Thursday, July 30, 2009

Tell Me About Yur Mozzer. . .

Dear reader, there has been an outrage in the psychiatric community. I read about it in an obscure regional journal called the New York Times, and since likely none of you have heard of this journal, I thought I should fill you in. Apparently, a Dr. James Heilman from Moose Jaw, Canada has destroyed the Rorschach test. Of course, in his defense, what else are you going to do in Moose Jaw during the summer. . . without hockey.

The Rorschach test was created by Swiss psychologist Hermann Rorschach after he wrote his 1921 book “Pyschodiagnostik” -- a real page turner. Rorschach died a year after writing the book, when he misinterpreted some signs that warned of approaching danger.

For those of you who don’t know, the Rorschach test involves showing a series of ink blots to crazy people and using what they claim to see in the ink blots to determine their inner motivations. If you see your mom, you have mommy issues. If you see your dad, you have daddy issues. If you see your sister, you live in West Virginia. To put this in technical terms, a “real” doctor would tell you: “the underlying assumption is that an individual will class external stimuli based on person-specific perceptual sets, including needs, base motive, and conflicts, and it’s covered by insurance.”

Many skeptics consider the Rorschach test to be pseudoscience and they suggest that it is akin to cold reading.

[Which reminds me, we want to send a shout out to a certain reader who has an "a", an "s", or an "e" somewhere in their name, who works in a thankless but important profession, and works harder than everyone else in their office, but who doesn't get the recognition they deserve. . . you're our favorite reader. . . but let's keep that between us -- we wouldn't want the others to get jealous. ;-)]

So let’s get back to Dr. Heilman. Several months ago, Dr. Heilman, an emergency room physician, infuriated the psychological community when he posted all 10 original Rorschach plates, along with some common responses to each image, onto the Wikipedia (a division of Wikimedia, a wholly-owned subsidiary of The Intelligence Suppression Group, Inc.).

According to Gottfried Nussjob, of the Psychological Analysis Normalization Integration Center (PANIC), a trade group, posting these images on the Wikipedia is the equivalent to posting an answer sheet to next year’s SAT, something recently suggested by Joe Biden to raise student performance. Nussjob, thinks this is bad.

Dr. James Heilman
-- Worse than Hilter?


Nussjob initially stated, “The more test materials are promulgated widely, the more possibility there is to game it.” But he then backtracked, when he realized this implied that psychologists could not see through obviously fake answers. He thus stated, “forget I said that.” His attorney later wrote, “The process of making sense of one’s experience is gratifying. To take Rorschach’s test is to make sense of ambiguity in the context of someone who is interested in how you do that. It is dangerous to use these materials without proper guidance. . . like using a Ouija Board alone on Halloween.”

Dr. Heilman responded that posting these plates was no worse than posting the Snellen eye chart: “Yeah, eh. You can go to the car people and you could recount the chart from memory, sure, and you could get into an accident. . . what was your point again?”

Well the point is that we at Commentarama are all about helping our readers cheat on tests. So with that in mind, we’ve taken the liberty of reproducing the offending images below and providing you with a few, good safe answers which will help you fool any court-ordered psychologist.

Let us begin. Take a look at each image and then memorize our explanation below. . .


Bad Answer: Bat, Butterfly, Moth

Good Answer: This test throws you a real curve ball right out of the gate. They want you to answer Bat, Butterfly or Moth -- all caught with nets. See the problem? In reality, this image is an electromagnetic depiction of the human soul, after being crushed by a bus. Tell the reviewer, “I see dead souls.”


Bad Answer: Two Humans

Good Answer: Humans? Like, two hairdressers playing patticakes? Not likely. This image in fact represents three distinct personalities, buried deep within one mind, desperately struggling not to surrender to their urge to kill again. Just repeat that to the reviewer.


Bad Answer: Two Humans

Good Answer: Do you see two waiters with both male and female genitalia? Really? Seriously? Wow. . . how’s that whole crossdressing thing working out for ya? Listen, whatever you do, don’t mention genitalia and don't mention the waiters. Do you remember those silver, perpetual motion birds, with the top hats -- the ones you tip over and they would bob up and down, pecking the ground over and over? That’s what this is. . . just two silver peckers.


Bad Answer: Animal Skin, Massive Animal

Good Answer: This image shows the despondence of being unable to reconcile the relationship you had with your mother with the need to develop a fully mature super ego. . . or it’s a troll riding a motorbike, either answer is acceptable.


Bad Answer: Bat, Butterfly, Moth

Good Answer: This one probably is a bat or a butterfly, but if you tell them that, they will write: “patient lacks imagination, possibly bed wetter.” The better answer, according to the Psych Manual, is to tell them you see your mother. . . in a wig. . . holding a beer.


Bad Answer: Animal Hide, Rug

Good Answer: Don’t fall for this one either, there are no animals hiding here. This is a flattened violin. Your best answer, “It’s the day the music died.”


Bad Answer: Human Heads, Faces (or was that ‘feces’? I’m too lazy to check.)

Good Answer: Some will tell you that this is two dancing American Indians who have bumped buttockses. And you can probably see that, can’t you, you sick pervert! What it really is. . . actually, it does kind of look like that. Ok, run with it.


Bad Answer: Pink Animal

Good Answer: Just tell ‘em its pink. . . only pink. . . and that makes you kind of angry.


Bad Answer: Orange Human

Good Answer: Orange Human? Like orange beef? Don’t tell them that. . . that road leads to thorazine city. This is two dragons, riding on hippos, crushing a herd of pigs.


Bad Answer: Blue Crab, Red Lobster, Spider

Good Answer: Blue crabs? Red Lobsters? Yellow stars? Forget the lucky charms. This is two gay British cops in Paris, near the Eiffel Tower, and they have crabs.


There you go. Follow our plan and they are sure to declare you unbelievably sane. Just remember don’t let them make you change your answers. . . it’s what they want you to do.


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Wednesday, July 29, 2009

RTRP: CommentaramaCare Part III, The Coverage Plan

Today we finish the CommentaramaCare proposal. In this article, I will outline how the coverage system should be reformed to reduce health care costs, to save the government a fortune, and to improve coverage. In a second article, to be posted later today, I will summarize the entire CommentaramaCare proposal and outline its costs and cost savings.

The Coverage Plan

CommentaramaCare proposes making health insurance more like car insurance or home owners insurance, where individuals make routine payments out of their own pockets and then use the insurance only as a form of quasi-catastrophic protection. This quasi-catastrophic coverage would kick in after a person has spent $5,000 on health care during the year, and would cover all remaining health care costs that person experiences during that year.

Such a plan should:
• Reduce the cost of medical care by encouraging buyers of health care (patients) and sellers of health care (doctors) to deal directly with each other rather than through a middle man for most issues;

• Reduce the cost of insurance to the average person;

• Break the link between employment and insurance;

• Cover everyone regardless of pre-existing conditions;

• Dramatically cut what the government pays to provide health care to those on public programs (i.e. Medicare, etc.); and

• Allow the government to increase coverage to eliminate the uninsured problem.

Before we dig into the specifics, let us be clear. This proposal does NOT:
• Ban any form of private insurance -- you can continue to buy any type of insurance you want;

• Impose fines to force people to change their insurance plans; or

• Advocate that the government issue insurance -- not one penny is paid to the government by anyone under this plan.

Here are the details:

The Problem With The Current Scheme -- Runaway Costs

There are two broad complaints with the current system: (1) medical costs are out of control and (2) not everyone has coverage. Let's start with costs.

We have previously outlined several significant cost reduction measures, but we have not yet addressed the primary cause of out-of-control costs. There is significant evidence that the current insurance system is the main reason that health care costs are skyrocketing. Indeed, as the following graph from John Stossel shows, there is a dramatic and clear relationship between the increase in medical costs over the past fifty years and the increasing percentage of medical costs that are paid for by insurance:


Notice that as the percentage of health care costs paid directly by patients has declined, the cost of health care has increased. As Stossel states:
This interesting chart from the Goldwater Institute illustrates one of the main reasons health care costs have been skyrocketing: Americans have been paying less and less out of their own pocket. It's basic economics that the less you have to pay for something, the more of it you'll use. And yet the “reformers” keep pushing for MORE health insurance.
And this makes intuitive sense.

In a normal market, sellers want to charge as much as possible. But that instinct is held in check by the need to attract buyers, who want to pay as little as possible. When millions of willing buyers and sellers haggle over price, the resulting consensus tends to set the price most efficiently.

But under our current system, buyers (patients) don’t deal directly with sellers (doctors). Instead, buyers pay a small flat fee, and leave it up to a third party (the insurer) to handle the negotiations and the payments. Thus, the laws of supply and demand don’t work properly. Indeed, what you have is called a “moral hazard,” because the patient wants as much care as possible and doesn’t care what it costs, because they don’t pay for it.

Moreover, patients have no incentive to keep the costs of treatment down: why find a cheaper lab to run your lab work, or why run the MRI without contrast, or why engage in preventative care when it doesn't cost you anything not to bother? And that is the problem. No other field accepts such a pricing model.

The Solution -- Make Health Insurance Like Car/Home Owners Insurance

So do we ban insurance? Absolutely not. Not only does CommentaramaCare firmly believe in letting people satisfy their own consumer choices, but insurance is necessary to prevent serious medical conditions from bankrupting people.

Instead, we need to remake health insurance along the lines of car insurance or home owners insurance, so that people again begin to care what their treatment costs.

Thus, CommentaramaCare proposes encouraging Americans to abandon their current insurance in favor of obtaining a quasi-catastrophic policy that kicks in once a person has spent $5,000 on health care during the year, and which would cover all expenses thereafter through the end of the year.

Such a plan would give people an incentive to keep their costs down to reduce the amount of the $5,000 that they pay. But at the same time, it would also ensure that no one would be bankrupted by a sudden, serious illness.

What Would This Cost The Average American?

Right now, the average American spends $7,500 per year on health care. As just mentioned, we are proposing a deductible level of $5,000. Ergo, if the cost of the insurance works out to less than $2,500 a year, there will be no net cost increase to the average person.

My sampling of catastrophic plans has found that most plans currently run between around $100 per month to $200 per month, i.e. $1,200 a year to $2,400. Therefore, even if we take the high end estimate, the average American would save $100 a year under this plan.

And keep in mind, this assumes that you have more than $5,000 in medical bills during the year. Anything less than that will result in direct savings to the individual. Thus, a person who has no medical bills at all during the year, would save $5,100 over the current average. Likewise, a person who was on a flat rate plan (like the one discussed in the last article) and who had only routine medical issues, would have yearly medical expenses of only $3,600 ($200/month insurance + $100/month flat rate plan). This is less than half of the current average cost.

Further, it is more than likely that the cost of such insurance will fall significantly when the rest of the reforms kick in. As you will see in the summation, the savings under this plan could be vast. Presumably, some portion of that would be reflected in a reduction in the cost of insurance.

How To Encourage People To Switch Over

Now, it is easy to say, “encourage people to rethink”, but how do you actually get people to switch over to the new system? To encourage (NOT FORCE) people to make this switch, CommentaramaCare proposes:
• Making the premiums on the catastrophic policy tax deductible to the individual (I would suggest treating them like an HSA);

• Making medical debts non-dischargeable in bankruptcy; and

• Making the first year deductible limit $10,000 rather than $5,000 to discourage people from waiting until they are sick to sign up for the insurance. (This would be implemented in the future, after the plan is established and people had the chance to switch over.)
Moreover, to encourage (NOT FORCE) people to give up their current plans, which are distorting the pricing mechanism in the current system, we also recommend eliminating the tax deductions for any coverage that exceeds the catastrophic coverage. This would not prevent individuals from obtaining coverage that is superior to the catastrophic coverage, it simply won’t be tax deductible.

How Such Policies Would Be Created

Now comes the tricky part. To make this plan work, such insurance must exist. In fact, three things must be guaranteed:
• That such catastrophic plans, which cover all expenses after the $5,000 deductible, will exist and will be generally available to anyone who wants such a plan;

• That persons with pre-existing conditions can obtain such coverage, and at reasonable rates; and

• That providers cannot terminate individuals who experience high medical costs.
This could be achieved by imposing such mandates on the insurance industry. However, CommentaramaCare opposes mandates because people should be free to buy whatever insurance they want, on whatever terms they wish. Imposing coverage requirements violates that principle. It also could be achieved with a government-run option, but CommentaramaCare opposes that for obvious reasons.

So we favor a third alternative. Under this method, the federal government, through the Health Care Administration (“HCA”), will procure such insurance and make it available for the public. Here’s how this would work:

The HCA will divide the United States into geographic districts. For each district, HCA will open a series of $0 contracts for competitive bidding. A $0 contact is one under which the government promises no money. Any insurer in the country could bid on any of these contracts, without regard to state licensing requirements (subject only to obtaining HCA certification).

These contracts will require any insurer who submits a bid to agree to cover a certain number of people (specified by the insurer) at a fixed price (specified by the insurer). The contracts will specify the precise coverage terms, which would include the requirements detailed above, plus whatever other coverage requirements are deemed necessary by the HCA administrator to effect the coverage plan.

By bidding, insurers agree to accept any person who signs up for the plan (up to the number of persons specified in the insurer's bid) at the fixed price, without regard to age or medical condition or any other factor (although family plans should be allowed).

HCA would then accept all conforming bids, and would publicly list these providers and their fixed prices. After that, any member of the public can contact these providers directly and sign up at the fixed price bid by the insurer until that plan is full.

Here are the benefits of this plan:
• This method ensures that anyone can get access to such insurance, regardless of employment status or pre-existing condition;

• This method reduces insurance costs through the use of competitive bidding and large scale pooling;

• No money is given to the government under this plan; and

Private insurance will continue to exist. Indeed, not only does this plan rely on private insurers, but it leaves private insurers free to offer superior or inferior (and presumably cheaper) coverage as they see fit. If you want more coverage than the minimum, you can buy it. If you want less coverage than the minimum (e.g. a $10,000 deductible or a plan with co-pays or limited coverage), you can buy that too. You can even continue under your current plan and ignore the new system entirely. And since there is no government-subsidized insurance to compete with, the government will not crowd out private insurers.

(** The government currently does something similar for its own employees.)

Saving The Government A Fortune AND Expanding Coverage

This biggest surprise in this program comes in the remake of government insurance, i.e. Medicare/Medicaid/Tricare, etc. CommentaramaCare proposes eliminating these programs entirely and replacing them with one program to be run by the HCA. This can save the Government a fortune, if done right. . .

Rather than trying to develop a separate insurance plan for these recipients, as is currently done with Medicare/Medicaid, etc., the HCA should use the money that would have been spent on such insurance to instead (1) buy these recipients commercial catastrophic insurance, as just discussed, and (2) provide some level of subsidy for the $5,000 deductible (depending on income-level, age, military status, etc.).

Consider this. . . if the cost of the new catastrophic insurance remains around $2,400 annually, and (for the sake of argument) the government chooses to pay the full $5,000 deductible for each of these recipients, and they all use the full $5,000 deductible, it would cost the government $7,400 per recipient to pay all of their medical expenses during that year. The government currently spends $11,093 per Medicare/Medicaid recipient. Thus, by switching to this plan, the government could save $3,700 per recipient. With 81 million recipients, that means a total saving of $299.7 billion dollars -- and this is an annual figure, not a fake 10 year projection.

Moreover, still assuming the projected cost of $7,400 per person, this means that the government could ADD another 40.5 million people to this program without spending a penny more than is currently spent. Since only 7.3 million Americans truly can’t afford insurance, this allows the government to extend coverage to those persons and still generate cost savings of $245.7 billion per year!
(** This assumes full 100% subsidies and full use of the program -- thus, the savings figure likely will be higher. It also does not include any cost savings from eliminating vast amounts of bureaucracy at the state and federal level.)
Finally, to make the deductible subsidy work, HCA would pay the insurers directly on behalf of those receiving subsidized policies, and HCA would issue a health insurance credit card directly to the covered individuals. Those cards would allow the holders to acquire only health care products and services (using product codes). And depending on the level of income subsidy desired, each card could contain any amount up to $5,000.

Illegal Aliens

Lastly, on the issue of illegal aliens, it is clear that these costs should not be borne by the states or by individual providers, as only the federal government has the power to stem the flow of illegal immigration and to deal with foreign governments. Thus, CommentaramaCare proposes (1) that the federal government fully reimburse providers for the costs of providing such care, and (2) that the federal government seek to charge the home countries of these aliens for the costs they have incurred.

CONCLUSION

Without forcing anyone to participate, without raising taxes, and without endangering anyone’s current plan or private insurance, this plan should reduce the cost of medical care within the country, reduce the cost of insurance to individuals, reduce the cost of providing care to persons on government assistance, and ensure that everyone in the country who wants coverage can get it at reasonable rates.

For further analysis, particularly related to costs, see the next post. . .

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Monday, July 27, 2009

How Conservative Are Americans Really?

As a sea of blue ballots swept the Republicans from the Congress and the White House, many on the left (and the RINOs on the near left), rushed out to declare the end of conservative America. The era of Reagan was dead. The country had moved left. It was time to consider a new way.

But have Americans really moved left? No, they didn't. Let’s look at some recent polling data. . .

The Democratic Party Is Crashing

Despite the Democrats total control of the Congress and the White House, the American public is very unhappy with the course the Democrats have charted. Indeed, only 30% of Americans think we are headed in the right direction -- a number that should be much higher if the public had shifted left.

And this reflects in people’s opinions about the parties. A full 54% of Americans now say the average Congressional Democrat is too liberal (only 36% believe the average Republican is too conservative). Consequently, for four weeks now, the Republicans have led the Democrats in the generic Congressional ballot (42% to 38%). This lead is similar to 1994, when the Republicans captured the Congress for the first time since dinosaurs roamed the Earth.

Moreover, Americans now trust Republicans more than Democrats on eight of ten key electoral issues:

(click on chart to enlarge)


Obama Is Crashing Too

Obama too has lost steam. He is now seen as liberal by 76% of Americans, with 48% describing him as "very liberal." This is not good news for Obama as only 20% of Americans view the description "liberal"” as a positive.

This fact reflects in his approval rating, which has fallen to 49% for the first time. And this is after his 55% June approval rating made him the tenth least-liked President of the last twelve at that point in his presidency. He beat out only Clinton and Gerald Ford.

Further, a majority (53%) of Americans now think that it is somewhat likely that the next President will be a Republican. In fact, while Obama beat McCain by a comfortable margin (53% to 46%), Obama only ties Mitt Romney in the latest poll (45% to 45%) and he only beats Sarah Palin (48% to 42%). This is hardly a recipe for success.

Americans Remain Deeply Conservative

But opinions about politicians are one thing, how do Americans feel about the issues? The answer is that they are remarkably conservative. Let’s take a closer look at the data.

Below is a chart, in which I’ve listed various issues and plotted how the public (as well as Republicans, Democrats, and the Unaffiliated) line up on those issues. Note that the further to the right each data point rests, the more conservative that group was in its response, and vice versa. Anything above 50% should be considered a conservative response, anything below should be considered liberal.

The results are quite interesting. Take a look and then we’ll talk. . .

(Click to Enlarge)


** All data from Rasmussen and/or Gallop
** Questions rephrased for brevity and clarity


Consider this. . .
• The public as a whole only dips below the 50% demarcation line once. This indicates a generally conservative public.

• Unaffiliated voters only drop below the 50% demarcation line once. Moreover, they respond more often above 60% than they do below 60%, thus indicating a very conservative group.

• Republicans consistently responded between 65% and 90%, again indicating a very conservative group.

• Democrats are the outliers. They fall significantly lower than any other group on each data point, although they often respond above the 50% demarcation line as well.

So what does this tell us? It tells us that America remains a conservative country. It tells us that the electoral failures of the last two elections were not the result of a shift to the left by the public, but by a failure of the Republican party to connect with voters.

It also tells us that shifting to the left is the wrong idea. Indeed, between 60% and 70% of non-Democrats favor the conservative view on virtually every issue. Thus, there is little to be gained and much to be lost by a shift to the left.

The first chart further tells us that the areas in which the Republicans must improve their connection with the electorate are (1) health care, (2) education, and (3) government ethics. (Might we suggest CommentaramaCare? We will also discuss education reform and ethics reforms in the future.)

Finally, this tells us that the Democratic agenda will remain deeply unpopular, as is being borne out now in Obama’s poll numbers and in those of the Democratic Congress.

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Sunday, July 26, 2009

я люблю тебя

Love is in the air dear reader, and online. Just this very morning, I was contacted by a lovely young woman, who sounds (if I may say so) quite interested in me. Hubba hubba. Now admittedly, I haven’t had the chance to read the whole e-mail, as it’s been a busy morning. But I have time now, so join me as I learn more about the woman of my dreams!

Her name is Oksana. . . or it could be Svetlana (but I think that’s just a typo), and she lives in Georgia (possibly near Atlanta?). She got my e-mail from someplace called “Soul Mate Service -- Agency of the International Acquaintances.” That sounds pretty impressive, kind of Austin Powersy. I wonder how they got my name?

Anyhoo, she continues:

At Soul Mate to me has told that you looking for serious women to relationship.” And indeed I am, I’m done with relationshiping clowns. . . and jugglers.

I hope you still in search of serious relationships with women.” Um. . . I don’t quite know how to take that. Is she hoping that I’m not gay or is she hoping that I’m lonely? Hmmm.

As I am microbiologist by profession, I am fond of nature.” Makes sense.

I like travel in nature best of all.” A nudist! I guess that makes her French? As an aside, I’m down with nudism, though I’m not sure where you keep your car keys?

Im kind, caring, calm, honest, cheerful, understanding, responsive and charming lady. I like dancing, traveling, nature, cooking, sport and people. I can be firm or tender depending on the situation, but I always stay woman.” Now that’s good to know. Although, it is a little troubling that she felt the need to assure me on this point. . . I wonder if there is something I should know?

I want to make my live bright and saturated, I dont like being boring and doing nothing. So, you can be sure, you will never boring with me.” I don’t know, I’ve bored house plants.

Im very sociable and cant imagine my life without communication with people.” Yes, that would be difficult, though hermits seem to pull it off.

I enjoy watching moves with my friends.” Me to, nothing beats watching movers do their thing.

In winter time I love scatting.” Whoa! Now this bothers me! This could be a deal breaker.

On the whole, I am very romantic and tender, kind, jolly and well-bread person.” Well-breaded? Tender? I guess that’s better than gamey, but not by much, especially considering the whole scatting thing. And I wonder what “on the whole” means? Is this perhaps code for “experiences brief moments of homicidal rage, followed by intermittent scatting”?

I am communicable and goal-oriented.” So is a virus.

I think that all life of a woman is LOVE and at first a man should love a woman and then understand.” *scratches head*

Now some words about mine search. I looking for serious relationships here.” More than one? Call me a jerk, but I’m starting to doubt this is going to work out.

I want man to find for making strong and happy family in the future. I know that it is difficult to find future love by so way.” Sure is, but it’s easier than trying to find past love -- which requires a time machine.

I am looking my second half, man who wants to create his own family.” Half of you is a man? Which half?

I am looking man who is caring and cheerful.” Sure, whatever.

He is optimistic.” Good luck finding that.

He has big heart.” What?! You want someone with an enlarged heart? Well fine, if we’re going to play that game, then I want a woman with a big, floppy liver and a hump.

He is self sure. He should trust me completely.” Strangely, I’m finding that rather difficult at the moment.

He must become the most intimate and important man in my life, and respect and understand me. I want him to have his own opinion about everything!” Maybe this e-mail was meant for Lawhawk?

I wish see your country.” Since when is Georgia in another country? Texas maybe, but not Georgia.

We should communicate much and long time what to come to it. Not so?” Wait a minute, are we talking haggling or negotiations? This is sounding worse and worse by the minute.

I hope that you will also be write about yourself and city where you live and sent photos.” You know what, I don’t think so.

Sorry dear reader for wasting your time. Please disregard this entire post.

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Thursday, July 23, 2009

Lindsey Graham: “[Only Some] Elections Have Consequences”

Let us be blunt. Sonia Sotomayor should never sit on the Supreme Court. Even without the hints of bigotry, she lacks the judgment, understanding and skill needed to make her a competent jurist, and she certainly does not display the kind of outstanding legal mind that should be elevated to the Supreme Court. She is, at best, a poser, and, at worst, an inconsistent tyrant.

Yet, she will be confirmed, and that’s fine. Everybody loves a fool, and history will simply add her to the growing list of albatrosses hanging around the well-feathered neck of Obama’s legacy.

But this post is not about Sonia Sotomayor. This post is about Lindsey Graham (RINO, SC) and those like him in either party.

Graham announced yesterday that he will support nominee Sotomayor because, as he put it, “elections have consequences.” But that is not a valid basis for supporting a President’s nominee. Indeed, the Constitution does not envision the Senate as a rubber stamp for a President’s appointments. Instead, the Senate is called upon to provide “advice and consent” on appointments, not to approve them without complaint.

If a nominee is inadequate, it is the duty of every Senator so finding to stand up in opposition to that nominee, and to demand that the President nominate someone else, someone the Senator can support. That’s called checks and balances. That’s how our government works. To surrender this role on the basis that the President has won an election is to abdicate one of the primary constitutional functions of a United States Senator.

Remember, Senator, the oath of office for Senators requires Senators to pledge to support and defend the Constitution and to faithfully discharge the duties entrusted to the office:
I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter: So help me God.
Nothing in there says, “unless the other guy won an election.”

Nor can Graham's submissive desires be attributed to some political courtesy extended by one party to another. Indeed, the Democrats extended no such courtesies when they smeared Robert Bork, Douglas Ginsberg or Clarence Thomas, or when they prevented John Tower from becoming Reagan’s Secretary of Defense (an historical first), in a party-line vote, because of suggestions of “womanizing” and “alcoholism.”

And speaking of elections, might one wonder why Senator Graham only recognizes the consequences of the election of the President? Was the Senator himself not elected to represent the people of South Carolina? How does declaring an intent to ignore that mandate in favor of rubber stamping a President recent-elect satisfy that election? Or do only some elections have consequences?

Now admittedly, Graham also stated that he felt that Sotomayor was well-qualified. And if that had been his sole reasoning, one could quibble with his conclusion but not challenge the good faith basis of his decision. But he had to add that extra piece. . . his abdication of his role. . . his declaration of submission, and that is the problem.

It absolutely pains me to say this, Senator Graham, but look at Robert Byrd. Agree with his politics or not, Byrd fully understands his role as a check on the power of the Executive.

And let me not limit this criticism merely to the submissive Senator Graham. This criticism should be extended to every member of Congress or the Senate, in either party, who fails to represent the people they have been elected to represent, and who fails to faithfully discharge the duties of their office.

Representative democracy only works when the representatives represent. It does not work, when they decide to make up their own rules.

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Wednesday, July 22, 2009

RTRP: CommentaramaCare Part II, Reforming The Medical Profession

PelosiCare is dead. . . for the moment. But CommentaramaCare lives on! In the first part of our proposal, we took on tort reform. Today, we reform the medical profession itself.

The medical profession needs to be reformed (1) to improve oversight and ensure quality control, (2) to decrease the number of preventable medical injuries, (3) to decrease the number of medically unnecessary tests/procedures, and (4) to reduce costs.

To a degree each of these goals is related. As noted before, the primary factor in causing health care costs to skyrocket is over-treatment. The primary cause of over-treatment is lack of knowledge of the standards of care. Lack of knowledge of the standards of care also contributes significantly to the large number of preventable medical injuries. Improving oversight over the profession can lead to improved compliance with the standard of care and can reduce the number of preventable medical injuries.

Thus. . .


Reform One: The Federal Medical Board

CommentaramaCare proposes federalizing the oversight/regulation of the entire health care profession (doctors, nurses, psychologists, therapists, hospitals, etc.) under a new Federal Medical Board.

Right now, the medical profession is regulated by individual states. To practice within a state, a provider must obtain a license from that state’s licensing board and then comply with whatever regulations/requirements that state imposes. This system suffers the following defects:
• This system makes it very difficult and expensive for providers to move between states. This disrupts the ability of suppliers (doctors) to satisfy demand (patients), limits the available treatment for “disfavored” or "medically under-served" regions, and prevents creative business structures that could expand patient options.

• State boards are under funded, lack the personnel to conduct effective investigations, and often lack the expertise to promulgate effective regulations or enforce them consistently.

• State boards are highly politicized. Indeed, statistically, doctor disciplinary rates vary from state to state far beyond what one would expected from a “fair” system.

Moreover, anecdotally, I have seen hospital administrators admit (under oath) to holding up the expansion plans of competing hospitals by filing unwarranted objections with state regulators. I have seen license applications delayed or denied to protect local interests from competition. And I have seen medical boards allow highly dangerous, but politically-connected doctors to continue practicing unsupervised, while simultaneously revoking/suspending the licenses of out-of-state providers for minor infractions.
Thus, state regulation should be replaced entirely by one, consistent federal regulatory scheme to be organized under a Federal Medical Board (“FMB”). The FMB will have three functions: (1) medical licensing, (2) establishing standards of care and best practice guidelines, and (3) regulating medical education:

1. Medical Licensing

The FMB will be charged with handling all aspects of medical licensing. To that end. . .
• The FMB will set up expert panels (one for each field of medicine: doctors, nurses, psychologists, etc.), who will establish standards for issuing medical licenses.

• A second set of expert panels will review license applications. If a candidate satisfies the requirements, that candidate will be granted the relevant license, allowing them to practice anywhere within the United States.

• A third set of panels will conduct disciplinary proceedings. This panel will have the power to investigate all complaints against providers, to conduct hearings, and to discipline providers as needed.

All disciplinary proceedings should remain confidential unless the provider is disciplined, in which event the details should be made public. To encourage full participation, all licensed providers will be obligated the report any violations of the standard of care (as previously discussed).

All panels will consist of five licensed professionals from the relevant profession, i.e. doctors, nurses, etc. (except for the disciplinary panel which also will include one expert from another medical profession and one layperson) -- no lawyers, no politicians. All panel members should serve three year staggered terms, appointed by the President and approved by the Senate, to reduce the ability of any one administration or Congress to influence the panels.

2. Standards of Care/Best Practices Guidelines

Standards of care represent the minimum level of care that physicians should provide to patients in a given situation. Several studies have shown that providers often do not know the appropriate standard of care. This is the primary cause of both under-treatment and over-treatment.

Right now medical standards are essentially set by juries after the fact. CommentaramaCare proposes using another set of expert panels, again within the FMB, to establish standards of care in advance for each aspect and speciality within the medical profession, e.g. nursing, GPs, cardiologists, OB/GYN, etc.

These panels would have the power to hear proposed standards, to investigate those proposed standards, and to establish those standards after public hearing, where a broad consensus exists within the specific field of medicine that the relevant standard of care represents the generally accepted method of treatment.

If no consensus exists, the panel should refrain from declaring a standard, though it may instead issue a best practices guide for educational purposes.

When a standard is issued, doctors may treat that standard as a legal safe harbor. In other words, if they comply with the standard, they will know they cannot be sued for failing to provide adequate care. Thus, for example, if the standard calls for doing an MRI, a patient could not sue the doctor for failing to order a dozen other tests that might also have found the problem, but which are not required by the standard.

However, it must be stressed that these standards represent only minimum levels of treatment and, as such, do not limit the types of treatment that can be provided. In other words, just because a standard exists, does not mean the doctor is prohibited from providing additional treatment. Thus, in the MRI example above, the doctor could order those dozen other tests if the doctor believed they were appropriate.

3. Education

Finally, the FMB would be responsible for the regulation of medical education. This encompasses two aspects:
• First, the FMB will be responsible for disseminating all standards and practice guides to providers. It will also implement and regulate continuing medical education and training.

• Secondly, the FMB will be responsible for certifying medical schools as offering acceptable programs for licensing candidates. It will also be charged with studying (1) whether the current system trains providers adequately, and (2) finding ways to lower the cost of medical education to students.


Reform Two: Alternative Business Structures

CommentaramaCare also proposes freeing providers to arrange their business and billing practices in more creative ways. Right now, doctors are often rigidly controlled by state regulation, which prevents them from offering new and innovate ways to provide better care at lower cost.

For example, last year, I discovered a local doctor who has done something innovative. He decided that he was wasting too much effort dealing with billing issues. His response was to calculate his monthly costs, estimate his number of patients, and offer a plan whereby he charges a flat monthly fee (well below $100) to anyone on the plan. Under the plan, the patient can see the doctor any number of times in that month, free of charge. Moreover, any procedures that can be conducted within the facility (e.g. cultures, blood tests, etc.) also are free of charge, as are certain generic medications (others are provided at cost).

This innovative plan has proven highly profitable to the doctor, has saved me a fortune, and could probably dramatically cut the costs of preventive and run-of-the-mill health care in the United States. But here’s the catch.

When this doctor first opened his doors, he was immediately shut down by the state because local insurers complained his flat monthly rate constituted insurance. He was even criminally charged twice for selling insurance without a license. When he finally beat those charges, other local doctors brought complaints against him with the state medical board, which took another year to resolve. Now he has a run-away success on his hands, but it took him two years and several hundred thousand dollars in legal fees to break through the hurdles put in his path. (His attempts to franchise the idea to other states have met similar resistance.)

By eliminating the state regulations that local interest groups use to tie up their competitors, CommentaramaCare hopes to free doctors to come up with innovative new ways to run their practices -- like flat rate plan or others not even considered at this point.


Reform Three: Open Pricing/Single Bill

Finally, to control health care costs, we need to allow the disciplines of supply and demand to function (more in next article). To achieve that, buyers must be made aware of the prices they will be charged. This requires two reforms:
• First, we must require open pricing. In other word, providers must make available to any patient or potential patient, in advance, a price list for all procedures that they offer, so that potential patients can compare providers and seek competition. Right now, patients don’t learn the cost of procedures until well after the procedure is finished (if ever).

• Secondly, we must end the virtual shell game of allowing multiple providers to bill separately for their involvement in the same procedure. If you have an operation right now, you will be billed separately by the doctors, the hospital, the radiologists, the anesthesiologists, etc. Requiring one joint bill per procedure, not only is necessary to allow patients to accurately assess the costs (a necessary ingredient for competition) but likely will also cause providers to look for lower cost suppliers/partners or to seek more competitive rates.


Conclusion

Taken together, these reforms should (1) improve the quality and consistency of oversight, (2) improve compliance with the standards of care, which should decrease the incidence of over-treatment and under-treatment, and reduce the numer of preventable medical injuries, and (3) reduce medical costs by allowing market discipline and innovation to restructure the doctor/patient relationship.


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Tuesday, July 21, 2009

Through The Legal Looking Glass: Six Annoyed Persons

The most critical moment in any case is when the jury is chosen. A good jury gives you a fair chance to win your case. A sympathetic jury, makes it all a little easier. An unsympathetic jury makes it a lot harder. A biased jury can kill you.

And how does one get a jury? Read on. . .

In the American system, most trials are decided by juries -- though bench trials (judge only trials) are becoming more common. All jury consist of twelve people. . . right? Actually, no. Despite what the movies have told you, civil cases are almost always decided by six jurors, who must return a unanimous verdict. Moreover, in 1970, the Supreme Court held that criminal cases also could be tried by six person juries, except death penalty cases.

The selection of jurors begins the day you first register with the state. By getting a drivers license or registering to vote (depending on state law), you put your name into a lottery, which can land you in the courtroom.

Every court term (there are usually four per year), the court randomly draws names from this lottery pool to serve as jurors during that term. If you are chosen, you will be notified to appear at the courthouse on a particular date and time. You will also be asked to fill out a juror questionnaire, which asks for information like: name, address, age, family status, prior jury service, occupation, religious beliefs, and disability.

As the trial approaches, the clerks will forward these questionnaires to the attorneys for each side. Over the next couple weeks, the attorneys pour over the questionnaires trying to figure out how these potential jurors might view the case. Would a librarian or a nun reacted better to an alleged mugger? Does a construction worker care more or less than an accountant about bad checks? Will that 21 year old brick layer, who wrote “I don’t want to f***ing be on a jury” on his questionnaire, have the right frame of mind to hear your corporate fraud suit? This other guy lives in the rich part of town, will he side with the business or the employee . . . here’s a clue, he's a union rep.

The attorneys also contact everyone they know to see if anyone knows these people. I had a potential juror once who looked great on paper for a plaintiff’s case, until I learned that he hangs out in bars telling people that he’ll “never give a penny” to anyone who brings a lawsuit.

The attorneys also prepare questions they intend to ask the potential jurors to determine whether or not the person should be allowed to serve on the jury. These questions are called voir dire, (pronounced: “vwa dēr”) and will be exchanged (and fought over) by the attorneys a few days before the trial.

When the day of the trial arrives, the people who filled out the questionnaires arrive at the courthouse. . . at least, most of them do. Usually around 30 are called, with 25 or so showing up. The clerks will gather these potential jurors and bring them to the right courtrooms.

Once in the courtroom, the judge calls individuals at random from the group until the jury box is full (usually between 18-24 people). The rest are typically dismissed at that time. So long my favorite juror. . .

Then the voir dire begins. Although some judges handle the voir dire themselves, it is usually left up to the attorneys. Each attorney starts by asking general questions to the jury panel, asking for a show of hands. For example, “do any of you know the defendant?” If a juror raises their hand, the attorney gets to follow up with further questions to that individual juror, to understand the details. Sometimes this is handled in the judge's chambers when the details are embarrassing. Otherwise, it's done in open court, and it can be quite conversational.

What you’re looking for is whether or not the juror may legally sit on the jury, e.g. convicted felons may not sit on juries and must be removed. You’re also trying to learn any prejudices the individual jurors might have. Thus, you ask about any relationships they have to the parties, or the attorneys, or the witnesses. You ask if they’ve ever sued or been sued. And you ask their views on specific issues related to the case: "You believe that anyone who gets arrested must be guilty? Tell me more."

As an attorney, it is your job to figure out that the overly-eager young woman who described herself only as a “housewife” on her questionnaire, is married to a doctor. . . a doctor who’s been sued, and that she sits on a committee that lobbies to change medical malpractice laws in the state. (true story)

When someone is disqualified (like our brick layer felon) or they have given reason to believe they cannot be impartial (like our housewife activist), you approach the judge and you ask that they be struck from the panel for cause. The felon has to be struck, by law, but the others. . . that's up to the judge, and judges don’t like striking jurors for cause.

Here’s why. As people are removed for cause, the panel gets smaller and smaller. If the numbers fall below a certain point, the panel is considered busted and a new jury panel must be called, which means the whole trial needs to be rescheduled. Not only is this chaos on people’s schedules, but speedy trial rules require that criminal trials begin by certain dates. Busting multiple panels can cause the state to violate that provision and can lead to the case being dismissed. Thus, judges struggle to keep jurors on the panel.

One of the tools judges use to keep jurors around is to “rehabilitate” the juror by asking them to state that their apparent prejudice won’t be a problem: “You’ve indicated that you have actively campaigned to stop medical malpractice suits. Despite this, do you think that you can decide the facts of this medical malpractice case fairly?” And the housewife nods her head, because she really wants onto this jury. But that’s good enough for the law, so she will make it to the next round. The union guy who claims he “hates rich doctors” won’t.

Once the voir dire is done, the final stage begins: peremptory challenges. In this phase, the attorneys get to toss people off the jury without providing any reason. (Though there is a caveat with regard to certain discrimination issues.)

How does this work? Each side is given a set number of strikes, which they will alternate using. The number of strikes varies, but is typically between 3-4 for regular jurors, and 1-2 for alternate jurors, who are chosen separately.

And how do you decide who to strike? That’s the question. By now, you’ve struggled to add up all the responses in your head, and you’ve begun to figure out who you want off the jury. And trust me, sometimes, these are very difficult choices. It is a strange feeling to leave the other party’s cousin on a jury because they seem more fair than the other people you need to throw off, but sometimes that's the best strategy. (FYI, being cousins or friends typically does not count as "cause".)

Once you’ve decided, you take a deep breath, hope that luck is on your side, and you put an “X” on the jury sheet next to the juror you want tossed off. And like that, they’re done. Housewife, you’re outta here lady. Impartial my asp.

You then hand the sheet to the bailiff, who hands it to the other side. They mark somebody they want struck, usually the one you most want on the jury, then the bailiff hands it back to you. Whoa! They struck that angry dude sitting in the back, the one you were going to strike next! Hallelujah!! So you mark the next one on your list. . . and so it continues, like the NFL Draft in reverse.

And when you’re done, the judge breaks the news to the jurors. You’re it, get comfortable.

Finally, let me say, that contrary to popular belief, it’s not easy to get out of jury duty. Nor do lawyers look for stupid jurors or inept jurors. Most attorneys want reasonable, smart people who will be able to sit through a multi-day trial, pay attention, understand what is said, and follow the law as it is explained by the judge in the jury charge. And happily, that’s generally what the system provides.


(P.S. We won the case with the cousin sitting on the jury.)

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Monday, July 20, 2009

Did Ancient Astronauts Build My House?

Aliens built the Great Pyramids. That’s as irrefutable as global warming. . . at least according to this guy on TV the other night. What’s more, as TV Man's logical tour de force unfolded, it suddenly dawned on me. . . ancient astronauts built my house! Seriously! Let's follow TV Man's logic, and you too will see the truth.

According to TV man, no one saw the pyramids being built. And he’s right. We don’t have a single photo of anyone building the pyramids. Sure, we have some hieroglyphs, but those are vague and subject to interpretation. It’s best to ignore them.

Now consider this: the same thing is true for my house. I never saw the house being built, my neighbors never saw the house being built, and 1940's Man left no photos of how he supposedly did it. Ergo, we must conclude that, at the least, we have a mystery, and that aliens could be at the heart of it.

Further, the pyramids were made of materials that TV man assures us the ancient Egyptians knew nothing about. The same is true of my house. Indeed, my house is made of many materials that I do not understand. And if I don’t understand them, there is no way that the vastly more primitive 1940's Man could have understood them. . . unless he had help! Voila!

Now I’m sure that “experts” will tell you that 1940's Man had the ability to make such materials -- just like “Egyptologists” will tell you that ancient Egyptians could have made the pyramid materials, but, as TV explained, those experts earn their living by selling their theories. If they admitted the truth, they could no longer sell their books or teach their courses. So obviously, they are lying, and we should dismiss these self-proclaimed experts.

So ask yourself, if 1940's Man could not make the materials in my house, where did he get them? There can be only one answer -- aliens. It’s only logical.

Incredible, right? Just wait, there's more. . .

Many of the materials in my house are not indigenous to this area, just as the large stones used to build the pyramids were not indigenous to that area. I see no aluminum mine around here, and certainly no plywood trees. I’ve never seen a brick lying around anywhere in nature. So am I supposed to believe that 1940's Man shipped these materials to this area just to build a house? Ridiculous! Why would he do such a thing? How could he do such a thing? There wasn’t even a highway system before the 1950s!

And that's not even the best part. My house, like the pyramids, aligns almost perfectly East West North South. Why would humans do this? I can’t think of a reason, and neither could TV Man, unless it was to please the aliens. And even if such a reason could be found, how could they do it? You would need to hover above the house to achieve this and we all know that 1940's Man could not fly.

Also, just as TV Man found with the pyramids, if you count the number of houses on my block, you will find that the number of houses equals the number of planets in the solar system, at least until they demoted Pluto, and if you don’t count all the little planets at the end. . . and if you don’t count the two houses on the end of the street. But otherwise, it fits perfectly.

Finally, there is one last piece of evidence, a coup de gras. Just as ancient Egyptians drew images that kind of looked like aliens, 1940's Man too drew images of aliens. . . and they were wearing tool belts.

There you go, irrefutable proof. Creeeeeeeepy.

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Sunday, July 19, 2009

PelosiCare Analysis Continued

On Friday, we outlined how the House version of Obamacare (PelosiCare) requires everyone to get “approved” medical coverage (H.R. § 101) or face a fine equal to 2.5% of your gross taxable income. (H.R. § 401).

Here are more details of the bill:


How Does The Public Option Work

PelosiCare creates a new Public Health Insurance Option.

So how does it work? We don’t know. The exact details of the Public Option plan will be established by a Health Choices Administrator (HCA), who will report to the Health and Human Services secretary.

However, we do know the following:

• The Public Option plan will have four tiers: (1) a basic level, (2) an enhanced level, (3) a premium level and (4) a creatively-named “premium plus” level (it’s double-plus good!). (H.R. § 203). The price difference from one level to the next may not exceed 10%.

• The HCA may negotiate directly with providers (H.R. § 224), and may require such "cost savings measures" as value-based purchasing, bundling of services, differential payment rates, performance based payments, price caps, etc. If physicians/providers want to participate they must agree to the rates established. (H.R. § 225).

• The HCA may negotiate directly with drugs companies. (H.R. § 223).

Who Qualifies For the Public Option

To qualify for the Public Option, individuals must not be eligible to join another “acceptable” plan either through an employer, Medicare, Medicaid, Tricare, the VA, or a state health plan. (H.R. § 202).

Employers are required to provide qualified private insurance. If they refuse, they will be fined 8% of the employee’s wages. (H.R. § 412). This decreases to between 0% and 6% for small businesses that earn less than $400,000 (those earning less than $250,000 pay 0%).


Subsidies

For all persons legally in the country and not eligible for Medicaid, PelosiCare promises subsidies to help pay the premium costs for an acceptable policy (either Public Option or private insurance). (H.R. § 242). However, persons who receive health care through an employer are not eligible for such subsidies (consider this an incentive for people to avoid working).

The subsidies range between 70% and 97% of premiums, depending on family income. (H.R. § 242).

To be eligible for a subsidy, family income must be between 133% and 400% of the poverty level. (H.R. § 242). Depending on family size, this means:

• Family Size 1, income between $14,403 and $43,320.
• Family Size 2, income between $19,378 and $58,280.
• Family Size 3, income between $24,352 and $73,240.
• Family Size 4, income between $29,326 and $88,200.
* uses 2008 data

FYI, according to the Census Bureau, 61% of households (one or more persons) earned less than $60,000 in 2005. Thus, expect around 60% of Americans to be eligible for a subsidy. . . and the other 40% to flee.

No payments may be made under this plan for illegal aliens. (H.R. § 246).


How Does Congress Plan To Pay For PelosiCare

Good question. The numbers are nonsense. No full CBO estimate of the bill’s costs has been completed to date, but the bill is currently estimated to cost more than $1.65 trillion over ten years.

An estimated $781 in tax hikes are planned from the following two sources:

1. The fining of employers discussed above (H.R. § 412). This is estimated to bring in $237 billion over ten years; and

2. An income tax surcharge at the following rates: 1% for income above $350,000, 1.5% for income above $500,000, and 5.4% for income above one million dollars. (H.R. § 441). However, this will go up automatically to 2%, 3% and 5.4% when the cost projections prove to be false. This is estimated to bring in $544 billion.
An additional $525 billion is estimated to "saved" from reducing payments to private insurers and drug makers. Fortunately, it’s unpatriotic to pass those costs on to private customers, right?

The remaining $344 billion will come from ________.


New Requirements For Qualified Plans

As noted previously, PelosiCare generously allows individuals to acquire “acceptable coverage” from “qualified” private medical plans.

To be considered a “qualified” plan, the private insurance must do the following:

• The plan may not exclude pre-existing conditions. (H.R. § 111).

• The plan may only vary the rates it charges for age, family size, and geography. (H.R. § 113).

• The plan may not terminate your coverage unless you stop paying the premiums. (H.R. § 112).

• The plan must use “cost sharing” measures, such as requiring co-payments. (H.R. § 117).

• The plan may not discriminate “without regard to personal characteristics extraneous to the provision of high quality health care or related services.” (H.R. § 152).

• The plan must offer an “essential benefits package” that is consistent with the standards TO BE established by the HCA. (H.R. § 124). In other words, the crux of the plan will be figured out later.
The HCA can also require rebates to enrollees whenever the plan does not meet a medical loss ratio defined by the HCA. (H.R. § 116). This provision is not clear in the bill, but it appears to be a profit-cap.


Cost Savings

Uh.

And they’re going to stop waste, fraud and abuse. (H.R. § 226).


Impressions

The bill. . .

1. Contains no real cost savings, just cost shiftings.
2. Provides few details of how the Public Option will work.
3. Does nothing to address costs imposed on states and providers by illegal aliens.
4. Leaves the current nightmarish bureaucratic system in place.
5. Promises subsidies at an unsustainable rate.
6. Uses math that simply does not add up.

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Friday, July 17, 2009

Obamacare: Investor's Business Daily Wrong About Private Insurance

By now you’ve all probably heard about the Investor's Business Daily article that claims that the House version of Obamacare would ban private insurance. This is not correct. IBD has misread the bill. But that is not to say that the bill is good in any way. . .

IBD is claiming that the House bill “mak[es] individual private medical insurance illegal.” According to IBD,

So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

[This] bill . . . will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.
However, this is not correct. IBD has misunderstood the portion of the bill to which they refer.

The way this bill works, individuals are required to obtain “acceptable” medical coverage. (H.R. § 101). If you do not have “acceptable” medical coverage, you will be charged an income tax surcharge of 2.5%. (H.R.§ 401).

“Acceptable” medical coverage can be obtained from any of the following: (1) the new “Public Health Insurance Option,” (2) Medicare, (3) Medicaid, (4) Tricare, (5) VA coverage, (6) state health plans, (7) a “qualified” private sector plan, or (8) a "grandfathered" private plan. (H.R. § 202).

The section IBD found addresses “grandfathered plans.” A grandfather plan is an existing plan, i.e. the private plan you currently have. The House plan provides that these grandfathered plans may not enroll new persons after the date the House bill takes effect, nor may they change their coverage. (H.R. § 102). Thus, these plans are likely to die off.

But this does not mean the end of private insurance. Private insurers will still be allowed to issue either qualifying or non-qualifying plans. Here is the difference:


Qualifying plans. A qualifying plan is a private plan that satisfies certain requirements to be established by the Health Insurance Exchange. These requirement involve coverage, benefits and consumer protection. For example:

Qualified plans (QP) may not exclude pre-existing conditions. (H.R. § 111).

Your coverage cannot be cancelled unless you stop paying the premiums. (H.R. § 112)

Providers can only vary rates according to age, family size, and geography. (H.R. § 113)

QP plans must provide the minimum types and levels of coverage established by Health and Human Services, e.g. hospitalization, drug benefit, etc. (H.R. § 124).
Qualifying plans can be purchased individually or by employers. If your employer offers a qualified plan, you are not eligible for the Public Health Insurance Option. (H.R. § 202).


Nonqualifying plans. Nothing in the House bill bans private insurers from offering non-qualifying plans, i.e. plans that do not meet the requirements for qualifying plans. Thus, presumably any type of health plan can still be offered. However, there is a catch. If your only coverage is a non-qualifying plan, you will not be considered as having “acceptable” medical coverage.

In that event, you can be fined at a rate of 2.5% of your gross taxable income. (H.R. § 401).

Thus, while the bill will encourage people to switch to new plans or the Public Insurance Option, it certainly does not ban private insurance as IBD asserts.

That said, the bill remains a horror.


I will provide a more in-depth look at the entire bill in a few days.

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Thursday, July 16, 2009

Barack Obama: Love Machine

By now we’ve all seen the photo of Barack Obama leering at the young woman. It’s no big deal ABC gushed in their defense of the President. Having seen the video, I am inclined to agree. But that doesn’t mean they aren’t covering up a deeper problem with our new President. Dear Reader, see what we've uncovered for you. . . . .

Two months ago, in an event that none of the networks covered, Hillary Clinton accused the young President of touching her inappropriately. “He used a Vulcan nerve pinch on me and then kissed me. . . like this.”



An angry President Obama denied the charge: “I did not have sex with that woman.”



But she didn't say sex sir, and soon photographic evidence came out. Duck, duck, goosed.



New York Times: "Hillary Vindicated! Republicans evil!"



Soon rumors surface of another woman. “No, there’s no truth to these rumors. This woman is a liar.”



Joe Biden, the voice of integrity, is troubled.



Biden demands Barack come clean, but Barack spits in his face.



Biden returns fire, escalating their spitting match.



An angry Biden supports this mystery woman, who turns out to be Kathleen Sebelius! “Oooga booga, and then he jumped out of the Oval Office closet at me.”



The President responds angrily. “I did not have sex with those two women.”



But then this photo surfaces of the President ravishing an unwilling Nancy Pelosi. "You smell gooood."



“This is an outrage. I am being smeared by a vast right wing conspiracy.”



But as he speaks, another photo emerges, of the President demanding "consideration" for appointing Judge Sotomayor. He would later claim he was only looking for somewhere to spit out part of a wangdoodle, when Sotomayor stepped in the way.



Senate hearings are held. “How large is your wangdoodle sir?”



“No Senator, it’s much bigger than that.”



The Senate is troubled. “We do not approve of innuendo.”



Soon other women appointed by the President make similar claims. He denies each claim: “I did not have sex with those five women.”



Until he realizes he cannot win. “I shall change my ways," he agrees.



But has he? Seen here, Barack Obama giving Hosni Mubarak a special greeting. “Meester Prezident!”




There you have it, the first big cover-up of this young administration. And there wasn't a word about this in the press. Terrible.

Of course, I might be reading too much into these photos.
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Troll Smacking

The net crawls with trolls. We’ve all run into them, and we will continue to run into them. But many people don’t know how to handle them. So let’s talk about troll smacking.

What Motivates Trolls

To fight a troll, one must first understand what motivates trolls. Trolls come in all shapes and sizes and use various techniques. But that’s only window dressing. At their cores, trolls are looking for something that only you can give them . . . a sense of power.

People who troll are psychologically messed up (that’s a technical term). They see the world around them and they don’t understand why they are so unhappy when everyone else around them seems to be living normal happy lives. They feel inferior and powerless, and the only way they know to overcome that feeling is to gain control over someone else. This is the same impulse that drives bullies and rapists and thrill killers, the desire to feel power over another human being.

If you don’t understand this, you will never understand the troll mentality. They don’t care about your politics. They don’t care about your religion. They don’t care about your hobbies. They only care about how you can make them feel. They need to control you to make themselves feel better, and the only way to control you on the internet is to find something that you care about and to attack it.

With this in mind, let’s consider how not to handle trolls.

How NOT To Handle Trolls

If you cruise the net, you will see many techniques for dealing with trolls. Most of these will only lead to more problems. Here are some common techniques you should avoid.

1. Lashing Out. Ok, this isn’t normally a recommended technique, but you see it done all the time. The problem with lashing out at a troll is that this plays into the troll’s hands more than anything else you could possibly do. This is miracle grow for trolls. The angrier you get, the greater the troll’s joy, because the greater your anger, the greater the troll’s control over you. The only thing you could do to make this worse would be to combine your anger with a threat. Nothing says helplessness more than an impotent threat. Avoid this at all costs.

2. Disputing The Troll’s Facts. “Mr. Troll, you have your facts wrong.” Give it up. You’re playing the troll’s game. The troll doesn’t care what you say, because it doesn’t care about winning the argument. It only cares that it found someone to exploit, and exploit it will. It will lie, cheat, and say whatever it takes to keep you on the hook until it gets the reaction it wants.

With each passing word, the troll gains more and more information about what matters to you. And as its knowledge grows, so does its control over you. Knowledge is power. It will get you.

But you say you can’t be gotten, right? Wrong, the troll had you the moment you began arguing with the troll. Not only does it get a kick out of you wasting your time trying to win a debate you can’t win, but it is using you like a puppet to fill up the board with gibberish. With each passing comment, you make it harder and harder for other posters to avoid being pulled into this argument. Congratulations, you’re advertising for the troll.

3. Politely Tell It To Leave. Some people suggest politely telling trolls to leave. This doesn’t give trolls the same satisfaction as an angry response, and it doesn’t fill the board, but it lets the troll know that it has annoyed you. You’ve nibbled the bait. And this will encourage the troll to try to reel you in, which can lead to the problems just discussed.

A corollary to this method is to post “DFTT” (“Don’t Feed The Troll”) or to ignore the troll’s post. This is generally good advice, except for two problems. First, and most importantly, you need to realize that you are playing a risky game. If the troll has targeted you, and you choose to ignore it, you are stating your intent to begin a battle of wills. You are telling the troll that no matter what it throws at you, you will ignore the troll. Thereafter, you cannot respond. If you do, the troll knows that it has broken you. You have given it exactly what it wants.

Secondly, on a public board, this strategy removes any control that you have over the situation. You will need to wait for the troll to make each of the next moves. You also need to worry about some third party coming along “to help you out,” and pulling you into the debate in the process.

How TO Handle Trolls

So what should you do? The only way to beat a troll is to deprive it of the one thing it needs -- the sense of control. How do you do that? Here are some rules.

1. Maintain A Positive Tone. Always use a positive and happy tone in your comments. Remember, the moment you show the troll that you are upset, it wins. If you stay happy, it loses and it will lose interest.

2. Exploit The Troll’s Inferiority Complex -- Attack Its Trollhood. Although you must maintain the positive tone, you should also work to exploit the troll’s inferiority complex. Anything you can do to make the troll feel that you control it will strip the troll of the pleasure of trolling and will drive it away.

In this regard, you should consider always adding a hint condescension to your comments. For example, address the troll in terms like “pumpkin” or “kitten” or “kid,” which demeaning or dismissive when used with mere acquaintances.

Also, try to phrase your responses as if you are judging the troll, and you aren’t impressed with what you’ve seen. For example, good responses to its posts include:

• “You can do better than that.”
• “You need to step up your game.”
• “Even for a troll, that was weak. Come on, make me feel it.”
• “Are you new at this? The normal trolls use more ALL CAPS.”
Notice that not only do these responses deny the troll the response it wants, they give you control of the relationship because you place yourself in the position of commanding the troll. This will strike at the very heart of why the troll has come.

3. Turn The Tables On The Troll. Remember, the troll is trying to upset you. To do that, they have set bait. Never take it. Under no circumstances should you ever respond to the points they have made. Instead, try the following. . .

a. Toss The Bait Back At Them. When they blast you with their best post, respond by tossing the bait right back. For example, ask them to rephrase the point or provide further explanation:

• “That’s a lot to read, can you shorten it?”
• “I don’t understand your question. Take another look at it and get back to me.”
• “Wow, you’ve got a lot of typos there. Do you want to fix those before I take a look at your point?”

Notice that in each response, you control the troll. You’ve given no hint that you bothered to read the post or that you are upset. To the contrary, you’ve told the troll that if it wants to continue, it will be on your terms.

b. Change The Topic. If tossing the bait back isn’t your thing and you want to have some fun, try controlling the conversation by changing the topic. This can be done in several ways.

First, look for some flaw in the question/statement. Can the question/statement be read in multiple ways? If so, answer it in the way it was not intended. This will be particularly easy where the troll attempts to use sarcasm, which can be read literally to change the meaning:

Troll: “Yeah, he’s smart.”
You: “Glad you think so.”

This can also be done where the troll uses words that have multiple meanings. For example, as Writer X reminded me, I recently had a little fun with a troll. After evading all of his attempts to get an answer out of me, he finally asked, “why won’t you engage me?” Seeing as how engage has multiple meanings, I switched his meaning and replied, “are you asking me out?” This stumped the troll, and he went away.

You can also change the topic more bluntly if you desire. For example, rather than responding to the post in any way, instead state, “Can I ask you a question?” and then ask the question right away, “Do you get Newsweek?” or “Do trolls wear hats?”

This is a no-win situation for the troll. If it answers the question, it is playing your game, something that goes against its need for control, and you can further exploit this by continuing to pepper the troll with questions until they leave. If the troll refuse to answer the question, then you make the troll look like a coward by going after it: “You didn’t answer my question” . . . “You still haven’t answered my question.” . . . “Why won’t you answer my question?” This again frustrates the troll’s desire to be the predator.

(In fact, you can use this technique to continue to frustrate the troll thereafter by simply following up any future troll posts with “why won’t you answer me?” And if it finally does answer, you can rub in your victory (“ha ha, made you answer”), and then demand that it answer further questions.)

You can also take a more aggressive stance in the initial question by asking something insulting, like “Hey Pumpkin, how are things in the old basement?”
4. Evade, Deny, Insult. When you try to change the topic, you can expect the troll to respond with something like “you didn’t answer my question.” Use the principles above to fashion an appropriate response. For example, make the troll work for it by responding, “what question?” Or try the evasive, “I thought I did?” or the insulting “you were serious?” or “you’re kidding right?”

5. Reverse Troll. If the troll can’t be sidetracked from its mission, and it just keeps throwing facts and argument at you, you should play reverse-troll. Simply respond, “All lies.” or “Nope.” When it challenges you to prove your assertion, just reply “no,” and then try again to change the topic. Few trolls will bother with you after that because they know they can’t control that conversation.

6. Insults. Finally, when the troll turns to insults, which it will, remember not to play its game. Your best bet is to look down your nose at the troll, either by making its attack sound childish (“Are we back in grade school now?”), by responding with humor (“And here I thought we were getting along so well.”), or by combining humor and childish treatment (“Now now, I won’t keep playing with you if you’re going to take that tone.”)

Conclusion

If you follow these rules, and always keep your eye on never letting the troll feel that it controls you, then you can dispatch trolls pretty easily and have a little fun in the process. Just remember that you should never take their comments personally, no matter what they say.

* Thanks to Writer X for having a post on her website yesterday that reminded me that I had promised to write this article.
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