Relevant and even prescient commentary on news, politics and the economy.

Bronze ACA Plans are Terrible. Bronze plans are often the best Choice

Andrew Sprung writes about the ACA. I read him quite often as his posts are expert analysis of the ACA and healthcare.  Mostly recently this commentary was posted by Andrew on the benefits of getting a Bronze plan as opposed to a Gold plan if facing large out of pocket expenses (premiums + deductibles).

“XPOSTFACTOID”   Mostly about the ACA: Obamacare to Trumpcare.

Bronze plans are terrible. Bronze plans are often the best choice.

In discussion of the ACA marketplace (and health insurance generally), deductibles are often used as a stand-in for out-of-pocket costs. Now here cometh David Anderson to remind us that a plan’s maximum out-of-pocket cost (MOOP) can be just as important — and that the MOOP often does not particularly correspond to metal level.

The highest allowable MOOP at all metal levels is $8,150 (a travesty by international rich country standards). Here is David’s mapping of the range of MOOP for gold plans in states. Dark green is $2,500 MOOP; dark red is $8,150.

As David points out, bronze plans will be a better deal for anyone who knows they’ll hit the out-of-pocket max. As he’s pointed out elsewhere (and in passing here), it takes a lot more spending to hit the high max in a gold plan — say, $30,000 — than in a bronze plan. That’s because once you meet your deductible (likely to be relatively low in a gold plan with high MOOP), a high percentage of ensuing costs will be covered in a gold plan until the MOOP is reached, at which point coverage goes to 100% for ensuing costs (if you stay in network).

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Surprise Billing To Be Resolved in February 2020 to be Enacted in 2022

I had wondered why the Senate (Schumer) had backed off on legislation controlling surprise billing. It turns out there is a House bill also and I am sure they are going back and forth on this. Recently, two bills have emerged in the House and one from the Senate. Medscape, “House Committees Advance Bills to Address Surprise Billing.”

Of course if Congress’s butt was on the line, a solution would have been found quickly and enacted in 2020. At the end, see which one I would back.

The House Ways and Means Committee bill passed by a voice vote bipartisan bill. It seeks to establish more use of third-party negotiators ( arbitration) for settling certain disputes about payment for out-of-network care. This bill has the support of the American Hospital Association and the American College of Emergency Physicians. The American Medical Association also praised the committee’s reliance on mediation for disputes on bills.

The House Education and Labor Committee advanced a hybrid proposal seeking to use established prices in local markets to resolve many disputes about out-of-network bills. Key to this bill is the use of arbitration above a certain cost. Bills greater than $750 or in the case of air ambulance services $25,000; clinicians and insurers could turn to arbitration for an independent dispute resolution. House Education and Labor passed this bill in a 32-13 mixed vote with some Republicans and Democrats opposing and in favor.

The latest Senate Health, Education, Labor and Pensions (HELP) Committee of legislative proposals also addresses surprise medical billing. The HELP bill called for mandating that insurers reimburse out-of-network costs on the basis of their own median rates for in-network providers.

The Education and Labor Committee bill is estimated to save $24 billion, the Senate HELPS bill is estimated to save $25 billion, and the Ways and Means’ bill would save almost $18 billion  all over 10 years. It is suggested the greater use of arbitration in the Ways and Means’ bill will result in less savings.

Read on about the private equity involved and providers.

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Doctor Surprise Billing

This doctor is a bit much; but, he gets a point across which I have been making also. The issue(s) Dr. ZDogg  is describing about what commercial healthcare insurance, Medicare Advantage plans, hospitals, and now doctors are doing needs to be told over and over again. Schumer and the Senate have to release the portion of the House Budget bill that dealt with Surprise billing.

ZDoggMD reacts to ridiculous medical bills, MedPage Today, February 6, 2020


Going to her PCP located in Manhattan, a woman complains of a sore throat. Forget the Manhattan part of this as various versions (surprise billing)  of this situation are happening everywhere. The doctor swabbed the throat, sent it off to the lab, ordered some tests, and then gave her a prescription for antibiotics. She took her meds and went on vacation feeling better.

The tests came back negative. She later received a bill for ~$26,000.

The  lab was out of network which usually results with insurance only paying a portion of the bill and the patient the balance unless the insurance negotiates a lesser charge (hospital 3rd party employees) which they will pay. This is another version of Surprise Billing, not in a hospital setting, which we have heard so much about, and the patient gets screwed with the balance of the Surprise Billing.

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Does America Hate Its Children?

December 2012,  Robert Reich wrote about America’s children   .   .   .    Remember the Children.

“America’s children seem to be shortchanged on almost every issue we face as a society.

Not only are we failing to protect our children from deranged people wielding semi-automatic guns.

We’re not protecting them from poverty. The rate of child poverty keeps rising – even faster than the rate of adult poverty. We now have the highest rate of child poverty in the developed world.

And we’re not protecting their health. Rates of child diabetes and asthma continue to climb. America has the third-worst rate of infant mortality among 30 industrialized nations and the second-highest rate of teenage pregnancy, after Mexico.

If we go over the “fiscal cliff” without a budget deal, several programs focused on the well-being of children will be axed – education, child nutrition, school lunches, children’s health, Head Start.

Even if we avoid the cliff, any “grand bargain” to tame to deficit is likely to jeopardize them.

The Urban Institute projects the share of federal spending on children (outlays and tax expenditures) will drop from 15 percent last year to 12 percent in 2022.

At the same time, states and localities have been slashing preschool and after-school programs, child care, family services, recreation, and mental-health services.

It seems as if every one of usual major interests have political clout – except children. They can’t vote. They don’t make major campaign donations. They can’t hire fleets of lobbyists.

Yet they’re America’s future.

If you follow the link to Robert Reich’s commentary you can read what major interests have the clout and dominate America’s interests.


Eight years later, January 2020 and Paul Krugman is asked a question by a correspondent.

“What important issue aren’t we talking about?”

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Why You May Never Learn the Truth About Anything in Washington

I hang around some pretty intelligent people who have smart friends commenting on their facebook pages. The first part of this post is from a comment on Claude Scales’s Facebook page by William R. Everdell. I think it fits with the NYT article Claude referenced. The second part of this is a shorten version of the NYT Opinion article “Why You May Never Learn the Truth About ICE,” Matthew Connelly, Professor of History, Columbia.

George Orwell in “‘1984’, Winston Smith was dropping documents into the ‘memory hole’ by his desk at the Ministry of Truth – Minitrue

‘Who controls the past controls the future: who controls the present controls the past.’

The Department of the Interior and the National Archives have decided to delete files on endangered species, offshore drilling inspections and the safety of drinking water.

This turns out to be just one action in a series of Trump administration attacks on the National Archives and the laws and funding supporting it, all of them aimed at preventing citizens of the republic learning from History.” William R. Everdell, Historian – Facebook

Examples of how this is happening have yet to be examined by Congressional Hearing.

Early in the new year, a photograph of the Women’s March – 2017 was put on display for the “Rightfully Hers: American Women and the Vote,” exhibit. The photo was altered to purposely distort Trump’s name and any words “referencing female anatomy” on depicted posters. Archivist of the United States David Ferriero later apologized for the distortions.

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Near Where I Live

If you not seen it in the news at night, online, or in a physical newspaper; there was an incident which occurred not far from my home which I believe is important. Washtenaw County is south of where I live (Livingston County) and is a blend of ethnicity, different cultures, citified spots, and rural areas. In it is Ann Arbor and the University of Michigan. Ann Arbor is a hotspot for liberal attitudes and consequently  .   .   .  Democrats. The whole area from Detroit westward to Ann Arbor and north into Livingston County is changing.  While this is not a story about Livingston County, the county residents there are afraid of the change which a proposed light rail service going into Ann Arbor from Livingston and then Detroit which could carry people to work   .   .    .    would bring. The train would go both ways.

Michigan coming into the 21st Century (finally) is scary for people accustom to driving as lone passengers in  too big, too fast, too often pickup-trucks and “suvs” everywhere including work.  The growing population is changing  both counties from rural farming to suburban/urban. It screams for other modes of transportation and living.

This is a long introduction  to the ” rest of the story.”

I live in Livingston County which is situated north of Washtenaw County. Besides Ann Arbor there are a number of small communities surrounding Ann Arbor, which are growing, and slowly crowding out the rural farm areas. There is an influx of Black and Hispanic citizens moving into these areas which has newer and less costly homes which would not be found in the wealthy belt surrounding Detroit. The schools are having to make room for other cultures and races. Saline is one of the growing communities with a population of ~10,000.

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And the Verdict . . . (as if we did not know)?

Stolen from the comments section. Will Romney pay the price? I do not think so. He may get critiqued by the madman in the White House; but, I am not so sure if he can touch Romney.

By EMichael

Credit where credit is due. Despite the fact that he faces almost no repercussions for his vote, Romney deserves credit.

Otoh, let us hope that Collins latest reptilian act costs her the Senate.

“No, Romney set himself apart. Even if he is only concerned with the judgment of history, it has put him in a far better place than the sycophants and enablers who so befouled the old halls of the legislature during the president’s pantomime State of the Union address Tuesday night. Romney’s speech was sweeping, decisive, and hardly short on moral clarity.
In one section, he got to the heart of it.

‘What he did was not “perfect”— no, it was a flagrant assault on our electoral rights, our national security interests, and our fundamental values. Corrupting an election to keep oneself in office is perhaps the most abusive and destructive violation of one’s oath of office that I can imagine.’

That’s it. The president attacked American democracy, undermining the legitimacy of an American presidential election, to keep himself in power. He used his power to stay in power, regardless of the people’s will. It is the essential abuse of power. It is the elemental high crime and misdemeanor. The president extorted an ally who’s under assault by authoritarian Russia until they agreed to ratfuck his domestic political opponent for his own personal gain. Then he sent his lawyers to the floor of the United States Senate to argue that if he deems his re-election to be in the national interest, he can do anything to get re-elected. Never mind that the purpose of the election is to allow voters to decide if his re-election is in the national interest. These craven fools would make for themselves an American king and gleefully bow before him.

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Trolling . . .

Elizabeth Warren

Listen or read, your choice. This is presidential material for our troubled nation.


While other senators were throwing questions at opponents, Warren decided to ask whether the Chief Justice has hurt the credibility of the Supreme Court by participating in a trial with no witnesses or evidence. And Roberts had to read the question  per the rules of the Senate.

“At a time when large majorities of Americans have lost faith in government, does the fact that the chief justice is presiding over an impeachment trial in which Republican senators have thus far refused to allow witnesses or evidence contribute to the loss of legitimacy of the chief justice, the Supreme Court and the Constitution?”

Adam Schiff (D-Calif.) responded to Warren’s query, “I would not say that it contributes to a loss of confidence in the chief justice, I think the chief justice has presided admirably.”

When you play the stooge, one has to expect to be labeled as a stooge.


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Other Immigration Issues Here and Elsewhere

From SWI, Swiss news: Switzerland’s House of Representatives has rejected an initiative by the right-wing Swiss “People’s Party” to limit immigration and cancel a deal with the European Union on the free movement of people.

Albert Rösti, head of the Swiss People’s Party warns that “uncontrolled” immigration could increase the current 8.5 million Swiss population to ten million and place additional pressure on infrastructure and the environment. It also says free movement of people encourages employers to recruit foreigners at cheap rates rather than Swiss people.

Sound familiar?

Per , Switzerland faces a “shortage of workers 10 years out according to the Swiss Employers’ Association which warned Switzerland could face a shortage of 700,000 workers in ten years’ time.  Immigration is a key to plug the gap.”

To help close the potential gap, professionals possessing engineering backgrounds will be needed with a priority on civil and electronic engineering being the most important. Also technical skills in such fields as heating, ventilation, and air-conditioning have moved up from third to second place in needed skills followed by fiduciaries, auditors, and IT ability. These types of capabilities and skills are not possessed by present day migrants coming to Switzerland.

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US Firearm Related Mortality

New analysis of 1999-2017 firearm deaths looks at changes in each state and within age, gender and racial/ethnic groups

Nationally, firearm-related mortality rates increased in period 2015–2017 after remaining relatively stable in period 1999–2014. Firearm mortality increases can be seen in “most” states and the demographics to the mortality seen in varying degrees. The increases suggest a worsening epidemic of firearm mortality geographically and demographically abroad. In both time periods, the fractions of firearm deaths due to suicide and homicide remained consistent.

In order of magnitude, the rates of homicides, suicides, and unintentional deaths incurred in the United States are 25.2, 8.0, and 6.2 times higher than rates occurring in other developed countries. While remaining relatively stable from 1999 to 2014, the age-adjusted firearm mortality rates in the US increased for three consecutive years starting in 2015 as shown in Exhibit 1. One has to wonder why this could be.

Click on the image to enlarge.

The increases are also apparent across the nations demographics (race, sex, age), mechanisms of death (suicide, homicide, etc.), and are broken down by states across the nation which I will not be showing today. Well beyond a majority, the states saw increases and a few have experienced decreases. The Health Affairs study “US Firearm-Related Mortality: National, State, And Population Trends, 1999–2017,” is the first to define the mortality of deaths by state. The Health Affairs state detail is too massive to display here and the study is only open to subscribers. I believe the more important part of this study is the upturn in the death rate starting in 2015. One can only speculate what has brought on the increase.

After the leap, Methodology, Limitations, and Conclusions

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