Archive for August, 2012

Oh, It Gets Even Better

About Those Medicare Cuts

Ed Kilgore deconstructing Romney’s fallacious claims that Obama made cuts to Medicare and that only he [Romney] will preserve Medicare. (Pay no attention to the fact that Romney wishes to scrap Medicare and replace it with a voucher system.)

At WaPo’s Wonkblog this morning, Sarah Kliff usefully deconstructs the issue, noting that the famous $716 billion does not involve any benefit cuts, and is composed roughly in thirds of (a) reduced subsidies for the grossly expensive Medicare Advantage pet rock that Republicans have foisted on the program in a failed effort to show how competition could reduce Medicare costs; (b) lower reimbursement rates for hospitals, which supported this change in the expectation that ACA would give them more patients; and (c) miscellaneous reimbursement changes affecting hospitals and home health providers, among others, but again, not affecting benefits or the availability of services.

For those keeping up, Romney just double-downed on his intention to replace Medicare with a private voucher program, and at the same time (get this) blamed Obama for destroying Medicare by making it more efficient.

Sometimes, I can’t believe the stuff that comes out of people’s mouths.

UPDATE: A reader pointed out that this rhetoric continues while they criticize Obama over deficits. Yet when he actually cuts fat from the budget and reduces expenditures, like he did with the $700 billion to Medicare, he’s also criticized.

Are Luxury Food Items Worth It?

Josh Ozersky writing for Time.

✁ In re Medicare

Social Security is 77 today. In 1965, President Johnson enacted Medicare under Title XVIII of the Social Security to provide healthcare to those older than 65 years of age.

Earlier this year, Paul Ryan introduced the “Path to Prosperity”, his blueprint for America, which fundamentally changes the way a host of government programs would be budgeted, including, most notably, Medicare. While Romney and Ryan seem to deny claims that their ideas would significantly change these social programs, the CBO concludes otherwise.

Up until last week, Medicare was an idea that received bipartisan support among our electorate. Sure, some will point out that we have a funding problem on our hands with Medicare. Fewer will point out that this problem doesn’t actually emerge until 2024. But, upon selecting Ryan as Romney’s running mate, Republicans, for the first time, officially became opponents of Medicare. It’s sad, shocking, and should have people livid that a majority party is proposing such an idea.

There’s a tremendous amount to be said about healthcare in the United States. Those words can be saved for someone else. But some very basic concepts need to be pointed out about Medicare and Ryan’s voucher plan.

Since 1965, Medicare has transformed society for the elderly. Prior to Medicare’s passage, most of the elderly could not afford adequate healthcare. Medicare changed this. As a result, the life expectancy increased in the US and the percentage of elders living in poverty decreased. The benefits are self-evident. Medicare has improved the lives of millions and transformed the United States to an empathetic, healthy, responsible nation.

Healthcare is a tricky industry to wrap one’s head around, mostly because everyone needs it, and no one thinks they need it until they actually do. The finances are even more difficult to grasp, since most of the fiscal issues related to Medicare are a result of the baby boomers aging, leaving fewer non seniors to pay for the benefits of their elders.

The Ryan Plan wants to phase out Medicare by providing vouchers ($6,500 credit to buy private healthcare) to future seniors that are currently younger than 55. Sure, such a plan gets the fiscal responsibility off the government’s shoulders, but it also serves to theoretically cut benefits to elders in a variety of ways. To begin, buying individual insurance plans are expensive, because the individual lacks the ability to buy in bulk to drive prices down.

It’s not difficult to see that $6,500 will not cover an individual as thoroughly as Medicare would (after Medicare’s $140 premium, 80% of approved costs are covered under Medicare Part B). Considering the average price of healthcare today is over $5,000, how much will a plan cost for a senior (the age at which one becomes the greatest consumer of healthcare)? Surely it has to be significantly higher than the average.

And what if you’re sick? Since every person is now responsible for purchasing healthcare individually, the sick (as greater risks to insurance companies) will pay even higher prices. Unless additional measures are put into place, it should come as no surprise that a certain percentage of our seniors will no longer be able to afford healthcare, even with these vouchers. Can a sick senior afford $12,000 annual healthcare plans? And what about the costs passed on to the rest of society for these newly uninsured’s trips to the emergency room?

There are serious conversations we need to be having regarding healthcare, Medicare, and Medicaid. Going back to an era where our seniors cannot afford to be cared for with dignity during their most sensitive years is not a matter we should even be discussing.

Senior Healthcare before 1965

Blaming Medicare for all of the United States’ woes appears to be all the rage these days.

The Medicare Commission takes a look at life before Medicare.

Prior to 1965, nearly half of the elderly had no health insurance and many others had inadequate coverage. Medicare was enacted to help assure that virtually all citizens age 65 or older would have health care coverage. The program was modeled on the standard employer-sponsored health plans of the day. Increased access to and insurance coverage of health care has resulted in significant benefits for the elderly including improvements in health and income status. For example, life expectancy at age 65 has increased several years and the poverty rate for the elderly has declined by about half.

Seems that a good rule of thumb before getting rid of something is to ask oneself why it exists in the first place. Medicare solved the problem of many senior citizens (the population with higher medical expenses) dying in the streets, poor. Sure, there are real fiscal issues facing the US Healthcare system today, but gutting the program ignores historic conversations we’ve already had.

A Land without Guns

How Japan Has Virtually Eliminated Shooting Deaths

A Brief History of Money

James Surowiecki on the, abstraction of money:

Kublai Khan was ahead of his time: He recognized that what matters about money is not what it looks like, or even what it’s backed by, but whether people believe in it enough to use it. Today, that concept is the foundation of all modern monetary systems, which are built on nothing more than governments’ support of and people’s faith in them. Money is, in other words, a complete abstraction—one that we are all intimately familiar with but whose growing complexity defies our comprehension.

✁ Why I’m backing

I just backed is a service that hedges against Twitter, as Twitter continues to dismantle the service everyone feels is so great as it tries to find a viable revenue model. In essence, is everything people like about twitter, except that its business model is honest and simple; if you value conversation and free flow of information without the need for advertisers to subsidize such discussion, you pay for this value.

The reason I support this endeavor is not because I am against advertising, or profit, or commercialism. It’s more nuanced. At the end of June, Twitter announced that it would be “delivering a consistent Twitter experience” to its users, which many surmised signaled the beginning of the end of third party integration and support with Twitter. Benjamin Brooks believes that the day where developers are cut off is inevitable, and I agree with his logic. In order for Twitter to make money, it needs to sell ads, and it can only ensure you see these ads if they control every aspect of your experience.

I wholeheartedly support Twitter in its attempt to generate profit from the service they provide. However, I am deeply concerned by the direction it appears Twitter will take to accomplish this goal. Several years ago, Twitter quickly developed into a brilliant platform for anyone to share thoughts in concise quips. And there’s probably never existed a better platform for the propagation of the marketplace of ideas, as retweets and favorites legitimize and strengthen viewpoints and challenge traditional notions. This concept is further bolstered by a strong developer API, that enables any social service to “bolt into” the existing Twitter platform, cementing Twitter as the commons for which all discussion, in whatever form, takes place.

But in its desire to generate revenues, Twitter now sees outsiders as a threat to its bottom line, as they cannot control every aspect of the experience when one “bolts into” the service. In addition, advertisements are being “promoted” in timelines. And third party developers fear that Twitter is ready to pull the plug on them on any day. They theorize that the only developers that will exist from that point are those who build apps inside the network (in the style of Facebook). With these changes, it appears that even to this day, Twitter still does not understand the service it provides to the world.

Twitter is the first service that treats all accounts, whether person, place, business, or thing, equally, as individual voices. That voice becomes relevant only after a vetting process. Fundamentally, Twitter creates a service where connections create legitimacy and trust within the community. This is Twitter’s currency. Traditional advertisements or promoted tweets devalue this currency of trust, as it begins treating certain voices as more equal. By failing to realize the uniqueness and organic nature of each voice, Twitter misses an opportunity to develop an alternative revenue model each time it displays a promoted tweet in current form.

It also fails to see that every developer that builds a service on top of Twitter only serves to strengthen Twitter’s gravitational force1. Allowing development to further explore concepts such as these will serve to create additional value for Twitter2.

I’m sticking with Twitter for now because I love the community and the discussion is enables. But, if Twitter continues in the direction I believe it’s going, I’ll be giving a real shot going forward3. I believe in paying for things that add value to my life. I give my money in exchange for a service I like. Is there a better business model than that?

If you’re interested in supporting an honest company, check out They’re three days from the deadline and only about half-funded4. Give it a shot.

  1. Not to mention that much of the novel features such as retweets, hashtags, and @replies were concepts originally invented by outside developers. []
  2. Perhaps these features and the developers are the ones Twitter should be exploring for revenue. Considering that every television show now includes a hashtag in the lower corner of the screen, charging companies to encourage conversation, while giving hashtags even more functionality, might be a more effective business model. []
  3. So long as it’s initial funding period is successful. []
  4. And if they don’t succeed, you get your money back. []

Louis CK’s Shameful Comedy

Speaking of Louis CK, Frank Chimero does a terrific job of explaining his je ne sais quoi.

CK’s comedy does the job of finger-placing our dirty, shameful thoughts. It doesn’t validate them, but it does recognize and identify them, and in their airing, we have to consider and deal with the lines that separate how we are expected to behave and think, and the shameful dirt of this world.

The A.V. Club interviews Louis CK

Nathan Rabin chats with the ever thoughtful and funny Louis CK on his work.

You know what? That’s the central question of my life—how to manage all of that. There’s a woman I see who’s not my therapist, but she’s like an old friend who’s a therapist in profession. She lets me talk to her like a therapist once in a while, and she does a great thing. Whenever I have a big dilemma, like this is a big problem in my life, she always says, “Wow, you’re going to have to figure that out.” [Laughs.] That’s all she says. And so I had to figure it out. I had to put some time and effort into figuring out how to manage energy and time and brain effort and all that stuff.

Louie’s insight on life and his work ethic easily makes this interview worth the read. But honestly, anything by Louis CK is worth your time (or money).