Tag: Premium

A newly released study examined Medicaid effectiveness in Oregon, a topic of particular interest given that Obamacare greatly increases Medicaid coverage. Sarah Kliff summarizes the mixed results:

New Medicaid enrollees had less trouble paying their bills and saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent. But on a simple set of health measures, including cholesterol and blood pressure levels, the new Medicaid enrollees looked no different than a separate group, who applied for the benefit but were not selected in a lottery.

Suderman pounces:

This study is perhaps the best and most important study of Medicaid’s health effects ever conducted, and it has huge implications for public policy—in particular for Obamacare’s Medicaid expansion, which is supposed to account for about half of the law’s increase in health coverage. Obamacare supporters had used the results from the study’s first year, which showed large gains in self-reported health, to argue that the law’s expansion of Medicaid was justified. The second-year results significantly complicate that argument.

Michael Cannon piles on:

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid. The Obama administration has been trying to convince states to throw more than a trillion additional taxpayer dollars at Medicaid by participating in the expansion, when the best-designed research available cannot find any evidence that it improves the physical health of enrollees. The OHIE even studied the most vulnerable part of the Medicaid-expansion population – those below 100 percent of the federal poverty level – yet still found no improvements in physical health.

Jonathan Cohn sees the study differently:

The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses.

That may sound obvious—of course people with insurance are less likely to struggle with medical bills. But it’s also the most under-appreciated accomplishment of health insurance: Whatever its effects on health, it promotes economic security. “The primary purpose of health insurance is to protect you financially in event of a catastrophic medical shock,” Finkelstein told me in an interview, “in the same way that the primary purpose of auto insurance or fire insurance is to provide you money in case you’ve lost something of value.”

Aaron Carroll is on the same page:

The reason I have insurance, and likely you do as well, is to protect you from financial ruin. When I get sick, I don’t sit at home and let the insurance take care of me. I get off my butt and use the health insurance as the means by which to get health care. Medicaid is about access. It’s just the first step in the chain of events that leads to quality.

Avik Roy counters this argument:

[W]e could have achieved the same outcome for a fraction of the price, by adopting the plan proposed by Florida’s Will Weatherford and Richard Corcoran: Offering low-income Americans a subsidy with which to purchase catastrophic coverage on the open market. That plan was foiled by people—including Republicans—who insisted on expanding Medicaid instead.

McArdle lowers her expectations:

Given this result, what is the likelihood that Obamacare will have a positive impact on the average health of Americans? Every one of us, for or against, should be revising that probability downwards. I’m not saying that you have to revise it to zero; I certainly haven’t. But however high it was yesterday, it should be somewhat lower today.

And Ray Fisman feels that “the findings should give pause to even those who are most committed to universal health insurance.” The lesson he draws:

[T]he Oregon experiment is yet another argument in favor of the increasingly common view that access to medical care is necessary but far from sufficient for good health. What’s the use in prescribing statins to reduce cholesterol to patients who don’t take their meds, continue to consume potato chips and soda unabated, and ignore health care providers’ pleas to walk more and drive less?

But changing habits, compliance, and lifestyles is a much taller order, and viewing health care in this way can make the Affordable Care Act, despite its enormous ambitions, seem almost too timid or narrow in its focus. It requires that our conception of health care go beyond a passive delivery system of waiting for patients to come into the clinic and get out into the community to reach patients in their daily lives.

(Photo: Medical Director Elisa Melendez examines Maximo Chavez, during his two week checkup at Clinica Tepeyac in Denver, CO, Thursday, March 22, 2012. His mother, Lilian Mendoza, says her family does not have insurance but hopes Maximo will qualify for Medicaid in the near future. Craig F. Walker, The Denver Post via Getty Images)

A reader pushes back against this post:

It is not obscene to post pictures of happy kids with firearms on a company website. Cricket is marketing to parents. The term “marketing to kids” is more appropriate for campaigns that push something harmful into spaces where kids will be found, as with heavily-sugared cereals advertised on cartoon shows. Cricket isn’t doing anything like this. It is producing a rifle-sized appropriately for children to shoot. That’s not a terrible thing. Gun owners with kids generally want to share their interest with their offspring. If you are going to shoot with your kids, a rifle that fits them is a good thing to have.

There are sound reasons to teach children to shoot.

For one, none of us is getting any younger. It is not a given that I will be around for my kids when they reach an age when the editors of Mother Jones will be comfortable with them learning to shoot. For another, if you know teenagers, then you know that 18 is a lousy time to introduce something potentially dangerous to them. There is a litany of rules for safe firearm handling. Those are best learned early, before the age of risk taking and rejection of authority.

I don’t believe in the ever-elongated infantilization of kids. Ours have real responsibility and even authority appropriate to their development. I believe they will be better prepared for adulthood than others in their age cohort who will have been sheltered from everything significant until suddenly turned loose.

I’m raising my son to be careful with firearms and respectful of their potential to harm. So far he has earned numerous accolades from other adults for his safe gunhandling skills. I have a shortened version of a regular bolt-action rifle for my kids. It’s approximately the same size as a Cricket. But I also keep that rifle in a safe, because it is not his burden to bear.

The rifle that Cricket manufactures has a number of safety features particular to it that are not present on standard firearms. They did their part. They are not insidious or evil for posting pictures sent by proud and happy parents on their website.

(Photo: A screenshot from the “Kids Corner” section of Cricket’s website)

Sixteen-year-old Kiera Wilmot, “known among staff for her exemplary record at Bartow High School and her status as a good student,” has been expelled from her high school:

The teen is accused of mixing household chemicals in a tiny 8-ounce water bottle, causing the top to pop off, followed by billowing smoke in an small explosion. Wilmot’s friends and classmates said it was “a science project gone bad, that she never meant to hurt anyone.”

Jesse Walker summarizes the rest of the story:

So: No one was hurt. There’s no sign that Wilmot was up to something malevolent. The kid’s own principal thinks this wasn’t anything more than an experiment, and he says she didn’t try to cover up what she had done. What punishment did you think she received? A stern talking-to? A day or two of after-school detention? Maybe she’ll have to help clean up the lab for a week?

Nope. The budding chemist has been kicked out of school and charged with a couple of felonies.

Update from a dissenting reader and teacher:

The police say the student was trying to create what’s known as a “Works Bomb”.  The chemicals aren’t stuff she got from the chem lab, and the “experiment” was not part of class or even an extrapolation from a different assignment.  This was chemicals she brought from home with the purpose of blowing something up.

Basically, they mix drain cleaner with aluminum foil and seal the bottle.  Chemical reactions occur, pressure builds and, eventually, an explosion happens. In this case, she used the wrong bottle and the pop top released the pressure before it exploded.  Still, the fumes and chemicals are dangerous in and of themselves.

The videos on YouTube of works bombs include warnings like:

***CAUTION*** Works Bombs can and are highly dangerous to both your outsides and your insides!!! Do NOT stand anywhere near one of these explosives as it goes off as you will suffer from serious injuries or worse… and most definitely do NOT approach the works bomb afterwards while it is still fuming without a proper mask AND gloves … as the chemicals in this mix can lead to BLINDNESS, LUNG IRRITATION AND BURNING, SKIN IRRITATION AND BURNING, and if you breath in enough of this chemical it will KILL YOU!

While I don’t know her and can’t gauge her motives or level of understanding, as a teacher I can tell you there’s no way we can allow kids to create explosions on school grounds.  Ignoring the moral problems with allowing students to place others in danger, the legal liabilities if someone were to get hurt would cut deep into already woefully inadequate school funding.

You can talk to the police about whether two felony charges is an overreaction. But from a school perspective, there isn’t a school punishment too large for a student who does this type of stuff on campus.

A reader writes:

About 25 years ago, my great-uncle Bill, age 98, still driving in his small town in northwestern Ohio, caring for his half-blind, half-deaf wife, still living in their two-story house plus basement – about 25 years ago, he went out rather late one cold January night to take out the kitchen trash.  His wife of 70-some years had already gone to bed.  He made it down the several steps from their back porch to the back sidewalk that led to their garage and slipped on the icy sidewalk.  He broke his hip.  No one could hear his cries for help (if there were any), as of course windows were closed.  He could not get up.  He froze to death.  He was a really nice man, and his death was devastating for his wife.  But I hope he did not suffer any and merely “slipped the bonds of earth.”

Craig Medred, an Alaskan native, pounces on Brian Phillips’s essay narrating his trip above the Iditarod Trail:

Ohmygawd, a whole week and a half in the dangerous, bone-deep cold as he flew from warm checkpoint to warm checkpoint in an airplane.

And the blizzards and baneful travel conditions that are irrelevant because when the weather gets bad, the planes that carry reporters like Phillips don’t fly. And yes, the total isolation when you’re in the air in the airplane between the warm checkpoints which are pretty well wired to the tubes these days.

You can find an Internet connection in every village out there to check your email, update your Facebook page, and do all the things those who worry about their connectivity need to do. Rohn, a lone U.S. Bureau of Land Management cabin in the heart of the Alaska Range, lacks an Internet connection, as do the deserted mining communities of Ophir and Iditarod, but it doesn’t appear Phillips spent much, if any, time at those comparatively remote checkpoints.

Surprise, surprise, surprise.

But then you have to wonder what Phillips did visit, because it certainly wasn’t the modern Iditarod Trail.

It’s become wildly successful:

Marginalized only a few years ago, the LGBT community is not only finding support in the legal sphere but has been winning broad acceptance in the media and in public life. From Vietnam’s first gay parade last August in Hanoi to an openly transgender contestant on last season’s Vietnam Idol (an American Idol franchise), it’s as if the closet door has exploded off its hinges. International attention grew in February of this year when Vietnamese photographer Maika Elan won a World Press Photo Award for her series The Pink Choice, documenting the lives of Vietnamese gay couples. … Perhaps the best example of the mainstreaming of the LGBT community is the Youtube-based sitcom My Best Gay Friends, which has become a legitimate viral hit in Vietnam, often garnering more than one million views per episode.

Sample of the show seen above. However, the progress for gays in Vietnam is not seeing corresponding progress for human rights in the country:

[I]t’s slightly ironic that a country with an “abysmal human rights record,” according to Human Rights Watch, is simultaneously a leader in the region in advancing gay rights. HRW’s 2013 World Report singles Vietnam out for repression of political dissent, curtailing freedom of expression and religion, and lack of an independent judiciary. It’s a bit like coming home with four Fs and one A+ on your report card. Clearly, gay rights are not seen as a serious threat to anyone in power. Whether the issue remains compartmentalized or if there will be some kind of spillover into other areas of human rights will be interesting to watch. But for now, the march towards LGBT equality is starting to feel inevitable.

Previous Dish coverage of gay rights in Vietnam here.

 

Technology writer Paul Miller returns from a year of self-imposed Internet exile, which was designed to improve his life and initially did the trick:

I lost 15 pounds without really trying. I bought some new clothes. People kept telling me how good I looked, how happy I seemed. In one session, my therapist literally patted himself on the back.

I was a little bored, a little lonely, but I found it a wonderful change of pace. I wrote in August, “It’s the boredom and lack of stimulation that drives me to do things I really care about, like writing and spending time with others.” I was pretty sure I had it all figured out, and told everyone as much. As my head uncluttered, my attention span expanded. In my first month or two, 10 pages of The Odyssey was a slog. Now I can read 100 pages in a sitting, or, if the prose is easy and I’m really enthralled, a few hundred. …

Without the retreat of a smartphone, I was forced to come out of my shell in difficult social situations. Without constant distraction, I found I was more aware of others in the moment. I couldn’t have all my interactions on Twitter anymore; I had to find them in real life. My sister, who has dealt with the frustration of trying to talk to me while I’m half listening, half computing for her entire life, loves the way I talk to her now. She says I’m less detached emotionally, more concerned with her well-being — less of a jerk, basically.

But the catharsis didn’t last:

When I stopped seeing my life in the context of “I don’t use the internet,” the offline existence became mundane, and the worst sides of myself began to emerge.

I would stay at home for days at a time. My phone would die, and nobody could get ahold of me. At some point my parents would get fed up with wondering if I was alive, and send my sister over to my apartment to check on me. On the internet it was easy to assure people I was alive and sane, easy to collaborate with my coworkers, easy to be a relevant part of society. So much ink has been spilled deriding the false concept of a “Facebook friend,” but I can tell you that a “Facebook friend” is better than nothing. My best long-distance friend, one I’d talked to weekly on the phone for years, moved to China this year and I haven’t spoken to him since. My best New York friend simply faded into his work, as I failed to keep up my end of our social plans.

My plan was to leave the internet and therefore find the “real” Paul and get in touch with the “real” world, but the real Paul and the real world are already inextricably linked to the internet. Not to say that my life wasn’t different without the internet, just that it wasn’t real life.

Contra Bouie, Sean Trende argues that the partisan shift in Dixie was not as dependent on the racial strife of the ’60s as most people assume:

In fact, the white South began breaking away from the Democrats in the 1920s, as population centers began to develop in what was being called the “New South”… . In the 1930s and 1940s, FDR performed worse in the South in every election following his 1932 election. By the mid-1940s, the GOP was winning about a quarter of the Southern vote in presidential elections. But the big breakthrough, to the extent that there was one, came in 1952. Dwight Eisenhower won 48 percent of the vote there, compared to Adlai Stevenson’s 52 percent. …

Perhaps the biggest piece of evidence that something significant was afoot is Richard Nixon’s showing in 1960. He won 46.1 percent of the vote to John F. Kennedy’s 50.5 percent. One can write this off to JFK’s Catholicism, but writing off three elections in a row becomes problematic, especially given the other developments bubbling up at the local level. It’s even more problematic when you consider that JFK had the nation’s most prominent Southerner on the ticket with him.

But the biggest problem with the thesis comes when you consider what had been going on in the interim:

Two civil rights bills pushed by the Eisenhower administration had cleared Congress, and the administration was pushing forward with the Brown decision, most famously by sending the 101st Airborne Division to Arkansas to assist with the integration of Little Rock Central High School.

It’s impossible to separate race and economics completely anywhere in the country, perhaps least of all in the South. But the inescapable truth is that the GOP was making its greatest gains in the South while it was also pushing a pro-civil rights agenda nationally. What was really driving the GOP at this time was economic development. As Southern cities continued to develop and sprout suburbs, Southern exceptionalism was eroded; Southern whites simply became wealthy enough to start voting Republican.

Trende’s book, The Lost Majority, digs deeper into this contrarian history.

Nate Silver’s demographic and immigration reform calculator is worth a look. The graphic below shows what happens if you apply the model’s defaults to the next 35 years:

Silver explains how immigration reform could change these calculations:

Suppose, for example, that the voter population grows in accordance with the defaults assumed in the model. This would produce a net of 6.3 million new votes for Democrats by 2028.

And suppose that 25 percent of the immigrants currently here illegally gain citizenship and vote by 2028. The model calculates that this would provide another 1.2 million votes for Democrats.

But suppose also that, as a result of immigration reform, the Republicans go from winning about 28 percent of the Hispanic vote and 24 percent of the Asian vote (as they did in 2012) to 35 percent of each group by 2028. That would shift about 4.8 million votes back to the G.O.P. — about four times more than it lost from the immigrants becoming citizens and voting predominantly Democratic. However, it wouldn’t be enough to outweigh the Democratic gains from long-term population growth.

Douthat thinks that immigration reform can help the GOP “only if such a reform somehow complemented a new conservative economic agenda rather than posing a substitute for one.” He isn’t holding his breath:

I can imagine an immigration overhaul finding a place in a broader right-of-center vision that’s geared toward reassuring blue-collar whites, enticing middle-income Hispanics, and boosting new immigrants into the middle class.

But that vision doesn’t exist at the moment, and it isn’t likely to emerge in a world where the Congressional G.O.P. can’t even manage to take baby steps toward an Obamacare alternative. And so long as that’s the case, the kind of immigration reform being contemplated is likely to be worse for the G.O.P. politically than a similar bill would have been under George W. Bush. For all his faults, Bush understood that his party couldn’t win over Hispanics — or any economically-vulnerable constituency — without substantive as well as symbolic overtures. Right now, his successors seemed poised to learn that lesson the hard way.

Tim McDonnell ponders the results of a new study that gave liberals and conservatives the choice between conventional light bulbs and the more energy-efficient compact fluorescents:

Both bulbs were labeled with basic hard data on their energy use, but without a translation of that into climate pros and cons. When the bulbs cost the same, and even when the CFL cost more, conservatives and liberals were equally likely to buy the efficient bulb. But slap a message on the CFL’s packaging that says “Protect the Environment,” and “we saw a significant drop-off in more politically moderates and conservatives choosing that option,” said study author Dena Gromet, a researcher at the University of Pennsylvania’s Wharton School of Business.

… Gromet said she never expected the green message to motivate conservatives, but was surprised to find that it could in fact repel them from making a purchase even while they found other aspects, like saving cash on their power bills, attractive. The reason, she thinks, is that given the political polarization of the climate change debate, environmental activism is so frowned upon by those on the right that they’ll do anything to keep themselves distanced from it.

This is really a form of tribal nihilism. One party has become entirely about a posture, not a set of feasible policies. I can see no reason whatever that conservatism must mean destroying the environment – or refusing to do even small ameliorative things that can help. There should be a robust conservative critique of liberal approaches to climate change, but the point is to get a better grip on slowing that change and more effectively protecting the environment by conservative ideas and principles. Snark is not a policy, although it may be a successful talk radio gimmick.

The trouble is that the talk radio gimmickry now defines an entire political party. Kevin Drum sighs:

On the right, both climate change and questions about global limits on oil production have exited the realm of empirical debate and become full-blown fronts in the culture wars. You’re required to mock them regardless of whether it makes any sense. And it’s weird as hell. I mean, why would you disparage development of renewable energy? If humans are the ultimate creators, why not create innovative new sources of renewable energy instead of digging up every last fluid ounce of oil on the planet?

I can remember when even Glenn Reynolds wanted an all-of-the-above approach to tackle climate change because energy innovation was a no-brainer, even if it didn’t always work out.

A reader responds to this post:

Under the category of “you’re doing it wrong”, I might suggest that one problem is that so many people put the condom on dry. Put some lube on first and the sensitivity is greatly improved. I’m surprised now many guys I’ve had sex with seem unaware if this tip. Maybe I was the only one paying attention during all those presentations in college. And not the molecule of lubricant some condoms come with. Use a bunch.

Another reader:

I was glad to see I’m not alone in losing a fair amount of sensitivity during sex thanks to condoms – and I was circumcised as an infant, so my senses are already dulled – but I’m going to keep wearing condoms. When I read in that post that the withdrawal method of birth control has a failure rate of four percent while condoms have a failure rate of two percent, I take away that “pulling out” is twice as likely to result in unplanned pregnancy as wearing a condom. That two percent is a significant two percent to me (and, more importantly, to my girlfriend).

Also, isn’t it only natural to connect that post to the posts last week about guys becoming addicted to dopamine, online porn, and Viagra?

A few more readers overshare to that “Master Of Your Own Domain” thread after the jump:

Like you I’m vintage ’63 and grew up Catholic in a traditional lower-middle / working class environment. Useful information about sex, other than the church’s helpful “it’s a sin – so don’t,” was scarce. I was also a bookish loner, thus without access to the carnal wisdom of my peers.  At fourteen my experiments with “what sex would feel like” involved simply clamping my erection, tightly, in my fist. The concept of adding motion never dawned on me.

By fifteen I had graduated from “MAD” magazine to “National Lampoon,” which was racy and had the occasional picture of naked breasts.  Carefully reading a new issue on the long Thanksgiving morning drive, I came across the fantasy story “My Penis,” the tale of a hot high school cheerleader who suddenly wakes up one morning with a dick, and all the things she later does with it. Masturbation was described. In detail.

That night on the couch in grandma’s living room I put my newfound knowledge into practice – and have yet to stop.

Another:

I never had a problem with masturbation. There were a few weeks when I was 15 or so when I wouldn’t but the urge became irresistible  And I concluded that if God didn’t want me to do it, he wouldn’t give me the urge. And there have been times when I don’t have the urge.

I have a problem with recurrent prostate infections. Some men do, just like women have recurrent vaginal infections. One of the things to be done is to empty it out fairly often. That was the cure before there were antibiotics – expressing it. Flush out the infection and hope it goes away. First time it happened it was very very bad. No symptoms specific to prostatis like burning urination or orgasm. Just that I would get up in the morning feeling okayish and by late afternoon I would be running a fever. Had to take a nap. Would take one and the fever would be gone – but the nap was hours long. And by mid evening it would be back. I’d go to bed early and wake up in the morning feeling okay. Until late afternoon. Took about a week to decide to go to the doctor. I now watch for subtle symptoms. I can predict within a day or so when I’m going to get the urge to nap. Being very very sleepy is one of the symptoms.

I haven’t noticed much of a change since my late teens. I don’t want to hump any man still breathing but I get the urge about once a day and if I don’t have anything else to do I indulge it. I still enjoy it as much as I did when I was 16. Maybe not as noisy but it’s still a lot of fun.

Depending on how you want to read Romans, Saint Paul warned us against doing things that go against our nature. Some men want to do it three or four times a day and some men want to do it once and some men want to do it twice a month. Whatever works for you. But deliberately not cumming? I’d put in the same category that we are warned about in Romans.