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Showing posts from November, 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 o

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 suppor

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 th

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

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  lais

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 m

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

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 G

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: P lease 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

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

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

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 ov

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 conc


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.

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

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 Chi

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 C

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 p

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 of Foreign 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 se