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The Affordable Care Act Is Poorly Designed for Dealing With Epidemics and the GOP Plan Is Even Worse

By: Thursday October 16, 2014 12:00 pm

Universal health care better protects the population during epidemics

It want to begin this post by saying the risk of America suffering from a serious and fast moving epidemic, like seen in the movie Contagion, is extraordinary small. I’ve repeatedly pointed out that the high level of concern about Ebola in the United States at this moment is unfounded, but since the media is focused on the issue of contagious disease it does provide an opening for talk about one of the big trade-offs we have made in the design of our health care system.

Our country has for years seen a push towards more “skin in the game” when its comes to health insurance. Policies often carry high deductibles and co-pays. This trend existed before the passage of the Affordable Care Act but the law was specifically design to encourage its spread. The exchanges encourage people to buy “silver plans” which have significant cost sharing and includes an excise tax on employer-provided insurance pushing companies to not provide generous coverage.

This is supposed to save money by making individual more conscious “health care consumers.” It can work in certain situations. The cost may defer some people with a sore throat from going to the doctor and most sore throats will go eventually away on their own. Of course, in the rare event of a serious epidemic that is exactly the opposite of behavior you want to encourage.

Since the risk is so incredibly small one can argue this is a reasonable risk trade-off to reduce overall spending; but there are many first world countries that provide actual universal health care for significantly less money, with low out-of-pocket costs for patients. So the trade-off isn’t really between a slightly cheaper system and one marginally more likely to detect infected individuals sooner. It was among a cheaper system, one more likely to quickly detect diseases, and allowing the health industry to make incredible profits ripping off the public. Democrats decided to mostly favor the latter at the expense of the former two.

Of course the current Republicans’ health care ideas, which are a vague combination of repeal, promise of market magic, buzzwords, and opposing mandatory paid sick leave, would be an even a worse system for dealing with rapidly spreading disease. The current plans they are discussing don’t even try to get near universal coverage.

This is something to keep in mind as you hear politicians grandstand about Ebola to score political points. Most of them actively fought against, and continue to fight against, the United States adopting a cheaper actually universal health care system that would also be much better designed for dealing with the possibility of serious contagious diseases.

Americans Are Way Too Worried About Ebola

By: Tuesday October 14, 2014 7:48 am
air pollution

People should worry more about air pollution, which causes 200,000 early deaths each year

The American public is radically more concerned about an Ebola outbreak here in the US than they should be.

According to a new Washington Post/ABC News poll 43 percent are worried that they or someone in their immediate family might catch the Ebola virus. In addition an incredible two thirds of the country is concerned about the possibility of a widespread Ebola epidemic occurring in the United States.

To put it simply this is an insane and completely unjustifiable level of fear. You are more likely to be killed by basically anything other than Ebola. The media has done a serious disservice feeding this irrational fear.

Ebola is a nasty virus but it is mainly a problem in West Africa because of bad infrastructure, serious poverty, highly inadequate health care systems, local funeral traditions, and government corruption.

Ebola is not airborne. It can only be spread by direct contact with body fluids, so there is basically no way it can become an epidemic here in the United States, with an adequate disease response system. Unless you are touching dead bodies of Ebola victims or people who appear very sick, since people are not contagious until they develop symptoms, there is basically no chance of you contracting the virus. Since only a handful of America’s trained health professional are working with the few people infected with Ebola in this country the other 99.9999% of us are fine.

Americans should be worried about almost anything else instead of Ebola. Like for example air pollution, which causes 200,000 early deaths each year according to one study, and well deserves this level of public concern.

Photo by under Creative Commons license

Almost All Americans Think Mandatory Minimums for Non-Violent Offenses are Stupid

By: Monday October 13, 2014 7:37 am

jail prisonWhen it comes to issues of criminal justice and drug policy reform, the populace continues to be way out ahead of federal politicians.

A Reason-Rupe poll last week found an incredible 77 percent support eliminating mandatory minimum prison sentences for nonviolent offenders so that judges have the ability to make sentencing decisions on a case-by-case basis. Only 17 percent oppose this change, which is serious fringe territory, yet this where many in Congress still stand.

Most nonviolent mandatory minimum sentencing laws in this country have to do with drugs. There is currently a bipartisan bill in Congress, the Smarter Sentencing Act, which would merely reduce the mandatory minimum for some nonviolent drug offense. The Congressional Budget Office has projected this would save taxpayers billions.

This deficit reducing bill is even more modest than what an overwhelming majority of Americans would support, yet it is still real danger not passing this year. Its no wonder Congress’ approval rating is in the single digits.

Vermonters: Help Us Stop Out of State Prison Transfers

By: Thursday October 9, 2014 10:43 am

Thirteen Vermont inmates at a Corrections Corporation of America (CCA) private prison in Arizona were recently thrown into solitary confinement after refusing to return to their cells and damaging equipment in the facility.

CCA is calling it a “disturbance,” but it sounds more like a demonstration. The details are reminiscent of a protest last month when 400 Dominican inmates at CCA’s for-profit federal immigrant detention center in Youngstown, Ohio peacefully opposed their treatment and living conditions for 14 hours straight.

The Vermont prisoners similarly expressed frustration with CCA’s restrictive rules and with being sent out of state, beyond the reach of family and community.

These inmates are among 500 from Vermont who have been shipped to facilities in other states. With CCA’s contract due to expire in July, Firedoglake is teaming up with Grassroots Leadership to demand Vermont Governor Peter Shumlin bring these inmates home and end interstate transfers for good.

If you live in Vermont sign and share our petition: End out-of-state private prison transfers and bring Vermont inmates home.

Not from Vermont? Use our share tool to spread the word about this campaign and help us recruit more signers to this petition.

Vermont is one of four states that has adopted this ineffective and expensive band-aid to address prison overcrowding.

Out-of-state private prison transfers put an undue financial and emotional burden on prisoners’ families while sending hundreds of millions of taxpayer dollars to for-profit prison corporations like GEO Group and Corrections Corporation of America. According to a report put out by Grassroots Leadership, interstate transfers actually increase prisoner isolation and lead to higher rates of recidivism.

The incident in Arizona isn’t the only one involving transferred Vermont prisoners. In January, the warden at the CCA-run Lee Adjustment Center in Kentucky resigned after incidents of violence put 200 Vermont inmates on a three-week lockdown. The state of Kentucky has stopped sending inmates to Lee altogether — in part because correctional reforms have reduced its overall inmate population.

We need to urge the governor to join him and end this policy before he renews the contract to house 500 inmates out of state in the coming weeks.

Sign our petition asking Governor Shumlin to end interstate private prison contracts and bring Vermont prisoners home.

Affordable Care Act Is Not Working Better Than Anyone Expected

By: Thursday October 9, 2014 9:07 am

Paul Krugman’s defending President Obama

Paul Krugman has new Rolling Stone article In Defense of Obama, but he decides he needs some historical revision for his defense. He claims the Affordable Care Act is “working better than anyone expected.” From their article:

Then technical difficulties with the website seemed to threaten disaster. But here we are, most of the way through the first full year of reform’s implementation, and it’s working better than even the optimists expected.

We won’t have the full data on 2014 until next year’s census report, but multiple independent surveys show a sharp drop in the number of Americans without health insurance, probably around 10 million, a number certain to grow greatly over the next two years as more people realize that the program is available and penalties for failure to sign up increase.

I don’t know how this could be called beyond what “optimists expected.” After all, the Congressional Budget Office report four years ago projected the number of uninsured would drop by 18 million from 2013 to 2014. It is true Republican governors refusing to expand Medicaid is part of the reason the drop in uninsured wasn’t as as big as predicted. Analysis shows that could result in 6.7 million more uninsured by 2016, but even accounting for this it looks like the numbers came just under target. President Obama’s decision to delay the employer mandate also deserves some blame, though. It is a major revenue generator and coverage expander which is still not in place yet. If Krugman really thought these CBO numbers were beyond optimistic four years he should have said something at the time.

On the positive side, Krugman does remember these CBO reports pointed out exchange premiums were slightly lower than projected four years ago, but that is partly because the overall economy has significantly underperformed from 2010-2014, and the exchanges allowed insurers to offer slightly worse packages than the CBO thought they would.

On the negative side, it is fair to say building and running the exchanges went much worse than most people predicted, and it is more difficult to help people select policies on the exchanges than was originally promised.

The drop in uninsured is slightly smaller, premiums are slightly better, and the structure is not as user friendly as was hoped. While the law is functioning better than some of the absurd Republican doomsday predictions about it, it is working roughly as reasonable experts said it would from the start.

We Should Create Two New Partisan Budget Offices

By: Tuesday October 7, 2014 8:18 am


A new concern among some Liberal commentators is that if Republicans win control of the Senate they will change how the Congress Budget Office works to make its results more pro-Republicans. Mainly it is fear they will have it adopt a form of “dynamic scoring” which assume tax cuts almost always spurs growth.

This has given me an idea. In addition to the non-partisan CBO Congress should created two new partisan budget offices, one Democratic and one Republican. They would be modeled, funded, and run just like the CBO but the employees of each would be selected only be their corresponding party leaders.

The economy is the top issue for voters and the disagreement between Democrats and Republicans on how to address it are substantial. Often the parties don’t just ideologically disagree on what are acceptable tradeoffs they often fundamentally disagree on what impact new policies will actually have on the economy. I say lets put this disagreement to a real test.

Lets have both parties choose teams of economists to make official predicts about the impact of each major bill. Lets get the parties on record. Over the years we will than be able to see how well the predictions fit reality and see if one party’s outlook is more accurate. We will have a real test of who understand the economy and what it needs better.

If Republicans truly believe dynamic scoring produces more better results they should welcome this opportunity. If they are actually right their partisan budget office would prove it by out perform the non partisan CBO and the Democratic budget office.

Prediction Creep in Syria

By: Tuesday October 7, 2014 7:05 am

They’re just getting you used to the idea

While our military operations in Syria against ISIS have only started the prediction creep is already growing rapidly. That is when top politicians, Obama officials, military leaders, and outside experts start telling us that the relatively limited campaign we were sold could easily become much longer and more involved. This mentally prepares people for the actual mission creep.

The most extreme example so far is former Secretary of Defense Leon Panetta who told USA Today he thinks “we’re looking at kind of a 30-year war,” not just against ISIS, but also related groups in several other countries.

He is not alone in predicting that this war is going well beyond the limits Obama initially indicated. VP Joe Biden has already declared it will be a “hell of a long fight” against ISIS. The Chair of the Joint Chiefs of Staff Gen. Martin Dempsey said it might be possible ground troops will be needed. Former Defense Secretary Robert Gates said a “small number” of American ground troops will be needed to vanquish ISIS.

Speaker John Boehner (R-OH) made it clear that he thinks ground troops will eventually be needed, a position shared by many prominent Republicans.

The prediction creep isn’t just a national phenomenon. Former UK Prime Minister Tony Blair also thinks there may come a time when Western combat forces will need to be used.

If you don’t think wars in the Middle East will take more resources, time, and effort than was originally promised you haven’t been paying much attention the past decade.

Because Our Plan for “Success” in Syria Worked So Well in Libya

By: Monday October 6, 2014 10:08 am
Tomahawk missile launched Libya

Tomahawk missile launched in Operation Odyssey Dawn

Our strategy in Syria is remarkably similar to our previous strategy in Libya. In both the idea is heavy international air strikes combined with arming and training local “moderate” rebels, but no ‘boots on the ground.’ So before we spend billions in Syria we should take a moment to see how well this basic plan worked in Libya.

Apparently, not well. Three years after our involvement the capital of Libya, Tripoli, is now so dangerous the parliament has been forced to fee. From the Washington Post:

In August, Libya’s parliament moved to Tobruk, with members saying they were facing a constant risk of violence in the capital. Dozens of politicians, journalists and activists in Tripoli have been arrested, kidnapped or killed, a trend that has only intensified since a loose alliance of mainly Islamist militias going under the name of Libya Dawn took control of most of the city several weeks ago.

This port city of 200,000 was little prepared for its new role as a strategic hub for those in retreat. There are only five hotels, so the authorities initially rented a Greek car ferry to house the overflow, while they tried to find more permanent accommodations.

The fact is that we have a really poor track record when it comes to bombing countries into stable democracies.  That doesn’t seem to get enough attention.

Mindless Panic Over Ebola Is Better Than Mindless Panic Over ISIS

By: Friday October 3, 2014 9:21 am

Ebola is not a serious threat in the United States

I was thinking about pointing out how the media hyperventilating over Ebola in the United States is overblown, because the chance of someone in American dying from it is likely way less than them winning the lottery. While it is a very unpleasant disease that is serious problem in Western Africa, that is mainly because of extreme poverty, insufficient health care services, and problematic governments. America has the systems in place to effectively deal with this.

But pointing this out is won’t do much good because it seems the default setting for the media and politicians in the height of the campaign season is spread mindless panic about something that affects very few Americans and no real danger to the American public as a whole. This panic is either replaced by a new panic or ends with the adoption of rash and often stupid fixes.

Having the focus on people exacerbating regular Americans’ fears about Ebola is preferable to exacerbating regular Americans’ fears about ISIS, with the probability of their killing any particular person living in the United States  is practically nil. At least a panicked overreaction to Ebola might lead to a positive spillover — like deciding to do improve health care services in parts of Africa, instead of getting us involved in another expensive and ill-convinced war in the Middle East.

Obamacare Is Just Like the Swiss Health System – minus all the good stuff

By: Tuesday September 30, 2014 9:09 am

The Swiss Alps, just like the Berkshires but different

Several reporters have compared the Swiss health care system to Obamacare after Switzerland’s recent vote to keep it, including the Washington Post: “Switzerland rejects single-payer, will keep its own version of Obamacare” and Vox: “Switzerland rejects single-payer in landslide, keeps its version of Obamacare.”

The similarities between the two systems are mostly superficial, both mandate people buy individual insurance. The differences, though, are huge. Obamacare is basically the Swiss system with all the important rules that make it work properly removed. Four of biggest elements Obamacare’s basic structure lack are:

  1. All basic health insurance in Switzerland is provided on a nonprofit basis, while the Affordable Care Act exchanges are full of for-profit companies.
  2. The premiums people are expected to pay for what is a good package is capped by the government to assure it is actually affordable for everyone. While the ACA provides subsidies for some low income people, it doesn’t provide this basic protection.
  3. The maximum allowed deductible/out of pocket allowed in Switzerland is a fraction of what is permitted on the Affordable Care Act exchanges, so that it actually protects people from serious financial problems if they get sick
  4. Most importantly, Switzerland uses an all-payer system to set a uniform price schedule. This helps control costs and reduce the administrative waste caused by hundreds of payers each negotiating individual prices with thousands of providers. It also stops the absurd practice of out-of-network providers extorting excessive payments from them.

While the Swiss health care system is not my favorite given its relatively high costs, it is infinitely better than system created by the ACA. They are only similar in the way a lame old donkey kind of looks like a thoroughbred race horse – if you squint really hard. To call the Swiss health care system a version of Obamacare is an insult to the work they have done over there and gives a false impression of what the ACA will accomplish.