Thoughts on the President's Speech

I'm much happier with this speech than I'd expected. I think the President made a strong case for the public option, which was in itself good. And he also referred to a plan that includes the public option "my plan". That's good, too.

But, even better, I think the President drew a line in the sand on the public option. A fine line, and a line that is open to some interpretation, but a line nonetheless. I haven't gone back to the video to confirm my notes, but I am pretty confident that I got at least the gist: he's open to any alternative to the public option that achieves its goals, that is, anything that insures that all Americans have access to affordable insurance. Short of a single-payer system--which is certainly not in the cards today and I doubt will be in my lifetime--I don't see how you achieve that goal without a government-backed insurance plan that introduces real competition into the market.

Both substantively and tactically, I think that the President made a smart move by mentioning medical malpractice reform. Republicans have a valid point about fear of lawsuits and the cost of medical malpractice insurance being a contributor to the rising cost of health care. It is far from the biggest cause, but it is a cause and we should be looking at ways to address everything that's contributing to the spiraling cost of health care in the US. I'm genuinely interested in what happens with this. Tactically, of course, it makes it just a little bit harder for the Republicans to use malpractice reform as their default alternative to broader health care reform.

Update: Josh Marshall also notes the President's drawing a sort of faint line in the sand on the public option, though he is a bit more skeptical than I am. I agree with Josh's contention that there is a lot of wiggle room in the President's position, but, I think it gives those of us who support the public option rather more leverage than I'd expected from the speech.

Live Blogging the President's Health Care Address

7:16--Here we go! Don't want to throw anything at the TV. Yet. I am not optimistic about this speech.

7:18--Think he struck about the right tone on the economic recovery by pointing out success in pulling the economy "back from the brink" but acknowledging work ahead and committing to do that work.

7:19--"Not the first President to take up this call, but I am determined to be the last." Like the fight. Let's see the substance.

7:20--Framing the state of affairs as a failure is good.

7:21--Hadn't heard the "30m who can't get health insurance" number before. Can't because they can't afford it, or, because of pre-existing conditions?

7:24--Going at the cost issue now. Not sure how he is going to wriggle around needing the public option to bring in competition and drive down costs.

7:28--"The time for games has passed". The Obama v Congress things would have been so much better earlier this summer, but, it may still work.

7:29--The Beef, Part I: You got insurance? Great. You can keep it. But, we make it better:
a) no more exclusions for pre-existing conditions.
b) illegal for insurance companies to drop policies on sick.
c) illegal for insurance companies to set coverage caps.
d) set limits on out-of-pocket expenditures
e) require insurance companies to cover preventive care, e.g., colonoscopy

7:32--The Beef, Part II: No insurance? Ok. We got an insurance exchange for you where you can shop, leveraging the law of large numbers to keep prices down. Insurance companies have an incentive to participate because there is money to be made.

7:35--The Beef, Part III: What about those who don't want health insurance? They are costing us money. People will be required to carry basic health insurance and businesses will be required to provide as well. ~95% of small businesses exempt. "Improving our health care requires everyone to do their part".

7:38--What was that? Somebody shouted out something that made Pelossi and Biden blanch. Will be interested to find out who it was and what they said--it was in response to Obama's calling the claim that reform would include coverage for illegal aliens.

7:41--Sounds like the same asshole said something when Obama said he didn't want to put health insurance companies out of business.

7:41--Defense of the Public Option, starting now. Come on, Obama. Make the case.

7:43--Saving from lower admin costs, no profits.

7:44--He refers to the public option as part of "my plan". Surprising. But also opens to door to a law that doesn't have it.

7:45--"If Americans can't find affordable insurance, we will provide you with a choice." That seems to be his line in the sand. I wonder where we can wiggle from there?

7:46--How are we paying for it? Will not sign on to a bill with a plan that will add to the deficit.

7:47--Most of this can be paid for by reducing waste. Contentious point, let's see how he makes it.

7:49--What are these Medicare subsidies to doctors that are going away?

7:52--Fee for insurance companies' most expensive policies. Makes a lot of sense. These plans add no measurable results in terms of health outcomes.

7:53--Very clever bone tossed to the Republicans on malpractice insurance. Will be interesting to see how this is fleshed out.

7:54--Bending the arc.

7:55--Here's the [political] plan: If you're serious, my door is open. If you just want to kill the plan rather than make it better, pound sand. If you talk shit, we will call you on it.

Tuesday's Gmail Fail

Google has posted their official explanation of Tuesday's nearly two-hour Gmail collapse:

Here's what happened: This morning (Pacific Time) we took a small fraction of Gmail's servers offline to perform routine upgrades. This isn't in itself a problem — we do this all the time, and Gmail's web interface runs in many locations and just sends traffic to other locations when one is offline.

However, as we now know, we had slightly underestimated the load which some recent changes (ironically, some designed to improve service availability) placed on the request routers — servers which direct web queries to the appropriate Gmail server for response. At about 12:30 pm Pacific a few of the request routers became overloaded and in effect told the rest of the system "stop sending us traffic, we're too slow!". This transferred the load onto the remaining request routers, causing a few more of them to also become overloaded, and within minutes nearly all of the request routers were overloaded. As a result, people couldn't access Gmail via the web interface because their requests couldn't be routed to a Gmail server. IMAP/POP access and mail processing continued to work normally because these requests don't use the same routers.

This is stunning incompetence from an organization that I've come to expect excellence from. First, not having good data on traffic load before undertaking an upgrade of this sort is indicative of incredible sloppiness. Second, having a router overload algorithm that defaults to shutting down routers rather than simply routing traffic more slowly is idiotic (up to a point--at some point traffic becomes so slow as to render it useless).

Google says that they've addressed these issues, but, I have to say this shakes my faith in a company that I've come to regard as a paragon of excellent quality and service.

Bill Clinton's Success in North Korea

I expected the resolution of the imprisonment of American journalists Laura Ling and Euna Lee in North Korea to be resolved as a side-deal with the North Koreans. The scenario I envisioned was something like a standoff between the US and North Korea over an intercepted North Korean ship suspected of carrying components for nuclear weapons bound for Burma.

The actual result was substantially better. The women are safely home in the US rather than facing hard labor in the North Korean gulag. That's obviously good. Less obviously good is that it came at a lower price to the US than in the scenarios I'd imagined. North Korea really had few chips to play so the relative value of their hostages was low. Consequently, the price the US paid was having a former president sit on a stage looking at Kim Jong Il like he'd just farted. I'm good with that.

Amazon's Kindle Caper, Redux

Andrew Sullivan flags a case of a student who lost his summer reading homework when Amazon nabbed his copy of 1984. I alluded to such a possibility here when the story initially broke.

What Is In Your Health Care Bill? Part 2

Picking up where I left off in Part 1 of my analysis of a list of claims about H.R. 3200 that is circulating around the Internet.

pg 124 lines 24-25 HC No company can sue the Government on [sic.] price fixing. No "judicial review" against Government Monopoly

Probably because this isn't price fixing. Also not clear how this is a "government monopoly" in that the government is merely creating a mechanism by which private companies compete for customers. (A single-payer system would be a monopsony, but unfortunately that's not in the cards.)

pg 127 Lines 1-16 HC Bill - Doctors/ #AMA - The Government will tell YOU what you can earn.

Nothing in the bill requires that a physician participate in the program.

Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE

Not true. First, the bill requires that the employer auto-enroll employees at the lowest priced option, not the public option. Second, p 148, line 3 allows for employees to opt out.

Pg 146 Lines 22-25 Employers MUST pay for health care for part time employees and their families.

True, in part. The requirement is that employers pay for part-timers on a pro-rated basis based on the number of hours they work vs. the number of hours of full-time employees work. Without a requirement like this, unscrupulous employers (or any employer with a fiduciary responsibility to investors for that matter) would make as many jobs part time as possible to skirt the requirement.

Pg 149 Lines 16-24 ANY Employer with a payroll over $400k who does not provide the public option will pay 8% tax on all payroll/pg 150 Lines 9-13 Business with a payroll between $251k & $400k who doe not provide the public option well pay 2-6% tax on all payroll

True. If you are going to require employers to provide insurance, this seems like a pretty fair penalty for those who break the law.

Pg 167 Lines 18-23 ANY individual who does not have acceptable health care according to the Government will be taxed 2.5% of their income.

True. The "acceptable health care" according to the government is a plan that meets the requirements for the "basic" plan. The tax is also capped at the average price of such a plan, so the intent is clearly to motivate people to get insurance.

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)

Seems to be correct, not sure what the reason for this is given that I believe that nonresident (but still legal) aliens are eligible for benefits. One interesting thing is that there is a corollary for US citizens who don't live in the US: they are also considered to be covered and not subject to the tax.

Pg 195 HC Bill -officers & employees of the health care Administration (Government) will have access to ALL Americans financial and personal records.

This is an absurd claim. The bill modifies the laws governing the IRS to require them to provide the Health Care Administration with basic tax information (income, number of dependents, etc.) necessary for determining a person's eligibility for insurance subsidies. Your bank account, investment portfolio, divorce proceedings, etc. are safe from the HCA.

PG 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax" Yes, it says that

No, it doesn't. What it says is "The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55." In other words, you can't deduct the tax for not having health insurance (it's really a penalty that is administered by the IRS, I'd argue) from your income for purposes of determining your eligibility for health insurance subsidies.

Coming up next, a look at a whole group of claims that are based on the assumption that Medicare and Medicaid don't exist (and are probably a bad idea). . .

What Is In Your Health Care Bill? Part 1

A document of unknown provenance purporting to provide the low-down on the House health care bill is making its way around the interwebs and fax machines. It turns out to be filled with fabrications and distortions. Here's the approximately the first half of the document with commentary and factual corrections:

There is a lot of talk about the Health Care Bill, HR 3200. It is said some lawmakers who voted on it have not even read it. You can access the health plan that passed the House of Representatives, all 1017 pages. Here's the link: http://frwebgate.access.gpo.gov/cgi- bin/getdoc.cgidbname=111_cong_bills&docid=f:h3200ih.pdf

Bad link. Try this:
http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

Pg 22 of the HC Bill MANDATES the Government will audit books of ALL EMPLOYERS that self insure!!

What the bill requires is a study of "the large group insured and self-insured employer health care markets". The study does include an analysis of "[t]he financial solvency and capital reserve levels of employers that self-insure by employer size", but this is hardly an audit.

Pg 30 Sec 123 of HC bill - THERE WILL BE A Government COMMITTEE that decides what treatments/benefits you may have. Pg 29 lines 4-16 in the HC bill - YOUR HEALTH CARE will be RATIONED!!!

Sec 123 describes the establishment of the "Health Benefits Advisory Committee", a board headed by the surgeon general and comprised mostly of non-government employees. Its purpose is to establish a minimum level of benefits, things like coverage for hospitalization, prescription drugs, and maternity care.

Pg 42 of HC Bill - The Health Choices Commissioner will choose Your [sic.] health care Benefits for you. You have no choice.

Again, this refers to establishing minimum standards for Qualified Health Benefits Plans (QHBPs).

PG 50 Section 152 in HC bill - Health care will be provided for ALL non US citizens, illegal or otherwise

What the bill says is "Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services." Section 246 explicitly prohibits the federal government from paying for these services, however.

In other words, this is exactly the way things work now: patients who show up at a hospital and need treatment get it, irrespective of their immigration status, hair color, sex, etc.

Pg 58HC Bill - will have real-time access to individuals finances & a National ID Healthcard will be issued

This refers to Section 1173A which provides for standardization of electronic administrative transactions, the intent of which is to reduce administrative costs by having a standard system for claims administration and payment. One of the goals for this system is that at the point of service, a health care provider should be able to determine what kind of coverage the individual has and what their financial responsibility (co-payments, etc.) are. In other words, Big Brother won't have access to your bank statements, just to information about your health care coverage.

Also, the bill says that this "may include utilization of a machine-readable health plan beneficiary identification card". [emphasis mine] Kinda like the one you probably have right now (if you have insurance, of course).

Pg 59 HC Bill lines 21-24 Government will have direct access to your banks accounts for election funds transfers

You'll have the option to make your copayments via electronic transfer. Or not. "Direct access to your bank accounts"? Hardly.

PG 65 Sec 164 Not everyone will have to go on the plan. There will be a separate, subsidized plan for Government [sic.] retirees and their families including Unions [sic.] & community orgs (ACORN).

I don't see anything in Section 164 that has anything to do with this.

Pg 72 Lines 8-14 Government is creating an health care Exchange to bring private health care plans under Government [sic.] control.

Government regulation does not equal government control. The bill proposes creating a Health Insurance Exchange and participating insurers will have to abide by the rules for those insurers, including providing minimum benefits as discussed above. This supplements the current system in which health insurance coverage is tied to your employer: loose your job, loose your coverage and God help you if you have a pre-existing condition when you try to get new insurance.

PG 84 Sec 203 HC bill - Government mandates ALL benefit packages for private health care plans in the Exchange

No, this is not true. The bill establishes minimum requirements (and sets pricing standards) for participating insurers. In a nutshell, there are four tiers of coverage--basic, enhanced, premium, and premium-plus--and participants must offer all plans beneath the top level of coverage that they offer. e.g., if you offer a premium plan, you have to offer both basic and enhanced plans as well. As I read the bill, an insurer can offer whatever it wishes under premium-plus plans so long as it plays by the rules for its basic, enhanced, and premium plans.

PG 85 Line 7 HC Bill - Specifications for of Benefit Levels for Plans which means the Government [sic.] will ration your health care/Specifications of Benifit [sic.] Levels for Plans [sic.] like AARP member plans- your health care will be rationed

I certainly don't get this from p 85, line 7. I'll take up the notion of health care rationing another time (hint: it's already rationed and the folks doing the rationing do not exactly have your interests at heart).

PG 91 Lines 4-7 HC Bill - Government mandates linguistic appropriate services. Example - Translators for illegal aliens

Turns out to be a bad example since the bill explicitly prohibits government coverage of illegal aliens.

Pg 95 HC Bill Lines 8-18 The Government [sic.] will use groups i.e., ACORN & Americorps to sign up individuals for the Government [sic.] health care plan

Makes sense to me--if you develop a program like this you should promote it. And, sure, the government would likely consider ACORN (the boogey man of the right) for this roll--they are damned good at community outreach especially in communities that are otherwise hard to reach. Americorps would also be a good choice since it is, well, a government program. I'd think that religious groups would also be good candidates.

PG 102 Lines 12-18 HC Bill - Medicaid Eligible Individuals will be automatically enrolled in a national Medicaid program. No choice

A fine idea that will save a lot of money. The overwhelming majority of people who are eligible for Medicaid but not enrolled aren't enrolled because they don't know they are eligible. These are exactly the kind of patients who, for example, present at emergency rooms on the verge of diabetic coma because they haven't been receiving regular health care.

More later . . .