Friday, August 29, 2014

"We don't have a strategy yet. Let me repeat that..."


Regardless of whether Obama's assertion that "we don't have a strategy yet" for confronting ISIS in Syria and potentially beyond (as opposed to in Iraq) was well advised, it was not a gaffe in the sense of an inconvenient truth that slipped out.

It couldn't have just slipped out, because Obama reiterated the point and elaborated it at length. His reasons for describing the strategy as in progress and TBA were multiple: 1) to reassure that he was not beginning a large-scale military operation without consulting Congress; 2) to pressure prospective coalition partners to play their parts and emphasize that US action depends in large part on their cooperation; and 3) to differentiate between immediate, limited military action and a more sustained, multilateral, slower-building and Congressionally authorized effort.  That's all in his second iteration of the strategy-to-be:

Gideon Levy, Jeremiah

I want to stay near silent in paying tribute, via this 2010 profile by Johann Hari, to Gideon Levy, Israel's most hated Jewish Israeli reporter and one of its bravest. Just a couple of excerpts below (okay, four)..

Levy’s father never saw any parallels between the fact he was turned into a refugee, and the 800,000 Palestinians who were turned into refugees by the creation of the state of Israel. “Never! People didn’t think like that. We never discussed it, ever.” Yet in the territories, Levy began to see flickers of his father everywhere – in the broken men and women never able to settle, dreaming forever of going home.

and

Thursday, August 28, 2014

Inching toward immortality

Kaiser Health News reports on medical research -- funded, albeit minisculey, by the ACA -- that taps into longstanding dreams:
Imagine if scientists could recreate you---or at least part of you---on a chip.

That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment.

Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy's lab are working to make that happen. Funded under a provision of the health law, they're trying to grow human organ tissue, like heart and liver, on tiny chips.
Science fiction writers  have long envisioned variations on this theme-- e.g.. organ banks, rejuvenation via replacement of body parts. transfer of a individual consciousness into a spare body.  Back in the disk drive era, I put a less physical imagining into a children's poem:

A Good Dream

I dreamed I saved my sister on disk--
brother, was I relieved.
If any harm should come to her
she could be retrieved.

Wednesday, August 27, 2014

Will the ACA reduce the disability rolls?

Two years ago, I was riveted by TNR reporter Alec MacGillis' chat with a woman on line for a free REM medical clinic in rural Tennessee. Notwithstanding that she knew nothing about the ACA, she offered a stunning instant analysis, once the basics were described to her, of one likely economic effect:
..it it was hard to find visitors to the clinic who would not benefit directly from the law. Barbara Hickey, 54, is a diabetic who lost her insurance five years ago when her husband was injured at his job making fiberglass pipes. She gets discounted diabetic medication from a charity, but came to the clinic to ask a doctor about blood in her urine.

Under the law, she would qualify for Medicaid. Her eyebrows shot up as the law was described to her. "If they put that law into effect, a lot of people won't need disability," she said. "A lot of people go onto disability because they can't afford health insurance."
Lo, Ms. Hickey was a prophet (perhaps). In Arkansas, which has sliced its uninsured rate almost in half since ACA enactment, mainly by enrolling nearly 200,000 Arkansans in the state's "private option" Medicaid alternative, disability claims seem to be dropping.* Modern Healthcare's Paul Demko reports:**

Monday, August 18, 2014

In which Clinton slams Obama by articulating his "organizing principle"


A typical account of Hillary Clinton's assessment of Obama's foreign policy in the Goldberg interview ran like this one in the New York Times:
Her blunt public criticism of the president’s foreign policy in The Atlantic this week touched off frustration among Mr. Obama’s advisers and supporters, especially her suggestion that under Mr. Obama, the United States lacked an “organizing principle” in its approach to international relations. “ ‘Don’t do stupid stuff’ is not an organizing principle,” Mrs. Clinton said.
Three things to note about this takeaway:

1. Clinton didn't say that "don't do stupid stuff" is Obama's organizing principle, or that he lacks one. In fact she said the opposite.

2.  The "organizing principle" that Clinton articulated, when pressed, is indistinguishable from Obama's, and, just like Obama's, incorporates "don't do stupid shit" but doesn't end there  (though the particulars of her favored policies on specific issues may quite different, in disturbing ways -- more on this at bottom).

3. Obama has articulated that principle continually since his first year in office.

Sunday, August 17, 2014

A stealth modernist's divine lamppost

Lev Grossman, a fantasy writer whose works I have not yet been privileged to read, has a wonderful, wonderful, wonderful tribute to C. S. Lewis, who brought him into the worlds of reading and of fantasy. He focuses first on a passage that I used to xerox for students, also trying to capture its magic:
Even more than that, it’s the way he uses language—which is nothing like the way fantasists used language before him. There’s no sense of nostalgia. There’s no medieval floridness. There’s no fairy tale condescension to the child reader. It’s very straight, and very clean—there’s no Vaseline on the lens. You see everything clearly, not with sparkles or a flowery sense of wonderment, but with very specific physical details. Look at the attention to detail as you watch Lucy going through the wardrobe:
This must be a simply enormous wardrobe!" thought Lucy, going still further in and pushing the soft folds of the coats aside to make room for her. Then she noticed that there was something crunching under her feet. "I wonder is that more mothballs?" she thought, stooping down to feel it with her hand. But instead of feeling the hard, smooth wood of the floor of the wardrobe, she felt something soft and powdery and extremely cold. "This is very queer," she said, and went on a step or two further.

Friday, August 15, 2014

"What's a subsidy?" -- It's hard to reach the uninsured

Back in May, I noted a remarkable finding in a McKinsey survey of those who bought or sought health insurance in the individual market during the ACA's first open season:  Most of those who failed to obtain coverage were eligible for subsidies but did not know they were eligible. Two thirds of subsidy-eligible respondents who visited healthcare.gov but did not enroll were not aware of their eligibility -- and so had no idea how much health insurance would actually cost them.

Those findings are corroborated in a survey conducted at about the same time (April 10-28), commissioned by EnrollAmerica and conducted by PerryUndem Research/Communication. I just happened on this because HuffPost's Jeffrey Young cited the results in a story about the challenges of meeting signup targets in ACA year 2. Ignorance among the uninsured remains perhaps the greatest barrier (excepting the refusal of about half the states to accept the law's Medicaid expansion).

The EnrollAmerica survey drew responses from 671 new enrollees and 853 people who remained uninsured. 60% of those who remained uninsured said they wanted insurance. Only 21% of those who did not try to enroll knew that financial help was available to low-to-moderate income buyers -- and only 38% of those tried but failed to enroll were aware of this basic fact.

Perhaps even more remarkably, only 56% of those who did enroll in coverage knew that the law gives financial help to low- and moderate-income buyers. At the same time, 75% of enrollees, including 69% of those who enrolled online, said that the signup process was easy. Perhaps in this one regard it was a bit too easy, i.e., it was not hammered home that your friendly federal government was subsidizing your purchase.

Wednesday, August 13, 2014

Hillary Clinton was not so hawkish on Iraq

Jonathan Ladd sensibly questions the premise that  Hillary Clinton would act like a hawk as president, as opposed to talking a little like one now. As evidence that she would not, he cites the foreign policy continuity between the (Bill) Clinton and Obama administrations (of which she is of course a lynchpin), and the fact that the only hawkish action she's ever taken was her vote in October 2002 to authorize the use of force in Iraq.

I would complicate somewhat Ladd's contention that in her tenure as Obama's Secretary of State Clinton's "actions supported President Obama's less confrontational, less militaristic policies rather than the neoconservative policies advanced by the Bush administration." She supported the generals' plans for a surge in Afghanistan (the modifications were all Obama's own), urged the Libyan intervention, supported early intervention in support of "moderate" rebels in Syria, and claims that she always worked either to deny or reduce to a token Iran's "right to enrichment."  That doesn't mean that she wasn't a loyal administration member, but it does indicate that her relative hawkishness is more than talk. I find her stance with regard to Iran particularly disturbing, in that it bespeaks not just "hawkishness" per se but also near-complete deference to Netanyahu and AIPAC -- a deference to which her Goldberg interview pays really stunning and disturbing tribute.

To switch gears, though, I'd like to offer collateral support to Ladd's contention that Clinton's Senate vote to authorize the use of military force in Iraq does not necessarily indicate a predisposition to use military force generally.  Ladd concentrates on the strong political incentives to support the resolution. I'd add that Clinton cast her vote as a vote for diplomacy and a chance to avoid war. On several occasions following, she urged Bush not to rush to war. She was hardly a profile in courage in this regard: those urgings devolved into meek peeps as war approached in March 2003. But they do indicate that if she held the reins, she may have been content to force invasive inspections -- arguably a tool of the kind of "smart power" she claims to advocate.

If you're dropping ACA coverage for any reason, I'd like to hear from you

[moving this forward per request for input at bottom...]

Charles Gaba, ACA signups tracker extraordinaire, dives into a scary-sounding claim about attrition among people who signed up for private health plans on ACA exchanges -- Aetna enrollments to drop 30%! -- and provides some clarity: attrition for private insurers generally is likely coming in at about 2.5% per month, as expected.

That attrition -- offset, to an unclear degree*, by off-season "special enrollment period signups -- is expected and normal. A Kaiser study found that only 62% of people who had individual market coverage in January 2010 still had in July 2010.  According to an older study by Mathematica Policy Research,  while, 5.3 percent of the non-elderly population had non-group [individual market] coverage  in any given month, only 2.1 percent held non-group coverage for the entire year, and 9.7 percent had non-group coverage at some point during the year.

Of the four people I know personally who obtained insurance on ACA exchanges, none will stay pat for more than fourteen months, and two will be off their plans within six months of signup. One is a woman recently divorced who found a job in July and was covered by her employer as of August 1; another is entering a graduate program that provides free (or at least premium-free) health insurance, effective Sept. 1. A third is switching from a high-deductible ACA plan to insurance provided by his wife's employer. Another qualified for Medicaid, then found a job (without insurance) in June, notified the authorities and was allowed to remain on Medicaid for a year, dated from the point when he reported change of status. If his income doesn't change, he'll qualify for a subsidized private plan with Cost Sharing Reduction when his Medicaid eligibility ends.