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![[info]](http://l-stat.livejournal.com/img/syndicated.gif) dailykos | |
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http://rss.dailykos.com/~r/dailykos/index/~3/fh2vJpwo8yQ/-The-New-Compromise:-The-Good,-the-Bad,-and-the-Murky Details of what exactly in this bill are still rather unclear, though not as unclear as the final outcome. While the Medicare buy-in is getting accolades from progressives like Howard Dean, it's important to keep in mind that we don't know that's what we're even go to be getting (and just watch ConservaDem opposition line up to it, now that they know Howard Dean likes it). What looks like a relatively decent idea now could just be a ghost of it's former self by the time it becomes sausage. That said, what are the good and bad parts of what we know about this compromise, and what still needs to be answered? Number one on the good list: they're even talking about a Medicare expansion. It's a progressive policy that a lot of people wanted to start with (Medicare for All?), while also being a good common-sense move. It's an existing public option, and it has always made more sense to use it than to create a new one from whole cloth. Also on the good list: two proposals from Jay Rockefeller, "requiring insurers to spend at least 90 percent of premium money on medical care, rather than on administrative costs or profits," and "to reauthorize the Children’s Health Insurance Program, which was set to expire in Oct. 1, 2013." Additionally, the requirement that insurers would have to spend "at least 90 percent of premium money on medical care, rather than on administrative costs or profits" is an improvement over the 85 percent in the existing bill. Of course, there's not a particularly strong regulatory framework to force insurers to keep premiums affordable, so the result of this one might very well be premium increases (which are going to happen regardless, particularly if there is not a competing public option). What is not so good: People from 27-55 are still out of luck in terms of high quality, affordable insurance. In the base bill, the basic, lowest level qualified program in the exchange has a very low actuarial level, 60%, which is worse than 99% of employer-based plans. What that basically means is that patients will have to pay, between premiums and out of pocket costs, 40% on average of their supposedly covered costs. Lots of people, mandated to buy insurance, are going to be choosing this lowest level program because it will be the least expensive. There will be some basic preventive care included in the package, but in the event of a serious illness or injury, the people in this plan will still face huge bills. The House bill sets that lowest level at 70%. Compounding that, according to "people familiar with the negotiations" Medicaid eligibility expansion has been dropped, apparently confirming what Rockefeller said yesterday. He had been attempting to raise the eligibility to 150% of poverty, but it remains at the level in the base bill, 133%. The House bill sets Medicaid eligibility at 150% of poverty. Additionally, those eligible for Medicare buy-in won't get subsidies for the first three years. The buy-in would be available in 2011 for people who will end up in the exchanges--those who cannot find affordable individual plans and don't have group coverage. Subsidies won't be available to them until the exchange kicks in in 2014. Meaning, it's going to be expensive. And as Howard Dean told Greg Sargent, "That’s a huge problem that may tip this into being not real reform." Affordability, one of the keys to this whole conundrum in the first place, hasn't yet been adequately solved. Until it is, the mandate should also be triggered. And there are all of the questions that remain unanswered until the actual bill comes back from the CBO and we actually see it. Over at TNR, Jon Cohn has a pretty comprehensive list of ten questions that need to be answered before we know if this deal is worth trading a strong public option for. 1. Would funds from the younger people on Medicare mix with the funds from the traditional, over-65 population? This is a critical design question that will impact everything from the premiums people pay to the long-term finances of the Medicare Trust Fund. Previous proposals have tended to segregate the two pools, so that the Medicare Trust Fund would not be affected. And that may well be politically necessary now: Already, Joe Lieberman has released a statement saying he'll consider this idea if, and only if, it doesn't adversely affect Medicare finances. Of course, if the government let all 55 year olds opt into the program, their premiums could actually help the Medicare Trust Fund, since they'd be--on average--healthier and younger than typical Medicare beneficiaries. But you can safely assume the same senators skeptical of expanding government programs will raise eyebrows about that. 2. Which older workers get to buy Medicare--and when? Starting in 2014, people over 55 buying insurance through the newly created exchanges--that is, people without access to group coverage or eligible for an existing government plan--could choose Medicare. But what happens before then? The plan is to make Medicare available to workers older than 55 starting in 2011--which is great, since this is an initiative the government can, and should, get up and running as fast as possible. But it's not clear yet whether, during those early years, only people that qualify as "high risk" because of pre-existing medical conditions would have the option available to them. If it's just a program for high-risk people--and if, as I expect, the new Medicare funds are treated separately--that'd turn the new program into a dumping ground for sick patients. In other words, it'd be an actuarial disaster. 3. Would the Medicare buy-in have some sort of risk adjustment? Even if the program is open to all people over 55 without access to group of government insurance, it could still attract disproportionately unhealthy people, driving up the program’s premiums--which, again, could make the program unaffordable and ultimately unsustainable. This is a common problem of systems with competing insurance plans, one the new exchanges would solve via "risk adjustment"--that is, taking money from plans attracting unusually healthy people, then giving it to plans attracting unusually sick ones. But will Medicare for older workers be part of this scheme? Or will it be excluded somehow? 4. Will there be subsidies or some other form of financial assistance before 2014? Once Medicare operates through the new insurance exchanges, people buying into it will be eligible for subsidies. But what happens before then? The premiums will likely be higher than many people can afford. The government could provide financial assistance in any number of ways--tax credits, charging higher premiums in subsequent years. Either way, though, it means asking somebody to pay a little more money, at some point. 5. Would the Medicare buy-in include supplemental benefits--or an option to buy them? The basic Medicare package (Parts A and B) covers most physician and hospital services. But it comes with reasonably high cost-sharing. Most senior citizens end up buying supplemental coverage to cover the cost-sharing, partially or fully. They also buy drug coverage through the new Medicare Part D. Would young workers on Medicare be able to purchase supplemental policies as well? If not, would there be some other enhancements of the Medicare benefit for them? 6. Would the Medicare buy-in pay Medicare rates? Yes, this is the exact same argument we had over the public option before. Don't think for a second we couldn't have it again. (The hospital lobby is already attacking the idea.) Senators could decide, instead, to have it negotiate rates with providers. And if it's negotiating rates, it will have to charge higher premiums. 7. Has somebody thought through the expansion and retooling of the Office of Personnel Management? OPM does a great job of managing policies for federal employees, but it’s a relatively small staff--and not necessarily equipped to manage a whole new series of plans, each with its own networks of doctors, hospitals, etc. If they’re going to take charge of this new national non-profit option, they’re going to need more bodies--and, perhaps, wider authority. 8. If there is a trigger mechanism, what conditions pull it? Level of premiums? Growth in premiums? The number of insurance options in a given area? 9. If there is a trigger mechanism, what kind of plan appears if the trigger gets pulled? Is it a real public plan? Or are we back to the watered down compromise versions? 10. How do you enforce the 90 percent rule? The idea here, which Rockefeller has been pushing for a while, is to require that all insurers show a "medical-loss ratio" of at least 90 percent--that is, to make sure they spend at least 90 cents of every dollar in premiums on actual patient care. The good plans do this already--the not-so-good ones, not so much. But the regulation is meaningless if you can't enforce it. And, lord knows, insurance companies know how to get around regulations. Again, we don't know if this deal is really a deal that will be survive. Lieberman is already whining about the trigger that is included. Providers--including hospitals, doctors, and insurers- and rural state senators, including Conrad and Dorgan, are raising hell about the buy-in, arguing that "Medicare’s lower reimbursement rates would shift costs to private payers and disadvantage hospitals in rural districts." Until some of these details are made clearer and these problems resolved, there is one thing that cannot happen. The House cannot agree to forego conference and allow this bill to be ping-ponged.
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![[info]](http://l-stat.livejournal.com/img/community.gif) customers_suck
![[info]](http://l-stat.livejournal.com/img/userinfo.gif) dozaloz | |
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This is a suck/wtf that was going on while I was having my lunch break at work a couple of weeks ago. One of the assistant managers had been dealing with a very stubborn customer who would not take 'no' for an answer and had come up to the staff canteen to get help from the store manager, who was also having her lunch break at the time. The AM was telling the SM what had been happening...and of course everyone in the staff room was listening in >w> I'll write it in script mode, but as it's second hand it obviously isn't word for word, especially the dialog between the member of staff and the customer because that's third hand (the member of staff told the AM who then told us).
SC: Stubborn Customer
MS: Member of Staff
AM: Assistant Manager
MS is restocking near the store Christmas tree, which is decorated with lots of shiney round baubles in the store's colours. SC walks up to MS and asks for her help.
SC: The decorations on your tree are beautiful, are they for sale?
MS: No, sorry, we don't sell Christmas decorations.
SC: But surely if you have them on display then you should have them for sale?
MS: Well, the ones on the tree are made specifically for the store as they are the store's colours. The tree is there purely for decoration, neither it nor anything on it are for sale.
SC: Right, well, I'd like to speak to your manager about that.
MS: *gets AM and updates her on the situation while bringing her over to SC*
SC: Are you a manager?
AM: I am, and I understand that you're interested in the decorations on the tree. I know they're lovely, but unfortunately we don't sell them in the store as they're a company design and only there to add a bit of festive cheer to the place. There are probably similar ones in <insert store names here> though :)
SC: Well it's the colours that I really like as they would look perfect in my living room, and if they're the store colours then they probably won't sell them anywhere else. How much would you be willing to sell them for?
AM: ...sorry?
SC: I want to buy the baubles, just name the price. I can pay by cash if it makes it easier.
AM: I'm sorry, but they're not for sale
SC: Why not?! Can't I just give you some money for them? How about if I order them from the supplier?
AM: They aren't store merchandise so we can't sell them to customers. There's no way to log them on our system because they don't have a bar code, and we only get however many we're given so we can't order them for customers. <insert stuff about store policy etc etc>
SC: Well that's got to be false advertising. You have them on display, therefore they must be for sale. I'm offering to pay for them so I don't see what the problem is, or do you not want to make a profit? I want to speak to the store manager NOW, this is absolutely ridiculous.
AM: The store manager is on her lunch break at the moment, but even if I did get her she would tell you the same thing. The baubles are not for sale, they are there only for decorative purposes and no-where do we advertise them as being for sale. I'm sorry, but there's nothing we can do.
Apparently at this point the customer starts kicking and screaming like a spoilt child and causing a huge fuss. She demands that she be sold the baubles, going on about false advertising and consumer rights, and will not leave the store until she has seen the store manager. The AM agrees to get the SM and comes up to the staff room to explain the situation. We all listen, amused and slightly bewildered, and the SM agrees to go down and see the customer.
About 15 minutes later, the SM comes back up looking frustrated and we ask her what happened. Apparently, the customer refused to leave the store and kept offering money for the baubles but wouldn't take no for an answer, and eventually they had to threaten to call security because she was causing such a fuss xD;
What I really didn't get was why she was so desperate to have those baubles...I mean, the baubles are nice, but not that nice, and you could probably get similar ones anywhere...really nothing to cause such a fuss over e_e
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dailykos | |
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http://rss.dailykos.com/~r/dailykos/index/~3/f4wbLrUvBJw/-Measure-Dignity,-Not-Growth With the market up and the recession over for nearly a quarter, it sometimes seems that what we call the economy is impossibly detached from the lives of the people who live and work in that economy. It is. Not only has the Chicago School Economics that's dominated the last three decades presented a deliberately simplified view of the world that has helped Republicans to love capitalism to death, we've learned to measure our progress by abstract values that have almost no impact on anyone. That's how America can have two decades of "steady growth" during which the average worker's salary lost ground against inflation, health care costs (and worker's share of that cost) skyrocketed, pension benefits went the way of the dinosaur, and the disparity between rich and middle class grew into a ever-broader gulf. On the other hand, Japan "suffered" through a scary, scary "lost decade" in which unemployment, wages, pension benefits, and health care either held steady or improved. The question becomes, by measuring GDP are we measuring anything of worth? Are we measuring something that accurately reflects the economy? A growing number of economists think we need to change. Instead of measuring consumption as the mark of a strong economy, why not measure the quantity and quality of employment? The recession has brought output down to 2006 levels in most rich countries. That’s not good, but... Only a culture obsessed with always having more stuff and services could be seriously troubled by so modest a decline. ... Unemployment is a much greater evil. Human dignity is lost when workers who want jobs cannot find them. Chronic unemployment is also bad for future economic growth, as idle workers lose skills and motivation. In comparison, a few days less holiday or few more months delay before buying a new car look trivial. The biggest problem facing the United States may be that the people trying to solve the problems are those who have bought deeply into the ideas that brought on the problems. If we don't shake free of our obsession with a kind of market purity, that business is always the right solution, that deregulation is always a net positive, and that increased consumption is always good, we have problems too big to be measured by any statistic. Obama’s economics team is made up almost entirely of professional insiders. Such choices make it easy for critics to say the administration has borrowed a narrow economic worldview from Wall Street. And the established figures are likely to close the door on the next John Maynard Keynes, who was a professor but pretty much an outsider when he came to prominence in the 1930s.
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cooking
brunkva | |
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Hi!
I often come into this community and with pleasure look through recipes. I want to offer the recipe of my favourite soup. It is very tasty soup! The Surprising combination of a gentle pumpkin and sharp roll with cheese.
I hope, it will be pleasant to you.
(I beg your pardon for my not very good English.)
For soup:
900 g - a pumpkin, 1 large bulb, Cream - 150-200 ml, salt, black ground pepper, lemon juice - 1 soup spoon, soya sauce - 1 soup spoon, grated thin skin of a lemon - 1 soup spoon , a parsley for an ornament.
From a pumpkin and onions remove a peel. Vegetables cut on the most parts, put in saucepan, fill in with water and cook to softness.
Of a ready pumpkin make mashed potatoes. The onions can be thrown out, it is not necessary to us any more. Mashed potatoes shift back in a pan, to add 1 small cup of our broth, cream, pepper, add grated thin skin of a lemon, juice of lemon, soya sauce, salt (if necessary). Soup strongly heat up, but do not lead up to boiling. Voilà, all is ready!
Fill plates with soup, decorate with rolls with cheese, leaves of parsley and strew a paprika pinch.
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For roll:
1 Unleavened wheat cake (here such http://i034.radikal.ru/0805/26/50c2e353160a.jpg) (or tortilla), 150 g grated cheese, sharp red pepper, parsley bunch (finely cut).
Unleavened wheat cake strew grated cheese. Generously, but moderately strew sharp red pepper, strew a parsley. To make a dense roll. The roll wrap up in a foil. To bake in a hot oven of 15 minutes. Cut the ready roll and add in soup.
Enjoy! :) Tags: type: soup
where?: Russian Federation, Москва
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cooking
firehorse | |
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I finally feel like I've mastered yogurt. I've got a culture I like and get a consistent batch every time. Now I'd like to start adding flavor, especially vanilla and lemon. My question is when do I add it-during the heating-the-milk phase, after I've stirred the culture in, or after it's yogurt? If it makes a difference, I've got vanilla extract, vanilla bean goo and empty vanilla beans (currently flavoring raw sugar for cookies, but I could sacrifice one for the cause). Also, any ideas on what I should use for lemon flavoring? Lemon juice would just curdle it and any lemon flavoring I've tried is fake tasting, like lemon Pledge. I'm open to suggestions, even if it starts with 'zest X lemons...'.
On a related note, can I make sour cream the same way-use a culture and cream and let nature take its course? I googled and got both 'no, it's all pasteurized' and 'yes, but it's difficult', but no instructions.
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