From Ostrum's Nobel Lecture, which is dense but fast-moving and well worth reading and study:
The classic assumptions about rational individuals facing a dichotomy of organizational forms and of goods hide the potentially productive efforts of individuals and groups to organize and solve social dilemmas such as the overharvesting of common-pool resources and the underprovision of local public goods. The classic models have been used to view those who are involved in a Prisoner’s Dilemma [PD] game or other social dilemmas as always trapped in the situation without capabilities to change the structure themselves. This analytical step was a retrogressive step in the theories used to analyze the human condition. Whether or not the individuals who are in a situation have capacities to transform the external variables affecting their own situation varies dramatically from one situation to the next. It is an empirical condition that varies from situation to situation rather than a logical universality. Public investigators purposely keep prisoners separated so they cannot communicate. The users of a common-pool resource are not so limited.
When analysts perceive the human beings they model as being trapped inside perverse situations, they then assume that other human beings external to those involved – scholars and public officials – are able to analyze the situation, ascertain why counterproductive outcomes are reached, and posit what changes in the rules-in-use will enable participants to improve outcomes. Then, external officials are expected to impose an optimal set of rules on those individuals involved. it is assumed that the momentum for change must come from outside the situation rather than from the self-reflection and creativity of those within a situation to restructure their own patterns of interaction.
So, whenever you hear an analyst or expert, especially an economist, invoke the Prisoner's Dilemma, you might ask yourself:
1) Whether the key assumption -- that game participants cannot communicate -- is realistic*, and
2) Whether the analyst or expert is personally invested in the "optimal set of rules" they will seek to impose on you (and people like you).
Indeed, considered in this light, "rationality" looks an awful lot like mere compliance. Read below the fold...
Sheesh, twice now? LA Times:
The Obama administration again delayed a requirement that large employers provide their workers with health benefits, offering businesses more relief from the president's health law deadlines.
Under the law, employers with more than 50 full-time employees must offer affordable health benefits or pay fines, a requirement originally scheduled to go into effect this year but postponed until 2015.Read below the fold...
Nice article from George Packer, especially if you're a book lover, and even more especially if you've been a book lover all your life:*
In 2009, after a career at publishers large and small, Robinson was laid off by Scribner, amid downsizing. Faced with his own professional extinction, and perhaps the industry’s, he co-founded a new company, OR Books, with a different business model. Robinson did research and found that fifty to sixty per cent of the list price of a book goes to Amazon or to another retailer. When he was starting out, in the eighties, that figure was more like thirty or forty per cent. A small-to-midsize publisher has to spend between ten and fifteen per cent on sales, warehousing, and shipping. This leaves little more than twenty-five per cent of the book’s price for editorial counsel, production costs, publicity, paying the author, and whatever profit might be left over. A shared sensibility for a certain kind of fiction or nonfiction writing unites everyone along the way: authors, agents, editors, designers, marketers, reviewers, readers. “The only point at which Bezos enters that chain is to take all the money and the e-mail address of the buyer,” Robinson said. “There’s an entire community of people, and Bezos stands in the middle of it and collects the money.”
Instead of going through Amazon, OR Books sells directly to customers, using printers in Minnesota and the U.K. It pays about fifteen per cent to the printer and keeps the rest. “After four years, we’re just profitable,” Robinson told me. “It works.”
Well, it works as long as one thing is true: Read below the fold...
ObamaCare Clusterfuck: Is there something about Democrats that caused five separate ObamaCare website debacles?
We all know how Obama -- assuming his staff aren't lying to cover for him -- was never told and worse, never asked about the problems with the Federal Exchange website. And we also know that to this very day nobody has been fired for the debacle, or even disciplined. (Obama, needless to say, is nominally a Democrat.) Now we see the same sort of administrative and executive dysfunction in four Democratic states whose Exchanges failed as well. ProPublica:
Much has been written (and will continue to be written) about the spectacular failure of health insurance exchanges in Minnesota, Massachusetts, Oregon and Maryland—all blue states that support the Affordable Care Act.
One common element emerging in the coverage of these exchanges is that at least some state employees knew they were heading for disaster but didn’t take action early enough to remedy it. All the states have blamed some, if not all, of their problems on outside tech contractors.
Well, yes. With Democrats, it is always, 100% of the time, somebody else's fault. Mean Republicans! Outside contractors! Ralph Nader! Some detail on each state: Read below the fold...
ObamaCare Clusterfuck: Supplemental private insurance emerges to cover the high out-of-pocket costs of ObamaCare's insurance
As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers.
The policies are promoted as helping cover out-of-pocket expenses that can reach thousands of dollars in plans offered by employers and the health law’s online marketplace.
"These supplemental health products have been recently — and we believe will be in the future — one of the fastest growing components of the employer benefits market," said Todd Katz, an executive vice president with MetLife.
Some experts, however, see risk for policyholders in the lightly regulated plans, which tend to be highly profitable for insurers and might be mistaken for more generous coverage.
Just when you think the hilarity can't get more intense, eh? ObamaCare not only guarantees the health insurance parasites a market, it's so poorly designed -- or so well designed -- that it opens up whole new markets for them! You can insure yourself against ObamaCare's crappy policies if you buy a second, additional, crappy policy! It's GENIUS!! Only a satirist of, say, Jonathan Swift's calibre could come up with an appropriate response. But wait! He did! Read below the fold...
ObamaCare Clusterfuck: ObamaCare not so affordable for families at three and four times the poverty line
Who knew? Kaiser Health News:
The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.
But the promise comes with a catch for almost 3 million people earning between three and four times the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in.
That could take a substantial bite from their budgets — potentially as much as $600 a month for mid-priced plan for a family of three earning between $58,590 and $78,120.
And that's before we talk about the high deductibles, the high co-pays, narrow networks, narrow formularies, and balance billing. Read below the fold...
Wow, shocker. Normally, I don't pay much attention to WaPo fact-checking -- I mean, why would I? -- but Glenn Kessler has a nice compendium of material I know to be true, so herewith on Dick Durbin's claim on Sunday's MTP:
DURBIN: Bob, let’s look at the bottom line. The bottom line is this: 10 million Americans have health insurance today who would not have had it without the Affordable Care Act. Ten million.
Interesting if true. Except so very, very not true. Read below the fold...
First Look's first article (and, apparently, magazine) is out with an article by Glenn Greenwald and Jeremy Scahill:
According to a former drone operator for the military’s Joint Special Operations Command (JSOC) who also worked with the NSA, the agency often identifies targets based on controversial metadata analysis and cell-phone tracking technologies. Rather than confirming a target’s identity with operatives or informants on the ground, the CIA or the U.S. military then orders a strike based on the activity and location of the mobile phone a [some] person is believed to be using.
The drone operator, who agreed to discuss the top-secret programs on the condition of anonymity, was a member of JSOC’s High Value Targeting task force, which is charged with identifying, capturing or killing terrorist suspects in Yemen, Somalia, Afghanistan and elsewhere.
Interesting they've got a drone operator as a source, eh? Obama must be really pissed off about that, and he takes such things very personally.
His account is bolstered by top-secret NSA documents previously provided by whistleblower Edward Snowden. It is also supported by a former drone sensor operator with the U.S. Air Force, Brandon Bryant, who has become an outspoken critic of the lethal operations in which he was directly involved in Iraq, Afghanistan and Yemen.
In one tactic, the NSA “geolocates” the SIM card or handset of a suspected terrorist’s mobile phone, enabling the CIA and U.S. military to conduct night raids and drone strikes to kill or capture the individual in possession of the device.
The former JSOC drone operator is adamant that the technology has been responsible for taking out terrorists and networks of people facilitating improvised explosive device attacks against U.S. forces in Afghanistan. But he also states that innocent people have “absolutely” been killed as a result of the NSA’s increasing reliance on the surveillance tactic.
One problem, he explains, is that targets are increasingly aware of the NSA’s reliance on geolocating, and have moved to thwart the tactic. Some have as many as 16 different SIM cards associated with their identity within the High Value Target system. Others, unaware that their mobile phone is being targeted, lend their phone, with the SIM card in it, to friends, children, spouses and family members.
Some top Taliban leaders, knowing of the NSA’s targeting method, have purposely and randomly distributed SIM cards among their units in order to elude their trackers. “They would do things like go to meetings, take all their SIM cards out, put them in a bag, mix them up, and everybody gets a different SIM card when they leave,” the former drone operator says. “That’s how they confuse us.”
Funny. Rather like a suburban key party, except with database keys (the unique identifier of the SIM, used as a selector by the NSA), and with a rather different outcome envisaged. Read below the fold...
ObamaCare Clusterfuck: Louisiana insurerers refuse to accept payments from HIV/AIDS patients under Ryan White program
Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud. ...
The state's largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued. ....
"In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law," Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters. ....
The dispute goes back to a series of statements from Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency.
In September, CMS informed insurers that Ryan White funds "may be used to cover the cost of private health insurance premiums, deductibles, and co-payments" for Obamacare plans.
In November, however, it warned "hospitals, other healthcare providers, and other commercial entities" that it has "significant concerns" about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud. ....
On Friday, CMS spokeswoman Tasha Bradley told Reuters that, to the contrary, Ryan White grantees "may use funds to pay for premiums on behalf of eligible enrollees in Marketplace plans, when it is cost-effective for the Ryan White program," meaning that having people with HIV/AIDS enroll in insurance under Obamacare could save the government money.* ... Maginnis did not respond to further requests, sent after business hours, for comment on CMS's Friday statement.
Wait, wait, who does the figuring on "cost effective"? And since when did the government not accept the check with one hand (ObamaCare) that it wrote with the other (Ryan White)? This is crazy pants! Read below the fold...
nfavorable polling for Obamacare and actions taken by New Hampshire’s congressional Democrats last week to fix it underscore Democrats’ continued complicated relationship with the health care law heading into election season.
Republicans will do their best to make sure this doesn’t change anytime soon.
First District Rep. Carol Shea-Porter told President Obama in a face-to-face meeting last week that people need to resign over the flawed roll out of the health care website. And in late January, she sought clarification from the Centers for Medicare and Medicaid Services on access to health care for children who qualify for Medicaid while their parents don’t – a glitch that federal officials say was fixed last week. Shea-Porter’s team was quick to highlight both as examples that she is fighting to help New Hampshire families.
And you know what? Read below the fold...
ObamaCare Clusterfuck: "Per beneficiary" limits a loophole insurance companies can drive a truck through?
ObamaCare defenders consistently point to caps on dollar costs as one of the main benefits of ObamaCare. However, via Michael Olenick, from ObamaCare Facts ("dispelling the myths") we read this:
While you may have to meet a certain amount of out-of-pocket expenses (deductible) before essential benefits are covered, the Affordable Care Act prohibits health plans (grandfathered and non-grandfathered) from imposing annual and lifetime dollar limits on essential benefits.
So far so good. Now get this:
Health plans can still however set limits on the number of times you can receive a certain treatment.
Hmm. How can this be? Let's go to the text of the statute; I'm guessing 42 U.S. Code § 300gg–11 - No lifetime or annual limits: Read below the fold...
One of those "world turned upside down" things that keeps happening with the ObamaCare story: Megan McArdle isn't always wrong!
Don't Judge Obamacare by Medicaid Numbers
The latest reports we have on Medicaid enrollment suggest that 6.3 million people had been “deemed eligible” for Medicaid since Obamacare went live Oct. 1. But almost no one thinks that means 6.3 million people have gained new insurance; some of them were already eligible, and some of them won’t have actually signed up.
We don’t know how big the difference is between people who were deemed eligible and people who actually got new insurance. The new report, from health-care consultancy Avalere Health LLC, suggests that the answer is “very big”:
"Avalere estimates that from October through December 2013, between 1.1M and 1.8M people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA)." ...
This is less than a quarter of the 8 million people that the Congressional Budget Office projected would enroll in Medicaid this year thanks to the health-care overhaul. However, unlike the exchanges, Medicaid will remain open for enrollment year-round, so the administration doesn’t need to sign up all those people in the next two months. We won’t really have a good sense of what this year’s Medicaid numbers will look like until we get data for April and May and see whether Medicaid enrollment falls off the way exchange enrollments are expected to, or whether it remains elevated throughout the year.
Still, this is a good reminder that the early gross data we’re getting from the administration aren’t necessarily a good guide to what the net result will be on insurance coverage.
Soft numbers and sloppy record keeping have been hallmarks of the ObamaCare project from the very beginning. Read below the fold...