Re-playability: 8
Rock and Roll Factor: 8
Album Layout: 5
Impact/Longevity: 10
Overall Enjoyability: 9
Total: 50
If you had asked me to rank based solely on my gut feeling, I probably would have leaned towards Revolver as my favorite. Even broken down into categories, it's still awfully close to number 1 and probably has been at some point in my life. Whereas the metaphorical dam began to crack stylistically during Help! and Rubber Soul, it flat-out broke with Revolver and they discovered a whole new realm of originality. At the time of ranking them and writing this, though, I feel like the album layout ends up being it's only real shortcoming. It has some of the most unquestionably hard-rock songs they ever released, with "Taxman", "She Said She Said", "And Your Bird Can Sing", and "Tomorrow Never Knows". But it's sort of the randomness of the other songs that throws me off, and they're intermixed at odd places. "Eleanor Rigby" and "For No One" are astounding songs and offer a great change of pace, but there's just slightly too much off-pace stuff for one album. But the reason this record ranks so much higher than one like The White Album is because of the knock-your-socks-off quality of every song, whether it's softer, hard rock, or experimental. The personal impact for me is huge with this record, when as a kid it was almost difficult to fathom its awesomeness the first time I listened to it.
Shout Out: "She Said She Said"
2. Help!
Originality: 7
Re-playability: 10
Rock and Roll Factor: 7
Album Layout: 8
Impact/Longevity: 9
Overall Enjoyability: 10
Total: 51
I do know for a fact that this album has been number 1 for me before, and I could actually see the argument for a 10 in pretty much every category. Trying to be more critical, however, it fell just short of number 1. From first to last the record has a sort of flow to it, and while some songs end up being sort of ho-hum for me (sorry again, Ringo) they all work together to make an album I can just put on repeat and enjoy over and over (ironically, I believe this was one of their albums that was cobbled together rather quickly). Tied to the re-playability is the overall enjoyability, the only album to get a 10 in this category: it's always been my go-to album for when I want to just listen to the Beatles in general, since it fits almost any musical mood I'm in. It's always been slightly disappointing to me that Lennon was always so critical of their work in later years, and the movie Help! and the song "It's Always Love" are two examples of his criticism. To me, it just goes to show you that maybe the artists themselves are sometimes their biggest critics. And, perhaps, that you don't need to have the artist's approval to enjoy their work.
Shout Out: "It's Only Love"
Just for fun, here's the trailer for the movie Help! which ends up being just about as random as the movie itself. Despite the band itself being sort of ambivalent towards the movie, it's been one of my favorites since I was a kid.
1. Rubber Soul
Originality: 9
Re-playability: 8
Rock and Roll Factor: 10
Album Layout: 10
Impact/Longevity: 7
Overall Enjoyability: 9
Total: 53
I knew I had always enjoyed Rubber Soul, but I'm not sure I would have predicted it to be ranked number 1 (again, categorically speaking) until I actually analyzed it. Like Help!, there's an overall flow on this record but I think the band managed to actually take it to another level. The change of pace from song to song works in a complementary way, they experimented with new sounds (like the fuzz bass on "Think For Yourself") without doing it to distraction, and while there are comparatively few of my "all time favorite" songs on this album, it excels in the overall quality of every single track for me. Even the low point of the album, "Run For Your Life", is listenable if you ignore some of the worst lyrics the band ever wrote in their entire catalog (interestingly, I read John hated the song himself and it's one of the few opinions of the band from his later years that I thoroughly agree with: it alone holds the album back to any degree for me). Some may wonder why the rock and roll factor ranked higher than Revolver, but to me it's the same as I mentioned above: when there are experimental or slower songs, they still retain their rock and roll roots. Plus, "Think For Yourself", "Drive My Car", and "The Word" are comparable to most harder rock songs on Revolver. For the past few years, I'm more likely to either play this record on repeat or sit down and listen to it song by song than any other. For that and everything else I mentioned, I crown it as the number 1 Beatles album.
Shout Out: "Think For Yourself"
Considering how long this post is, I actually felt like I've left out so much more that I wanted to include. But as for the rest of the guys here, how do you rank the albums? I would be interested in comparing.
Why did it take me so long? Partially because I kept forgetting or delaying. But I also honestly agonized over this. I thought it would be fun, but then it started feeling more and more like I was trying to pick my all-time favorite Futurama episode (which is obviously the benchmark for tough decisions).
So a few disclaimers that I have to say or else I'll seriously feel guilty about writing this. First of all, a relatively poor ranking does not in any way mean I hate the album. Even the worst album is still awesome in its own way. It's all pretty subjective and based on my personal opinion, so since I generally like the middle-period the most it shouldn't be surprising those do relatively better. I tried to make the categories fairly broad in range. "Album layout" is based on the CD version, which I realize is different from how they incorporated it onto a record, but to me it was a useful way to quantify how all the songs sort of work together. "Overall enjoyability" is my way of comparing the albums to one another, since again even the poorly ranked albums I thoroughly enjoy (and since I enjoy them all so much, generally even the lower-ranked albums get a 5 or 6 in that category). And "Rock and Roll factor" does not necessarily mean "hard rock", as we typically imagine it meaning today; so I would still consider a softer or acoustic song like "All I've Got to Do" or "Norwegian Wood" pretty solid rock and roll. The "Shout Out" song from each album is either because I feel it's greatness is often overlooked or because it's simply an amazing song.
I tried to be stingy with the 10s, and afterwards I went back through my list and made myself dock each album more points in order to create some more variance. Interestingly, even with all of that there ended up being groupings of albums that naturally organized into tiers. It wasn't intentional, but I decided to include the tiers anyway. In the end, I was somewhat surprised where some of the albums ended up when I actually score them based on categories rather than just my gut feeling.
So, after that rather long introduction, here are my personal rankings starting with the worst tier, which is...
4th Tier: Something is Missing...
13. Yellow Submarine
Originality: 7
Re-playability: 2
Rock and Roll Factor: 3
Album Layout: 1
Impact/Longevity: 1
Overall Enjoyability: 2
Total: 16
No surprise here. It's not really a fair fight to begin with honestly: only six Beatles songs, two of which were already released. The other side is the classical music soundtrack for the film, not exactly what I would consider Beatles music. Originality is certainly not lacking, especially considering George wrote 1/3 of the songs (which admittedly amounts to 2 of them). However, the album was cobbled together and it really shows. Re-playability is a 2 only because it is so short, and the rock and roll factor was saved primarily by "Hey Bulldog" and George's two songs. Ironically, "Hey Bulldog" has always been one of their most "rockin'" tunes for me. It's a shame it was stashed away on such a weak album.
Shout Out: "Hey Bulldog"
12. Let it Be
Originality: 6
Re-playability: 2
Rock and Roll Factor: 6
Album Layout: 3
Impact/Longevity:3
Overall Enjoyability: 3
Total: 23
This score didn't surprise me all that much either. Let it Be is hurt a bit by the fact that it was basically cobbled together like Yellow Submarine, albeit with a little more care. I guess they were going for a live sound, but it makes a lot of the songs sound sloppy. And the odd half-songs like "Maggie Mae" and "Dig It" hurt the album layout and make it tough for me to really care, especially with "Dig It" since I think it would have been a decent song had they completed it. And "The Long and Winding Road" is a little too much for me, although in Paul's defense I guess it was intended to be much more toned down than what the producer Phil Spector made it out to be and in that way I think it could have been a fine song. Both re-playability and the album's impact are very personalized scores, because I listen to the album comparatively rarely and hence its impact on me is limited. I should maybe note that I'm referring to the original album, not the Let it Be... Naked version, which apparently cleans a lot of that stuff up. In the end, it wouldn't change its order in the rankings, though. When you consider all the fighting between the band and that it was their last released album (though much of it was actually recorded earlier than Abbey Road) it's a rather sad way for the Beatles discography to end (ignoring all the compilations and oddball Christmas albums, etc.).
Note: after writing this, I bought a copy of Let it Be... Naked. It is remarkably better, but overall the album would remain at #12. Still though - much improved.
Shout Out: "Dig A Pony"
11. A Hard Day's Night
Originality: 8
Re-playability: 3
Rock and Roll Factor: 3
Album Layout: 6
Impact/Longevity: 4
Overall Enjoyability: 6
Total: 30
This album has always been something of a mystery for me: for no particular reason, I've always struggled to really get into it like I do the other albums. It's a fine record, but something about it has never quite worked for me. The originality is pretty solid, considering it was their first album devoid of cover songs. But on the other hand, there isn't a whole lot of variability with the songs. There's a lot of acoustic stuff, and while I said that doesn't necessarily hurt the rock and roll factor, it kind of does when it permeates the album so much. That being said, some really great softer or acoustic songs appear on this album, such as "I Should Have Known Better" and "And I Love Her". In the end, it's an album that's at something of a crossroads in Beatles history and you can definitely see the maturation of their song-writing.
Shout Out: "Things We Said Today"
3rd Tier: Pretty Awesome
10. Magical Mystery Tour
Originality: 7
Re-playability: 2
Rock and Roll Factor: 4
Album Layout: 5
Impact/Longevity: 8
Overall Enjoyability: 5
Total: 31
Well, there are unquestionably a lot of unique songs, that's for sure: an instrumental ("Flying"), a song written to deliberately confuse people obsessing over the meaning of lyrics ("I Am the Walrus"), and even a song that borders on show tunes ("Your Mother Should Know"). In a way, though, that is what interrupts the flow of the album for me: the opposite of A Hard Days Night, there are so many different styles of music on one album. I know most stoner-rock fans would object to its rock and roll factor being 4, and I am sort of torn in that regard, but some of the songs really do stray from rock and roll and just enter into "weird" territory. That's not necessarily bad, but it's hard for me to get in a rock-and-roll mood that way, especially on a fairly short record. There's a lot of Paul on this album, and as a result sometimes that makes the album end up more bubblegum or pop-ish; hence you get songs like "Penny Lane" and "Your Mother Should Know". Some of these songs are great, but they make the record seem disjointed.
Shout Out: "Magical Mystery Tour" (this could be a stretch, but to me this song could be an early example of ska music).
9. Please Please Me
Originality: 4
Re-playability: 6
Rock and Roll Factor: 6
Album layout: 8
Impact/Longevity: 3
Overall Enjoyability: 6
Total: 33
As a kid Please Please Me was always sort of forgettable, but for some reason the older I get the more I love this album. The history itself is pretty impressive: recorded in a single day, over the course of a 10-hour session where the band actually practiced and planned songs during their lunch. Please Please Me is essentially the group's live show and has become a way for me to imagine hearing them play at the Cavern during their early days. It has that raw, classic rock and roll feel and always seems like the Beatles at their purest. The re-playability is pretty good because it's such a fast-paced album, but it's hurt a bit by its lack of longevity to me: I was introduced to the album a lot later than most of the others so it took longer to appreciate it, and to me songs like "Chains" and "Boys" work a lot better in a more chaotic, live show setting than on a recording.
Adding to the impressive history of the album, John had a cold during the recording sessions. You can hear it pretty easily in the shout out.
Shout Out: "Anna (Go to Him)"
8. The Beatles (The White Album)
Originality: 8
Re-playability: 3
Rock and Roll Factor: 10
Album Layout: 4
Impact/Longevity: 5
Overall Enjoyability: 6
Total: 36
If I had to sum up the White Album in one word it would be "chaos". That's not a bad thing, the album is definitely fun to listen to, but in the end it's what hurts the overall enjoyability for me, because my God the weird songs are distracting. It also affects how I view the album layout (I also took an extra point off simply for their decision to keep the junk song "Wild Honey Pie" on there). It's just hard to get into the album when you go from "Revolution 1" to "Honey Pie." The length of the album keeps the rock and roll factor high for me: there's so many songs that they cancel out the throwaways like "Why Don't We Do It in the Road" and "Good Night". On the other hand, while I'll gladly listen to some of the songs over again, I almost never play the whole album a second time through due to the length. All the negatives aside, this album has some amazing songs on it, like "Birthday", "Glass Onion", and "I Will". It was tough choosing a shout out.
Shout Out: "Savoy Truffle"
7. Beatles For Sale
Originality: 7
Re-playability: 9
Rock and Roll Factor: 6
Album Layout: 7
Impact/Longevity: 3
Overall Enjoyability: 8
Total: 40
Beatles for Sale has always been solidly in the middle for me. It's only weakness is that it doesn't quite have the impact that other albums have had, although it has to be their most underrated record. All the songs on it are pretty great, with the exception of "Mr. Moonlight", and it has a good mix of classic rock and love songs, with some new songs that made a bigger leap in originality than the previous A Hard Day's Night, in my opinion. There are covers again, but apparently they were rushed during the recording so that can be excused (that sounds like I don't like the cover songs, which isn't the case. I just meant as far as originality is concerned). Also, the cover songs have a bigger Beatles "twist" to them. I also get this sense that the softer songs are more soft rock than A Hard Days Night as well, but that's pretty subjective I guess. I could re-rank the albums again in 10 years and see a lot of variability, but Beatles For Sale would most likely still be solidly in the middle. It's a great album.
Shout Out: "Baby's in Black"
2nd Tier: Solid Though-and-Through
6. Sgt. Pepper's Lonely Hearts Club Band
Originality:10
Re-playability: 4
Rock and Roll Factor: 5
Album Layout: 10
Impact/Longevity: 9
Overall Enjoyability: 6
Total: 44
If this blog was read by people outside of our circle, this is where I would expect to get some flak and claims that I simply don't know The Beatles. I love the album, but similar to Magical Mystery Tour it's just sort of all over the place. That's great, and the theme style is pretty original, but I always feel like the album is slightly distracting. I'm flexible about what is "rock" music, but it's tough to call the whole middle of the album rock and roll, with songs like "She's Leaving Home" and "Within You Without You". I've said it a million times already, but: both of those songs are amazing and really add to the originality of The Beatles as a whole, but you can't really put them on as background music at a party or something. And while I can and do listen to songs like "Lovely Rita", "Good Morning Good Morning", and "A Day in the Life" over and over, as an entire album usually once through is enough for me. One minor aside, here: say what you want about the movie Across the Universe, but after seeing it I suddenly found myself enjoying "With a Little Help From My Friends" a whole lot more. Ultimately, this album knocked my socks off the first time I heard it and it ranks ahead of the majority of the pack. In hindsight, I would have liked to see more John and George on the album, though. (Paul has lead vocals on 7 of the 13 songs).
Shout Out: "Lovely Rita"
5. With the Beatles
Originality: 5
Re-playability: 6
Rock and Roll Factor: 8
Album Layout: 10
Impact/Longevity: 8
Overall Enjoyability: 7
Total: 44
With the Beatles is similar to Please Please Me in that it comes close to a live show and displays the band at their purest, but everything seems up a notch from their first record. It comes off as thoroughly more rock and roll, albeit very classic rock and roll as opposed to their later records. Both have the same amount of cover songs, but the original tracks are more developed and advanced. To me the re-playability and overall enjoyability are linked, and that's one of the main strengths of this record: whether I'm attentively listening to each song or have it on in the background, I can replay With the Beatles quite a few times and still get excited when a song like "It Won't Be Long" or "Don't Bother Me" comes up next. And although it's tied with Sgt. Pepper, I gave With the Beatles the edge due to overall enjoyability. This was one of the first full Beatles albums I was introduced to as a kid, so it has some personal impact for me, but historically it was pretty huge as well. With the Beatles and Beatles for Sale are the two strongest arguments against people who claim the group's early stuff isn't any good (although I've found that often times the people who say that are stubbornly going to resist anything you say anyway). As for the shout out song, a hat tip to Rolling Stone's "The Beatles: The Ultimate Album-by-Album Guide" for this: "With the Beatles... leans heavily on double-tracked lead vocals. It isn't easy to do: The singer must record a second vocal track that is, ideally, a mirror image of the first. All of the Beatles were proficient at it, but on this cover of an obscure song by the Donays, Harrison is positively astounding." Listen to the pre-chorus. I couldn't have said it better.
Shout Out: "Devil in Her Heart"
4. Abbey Road
Originality:10
Re-playability: 6
Rock and Rock Factor: 10
Album Layout:6
Impact/Longevity: 8
Overall Enjoyability: 7
Total: 47
It might seem odd that Abbey Road and Meet the Beatles are ranked so close together, but to me that just illustrates how varied and amazing their styles of music were. The originality is pretty outstanding here: very little that seems forced (unlike The White Album), a rare song written by Ringo, a medley at the end, and my favorite Beatle, George, really shining with possibly the two best songs on the album, including my #1 song - "Something". Some may wonder why the album layout isn't higher considering the medley, and perhaps I was a bit harsh but the category took a huge hit with the song "Maxwell's Silver Hammer". Putting it on the album was bad enough, but placing it right after a brilliant song like "Something" is like having an obnoxious alarm jolt you awake from a perfect dream. Lastly, I feel like "Octopus's Garden" is somewhat underrated. It isn't the greatest song ever, and I used to dislike it a lot myself, but the more I listen to it the more I find myself enjoying it. The guitar solo is catchy and the lyrics are simple, in a good way. Sometimes you need a meaningful song like Lennon's "Give Peace a Chance", and sometimes you need something more lighthearted like "Octopus's Garden".
The shout-out would have been "Something", but since I already built it up enough I'll go with a more "under-the-radar" song:
Shout Out: "Oh! Darling"
1st Tier: Knock Your Socks Off
3. Revolver
Originality: 10
Re-playability: 8
Rock and Roll Factor: 8
Album Layout: 5
Impact/Longevity: 10
Overall Enjoyability: 9
Total: 50
If you had asked me to rank based solely on my gut feeling, I probably would have leaned towards Revolver as my favorite. Even broken down into categories, it's still awfully close to number 1 and probably has been at some point in my life. Whereas the metaphorical dam began to crack stylistically during Help! and Rubber Soul, it flat-out broke with Revolver and they discovered a whole new realm of originality. At the time of ranking them and writing this, though, I feel like the album layout ends up being it's only real shortcoming. It has some of the most unquestionably hard-rock songs they ever released, with "Taxman", "She Said She Said", "And Your Bird Can Sing", and "Tomorrow Never Knows". But it's sort of the randomness of the other songs that throws me off, and they're intermixed at odd places. "Eleanor Rigby" and "For No One" are astounding songs and offer a great change of pace, but there's just slightly too much off-pace stuff for one album. But the reason this record ranks so much higher than one like The White Album is because of the knock-your-socks-off quality of every song, whether it's softer, hard rock, or experimental. The personal impact for me is huge with this record, when as a kid it was almost difficult to fathom its awesomeness the first time I listened to it.
Shout Out: "She Said She Said"
2. Help!
Originality: 7
Re-playability: 10
Rock and Roll Factor: 7
Album Layout: 8
Impact/Longevity: 9
Overall Enjoyability: 10
Total: 51
I do know for a fact that this album has been number 1 for me before, and I could actually see the argument for a 10 in pretty much every category. Trying to be more critical, however, it fell just short of number 1. From first to last the record has a sort of flow to it, and while some songs end up being sort of ho-hum for me (sorry again, Ringo) they all work together to make an album I can just put on repeat and enjoy over and over (ironically, I believe this was one of their albums that was cobbled together rather quickly). Tied to the re-playability is the overall enjoyability, the only album to get a 10 in this category: it's always been my go-to album for when I want to just listen to the Beatles in general, since it fits almost any musical mood I'm in. It's always been slightly disappointing to me that Lennon was always so critical of their work in later years, and the movie Help! and the song "It's Always Love" are two examples of his criticism. To me, it just goes to show you that maybe the artists themselves are sometimes their biggest critics. And, perhaps, that you don't need to have the artist's approval to enjoy their work.
Shout Out: "It's Only Love"
Just for fun, here's the trailer for the movie Help! which ends up being just about as random as the movie itself. Despite the band itself being sort of ambivalent towards the movie, it's been one of my favorites since I was a kid.
1. Rubber Soul
Originality: 9
Re-playability: 8
Rock and Roll Factor: 10
Album Layout: 10
Impact/Longevity: 7
Overall Enjoyability: 9
Total: 53
I knew I had always enjoyed Rubber Soul, but I'm not sure I would have predicted it to be ranked number 1 (again, categorically speaking) until I actually analyzed it. Like Help!, there's an overall flow on this record but I think the band managed to actually take it to another level. The change of pace from song to song works in a complementary way, they experimented with new sounds (like the fuzz bass on "Think For Yourself") without doing it to distraction, and while there are comparatively few of my "all time favorite" songs on this album, it excels in the overall quality of every single track for me. Even the low point of the album, "Run For Your Life", is listenable if you ignore some of the worst lyrics the band ever wrote in their entire catalog (interestingly, I read John hated the song himself and it's one of the few opinions of the band from his later years that I thoroughly agree with: it alone holds the album back to any degree for me). Some may wonder why the rock and roll factor ranked higher than Revolver, but to me it's the same as I mentioned above: when there are experimental or slower songs, they still retain their rock and roll roots. Plus, "Think For Yourself", "Drive My Car", and "The Word" are comparable to most harder rock songs on Revolver. For the past few years, I'm more likely to either play this record on repeat or sit down and listen to it song by song than any other. For that and everything else I mentioned, I crown it as the number 1 Beatles album.
Shout Out: "Think For Yourself"
Considering how long this post is, I actually felt like I've left out so much more that I wanted to include. But as for the rest of the guys here, how do you rank the albums? I would be interested in comparing.
Thursday, April 17, 2014
The week Obamacare won
This may be the week that "Obamacare" became "The Affordable Care Act." With the news that the law will cover more people that expected, cost less than expected, and only get better from here, now seems as good a time as any for the GOP to starting walking back their 5-year-long attempt to associate the law with Obama.
Let's take a look at where we are.
Exchange enrollment has exceeded expectationsLet's take a look at where we are.
The magic number of the 7 million enrollment target (downgraded to 6 million after the website fiasco) hasn't just been met, it's been vastly exceeded.
Obamacare Tears Down Goalposts: 8 Million Sign-Ups
President Barack Obama announced Thursday that 8 million Americans had enrolled in private health coverage under Obamacare -- the final evidence that the law signed up far more Americans than most would have thought possible during the doldrums of last fall.
The uninsurance rate continues to fall.
Enrollment in private coverage through the exchanges (and potentially into private employer-sponsored coverage as well) and in public coverage through the Medicaid expansion has been reaching the uninsured.
Health insurance gains since last fall hit 12 million, survey shows
President Obama’s health law has led to an even greater increase in health coverage than previously estimated, according to new Gallup survey data, which suggest that about 12 million previously uninsured Americans have gained coverage since last fall.
Premiums and ACA costs are lower than anticipated.
All this is going to be cheaper than expected. The price tag of the law has fallen as premiums have come in below projections.
Lower premiums (yes, really) drive down Obamacare’s expected costs, CBO says
The health-care law's expansion of insurance coverage will cost $104 billion less than projected over the next decade, according to revised estimates from nonpartisan budget analysts Monday. Obamacare's lower-than-expected costs will come largely because premiums will be cheaper than previously thought.
The CBO and the Society of Actuaries anticipate only modest premium growth next year.
Despite a few scattered vague predictions of double digit premium increases this year, the general expectation is that premium increases will be historically low.
Smaller premium hikes forecast in 2015 for Obamacare
Insurance premiums under Obamacare are projected to rise less than 3 percent in 2015, a smaller-than-expected jump as the health insurance exchanges enter their second year.
The CBO and Joint Committee on Taxation released a series of new estimates Monday on the law’s costs and the number of people it will cover.
New data signal smaller jump in health care costs
"The double-rate increases we've been hearing are probably exaggerated," says Dave Axene, a fellow with the Society of Actuaries, adding that there would be wide variation across the country. "That's not what we're seeing from the actuarial organizations — I guess we're being a little bit more optimistic."
The exchanges are about to get more competitive.
This year was only the beginning! Insurers were feeling out what the new marketplaces would be like and the strong enrollment numbers are convincing some to expand their participation in the exchanges and others to enter them for the first time. This is going to be especially important for small markets; for instance, New Hampshire only had a single insurer (Anthem) selling in its exchange this year. By the next open enrollment at the end of this year, that number will have grown to three competing insurers.
Insurers see brighter Obamacare skies
Health insurers got their first taste of Obamacare this year. And they want seconds.
Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.
Health care quality is improving.
The coverage expansions may be new this year but quality improvement isn't. The ACA has been working on that front for at least 2-3 years now and the results (while not news this week like the stories above are) are worth nothing.
National Committee for Quality Assurance -- State of Health Care Quality
This year [2012] we saw significant improvement in measures included in the Medicare Star rating pay-for-performance program for health plans that participate in Medicare Advantage. Although Medicare Advantage plans have reported on quality and results have been reported to consumers for many years, the Affordable Care Act required the Medicare program to make higher payments to health plans with better quality performance, starting in 2012. In addition to this new program, the Department of Health and Human Services established a demonstration program to complement it, making even higher payments to plans with better performance.
Obamacare Shows Hospital Savings as Patients Make Gains
Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law.
More hospitals improve quality of care
A larger number of hospitals are showing improvements in their quality of care said the Joint Commission in its annual report on quality and safety of hospitals.
All Pioneer ACOs improved quality; only third lowered costs
All 32 of the accountable care organizations in the program improved patient care and patient satisfaction against benchmarks, according to results shared with the Wall Street Journal in advance of their public release.
Is Obamacare working? Hospitals finally see drop in readmissions
New CMS figures show that the national rate of 30-day readmissions for Medicare patients dropped to 17.8% in November 2012 after spending years stuck at 19%—and White House officials say the Affordable Care Act deserves the credit.
The health care system is re-designing itself to start holding down costs and improving quality in the long-term.
The bigger question is whether health care reform is taking root to ensure that the system is on a sustainable footing going forward. And the evidence has been mounting that it is.
Do Structural Changes Drive the Recent Health Care Spending Slowdown? New Evidence
Value-based purchasing of hospital services has had a significant impact on hospital behavior. Hospitals are highly sensitive to changes in financial incentives. Movement away from a preponderance of fee-for-service payments is also likely to permanently alter hospital behavior. For instance, emphasis on reduced readmissions has reportedly changed how hospital managers think about care delivery, from the care delivered within their four walls towards coordinating care outside their four walls as they track patients as they return to the community or to various post acute care settings.
An observation is that hospitals and other providers are being called to change their care delivery models and business models as payment systems evolve. In a general sense this is leading to a re-engineering of care- slow to start with, but gaining momentum over time. The ACA, with its call for CMMI grants, shows the potential magnitude of private and public sector experiments with alternative organizational forms such as ACOs and medical homes in combination with payment system incentives in the form of payments for value, payment bundling and capitation and prompting the health care industry to reconsider delivery models that reduce incentives for volume of care under fee-for- service. As organizational forms and payment models evolve, augmentation of computing powers and more ready access to “big data” claims files emphasizes an ability to better understand the consequences of change in terms of clinical and economic outcomes.It's impossible to tell what effect any of this will have on the elections this year. While public opinion polling has generally shown that people don't want to scrap the law, it's also usually shown that they don't love it.
Unclear. But what does seem clear is that the ACA isn't going away anytime soon.
Wednesday, September 25, 2013
Then and now
Some fun with numbers.
Every year, give or take, the actuaries at the Centers for Medicare & Medicaid Services (CMS) come out with their projections of what total health spending across the entire economy is going to be over the next several years. CMS is also the entity that officially keeps track of total national health spending so these projections are taken pretty seriously. They released their most up-to-date projections a few days ago.
Back during the '08 presidential campaign, Obama used to (often in somewhat inartful language) promise that under his health plan the average family would save $2,500 per year. Despite some folks claiming this means he promised everyone's premiums would drop by $2,500, the correct way to understand this is as a pledge that out-of-control cost growth in health care would be brought into check, slowing to the point that spending is $2,500 lower than it otherwise would have been. It may still be higher next year than last, but spending will be lower than it was going to be and you'll have money in your pocket that you didn't expect to.
Now we're conflating total health spending across the entire economy and health insurance premiums (which are affected by other distributional factors) a bit here but when we talk about bending the health care cost curve we're talking about slowing the growth of total spending, with the thought that eventually premium growth will follow the trend.
We can compare the CMS actuaries' health spending projections released this month with those they released in 2008, back when on Obama was on the campaign trail:
The changes in their projections reflect the slowdown in health care spending growth that's taken root over the past few years. The total savings thanks to the slowdown from 2009-13 (i.e. the difference between the blue and red lines) alone are over a trillion dollars.
But we can zoom in on this year. It was thought that total health spending would be $3.3 trillion this year, had the cost trends of the 2008 era persisted. But they didn't. Instead, spending this year is closer to $2.9 trillion. The savings from that slowdown is about $390 billion--about $1,245 per person.
Given that the average household has 2.58 people, that means Obama's "$2,500 in savings" pledge would translate to $969 in savings per person in the average family. In other words, thanks to the health care spending slowdown, the savings that Candidate Obama sought have been achieved and then some.
The portion of the slowdown that can be attributed to health reform is currently up for debate but the (favorable) change in the spending picture since 2008 is undeniable.
Every year, give or take, the actuaries at the Centers for Medicare & Medicaid Services (CMS) come out with their projections of what total health spending across the entire economy is going to be over the next several years. CMS is also the entity that officially keeps track of total national health spending so these projections are taken pretty seriously. They released their most up-to-date projections a few days ago.
Back during the '08 presidential campaign, Obama used to (often in somewhat inartful language) promise that under his health plan the average family would save $2,500 per year. Despite some folks claiming this means he promised everyone's premiums would drop by $2,500, the correct way to understand this is as a pledge that out-of-control cost growth in health care would be brought into check, slowing to the point that spending is $2,500 lower than it otherwise would have been. It may still be higher next year than last, but spending will be lower than it was going to be and you'll have money in your pocket that you didn't expect to.
Now we're conflating total health spending across the entire economy and health insurance premiums (which are affected by other distributional factors) a bit here but when we talk about bending the health care cost curve we're talking about slowing the growth of total spending, with the thought that eventually premium growth will follow the trend.
We can compare the CMS actuaries' health spending projections released this month with those they released in 2008, back when on Obama was on the campaign trail:
The changes in their projections reflect the slowdown in health care spending growth that's taken root over the past few years. The total savings thanks to the slowdown from 2009-13 (i.e. the difference between the blue and red lines) alone are over a trillion dollars.
But we can zoom in on this year. It was thought that total health spending would be $3.3 trillion this year, had the cost trends of the 2008 era persisted. But they didn't. Instead, spending this year is closer to $2.9 trillion. The savings from that slowdown is about $390 billion--about $1,245 per person.
Given that the average household has 2.58 people, that means Obama's "$2,500 in savings" pledge would translate to $969 in savings per person in the average family. In other words, thanks to the health care spending slowdown, the savings that Candidate Obama sought have been achieved and then some.
The portion of the slowdown that can be attributed to health reform is currently up for debate but the (favorable) change in the spending picture since 2008 is undeniable.
Thursday, May 23, 2013
Unskew those premiums!
Six weeks ago when I posted Obamacare: What's in it for you? only a single state had released the rates filed for health insurers who intended to sell in its new marketplace under the law: Vermont. As of today that number has grown to seven states as next year's premiums slowly trickle out.
Earlier this month, House Republicans and conservative media began pushing the notion that premiums in the new marketplaces would be jumping 400% in the new marketplaces next year. That strikes me as slightly odd strategic positioning, as by setting expectations that low smaller premium increases are going to look good by comparison. Was conservative media again setting up the true believers for bitter, inconceivable disappointment (similar to last year, when they pretended that "unskewing" opinion polling revealed that Mitt Romney would coast to an easy electoral victory)?
I'll take away the suspense:
Dems: Early data show premiums falling under Obama health law
Washington:
Premiums drop, coverage expands in Washington's exchange
Oregon's 2014 health premium filings spark relief, questions
California:
ObamaCare plans cheaper than expected in key rate filing
Colorado's premiums (released yesterday) don't seem to have gotten enough analysis yet to allow a comparison--reportedly they're all over the map, as there are going to be over 800 plans for sale next year.
Division of Insurance Reviewing Hundreds of New Health Insurance Plans
I'm beginning to suspect that someone in GOP headquarters has badly mismanaged the expectations game.
Earlier this month, House Republicans and conservative media began pushing the notion that premiums in the new marketplaces would be jumping 400% in the new marketplaces next year. That strikes me as slightly odd strategic positioning, as by setting expectations that low smaller premium increases are going to look good by comparison. Was conservative media again setting up the true believers for bitter, inconceivable disappointment (similar to last year, when they pretended that "unskewing" opinion polling revealed that Mitt Romney would coast to an easy electoral victory)?
I'll take away the suspense:
Dems: Early data show premiums falling under Obama health law
Insurers have filed preliminary rates for 2014 in Maryland, Oregon, Rhode Island, Vermont and Washington state. In most cases, rates haven't spiked as a result of the healthcare law.
Premiums for the cheapest insurance plan in Oregon are expected to fall by an average of 11 percent, and customers in Washington could see a price drop of 21 percent for the cheapest policy, according to the Democratic summary of state rate filings.
Insurers in Vermont and Rhode Island said rate increases would not be significantly affected by the Affordable Care Act.But let's drill a little deeper into individual states, as well as the press their rate filing are getting in the media.
Washington:
Premiums drop, coverage expands in Washington's exchange
Despite predictions of rate shocks, most consumers in Washington state will actually see lower premiums and enhanced coverage when they buy insurance through the state's health insurance exchange.
Washington Insurance Commissioner Mike Kreidler on Tuesday released rates proposed by insurers, including Premera Blue Cross, Lifewise, Group Health Cooperative, BridgeSpan and Molina Health Care of Washington, for health plans they will sell on the state-run online marketplace, called the Washington Health Plan Finder, reported the Spokesman-Review.
And those prices don't include federal subsidies available to consumers, so the premiums that consumers will pay actually will be less than the rates proposed.
"We're pleasantly surprised with the individual rates we've seen so far," Kreidler said. "In many cases, people will get better benefits and pay less--especially if they qualify for subsidies."Oregon:
Oregon's 2014 health premium filings spark relief, questions
Massive health insurance premium hikes predicted as the inevitable result of federal reforms haven't materialized in Oregon.
The lower-than-expected preliminary rates come as much-needed good news for the Affordable Care Act. The law, passed in 2010, has been plagued by resistance in Congress and complaints of snafus as the Jan. 1 startup for expanded coverage draws closer.
"I was surprised that there were so many competitive rates and they were somewhat lower than I expected," says Rocky King of Cover Oregon, set up to help people and small businesses shop for insurance plans and qualify for tax credits starting in October.
California:
ObamaCare plans cheaper than expected in key rate filing
New insurance policies under President Obama's healthcare law will cost significantly less than expected in California.
The state released rate filings Thursday for the policies that will be sold through the health law's insurance exchange. Experts had been especially eager to see California's rates, and it is the first large state to release price information for next year.
The average plan will carry a monthly premium of $300, regulators said. Most people will receive a subsidy to help cover part of that cost, and cheaper options are also available.
The Congressional Budget Office predicted in 2009 that premiums for a middle-of-the-road exchange plan would come to about $5,200 per year.
Other states have seen their rates track relatively close to that figure, but California's plans came in substantially lower — about $3,600 per year before subsidies.
Colorado's premiums (released yesterday) don't seem to have gotten enough analysis yet to allow a comparison--reportedly they're all over the map, as there are going to be over 800 plans for sale next year.
Division of Insurance Reviewing Hundreds of New Health Insurance Plans
Denver – The Colorado Division of Insurance is reviewing hundreds of proposed new health insurance plans designed to offer coverage to consumers and small businesses starting January 1, 2014. The new plans must meet certain federal requirements for benefits and premiums, as outlined in the Affordable Care Act (ACA). This includes health plans sold through Connect for Health Colorado, the state’s new health insurance marketplace. It opens on October 1, 2013, offering plans that begin in 2014.
Health insurance carriers had until May 15 to submit their plans for review. A total of 17 carriers submitted a combined total of 813 health plans for the individual and small group markets. These will be sold through Connect for Health Colorado, as well as outside of the new marketplace.
“We are very encouraged by the number of health insurance carriers that want to participate in Colorado,” said DOI Commissioner Jim Riesberg. “As the regulatory agency charged with ensuring a competitive marketplace for health insurance companies in Colorado, we believe that a greater number of carriers means more choice for Colorado consumers.”
I'm beginning to suspect that someone in GOP headquarters has badly mismanaged the expectations game.
Wednesday, April 17, 2013
A Big Curriculum Vitae Cannot Hide an Ass Forever
I usually don't get into the middle of topics like these. Today, for some reason, this irked me in a way unlike other comments of its kind, probably because of the individual behind these statements:
Ben Carson is a renown neurosurgeon at Johns Hopkins, with an impressive range of publications and Chair appointments and whatnot. I'm not going to go into what a big deal he is, because you can probably see that on his wikipedia page. Or you can read one of his books and he'll tell you himself. The man has power in the medical community, and he has a reputation of being a technically gifted surgeon, good enough that people would seek him out when they had a particularly awful or rare disease. The man's 61 years old though, near retirement, and of late he has started to step from the medical world to the political realm as one of the republicans' alleged championed candidates for the next presidential election. He's a Seventh-Day Adventist Christian, and he's not afraid to let the world know his religiously-guided views.
Here's where I find his comments upsetting and ironic (besides comparing gay marriage with NAMBLA and bestiality, because, well, I assume most rational people think that's fucked up): In the clip, Carson describes the establishment of heterosexual marriage as a "well-established fundamental pillar of society" and says that gays, pedophiles, and zoophiles (had to look that one up) "don't get to change the definition [of marriage]." He goes on to say that he's against anyone who "wants to come along and change the fundamental definitions of the pillars of society."
Let's take a look at those statements. It seems to me that by "pillars of society" Dr. Carson is referring to the Seven Pillars of Society as defined by Christian followers. The Seven Pillars are: Government, Family, Business, Media, Education, Religion, and Arts & Entertainment. We could also take "pillars of society" to mean the American traditions that have been upheld for generations, which have become ingrained in our culture through the centuries. Either way, his argument here doesn't make much sense to me.
In his books, Dr. Carson relates the many barriers he had growing up. He was from a poor family, raised by a single mom, and he was an African American during a time that the vast majority of doctors were white. Color barriers were possibly the strongest walls he had to break through to become a physician, and he describes holding fast to his religion, which got him through many of his darkest hours. So what, you may ask?
Back in the day, slavery was defended with religion. Proponents would cite Bible verses to justify keeping slaves, to justify their mistreatment, and to sometimes justify raping them:
"slaves, obey your earthly masters with fear and trembling" (Ephesians 6:5), or "tell slaves to be submissive to their masters and to give satisfaction in every respect" (Titus 2:9).
If you asked slaveholders, opponents of slavery could be described as wanting to "change the fundamental pillars of society", to destroy the masters' livelihood and to directly disobey the Word of God. So what happened? Why don't we have slaves anymore? Those questions might anger some individuals, because the answer is so blatantly clear. A morally good society toppled the senseless, racist, absolutely evil practice of servitude with a Civil War, though the war for true integration of African Americans continued into the 20th Century (and still continues to this day, to be honest). Dr. Ben Carson was born (in 1951) at an interesting time, a time of intense racism, but a time where early integration was taking hold. He reaped some of the benefits of the bloodshed during the 19th Century, where those "pillars of society" were shaken and eventually brought to the ground. He could become a neurosurgeon because those pillars no longer existed and were ever-so-slowly being replaced by new ones.
Now Ben Carson is trying to reinforce other pillars, to prevent some individuals from achieving the same equality that he dreamed of as he went through school. To continue his analogy, and to make my views perfectly clear if they weren't before, I think that some ugly, moldy, fading, crumbling pillars of society need to be hit with a wrecking ball so newer, stronger ones can be built in their place to support the modern architecture of society. Interracial marriage and women's rights, as two examples, are other pillars recently constructed from the wreckage of age-old traditions. Not many sane people would argue that women need to stay in the kitchen and tend to children at home forever, but that wasn't the case only a few generations ago.
Unfortunately for Dr. Ben, not everyone seems to share his opinions on gay marriage. He was scheduled to speak at the commencement for Hopkins Medical School this year, but due to student protests over his comments, and the above statement by the dean of the school, he decided to step down from the job. Here's a quote from his apology letter to Johns Hopkins:
"Although I do believe marriage is between a man and a woman, there are much less offensive ways to make that point. I hope all will look at a lifetime of service over some poorly chosen words."
And here I will make my last point. The "poorly chosen words" that he describes refers to comparing homosexual individuals to pedophiles and zoophiles, not to his "pillars of society" comment. Not only is he an ass for saying these demeaning comments, to me it appears that his moral compass has somehow lost its center, if it was ever even magnetized correctly in the first place. For me, it is not these "poorly chosen words" that so angers me, it's his deep-rooted opinion of homosexuals within the recesses of his heart that truly upsets me. It upsets me that this man is (was?) a highly respected neurosurgeon, representative of not only himself or Johns Hopkins, but in a way a representative for physicians and the medical community, whether he wants to be or not. Even a lifetime of service, or a CV 60 pages long, doesn't change the fact that I no longer have a desire to shake his hand.
I wish to say, from a lowly soon-to-be doctor with respect for every patient regardless of their race, gender, or sexual orientation, to a seasoned, respected, accomplished, world-renown neurosurgeon with a giant CV:
Fuck you, Dr. Carson.
Ben Carson is a renown neurosurgeon at Johns Hopkins, with an impressive range of publications and Chair appointments and whatnot. I'm not going to go into what a big deal he is, because you can probably see that on his wikipedia page. Or you can read one of his books and he'll tell you himself. The man has power in the medical community, and he has a reputation of being a technically gifted surgeon, good enough that people would seek him out when they had a particularly awful or rare disease. The man's 61 years old though, near retirement, and of late he has started to step from the medical world to the political realm as one of the republicans' alleged championed candidates for the next presidential election. He's a Seventh-Day Adventist Christian, and he's not afraid to let the world know his religiously-guided views.
Here's where I find his comments upsetting and ironic (besides comparing gay marriage with NAMBLA and bestiality, because, well, I assume most rational people think that's fucked up): In the clip, Carson describes the establishment of heterosexual marriage as a "well-established fundamental pillar of society" and says that gays, pedophiles, and zoophiles (had to look that one up) "don't get to change the definition [of marriage]." He goes on to say that he's against anyone who "wants to come along and change the fundamental definitions of the pillars of society."
Let's take a look at those statements. It seems to me that by "pillars of society" Dr. Carson is referring to the Seven Pillars of Society as defined by Christian followers. The Seven Pillars are: Government, Family, Business, Media, Education, Religion, and Arts & Entertainment. We could also take "pillars of society" to mean the American traditions that have been upheld for generations, which have become ingrained in our culture through the centuries. Either way, his argument here doesn't make much sense to me.
In his books, Dr. Carson relates the many barriers he had growing up. He was from a poor family, raised by a single mom, and he was an African American during a time that the vast majority of doctors were white. Color barriers were possibly the strongest walls he had to break through to become a physician, and he describes holding fast to his religion, which got him through many of his darkest hours. So what, you may ask?
Back in the day, slavery was defended with religion. Proponents would cite Bible verses to justify keeping slaves, to justify their mistreatment, and to sometimes justify raping them:
"slaves, obey your earthly masters with fear and trembling" (Ephesians 6:5), or "tell slaves to be submissive to their masters and to give satisfaction in every respect" (Titus 2:9).
If you asked slaveholders, opponents of slavery could be described as wanting to "change the fundamental pillars of society", to destroy the masters' livelihood and to directly disobey the Word of God. So what happened? Why don't we have slaves anymore? Those questions might anger some individuals, because the answer is so blatantly clear. A morally good society toppled the senseless, racist, absolutely evil practice of servitude with a Civil War, though the war for true integration of African Americans continued into the 20th Century (and still continues to this day, to be honest). Dr. Ben Carson was born (in 1951) at an interesting time, a time of intense racism, but a time where early integration was taking hold. He reaped some of the benefits of the bloodshed during the 19th Century, where those "pillars of society" were shaken and eventually brought to the ground. He could become a neurosurgeon because those pillars no longer existed and were ever-so-slowly being replaced by new ones.
Now Ben Carson is trying to reinforce other pillars, to prevent some individuals from achieving the same equality that he dreamed of as he went through school. To continue his analogy, and to make my views perfectly clear if they weren't before, I think that some ugly, moldy, fading, crumbling pillars of society need to be hit with a wrecking ball so newer, stronger ones can be built in their place to support the modern architecture of society. Interracial marriage and women's rights, as two examples, are other pillars recently constructed from the wreckage of age-old traditions. Not many sane people would argue that women need to stay in the kitchen and tend to children at home forever, but that wasn't the case only a few generations ago.
Unfortunately for Dr. Ben, not everyone seems to share his opinions on gay marriage. He was scheduled to speak at the commencement for Hopkins Medical School this year, but due to student protests over his comments, and the above statement by the dean of the school, he decided to step down from the job. Here's a quote from his apology letter to Johns Hopkins:
"Although I do believe marriage is between a man and a woman, there are much less offensive ways to make that point. I hope all will look at a lifetime of service over some poorly chosen words."
And here I will make my last point. The "poorly chosen words" that he describes refers to comparing homosexual individuals to pedophiles and zoophiles, not to his "pillars of society" comment. Not only is he an ass for saying these demeaning comments, to me it appears that his moral compass has somehow lost its center, if it was ever even magnetized correctly in the first place. For me, it is not these "poorly chosen words" that so angers me, it's his deep-rooted opinion of homosexuals within the recesses of his heart that truly upsets me. It upsets me that this man is (was?) a highly respected neurosurgeon, representative of not only himself or Johns Hopkins, but in a way a representative for physicians and the medical community, whether he wants to be or not. Even a lifetime of service, or a CV 60 pages long, doesn't change the fact that I no longer have a desire to shake his hand.
I wish to say, from a lowly soon-to-be doctor with respect for every patient regardless of their race, gender, or sexual orientation, to a seasoned, respected, accomplished, world-renown neurosurgeon with a giant CV:
Fuck you, Dr. Carson.
Sunday, April 7, 2013
ObamaCare: What's in it for you?
A while back, Teej and I were discussing the Affordable Care Act (ACA) and what it could mean for him. I'm not sure my explanation of how it works at a practical level was particularly clear or useful. But this medium is a little more conducive to presenting complex concepts. So I'm going to try to lay it out here and illustrate in concrete terms what it means, using real live (not hypothetical) newly available numbers to go with it. This will all be from the perspective of an unmarried guy in his '20s, as that seems to be the readership, though the only thing that really changes for different household sizes is the particular numbers.
One disclaimer before we begin: this post is about the new insurance marketplaces being set up as we speak, and most people will not be buying through those marketplaces. If your income is lower than the thresholds we're going to talk about below, you'll be eligible for Medicaid--though the exchange website will still probably be your first stop on the way to getting coverage. The politics and policy of the Medicaid expansion are a topic for another post (or series of posts!). And if you get insurance through work, this won't apply to you. This is really about what happens to people who have to buy insurance on their own.
Enter TheExchange Marketplace
By way of introduction to all this, it's important to remember the basic change that's happening later this year and why. Most people with private health insurance have it through their jobs in the form of employer-sponsored insurance, the red piece of the pie to the right. While the ACA does affect those people a bit (mostly in the form of some new benefits and consumer protections), the insurance reform provisions of the law are primarily aimed elsewhere: at the individual market, the place where people who need to get insurance on their own shop for it.
In most states, people shopping in the individual market have far fewer consumer protections available to them than do people with employer-sponsored insurance. The insurance policies themselves are skimpier, premiums are more volatile, and "pre-existing condition" is a much deadlier phrase. And since those folks are buying insurance on their own (hence the name "individual market"), they lack the "strength in numbers" advantages that people in employer-sponsored group coverage enjoy. Only about 5% of the population currently gets health insurance through the individual market but expansions in private health insurance coverage will swell the ranks of the individual marketeers. But beyond people simply not being able to afford coverage or being turned away for pre-existing conditions, the individual market doesn't act much like a market:
That's from an excellent and relatively succinct overview of what problems health insurance exchanges--recently re-branded by HHS as Health Insurance Marketplaces--are being created to correct and how they're going to do it. The short, short version is that they're creating competitive, transparent, consumer-friendly marketplaces where the playing field is level between you and the insurance companies.
Starting in October of this year, people will be able to start shopping for insurance through them. While they were originally envisioned as being primarily state-designed and state-operated, political intransigence has led to HHS having to step up and run federally-facilitated exchanges in 33 states. But that's a story for another time. Let's get into what's going to be sold in these marketplaces.
Tiers of a Clown
Since part of what makes a market a market is offering consumers intelligible and meaningful choices, exchanges will have a way of organizing health insurance plan options to allow more apples-to-apples comparisons between them. Plans will be grouped into four tiers, named after metals:
The tiers represent varying levels of generosity across the plans. Note that this does not mean a platinum plan is offering more benefits than a bronze plan. All plans are required to offer a set of essential health benefits, a fairly comprehensive set of services across ten categories of coverage. Plans can offer more but they can't offer less.
The metal level instead refers to the health plan's actuarial value, a measure of what proportion of the costs for those benefits it can expect to cover for a given population. A bronze plan, for instance, will have roughly a 60% actuarial value, meaning that it will pay 60% of the costs of those benefits and enrollees will pay for the remainder of the costs through deductibles and coinsurance when they go to get care. These plans are the skimpiest metal plan, not in the sense that they cover fewer benefits but in the sense that they require you to pay for a larger proportion of them if you need to use those benefits. The tradeoff is that the monthly premiums will be lower.
Silver plans have a 70% actuarial value, gold 80%, and platinum 90%. As you climb the metal ladder, the monthly premiums increase but so does the generosity of the plan; if you need to use covered medical services, swankier metal plans will pick up more of the tab. Silver plans, as we'll see, are sort of the default option but shoppers in the exchanges can choose a plan from any metal tier they like.
A major part of the "affordable care" bit of the law's title is a reference to this table. The idea is that people buying health insurance in an exchange will have their income protected, i.e. the amount they have to spend on health insurance premiums will be capped at a certain percentage of their income.
So for instance someone at 150% of the poverty line will not be asked to pay more than 4% of his income on health insurance premiums. Meanwhile someone at 250% of the poverty line won't be asked to pay more than 6.3% of his income on premiums.
Now since we're thinking specifically of a single person, we can translate those percentages into dollar amounts. I'm going to base this on the 2013 poverty thresholds, which have the poverty line at $11,490. It might be slightly higher next year when the tax credits and exchanges become available, but that won't change what we find here very much. Here's the table above, recast in terms of the caps on what folks of various incomes pay on their premiums:
Remember that those numbers rise smoothly on a sliding scale within each tier. This should give you a rough estimate, based on your income, of the premium you would be asked to pay for the second cheapest silver plan in your area.
Not So Fast!
Seems simple enough, right? You don't even need to know what the actual premium the insurer is charging is going to be because your personal contribution to your premium is spelled out right there in black and white. But it can be as simple or complicated as you like.
This is because of the way the value of your tax credit is calculated. As we saw, the federal government is offering you some fixed sum of money equal to [Cost of 2nd cheapest silver plan] - [your required contribution]. That means if you buy that second cheapest silver plan, all you pay for your premium is your required contribution, as pulled from those tables above.
But you don't have to buy that particular plan. You're well within your rights to buy a more expensive silver plan, or a gold or platinum plan. The government still gives you that fixed amount of money and you have to cover the rest of the cost of the plan. Obviously that means you would end up paying more--maybe a lot more--than the tables above would suggest.
On the other hand, you could also opt for a cheaper plan. That might be the very cheapest silver plan or a bronze-level plan. In that case, you still get the full value of the subsidy, meaning your own required contribution is going to go down.
Let's All Go to Vermont
Let's illustrate with a real example using actual premium values. Right now exchanges are soliciting interest from insurance companies who might participate later this year and they're asking them to submit information on how much they will charge in premiums. Most states (and the federal government) are going to let those numbers trickle in over the next 1-3 months. But one state, Vermont, has finished that process and recently made the numbers public.
They put together two tables collecting those premium numbers here. (As an aside, you'll notice that there are two tables because one lists prices for Standard Qualified Health Plans (QHPs) and one lists prices for Non-Standard Qualified Health Plans. In putting out feelers to insurance companies to see if they would sell in the exchange, Vermont made clear that participating insurers will have to sell plans with certain standard designs, meaning the plans' deductibles and co-insurance requirements for different services have to be what the state specified. You can see the specifications for the standard plans starting on page 50 of this document. However, in addition to those plans the insurers are allowed to innovate and sell other "non-standard" plans with different designs. Both kinds of plans "count" when figuring out what the cheapest silver plan is.)
Let's look at just silver plans available to a single person shopping in the Vermont exchange. Between the two insurers selling them, Blue Cross Blue Shield of Vermont (BCBSVT) and MVP, there are eight different silver plans you could choose from. The second cheapest one on the market is BCBSVT's non-standard "Blue for You" plan (listed on the second page of that document), weighing in at $413.03 per month.
So now we have the value of the tax credit you have to play with, dear Vermonter. It's going to be $413.03 minus your required monthly contribution. So let's suppose you're making exactly $22,980. Convenient! According to our table, that means that if you buy that Blue for You plan your contribution to the premium will be $121 per month. The government's subsidy to you is $413 - $121 = $292. (For simplicity's sake, let's ignore the 3 cents).
But maybe you don't want to buy the Blue for You silver plan. You're an extravagant type and you want the top of the line: MVP's $614.77 per month platinum plan. You can go buy it and put the government's $292 toward it but that means you're on the hook for paying the other $322.77 every month.
Or maybe you want to go the other way. You're looking to minimize your own premium contribution and so you hone in on the cheapest metal plan on the market: BCBSVT's "Blue for You CDHP" bronze plan. That's $350.08 per month. You still get to put the government's $292 toward that plan, which leaves you on the hook for only about $58 per month. Significantly less than the $121 you'd be paying if you went for the silver plan to which the subsidy's value is pegged. Indeed, for people with lower income than you (who are thus eligible for a larger federal subsidy), they can get their own contribution down to zero for some of the bronze plans. Of course, their own required contribution for the benchmark silver plan is correspondingly smaller than yours and so they don't lose much in paying it and opting for the more generous coverage of a silver plan.
Back to the figure, this time expanded. You can see from the varying total heights of the bars below the difference in total plan costs from plan to plan. The platinum plan on the far right is the most expensive and so it's correspondingly the tallest. It also requires you to pay the most for your premiums, since the federal share of the costs (the tax credit) has a fixed value.
As this visually (hopefully) makes clear, you can vary your actual monthly contribution to the premium, represented as the red share of the total premium, by choosing cheaper or more expensive insurance plans.
The numbers in this section, of course, are unique to Vermont. The actual premiums and the number of plans to choose from will vary from state to state, although the numbers aren't likely to vary substantially from the Vermont examples we've looked at here.
A word of caution
It's worth noting that there's a special benefit to buying a silver plan. The ACA doesn't just provide subsidies for health insurance premiums, it also provides subsidies for cost-sharing. That means it will help you pay for part of your deductible if you need care, as well as part of your co-pays or co-insurance. However, while the premium tax credit can accompany you to any coverage tier and be applied to any plan, the same is not true of the cost-sharing subsidies: the cost-sharing subsidies are only available if you buy a silver plan. If you buy a bronze plan to get your premium contribution as low as possible, should something happen and you actually need care you'll have a very large deductible (in Vermont's standard bronze plan designs, the deductible is around $2,000) to grapple with and no help in doing so. Something to keep in mind.
Secret Option F
There's one other option in the exchanges I haven't mentioned. This is a plan type that's available only to people under 30 (or people who otherwise don't have access to an affordable plan). It's called a catastrophic plan and is designed specifically to offer less generous coverage than any of the metal tiers. Why is this desirable? It was felt that since young people are less likely to use coverage, they'd be more willing and eager to buy a lower-premium, high-risk "young invincibles" plan than more standard coverage.
However, if you choose the catastrophic option you get no financial assistance. While you can take your federal tax credit and put it toward any plan bronze through platinum, you cannot put it toward a catastrophic plan. The entire premium is on you. And it probably goes without saying that you'll also have no help in paying for the cost-sharing, which by design is sizable in these plans.
Everybody Got That?
Hopefully this was clear enough to give you a sense of what you can expect if you end up buying insurance through an exchange. Comments welcome--if something's unclear or underdeveloped, I'm happy to revise.
One more thing: if the exchange does its job right, you won't actually have to know any of this. You'll fill out the application and it will figure out what you're eligible for and explain to you what you can and cannot apply it to. You won't need to sit there with a calculator and a set of tables to figure things out.
One disclaimer before we begin: this post is about the new insurance marketplaces being set up as we speak, and most people will not be buying through those marketplaces. If your income is lower than the thresholds we're going to talk about below, you'll be eligible for Medicaid--though the exchange website will still probably be your first stop on the way to getting coverage. The politics and policy of the Medicaid expansion are a topic for another post (or series of posts!). And if you get insurance through work, this won't apply to you. This is really about what happens to people who have to buy insurance on their own.
Enter The
 |
| CBO's February 2013 estimates |
In most states, people shopping in the individual market have far fewer consumer protections available to them than do people with employer-sponsored insurance. The insurance policies themselves are skimpier, premiums are more volatile, and "pre-existing condition" is a much deadlier phrase. And since those folks are buying insurance on their own (hence the name "individual market"), they lack the "strength in numbers" advantages that people in employer-sponsored group coverage enjoy. Only about 5% of the population currently gets health insurance through the individual market but expansions in private health insurance coverage will swell the ranks of the individual marketeers. But beyond people simply not being able to afford coverage or being turned away for pre-existing conditions, the individual market doesn't act much like a market:
One of the great challenges in buying health insurance has been a highly fragmented market. Individuals and group purchasers lack a reliable means for seeing their choices in one place and in a manner that allows them to compare what the plans cover, which providers are in various plans’ practice networks, how cost-sharing might differ, and how numerous competing plans might compare on key measures of quality performance. Nor has there been an active, consumer-oriented system for assuring that insurance plans that are offered in the individual and small group markets provide comparable coverage, cover the benefits that are considered essential to any health insurance plan, have accessible provider networks, and are accountable for specific measures of health care quality.
That's from an excellent and relatively succinct overview of what problems health insurance exchanges--recently re-branded by HHS as Health Insurance Marketplaces--are being created to correct and how they're going to do it. The short, short version is that they're creating competitive, transparent, consumer-friendly marketplaces where the playing field is level between you and the insurance companies.
Starting in October of this year, people will be able to start shopping for insurance through them. While they were originally envisioned as being primarily state-designed and state-operated, political intransigence has led to HHS having to step up and run federally-facilitated exchanges in 33 states. But that's a story for another time. Let's get into what's going to be sold in these marketplaces.
Tiers of a Clown
 |
| While factors like your gender and medical history won't raise your premiums, smoking will. |
Platinum
Gold
Silver
Bronze
The tiers represent varying levels of generosity across the plans. Note that this does not mean a platinum plan is offering more benefits than a bronze plan. All plans are required to offer a set of essential health benefits, a fairly comprehensive set of services across ten categories of coverage. Plans can offer more but they can't offer less.
The metal level instead refers to the health plan's actuarial value, a measure of what proportion of the costs for those benefits it can expect to cover for a given population. A bronze plan, for instance, will have roughly a 60% actuarial value, meaning that it will pay 60% of the costs of those benefits and enrollees will pay for the remainder of the costs through deductibles and coinsurance when they go to get care. These plans are the skimpiest metal plan, not in the sense that they cover fewer benefits but in the sense that they require you to pay for a larger proportion of them if you need to use those benefits. The tradeoff is that the monthly premiums will be lower.
Silver plans have a 70% actuarial value, gold 80%, and platinum 90%. As you climb the metal ladder, the monthly premiums increase but so does the generosity of the plan; if you need to use covered medical services, swankier metal plans will pick up more of the tab. Silver plans, as we'll see, are sort of the default option but shoppers in the exchanges can choose a plan from any metal tier they like.
The Tax Credit
If you're eligible, when you shop for coverage through an exchange a subsidy will be made available to you to help you pay for an insurance plan (and if you're eligible for Medicaid instead, the exchange application process will let you know that and help you in enroll in it). Technically you'll get a refundable, advanceable tax credit. Refundable because its value can actually exceed your total tax burden, in which case the government is giving you money. Advanceable because you don't have to wait until tax time to get it back, it's available upfront when you go to buy insurance--so none of that money actually has to come out of your pocket.
Though HHS is still working the kinks out of their draft of the application process, they've produced a video to show you what the process will be like for a single person:
But how does the tax credit work? Its value will be pegged to the cost of a certain silver plan in your marketplace--the second cheapest silver plan--through a fairly simple formula:
[Value of the federal subsidy] = [Cost of 2nd cheapest silver plan] - [your required contribution]
What that says it that there's some amount of the premium you'll have to pay for the second cheapest silver plan, and then the federal government will pay for the rest of it. Or in picture form:
As we'll see a little more clearly later, this particular insurance plan just serves as the benchmark for calculating the size of the federal subsidy to which you're entitled. You don't have to actually buy that particular silver plan to get the tax credit.
Structuring the subsidy this way helps to retain the incentives and dynamics that should undergird markets. More expensive plans cost consumers more, as they should. Consumers still have incentives to buy less expensive plans (or at least carefully weigh the costs and benefits of buying more expensive plans) and insurers still have an incentive to offer the cheapest plans in the market, because those are the plans that will be most attractive to shoppers--even the subsidized ones.
Show Me the Money!
I mentioned that you have a required contribution to your premium which--along with the price of the second cheapest plan available to you--determines the size of the tax credit you get. If your income is under four times the poverty line, your contribution is limited to a certain percentage of your income. The particular percentage will depend on your income; it increases on a sliding scale, as you can see from this table pulled right from the ACA:
If you're eligible, when you shop for coverage through an exchange a subsidy will be made available to you to help you pay for an insurance plan (and if you're eligible for Medicaid instead, the exchange application process will let you know that and help you in enroll in it). Technically you'll get a refundable, advanceable tax credit. Refundable because its value can actually exceed your total tax burden, in which case the government is giving you money. Advanceable because you don't have to wait until tax time to get it back, it's available upfront when you go to buy insurance--so none of that money actually has to come out of your pocket.
Though HHS is still working the kinks out of their draft of the application process, they've produced a video to show you what the process will be like for a single person:
But how does the tax credit work? Its value will be pegged to the cost of a certain silver plan in your marketplace--the second cheapest silver plan--through a fairly simple formula:
[Value of the federal subsidy] = [Cost of 2nd cheapest silver plan] - [your required contribution]
What that says it that there's some amount of the premium you'll have to pay for the second cheapest silver plan, and then the federal government will pay for the rest of it. Or in picture form:
As we'll see a little more clearly later, this particular insurance plan just serves as the benchmark for calculating the size of the federal subsidy to which you're entitled. You don't have to actually buy that particular silver plan to get the tax credit.
Structuring the subsidy this way helps to retain the incentives and dynamics that should undergird markets. More expensive plans cost consumers more, as they should. Consumers still have incentives to buy less expensive plans (or at least carefully weigh the costs and benefits of buying more expensive plans) and insurers still have an incentive to offer the cheapest plans in the market, because those are the plans that will be most attractive to shoppers--even the subsidized ones.
Show Me the Money!
I mentioned that you have a required contribution to your premium which--along with the price of the second cheapest plan available to you--determines the size of the tax credit you get. If your income is under four times the poverty line, your contribution is limited to a certain percentage of your income. The particular percentage will depend on your income; it increases on a sliding scale, as you can see from this table pulled right from the ACA:
| In the case of household income (expressed as a percent of poverty line) within the following income tier: | The initial premium percentage is-- | The final premium percentage is-- |
| Up to 133% | 2.0% | 2.0% |
| 133% up to 150% | 3.0% | 4.0% |
| 150% up to 200% | 4.0% | 6.3% |
| 200% up to 250% | 6.3% | 8.05% |
| 250% up to 300% | 8.05% | 9.5% |
| 300% up to 400% | 9.5% | 9.5% |
A major part of the "affordable care" bit of the law's title is a reference to this table. The idea is that people buying health insurance in an exchange will have their income protected, i.e. the amount they have to spend on health insurance premiums will be capped at a certain percentage of their income.
So for instance someone at 150% of the poverty line will not be asked to pay more than 4% of his income on health insurance premiums. Meanwhile someone at 250% of the poverty line won't be asked to pay more than 6.3% of his income on premiums.
Now since we're thinking specifically of a single person, we can translate those percentages into dollar amounts. I'm going to base this on the 2013 poverty thresholds, which have the poverty line at $11,490. It might be slightly higher next year when the tax credits and exchanges become available, but that won't change what we find here very much. Here's the table above, recast in terms of the caps on what folks of various incomes pay on their premiums:
| In the case of household income within the following income tier: | Maximum monthly premium (low end) | Maximum monthly premium (high end) |
| Up to $15,282 | $25 | $25 |
| $15,282 up to $17,235 | $38 | $57 |
| $17,235 up to $22,980 | $57 | $121 |
| $22,980 up to $28,725 | $121 | $193 |
| $28,725 up to $34,470 | $193 | $273 |
| $34,470 up to $45,960 | $273 | $364 |
Remember that those numbers rise smoothly on a sliding scale within each tier. This should give you a rough estimate, based on your income, of the premium you would be asked to pay for the second cheapest silver plan in your area.
Not So Fast!
Seems simple enough, right? You don't even need to know what the actual premium the insurer is charging is going to be because your personal contribution to your premium is spelled out right there in black and white. But it can be as simple or complicated as you like.
This is because of the way the value of your tax credit is calculated. As we saw, the federal government is offering you some fixed sum of money equal to [Cost of 2nd cheapest silver plan] - [your required contribution]. That means if you buy that second cheapest silver plan, all you pay for your premium is your required contribution, as pulled from those tables above.
But you don't have to buy that particular plan. You're well within your rights to buy a more expensive silver plan, or a gold or platinum plan. The government still gives you that fixed amount of money and you have to cover the rest of the cost of the plan. Obviously that means you would end up paying more--maybe a lot more--than the tables above would suggest.
On the other hand, you could also opt for a cheaper plan. That might be the very cheapest silver plan or a bronze-level plan. In that case, you still get the full value of the subsidy, meaning your own required contribution is going to go down.
Let's All Go to Vermont
Let's illustrate with a real example using actual premium values. Right now exchanges are soliciting interest from insurance companies who might participate later this year and they're asking them to submit information on how much they will charge in premiums. Most states (and the federal government) are going to let those numbers trickle in over the next 1-3 months. But one state, Vermont, has finished that process and recently made the numbers public.
They put together two tables collecting those premium numbers here. (As an aside, you'll notice that there are two tables because one lists prices for Standard Qualified Health Plans (QHPs) and one lists prices for Non-Standard Qualified Health Plans. In putting out feelers to insurance companies to see if they would sell in the exchange, Vermont made clear that participating insurers will have to sell plans with certain standard designs, meaning the plans' deductibles and co-insurance requirements for different services have to be what the state specified. You can see the specifications for the standard plans starting on page 50 of this document. However, in addition to those plans the insurers are allowed to innovate and sell other "non-standard" plans with different designs. Both kinds of plans "count" when figuring out what the cheapest silver plan is.)
Let's look at just silver plans available to a single person shopping in the Vermont exchange. Between the two insurers selling them, Blue Cross Blue Shield of Vermont (BCBSVT) and MVP, there are eight different silver plans you could choose from. The second cheapest one on the market is BCBSVT's non-standard "Blue for You" plan (listed on the second page of that document), weighing in at $413.03 per month.
So now we have the value of the tax credit you have to play with, dear Vermonter. It's going to be $413.03 minus your required monthly contribution. So let's suppose you're making exactly $22,980. Convenient! According to our table, that means that if you buy that Blue for You plan your contribution to the premium will be $121 per month. The government's subsidy to you is $413 - $121 = $292. (For simplicity's sake, let's ignore the 3 cents).
But maybe you don't want to buy the Blue for You silver plan. You're an extravagant type and you want the top of the line: MVP's $614.77 per month platinum plan. You can go buy it and put the government's $292 toward it but that means you're on the hook for paying the other $322.77 every month.
Or maybe you want to go the other way. You're looking to minimize your own premium contribution and so you hone in on the cheapest metal plan on the market: BCBSVT's "Blue for You CDHP" bronze plan. That's $350.08 per month. You still get to put the government's $292 toward that plan, which leaves you on the hook for only about $58 per month. Significantly less than the $121 you'd be paying if you went for the silver plan to which the subsidy's value is pegged. Indeed, for people with lower income than you (who are thus eligible for a larger federal subsidy), they can get their own contribution down to zero for some of the bronze plans. Of course, their own required contribution for the benchmark silver plan is correspondingly smaller than yours and so they don't lose much in paying it and opting for the more generous coverage of a silver plan.
Back to the figure, this time expanded. You can see from the varying total heights of the bars below the difference in total plan costs from plan to plan. The platinum plan on the far right is the most expensive and so it's correspondingly the tallest. It also requires you to pay the most for your premiums, since the federal share of the costs (the tax credit) has a fixed value.
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| Because the value of the tax credit is pegged to the value of the second cheapest silver plan, its value is the same regardless of which plan you buy. |
The numbers in this section, of course, are unique to Vermont. The actual premiums and the number of plans to choose from will vary from state to state, although the numbers aren't likely to vary substantially from the Vermont examples we've looked at here.
A word of caution
It's worth noting that there's a special benefit to buying a silver plan. The ACA doesn't just provide subsidies for health insurance premiums, it also provides subsidies for cost-sharing. That means it will help you pay for part of your deductible if you need care, as well as part of your co-pays or co-insurance. However, while the premium tax credit can accompany you to any coverage tier and be applied to any plan, the same is not true of the cost-sharing subsidies: the cost-sharing subsidies are only available if you buy a silver plan. If you buy a bronze plan to get your premium contribution as low as possible, should something happen and you actually need care you'll have a very large deductible (in Vermont's standard bronze plan designs, the deductible is around $2,000) to grapple with and no help in doing so. Something to keep in mind.
Secret Option F
There's one other option in the exchanges I haven't mentioned. This is a plan type that's available only to people under 30 (or people who otherwise don't have access to an affordable plan). It's called a catastrophic plan and is designed specifically to offer less generous coverage than any of the metal tiers. Why is this desirable? It was felt that since young people are less likely to use coverage, they'd be more willing and eager to buy a lower-premium, high-risk "young invincibles" plan than more standard coverage.
However, if you choose the catastrophic option you get no financial assistance. While you can take your federal tax credit and put it toward any plan bronze through platinum, you cannot put it toward a catastrophic plan. The entire premium is on you. And it probably goes without saying that you'll also have no help in paying for the cost-sharing, which by design is sizable in these plans.
Everybody Got That?
Hopefully this was clear enough to give you a sense of what you can expect if you end up buying insurance through an exchange. Comments welcome--if something's unclear or underdeveloped, I'm happy to revise.
One more thing: if the exchange does its job right, you won't actually have to know any of this. You'll fill out the application and it will figure out what you're eligible for and explain to you what you can and cannot apply it to. You won't need to sit there with a calculator and a set of tables to figure things out.
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