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Member since: Sat Jan 5, 2008, 08:45 PM
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Adverse Selection and how the Republicans just killed the ACA

The whole idea of insurance is to spread the risk among the largest population. Let's say that we want to help people who get Multiple Sclerosis a terrible condition that attacks people at random. If everyone is covered by MS insurance we can amortize it over 300 million and have a per capita charge of $ 1.00 per person.

If the number of people who buy the insurance is reduced the per capita charge increases.

If we force the insurance company to provide care for all of the MS but don't require a mandate this creates a situation of "ADVERSE SELECTION";

here is how adverse selection is explained with life insurance and smokers/non smokers

The term "adverse selection" was originally used in insurance. It describes a situation where an individual's demand for insurance is positively correlated with the individual's risk of loss.

This can be illustrated by the link between smoking status and mortality. Non-smokers typically live longer than smokers. If a life insurance company does not vary prices according to smoking status, its life insurance will be more valuable for smokers than for non-smokers. Smokers will have greater incentives to buy insurance from that company and will purchase insurance in larger amounts than non-smokers. As smokers are at higher risk of early death due to their smoking status, and more smokers than non smokers will purchase life insurance, the average mortality rate increases. This increase means the insurer will spend more on policy payments, leading to losses.

In response, the company may increase premiums. However, higher prices cause rational non-smoking customers to cancel their insurance. The higher prices combined with their lower risk of mortality make life insurance uneconomic for non-smokers. This can exacerbate the adverse selection problem. As more smokers take out life insurance policies and increase the insurer's mortality rate, its prices will continue to rise, which in turn will mean fewer non-smokers will purchase insurance. Eventually, the higher prices will push out all non-smokers and the insurer will also be unwilling to sell to smokers. No more interactions will take place, and the life insurance market will collapse.

Legislative Adverse Selection occurs when legislation destabilizes the natural selection then it creates a death spiral for the insurance plan. When you mandate that the insurance company must accept everyone regardless of pre existing conditions BUT then takes away the individual mandate they are creating Legislative Adverse Selection.

If we require Health Insurance companies to cover people with pre-existing conditions but don't have an individual mandate we will set up a death spiral for the ACA.


Susan Blumenthal, M.D., Contributor

Public Health Editor, The Huffington Post; Former U.S. Assistant Surgeon General

Repealing the Individual Mandate would not only create an influx of adverse-selection by depleting the Marketplace of many young and healthy individuals who abandon the Marketplace while seeking “skimpy” insurance plans, but might also result in the Marketplace becoming victim to an exodus of individuals abandoning purchasing health insurance altogether. On November 26, 2017, the CBO reported that repealing the ACA’s Individual Mandate might increase the number of uninsured Americans by 4 million by 2019 and by 13 million by 2027 while reducing the federal budget deficit by less than originally forecast. Sick and older Americans, some of the most vulnerable individuals needing insurance coverage, would likely remain in the Marketplace and be subject to higher premium prices — projected to increase an additional 10 percent over the next decade — resulting from instability caused by adverse-selection.

Unable to kill the ACA by guillotine the Republican Senators killed by slow strangulation.

Senator Collins, Senator Murkowski and all of the others who said that they would protect the ACA and healthcare for the middle class and poor lied.

The ACA is now a dead health plan walking. It will take a couple of years but without the mandate it will be a plan that will end up only with those who have current conditions signing up for it and others opting out as premiums will start to radically increase.

This is the most cynical move possible. Keep the popular requirement mandating insurance companies must take everyone and then take away the individual mandate so that the plan becomes unsustainable.

In Trumpism epistomology was the first casualty, and why there is still hope.

At some time in the 5th century BC Aeschylus enumerated a truth that has been repeatedly confirmed in our lifetime, "In war, truth is the first casualty."

We can now update that with “In neo fascism, epistemology is the first casualty”

Systemic philosophical or theological discussion doesn’t start with what you know but the more important question “how do you know what you think you know”. Up until Copernicus knowledge was thought to be the recitation of the obvious: God made us, we live by simple rules and noting that which can be easily observed.

When Copernicus established that the most obvious known fact, that the Sun “rose in the East and set in the West” was not a fact and that we were instead a sphere rotating through space, human reasoning went through a crises of epistemology. How should we know anything? Are we even human beings or could we be (in the absurd) a butterfly dreaming that we are humans. Descartes established a new foundation with “I think therefore I am”, that knowledge can be certain on the basis of rational discourse and the use of the scientific method.

In 1970 Alvin Toffler observed in “Future Shock” that technological change would continue to speed up until it would happen at a rate that was faster than the psychological ability of society to absorb it. It would create pockets of fear. That is exactly what we are witnessing.

Please take a minute and read this disturbing article by The Guardian. It documents that farmers in the US are committing suicide at a rate much higher than not just the population but higher than other high risk groups, like veterans.



Last year, a study by the Centers for Disease Control and Prevention (CDC) found that people working in agriculture – including farmers, farm laborers, ranchers, fishers, and lumber harvesters – take their lives at a rate higher than any other occupation. The data suggested that the suicide rate for agricultural workers in 17 states was nearly five times higher compared with that in the general population.

After the study was released, Newsweek reported that the suicide death rate for farmers was more than double that of military veterans. This, however, could be an underestimate, as the data collected skipped several major agricultural states, including Iowa. Rosmann and other experts add that the farmer suicide rate might be higher, because an unknown number of farmers disguise their suicides as farm accidents.

The US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally: an Australian farmer dies by suicide every four days; in the UK, one farmer a week takes his or her own life; in France, one farmer dies by suicide every two days; in India, more than 270,000 farmers have died by suicide since 1995.

When we look at the irrational embrace of neo fascism in Trump and scratch our heads why rural parts of the country (and other countries), even those that are located close to normal urban and progressive communities, embrace policies of tribalism, we can see the reason, they are filled with fear. Fear is the fuel that has empowered fascism for a hundred years. In their fear they cling to their guns, their bibles and the false memory of a simpler time when society could be ordered by the simple observation in known truths; The sun rises and sets and human society was based on families that had a simple formula – a man, a women and children, that all you needed to succeed in the work place was to show up and work hard.

We need to face that what we are seeing is in fact a new branch of fascism. It is a world view that is not based on reason or fact but the Nietzsche like birth of the “strong man” who intends to reorder society not by reason but as an extension of their personality camouflaged democratic institutions. In this way Trump is like other “strong men” of fascism like Mussolini.

Truth, for people like Trump, is simple; it is not in a fact but in bellicose repetition of a lie where the truth of a thing is established not by reason but by the forceful assertion of a phrase. In the New York media and property world Trump was able to establish a win by simply wearing down critics by an obstinate repetition of a lie and that is the game that he is playing now.

Where the News Media went wrong with Trump is when they allowed him to state a known lie and after a few attempts at questioning “went on” to the next object. When Trump entered the absurd world of “birtherism” the news media should have never asked him another question, never moved on. They should have repeatedly asked him to explain how he arrived at that lie. Until he conceded that lie then they should have not let him make any other point. He won by his persistence.

We must now re-establish reason as the currency of public conversation. We should never again let one of our courageous leaders be targeted by absurd allegations that parallel Trump’s tactics of bellicosity and repetition as a substitute for fact and reason.

We should also understand that for many in the rural areas of our country the embracement of Trump is a cry for help. The are afraid of the future that takes their children to live in urban areas far away and eliminates jobs that have provided stability for families for generations.

How can we take the higher road, understand the pain that has mobilized our political enemies into an eruption of fascist irrationality and find a path forward that unites our common interest based on shared values? I would suggest we could accomplish this by simply recalling the wise leadership of the man who spent 8 years doing it day in and day out. The strange reality we live in is the country that has tens of millions that support Trump is the same country that elected and re-elected President Obama.

We must insist on a return to compassion and reason. Exhaustion, lassitude and defeat are not options.

Russian Roulette Republicans

It is entirely possible that all 51 Republican Senators want to pass a terrible tax bill.

However there is, I believe, a much simpler explanation for the Senate vote.

They passed a terrible bill that will not get past the debt hawks in the House and the House Republicans will make substantial changes and return it to the Senate where it will lose at least two more Senators and fail.

Why would the Republican Senators who are seriously against this legislation (and there may be more than those that telegraphed a problem with it) vote for it?

They are tired of being blamed by the radicals in the Republican House and getting challenged in primaries by Tea Party. The House can pass the Senate bill without any changes and send it to the President. If they make any changes the Senate Republicans can say "we did what we had to do but it is the purists in the House that sabotaged it".

Of course if the House Republicans pass the Senate bill then it will hurt the Republican Senators in the General Election but not in the primaries and that is their greatest concern. Senator Lugar, Bennet and Murkowski all lost in the primary and would have easily won in the GE. Murkowski won on an independent ticket.

The Senate Republicans have put a bullet in the chamber and dared the House to pass it knowing that if it goes back to the Senate it will not pass, especially if they lose on Tuesday and the responsibility will be 100% on the House Republicans.

Stupid on stupid: "The lawyer ate my tweet homework"

Woke up to this

John Dowd, President Trump's personal lawyer, tells me that a Trump tweet that caused an eruption yesterday was "my mistake," made in a tweet he had drafted and passed to White House social media director Dan Scavino.

It is a stupid excuse of course but the question who drafted it is of no consequence. The point is that Trump tweeted it out and found nothing untruthful with it.

However this is just more lies on other lies. No attorney is drafting tweets for Trump to send out. All attorneys are telling Trump to stop talking about the case, stop tweeting about the case and refer all questions to a single attorney that represents the entire defense team. If that attorney says anything more than "We have no comment" he will be sacked.

Have Dowd and Savino explain minute by minute before FBI agents what happened and maybe we can get these asses understand that they have to stop lying but more likely we are going to get more guilty verdicts.

Evidence of a cover up (lawyer ate the tweet) about a cover up (the actual tweet) of a felony obstruction claim(Flynn lying to the FBI) about the conspiracy (conspiring with the Russians to modify the sanctions) of sedition (not treason).


Congress has passed laws creating related offenses that punish conduct that undermines the government or the national security, such as sedition in the 1798 Alien and Sedition Acts, or espionage and sedition in the Espionage Act of 1917, which do not require the testimony of two witnesses and have a much broader definition than Article Three treason. Some of these laws are still in effect. Some well-known spies have been convicted of espionage rather than treason.

We are literally watching people commit felonies before our eyes in slow motion. If the lawyer states before FBI agents that he drafted the tweet and did not, its another level of obstruction. Whether he drafted it or not it has been tweeted out and Trump hasn't disowned it. Who "drafted" the tweet is of zero relevance.
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