Since I believe that the attack on Phil Robertson was primarily about the media’s distaste for Paul’s message about sin in 1st Corinthians I asked the rhetorical question, What would Paul Do? Discussing homosexuality is a tough subject but I doubt Paul would shy from the task at hand. He died as a martyr for his faith. I believe that Paul sensed that there were some “homosexual offender problems” in the church of Corinth because the NIV and NKJV translations say so in pretty definite terms. Churches seek out the broken and those overwhelmed with guilt so why is anyone surprised if a church seems to get more than its fair share of adulterers, prostitutes, drug addicts, drunkards, and people with homosexual issues. The Message and Voice interpretations of this chapter focus more on sin and less on naming names. In the context of that time in history I don’t know what homosexual offender means. Although we are probably more tolerant to homosexual lifestyles than at any time in history, we still have homosexual problems that need to be addressed. Some of the problems are pretty complicated and uncomfortable. Was Ted Haggard a heterosexual with a homosexual obsession? On the other hand New York Mayor Bill de Blasio’s wife is complicated and comfortable with her past. She is a former lesbian who is happily married. There is probably something a church leader can learn from her.
Affordable Care Act Loser #7 – Health Reimbursement Account
Last week my boss informed me that our Health Reimbursement Account(HRA) would be phased out at the end of 2014 and he said that the most recent interpretation of Affordable Care Act by the Department of Labor had effectively outlawed the HRA. He and our HRA administrator discussed the options and do not have a clue what they were going to replace it with in December 2014. As of right now we do not have a company supported health care plan for 2015. Our present plan is a stand-alone health reimbursement arrangement in which I am reimbursed for paying my health insurance premium. It is a very simple, portable health care plan that worked really well before the Affordable Care Act. Since the company is small enough to be exempt from most of the Affordable Care Act I was hopeful that I could continue the HRA in the future. It is truly ironic that the people who voted for the Affordable Care Act seem to be the last people to figure out that they have condemned some of us to health care hell. Abandon hope all ye who enter here.
The sad part is that the demise of the HRA did not have to happen this way. As an example the Public Health Services (PHS) Act Section 2711 requires a health insurance issuer to not establish lifetime limits on the dollar value of benefits for any participant or beneficiary. I can see how this requirement should be applied to my insurance company, Aetna, so I am not surprised that my insurance company has already complied. This was one of the positive contributions of the Affordable Care Act that had bipartisan support. I do not understand why our bureaucrats are applying this restriction to a HRA used to purchase a health insurance policy that complies with the requirement. The Department of Labor has grudging accepted that a flexible spending plan can be used to pay health insurance premiums if it provides preventative care as required by PHS Act Section 2713 at 100% without cost-sharing, too. Huh? Since my insurance plan already complies with both of these requirements, isn’t this redundant? Zane Benefits thinks that a new plan they call a limited Healthcare Reimbursement Plan (HRP) can be constructed to comply with the Department of Labor requirements. All of this sounds so iffy I have to ask the question why did the Department of Labor decide to screw with health insurance that was working? It sure looks like it is deliberate malfeasance. Here are two alternatives my company is probably looking at for 2015.
- In an effort to avoid unnecessary employee turnover they might opt to give everyone a $5,000 raise and tell us to get our health insurance from the exchange. $5,000 was the amount they contributed to the HRA last year.
- As a company with less than 50 employees it is not obligated to provide me with health insurance. They might opt to drop the HRA with no change in employee compensation.
In this strange as hell health care world the “raise” option is actually less attractive because the subsidy is greater than what the raise provides after you take out the taxes. A raise will likely push my income above the 400% FPL so I will not receive a subsidy. Since I do not qualify for a subsidy and my monthly premiums will go from about $407 to over $886 per month(2014 rates) for the lowest cost bronze plan, my out of pocket costs will zoom from zero to about $6,000 a year even when I account for the raise. The second option qualifies me for a subsidy and my total out of pocket costs is just $4,800. In 2015 I have the option to pay an additional $6,000 or $4,800 for heath insurance I paid zero for in 2013. Either way I lose. The only way to minimize my loses is if I can keep the HRA just the way it was.
So for a person who went without health insurance from 1998 to 2008 it looks like there is a very good chance that my wife and I will roll the dice and go without health insurance in 2015. Until the Affordable Care Act was passed we were part of the solution. We had health insurance and we were healthy. In fact we were the perfect health insurance customer. We never made a claim. Now we are part of the problem in this strange, strange health care hell.
Hoppin John for 2014
Like last year I am cooking Hoppin John. It has a little ham, bacon, onion, celery, and black eye peas. It a nice comfort food and tastes good as a leftover. Here is the picture I took. I used the same Cook’s Country recipe as I used last year.
Phil Robertson and 1st Corinthians
Everybody is talking about what Phil Robertson said in the GQ interview, What the Duck? Various newscasters have described his comments as crude, rude, and flat out wrong. Their comments sounded so politically correct, I had to look for myself. Our newscasters are pretty low on my integrity list ever since they looked the other way when Martin Bashir suggested that Sarah Palin “truly qualified for a dose of discipline from Thomas Thistlewood”. Martin Bashir made this now infamous defecation in her mouth remark in response to her comments about our current federal debt policies. If we look at Martin’s comments in its entirety he used most of his words to attack Sarah Palin as “America’s resident dunce” rather than to substantiate his position of why he thinks her statements on federal debt are wrong or dumb. His use of an anecdotal story of slavery in 1756 is not much of an argument for or against current federal debt policies in 2013. Under the guise of journalism he deliberately wandered off the subject to make a malicious personal attack. If Martin Bashir gets lax treatment from his peers for his remarks then Phil must of said something really vile.
So with the journalism bar set so low, what did Phil say in the GQ interview? Here is the Corinthians related quote from the GQ interview that got me speed reading Corinthians on Friday night.
“Everything is blurred on what’s right and what’s wrong,” he says. “Sin becomes fine.”
What, in your mind, is sinful?
“Start with homosexual behavior and just morph out from there. Bestiality, sleeping around with this woman and that woman and that woman and those men,” he says. Then he paraphrases Corinthians: “Don’t be deceived. Neither the adulterers, the idolaters, the male prostitutes, the homosexual offenders, the greedy, the drunkards, the slanderers, the swindlers””they won’t inherit the kingdom of God. Don’t deceive yourself. It’s not right.”
During Phil’s darkest days, in the early 1970s, he had to flee the state of Arkansas after he badly beat up a bar owner and the guy’s wife. Kay Robertson persuaded the bar owner not to press charges in exchange for most of the Robertsons’ life savings. (“A hefty price,” he notes in his memoir.) I ask Phil if he ever repented for that, as he wants America to repent””if he ever tracked down the bar owner and his wife to apologize for the assault. He shakes his head.
“I didn’t dredge anything back up. I just put it behind me.”
These quotes sound very familiar to the argument that the Apostle Paul was making to the Corinthians. From the introduction to 1st Corinthians in the NIV Study Bible, we can see that the purpose of Paul’s visit was that “some of those who had come had brought disturbing information concerning moral irregularities in the church”. So Paul writes a letter to the Corinthians to help get them back on track with God. In chapter 6 he argues that the arbitrary judging of others was doing serious harm to the fledgling church and reminds them that judging others is God’s job. Then Paul gives them a laundry list of sinful behavior in which neither “the sexually immoral nor idolaters nor adulterers nor male prostitutes nor homosexual offenders nor thieves nor the greedy nor drunkards nor slanderers nor swindlers will inherit the kingdom of God”. He follows this up with the reminder that although “Everything is permissible for me but not everything is beneficial”. This sounds like pretty good practical advice to a group of people struggling with at least eight morality issues. When we look at what Phil and Drew said in the article, you have to say that their comments are very close to what the Apostle Paul told the Corinthians. Unlike the comments made by Martin Bashir, Drew and Phil’s comments were neither personal or malicious attacks on some person or group and were on target with Paul’s message. When you read the story about Phil’s darkest days in the early 1970s, they chose to highlight the difficulty Phil had with seeking repentance. To me this part of the interview sounded like a mini sermon on the challenges of applying Paul’s message to a real world situation. So when did Paul’s hopeful message to the Corinthians of God’s grace and repentance get transformed by our media into a homophobic rant? If Phil is just the messenger then the ire of our newscasters is actually a thinly veiled, theological criticism of Paul’s message. This group that quickly criticized Phil is the same group that struggled mightily to condemn Martin Bashir’s journalism as slander. As Phil said, “Everything is blurred on what’s right and what’s wrong.” If Paul was still alive, what would Paul do?
Affordable Care Act Loser #6 – Big Government
I realize that the gift came a little early for Christmas but for all of the fans of small government the thought is appreciated. It has been practically impossible to convince the majority of the people that big government can be a big part of the problem until we saw the stumbling, bumbling failures surrounding the rollout of www.healthcare.gov. The Affordable Care Act supporters did something to the American people that the Tea Party could never accomplish. They convinced the American people that when it comes to health care reform, if you want a really big scandal you need a federal program! This week a Pew poll confirmed that “seventy-two percent of Americans say big government is a greater threat to the U. S. in the future than is big business or big labor, a record high in the nearly 50-year history of this question”. When I started working in 1976 only 38% of Americans viewed big government as a greater threat to the future of the U. S. With health care expenditures in the United States at about 18 percent of GDP, is this an indicator that we are winning the race to the bottom and we need to stop doing health care the way we have done if for the last fifty years. When you combine the allegations of mismanagement and lying with the thought that we are asking the IRS to force individuals and businesses to buy health insurance, part of the problem can now be laid at the feet of big government and federal programs. It is very easy to dismiss the Affordable Care Act as more of the same with more subsidies rather than an attempt at health care reform. It was a missed opportunity for big government to demonstrate that they can improve health care better than local or state governments. As the people who purchase health insurance in the individual market have found out, you should be very worried when someone says we are from the government and we are here to help!
My Approach To Deciding On A Health Care Plan in 2014
My health insurance plan’s grandfather status expires in 2014. Before the end of 2014 I will have to choose a new plan and since I can take advantage of the subsidy available from the exchange I will either purchase the new policy from the exchange or go without health insurance. Since I recently went without health insurance for nearly ten years both options are reasonable financial options for my family. For the past five years I worked for a small business who offered a $6,000 per year HRA to their employees. I used $4,700 of this money to purchase a silverish-bronze plan health insurance plan with $3,000 deductible and a $5,000 out of pocket cost. Since I had $1,300 still left in the HRA to cover miscellaneous health care costs my net financial liability was approximately $1,700. As a healthy family my out of pocket costs from 2008 to 2013 has been zero. Naturally I would like to duplicate this strategy in 2015.
When I look at the current premium costs available through the exchange I am confronted with this premium versus deductible versus out of pocket cost dilemma. Here are my choices using 2014 premium rates to guide me.
1. I can achieve the same results with the lowest cost bronze plan(Healthspan HMO) with a $6,350 deductible. I will still have $1,300 for miscellaneous out of pocket costs which may be pretty handy with a narrow network HMO. I view this insurance as catastrophic care coverage or a slightly improved version of Medicaid. In fact several insurance companies participating in the exchanges specialized in serving the Medicaid market. To achieve the same piece of mind I had in 2013 I will have to save an additional $4,650 and put that into an emergency fund to cover the larger deductible. The good news is that the first $1,300 is already covered.
2. To achieve the same results with a silver plan(Anthem PPO cbey) I will have to shell out an $124 per month in addition to the company contribution because the silver plan is more expensive. Since there will be no excess funds left in the HRA and the insurance deductible is $5,000, I will have to save an additional $3,300 to achieve the same piece of mind.
When I look at the out of pocket costs and the network restrictions both the bronze and silver plan are inferior to my 2013 plan but better than going without insurance. If the subsidy disappears or if health insurance premiums significantly increase then the going without health insurance plan becomes the better financial alternative. If I have to choose a new plan and I do not have problems with a narrow network HMO then it makes more financial sense for me to trade down to bronze plan than to trade up to the silver plan. Regardless of which plan I choose I will have to increase my savings to cover the additional uncovered risk the Affordable Care Act has brought to the table.
The Affordable Care Act Losers
The Affordable Care Act and I have never gotten along. As a healthy person who purchases their health insurance in the individual market, I had a target on my back. For the Affordable Care Act supporters there is something evil about healthy people that needs to be suppressed. I don’t understand their quixotic logic but wishing it would go away is not helping. So I reluctantly assumed the position of designated whipping boy in their quest for health care reform. I was told to overlook my plight and remember that my sacrifice will usher in a whole new era of health insurance for for the uninsured and chronically ill. My inner cynic said that it seemed more of power grab than a genuine concern for the good of others. It reminded me of this line out of the novel, 1984.
“The Party seeks power entirely for its own sake. We are not interested in the good of others; we are interested solely in power, pure power.”
Still I was comforted by those conservative principles expressed by the President and other Affordable Care Act supporters that said I could keep my insurance and doctor if I wanted to. I even took the President up on his offer to look for a better health insurance plan offered in the exchanges. Surely the supporters would carry over enough of the old system to avoid an unnecessary introduction to Murphy’s Law. At the very least, they would offer a more affordable insurance option through the exchange. I looked, analyzed the plans, and finally decided that for the President and the Affordable Care Act supporters, words are cheap! It was just a means to the end. I was happier when I thought I was the only Affordable Care Act loser and am disheartened to see that they seem to have gone out of their way to piss off people. So let me identify my first five losers you may not be aware of. I am keeping number 6 for another day.
- The subsidies for the individual market come from that odd political threesome of Medicare Advantage “overpayments”, a tax on medical devices, and extending Medicare tax on incomes up to $250,000. So let me see if I understand this. We are taking money away from Medicare to subsidize insurance for the young in the hope that if enough young people sign up we will have enough money to subsidize those folks who have pre-existing conditions who are predominately elderly. If that is not weird enough for you, the only bipartisan agreement in health care debate is to revoke the tax on medical devices since it will likely increase health care costs. The only sustainable part of this plan that does not increase health care costs elsewhere is to increase the Medicare tax on the wealthy. It may be gallows humor but it sure looks like the politicians are gleefully looking forward to a massive to a passive, aggressive experience.
- I was surprised to find that even with a subsidy I had to choose a HMO plan with a pretty narrow hospital network that I am not familiar with or pay a lot more money for a PPO that covers my network. As Ezekiel Emmanuel might say, “You can keep your PPO if you willing to pay more money”. Is my preferred hospital network a loser? What made them a villain?
- I was surprised and humbled to find that the insured but chronically ill people can be losers, too. I never expected that the Affordable Care Act would screw the chronically ill! If the doctor or hospital you are using is not part of the exchange insurance plans, you are going to have to change. In other cases the doctor and hospitals are covered but at a much higher cost.
- As Emmanuel and Gruber will readily admit, it was part of the Affordable Care Act plan that a lot of insurance plans would be canceled and replaced with insurance plans that covered the “Essential Benefits”. The first phase was to cancel the health insurance available via the individual market. I suspect that the people with canceled plans are in shock. Since they are forced to be Early Adopters of www.healthcare.gov and pay higher insurance costs, they are responding with a very typical passive, aggressive response. A typical response by these designated losers is that the Affordable Care Act was supposed to screw “other people”, not them. At least they had showed the individual responsibility to purchase their own health insurance without a government subsidy. The second phase is going to get a lot more dicey since many of the grandfathered individual and group plans will be canceled in 2014. I doubt our politicians want to go to town meetings with a large group of people who have just found out that they are Affordable Care Act losers.
- I am still puzzled how does one replace Medicaid with a subsidized health insurance plan? I have a relative who is struggling with getting her life back together again after multiple bouts with unemployment. If she goes to www.healthcare.gov she will be automagically enrolled in Medicaid if she tells the truth about her income. If she knows the Medicaid income limits and purposely lies about her income, she can get a subsidized plan. I was curious what she might do since I believe that she is a good prospect to purchase and maintain health insurance. In her transition from part-time to full time employment this would be a nice personal goal. It certainly would enhance her self-esteem if there was a path for her to start paying for health insurance that did not require lying. I realize that the Affordable Care Act plan was to automagically enroll people in Medicaid if they have insufficient income. This fulfills a quest by Affordable Care Act supporters to reduce the number of people without health insurance but it creates a new problem. How do we encourage people to transition people from Medicaid to subsidized health insurance to normal health insurance? Between these two quests which is the greater good or can we do both? Is this a case where life imitates art and “you can check out anytime you like, but you can never leave”?
Image courtesy of Wikipedia.
Estimating The Magnitude of Future Problems With healthcare.gov
Last week I ran across a post by Paul Hammant’s blog, Testability and Cost of Change, that reminded me of another software engineering author, Barry Boehm, from my time. Paul included a quote which is the primary reason I believe the www.healthcare.gov web site will continue to have problems in 2014.
“Bugs are cheaper to find/resolve in a design stage, which is cheaper than finding them in development, which is cheaper than finding them in QA, which is cheaper than finding them in production”
Paul had a nice diagram of this relationship which I have reproduced here.
While looking up information on Barry Boehm’s writings on software engineering I ran across a slide from Stevens Institute of Technology that listed some of the reasons software project fail. Not surprisingly many of these reasons are being used to describe the development and management of the www.healthcare.gov site.
| Lack of User Input | 12.80% |
| Incomplete Requirements and Specs. | 12.30% |
| Changing Requirements and Specs. | 11.80% |
| Lack of Executive Support | 7.50% |
| Technology Incompetence | 7.00% |
| Lack of Resources | 6.40% |
| Unrealistic Expectations | 5.90% |
| Unclear Objectives | 5.30% |
| Unrealistic Time Frames | 4.30% |
| New Technology | 3.70% |
| Other(Poor Management Dominates) | 23.00% |
So how far are we away from a failed software project? Although I applaud Mr. Zients efforts to fix the front end bugs affecting the web site by November 30th , I think those of us who like to see the system fixed so we can move on to the unfinished business of health care reform are likely to be disappointed. Considering the multitude of security and back end problems along with admission that 40% of the system is not developed yet, it is easy to envision the public’s support for exchanges and the Affordable Care Act will wane further in 2014. The front end problems were not the most critical part of the system that needed fixing. They were the easiest to fix. At some point in 2014 we will look around and realize that when the average person believes the project has failed and they are not going to change their mind. Then the project has officially failed and the only question is when does the media recognizes the project has failed. So where does health care reform go if we have a failed web site? This is not the end of the world but it does make the remaining Affordable Care Act ideas that have not already failed much harder to implement. If you agree with me that the Affordable Care Act was primarily a political rather than a health care reform achievement then it is not unreasonable to argue that the web site has delayed health care reform for several years and that less partisan, incremental changes would have been more successful. Maybe this angst that we still have not done anything to rein in health care costs after four more years will bring clearer heads to the table. It is the elephant in the room. This partisan ring to rule them all has to go back to the mountain which bore it if we want “real” health care reform. A non partisan approach modeled after the procedures used to do identify which military bases to close is probably the best course of action. Although the Affordable Care Act supporters hate to admit this, the old system even with its problems continues to look much better than the new system with all of its problems. The biggest problem between the old system and the new system is that most of the designated “losers” in the new version have been arbitrarily chosen. This is never good politics and for some reason they continue to insist on saying that the Republican party is the stupid party. I wish! The new and improved version of the Affordable Care Act needs to have a whole lot less of these arbitrary “losers”. If you are designated as a Affordable Care Act “loser” then it should be something both parties can agree upon. Hopefully we can finally fulfill one of the President’s talking points and actually show people with “substandard” plans that there is a better and lower cost health care plan on the exchange. Picking arbitrary people as “losers” to fulfill your political ambitions for wealth distribution does not cut it!
Gratitude Is The Answer
Here is a You Tube video I saw today for the first time courtesy of Michael Hyatt’s post,
The Gift of Today””Lessons from a Monk. It is a video to bookmark should I stray from the way. Enjoy!
RE: Bad Managers Ruined Obamacare
I guess it is no surprise that I agree with Glenn Reynolds of Instapundit fame who wrote in his USA Today column that Bad Managers Ruined Obamacare. Engineers respect the consequences that the Mythical Man Month is probably a fact of life you cannot skirt around. Politicians ignore it at their own peril.
All appearances to the contrary, the managers involved in this debacle aren’t dumb. But they come from a background — law and politics — where arguments often take the place of reality, and plausibility can be as good as, or better than, truth.
What engineers know that lawyers and politicians often don’t is that in the world of things, as opposed to people, there’s no escaping the sharp teeth of reality. But in law, and especially politics, inconvenient facts are merely inconvenient, something to be rationalized away.
When our country has accomplished great things in the past, there has usually been a great engineer running the program: Hyman Rickover with the nuclear submarine program, or Wernher von Braun with the Apollo space program, for example. Rickover and von Braun were famously stern taskmasters, but they did not substitute wishes for reality.
Which may be why they were able to launch submarines, and rockets that astounded the world. While today, we can’t even launch a website.