Via here, we get this:

Insurers would have more leeway to vary prices by age, so that premiums for the oldest customers could be 3.49 times as large as those for younger customers. Today, premiums for the old can be only three times as high as premiums for the young, which is what the Affordable Care Act stipulates. According to sources privy to HHS discussions with insurers, officials would argue that since 3.49 “rounds down” to three, the change would still comply with the statute.

At some level, this is politically stupid since it explicitly raises the rates of older people while reducing it for the young–the opposite of the voting pattern for Trump. For me, the problem is the math–at most 3 times as large means at most 3 times as large, even 3.01 is out, never mind 3.1 or 3.49.

This will be similar to the “Pi Bill” from Indiana which indirectly says that pi is 3.2 (the bill tried to prove a method of squaring the circle, which is impossible, by making it a law).

This is the type of thing which shows why there needs to be a March for Science (it will be on April 22 with satellite marches all over the country).

Trumpcare=No Care

Via Kevin Drum, we see how well Donald Trump and Republicans have prepared for the elimination of Obamacare:

Congressional Republicans, despite pledging to quickly repeal the Affordable Care Act, are struggling with what parts of the law to roll back and how to lock up the votes they will need, particularly in the Senate, to push their ambitious plans.

Thirty-one states, including many with Republican governors, have expanded Medicaid through Obamacare and could lose billions of dollars if the law is cut back.

In Washington, Republicans are also struggling to figure out what to do with Obamacare insurance marketplaces that Republicans worked for years to dismantle. In a reversal, GOP leaders now are trying to figure out how to prevent their collapse, which would jeopardize coverage for millions more Americans.

Insurance experts, including leading industry officials, have repeatedly warned Republicans over the past several months that repealing the health law without a replacement risks destabilizing insurance markets and will push many insurers to simply stop selling health plans.

So, not only will the repeal likely lead to tens of millions of people losing their health insurance it might actually wreck the entire individual health insurance market. Things would be even worse than before the ACA was passed:

But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the startup years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

And now comes the reality of the “repeal and replace” initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.

Some in Congress seem to think that passing the “repeal” part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.

How does the Trump administration plan to deal with this?

The budget legislation gives congressional committees until Jan. 27 — a blink of an eye for lawmakers — to write legislation repealing major parts of the health care law. Likely targets include the law’s tax penalties for people who don’t obtain insurance, its requirement that many companies cover workers and tax increases on higher-earning individuals and many health care firms.

Aware they have no chance of quickly agreeing on replacement legislation, Republicans plan to delay when their repeal would actually take effect. A range of 18 months to three years — perhaps longer — has been under discussion.

Trump has provided few specifics about how he would revamp the nation’s $3 trillion-a-year health care system. Steps he and congressional Republicans have mentioned include greater reliance on tax credits to help people afford coverage.

Republicans don’t want to abruptly end health care coverage for millions of voters who live in GOP-represented districts and states, or cause chaos in health care markets and prompt insurance companies to stop selling policies. So they are considering including provisions in their repeal bill to protect consumers and insurers during the transition period.

Sen. John Thune, R-S.D., a member of the GOP Senate leadership, said that could include money to temporarily continue helping people afford to buy coverage and language letting the Department of Health and Human Services help stabilize insurance markets.

A few things:

  • Republicans have been talking about repealing the ACA since it was passed and they have no plan to replace it yet? Obviously they have never really planned a real replacement.
  • Given the above discussion, it’s very possible that the repeal of the ACA will crash the individual insurance market so it won’t matter if there are subsidies since there will be no companies willing to participate in the market. Why would a company participate in a market they know will be gone in a few years and which depends on Congress supporting them to break even–knowing that Congress reneged the last time such a promise was made?
  • Given all the complexities, they are going to write the repeal legislation very quickly. I’m sure they will be very well written and carefully vetted.

Donald Trump, being Donald Trump, is trying to get out the lie that any failure will be the fault of Democrats:

massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight – be careful!

Sorry Donald, this will all be on you and the Republicans. You will be responsible for tens of millions of Americans losing health insurance.

Thank you Donald Henderson

The Boston Globe has a partial list of people who died in 20016. It’s a long list, they start with Muhammad Ali and Elie Wiesel, then run through a long list of high-profile names all the way through Jim Delligatti (the man who invented the Bic Mac). They even include a few scientists. They do not include Donald Henderson (although he is in the addendum in the paper):

Dr. Donald A. Henderson, a leader of one of mankind’s greatest public health triumphs, the eradication of smallpox, died on Friday in Towson, Md. He was 87.

Starting in 1966, Dr. Henderson, known as D. A., led the World Health Organization’s war on the smallpox virus. He achieved success astonishingly quickly. The last known case was found in a hospital cook in Somalia in 1977.

Now I can understand not starting with him but in some ways he was one of the most consequential men in history:

It carried off many European monarchs and buried the lines of succession to thrones from England to China. Because it killed 80 percent of the American Indians who caught it, it was a major factor in the European conquest of the New World.

Three American presidents survived it: George Washington, Andrew Jackson and Abraham Lincoln. In the 20th century, before it was extinguished, it was blamed for at least 300 million deaths.

Smallpox had already been eradicated in much of the West but it was still killing 2 million people per year when the campaign started. Dr. Henderson was far from the only person working on the battle, but I would still expect a person who is responsible for saving up to 2 million people per year to get a higher profile than the man who invented the Big Mac.

Trump will screw Trump states

Kevin Drum put this up:

Once Obamacare’s subsidies are repealed, it’s likely that 3 million people with expensive pre-existing conditions will be instantly tossed out of the health care system, unable to get insurance and unable to afford proper care.

He’s using the numbers from here. If you look at the chart in Kevin Drum’s post you notice that the states with the highest percent of people with pre-existing conditions voted for Trump. In fact, there are 23 states that are at or above the US average of 27% with pre-existing conditions–of these 4 voted for Clinton including Maine which split electoral votes (3 for Clinton, 1 for Trump). And all 11 with 30% or higher voted strongly for Trump (Clinton got less than 40% of the vote in all those states).

Hey, here’s a scatterplot (DC is the one in the upper left):


Donald Trump has said he wants to keep the ban on people being denied health insurance if the have pre-existing conditions but the health insurance companies will go bankrupt unless they’re allowed to charge them much more and/or force almost everyone to have insurance. Since the mandate to have insurance is not one of the things Trump wants to keep, health insurance will become unaffordable to a good chunk of these people which is why Kevin Drum says that 3 million of these people will be instantly tossed out of the health care system.

Trump voters really know how to stick it to themselves.

Republicans want to cut, Medicare, ACA, Medicaid, and Social Security

Let’s see what Republicans plan now that they hold the three parts of government:

Amid all the hand-wringing over Republican plans to eviscerate Medicare and Medicaid and repeal the Affordable Care Act, it shouldn’t be overlooked that the GOP has the knives out for Social Security too.

Johnson’s “Social Security Reform Act” changes the program’s benefit formula to provide modest benefit increases for the lowest-earning workers in the system— those who earned up to an annual average of about $22,105 over their lifetimes in inflation-indexed pay — with cuts for everyone else ranging from 17% to as much as 43%, compared with currently scheduled benefits, by 2080.

The act would cut way back on cost-of-living increases for retirees. It would do this by cutting out cost-of-living raises entirely for retirees earning adjusted gross income of more than $85,000 ($170,000 for couples) starting in December 2018, and using the chained consumer price index to calculate the COLA for all others. (The income threshold would be adjusted for inflation.)

Finally, the measure also raises the full retirement age, which is now pegged to reach 67 by 2022, to 69 by 2030. this means that workers taking early retirement, which is permitted as soon as age 62, would face a steeper cut in annual benefits for starting early.

Hey, that’s great news for all the working-class people that were so upset that they voted for Trump … if they wanted to make their lives worse.

Anyway, let’s move on to Russia:

Trump’s team lashed out at the agencies after The Washington Post reported that the CIA believed that Russia had intervened to undercut Clinton and lift Trump, and The New York Times reported that Russia had broken into Republican National Committee computer networks just as they had broken into Democratic ones, but had released documents only on the Democrats.

There are even some Republicans who say this is a bad thing:

The Republicans who lead the congressional committees overseeing intelligence, the Pentagon and the Department of Homeland Security take the opposite view. They say that Russia was behind the election meddling, but that the scope and intent of the operation need deep investigation, hearings and public reports.

“We cannot allow foreign governments to interfere in our democracy,” Rep. Michael McCaul, R-Texas, who is the chairman of the Homeland Security Committee and was considered by Trump for secretary of Homeland Security, said at the conservative Heritage Foundation. “When they do, we must respond forcefully, publicly and decisively.”

Of course Trump hasn’t been going to many of the intelligence briefings so he knows more about what’s going on than those that actually go. I assume that’s his argument.

Fun time to be an American and Trump isn’t even President yet.

Fuck Donald Trump

I haven’t posted too much about Donald Trump, because he’s such an obviously terrible person and yet, at times, he has polled close to Hillary Clinton. Now that we’re getting somewhat close to the election I thought I would put up all the reasons to vote against him. Since almost all of this has been reported repeatedly, I’m not going to put in many links but might add them later.

  1. Let’s start with sexism/misogyny since that’s the latest thing that has exploded. In how many ways does this come up?
    1. He brags that he can sexually assault women without consequence.
    2. He brags that he was able to peak in to look at women nude at the Miss USA pageant since he ran it.
    3. It’s so well known that he cares only about a woman’s appearance that managers at his businesses make sure that he mostly only interacts with the prettiest women so he doesn’t fire them.
    4. He’s disgusted by perfectly natural aspects of women’s body (bloods coming out of her wherever).
    5. He freely leers at women.
    6. He freely insults women’s appearance who either don’t come up to his beauty standards or say anything bad about him.
    7. He has tried to fire women who either don’t sleep with him or get pregnant.
  2. He’s incredibly racist:
    1. He discriminated against blacks in his housing complexes.
    2. He started the race by saying Mexicans are racist.
    3. He has said a judge couldn’t rule fairly against him because he is of Mexican descent.
    4. He seems to think all blacks live in slums.
    5. He was one of the most prominent people behind the conspiracy about President Obama’s birth certificate.
    6. He still believes in the case against the Central Park 5 even after evidence has proved they were innocent.
    7. He has a habit of retweeting material from white supremacists.
  3. He is biased against Muslims:
    1. He claims they celebrated after 9/11 when they didn’t.
    2. He has said that all Muslims should be kept from entering the US.
    3. He has complained about a Gold Star family because they were Muslim.
  4. He was a bad businessman:
    1. He was basically broke in the mid-1990s because he had overpaid for Trump Airlines, many buildings, and casinos. He only got out of it by help from his father and the fact that he owed so much money he was able to convince his creditors to forgo much of what he owed.
    2. He routinely doesn’t pay people for work they have done for him.
    3. He has bought into numerous scams, the largest being Trump University.
    4. Almost all of the businesses that he has started have failed.
    5. The one thing he’s good at is publicity and selling himself.
  5. He lies all the time:
    1. A group that looked at his speeches found he lies about once every 3.5 minutes.
    2. He doesn’t care if people knows he’s lying–he will lie when there’s concrete evidence that contradicts what he says.
  6. His foreign policy is a complete mess even when it’s coherent enough to judge:
    1. He has said that numerous countries should build nuclear weapons.
    2. He thinks we shouldn’t automatically back countries in NATO.
    3. He thinks we should torture which is against international law.
    4. He thinks we should kill the families of terrorists which is against international law.
    5. He praises people like Putin and Saddam Hussein.
    6. He has intimated that he would fire at groups that irk him–Iranian boats that get too close to US ships, Russian airplanes that buzz US airplanes–seemingly not caring that this might cause wars.
  7. He doesn’t seem to have many serious proposals and the ones that he does would be terrible:
    1. He’s going to build a wall without saying how, even though, in places, this is almost physically impossible.
    2. He’s going to cut taxes so much it will make the current deficit tiny even though he’s going to cut numerous programs that help the poor and middle-class.
    3. He will get rid of Obamacare with nothing to replace it.
    4. He wants to outlaw abortion and has, at least once, said that the woman should be punished.
    5. Economists say his economic plans would drive the US into recession.
  8. He has autocratic tendencies:
    1. He has a habit of praising dictators.
    2. When he makes a claim he says that he will do something.
    3. He wants to make it easier to sue the press.
    4. He thinks the old NY City policy of stop and frisk should be expanded even though it was not shown to be effective and was declared unconstitutional.
  9. He has said he would put Hillary Clinton in jail even though she has been cleared of the charges he wants to put her in jail.

This is a list off the top of my head, I’m sure there are many more reasons so I might add to the list later.

Mylan and the EpiPen

Heather Bresch and Mylan Pharmaceuticals are both clever and stupid. Mylan is the company that makes the EpiPen, you might have heard about this. They were clever enough to spread their increases over many years:

Since 2009, Mylan has jacked up the price of the lifesaving allergy treatment an incredible 15 times. The list price on a two-pack of EpiPens is $609, up 400% from seven years ago.

And they mostly tried to hide the price from consumers:

Mylan said the company never intended for patients to pay the full price, expecting insurers would carry the load.

“We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter,” chief executive Heather Bresch said in a statement.

But they’re also pretty stupid. At some point you can’t hide price hikes if you do it so many times and increase the price too much–they just got too greedy and now a bunch of Senators have sent them a letter noticing that price of the EpiPens has soared as the salary of the CEO has as well:

Reports emerged last week that the company had implemented a series of gradual price increases inflating the price of the drug from $56.64 to $317.82, a 461% increase in cost since Mylan acquired the rights to EpiPen in 2007. During that same time, Heather Bresch, chief executive officer of Mylan, saw her pay rise $2,453,456 to $18,931,068, a 671% increase. Last week, she sold 100,200 of her shares in the company for more than $5m.

What’s their explanation?

“We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter,” Bresch said in the company’s statement Thursday. “Patients deserve increased price transparency and affordable care, particularly as the system shifts significant costs to them. However, price is only one part of the problem that we are addressing with today’s actions.”

Given that one of the reasons insurance premiums are soaring and copays are increasing is the increased cost of drugs, Heather Bresch is basically blaming herself and her company but pretending otherwise. So far it doesn’t seem to be working. You’ll notice that the prices in the Guardian article are the price Mylan charges the middlemen, so those increases are all on Mylan. Here’s hoping they lose lots of money over their greed.

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