[T]his working paper from Mark Duggan, Amanda Starc, Boris Vabson is about Medicare Advantage I think its provides some insight into the core problem with the entire design of the Affordable Care Act’s coverage expansion. It looks at what was the result off the government overpaying for seniors in Medicare Advantage, which is an exchange where seniors shop for subsidized private insurance. From the summary:
Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in [Medicare Advantage] plans. Our findings also reveal that only about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures.
If you spend a lot of money on a Rube Goldberg [hat tip, DCBlogger] system with middle middlemen some benefits will trickle down to regular people but huge amounts of money will be eaten up in profits and waste.
I don’t doubt the Affordable Care Act will actually help some people, but at an exorbitantly inflated price because of how inherently wasteful the design is. This creates a needless burden for all taxpayers and premium payers on the exchanges.
If only we had known this when ObamaCare was being passed! Read below the fold...
The research from consulting firm Avalere Health points to a little-known facet of policies on the ObamaCare exchanges known as "utilization management controls."
The controls allow insurance companies to limit access to certain medications to try and control costs and prevent abuse. People who enroll in ObamaCare plans are likely to encounter the hurdles if they're prescribed brand-name cancer or mental health drugs, Avalere found.
At least 51 percent of brand-name mental health meds come with special controls on the exchanges, compared with only 11 percent on the employer-based market, the analysis found.
Researchers noted that the presence of controls for psychiatric drugs was possible but unknown on roughly one-third of exchange plans and 40 percent of employer-based plans. Read below the fold...
If growth in Amazon’s ecommerce is limited, does it still make sense for Amazon to keep discounting retail and shipping costs so aggressively?
The limitations of online retail are well known. Last summer at a PandoMonthly talk, Fred Wilson of Union Square Ventures was asked what he thought about ecommerce. Wilson answered bluntly:Read below the fold...
The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.
Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension.
Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.
Nudge nudge wink wink. Boy, I bet all the people who took the mandate seriously are feeling pretty stupid right now. Read below the fold...
The following was posted on open salon by skypixie0. The link is here.
THE GOOD MIDDLE-CLASS SON
“Hi Mom, I graduated High School today.”
“That’s great son. I’m proud of you.”
“Hi Mom, I graduated University today.”
“Wonderful, my boy! You’ve done well indeed.”
“Hi Mom, I’ve been hired by XYZ company (a major corp.) Read below the fold...
Let's call this the Peyoteros revenge, or "unintended consequences bite", shall we.
Now, I am, of course, appalled (as would any right thinking person be) that the societal benefits of co-payment free birth control and insurance coverage for medical advice about the same) should be undercut by a law specifically intended to vindicate the influence of religion in the sphere of secular behaviour. Read below the fold...
Will the 2014 mandate to buy health insurance be enforced come tax time?
It sure doesn't look like it.
To be sure, the administration is not making any major announcements prior to the close of open enrollment on March 31 the better to get as many people to sign-up as possible. ...
A Treasury Department spokesperson (the IRS is charged with enforcing the mandate) said, "the rules are clear and taxpayers should be able to determine whether they had coverage for 2014, or if not, whether they owe a fee." But the spokesperson then pointed out the fee will be imposed only on those who don't have a valid exemption.
What's a valid exemption?
The administration just published a list of 14 valid exemptions with the first 13 including such things as having suffered from a flood or other disasters, the death of a close family member, and not finding an affordable alternative for a cancelled policy.
Then there is the 14th exemption: "Another hardship in obtaining health insurance." That is all number 14 says. ... Read below the fold...
Five months after Cory Booker ended his tenure as mayor to join the U.S. Senate, Newark is struggling with a leadership transition that’s left New Jersey’s biggest city on the brink of a state takeover.:
Booker’s connections to Facebook Inc. (FB) co-founder Mark Zuckerberg and billionaire financiers led to donations and investments for schools, downtown hotels, houses and offices.
[Booker] turned to what he called “venture philanthropy.” Hedge fund founders Bill Ackman and Leon Cooperman donated millions of dollars to improve parks and public safety. Zuckerberg pledged $100 million for education.Read below the fold...
From hagiography in the Times Sports section on concert promoter and Hollywood fixer Irving Azoff, who brought the Knicks owner James Dolan and coach Phil Jackson together, this little gem:
“[Dolan] would come to the concerts and say hello,” Azoff said. “In those days, he was much more focused on his guitar playing, and he was just starting to get serious with his music. Music is an amazing thing. I could give you the names of about 20 billionaire friends who care more about going to concerts than they do about their companies.”
Well, that explains a lot, if you think about it. Read below the fold...
Catherine Rampell offered a theory the other day, in a piece entitled: “Income inequality isn’t about the rich — it’s about the rest of us.” She says:
People don’t hate you because you’re beautiful. People hate you because they are getting uglier. . . .
And then later, she says:
Yes, anti-inequality rhetoric has grown in recent years. But it’s not the growing wealth of the wealthy that Americans are angry about, at least not in isolation. It’s the growing wealth of the wealthy set against the stagnation or deterioration of living standards for everyone else. Polls show that Americans pretty much always want income to be distributed more equitably than it currently is, but they’re more willing to tolerate inequality if they are still plugging ahead. That is, they care less about Lloyd Blankfein's gigantic bonus if they got even a tiny raise this year.
She proceeds to review polling data to show that this is so, and then advises the 0.1% that if they want to be left alone then “they should probably support policies that “promote the upward mobility of other Americans. . . “ such as Pell Grants, higher minimum wages, and early chidhood education. Read below the fold...
From the Atlantic, "On the Overprotected Kid":
In 1972, the British-born geography student Roger Hart settled on an unusual project for his dissertation. He moved to a rural New England town and, for two years, tracked the movements of 86 children in the local elementary school, to create what he called a “geography of children,” including actual maps that would show where and how far the children typically roamed away from home.
Hart’s methodology was novel, but he didn’t think he was recording anything radical. Many of his observations must have seemed mundane at the time. For example: “I was struck by the large amount of time children spend modifying the landscape in order to make places for themselves and for their play.” But reading his dissertation today feels like coming upon a lost civilization, a child culture with its own ways of playing and thinking and feeling that seems utterly foreign now. The children spent immense amounts of time on their own, creating imaginary landscapes their parents sometimes knew nothing about. The parents played no role in their coming together—“it is through cycling around that the older boys chance to fall into games with each other,” Hart observed. The forts they built were not praised and cooed over by their parents, because their parents almost never saw them.
Through his maps, Hart discovered broad patterns: between second and third grade, for instance, the children’s “free range”—the distance they were allowed to travel away from home without checking in first—tended to expand significantly, because they were permitted to ride bikes alone to a friend’s house or to a ball field. By fifth grade, the boys especially gained a “dramatic new freedom” and could go pretty much wherever they wanted without checking in at all. (The girls were more restricted because they often helped their mothers with chores or errands, or stayed behind to look after younger siblings.) To the children, each little addition to their free range—being allowed to cross a paved road, or go to the center of town—was a sign of growing up. The kids took special pride, Hart noted, in “knowing how to get places,” and in finding shortcuts that adults wouldn’t normally use.
I remember especially pride in the shortcuts! Read below the fold...