Author: bill

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What Is A “Radically Decentralized Federalism”?

I was reading Bill Gardner’s article on The Incidental Economist, Prediction: SCOTUS will find for the King plaintiffs, and I was perplexed by this statement.

The constitutional outcome of a victory for the King plaintiffs would be a radically decentralized federalism.

Since we already have existing state exchanges I am not sure how “radical” of a change this would be. Then I stumbled over the words “decentralized federalism”. Wikipedia defines federalism as,

The term “federalism” is also used to describe a system of government in which sovereignty is constitutionally divided between a central governing authority and constituent political units (such as states or provinces)

I suspect Bill is complaining over the perceived change from a centralized form of federalism to a more decentralized form. Since the states and and the federal government are already using a form of this decentralized federalism in running Medicaid, I do not see a problem if the Affordable Care Act respects the constitutional limits assigned to it. Since no one has attempted to make the case that the federal government has an overriding constitutional issue that requires them to regulate state health insurance, I find it fascinating that Bill was naïve enough to think anything other than decentralized federalism would be constitutionally acceptable. Congress knew that the Affordable Care Act was stuck with state exchanges with some type of federal support and no amount of wishful thinking was going to change that. The federal exchange would be created as a convenience to those states that could not afford to create and manage their own exchange. It was to be the exception and not the rule. The requirement of state exchanges is not a new argument. It was one of the points being made by Senator Baucus in this CNN clip, “Senate Hearing: Tax Credits are available for State Exchanges Only. Senator Baucus explains how The Affordable Care Act sets conditions where Tax Credits are available for State Exchanges Only.“

Since I would like to see major changes in the Affordable Care Act in 2015 rather than 2017, I hope SCOTUS rules in favor of the plaintiffs. The King is dead, long live The King!

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Is The Affordable Care Act Fundamentally Evil?

My insurance premium for January 2015 will be $479. This is up 18% from my 2014 insurance premium of $407 and up 54% from my 2011 premium of $311. Your mileage may vary but this is the good news! If I was foolish enough to purchase health insurance from the exchange in 2015 the lowest cost bronze plan will cost $923 and my potential out of pocket costs zoomed up from $5,000 to $12,000. For a person who has not made a claim against my health insurance since the mid 1990s, the idea of paying $479 a month is revolting. The idea of paying $923 a month is beyond comprehension. I was the perfect health insurance customer. I was happy even though I was arguably getting ripped off. My existing health insurance plan was being paid by my employer and even though this was not the perfect situation, my employer was happy and my family was happy. In those days my life was simple. I could spend my waking hours on the important things in life. Not surprisingly this situation was not that different from 1976 when  health insurance was simple, transparent, and well understood. Boy, have we screwed up a good thing! In those day health insurance was the ultimate no-brainer and everyone signed up. Now we ponder to what happened to the Do No Harm philosophy to health insurance? Today I feel that I have been drug into a fight I never supposed to be fighting. Courtesy of the Affordable Care Act my employer cannot use the Health Reimbursement Act to pay for my health insurance with pre-tax money. It is just another one of those unintended ACA consequences. My employer is trying to be compassionate in a difficult business environment and will give me a bonus in 2014 to try to overcome the dysfunctionality of the Affordable Care Act. Recently I was reminded by Professor Gruber that Affordable Care Act supporters have always been negotiating in bad faith with the healthy people who were supporting the health care system. Quite succinctly he reminded us that the Affordable Care Act was never about health care reform, it was about politics. Six years later and 21,000 pages later we are still trying to figure out how to bend the health care cost curve. If increased federalism cannot reduce health care costs in six years, we have to conclude it will never reduce health care costs. Now the healthy crowd is stuck with a “fool me one, shame on me” mentality. If repeating the same old thing over and over again and expecting a different result is a sign of insanity, what can we do to reform the Affordable Care Act except to let it suffer through a slow, miserable death? Are we doomed to re-live the TennCare debacle all over again. Our health care system was better six years ago and even better 30 years ago. We are going in the wrong direction. I can see a trend and the Affordable Care Act is fundamentally evil.

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Touchscreen Laptops Are Getting Pretty Affordable

I am planning an overseas trip and I was surprised how affordable touchscreen laptops have gotten. The laptop below is now going for $229.99. I thought it was a bargain at $269.99. For a windows guy who needs a keyboard for most of my work, this little laptop is a plenty powerful for internet browsing, responding to emails, emergency remote support, and streaming videos.

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Making Health Care Less Affordable and Harder to Get One Policy At A Time

Today my boss informed me that our Health Reimbursement Account(HRA) would end on December 14, 2014, so I better schedule my remaining health expenses to a date before the 14th. To help with the increased after-tax health costs they will be increasing my paycheck in 2015. Although it is not as nice as the Health Reimbursement Account they recommended that I set up a Health Savings Account. Awhile back I wrote a post, Affordable Care Act Loser #7 – Health Reimbursement Account, that explained that the Affordable Care Act and the Department of Labor had effectively outlawed the HRA. Their decision is a sad reminder that “common sense” and Affordable Care Act do not belong in the same sentence. Although my company is making a best effort attempt to overcome the Affordable Care Act dysfunctionality, the bottom line is that I will be paying a larger part of my health insurance costs than if I had a HRA. So while I will receive a pay increase, the net result after paying for health care with after-tax money is that I just took a pay cut. Anybody wonder why the nine most terrifying words in the English language are, “I’m from the government and I’m here to help.” I keep wondering how we reform health care when the HHS is at war with the healthy people. It looks like a strategy that was born to fail. It is as if the Health and Human Services mission statement should say, “Making Health Care Less Affordable and Harder to Get One Policy At A Time”.

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My Second 7-Minute Workout

Starting at 720 am my 7-minute workout app started nagging me about working out. My muscles were slightly sore from yesterday so I paid more attention to pacing myself in this workout. Over exuberance can lead to “bad” muscle soreness that requires taking a couple days off to recover. I did not want that. Everything was good so I followed it up with a 1.2 mile run. Yesterday I had an “easy” day and today I had a “hard” day.  Tomorrow I plan to follow up with a moderate or easy day. I will have to see how I feel when I wake up.

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My First 7-Minute Workout

2014-10-29 11_27_21-7 Minute Workout1I was reading the Lifehacker article, Get the Scientific 7-Minute Workout on Any Device with This Web App, when I realized that I was already doing part of the 7-minute workout everyday. A couple of years ago I started back running to lose some weight. Running has always been the fastest way for me to lose fat. The trick was how to ramp up the mileage and avoid injuries. Although I am ambivalent about the benefits of stretching, I am mildly enthusiastic about calisthenics. One of the benefits of calisthenics is that it allowed me to warm up my muscles and work on my ankle and hip flexibility. It is amazing how my range of motion had contracted over the years. I started off with toe touches and jumping jacks before adding the pushups and stomach crunches. Gradually it became the mainstay of my exercise program since it only took three minutes. It was hard for me to convince myself that I did not have three minutes available. Now I do not feel guilty when I take off days from running. Although the Lifehacker article was talking about a new phone app and website, I found that there were several 7-minute Workout apps with good reviews over at Google Play. I ended up choosing the 7 Minute Workout. This morning I tried the app out and was breathing hard half way through the program. One of the benefits of the program is that some of the new exercises work muscles that I do not use regularly. I will give it another shot tomorrow to see if the 7-minute workout is a keeper but I doubt I will have trouble talking myself into a 7-minute workout.

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It’s The IRS, Stupid!

2014 Midterm IssuesIsn’t it odd that Judge Walton thought the “prospect of future harm” by the IRS is  “speculative”.   Look at this chart of 2014 Midterm Issues from a recent Gallup poll and tell me that the prominence of “the way federal government works” issue does not bother you. We have a Constitutional crisis going on and Judge Walton just gave the IRS a pass on the most egregious behavior by the IRS since President Nixon. Arguably the behavior of Ms. Lerner and the IRS cover-up is much worse than anything the Nixon administration did. At least he had the decency to resign when he was caught. So for all of those people who thought that “the way federal government works” is a very important problem, Judge Walton has made the problem worse. It looks like laws and courts exist solely for the benefit of government agencies. Has our representative government officially been killed and replaced with an administration accountable to no one and a judicial system more than willing to look the other way?

If there is such a thing as an afterlife, President Nixon is probably pissed. For lesser offences he resigned the Presidency to preserve our way of government. Sadly this generation does not care about a form of government he once held dear. Let us imagine for a moment President Nixon is looking down on us and what he would see.

  1. Ms. Lerner targeted conservative groups under the auspices of the IRS. She realized that her targeting behavior was forbidden by IRS rules so she starts a cover-up. President Nixon chuckles. She releases the information about the targeting at a conference. This does not go over well and she is subpoenaed by Congress.  President Nixon chuckles some more. She makes a statement to the Congressional committee asserting her innocence and then promptly pleads the fifth. President Nixon chuckles some more and thinks the more things change, the more they stay the same.
  2. Despite IRS policies that say that IRS personnel must have either disk or printed backup copies of important emails, the IRS cannot produce Ms. Lerner’s and several others emails. President Nixon chuckles. The IRS deliberately ignored written policies and implemented a decentralized backup policy that is dependent on individuals who commit a crime will be stupid enough to leave behind incriminating evidence. Any IT guy will tell you that is a policy born to fail. Conveniently when the subpoenas arrive, the disk drives start failing and the IRS can no longer produce the emails. At this point President Nixon is probably wondering that if he was able to lose the Watergate tapes like this IRS lost the emails, the world would be different place today.
  3. President Nixon is confused with the IRS corruption problem. Evidently corruption in the IRS is not the IRS’s problem. The IRS had written policies they chose to not enforce. President Nixon chuckles because there have been no consequences. Judge Walton’s court has just said that corruption in the IRS is not the court’s problem because the IRS has promised to implement the policies they were already supposed to have already implemented. Judge Walton says that IRS corruption is not his court’s problem because the “prospect of future harm” by the IRS is  “speculative”.  President Nixon is chuckling again. He thinks the word “speculative” is a nice touch.

In the city of no consequences our federal government is running amok and Judge Walton has given his blessing.

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In The New Economy Are Low-paid Jobs An Improvement?

vpplogo_resizeA couple of days ago Marc Andressen said in a Business Insider interview that in the new economy “even low-paid jobs — is an improvement”. Here is the entire quote.

“The old farming jobs were f–king terrible jobs. I mean, farmers wake up at 6 in the morning and work 14-hour days. Industrial jobs — people would get killed in these factories all the time. Coal miners — people are trying to protect coal-mining jobs. They’re terrible, terrible jobs … In developing countries, everybody’s dying to get into modern factory jobs, because the alternative is far worse.”

Back in the 1980s and 1990s I worked at a chemical plant near Houston. During my 15+ years at the plan we had one on the job injury. Our safety record was good enough that we applied and was accepted as an OSHA Star site. I know. I was on the committee. I know the slogans and I really do believe that companies really mean it when they say “we like you just the way you are!” A safe workplace is good for the company’s bottom line and both management and the employees are happy! While I was on the committee I knew the injury statistics for various industries.  In the 1980s chemical workers and coal miners were not on the top ten list. Since it has been a few years since I looked at the numbers, I did a little research to see if anything had changed. Here is the list from a recent Forbes article, America’s 10 Deadliest Jobs.

1. Logging workers
2. Fishers and related fishing workers
3. Aircraft pilot and flight engineers
4. Roofers
5. Structural iron and steel workers
6. Refuse and recyclable material collectors
7. Electrical power-line installers and repairers
8. Drivers/sales workers and truck drivers
9. Farmers, ranchers, and other agricultural managers
10. Construction laborers

Yup, the list is pretty much as I remember. Industrial jobs did not make the list either. Mr. Andressen was 0 for 2 in job safety predictions. Our country learned a lot of bitter lessons improving mine safety since 1900s and the unions and coal companies are proud of their progress. The same can be said for industrial jobs, too.

I am kind of surprised Mr. Andressen did not crank up his favorite browser and check the safety and salary information for coal mining before he spoke.  If he did he would find that the average coal miner salary in 2013 was $82,058 while the average U.S. worker got $49,700. According to the Glassdoor the average hourly wage for a Starbucks Barista is $9.32 per hour or about $18,640 a year if they work full time for 50 weeks. When you look at the safety record and the salary, I think it is pretty obvious why coal miners want to hold on to their jobs. These “new economy” jobs are jobs you take while you are look for a real job.

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Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

Last week I wrote the post, What Scares Me About Ebola Is How We Have Handled Sepsis, and Kaiser Health News and NPR has followed up with an article expressing the same concern, Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived. The Ebola infections by health care workers in the United States reminds us that infection control is a serious, unresolved health care problem for both health care workers and patients. The article is well researched and worth the read. My favorite quote is,

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.