Off the grid

I’m going to have very limited access to the Internet for the next six weeks so I won’t be blogging and comments are shut down.

I thought I’d leave you with a video (Via Ace of Spades). Someone set a camera up in front of his fireplace and let it run for about three hours. Every so often he pokes the fire or puts a new long on it. The fire burns nicely and the snaps and crackles are almost enough to make it feel warm. There are a couple of “click here” banners at the beginning of the video but they disappear by a minute in.

We started this running Christmas Eve; lit our seasonal candles; turned on our little, lop-sided ceramic tree; and spent a couple of hours listening to Christmas music courtesy of the Mormon Tabernacle Choir:

Fireplace video

Have a very Happy New Year everyone. See you in February.

A meandering manifesto

One line of argument (loosely speaking) that I’ve seen popping up around the Internet consists of supporters of ObamaCare accusing those who are currently insured in the individual market and are complaining about ObamaCare making their situations worse, of being selfish. Or, as one commenter at that recent Megan Mcardle post put it, we’re “hard hearted” for ignoring the “thousands - maybe hundreds of thousands - who can’t get health insurance preACA, who can now”.

It took a few iterations of this for me to realize that I was starting to feel defensive and guilty for wanting to buy what I prefer with my own money. Once I did realize it, I got exasperated with myself and wrote in response to that commenter:

I absolutely support doing something to help people who are too poor to afford health care. (Pre-existing conditions are a little trickier. In some circumstances, yes, I support providing help. However, if an adult who could have afforded health insurance decided to gamble and not get it, I don't think other policy holders should have to pay for her treatment when she gets sick and *then* decides she needs health insurance.) If you had asked me 3 years ago if I'd throw an extra $1000 in the pot every year to help poor people get health care, I would have said yes. But the ACA asks me and many more like me to throw extra money in the pot and get worse (for me) health insurance and have fewer choices in health insurance and pay a fine/tax if I don't want to spend the extra money for worse health insurance. Not being a saint, I'm angry about that. Not being a supporter of government coercion, I'm opposed to that.

I'm especially opposed to it because there are much better (and much simpler) ways to have helped the uninsured and the people who passed this bill decided against all of them and went the ACA route instead. I'm especially angry about it because a lot of the people who think I should be happily willing to get a worse deal to help others have employer-sponsored health insurance and, oddly, don't seem eager to opt out of that insurance and buy on the individual market in order to help with the helping out.

In retrospect, I would have left off the first three sentences. They’re everything up through "I would have said yes." That's absolutely true for me but they give it gives too much legitimacy to the idea that other people, who don’t want to spend money to help the poor buy health insurance, are, in fact, selfish or hard-hearted. They aren’t. They’re just people who would rather spend their money on something else and there’s nothing wrong with that. It’s their money, after all.

Also, after writing that comment, I realized that there was nothing stopping me three years ago - or 30 years ago - from putting together a group of like-minded people, having each of us throw $1000 in the pot each year, and helping poor people buy health insurance. That realization, and the fact that I did nothing of the kind, brought home to me just how much I tend to see government action as the appropriate way to handle issues like this - notwithstanding my shift from leaning Left to leaning Right.

It took the very personal fall-out from ObamaCare for me to truly understand how and why getting the government involved should always be a rare move of last resort rather than a default position. And for helping me generalize my difficulties with ObamaCare to the larger picture, I’m indebted to two men.

First, Grim for this comment to a post over at the Hall:

If it makes you feel any better, this stomping of the social contract in the name of "Progress!!!" isn't unique. It's a persistent feature of the project. Ask the people whose land is underneath TVA reservoirs. It didn't matter what they wanted, or that their ancestors' graves were laid there. It didn't matter that they'd be reduced from free farmers on their own land to some other way of life they had reason to hate. Their land was in the way of water and power, and whatever it cost them they'd have to move.

For that matter, ask the Apache. How do you live with these people again? I'm not sure they've figured it out yet.

Second, Kevin D. Williamson. I re-read his book, The End Is Near and It’s Going to Be Awesome, and realized I’d pretty much totally missed the point of the book the first time around. I originally read it thinking he had some interesting policy prescriptions. The second time, primed by my close encounter with ObamaCare, I realized he had some interesting ideas about what people might do as individuals or in groups if we are able to - or forced to - stop thinking in terms of government-imposed, fully-specified, one-size-fits-all policies.

Many years ago - 40 or more - I heard a news story about some poor Third World country. The government had decided it needed men to mine something or plant something or build a road or whatever. The government sent troops to a small village out in the middle of nowhere and scooped up all the men and boys who were the right age to do the work. The soldiers left with their captives and no one left in the village knew where the men and boys had been taken or if they would ever come home again.

I was horrified and heart-broken. That government, I was sure, was made up of cruel men who cared nothing for their fellow citizens. It never occurred to me that those men undoubtedly believed that they were doing the best thing for the country as a whole; that the suffering of a few was a fair price to pay for the betterment of many; and that those who opposed them were short-sighted and, quite possibly, selfish and hard-hearted to complain about the plight of a few when so many would benefit.

The damage from ObamaCare is not on the same scale as the damage from that Third World government’s policies, of course, but the shape of it is the same, as it is for the people displaced by the TVA, as it is for all the people whose lives have been disrupted or damaged in the name of progress or the greatest good for the greatest number or simply because those in our government are convinced they know what’s best for every man, woman, and child in the country. The intentions may have been good but the reality is that the government doesn’t know what’s best; the greatest good for the greatest number is an illusion; and progress is something people do, not something government creates. And you know what they say about the road to Hell.

This shift in my outlook feels very odd to me because so much of my blogging has been about what policies I think the government should be imposing. It will take a while for me to rearrange my thinking now that I understand that the lesson of ObamaCare is that the answer to the question, “What’s the best government health care policy, government education policy, government agricultural policy, government energy policy, government whatever policy?” is almost always going to be, “As close to none as possible”.

And if I’m no longer arrogant enough to believe I know what everyone else should be doing, what the heck am I going to blog about? All the people who still are that arrogant?

As a favour

{When one has been threatened with a great injustice, one accepts a smaller as a favour. - Jane Welsh Carlyle}

In an earlier post, I wrote about the lack of out-of-network coverage in many ObamaCare policies. Recently, I posted something about it as a comment to a Megan McArdle piece:

At least in my State (NJ) most ObamaCare plans have no out-of-network coverage other than covering an Emergency Room charge. None of the Bronze policies offer out-of-network coverage; only the AmeriHealth Silver, Gold, and Platinum have this coverage. No out-of-network coverage means no access to specialized medical facilities like MD Anderson, Memorial Sloan Kettering, Mayo Clinic. As far as I can tell (and I find this hard to believe so I need to double-check this), it also means that if a policy holder is traveling and has a heart attack or breaks something major and has to spend time in a hospital in another State, those expenses (beyond the ER charges) are not covered by insurance.

Someone pushed back in a reply and inspired me to do what I’d said I was going to do: double-check. I talked to a sales rep at my insurance company and here’s what the rep told me:

- If I’m traveling and I have a heart attack or break something major or whatever and have to spend time in a hospital and get medical care because I can’t make it back to New Jersey (in other words, in the case of a true emergency), my insurer will cover my out-of-network care just as if I was in-network. Same deductible, same co-insurance.

- If I need care I can’t get in-network, there is a process by which I can apply to get that care paid for. The sales rep couldn’t describe the process in detail but it apparently involves paperwork and attestations by my doctors that I can’t get the care from an in-network doctor.

Being able to buy out-of-network coverage is still preferable, of course. I can imagine some lively disagreements over what constitutes an actual emergency and at what point during one I’m well enough to travel. And I can imagine even livelier discussions over whether I really need to see the guy in Manhattan who’s done fifty reverse shoulder replacements with a 90% success rate or I can get by with the in-network guy in New Jersey who’s done two, neither of which turned out very well. If I have out-of-network coverage, I make those decisions myself - so long as I’m willing to stand the higher deductibles, co-pays, and out-of-pocket maximums. If I don't, the insurance company makes those decisions.

Still, the situation is better than what I thought it was. I imagine I'll be saying that about a lot of things in ObamaCare, as the now outrageous becomes the new normal.

Christmas light show

I enjoy and am amazed by Christmas light shows and this one from 2010 is wonderful:

Holdman Christmas Lights

Merry Christmas, everyone.

Slow Cooker Bourbon Breast of Chicken

This is not a Christmas or New Year or holiday recipe in any traditional sense; the only holiday-ish thing about it is the bourbon. However, it is a wonderful recipe to put together before heading out to lunch and a day of shopping or gift returning - or any afternoon activity. I only found a couple of references to it on the Internet (a little different from my version) which really surprised me because we love it.

I was told this recipe originally appeared - in some version - in Crock Cookery by Mike Roy (Ward Ritchie Press, 1975) but I can’t swear to that.

I make the recipe as is for 2 chicken breasts to yield a lot of sauce. When I make this with 4 chicken breasts, I double all the sauce ingredients (from onion on down), but don’t use all the liquid from the tomatoes/mushrooms - it’s too watery.

Slow Cooker Bourbon Breast of Chicken

Ingredients:

4 chicken breast halves, skinless
2 Tablespoons oil (I use olive oil)

1/4 cup flour
1/2 teaspoon paprika
1 teaspoon salt

2 tablespoons chopped onion
2 tablespoons chopped fresh parsley (or 2 teaspoons dried)
1/4 teaspoon dried chervil (or substitute 1/4 teaspoon of dried parsley)

One 4-oz. can mushrooms, undrained
One 10-oz. can tomatoes (I can’t find this size can so I use about 2/3 of a 15 ounce can; the whole 15 ounces is too much for this recipe)
1/8 teaspoon Lawry's Season Salt
1 teaspoon salt
1/4 teaspoon pepper
1/4 cup bourbon

Directions:

Heat oil in skillet.

Mix flour, paprika, and 1 teaspoon salt in brown paper bag.

Add chicken breasts one at a time and shake to coat breast with flour mixture.

(You can also mix flour, paprika, and salt on a plate or in a wide bowl and dredge the chicken.)

Saute chicken breasts on both sides until lightly browned (about 5-6 minutes per side).

Remove chicken breasts to slow cooker.

Add onion, parsley, and chervil to skillet and cook for just a minute or two. Turn off heat under skillet.

Add tomatoes, mushrooms, Season Salt, 1 teaspoon salt, and pepper to skillet. Stir to scrape up brown bits.

Stir bourbon into skillet.

Pour skillet contents over chicken in slow cooker.

Cook at low for 6 to 7 hours.

Serve over noodles.

Define "overpaid" - or "underpaid" for that matter

This is an about an old proposal to let consumers buy health insurance directly from insurers and let the insurers estimate the appropriate subsidies. Whether something like this is still on the table, I don’t know but I suspect some variant of it is probably in the mix somewhere, ready to be re-considered if January 1 arrives with millions of formerly insured still left uninsured.

Here’s how the Washington Post described this proposal when it was first floated:

On their own, insurers can help consumers through almost the entire enrollment process, but they need to rely on the federal online system for people to enter their incomes and find out whether the government will pay for part of their health plan. Since the enrollment period began Oct. 1, insurers have not had access to that feature — and, as a result, some have a lineup of potential customers unable to choose a plan and complete their purchase.

Part of the discussions lately between insurers and administration officials has been about what to do if that function is not fixed soon. One idea circulated within the insurance industry would be for HHS to approve a method to estimate subsidies and give preliminary tax credits based on those estimates — with the accurate amount determined later, once the system works better.

According to several people familiar with these conversations, insurance industry leaders have said that they would insist on a guarantee that they would be compensated for any underpayments — and that they have asked to keep any overpayments. Said one health-care consultant who is knowledgeable about insurance exchanges and who has been in touch with administration officials: “The concern is: Who bears the risk?”

Here’s how that plan from the Washington Post story was interpreted by Peter Suderman at Reason:

So the insurers have suggested a temporary measure: Let the insurers estimate the subsidies on their own. Any estimates that are too low would be reimbursable, and any estimates that are too high, the insurers would get to keep. In other words, the federal government, backed by taxpayers, would be on the hook for their bad estimates.

Can this possibly be legal? Can the administration seriously be considering this idea, which is potentially costly and politically disastrous? Imagine how Democrats will feel about turning over the central operations of the health law to insurers. Imagine how Republicans will react to a plan that could cost more, and will serve as an implicit admission that the exchanges simply won’t work without a major overhaul.

This doesn’t make sense to me, not because it seems like an insane idea but because both the Washington Post story and the Suderman take on it imply that somehow the insurance companies are going to end up being overpaid for the health insurance policies they provide. There’s no way that can happen.

Let’s say I want to buy a particular health insurance policy from Acme Insurance. Whether I buy that policy directly from Acme or buy it through the HealthCare.gov website, the premium Acme charges for the policy will cost the same; let’s say $500 per month. Now let’s say the HealthCare.gov website remains difficult and/or untrustworthy so the Obama Administration decides insurance companies can calculate the probable subsidy for someone buying a policy directly from them.

I promptly give up on trying to buy a policy through HealthCare.gov and buy one directly from Acme. I tell them my income information, they run it through their subsidy calculator, and they decide I should get a $250 per month premium subsidy. They bill me for $250 for my first month’s premium; I pay them. They bill the Federal government for the other $250 for that first month’s premium; the Feds pay them. Acme has now received $500 for my first month’s premium so I’m all paid up. The same thing happens for the second month of my health insurance contract, the third month, the fourth month. Then, finally, HealthCare.gov is working correctly. The insurers and the Feds begin the process of running people like me through the website to be sure everything has been calculated correctly.

First scenario: When the Feds check on my subsidy, they discover it has been calculated incorrectly. Rather than being subsidized to the tune of $250 each month, I should have been subsidized $300 each month. I’ve paid $200 more for my insurance than I should have and the Feds have paid $200 less for my insurance than they should have. However, Acme has not been either overpaid or underpaid; they’ve received exactly the $2000 they were due for my four months of insurance coverage. The needed adjustment is between me and the Federal government: the Feds owe me - not Acme - $200.

Second scenario: The incorrect calculation was in the other direction; rather then being subsidized to the tune of $250 each month, I should have been subsidized only $200 each month. I’ve paid $200 less for my insurance than I should have and the Feds have paid $200 more for my insurance than they should have. Once again, however, Acme has not been either overpaid or underpaid; they have still received exactly the $2000 they were due for my four months of insurance coverage. And, once again, the needed adjustment is between me and the Federal government: under this scenario I owe the Feds - not Acme - $200.

What about going forward once the error in the subsidy calculation is discovered, for the fifth, sixth, etc., months of my policy? What should happen under the first scenario is that Acme should start billing me for $200 each month and billing the Federal government for $300 each month; in other words, my monthly bill should go down by $50 each month. Under the second scenario, Acme should start billing me $300 and the Federal government $200 each month; in other words, my monthly bill should go up by $50 each month.

Neither the first or the second scenario results in Acme Insurance being overpaid or underpaid; Acme always gets the $500 monthly premium amount, no more, no less. There are no “underpayments” for it to be “compensated for” and there are no “overpayments” for it to “keep”. So what were the insurance companies asking for?

My guess is that they did not want to be in the middle of any adjustments that should be taking place between a policy holder and the Federal government. In my first scenario, where I’ve overpaid by $200, I imagine the insurers were unwilling to refund that $200 to me and then bill the Feds for it; they probably wanted the Feds to reimburse me directly. While this scenario doesn’t involve a lot of financial risk for the insurers, it does involve what is essentially a cash flow delay: they would have been paid “late” for $200 worth of premiums.

When a policy holder has gotten a larger subsidy than he should have, things can get really ugly. So in the second scenario, where I underpaid by $200, I can’t imagine the insurers would have been willing to give the Feds back the $200 over-subsidy and then try to get that money from me. This involves a huge financial risk for them as well as a huge public relations risk. If the Feds want that money back, the insurers would insist the government go after it directly.

I also wonder if the insurers wanted any over-subsidization to continue even after HealthCare.gov was straightened out and correct subsidies could be calculated. While the insurers would be delighted to tell the me from the first scenario that my monthly premium would drop by $50 a month, I’m sure they would resist strongly telling the me from the second scenario that my monthly premium was going to increase by $50 a month. So I imagine they asked that policy holders who were under-subsidized start receiving the correct (larger) subsidy while those who were over-subsidized continue to receive the incorrect (larger) subsidy.

I don’t think any of this is out of line for the insurance companies to ask for - there’s no reason they should bear the financial and public relations risk for the government’s incompetence - or insane for the government to consider - desperate times call for desperate measures. And, contrary to what the Washington Post article and the Suderman post seem to imply, there is no way an insurance company would end up overpaid for a particular policy. The premium amount is the premium amount, wherever the premium payment comes from.

There is, however, a danger in this that Megan McArdle notes as follows:

The potential abuses are obvious; the insurer with the most erroneous subsidy calculator gets all the business!

Well, yes. If Acme Insurance tells me I qualify for a $250 subsidy and Xenon Insurance tells me I qualify for a $400 subsidy, I’m buying from Xenon - and so is everybody else. Xenon isn’t going to make any more per policy than they would without this kind of plan but they will sell a lot more policies. Of course, there is a simple fix for this danger: whatever method HHS approves for quick and dirty subsidy calculations must be the same for all insurance companies in a State. Just one more little task for the State’s insurance commissioners.

As I said, this is an old proposal and appears to be dead in the water. I wanted to walk through it, however, because that’s how I clarify my thinking about topics and especially about the tangle that is ObamaCare. In particular, I believe it’s important to think carefully about the relationships among the Federal government, the insurers, and the policy holders. Despite the appearance that there are two bilateral relationships - Federal government with insurers and insurers with policy holders - the fact is that the relationship between the Federal government and policy holders is quite real and quite important. When the Federal government subsidizes a policy holder’s purchase of a health insurance policy, the government is not giving money to the insurer; the government is giving money to the policy holder.

The other ObamaCare orphans

My posts about ObamaCare have focused on those who have health insurance now but will lose their current plans as a result of the implementation of the Affordable Care Act. They are (we are) people who have gone along, taking care of our insurance needs, and are now getting a raw deal.

However, there is also another group of people who are getting a raw deal from the structure and implementation of ObamaCare: the people who have not been able to afford or not been able to get health insurance, and who were promised they would be able to get it as of January 1, 2014. It’s easy to say that they won’t miss what they’ve never had but I can imagine the worry, frustration, and heartbreak of those who are ill or, worse, have sick children; thought they would finally be able to get health insurance; and are now discovering they can’t afford the premiums or can’t afford the deductibles or simply can’t get through the websites to discover what’s available to them. And even those among them who don’t have illness in their family but believed the time was coming when they didn’t have to lie awake at night terrified that one of their kids would fall ill, must be bitterly disappointed.

This was all so unnecessary. There are many, many ways to help those who can’t afford health care. Ways that don’t require a huge, complex government mechanism; that don’t require a competent Administration; that would spend money on getting people health insurance - and health care - rather than on websites and administrative overhead. Ways to help that would actually help those who need it rather than serving the goals and ambitions of politicians and bureaucrats and ideologues

For the government to have made so many people’s lives worse is unforgivable. But for the government to have made promises it must have known it couldn’t keep to the most vulnerable among us is shameful.