Monthly Archives: October 2013

The greatness of Rosemary’s Baby

In the rush to acclaim Chinatown, we often forget how well Roman Polanski nails dream sequences (the best outside of Bunuel to date), the paranoia of pregnant woman, and going crazy in a big apartment in Rosemary’s Baby. As a waif with resources of alertness, Mia Farrow can’t be bettered. Polanski does wonders with John Cassavetes’ wary sinister quality too.

Happy Halloween!

“This is a program that, by design, is going to annoy literally millions of Americans immediately.”

I mean, the Affordable Care Act sucks. It always sucked.

All of that is exactly why this is a dumb way to give people health insurance. This is a program that, by design, is going to annoy literally millions of Americans immediately. It will improve most of those people’s lives, but it will do so in a way that feels as coercive as possible. It didn’t have to be that way! No one is ever annoyed that they qualify for Medicare or Medicaid. People may hate paying the taxes that fund those programs, but people always appreciate direct benefits.

Why this solution? Step into the time machine:

The way the ACA deals with people who had previously purchased crappy insurance on the individual market — and the way insurance companies have chosen to deal with these people — illustrates nearly every problem with attempting to design conservative, “market-based” ways to do things best done by straightforward government programs. It exposes the flaws in both the technocratic wing of the Democratic Party — a too-clever solution to a very simple problem — and the centrist third-way wing — making legislation intentionally worse to shield Democrats from increasingly ineffective accusations of liberalism, or to pick up Republican support that, in this environment, is never coming.

Pareene runs aground on solutions. Finding two hundred George Soros types to combat Koch Brothers dough will not happen when the idea of universal health care is discredited for a generation.

A history of opposition to the federal government: A Necessary Evil

To delineate his principles takes Garry Wills three hundred pages, using James Madison’s famous adage (“If men were angels, no government would be necessary”) as springboard:

But if men were angels, they would need no sexual partners, no education, no cooperation to feed and raise families. An angel (that fiction) has no body, no ignorant youth to be enlightened, no need for others. We do not conclude from this that sex and the family and education are evil in themselves. Being human is not an evil condition, but one needing completion from others, in love and companionship, in teaching and learning, in mutual support and correction — in all of which government has a part to play.

Why is it so difficult for Americans to admit this fact? One reason is that the semi-official philosophy of government we absorb, with various degrees of conscious articulation, is a vulgarized theory of John Locke’s social contract, which teaches that government is founded on a necessary loss of freedom, no on the enhancement of liberty. Another reason is that prudent watchfulness over governmental pretensions is imperative, and people fear that we will “let down our guard” if we grant that government is good in itself. To admit an essential goodness in government is not to say that everything governments do is good. but a simplistic conclusion is encouraged as the only safeguard against a surrender to despotism.

Published in 1999, A Necessary Evil squints through the smoke of William Jefferson Clinton’s impeachment, the Oklahoma City bombing, the Contract For America, Newt Gingrich, and talk show hosts. It’s a rearguard effort that looks simultaneously quaint and prescient, Wills’ own The Paranoid Style in American Politics but comprised of chapters discrete enough to publish in, say, The New York Review of Books without context.

Madison the constitutionalist, Wills argues, was not Madison the congressman and aide de camp of Thomas Jefferson in which capacity he wrote the astonishing Virginia Resolutions, the ur-text for Southern secession three score years later; rather, Madison recognized the void at the center of small-f-federalism, which was the palliative effect of a strong central authority cooling the passions of the states. A line from Abraham Lincoln’s first inaugural speech is also instructive: no constitution provides for its own destruction. Around the banal conclusion that politicians out of power say stupid things Wills rallies quotes from President Jefferson reeling from the disaster known as the Embargo Act, the enforcement of which made John Adams’ Alien and Sedition acts look like traffic ticket collection:

If all these people are convicted there will be too many to be punished with death. My hope is that they will send me full statements of every man’s case that the most guilty may be marked as examples, and the less suffer long imprisonment under reprieves from time to time.

Benjamin Franklin did not live long enough to direct his appraisal of Adams (“means well for his country, is always an honest man, often a wise one, but sometimes, and in some things, absolutely out of his senses”) at Jefferson.

Disquisitions on nullifiers, insurrectionists, seceders, and vigilantes constitute the bulk of Wills’ book, a lot of which readers have seen elsewhere but not synthesized so pithily. Opposition to Hamiltonian systems of credit and banking, he writes, inhibited the Confederacy’s establishment of sound legal tender, for example. That’ll show those secessionists. We dislike government so much that in the new systems we plant the seeds of their own demise.

Digging deeper into these tales of Obamacare woe

Yesterday I quarreled with an acquaintance who received a letter from Blue Cross Blue Shield rescinding her current policy but offering her the same at $200 more a month.

Awful, I said. Before I switched to the Blue Cross Blue Shield policies offered to Florida employees, I’d watched mine increase a hundred bucks a year in 2005 and 2006. Had she looked at comparable coverage on the Affordable Care Act exchanges?

She wasn’t able to get into the website but she did call the 800-number last Friday. A so-called “bronze” plan offered her a lot of things she said she didn’t need but was $150 cheaper than the original policy. This independent who voted for Barack Obama in 2008 but stayed home in 2012 was infuriated. Why couldn’t she keep her policy? She didn’t need any of these extra things!

Look at it like a leased car, I said. The dealer says that while it can no longer offer the same vehicle at the same price, it can offer a 2013 model with rear window defrosters, power steering, TV, and other gadgets…at half the cost of what you paid for your current vehicle. Not many people would insist, “I want my old car.” Besides, who’s to know that you won’t ever use these amenities? Maybe she’ll move to Illinois, where the defroster will save her on a winter morning.

This is the kind of problem I see with the ooh-awful stories I see on the teevee. Reporters don’t inspect their stories. Take this account by a woman named Deborah profiled on “NBC Nightly News,” a typical case:

We learn in this story that her insurer is cancelling her current plan, which costs $293 a month, because it doesn’t comply with the new law. They’ve offered her a new plan at $484 a month. That sounds like it sucks! But here are some things the story never tells us.

First, what exactly was her old plan? Deborah looks to be around 45. If she bought a plan on the individual market for $293 a month, I can guarantee you it barely deserved to be called insurance at all (I’ve bought insurance like this on the individual market). It probably had a deductible in the thousands of dollars and had substantial cost-sharing for any significant medical event. But the story doesn’t tell us what sort of insurance she has.

Paul Waldman entered her information on the California exchange. The results?

How does the $484 plan her current insurer is offering compare to the other ones she could get? Did she or the reporter go to the California exchange and try to figure that out? Apparently, they didn’t. But I did.

It took less than 60 seconds. Let’s assume that Deborah has a high enough income that she isn’t eligible for subsidies. I put in that I was 45 years old and got nine different choices for a Bronze plan, which in all likelihood most closely resembles what Deborah has now. The average monthly cost was $258, or $35 a month less than what Deborah’s paying now for her bare-bones plan. And that’s for a plan that, while it’s the least expensive option, almost certainly involves less cost-sharing that what Deborah has to deal with now. She can get a Silver plan, with more generous coverage, for $316, only $23 more than she’s paying now.

Living in Florida, whose legislature refused to accept the Medicaid expansion, sucks. If you’re below the poverty line in this state, well, get in line. But in California and Kentucky – to take the bluest of blue states and a dependably red one – their exchanges are about as complex to navigate as American Airlines’ reservations page.

Lou Reed: “It all started with the guitar.”

Bits from my favorite Lou Reed obits. Rob Sheffield reminds us of Reed’s prodigious guitar skills, not often heard solo:

It all started with the guitar. By the time he started the Velvets, Lou Reed was a master of every rock & roll rhythm — Bo Diddley and Chuck Berry, surf and doo-wop and rockabilly, James Brown breaks and Jimmy Reed shuffles — to the point where he could play any style of music and make it throb like rock & roll. So he could incorporate the avant-garde ideas of John Coltrane, La Monte Young, Albert Ayler, Ornette Coleman and others, just by absorbing them into his guitar.

Kudos for this sentence too: He followed up his infamous negativist statement, the 1975 noise-fest Metal Machine Music, with his warmest, friendiest, funniest record, Coney Island Baby, which began with the girl-group homage “Crazy Feeling,” the missing link between the Stylistics’ “Betcha By Golly Wow” and Madonna’s “Angel.”

What Lou Reed taught Ann Powers:

Reed’s songs are actually often quite pretty, his pop ear well-tuned by the ’50s rockabilly and doo-wop he loved as a Long Island teenybopper kid. But he would always show the sweat on the lips of the beauty queens and muscle boys he sang about. The fact that those queens were often in drag, and the boys were paying the rent with their erotic encounters, is in some ways secondary. (In another way it’s central, since few other rockers fleshed out those characters, especially the queer ones, the way Reed did.) Reed was just as willing to explore conventional married life unsparingly, as he did on his turning-40 album The Blue Mask, the New Wave crossover hit New Sensations or his late-in-life albums about partnered bliss with his artistic soulmate Laurie Anderson. What matters most in Reed’s music is the commitment to what’s difficult, whether it’s expressed through distorted guitar, lyrics whose exposure of a self or a situation peels deeper with each verse, or the kind of melodic richness that doesn’t comfort but instead renders a song’s singer vividly vulnerable.

Carl Wilson sees Reed’s heirs on every corner:

With this weekend’s news it is as if a magnetic field has lost its pole, as if I’d just been told that there are no more foxes left in any forests. It’s just difficult to factor that the world is without a Lou Reed in it. But then I walked down my street to get a coffee and saw a young woman with a nose ring, peroxide-white hair, leather jacket, and scowl sauntering up the other side and thought, Oh, good, there he is. Thanks in particular to his six or seven most intense years of soul-breaking effort, for a long while to come there still will be Lou Reeds everywhere, needling strangers for no reason while looking ’round the corner for the viola player they need to help them change everything.

“The unintended story of the ACA will turn out to be the redistribution of money from poorer States, to richer ones, an outcome imposed by the poorer states, upon themselves”


Most states will also have increased spending if they expand Medicaid; for North Carolina, in 2016 Kaiser estimates that the state will have to spend $390 Million to leverage around $4 Billion in extra federal money, and reduce the ranks of the uninsured by around 375,000 persons (about 475,000 more would be covered by Medicaid). To put the foregone $4 Billion in context, North Carolina’s total Medicaid budget in fiscal year 2014 is around $14 Billion, and there is certainly no alternative proposal as impactful on the uninsured in my state at any cost.

States that are not expanding Medicaid have historically received more in federal spending per dollar of federal taxes paid by the state ($2.18) as compared to States that are expanding ($1.85) and those that are considering expansion ($1.53), all in 2009, a year with a very large federal deficit. In year 2000, the last year of a federal surplus, those states rejecting expansion received $1.36 in federal spending per tax dollar paid as compared to $1.10 for those undertaking expansion (the fence sitters were net donor states, $0.87). Similar patterns held in both 1994 and 2004 (other years shown in this table I put together using IRS & Kaiser sources Tax Flows Table.10.25.13_blog).

While the Medicaid program is not the only means through which richer states have cross subsidized poorer ones, it has been a large and consistent source of such flows. By choosing not to expand Medicaid, the poorer, mostly politically “red” states are redistributing money toward the richer, mostly politically “blue” ones (there are exceptions; red Kentucky is both expanding Medicaid and has one of the best functioning State exchanges). Further, those States that are expanding Medicaid have also tended to set up state-based insurance exchanges, which are currently operating much better than the federal one, meaning that income based subsidies associated with the purchase of private health insurance may flow less freely to poorer states, at least in the short term. And there is a court case that could stop the flow of such subsidies to states not operating their own exchange all together. I have not tried to estimate the magnitude of these sources of redistribution from poor to rich states under different scenarios because things are so fluid, but the Medicaid numbers outlined are potentially just the start.

The income inequality feared by economists and to which shameless Republicans allude on occasion gets exacerbated by states rejecting the Medicare dough. Note this line: “The unintended story of the ACA will turn out to be the redistribution of money from poorer States, to richer ones, an outcome imposed by the poorer states, upon themselves.”