There are two really good articles about brainwrap to report today, but as usual even the best writers don't get all of the facts straight, and brainwrap has provided clarifications. I have further expanded on his clarifications below.
It has been a pretty good day in the crazy and the fatuous, but with glimmers of sanity here and there in the media, and actual good news in health. The rate of hospital readmissions is down significantly in the last few years, apparently because the ACA directly addresses the issue. And you might be able to make money from some of the ways that is happening. More below.
Do you remember me going on about Cognitive Dissonance yesterday? I have some excellent examples for you today.
In the past 2 days, there have been two very flattering profile pieces published about ACASignups.net and myself.New York: 9,800 more QHPs, 33.3K Medicaid since 3/31
[Tech President: ACASignups.net's Charles Gaba: Not Nate Silver, Just a Guy with a Spreadsheet (A detailed and geeky look at the development of ACA Signups, with lots of brainwrap quotes.)
Sarah Kliff at Vox.com: The best Obamacare data comes from a home office in Michigan (Really good on how hard this all is and how well brainwrap has done, by someone who tried and failed in her own efforts early on.)]
Both are pretty in-depth and involve interviews with others as well as myself, and they're both very well-written, but I do feel a need to clear up a few things:
1. I don’t “hate” being compared to Nate Silver; It’s incredibly flattering. I just think it’s a bit of an insult to HIM. That isn't false modesty...I really don't know anything about "probability distribution" or "loglinear regression" (in fact, I had to look those terms up just now). [Before Silver can get to the regressions, he has to have polling data. You are the only data aggregator in this space.]
2. I didn’t expect HHS to release the full, 30-page report every week, I just figured they'd release the top-line numbers (X in QHPs, Y in Medicaid or whatever) on a weekly basis (and hope they decide to do so the next time around). [Um, you wanted bureaucrats who understand how to communicate with the public?]
3. I didn’t know that Aaron Strauss was a data consultant or that he was in charge of the Analyst Institute; I figured he was a regular schmoe like myself. [We should all be such schmoes.]
4. None of my clients has actually said (yet) “That’s great, but where’s my website”?; that’s just what I'd be saying if I was in their shoes. A few have started to become understandably impatient, and I'm likely to lose a couple when the dust settles, however. [It's a good thing Kos sent out that blast and wrote that fundraising Diary in support of brainwrap, then. Kossacks can still donate.]
5. When I said "It doesn't do any good to have a huge number of people enrolled if they're all going to have diabetes", I'm not disrespecting those with the disease; I just mean that from an actuarial POV, it's the overall health mix of those who enroll which is important, not so much the total number. [Yeah, it's just an example of a chronic and once life-threatening condition that millions of people have, including me, Mokurai. Well, it can still kill you if you can't see a doctor, get a glucose meter, and get test strips and medicine regularly. It killed my father (in conjunction with Christian Science; bad combination) and my mentor, in both cases after decades of suffering from neuropathy.]
6. The section about me "not tracking" unpaid enrollments is, as anyone who follows this site regularly, simply not true. I have tracked this data in great (exhausting) detail, just keeping it separate from the paid enrollments whenever possible. [It is, of course, very easy to get confused about such things. On the few occasions when I have been in the papers, there has always been some major error in the story. Journalism schools and city editors used to teach, "Don't get it right, get it written."]
What is true, however, is that after months of arguing the point until I was blue in the face with detractors, I finally mushed all the data together into a simplified formula: 85% paid plus another 8% who will pay by the time their invoice is due or shortly thereafter (give or take). So no, I don't really track it on a daily/weekly basis anymore, but yes, if there's solid evidence that I'm off on my "93% paid-or-will-pay" rule, I'll be happy to nudge it up or down accordingly in the future.
7. Probably the most important clarification: I am not a "team of one". There are a couple dozen people who have been contributing enrollment data, links to surveys, reports and articles about the paid/unpaid issue, previously insured/uninsure issue and many other related topics for months...some of whom have been assisting me with this project since the beginning. [Our thanks to all of them. Us. You know who you are.]
Previously, brainwrap scaled back his projection of 8 million Exchange signups by April 15 to 7.6 million, because more young people with fewer spouses and children are in the queue. This is not a big deal except to bloviating and hyperobstructing Republicans. The two reports are
Motley Fool, 04/06/14: The Obamacare Number That Should Impress You the Most
There is a statistic, though, that doesn't require us to wait for more information and is overwhelmingly positive. The national rate for readmission of Medicare patients to hospitals after 30 days is falling significantly.It started to decline in 2010 from a peak of 19.2%, and the rate of decline is accelerating, as penalties from too-high readmission rates kicked in in 2012. We are currently at 17.8% nationally, with much variation. This saves lives and lots of money. The Motley Fool's interest in this question is that there are investment opportunities in technologies such as telehealth (monitoring patients in their homes) that reduce hospital readmissions and can improve outcomes.
Gallup, 04/07/14: In U.S., Uninsured Rate Lowest Since 2008
We went through the pros and delusional cons on this in yesterday's Diary.
Originally from April 5
More on the coming Sirius XM podcast from the Left Jab show. It will be up sometime this week.
April 7th, 2014A Tip-of-the-Tongue Taste of Thorstein Veblen
Charles “Brainwrap” Gaba, the ACA Signups Guru who changed the media’s tune on Obamacare, is in the ring to tell us how and why he decided to set the record straight with hard facts and real numbers.
It is impossible to understand American politics, or any politics, without understanding the concept of Conspicuous Consumption as expounded by Thorstein Veblen in his magnum opus, The Theory of the Leisure Class. This does not only mean the Consumer Society, Keeping up with the Joneses, Planned Obsolescence, and all that. It means that for many people the greatest imperative in life is an obsession with money and the social status it brings, and with political means of achieving and maintaining status.
I mean to explain this in one of these Diaries. Today I mean only to mention it. The idea is that being rich is taken to mean being smarter and more moral than others, and that maintaining that illusion requires demonstrating that you are richer than others through your houses, your clothing, and a multitude of other material things. For the super-rich, it means that their servants and employees and lawyers and so on have to demonstrate the same wasteful consumption and display patterns.
You also have to demonstrate that you have rich, and important, and gorgeous friends. Maybe trophy wives and arm candy.
But it also means that everybody at every lower level who is of this mindset has to find somebody else to be superior too, and if necessary somebody to keep in that inferior position by any means available, including the full force of the law. Thus Jim Crow, and keeping LGBTs in the closet, and the War on Women, and immigrant-bashing, and all of the rest. Look at any form of inequality in income, in assets, in social standing, in political clout, and you will see this principle in action.
And nowhere more so than in Republican Party politics, where much of the Southern Strategy was based on telling poor Whites that they could at least be certain of being above poor Blacks, that the 1% would look out for their selfish interests as long as they voted for the tax cuts and deregulation demanded by that 1%. And the same for the Religious Right, which is promised Dominion over certain narrow classes of sinner, notably women seeking family planning support, drug users, and of course LGBTs. And possibly Middle East Armageddon, with The Jews wiping out The Muslims in preparation for the Rapture and all of that, although not really.
Denying people health care based on poverty or any of the other invidious distinctions that make up the Republican War on Everybody Including Each Other, along with any other possible government benefit, is an obvious component of the strategy.
The leisure class lives by the industrial community rather than in it. Its relations to industry are of a pecuniary rather than an industrial kind. Admission to the class is gained by exercise of the pecuniary aptitudes—aptitudes for acquisition rather than for serviceability. There is, therefore, a continued selective sifting of the human material that makes up the leisure class, and this selection proceeds on the ground of fitness for pecuniary pursuits. But the scheme of life of the class is in large part a heritage from the past, and embodies much of the habits and ideals of the earlier barbarian period…As it finds expression in the life of the barbarian, prowess manifests itself in two main directions—force and fraud. In varying degrees these two forms of expression are similarly present in modern warfare, in the pecuniary occupations, and in sports and games.And, he should have added, in politics and certain forms of religion, as he brings out elsewhere in the book.
There is much more to Veblen's work, but this will do to start with.
Obviously not all human endeavor is to be explained in this way. We know that you can plead for the widow and the orphan without being one of them. but even in religion we have Jesus telling us to lay up treasure in heaven, which many interpret as making ourselves more important and more moral than everybody else. This cast of mined then requires Conspicuous Consumption in churches, Sunday-Go-to-Meeting clothing, religious TV shows, celebrity preachers, public bashing of selected classes of sinner, and so on, rather than feeding, clothing, sheltering, or providing health care for the poor and needy. You know, like The Good Samaritan (in spite of his utter abomination, to the Jews listening to Jesus preach, of eating pork).
I also plan mini-tutorials on Robert Axelrod's theories of The Evolution of Cooperation, and Martin Seligman's theories of learning and unlearning helplessness in Helplessness: On Depression, Development, and Death, which explain a great deal more of how we all got into these messes and how we might get out of them. Learned helplessness is particularly important in GOTV.
Today in the Crazy
I wrote a little tutorial on Cognitive Dissonance in yesterday's ACA Signups Diary, and look! Here it is in full flower. What a surprise. This is a good place to start.
No, no, says the noise machine, he totally spiked the ball on his victory lap just to be mean to us because he is an illegal tyrant and the extensions are illegal and we nearly have Obamacare repealed now, and it was only a field goal, not a touchdown, and we're winning because Haaaalp!!!
Have I mentioned Cognitive Dissonance yet today at all? Oh, right.
Spin at its finest. The actual number of signups, 7.1 million or more on March 31, is not the actual number because some were previously insured, and some haven't paid, and the rest of the partly true but totally irrelevant talking points. They now have better insurance (success!), and they will pay (success!) unless they find better insurance (success!) or get dumped from a job and have to go on Medicaid or expanded Medicaid (Not totally a success, but no longer working without a net isn't any kind of failure), or whatever. Anyway, remember, the real actual number is more like 26 million, and Republicans want people to lose their insurance because Obamenghaziiiiii!!!.
That survey that Fox News cites would be this one. Note that they are claiming that a survey showing a decline in the number of uninsured is proof that not that many people are getting insured. Have I mentioned Cognitive Dissonance yet today?
That was NBC. The same sort of positive story about the Gallup results is up at
Business Insider: This May Be The Best Evidence Yet That Obamacare Is Working
The New Republic: Another Day, Another Sign That Obamacare Is Working
And yet some GOP lawmakers are clinging to the idea that the number of cancellations is higher than the number who gained insurance, proving a net drop in those covered. Mitch McConnell is hanging on to this claim by his fingernails, falsely insisting that this is the case in Kentucky, where hundreds of thousands have signed up through kynect, the state exchange. Meanwhile, as Sahil Kapur details, other GOP lawmakers are continuing the drumbeat that the law is nothing but an unremitting catastrophe, probably because the GOP base cannot accept any other version of reality…Have I mentioned Cognitive Dissonance today?
Of course, it cannot be true that the law is functioning more or less as intended – Obamacare is fatally flawed; Republicans never entertained any other possibility – so therefore it isn’t.
Let us review. The current rate is 15.6%, the lowest it has been since the Bush housing bubble crashed. The rate of uninsured just before that was 14.4%. It has since trended upward throughout the recession and the War on Obamacare, peaking at 18.0% just before Open Enrollment on the Exchanges began, and then dropping sharply. Gallup's estimate is that 3.6 million were newly insured in Gallup's survey period, which ran from Jan. 2 to March 31. So it does not include the full effect of this Open Enrollment period. Much less, in fact, given how strong the surge was at the end. So phooey on Fox, which is comparing a box of apples that the grocery store just sold to oranges that were still on the tree at the time.
Have I mentioned Cognitive Dissonance?
If repeal is momentarily impossible, should Republicans work to improve the law to lighten the burden on Americans (“bide your time”) or should they demand that O-Care be implemented exactly as it was passed so that Americans can render a fully informed verdict on Democratic-led health care (“let it burn”)?Yes, which strategy will threaten to take away insurance from the most Democrats, and motivate them to the polls? Repeal, work to rule, or actually fix something? The whole complaint in this article is that some Republicans fixed something, raising deductible limits on employer-paid insurance, as requested by both some businesses and some workers, on a voice vote in the House. That's cheating!
Here is a let-it-burner cited in the article.
The merits of this particular policy are neither here nor there. The House GOP talks a big game in public and then rams through a provision that not only puts the GOP's fingerprints on ObamaCare but gives vulnerable Senate Democrats a talking point, "See, we can fix ObamaCare if the Republicans would just be flexible and reasonable like they were in this case!".And we are going to become the majority by next Tuesday at the latest by purging all of the RINO capitulationists. Please proceed, wingers.
Oh, have i mentioned…? Never mind. Here is another rant on the same theme.
More rage and more spin about the fix to deductibles for company health plans mentioned above.
Oh, they're totally true! Because, um, Cognitive Dissonance?
Del Marva [MD] Now: FROM THE LEFT: Despite GOP opposition, Obamacare has left the station
If there’s one thing Republicans hate even more than health insurance for a growing number of Americans, it’s empirical evidence that Obamacare is insuring a growing number of Americans.Columbian :Jayne: Since the beginning, Obamacare is failure of politics
Policies aside, [Lyndon] Johnson knew how to get things done. His legendary powers of persuasion relied upon what came to be known as “The Johnson Treatment” — he would corner a legislator and prey upon their weaknesses until they capitulated to his point of view.Delusional on three counts. First, what does that mean, politics aside? For Johnson, there wasn't anything but politics. What he got done with "The Johnson Treatment" was 100% politics.
If only Obama had that. If only he had come to office with more than charm and flowery rhetoric and promises of hope and change. If only he had recognized the need for a little bipartisan support for Obamacare, enlisting one or five or a dozen Republicans in the passage of the bill.
If Democrats had recognized the need to engage Republicans four years ago, perhaps the rhetoric over Obamacare would have dissipated by now. And perhaps we could be working to improve the law instead of just talking about it.
Second, Obama want way too far to engage and court Republicans four and five years ago, and got bupkes for it. Less than bupkes, because of giving away half of the store in the prenegotiations with himself.
Third, in what parallel universe did Republicans cooperate with Democrats after Johnson rammed through the Civil Rights Act, the Voting Rights Act, Medicare, and Medicaid? They went full Godwin on the Southern Strategy at their 1964 national convention, as observed from the floor by Rockefeller Republican and baseball and civil rights legend Jackie Robinson in his autobiography, I Never Had It Made.
That convention was one of the most unforgettable and frightening experiences of my life. The hatred I saw was unique to me because it was hatred directed against a white man. It embodied a revulsion for all he stood for, including his enlightened attitude towards black people.and they have never let up for a minute since. President Obama says that he wants to be another Abraham Lincoln, which set the haters going long ago, but it turns out that he is Lyndon Johnson and Jackie Robinson combined, and also part MLK and Nelson Mandela.
A new breed of Republicans had taken over the GOP. As I watched this steamroller operation in San Francisco, I had a better understanding of how it must have felt to be a Jew in Hitler's Germany.
Everything is impossible until the moment it happens.But for the haters, it has to remain impossible for decades, even centuries after it happens.
Michael Hiltzik at the LA Times: Subject to debate: Do the Obamacare delays break the law?
No…At any rate, no more than when Bush did it on Medicare Part D.
That's important, because Republicans hit this "lawlessness" theme like a broken record—Politico recently listed 15 reprises involving Obamacare and other laws. House Speaker John A. Boehner even used it as a rationale for not moving ahead on immigration reform, arguing that Obama couldn't be trusted to implement it lawfully. (That's one way to justify killing a law you don't want to pass in the first place.)Hiltzik was among the first in any mainstream media outlet to highlight the benefits of the ACA, in November 2013.