Friday, November 30, 2012

Soon Highmark will be asking you to pay $69 NOT to see the doctor . . .

You can't make this stuff up.

Highmark is now rolling out a new dermatology idea:  instead of actually being seen by a doctor, you photograph the affected area and send it in digitally.  Then the doctor decides whether or not you need to come in for a real appointment, or whether s/he will simply diagnose a picture.

The cost for this "service" will be $69, because it is NOT a covered benefit on any Highmark Blue Cross Blue Shield plan.

So let's get this straight:  instead of paying my Highmark co-pay (usually around $25 but never higher than $50) and having the opportunity to be examined by a real live dermatologist, I am now going to be asked to pay $69 NOT to be seen at all.

Highmark is simply gushing over this new "service":

"This new process makes it convenient for patients to access care," said Eric Starr, director of business innovation and development at Highmark. "They will just simply take a photo with a smartphone device or digital camera and then go to the secure website and send the image. Based on the image, the physician can determine if the patient can be treated virtually. This really modifies the workflow of the dermatologist allowing office visits to be used for the most critical cases."  A win for both the doctor and the consumer.
Yeah.  Aside from the fact that I cannot wait to see what happens when a doctor misdiagnoses something carcinogenic from a blurry digital image, this is a win for Highmark's accountants and nobody else.

You get stuck with a bill for more than your co-pay and don't see a doctor.

You also have absolutely no assurance that any particular doctor (or even any doctor) is the one providing your treatment advice.

Meanwhile, Highmark is spared having to pay out anything in claims.

Your doctor, by the way, will probably embrace this service for the following reasons:

1.  S/he first charges you $69 that s/he gets to keep for spending fifteen seconds looking at a photo.

2.  Then, in the well-grounded practice of defensive medicine, s/he tells you that you need to come in for an appointment, collecting another $25 from you, as well as the insurance company payment.  (In other words, Highmark has found a way to increase the doctor's capitated pay without actually having the company pay it.  Your effective co-pay to see a dermatologist just increased from $25 to $94.)

Thank you thank you thank you Karin Weldin Stewart, for allowing the unbridled philanthropy that is Highmark to set up shop in Delaware.

Read more here:

Wednesday, November 28, 2012

The kind of tactics you may expect from MedExpress (Highmark) in Delaware

I found it fascinating that the last time I wrote about MedExpress and Highmark BCBS the trolls came out to denounce me.  I did make one error--MedExpress is not wholly owned by Highmark, but has invested at least $50 million, but neither entity is willing to specify the exact investment or the precise relationship between the companies.

That having been said, it is instructive to look at the strategy being pursued by Med Express in Delaware and project what the future holds based on what MedExpress (and Highmark) have done in other states.

To begin with, let's understand what MedExpress intends to do in Delaware.  The original plan (as MedExpress execs communicated it to officials at Christiana Care and other physicians) was to open eight new urgent care centers north of the canal, and eight more centers in Kent and Sussex.  This would double the number of urgent care centers in Delaware, and even the MedExpress execs in these meetings admitted that the market would not support that total.

Their intention, physicians tell me, was clearly stated, We're Wal-Mart, and we will drive the independents out of business. They don't have the funding or the staying power to compete with us.  They have since backed off this plan slightly, stating that the four centers they have just opened in New Castle County will be the only ones opened up here for the moment, but they still intend to open eight more centers to the South.

In supporting that effort, as I am sure you already know if you listen to the radio or read the newspaper, MedExpress is dropping tens of thousands of dollars weekly in advertising to let you know that "a new neighbor" has come to Delaware.

The resources and intent for organizations like Christiana Care (which currently operates four urgent care centers of its own in NCC) to oppose this influx is limited.  Christiana can certainly afford to operate her own centers at a loss far longer than the independents, and my guess is that CC's strategy is to be willing to cede the independents' slots to MedExpress as long as they get to keep their own in business.  Christiana Care, officially, will not bring the issue to the Insurance Commissioner, because Highmark BCBS possesses an infinite number of ways to mess with millions and millions of dollars of CC billing.

So what does experience teach us about what MexExpress does when it comes into a market?

First, realize that health insurance companies buying into urgent care clinics is a national trend, and it's all about the bottom line rather than the quality of care. 
Further, those funding healthcare costs and other outside parties, such as institutional investors, have been looking to leverage the industry tailwinds to achieve cost reductions and/or increased profits. Examples include Humana's acquisition of Concentra in 2010, and the acquisition of the Boston-based nonprofit insurer Neighborhood Health Plan by Partners Healthcare, the largest hospital and physicians network in Massachusetts. In addition, payors have recently sought to partner with private equity investors for access to urgent care, including HighMark's investment in private equity-owned MedExpress in 2011, and WellPoint acquiring Physician's Immediate Care in June 2012.
Second, MedExpress and Highmark consistently team up to use their combined clout to drive regional and local competition out of business by almost any means.  Here's an example:  in the Pittsburgh area, once MedExpress had moved in, Highmark then excluded the University of Pittsburgh Medical Centers own urgent care locations from being providers within the Highmark network:

Highmark has excluded UPMC’s newest urgent-care center from its network of providers after modifying its policy for the clinics in all its service areas. That means the UPMC urgent-care center on Perry Highway in Wexford, which opened July 2, is not an approved provider in the Highmark network.
“Highmark will assess not only whether the centers meet the minimum requirements to deliver services performed in these centers, but also will evaluate whether our members have adequate choice of urgent care centers within a defined geographical area,” Highmark spokesman Michael Weinstein said in a prepared statement. “Some new urgent-care centers may not be included in Highmark’s provider network if a geographic area already has an adequate number of these centers to meet patient needs.” 
Did you get the import of that last paragraph?  Highmark (part owner of MedExpress) has decided that it is not the quality of care provided at urgent care centers in the region, but how many there are in the region that makes the decision which they will include in the Highmark provider network.

Let's put this in plain English in a Delaware context:  Once MedExpress has twelve urgent care centers in Delaware, Highmark has the ability to declare the market saturated and refuse to provide network status to any new centers--and they have a track record of doing so.  This will make it virtually impossible for any hospital or independent consortium of doctors to open a new facility, because Highmark BCBS is the largest insurance carrier in the Delaware, and if those patients can't come to your facility (regardless of the quality of care), then you won't make it.

Expect in-your-face competition from MedExpress:  in Indiana, for example, MedExpress made it a point to open its first new center directly across the street from an existing center owned by a local independent:

Meanwhile, privately owned MedExpress Urgent Care, a chain with offices in Colorado, Florida, Maryland, Pennsylvania, Virginia and West Virginia, where it is headquartered, is to open along Oakland Avenue in White Township on Aug. 28. 
It is located directly across the street from another urgent care center, Dr. H. William Fegley's Walk-In Medical Care Office, which opened in 2007.
What outcome were they looking for here?  Faced with a giant competitor that also had the power to exclude his existing clinic from BCBS networks, Dr. Fegley made the best deal he could with the devil:

Apparently, Dr. H. William Fegley decided he couldn't beat his competition. So he's joined them, creating a partnership that will challenge not-for-profit Indiana Regional Medical Center for patients and revenue. 
On Tuesday, Fegley and his new partners, West Virginia-based MedExpress Urgent Care, announced that Fegley has closed his practice and will begin treating patients as part of the MedExpress team, which began accepting patients at its new White Township office Tuesday.
Expect guerilla (or is that "gorilla" tactics) from MedExpress:  A story from another urgent care in this area, dateline about a week ago.  It was Saturday morning and there were 25 patients outside the door at opening hour.  In any clinic this is a 2-3 hour backup.  But the backup dissipated very quickly when, after about 45 minutes, one of the "patients" stood up on her chair in the waiting room and said, Hey, everybody!  Why are we waiting here?  I know where there is a new clinic that just opened that doesn't have any lines to get treatment.  I can lead you all over there!  And five patients walked out with her.  A paid shill?  I can't make that accusation, but ask yourself when was the last time you ever saw such behavior in any establishment that did not come from somebody with a definite self-interest?

Again I need to make the point that, as a Libertarian, I am in favor of free competition in the marketplace, but that's not what we are talking about here.  What we are talking about here is one of the most highly regulated markets in the nation (health insurance and care) and a set-piece example of crony capitalism, wherein big insurance companies take advantage of sleeping Insurance Commissioners (or of sleeping with the Insurance Commissioners) and the Federal mania for reducing health care expenditures to make Obamacare look affordable in order to drive competitors out of business.

Ask yourself some tough questions before you vote with your feet by walking into a MedExpress facility, questions like:

1.  What will it be like when MedExpress controls the overwhelming majority of urgent care facilities in Delaware?  What will it be like when the market can no longer keep pressure on them to provide good service?

2.  Where did they find the doctors and nurses to staff twelve new urgent care centers in Delaware?  What's their quality of care going to be like compared to the facilities you already know about?

And, most importantly,

3.  To what extent do you want your insurance company not only having the power to approve or disapprove your medical care, but also to be the entity that is providing that care?  Where does the doctor's autonomy end when he is at least in part also an employee of that insurance company?

Ironically, what the Highmark/MedExpress alliance is trying to do is bring a corporate version of single-payer healthcare to Delaware.  Only in this case maybe we ought to call it "single-provider healthcare."

Finally, here's the question:  where are our legislators and advocates while this happening?

Where are John Kowalko and Earl Jacques?

Where is Karin Weldin Stewart?

Where is the Democratic Party, or even the Progressive Democrats of Delaware?

At this point my last message is:  welcome all MedExpress/Highmark trolls, your canned comments are expected and relished.

Tuesday, November 27, 2012

It is always fun to click through the links. . .

Case in point, somebody recently cited this story at ThinkProgress in a comment thread at another blog:

Florida Republicans Admit Voter Suppression Was The Goal 

Of New Election Laws

That seems pretty clear-cut, doesn't it?

Except that when you read the part about Republicans "admitting" to voter suppression, you get this:   
Current party members and consultants confirmed the motive was not to stop voter fraud but to make it harder for Democrats and minorities to vote:
Wayne Bertsch, who handles local and legislative races for Republicans, said he knew targeting Democrats was the goal. “In the races I was involved in in 2008, when we started seeing the increase of turnout and the turnout operations that the Democrats were doing in early voting, it certainly sent a chill down our spines. And in 2008, it didn’t have the impact that we were afraid of. It got close, but it wasn’t the impact that they had this election cycle,” Bertsch said, referring to the fact that Democrats picked up seven legislative seats in Florida in 2012 despite the early voting limitations.
Another GOP consultant, who did not want to be named, also confirmed thatinfluential consultants to the Republican Party of Florida were intent on beating back Democratic turnout in early voting after 2008.
[...]A GOP consultant who asked to remain anonymous out of fear of retribution said black voters were a concern. “I know that the cutting out of the Sunday before Election Day was one of their targets only because that’s a big day when the black churches organize themselves,” he said.
Uh, OK, Wayne Bertsch actually says that they knew the heavy preponderance of Democratic early voting was perceived as a problem for Republicans, but he doesn't actually say--anywhere in the quote--that targeting Democratic votes was tied to any specific action.  In other words, the tag, "Bertsch . . . said he knew targeting Democrats was the goal" is at best inaccurate.

The second is a quote by an anonymous consultant about the opinions of other consultants, who are also--not surprisingly--anonymous.

The third is another another anonymous consultant (who is limned as brave but anonymous due to a fear of retribution) who explicitly says the African-American vote was targeted.

So, let's see--nobody in this article who is actually a Florida Republican has actually admitted to anything, despite the headline.

I don't doubt that there may have been such an intent going on there, but, folks, this ain't anything resembling proof, and the headline is intentionally misleading about what's in the story.

Old attorney adage:  major proofs require major evidence.

Comment rescue: raising your taxes and cutting government services is a "win win"

There are many perspectives on the so-called "fiscal cliff" that faces the US in just over a month thanks to the dual financial irresponsibility of both President Barack Obama and the US Congress.

This one, expressed at DelawareLiberal by cassandra m., is a startlingly candid admission that raising taxes on everyone while reducing services is a good thing, a "win-win":

The first thing to do is to remember that the $3500 average is an average that includes all tax brackets. People in the lowest taxable income range would see approx $400 increase, while the 1-2% who got the maximum benefit of the Bush tax cuts would see a $120K increase (approx.). The second thing to do is to remember that there are portions of the entire tax cut picture that were meant to expire. Such as the payroll tax reductions that were a part of the stimulus package. Middle class and working class people will feel this one more since that represents the larger portion of the tax cuts they got. And this cut largely stood in for raises they didn’t get but should have. The third thing to do is to remember that the Bush tax cuts were never paid for. Never. And one very large part of the deficits and debt that folks are screaming over come from the fact that GWB gave away alot of money for 10 years that has never been accommodated in the budget. 
The fact is that most Americans aren’t going to see a $3500 increase. But there will be an increase. And if the fiscal cliff does happen, you get increased revenues AND you get spending cuts that will certainly address the concerns of the debt and deficit hawks to some extent. Really, it is a win win. Sure it hurts everybody, and for all of the folks who keep saying that no household would manage its budget like this, hurting everybody is something of the point of the kind of austerity that keeps getting demanded. And here we are being treated to the spectacle of folks who are usually having on about too much spending and too much debt objecting to one big solution that attacks them both. 
I doubt that we’ll go over the fiscal cliff, and that President Obama will get his tax cuts for income under$250K. But even if we do, it won’t be long before the middle class portion of those cuts gets restored.
The source for her figures is here.

Checking that source reveals the nature of the "win win."

The middle-income rise, as cassandra points out, would not average $3,500/year, but what she doesn't tell you is that it would average $2,000/year, and that the poorest households would see a marginal rate jump of 5%, that the standard exemption for married couples filing jointly would drop by nearly $2,000, and that the fiscal cliff is not all about the Bush tax cuts, not by a long shot.  Poor people will be hurt by the expiration of the Obama stimulus tax cuts of 2009, middle-class people will be hurt by the failure of the government to renew the Alternative Minimum Tax "patch," and a large bite on the rich comes from new taxes for the implementation of Obamacare.

To quote the original Tax Policy Center document:

Average marginal tax rates would increase by 5 percentage points on labor income, by 7 points on capital gains, and by more than 20 points on dividends.
Absent legislative action, most tax cuts enacted since 2001 will expire on January 1, 2013, raising tax rates, reducing deductions and credits, and throwing millions of taxpayers onto the alternative minimum tax (AMT). The estate tax would hit more than ten times as many estates as in 2012. The 2 percentage point cut in the payroll tax rate would lapse, raising taxes on more than 120 million households with workers.2 Short-term tax breaks that Congress regularly renews, some of which have already lapsed, would disappear, boosting taxes for both individuals and businesses. And the 2010 healthcare legislation would impose new taxes on high-income taxpayers.
Federal tax collections would jump by more than $500 billion in 2013, more than 20 percent above what they would be without the cliff. Nearly 90 percent of all households would face tax increases averaging nearly $3,500. Middle-income taxpayers would see an average increase of almost $2,000.
The AMT operates parallel to the regular tax and sets a floor on total tax liability. Taxpayers whose income exceeds the AMT exemption must calculate both regular tax and AMT liabilities and pay the larger amount.6 EGTRRA temporarily increased the AMT exemption to preclude the alternative levy’s reducing the impact of other tax cuts in the legislation. Since then, Congress has repeatedly “patched” the AMT by setting higher exemptions but only for a year or two at a time. The most recent patch, enacted in 2010, covered tax years 2010 and 2011 and raised the 2011 exemption from $45,000 to $74,450 for couples and from $33,750 to $48,450 for others. If Congress does not enact another patch and extend it retroactively to the current year, the AMT will hit tens of millions more taxpayers, boosting their 2012 tax liability substantially.
Expiration of many tax provisions in 2013 would cause federal tax liability to jump by more than $500 billion in that year alone (table 4).12 That amount would represent more than a 20 percent increase in revenue, relative to the amount that would be collected if none of the provisions in the cliff took effect.
Exactly how is this a "win win"?  That idea is proposed by creating a specific straw man of the "deficit hawk," and saying, in effect, Isn't this what you wanted?  An increase in revenue and a decrease in services?  Well, this is what it looks like.

Actually, ah, . . . no.

What this looks like is a massive failure of the American government (on the part of both parties) to tell the truth about the realities of the dreck they've been selling us for over a decade.

That we can continue to have "free stuff" without every paying for it (Bush and Obama).

That we can continue to fight expensive, bloody, endless wars on a bloated defense budget without any consequences (Bush and Obama).

And that--without an election hanging over our heads--we can finally do what we've been wanting to do:  raise marginal tax rates on EVERYBODY and simultaneously continue to expand government spending.

In other words, if we go over the fiscal cliff, just because tax rates go up, expenditures won't go down (bet on it; they will start by exempting Defense, Medicare, and other major programs from the sequestration), and instead of a "win win" we will be in worse shape than we are now.

"Win win" my ass.

We will be withdrawing from Afghanistan in 2014 . . .

. . . except that we won't.

At least 10,000 US troops to stay on, because empires don't give back territory voluntarily.

Monday, November 26, 2012

Remember DWB [Driving while Black] in good ol' New Jersey?

Now that's apparently been replaced by DWH [Driving while Hunting and DWF [Driving while Fishing] as new legal activities that NJ law enforcement agencies are on the look-out for.

This time, however, it's brought to you by the Department of Homeland Security, not the New Jersey State Police.

Sunday, November 25, 2012

The myth of America's Libertarian past

The first three paragraphs of this post from our Brit friends at The Libertarian Alliance cover the whole (exactly, dead-on accurate) thrust of the piece.  Read the rest if you want details:

There’s a popular historical legend that goes like this: Once upon a time (for this is how stories of this kind should begin), back in the 19th century, the United States economy was almost completely unregulated and laissez-faire. But then there arose a movement to subject business to regulatory restraint in the interests of workers and consumers, a movement that culminated in the presidencies of Wilson and the two Roosevelts. 
This story comes in both left-wing and right-wing versions, depending on whether the government is seen as heroically rescuing the poor and weak from the rapacious clutches of unrestrained corporate power, or as unfairly imposing burdensome socialistic fetters on peaceful and productive enterprise. But both versions agree on the central narrative: a century of laissez-faire, followed by a flurry of anti-business legislation 
Every part of this story is false. To begin with, there never was anything remotely like a period of laissez-faire in American history (at least not if “laissez-faire” means “let the market operate freely” as opposed to “let the rich and powerful help themselves to other people’s property”). The regulatory state was deeply involved from the start, particularly in the banking and currency industries and in the assignment of property titles to land. (Even such land as was not stolen from the natives was seldom appropriated in accordance with any sort of Lockean homesteading principle; instead, vast tracts of unimproved land were simply declared property by barbed wire or legislative fiat.)

Too amazing to make up: Long Island Power Authority charges people for electricity during power blackout

Go two weeks without power and the LIPA will still send you a bill for estimated use, as if Hurricane Sandy never happened.

Secession crisis in Spain!?

To be clear, I believe that secessionist talk in the United States is an idea that is just as nutty now as it was in 2004, when some liberals proposed it, but divisive politics and a faltering economy create an atmosphere where lots of previously unthinkable things could happen.

Like in Spain:

Exit polls from the regional elections in Catalonia show that pro-independence parties are winning a huge majority: up to 95 of the 135 seats in the regional assembly, according to analysis from theFinancial Times. Worse, from Madrid’s point of view, the radical pro-independence forces are doing unexpectedly well. The next Catalan government will now be convinced that it has a mandate to hold a referendum on independence that Madrid says is illegal. 
In a worst case scenario, the provincial authorities will attempt a referendum that the national government tries to block. It will be interesting in such a case to see whether the police obey local authorities or listen to Madrid. At the moment, no one knows what comes next; there is zero trust between Barcelona and Madrid right now.

What if the Mayans had predicted the world would end in 1883?

According to this fascinating post, they would have been very close to being right, as nearly 4,000 meteors--many the size of the Tunguska meteorite--passed perilously close to our planet over a three-day period.

kavips, this one's for you.

Back in Action: the morass that is Obamacare

I have been listening to physicians complain about the Affordable Care Act for several months now.

Last week a physician orthopedic clinic told me that they are mandated to check blood pressures on every visit, even if it is not (". . . and 99% of the time, it's not," the Orthopedic surgeon told me) medically necessary or even relevant.  Orthopedic doctors have applied for a waiver, but are not optimistic.

Another physician told me, two weeks ago, about the nightmare that is the compliance requirement for Electronic Medical Records, where "one size is required to fit all," and the same questions must be asked of every patient, and those results MUST be reported to the Federal government.

Do you smoke?  MUST be reported to the Feds.

Have you ever used marijuana?  MUST be reported to the Feds.

Ever suffered from depression?  MUST be reported to the Feds.

Are you pregnant?  If you are a 17-year-old female, this MUST be reported by the doctor to the Feds, even though s/he is not allowed to report it to your parents.

But the crowning glory is this:  at your "free" annual physical, you MAY NOT discuss any new ailment with your doctor: 

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code —
insurance will not cover any new ailment under that code.
If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.
You, the patient, will then have to make a decision.
Do you want your “free” yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my “free” exam if you only discuss what Obamacare wants me to discuss.
Can't wait to see how many more new surprises are out there. . . . 

Back in Action: The nightmare to come with single-payer in Delaware

Thanks to Scott Gesty for pointing me to this one, a Forbes write-up about the many problems with the former HB 932 (the Floyd McDowell "I'm going to saddle Delaware with this crap if I have to get it re-introduced three hundred times" bill), which Representatives Kowalko and Jacques have promised to bring back in January.

This article doesn't actually say anything that Libertarian critics like Jesse McVay and I didn't lay out in detail a few months back, but this is to a national audience, and the brevity of the article gives it punch.

Here's a snippet, but read the whole thing:
But worst of all, our healthcare will no longer be in our control. The Orwellian and non-elected “Authority” will dictate what kind of care Delawareans can and cannot have. Supplemental insurance, which we provide to our employees in other single-payer jurisdictions (i.e. Sweden and the UK), is outlawed by the bill. 
I'm betting that there are too many Democrats in the General Assembly to allow this crappy bill out of committee, but I'm not betting on that too heavily.

Thursday, November 22, 2012

Here's hoping the DE GOP does not listen to Bret Stephens, but that Libertarians will

In a brilliant dissection of the Republican disconnect and descent in irrelevant oblivion, Bret Stephens explains, issue by issue, what the GOP would need to change to significant again. [h/t Kids Prefer Cheese by the way]. [My notes for Libertarians follow each section in blue.

On marriage equality:
If gay people wish to lead conventionally bourgeois lives by getting married, that may be lunacy on their part but it’s a credit to our values. Channeling passions that cannot be repressed toward socially productive ends is the genius of the American way. The alternative is the tapped foot and the wide stance.
Thankfully, the LPD is already there:  we're on record for marriage equality as the next best thing to getting government completely out of the marriage business.

On abortion:
Please tone down the abortion extremism. Supporting so-called partial-birth abortions, as too many liberals do, is abortion extremism. But so is opposing abortion in cases of rape and incest, to say nothing of the life of the mother. Democrats did better with a president who wanted abortion to be “safe, legal and rare”; Republicans would have done better by adopting former Indiana Gov. Mitch Daniels’s call for a “truce” on social issues. 
Libertarians have a genuine "big tent" on this one, and we need to remind people of that.  I am strongly for abortion rights, but I co-exist with other Libertarians who maintain a staunch anti-abortion position.  Where we agree is that (a) this can't be a one-issue litmus-test party and (b) keeping government funding and advocacy out of the issue is critical.

(As a side note, I will never forget how effective Virginia gubernatorial candidate Doug Wilder--no Libertarian, he!--was on this issue in the late 1980s.  When asked about abortion, he looked at the camera, smiled broadly and said [paraphrase], I prefer to trust the women of Virginia rather than the government to make these decisions.)

On insisting that English be declared the national language:
By the way, what’s so awful about Spanish? It’s a fine European language with an outstanding literary tradition—Cervantes, Borges, Paz, Vargas Llosa—and it would do you no harm to learn it. Bilingualism is an intellectual virtue, not a deviant sexual practice.
Libertarians would argue that the government has no damn business declaring any language to be "the national language."  A more pure example of unbridled statism would be difficult to find.

On the scientific illiteracy of some GOP candidates:
Which reminds me: Can we, as the GOP base, demand an IQ exam as well as a test of basic knowledge from our congressional and presidential candidates? This is not a flippant suggestion: There were at least five Senate seats in this election cycle that might have been occupied by a Republican come January had not the invincible stupidity of the candidate stood in the way. 
This one is important:  when we put people forth to speak for us, or as candidates, they need to be mindful of exactly what they are saying, and for the need to be credible at all times.

On immigration reform:
On the subject of idiocy, can someone explain where’s the political gold in demonizing Latin American immigrants? California’s Prop 187, passed in 1994, helped destroy the GOP in a once-reliable state. Yet Republicans have been trying to replicate that fiasco on a national scale ever since. 
If the argument is that illegal immigrants are overtaxing the welfare state, then that’s an argument for paring back the welfare state, not deporting 12 million people. If the argument is that these immigrants “steal” jobs, then that’s an argument by someone who either doesn’t understand the free market or aspires for his children to become busboys and chambermaids. 
And if the argument is that these immigrants don’t share our values, then religiosity, hard work, personal stoicism and the sense of family obligation expressed through billions of dollars in remittances aren’t American values. 
This argument is a perfect example of reframing an argument, and it is exactly what we need to learn how to do better.  Libertarian arguments are pretty much arguments from basic American values (self-reliance, non-aggression, voluntary cooperation) and we need to keep emphasizing that WE represent that mainstream.

Fortunately, there are no signs that the Delaware (or national) GOP are anywhere close to learning these lessons.  As evidence, all you need to do is tick off the names of the folks who are currently out front as "intellectual leaders" of the Delaware Republican Party:  John Sigler, David Anderson, Don Ayotte, Jon Moseley, Evan Quietsch, Pat Fish, Frank Knotts. . . .

Wednesday, November 21, 2012

Profoundly grateful to Beth Miller of the News Journal . . .

Brenda and Matt Petke: as I will remember them
. . . for the grace and sensitivity she brought to the story yesterday on the impact that Matt and Brenda Petke's lives have had on everyone in Delaware, whether they were fortunate enough to ever meet them  or not.

On Sunday afternoon I came home from a meeting in Dover to find that Matt had raked up all the leaves in my yard because he knew that with stitches in my back from recent surgery I would not be able to do it.  He had also detailed my eldest daughter's car and done a variety of small tasks for all of his neighbors.  Matt didn't like sitting still.

We sent our nine-year-old grandson down to his house a little later to give him a pumpkin pie in appreciation for his work.  Laughing, he told Shane that he was tempted to sneak a piece of the pie before he took Brenda out to dinner that night.

I'm always going to hope that he did.

US Senate quietly penciling in new government authority to

At least if Senator Patrick Leahy gets his way.

Here's the set of amendments the Senator is set to introduce to a bill that was widely touted as improving our rights to cyber-privacy:
✭ Grants warrantless access to Americans' electronic correspondence to over 22 federal agencies. Only a subpoena is required, not a search warrant signed by a judge based on probable cause.✭ Permits state and local law enforcement to warrantlessly access Americans' correspondence stored on systems not offered "to the public," including university networks.✭ Authorizes any law enforcement agency to access accounts without a warrant -- or subsequent court review -- if they claim "emergency" situations exist.✭ Says providers "shall notify" law enforcement in advance of any plans to tell their customers that they've been the target of a warrant, order, or subpoena.✭ Delays notification of customers whose accounts have been accessed from 3 days to "10 business days." This notification can be postponed by up to 360 days.
By the way, the current text of the bill defines the agencies that will acquire the power to access your emails, your Facebook accounts, your Twitter account, your documents stored with any online back-up provider:
. . . any executive department, military department, Government corporation, Government controlled corporation, or other establishment in the executive branch of the Government (including the Executive Office of the President), or any independent regulatory agency...
Who's included?  Here's a partial list:
Federal ReserveFederal Trade CommissionFederal Maritime CommissionPostal Regulatory CommissionNational Labor Relations BoardMine Enforcement Safety and Health Review CommissionOSHASecurities and Exchange CommissionGeneral Accounting OfficeUS Department of EducationSocial Security AdministrationFederal Communications Commission. . . and the list goes on and on and on like the Energizer Bunny . . .
This is WAY beyond any arguments about national security, folks.

What does the Postal Regulatory Commission or the US Department of Education have to do with protecting me from . . . anyone.

The slippery slope has gone from national security to the ease with which government prosecutions can be carried on for non-security related issues.


But, of course, our own Congressional delegation, as well as our own local supporters of President Obama's anti-civil liberties agenda, will roll right over on this one, too.

Not exactly Agenda 21, but now the UN weighs in on drug legalization in the US

It could be expected that the Drug Enforcement Administration would resist the legal changes in Colorado, Washington, and parts of Michigan to legalize marijuana.

It could also be expected that congressional delegations as cowardly as our own would not stand up for the majorities of citizens in those states (and around the nation, according to most polls) calling for an end not only to marijuana Prohibition, but also to the failed and destructive "war on drugs."

But I have to admit that it came as something of an Agenda 21-type surprise to find a senior UN official weighing in on what he and his organization think the correct Federal response should be:

VIENNA -- The head of the U.N. drug watchdog agency is urging U.S. federal officials to challenge ballot measures in Colorado and Washington that decriminalized possession of small amounts of marijuana for adults 21 and over. 
Raymond Yans says the approvals send "a wrong message to the rest of the nation and it sends a wrong message abroad." 
Yans heads the International Narcotics Control Board. He told The Associated Press on Tuesday he hopes Attorney General Eric Holder "will take all the necessary measures" to ensure that marijuana possession and use remains illegal throughout the U.S.
What exactly is that "wrong message," Mr. Yan?

That people in a democratic society have a right to decide for themselves what substances to put in their bodies?

That treating drug addiction issues like medical rather than criminal problems is a bad thing, because we don't have sufficient narco-terrorism due to the thriving trade in now-illegal substances?

That the US made a horrible mistake in repealing prohibition?

That the heads of state of multiple Central and South American governments who have applauded this change are both wrong and evil?

Or is it that the UN really is increasingly feeling like it should play a role in determining the internal social policies not just in the developing (read "dark-skinned") world, but also in the industrialized nations?

Remember the lobbyist-free administration we were promised?

70% of retired generals go to work for the defense industry, often using clearances and briefings to which they are still entitled to gain contracts for their new employers:

  • Dozens of retired generals employed by defense firms maintain Pentagon advisory roles, giving them unparalleled levels of influence and access to inside information on Department of Defense procurement plans.
  • The generals are, in many cases, recruited for private sector roles well before they retire, raising questions about their independence and judgment while still in uniform. The Pentagon is aware and even supports this practice.
  • The feeder system from some commands to certain defense firms is so powerful that successive generations of commanders have been hired by the same firms or into the same field. For example, the last seven generals and admirals who worked as Department of Defense gatekeepers for international arms sales are now helping military contractors sell weapons and defense technology overseas.
I once asked Senator Tom Carper about the broken Obama administration promise to curtail the impact of lobbyists on the Federal government.  I will always treasure his answer that it was unwise to lose the expertise of these people just because they had left direct government service, and that he saw no inherent conflict of interest in the revolving door between corporate America and governmental Washington.

That defense/industrial complex President Eisenhower warned us about?

Shame on us for not listening.

US military will cut health care for troops and their families before we cut back on wars

Instead of cutting back our foreign military entanglements, the Congressional Budget Office and the Pentagon are looking to cut the pay raises and health care benefits for US troops and their families in the event of a "fiscal cliff."

The fact that many of our military families are on food stamps or other forms of welfare, and that military pay raises have not even kept pace with benefit raises for those on public assistance notwithstanding, the CBO believes that one way to mitigate the fiscal cliff is to cap future military pay raises:
The CBO says that any impact reducing pay increases might have on recruiting and retention can be mitigated by offering larger enlistment and reenlistment bonuses.   The CBO pay cap option would mean military pay would lose nine percent to private sector wage growth over the five-year period.
Apparently paying a decent wage to the people (and the families thereof) that we send overseas to fight and die in our wars is not a profound concern to the US government.  Indeed, that government apparently isn't even interested in knowing how many military families are living in hardship:

The Defense Department doesn’t dispute or confirm the current number, and instead, refers such requests to the Defense Finance and Accounting. 
“We are the agency that would be tasked to gather that information,” said Carol Garcia, DFAS spokesperson. “But we haven’t collected it and aren’t looking for it because we haven’t been asked to.”
Also on the table is reducing the value of military medical coverage for our soldiers' families:
The CBO also suggests an option to raise TRICARE enrollment fees, deductibles or copayments, actions also proposed by the administration last April.  For working-age retirees, those under 65, fee hikes should be phased over five years and use a “tiered approach” so that senior-grade retirees would pay higher fees than lower-ranking retirees. 
Philpott reports that the CBO says higher enrollment fees not only would raise collections but also discourage retirees and families from relying on military health care versus civilian employer health insurance.  Higher deductibles and co-pays would restrain use of medical services too and also lower TRICARE costs.
I want you to re-read that last sentence in bold very carefully.  This marks a public statement by the Congressional Budget Office that the government intends to raise premiums explicitly to keep people from receiving medical services.  This is what the US government means when it talks about "lowering health care costs," and it belies the rhetoric that the government is interested in insuring that all Americans have access to quality health care.

No, this is the government saying, "We're going to take our military population, which is already so underpaid that thousands of our soldiers' families are on food stamps, and not only cap their future pay raises, but also ration their health care."

Now, as a Libertarian, I need to do a little educating here.  One facet of Libertarianism is the belief that government intervention should be minimalist at best.  And we could have achieved this goal with respect to the US military a long time ago by simply monetizing the benefits provided to soldiers and their families.  I recall clearly on active duty that we were always told, "Yes, your pay is low, but if you add in the value of all your benefits, it goes up to this figure."  So let's just pay our troops the value of those benefits and let them shop for themselves.  Doing so, however, is not currently possible because that would eliminate vast levels of government bureaucracy.  But the sad fact is that we could afford to pay our average enlisted infantryman $100K per year and still save money if not for that bloated support system.

A second point:  an equally important tenet of Libertarianism is is that you cannot actually trust the government (or other big organizations like mega-corporations) to keep their promises.

An example relevant to the current conversation:  in August, President Barack Obama promised soldiers and their families that neither their pay nor their health care benefits would be on the table in the fiscal cliff/sequestration crisis:

President Barack Obama will protect all accounts used to pay for military personnel from deep spending cuts that would kick in Jan. 2 if lawmakers fail to pass a $1.2 trillion deficit-reduction measure, placing a bulls eye on civilian employees and weapon programs. 
The move "is considered to be in the national interest to safeguard the resources to compensate the men and women service to defend our nation and to maintain the force levels required for national security," Obama writes in a July 31 memo sent to congressional leaders.
Now that the election is over, military families, surprise surprise--another politician lied to you to get your vote.

Monday, November 19, 2012


If you read Delaware Online you will see the story of two people killed in a tractor trailer crash last night.

Matt and Brenda Petke were our neighbors and our friends.  There are things that need to be done.

I'll check in here tomorrow.

It's important to remember (and too easy to forget) that it is ALWAYS somebody's family, somebody's neighbor, somebody's friend when you read these headlines.

Friday, November 16, 2012

The brief hiatus

Sorry, folks, had to have a bit of minor surgery today.  Everything worked out fine, but I won't be posting again here till probably Sunday.

Wednesday, November 14, 2012

Here's a challenge for Karin Weldin Stewart: MedExpress is Highmark, and that's a problem for both Delaware consumers and business people

See? MedExpress even has a guy
in a Blue Hen costume to go along
with bazillions in advertising.
So by now you have seen or heard all the advertisements for MedExpress, the "neighborly place" to get urgent medical care.

And as I have said elsewhere about them,
Whenever you hear a corporation (banks also come to mind here) talking about being a good neighbor, you know you need to hold onto your wallet.
But that's not specifically germane to the question of why our Insurance Commissioner should be interested in them.

What's germane is that MedExpress is a wholly owned subsidiary of Blue Cross Blue Shield Highmark, the good folks who just bought out the BCBS franchise for Delaware.  So for many of us, if we go to a MedExpress, no matter how friendly and how neighborly they may appear to be, we are really going to a subsidiary of our own insurance company for treatment.

This has some interesting implications, not just for patients, but also for other (some locally owned) urgent care centers around the state.

You see, among other things, according to what local physicians have told me, Highmark compensates other urgent care facilities seeing their patients at  $120/visit, but gives preferential reimbursement to their own facilities at $150/visit.

Moreover, MedExpress seems to be strangely immune to some of the technical legal niceties regarding whether or not you can own the lab attached to your own urgent care facility, and similar arrangements.

To the owners of other urgent care facilities (which includes Christiana Care, owning four in the area), MedExpress has made no bones about the fact that these clinics are coming into Delaware to do "Wal-Mart" on them--to use their incestuous corporate edge to drive their own prices down (temporarily) and drive everybody else out of business.

Of course, you can make your own estimate of where prices will thereafter go.

I wonder where the insurance commissioner is when the major carrier in the state slops over into providing medical care and then gives itself preferential compensation rates?

Oh, wait.  I forgot who the insurance commissioner is.  Never mind.

A note to forestall certain comments:  this is not a Libertarian whining for government intervention to correct the free market.  There is no free market here, there is a government-regulated market.  That's the only game in town.  This is a Libertarian pointing out that the government regulators appearing to be failing miserably at their jobs, and--as a result (no surprise!)--are privileging large corporations over local business people and entrepreneurs.

You claim to be able to run these markets in the public interest?  Then let's see you do it?

(And while you are at it, ask yourself whether the fact that Highmark/MedExpress is paying for massive advertising in the WNJ and on local radio has anything to do with why our dauntless media is not investigating this story.)

Final note:  if you want to find out about a true good neighbor urgent care facility in Delaware, check out Dr. Vince Schaller's Hockessin Walk-in.  Take five minutes to read about his operation and you will, frankly, drive right past the MedExpress the next time you need urgent care.

Tuesday, November 13, 2012

"Short women probably put more energy into reproducing": unbelievably, this is NOT a quote from a Republican candidate. . .

. . . but actual science!?

Public Education: How do we stop being everybody's laboratory

I'm serious.  Let's take a look at the state of Delaware public education.

We will apparently try anything once, and having tried it, we will organize an interest group to promote it an insure it never dies.

We've had (or still have, sometimes the boundaries are fuzzy) standards, high-stakes standardized testing in many different incarnation, benchmarks built off of the standards, performance indicators built off the benchmarks, authentic assessment, smarter balanced assessment, nationally normed assessment, state-generated assessments that had neither reliability nor validity but could control your child's destiny, lead teachers, data coaches, PLCs, magnet schools, alternative schools, online programs, charter schools, independent private schools, catholic schools (though not as many as before), themed schools, alternative routes to certification, new graduation requirements, different graduation requirements, common core standards, Vision 2012, Vision 2015, No Child Left Behind, Race to the Top, character education, school choice, no snack foods in schools, schools without cafeterias, schools based on letting in only bright kids, schools based on letting in only underprivileged kids, State Superintendents, State Secretaries of Education, schools with police officers in them, schools without police officers in them. . . .

This is starting to sound like the bad clone of a Tom Gordon campaign commercial, isn't it?

And I'm sure you could add more.

Some of these programs have been imposed on us by the Feds, others we have inflicted on ourselves, and others . . . just sort of happened and nobody's taking credit/blame for them (failure is always an orphan).

Jack Markell may be uniquely qualified to become the next Secretary of Education because he comes from the only state that has literally been gullible enough to try ANYTHING and EVERYTHING in the name of public education.  If it's a fad, we've fadded.  If it's a hoax, we've been taken in.  If it produces unintended consequences, we're living with them.

And we are still, demonstrably, failing at public education in Delaware.  Not everybody, not all schools.

But we are still condemning thousands of students to a substandard education in the one state that is small enough (in terms of population) and compact enough (in terms of geography) that we ought to be able to educate every single child to his-her-its highest potential.

We used to complain about having a state that is overall smaller than many urban school districts divided into 19 different school districts.  Now we have 19 school districts and I can't count how many charter schools, and we still have some of the highest private school enrollment in the entire country.

So here's my proposition (with apologies to Jonathan Swift):  Let's declare a ten-year moratorium on large-scale innovation in our public schools, and--during that time--if a current innovation fails (like a charter school or a dance program or whatever), let's put out a standing DNR order (Do Not Resuscitate) and let what's supposed to happen to failed experiments happen.  (I'm actually calling for a little Educational Darwinism among experimental programs, aren't I?)

Then let's actually focus our resources an our attention on educating poor kids and kids with special needs for a decade, because (you know what?) middle class and upper middle class parents will find a way to get their kids educated to their specifications, especially if we make them rather than the government responsible for funding their experiments.

I will be in my bunker waiting for bombs.

A few quick hits

1.  Newt Gingrich is baffled by the election results, particularly the part where Romney got fewer votes than McCain.

2.  Former Bush spokeswoman Karen Hughes takes a shot at Republican men talking about rape (one wonders why she didn't do this before the election):

"And if another Republican man says anything about rape other than it is a horrific, violent crime, I want to personally cut out his tongue," she wrote. "The college-age daughters of many of my friends voted for Obama because they were completely turned off by Neanderthal comments like the suggestion of 'legitimate rape.'"
3.  Keystone Politics chides Democrats for not loving the Libertarian Party more (and for not sending us more money).    If any Delaware Democrats would like to help fund the growth of the Libertarian Party (and the concurrent elimination of the Republican Party), please please let me know.

4.  The Los Angeles Times thinks maybe America has gone from being a Center-Right nation to being a Center-Libertarian nation.  Of course, sooner or later five Libertarians with eight different definitions of the ideology will show up in the comments section to explain that they got it wrong.  These are my people . . . .

Michael Munger's modest proposal for immigration reform

Caught this last week at Kids Prefer Cheese and meant to post about it, but as usual stuff happened.

Noting that there is now an outcry to "deal" with immigration reform after the election, Munger proposes a skeletal outline of what reform should look like:
What should this reform look like?
1. an easy path to citizenship for current "illegals"
2. all college diplomas earned by foreigners come with a green card stapled to them
3. a massive (triple? quadruple?) increase in the amount of visas for skilled workers
4. make the process for getting green cards and becoming citizens faster and cheaper
5. a gradually increasing flow of "unskilled" immigrants from around the world
 The only substantive criticism of these ideas that I have yet seen regards #1 and the propensity toward grade inflation ("If I don't pass this class, Professor, I can't become a citizen!").  But since grade inflation in higher education already exists in massive proportions, I'm not too worried about it.

But the reality of immigration is that it comes down to whether you see each new person entering the country as having one mouth (a potential welfare recipient who consumes our resources; a "taker") or two hands (a potential contributor to the economy and culture of the United Staates; a "maker").

There is also the issue that you cannot really resolve immigration issues until (a) you end the drug war and remove much of the economic motivation associated there, and (b) come up with a much more realistic strategy of dealing with the developing (including Islamic) world that does not require us to keep living in fear that some Al Qaeda operative will wade the Rio Grande disguised among all the hispanics (all brown people DO look alike, apparently).

Monday, November 12, 2012

Brilliant (brief) foreign policy send-up at

You probably have not heard the term "anti-access," and don't know how it relates to the militarizing of American foreign policy.  This article will take about five minutes to read, and leave you with some high-quality questions:

A snippet: 

Take, for example, a piece in the most recent issue ofForeign Affairs, the main establishment journal, by Andrew Krepinevich, a West Point graduate with a PhD. from Harvard who has served on the personal staff of three Defense Secretaries and now heads the Center for Strategic and Budgetary Assessments think-tank. Here is a key sentence:
"The challenges that China and Iran pose for U.S. security lie not in the threat of traditional cross-border invasions but in efforts to establish spheres of influence in, and ultimately to control access to, critically important regions."
Now, if that is how most Americans understand the supposed top two greatest threats the country faces, I’ll eat my foot. What the public sees constantly streaming on television, across headlines, and rushing out of politicians mouths is that Iran and China are outlaw states that are threats to the security of Americans. And that’s whypolling generally shows Americans are troubled by these two threats.