Need a Little Help – Again

From the Raleigh News & Observer, November 15, 2017: eliminating the mandate in the Affordable Care Act (aka Obamacare, ACA) for obtaining health insurance will save the Federal Government $300 billion.

If the taxpayer must pay a penalty for being uninsured, isn’t that payment revenue? If that revenue is eliminated, how does that save $300 billion?

I did a cost comparison on the Kaiser Family Foundation (KFF) website for a family of four (husband and wife both 45; children 10 and 14) living in Wake Forest, NC, with no health insurance from their jobs and annual income of $50K. No health insurance: penalty estimate, $2,045/year. Health insurance premium estimate: $17,534/year.

And the explanation on the KFF site indicated that the family’s cost might wind up at $0 with the standard deduction. I’m no accountant, but I do know that you can’t get insurance companies to charge you $0.  Wouldn’t that family would have to fork over $1,461 a month?  And when and how do they wind up at $0?

If I’m wrong thinking this is yet another form of voodoo economics, please set me straight.

The only prize for the correct answers will be my gratitude. Thanks!


		
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Walk in Another’s Shoes

Pretty sure the first time I heard “Walk in another’s shoes” it was mocassins, not shoes, and the words were attributed to an American Indian. As I recall the quote suggested one person has little or no hope of comprehending what another person must do to get through life without some equivalent life experience.

And so when I come across a particular written exposition of another’s experience, even though the piece comes from a work of fiction, I’m compelled to stop and think that experience through, try to imagine what I might have done, how I might have reacted, had it been me in those shoes.

And don’t stop here because what follows is fiction. After all, French Philosopher Albert Camus observed that; “Fiction is the lie through which we tell the truth.”

Here’s a recent example, from “The Assassin,” by Andrew Britton, pp. 51-52, Kensington Books, 2007.

The character quoted is Rashid al-Umari, son of a wealthy Sunni Iraqi power broker. Here is what he thinks of the war against terrorism in Iraq. Walk in his shoes for a moment:

“It was so typical, Rashid thought bitterly. History always repeated itself; the greatest of empires were also the greediest. After all, what separated the current American government from the British imperialists of the twentieth century? The answer was simple: nothing. In the end, the only real objective was to enrich the invading country, and no matter what the Americans said, their intent was not benevolent. One only had to look at the Western contractors pouring into the region to see that.”

And he walked in those shoes some time around 2005, just 2 years or so after the start of the war in Iraq. And that was 14 years ago…..

Social Media and the Wit and Wisdom on Facebook

Sometimes Facebook serves as something to occupy me while I’m on hold with my doctor’s office or waiting for a voicemail prompt that actually has something to do with why I’m calling.

And then there are those times when a Facebook post smacks me right in the area that is rumored to contain something capable of rational thought.  Two such posts just got me:

1)  Paraphrased: Those folks worried about destroying history by tearing down Confederate statues will be thrilled to learn about books, and 

2)  Also paraphrased: In July of 1776 a bunch of New Yorkers tore down a statue of George III, thereby making it impossible to learn who won the Revolutionary War.

This social media thing just might have a future……

Attention All Hackers!

We now have a distinguished (“very distinguished”), appointed Presidential Advisory Commission on Voter Integrity.

I can’t help being surprised, very surprised, that our President is still claiming massive, very massive, voter fraud.  There are dozens of excellent, very excellent, studies and research papers on the subject.  A simple, very simple, search using the phrase “voter fraud” produced a large, very large, number of hits (6,080,000), among which are various, very various, conclusions that voter fraud is statistically insignificant, very insignificant.

But insignificance is not my main, very main, concern today.  I can only wonder what a group of appointed members of an advisory committee might do with the records of (200 million?) voters.  Send them a postcard asking for proof of life?  Ask the ones who chose to register as Democrats or Independents whether they might want to make a switch?  Make those records available to already drooling, very drooling, cyber crooks making plans to grab all that information for their new, very new, credit cards, bank accounts, etc.?

Can’t help being concerned, very concerned.  (And yes, I’m imitating the style of the almost daily, very almost daily, barrage of tweets from, well, you know…..)  Puts me in mind of “Rain Man,” who said such things as: “I’m a good driver. I’m a very good driver.”  Or Demi Moore in “A Few Good Men,” who, upon hearing the judge deny her objection, said: “But your Honor, I strenuously object,” which of course didn’t persuade the judge to reconsider his ruling.

Still, I strenuously object to creating a new and massive pile of personal, very personal, information in the office of a newly appointed advisory commission.  Do they even have an office?

Thinkin’ about stuff……

Just finished reading an article about the Old Post Office in Washington, DC.  I spent a few years in that building in agent training and later in the Washington Field Office of the Federal Bureau of Investigation.  Most of us took the buses that dropped us off and picked us up within a few paces from the entrance.  I recall the morning I arrived early, only to discover, along with a few others, the frozen body of a homeless man who often panhandled up and down the local streets.

The Old Post Office is now Trump International Hotel, characterized by author Alex Altman in the June 15, 2017, issue of TIME magazine as “The Suite of Power; Why Donald Trump’s Washington Hotel is the Capital’s New Swamp.” Save up for a 90-minute couples massage at $460 or a VIP package (a week?) in a 6,300 square foot townhouse suite on two floors overlooking Pennsylvania Avenue, advertised for $500,000.

Not quite causing the inspiration from our top civil servant that John Kennedy provided in his inauguration speech:

“Let the word go forth from this time and place, to friend and foe alike, that the torch has been passed to a new generation of Americans – born in this century, tempered by war, disciplined by a hard and bitter peace, proud of our ancient heritage…  Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty.”

More on the order of “Ask not what I can do for you, but what you can do for me.”

Instead of Overbooking……

Nobody asked, but I have the answer to airline company overbooking, and I learned it in the summer of 1965 while on a graduate Russian language study tour of the USSR.  The tour was managed by Indiana University and funded by the National Science Foundation.

Our group, 25 high school Russian language teachers, showed up at the airport for a flight from one Soviet city to another. We were on time.  In fact, we were a bit early. Our departure time came and went, and we waited.  And waited.  Finally the professor in charge of our little group asked whether the flight had been cancelled, the aircraft was in need of repair, or what other reason explained why we were waiting for more than 2 hours for our flight. The answer: “We are waiting for more passengers to fill the seats that are still vacant.”

Problem solved.  Instead of overbooking, just don’t take off until the seats are all spoken for.

And thank you for flying Aeroflot.

Arithmetic and Health Care

Kevin Schulman, M.D., professor of medicine at Duke University and visiting scholar at Harvard Business School, provides us with a brief and, thank you very much, understandable explanation (Raleigh News & Observer, March 23, 2017, “Why the health care market doesn’t work.”)

First, the concept of any insurance system: we all pay into a pool of money that is used to reimburse us when whatever is insured is damaged and requires some of the pooled money to be fixed. Or, in the case of health care, healed – we hope.

In short, all of us who put money in the pool are sharing the risk. Few of us will avoid the misfortune, the need to have a car restored, a home repaired, a business to prop up after a fire or other disaster, a serious health problem treated, and so on. Those of us who never suffer such misfortune help finance the relief for those who do. (Somewhere along the line I recall reading that Ben Franklin either invented the concept of insurance or transplanted it in the Colonies.)

Health insurers are stuck trying to predict the ratio of healthy to sick people who will sign up for their policies. It’s not much of a stretch to grasp that the larger the number of sick policyholders the higher the cost of the insurance. That’s why the Affordable Care Act (or Obamacare – I never could figure out which was which; a smidgen of humor there…..) had a provision requiring people with no health care to pay what amounted to a tax.

For the pool to work, everybody has to jump in.

Next, here is the arithmetic to demonstrate the importance of the healthy/sick ratio. Dr. Schulman provides a conceptual model. “The key question is what proportion of the population who sign up for insurance will be healthy.” Suppose 80% of the population is healthy and each of those healthy people will require $1,000 a year for their health care services. The other 20%, sick people, will require $10,000.

80 healthy people x $1,000: $ 80,000

20 sick people x $10,000: $200,000

Total: $280,000

Cost per person ($280,000/100) $ 2,800

Decrease the number of healthy people to 70% and you get:

70 healthy people x $1,000: $ 70,000

30 sick peopole x $10,000: $300,000

Total: $370,000

Cost per person ($370,000/100) $ 3,700

Note the difference between $2,800 and $3,700 is $900. As a percentage, the difference is 32%.

Does 32% ring a bell, sound like a number that closely resembles the increases in health insurance premiums we’ve been hearing about?

What happened is that health insurance industry estimated (guessed) wrong. They used the 80% healthy percentage and wound up with the 70%.

And then there is the assumption that doctors and hospitals will work together to bring down the cost of health care? Why on earth would they do that? We have a profit based, market driven health care system, the object of which is to make money. Where is the incentive to lower prices?

If we start over with our health care system, shouldn’t the foundation principle be that we, the people, have an inalienable right to health care? If we don’t start and stick with that principle, the health care system will always be great for some, barely adequate for many, and attainable only in emergency rooms and the rare clinic for many more.