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Profile Information

Gender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 51,907

About Me

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity

Journal Archives

Do we need health insurance?


Do Americans need health insurance? The short answer is no — at least not in the form it currently exists in America.

It is true that in many wealthy countries private insurance companies are used in the financing of universal health care systems. But they are nothing like American companies. They are regulated public utilities and are told by their governments who to insure, what to cover and how much and when to pay. Most are prohibited from making a profit and are required to pay any willing provider. Not exactly the American model.

The purpose of health care financing systems should be — and is in all other wealthy countries — to facilitate the delivery of health care services, to protect individuals and families against huge medical care expenses and to avoid breaking the national bank while they do so. But in America, our private insurance system actually interferes with the delivery of health care and is rapidly becoming too expensive.

Last month I argued for adopting a universal health care system on moral, ethical and economic grounds. It is not only more humane but cheaper to cover everybody. We have moved in fits and starts toward that goal since the enactment of Medicare in 1965.

Allowing Insurers to Withhold Data on Enrollees' Health Status Could Undermine Health Reform

Center on Budget and Policy Priorities
Allowing Insurers to Withhold Data on Enrollees' Health Status Could Undermine Key Part of Health Reform

Risk adjustment is one of the critical elements of health reform (i.e., the Affordable Care Act, or ACA) that's designed to encourage insurers to compete based on price and quality - not on attracting the healthiest enrollees and deterring those in poorer health, as they typically do today in the individual and small-group insurance markets.

Under the ACA's risk adjustment provision, insurers in the individual and small-group markets with sicker-than-average overall enrollment will receive payments to compensate them for their resulting higher costs. The payments will come from plans that enroll healthier-than-average people who do not cost as much to cover. By compensating insurers that enroll people in poorer health, risk adjustment reduces the incentive for insurers to "cherry pick" the healthy and avoid enrolling people with chronic illnesses and other serious health conditions.

To implement this "risk adjustment" provision, the federal government proposes that the entities administering risk adjustment - states or the U.S. Department of Health and Human Services (HHS) - determine the health status of plan enrollees based on data that insurers submit to them, which is similar to how risk adjustment in Medicare works today. But some insurance companies, as well as some House Republicans, are urging the federal government to allow insurers to measure the health status of their enrollees themselves without submitting any data.

Risk adjustment is an essential element of the Affordable Care Act. Letting insurers calculate their own risk scores without having to submit the underlying data needed to make sure those calculations are accurate would place the health reform law's risk adjustment system at substantial risk of error, upcoding, and fraud, threatening the long-term success of the exchanges and the major health insurance market reforms scheduled to take effect in 2014.

BlueCross BlueShield Association
Letter to Centers for Medicare & Medicaid Services
Re: Proposed Rule for Standards Related to Reinsurance, Risk Corridors and
Risk Adjustment (CMS-9975-P)

We strongly recommend that HHS use a distributed model for accessing risk adjustment data. Our recommended model: 1) alleviates members' privacy concerns since States will not be collecting confidential, individually identifiable health information; 2) retains issuers' control of proprietary data that has strategic importance; and 3) allows States/HHS to maintain the same control over the process while alleviating the burden of creating, securing, maintaining and updating a large costly centralized multi-payer database.

National Bureau of Economic Research report on risk adjustment in the Medicare Advantage Program:

Thus the authors conclude that the Medicare Advantage program both increased total Medicare spending and transferred Medicare resources from the relatively sick to the relatively healthy, and that risk-adjustment was not able to address either of these problems.

Comment by Don McCanne of PNHP: Insurers that corner the market of healthy individuals have an unfair advantage over insurers that cover a greater number of high cost, sicker patients. To protect those insurers with high costs from failing in the markets, risk adjustment corrects for the market distortions by taking funds from the insurers with low cost patients and transferring them to the insurers with high cost patients.

Risk adjustment may be a great theory, but in practice it doesn't work very well. As an example, even though prohibited from selectively enrolling healthier patients, Medicare Advantage plans have been very successful at selectively marketing to the healthy. Insurers end up with significantly lower costs, even though they are paid higher amounts than are paid for patients in the traditional Medicare program.

My comment: Local insurers in my area are offering Medicare Advantage plans with subsidised exercise club memberships--Silver Sneakers. Nice extra benny, but seniors with health problems serious enough that they can't use an exercise club are obviously not going to go for those plans. By eliminating sick people, they stand to save far more than the exercise club subsidies will cost them. very sneaky cherry picking.

PNHP comments on the "Obamacare bomb"

The Bomb Buried In Obamacare Explodes Today-Hallelujah!
By Rick Ungar

I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is - in the main - little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception - and it?s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers' premium dollars they collect - 85% for large group insurers - on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true "bomb" contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we?ve seen in quite some time. Indeed, it is this aspect of the law that represents the true "death panel" found in Obamacare- but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Comment by PNHP cofounders Himmelstein & Woolhandler:

Limiting overhead to 15%-20% is far from the stringent regulation that Ungar implies. Private insurers' overhead currently averages about 14% nationwide, and they will probably be able to reclassify some items currently classified as overhead into the patient care expense category (despite regulations that attempt to stop this). Moreover, some current sales expenses will be offloaded to the insurance exchanges, which are likely to have overhead of 3-4%, and the exchanges' expenses will not count as part of insurers' overhead. Finally, ACOs will take over many of insurers' administrative tasks and expenses, but these ACO overhead expenditures will not count toward the 15%-20% overhead limit. In sum, total insurance overhead (and profit) is likely to grow, not fall in the years ahead."

Comment by Don McCanne of PNHP:

Never have we received as many requests to comment on an article as we have on Rick Ungar's "The Bomb Buried in Obamacare..." He is to be highly commended for his enthusiastic support of single payer, but his analysis that the insurers' requirement to comply with the statutory medical loss ratios is an Obamacare bomb that will cause so much damage that we'll be on an inescapable path to single payer might represent... well, perhaps a touch of hyperbole, intended or not.

In the response above, David Himmelstein and Steffie Woolhandler explain how the medical loss ratio will have very little impact on reducing total insurance overhead and profit, although some recategorization will likely take place. Thus it isn't quite the bomb that will relieve us of their excesses and intrusions, nor relieve the health care providers of the administrative burdens that are placed upon them by the insurers and by the general complexity of our fragmented, dysfunctional health care financing system.

That said, it is political season. We can thank Rick Ungar for providing us with well-meaning hyperbole that that is appropriately provocative and makes people want to look once again at single payer as an answer to our health care mess. As Ungar says, "we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it," even if the medical loss ratio bomb won't really budge us in that direction.

My comment: What will lead single payer is the continued spiraling of health care costs completely out of control. Hopefully, by the time the wheels come off of PPACA, we will have implemented single payer in at least a few states.

A blast from the past--Merry Fitzmas! Treason's Greetings!

This collection of jolly Fitzmas carols is culled from Daily Kos and Democratic Underground, October 2005. The expression Fitzmas was first used on Democratic Underground to refer to the eagerly awaited day on which Patrick Fitzgerald would recommend indictments of various high-level Bush administration people for their role in outing the undercover agent Valerie Plame. WHIG =White House Iraq Group. The reference to aspens turning in autumn at the same time (because they are connected at the roots) refers to the series of people turning on their connected buddies who were linked in the project of selling the Iraq war for the White House at any cost.

And what a wet firecracker all that turned out to be. Still, the occasion brought an unusual florescence of DU creative hijinks, worth celebrating even today. Most of these are the result of extensive collaboration, and I picked and chose my own favorite versions, often combining two or more. Posting in Good Reads because of not anticipating a lot of discussion.

O Aspen Tree

O Aspen tree, O Aspen tree,
Your roots are all connected.
O Aspen tree, O Aspen tree,
Your sources aren't protected.
How shall we sell the war to them?
Just send some lies to Judy M.
O Aspen tree, O Aspen tree,
Your roots are all connected.

O Aspen tree, O Aspen tree,
Your leaves are turning yellow.
Fitzgerald’s nailing Karl Rove
And other nasty fellows
Who lied to get us into war.
He’ll throw the book at media whores.
O Aspen tree, O Aspen tree,
Your leaves are turning yellow.

"Plame!" the White House Sources Say

"Plame!" the White House sources say,
"Wilson's wife is CIA!"
"She's the one who booked the trip
"To debunk the Niger tip."
Slowly now the Aspens turn!
Fitz has energy to burn!
He'll flip the sources from the WHIG,
Turn this into something big!
"Plame!" the White House sources say,
"Wilson's wife is CIA!"

Hark, the rotten traitors choke
Caught up in the lies they spoke
In the court they're standing tall
Facing jail time one and all
Now they spin and tell more lies
Wingnuts make up alibis
Crooks and liars every one
Fitz has got them on the run
Now they're hung they've got no hope
Karl ol' boy, don't drop the soap.

Don't Rest Ye Merry Democrats

Don't rest ye merry Democrats
Although they booked DeLay
Remember that indictments
Will come on Fitzmas Day
To save us all from Bush's hacks
Who led us all astray
O charges of treason and more
Treason and more
O charges of treason and more

From Karl Rove and Libby too
The name of Plame did slip
Once Wilson proved the liars wrong
Back from his Niger trip
Behold the rot that caused the leak
On Bush's sinking ship
O charges of treason and more
Treason and more
O charges of treason and more

To Rove the Great Deceiver
And Libby, Cheney's bitch
The plan to sell their pointless war
Went off without a hitch
But Karl's just a conjurer
And Scooter’s just a snitch
O charges of treason and more
Treason and more
O charges of treason and more

Patriots can speak freely now
That Rove is behind bars
And Cheney's booked, and Libby's done
For starting groundless wars
Our press will come alive again
But not without its scars
O charges of treason and more
Treason and more
O charges of treason and more

Good Fitz will throw the book at them
Or so my sources say
Hark! The time has come at last
To make these traitors pay
Our flag will stand for freedom now
On glorious Fitzmas Day!
O charges of treason and more
Treason and more
O charges of treason and more

The Little Leaker Boy

"Plame" they told them
pa rum pum pum pum
"She is fair game" they said
pa rum pum pum pum
The lamest smear they wrought
pa rum pum pum pum
And thought they'd not get caught
pa rum pum pum pum
rum pum pum pum
rum pum pum pum
So to slander him
pa rum pum pum pum,
Wilson's name.

So Fitzgerald
pa rum pum pum pum
Investigated them
pa rum pum pum pum
"I have no axe to grind"
pa rum pum pum pum
"For sure the truth I'll find"
pa rum pum pum pum
rum pum pum pum
rum pum pum pum
"Oh, they'll sing for me!"
pa rum pum pum pum
"to stay free."

Cheney plotted
pa rum pum pum pum
To hide his Iraq lies
pa rum pum pum pum
So Libby outed spies
pa rum pum pum
And Judy shilled for them
pa rum pum pum pum
rum pum pum pum
rum pum pum pum
Now they frogmarch on
pa rum pum pum pum
Fitz's work is done.

Do You Know What I Know?

Said the Ambassador to the New York Times,
"Do you see what I see?
In the Niger docs, New York Times?
Do you see what I see?
A lie, a lie, it sure looks like a lie
With an arrow that points to the Prez,
With an arrow that points to the Prez."

Said the Veep to the White House Iraq Group,
"Did you read what I read,
In the New York Times, mighty WHIGs?
Did you read what I read?
A threat, a threat, this is quite a threat
We must somehow not let it live!
We must slip this Wilson a shiv!"

Said Karl Rove to the pundits on TV,
"Do you know what I know?
In your studios, pundit friends
Do you know what I know?
A wife, a wife, Wilson has a wife --
And she spies for the US of A,
Yes, she spies for the US of A!"

Said Bob Novak to the people everywhere,
"Listen to what I say!
In the CIA, his wife works --
Listen to what I say!
A spy, a spy, Wilson's wife's a spy,
And Karl Rove says she’s 'fair game',
And Karl Rove says she’s 'fair game'"

Said the Shrub to his minion Karl Rove,
"What the hell did YOU do?
Blabbing to the press, Karl Rove?
What the hell did YOU do?
Shut up, shut up, we must both shut up,
I know nothing and neither do you.
I know nothing and neither do you."

Said Joe Wilson to the people everywhere,
"Do you get what THEY did?
Acts of treason, people everywhere!
Do you get what THEY did?
A frog, a frog, marching like a frog
That's how Rove should vacate his job
That's how Rove should vacate his job!"

Fitzmas Night

Fitzmas night, sleepless night,
Fitz is going to indict
Round yon White House, rumors are wild
Cheney's lawyer is on speed-dial
Bloggers are going to feast
Bloggers are going to feast.

Fitmas night, sleepless night
Wingnuts quake on the right
Indictments stream on Fitzmas day
Bloggers cheer "Hip-hip-hurray!"
Felons reap what they sow
Felons reap what they sow.

Rove’s Nuts Roasting on an Open Fire

Rove’s nuts roasting on an open fire
John Law snapping at his toes
Federal indictments being read by the hour,
And perps dressed up in prison clothes.

Everybody knows those turkeys in a prison cell
Would help to make the season bright
Fiendish plots had their eyes all aglow
But they'll find it hard to sleep tonight.

They know Fitzgerald's on his way
With big indictments in his attaché
And every one of us will crack a smile
To see Dick Cheney put away for awhile.

And so I’m offering these simple words
To all those neocons who choose
Not the truth, but to lie through their teeth
"Merry Fitzmas! You lose!"

Ode to Joy

Freude! Miller got the fuckin'
Daughter of the New York Times.
WHIGs entwined like roots of aspen,
All will go down for their crimes.
Scooter Libby has been busted;
Karl Rove has screwed the pooch.
Treason must not go unpunished;
Chickenhawks come home to roost.

O Little Town of Washington

O little town of Washington,
How still we see thee lie.
The folks below
Don't seem to know
That Fitzmas day is nigh.
The grand jury is weighing
Indictments `gainst these crooks.
Hopefully, we soon will see,
Fitzgerald throw the book!

Karl Rove, the Bald-faced Liar

Karl Rove, the bald-faced liar
Never gives the truth a chance.
He, Scooter, Bush and Cheney
Have to wear asbestos pants.

They sold the country on war,
Based on fraud and forgeries.
They lied to us and Congress,
They're awfully good at perjury.

Then one crisp clear autumn day,
Fitzgerald came to town.
"Karl Rove and your whole cabal,
You all are going DOWN!"

Then how the rats did scurry!
Everyone was jumping ship!
Karl Rove, I hate to tell you,
All the other Aspens flipped!

Away in a Jail Cell

Away in a jail cell, no plea for his bids
The little Lord Cheney is now on the skids,
George Bush in the White House shall not thee now save
Oh little Lord Cheney, you sniveling knave!

The aspens are turning, oh, Hannah hath spake,
And little Lord Cheney in his boots doth quake.
I loathe thee Lord Cheney! Come down from on high,
And stay in your jail cell till your time is nigh.

Goddam you Lord Cheney, we pray that you'll stay
Locked up in your jail cell ‘til your dying day!
And damn all your cohorts, seduced by your charms,
Oh take them down with you, and do no more harm!

Go Tell It on the Mountain

Go, tell it on the mountain,
Over the blogs, through cyberspace
Go tell it on the mountain,
Karl Rove's goose is cooked!

While wingnuts kept on spinning
And Judy was doin' time,
Behold to the grand jury
Was revealed a heinous crime.

Go, shout it from the rooftops,
Down in the bayou, Baghdad, too!
Go, shout it from the rooftops,
Dick Cheney's time is through!

George Bush he joked and jittered,
When lo! above the spin,
Rang out the big indictments
That did those bastards in..

Down in a DC courthouse
The aspens did suborn,
God sent incrimination
That blessèd Fitzmas morn.

A Frog March Together With You

Just hear those hand cuffs jingling,
Ring ting tingling too
Come on, it's lovely weather
For a frog march together with you,
Outside indictments falling
While friends are calling "Screw you,"
Come on, it's lovely weather
For a frog march together with you.

Giddy up, giddy up, giddy up,
Let's go, Let's eats lots of crow,
They said it couldn't happen, but now we know.
Giddy up, giddy up, giddy up,
It's grand, Just cuffing your hands,
We're gliding along with a song
Of a justice fairy land.

Rove's cheeks are nice and rosy
And comfy cozy in jail
He's snuggled up together
With a guy in prison named Nail
Let's take that road before us
And sing a chorus or two
Come on, it's lovely weather
For a frog march together with you.

Walking in a Beltway Wonderland

Pundits talk, are you listening?
On Rove's brow, sweat is glistening.
A beautiful sight,
Fitz will indict,
Walking in a beltway wonderland!

In the meadow we can build a snowman,
And pretend that he is Traitor Bush.
We'll call him unindicted co-conspirator,
And then we'll start to kick him in the tush!

Can’t you tell, we're excited
Just to see who's indicted
Those who have clout,
Will be frog-marched out,
Walking in a beltway wonderland!

O Come All Ye Liberals

O come all ye liberals
Joyful and triumphant!
O come ye, o come ye, and watch them go down.
Come and behold them--
Bush and Cheney's minions--
O come let us abhor them, o come let us abhor them,
O come let us abhor them
Libby, and Rove.

Sing, all ye snitches,
Sing in desperation--
Rejoice, all ye citizens of heaven and earth!
They will be goners,
We will say, "I told you so"--
O come let us indict them, o come let us indict them,
O come let us indict them.
Right to the top.

I Saw Three Shits on Fitzmas Day

I saw three shits perp-walking in
On Fitzmas day, on Fitzmas day
I saw three shits perp-walking in
On Fitzmas day in the morning.

And who were they, these shits all three?
On Fitzmas day, on Fitzmas day
And who were they, these shits all three?
On Fitzmas day in the morning.

The traitorous turd met his demise
On Fitzmas day, on Fitzmas day
His cuffs and leg-irons were oversize
On Fitzmas day in the morning.

Libby the liar begged for bail
On Fitzmas day, on Fitzmas day
As he was frog-marched off to jail
On Fitzmas day in the morning.

Losing his Dick caused Bush much pain
On Fitzmas day, on Fitzmas day
His lying crew saw the end of their reign
On Fitzmas day in the morning.

Karl got run over by an AG

Karl got run over by an AG,
Right inside the White House Fitzmas Eve.
You can say there’s no such thing as justice,
But even Scooter Libby now believes.

He’d been mostly living off his hubris,
Though they really hoped that it had peaked.
He forgot that somebody was watching
When he leaked and leaked and leaked and leaked.

When they found him Fitzmas morning,
After he was canned,
He had Fitz prints on his forehead
An indictment in his hand.

Oh-h-h-h, Karl got run over by an AG,
Right inside the White House Fitzmas Eve.
You can say you don’t believe in justice,
But now I think I’m willing to believe.

Carol of the Fitz

Hail to the Fitz, on high he sits
Soon he will say, “Busted today”
Fitzmas is here, crooks must appear
Singing like birds, their lying words

”I did no wrong,” that is their song
Yet do they sing of wrongdoing
We seem to hear words so unclear
From everywhere, filling the air

But they’re flipping, and Fitz will bring
Charges severe - Fitzmas is here
Merry merry merry merry merry Fitzmas
Merry merry merry merry merry Fitzmas

Though liars spin on without end
They can’t atone, covers are blown
Ding-dongs ding-dongs, ding-dongs ding-dongs
Ding-dongs ding-dongs, ding-dongs ding-dongs.

Hail to the Fitz, shredding to bits
All of the lies we do despise
Fitz knows the score of the postwar
Fitzmas is here, justice is near….

My journal archive

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