Tag: Premium

Sarah Kliff is impressed by the above chart:

This simple, four-line chart is amazing news for the federal budget. It shows that the government is expected to spend about $50 billion less paying for the Medicare program this year than it had expected to just four years ago. What this chart shows is how much the Congressional Budget Office expects we’ll need to pay for each and every Medicare beneficiary. And over the past four years, the forecasting agency has consistently downgraded the price of covering one senior’s health care costs.

Saving $1,000 per patient adds up quickly in a program that covers about 50 million people. More precisely, it adds up to about $50 billion in savings this year. The reduction in expected costs grows to $2,369 in 2019. With an expected 60 million seniors enrolled in Medicare that year, it would work out to more than $120 billion shaved off the total cost of the program.

Drum expects Medicare costs to continue declining:

There are two reasons for this. First, the growth rate of medical costs in general has been declining steadily for the past 30 years, and this has now been going on long enough that it’s highly unlikely to be a statistical blip. After a surge in the 80s and 90s, we really are returning to the growth rates that were common earlier in the century, and obviously this will affect Medicare.

Second, Obamacare really will have an impact. Not everything in it will work, but it includes a lot of different cost-cutting measures and some of them will turn out to be pretty effective. And who knows? If Republicans ever stop pouting over Obamacare, we might even be able to experiment with different kinds of cost reductions.

Tricia Neuman and Juliette Cubanskigo go into more detail on the factors at play:

In addition to scheduled reductions in Medicare’s more formulaic payment rates, providers may be tightening their belts and looking to deliver care more efficiently in response to financial incentives included in the ACA, and it is possible that these changes are having a bigger effect than expected.  For example, CMS recently reported that hospital readmission rates dropped by 130,000 between January 2012 and August 2013.  It is also possible that hospitals and other providers are using data and other analytic tools more successfully to track utilization and spending and to reduce excess costs.  Another more straightforward factor is that several expensive and popular brand-name drugs have gone off patent in recent years, which has helped to keep Medicare drug spending in check.

Whatever the causes may be, the slowdown in spending is good news for Medicare, the federal budget and for beneficiaries—at least for now, and as long as it does not adversely affect access to or quality of care.

A new report outlines what the world would need to do to head off severe global warming:

Given what we know about the sensitivity of the climate to added greenhouse gases, it’s possible to calculate how much more carbon dioxide we can admit while still having a reasonable chance of staying within the two degree Celsius envelope. What’s striking about these calculations is how many large changes we’ll have to make in order to get there. According to Jeffrey Sachs of Columbia University’s Earth Institute, the per-capita emissions would have to drop from five tons annually (where they are now) to 1.6 tons by 2050.

To accomplish this, Sachs says that all nations will have to undergo a process he calls “deep decarbonization,” which is part of the title of a report he’s helped organize and deliver to the UN [earlier this week]. Pathways to Deep Decarbonization, prepared by researchers in 15 different countries, looks into what’s needed to achieve sufficient cuts in our carbon emissions. The report finds that current government pledges aren’t sufficient, and the technology we need to succeed may exist, but most of it hasn’t been proven to scale sufficiently.

Plumer looks at what Sachs’ plan would mean for the US:

The United States eventually gets 30 percent of its electricity from nuclear power and 40 percent of its electricity from renewable sources like hydro, wind, and solar by 2050. Electric vehicles would handle about 75 percent of all trips. Large trucks would get switched over to natural gas. The coal plants that remained would all capture their carbon-dioxide emissions and bury them underground. Every single building would adopt LEDs for lighting.

David Unger reads through the report’s recommendations:

The biggest need: research and early-stage development. The world underinvests in clean-energy research, development, and demonstration by roughly $70 billion a year, according to the Center for Clean Energy Innovation, a Washington-based organization that designs and advocates for clean-energy policy. That amounts to only 13 percent of what the world spends on global fossil-fuel subsidies, according to CCEI, and 27.5 percent of what it invests in deploying clean-energy technologies.

“The main lesson in history is that targeted R&D works,” says Sachs, who says clean energy needs a large public-private effort along the lines of the Manhattan Project or the push to put a man on the moon. “The remarkable fact is that we have not invested [enough] in an issue that is of existential importance to the planet.”

Germany is investigating another suspected spy in Berlin:

[Yesterday] German police raided the Berlin-area apartment and office of a man suspected of spying for the US, the second case in less than a week. The investigation is ongoing, but German authorities are taking it “very seriously,” a spokesperson told reporters. Last week, a German intelligence officer was arrested for working as a double agent and feeding documents back to Washington. The 31-year-old intelligence officer, which The Daily Beast has dubbed “Herr Wannabe,” apparently volunteered to work for the CIA. He got caught when he tried to spy for Russia as well.

All this comes, of course, after revelations that the US had been tapping German chancellor Angela Merkel’s cellphone since 2002. Germany tried to use this embarrassing fact to negotiate a non-spying agreement similar to the ones the US has with the UK, Canada, and other countries. However, the US has resisted out of fear that more countries will want the same thing.

Today, the German government asked our top CIA official there to leave the country. Morrissey is somewhat surprised at this reaction:

One has to assume that the Germans are not so blinded by outrage here as the public stances might suggest, as they know well how the intelligence game is played.

The French have been stealing industrial secrets for years, even though the two nations work much more closely together on the EU project than the US and Germany do in other areas. When these details about business-as-usual get made embarrassingly public, it forces everyone to make a public show of the outrage. Removing a key link in the partnership through the mechanism of a diplomatic expulsion, though, goes a bit farther than contrived outrage. That’s a step one would expect to see between two antagonists, or two loosely-affiliated nations, not between close partners like the US and Germany.

Kirchick defends our espionage activities in Germany, which he calls “a less than trustworthy ally.” In particular, he highlights the country’s ties to Russia and Iran:

German outrage at American spying would also be easier to swallow if it weren’t so hypocritical. According to former NSA intelligence and computer systems analyst Ira Winkler, the BND has penetrated the SWIFT financial messaging network, passing on the information to German businesses. In his book Spies Among Us, he writes of “the apparent willingness of German businesses to funnel sensitive information and technology to nations that are hostile to the United States,” including Iran. Germany remains one of the Islamic Republic’s largest trading partners.

American espionage in Germany—home of the Hamburg Cell, the circle of 9/11 hijackers who hung out in the port city, unmolested, for years—is aimed at protecting the national security of both America and its allies, Germany foremost among them. And while the BND cooperates extensively with America’s intelligence services, it also has worked toward giving a leg-up to German businesses, an unwritten no-no in the intelligence world.

But the latest news doesn’t much trouble Mataconis:

Understandably, there will be some degree of a diplomatic price to pay from these latest spying allegations. Allies spying on allies is, as I said, one of those things that everyone does to some degree but which is never spoken of publicly. At the same time, though, it strikes me that we shouldn’t really be all that embarrassed about what’s been revealed here, except to the extent that we got caught and the President apparently spoke to the Chancellor without being aware of what had happened earlier that week. There are good reasons to keep an eye on what’s going on in Germany and, indeed, some of those reasons ultimately benefit the national security of Germany as well as the United States. Furthermore, foreign espionage does not raise the same civil liberties issues that the N.S.A.’s domestic programs do so it’s best not to conflate the two. Foreign intelligence is sometimes an unpleasant business, but that doesn’t mean it isn’t necessary and in this case it seems like its necessary.

A reader quotes an earlier one:

Perhaps we should apply that same formula to heterosexuals. Who needs another human being when there’s God? In fact, it’s pretty obvious that any relationship OTHER than one’s relationship with God is inferior, a distraction from our one and only necessary relationship. Right?

Although I don’t think he sincerely believed it, my evangelical, heterosexual father expressed precisely the theological stance this reader posits sarcastically: Marriage was provided by God as a moral option for humans too weak in the flesh to commit fully to a relationship with God. Of course this in no way supports an argument that heterosexual marriage is fine and homosexual isn’t, but it does display a fascinating worldview. There is a higher morality that humans are invited, but not expected, to achieve.

The evangelical reader who started the thread follows up:

I’m very grateful for your posting of my earlier comments on this topic! I don’t want to fill up your inbox and use too much of your team’s time. But I get the impression that you don’t get too much evangelical input. This email is sent in reaction to your reader in Dissent of the Day, Ctd.

Your reader is absolutely right that the evangelical church cannot talk with credibility about same-sex marriage without a coherent theology of singleness and heterosexual marriage.  Western society seems to treat single people as though they are living a kind of maimed half-life, robbed of ultimate fulfilment and human wholeness (and devaluing aromantic friendship, as you pointed out recently). It’s unsurprising that opposition to same-sex marriage attracts such ire in this context.

The Biblical viewpoint is very different (even if, sadly, that isn’t always what we see in churches). According to the Apostle Paul, singleness (for whatever reason) is a gift, neither superior not inferior to marriage. Indeed, he insists that marriage has tremendous dangers:

the spouse may become an idol, competing with God for attention (1 Corinthians 7:32-35). If a prospective marriage is going to stop the couple from giving “undivided devotion to the Lord”, they shouldn’t get married. Christian marriage is for those who will glorify God better together. It is, emphatically, not to fill some sort of gap in our hearts/ we should be looking to Christ to fill that gap. As Vaughan says, the fulfilment of our relational longings is found in knowing the God who made us: the evangelical position would be inexcusable were it not for this fact.

Every Christian – male or female, gay or straight, married or single – in reality already has a bridegroom. In Hosea 2, God declares his intentions regarding his rebellious people:

Therefore, behold, I will allure her, and bring her into the wilderness, and speak tenderly to her… I will betroth you to me forever. I will betroth you to me in righteousness and in justice, in unfailing love and in mercy. I will betroth you to me in faithfulness. And you shall know the LORD.

And let’s not forget that the word “know” here is the same verb used when Adam “knew” Eve; intimacy with God is total intimacy in every dimension. From the Biblical perspective, earthly marriage is just a shadow of this heavenly union, when Christ will become “one flesh” with his church (Ephesians 5:25-33).  I was foolish to describe God giving himself to us “in return”, as though this were some kind of transaction; I meant that walking more closely with God is always worth it (not just theologically, but emotionally and experientially) because one is walking more closely with God. Whenever we disobey his commands, we are defrauding ourselves of our joy, precisely because we have taken our eyes off God.

Another responds to that reader’s first email:

The “dissent of the day” reflects why all too many Americans, especially young Americans, are moving further and further away from evangelical and fundamentalist churches.  Once, as a very young, enthusiastic (and often naively egotistical) evangelical several decades ago now, I used a “Christian cliche” in a college class, the metaphor from the Revelation about “the blood of the lamb.” Some astute “non-believer” (to me) asked me if I meant literal lamb’s blood.  I had a difficult time explaining what the metaphor even meant, let alone why I was using it, because I was conditioned to use it within “the tribe,” the evangelicals with whom I had associated.

These types of Christians, in their attempt to explain their theology of sex do themselves no favor by wrapping their fear of their own bodes and the world around them with such a high view of God that God ends up being so ultimate, so necessary to our existence that anything short of “Him and Him alone” means a failed life.  How demeaning is that to our full humanity, one shared even by God Himself, to those of us who hold to the incarnation?  How much this clap-trap sounds like the same old tired God who claims to give us free will but only if we willingly deny that free will for him, a God who sounds more like a kidnapper, holding us hostage and saying we have the freedom to leave but He will kill us if we do?  What kind of freedom is that?

I don’t think too many of those in the American evangelical camp can quite grasp the disdain all too many have to them in this culture because no matter how hard they try, sincerity comes across as sanctimony.

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Every now and again, it’s worth remembering that they pretend to know everything but, in fact, know nothing about the Middle East, and have been proven wrong and wrong and wrong again on the subject. Their primary characteristic, of course, is never conceding a single error of judgment or denying responsibility for disasters in plain sight. So here’s a plethora of Dick Morris Award nominees from just last year about the now successfully completed withdrawal and destruction of Syria’s WMDs in the height of the civil war there. Drum roll please. First up – who else? – Krauthammer last September:

This is a clearly a way to get Obama off the hook politically. The chances of these weapons being eliminated from Syria are less than of the Chicago Cubs winning the World Series this year, and they are now mathematically eliminated.

Utterly wrong – and something he won’t ever cop to. Let’s go to Max Boot next:

If the U.S. is not seen as willing to strike Syria, what incentive does Assad have to comply with the terms of any disarmament deal? The most likely scenario is that Assad will agree to something in principle and then fudge on the implementation, knowing that Washington will have lost interest by that point.

Next up: a Kagan (little Freddy this time)! Notice the faux expertise and specificity of the bullshit:

Removing the weapons would require ground forces in large numbers. It appears that Assad keeps his chemical weapons at a variety of sites around the country, which would make it necessary to insert many strike forces simultaneously. Each strike force would need to be able to overcome the guard forces at each facility very quickly and then hold it against regime counterattacks. The strike forces would have to be accompanied by specialists in rendering chemical weapons safe enough to be transported, and those specialists would need to be supported and guarded…

The U.S. military has indicated that such an option could require tens of thousands of troops, and this quick sketch bears out that calculation. Since no one in this debate is advocating sending a large ground force into Syria, we have effectively dismissed the option of seizing the weapons or destroying them and thereby entered the realm of high-risk options.

Look: we all make mistakes. Plenty of other observers said it would be impossible as well (David Kay among them, with egg now all over his face). But when you have been wrong so consistently about so much, and have never copped to it, let alone reflected upon it, you should surely be a little circumspect in these instant, faux-expert opinions. And if you are a booker on cable news or an editor at an op-ed page, are you really going to keep giving these idiots a platform to be wrong yet again? Or are you going to grow some and care just a little about the truth?

Cohn comments on the new Commonwealth Fund report I highlighted earlier today:

The Congressional Budget Office predicted that, one year into full implementation, Obamacare would reduce the number of Americans without insurance by twelve million. That included the young adults who got insurance before 2014, by signing onto their parents’ plans. There’s been some controversy over exactly how many more young people are insured because of that new option, but the best estimates I’ve seen place the number somewhere between 1 and 2.5 million. Add that number to the 9.5 million from the Commonwealth survey, and you’re close or equal to the CBO projections.

Of course, the Commonwealth survey has a hefty margin of error and the CBO projections, revised to take account of the early technological problems on Obamacare websites, were never that scientific. But the figures seem to be in the same ballpark. That’s what matters.

Douthat isn’t ready to declare Obamacare a success:

[I]f the Commonwealth figure is right we’re probably looking at between 10 and 11 million newly-insured overall for 2014 (I’m relying on “best estimates” for the number of young adults that are slightly lower than Cohn’s), which is lower than the 12 million the C.B.O. projected in April, which is lower than the 13 million it projected after the website problems, which is lower than the 14 million it projected after the Supreme Court decision on Medicaid, which is lower … you get the idea.

All of which means that this new estimate, while useful, doesn’t really bring us any closer to knowing whether Obamacare enrollment will ultimately end up where its advocates hoped — making up ground lost during the disastrous roll-out over the next couple of years, and hitting 25-30 million newly insured by 2017 or so — or whether its current shortfalls will persist and it will end up many millions below that target.

Sanger-Katz focuses on how “people who got the new coverage were generally happy with the product”:

Overall, 73 percent of people who bought health plans and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with their new health insurance. Seventy-four percent of newly insured Republicans liked their plans. Even 77 percent of people who had insurance before — including members of the much-publicized group whose plans got canceled last year — were happy with their new coverage.

Kliff points to other details:

About four in ten Obamacare enrollees reported having signed up for Obamacare say they chose a narrow network plan, with lower premiums — but also fewer doctors and hospitals. This explains why just over one third (37 percent) say that all of the doctors they wanted were part of their insurance plan’s network. It’s possible that number could be an underestimate, as 39 percent said they weren’t sure which doctors were and weren’t included.

At the same time, subscribers who did see a doctor generally reported being able to schedule appointments pretty quickly. Most were able to get an appointment within two weeks.

On a less happy note, Flavelle finds that blacks are faring relatively poorly under Obamacare:

The uninsurance rate for whites fell to 12 percent from 16 percent; for Latinos, it plummeted, to 23 percent from 36 percent. For respondents who reported their race as “mixed” or “other,” the share without insurance was cut almost in half, to 11 percent from 20 percent. The exception to that trend was blacks. When the Commonwealth Fund conducted a survey from July to September last year, 21 percent of blacks reported being uninsured. This year, in a similar survey conducted from April to June, that level was effectively unchanged, at 20 percent.

Why?

A big part of the explanation, without question, is that a disproportionate share of blacks live in states that have so far refused federal money to expand Medicaid. Sixty-two percent of black respondents fall into that category, compared with just 39 percent of Latinos.