More Good News On Health Care Reform

With Republicans constantly putting out false ads and other misinformation regarding the effects of the Affordable Care Act, it is worthwhile to periodically look at the real news. As Politico points out, millions more people now have health care coverage:

A panel of health insurers agreed Tuesday that the number of insured people in the country has climbed by millions, despite arguments by some Republicans that the insured population has declined because of canceled plans.

“I don’t doubt that,” said Jay Gellert, president and CEO of the California-based Health Net, when asked whether there’s any real question that the nation’s insured population has grown.

Gellert spoke at a POLITICO Pro Health Care Breakfast Briefing with Karen Ignagni, CEO of the trade group America’s Health Insurance Plans, and James Roosevelt, president and CEO of the Massachusetts-based Tufts Health Plan.

Ignagni said that the rush of sign-ups late in the Affordable Care Act’s first enrollment period – which ended March 31 – were significantly younger than the earliest enrollees.

Some of those who initially opposed Obamacare are now benefiting from it:

Dean Angstadt fells trees for a living.

He’s a self-employed, self-sufficient logger who has cleared his own path for most of his 57 years, never expecting help from anyone. And even though he’d been uninsured since 2009, he especially wanted nothing to do with the Affordable Care Act.

“I don’t read what the Democrats have to say about it because I think they’re full of it,” he told his friend Bob Leinhauser, who suggested he sign up.

That refrain changed this year when a faulty aortic valve almost felled Angstadt. Suddenly, he was facing a choice: Buy a health plan, through a law he despised, that would pay the lion’s share of the cost of the life-saving surgery – or die. He chose the former.

“A lot of people I talk to are so misinformed about the ACA,” Angstadt said. “I was, before Bob went through all this for me. I would recommend it to anybody and, in fact, have encouraged friends, including the one guy who hauls my logs.”

Later in the report:

Angstadt faces a long recovery, but his conversion to ACA supporter is done. The political storm around the ACA, he said, is the political parties “fighting each other over things that can benefit people.”

“For me, this isn’t about politics,” he added. “I’m trying to help other people who are like me, stubborn and bullheaded, who refused to even look. From my own experience, the ACA is everything it’s supposed to be and, in fact, better than it’s made out to be.”

This example is of a person who had been uninsured because of being self-employed. One benefit of the Affordable Care Act, often distorted by conservatives, has been to get people out of the “insurance trap” where they had to work for large companies in order to obtain coverage. This means more people can start their own businesses or retire early:

Until recently, Mike Smith, 64, worked 11 hours a day, Monday through Friday and then half a day on Saturday, as a district manager for a national auto parts chain — a schedule he’s kept for nearly 40 years.  Early retirement, while certainly appealing, wasn’t a viable option for him because both he and his already-retired wife, Laura, also 64, relied heavily on his job-provided health insurance.

“At our age, with some preexisting medical conditions, it would have been very costly to buy insurance on the open market – about $3,000 a month,” he says.

But the Affordable Care Act changed that. The federal health law bars insurance companies from charging higher premiums to those with preexisting conditions, so the Smiths have been able to find a plan they can afford. The couple pays $200 a month for a subsidized health insurance policy they bought through California’s state-run marketplace, Covered California.

And that’s brought a big change to Smith’s household:  He’s joined Laura in early retirement. That means more time for him to help Laura care for his elderly in-laws as well as more down time to pursue some budding passions, namely playing his guitar and cooking new recipes.

But early retirees aren’t the only people benefitting from the federal health law.

A recent study by Georgetown University and the Urban Institute predicts the ACA will enable up to 1.5 million Americans to leave unfulfilling jobs and become self-employed or start new businesses. It’s a finding that runs counter to forecasts by ACA critics, who contend the federal health law will cost the nation jobs and cripple America’s small business economy.

It will take years to know for certain how the health law will change the work landscape broadly, but already the law has changed life for Rebecca Murray.

Last year, the Chicago resident says, her husband — a freelance IT worker — was diagnosed with chronic spinal arthritis. He needed good health insurance, which he received through Murray’s job as a social worker for a dialysis corporation. But Murray didn’t like her job.

Murray and her husband are both 31, with a 20-month-old daughter and a second child on the way. Before the Affordable Care Act, they couldn’t get insurance on the individual market market because of his preexisting condition.

But under the federal health law, they now qualify for a subsidized policy that will cost $535 a month for the whole family. Not inexpensive by any means, she says, but it does allow her to quit her job and launch an online business to help young women, like her, take care of sick loved ones.

“It’s thrilling. It’s exciting. It’s kind of like taking a leap into the unknown, and I know it’s a big risk,” she says of her new venture. “But this really is allowing me to finally step into what I feel is truly satisfying for the soul,” she says, adding that just a year ago, “I was convinced I would be a renal social worker for the next 30-something years and just raise my kids and hope they could live out their dreams instead.”

As more good news gets out about the successes of the Affordable Care Act, Republicans might find it increasingly difficult to continue with their false attacks, as Rick Scott has learned:

Gov. Rick Scott visited a senior center Tuesday to warn about cuts he said Obamacare is forcing in a popular version of the Medicare health program and to collect their horror stories.

What he found was a satisfied group with few complaints.

The 20 seniors assembled for a roundtable with Scott at the Volen Center were largely content with their Medicare coverage and didn’t have negative stories to recount.

And some praised Obamacare – a program that Scott frequently criticizes.

“I’m completely satisfied,” Harvey Eisen, 92, a West Boca resident, told Scott.

Eisen told the governor he wasn’t sure “if, as you say,” there are Obamacare-inspired cuts to Medicare. But even if there are, that would be OK. “I can’t expect that me as a senior citizen are going to get preferential treatment when other programs are also being cut.”

Ruthlyn Rubin, 66, of Boca Raton, told the governor that people who are too young for Medicare need the health coverage they get from Obamacare. If young people don’t have insurance, she said, everyone else ends up paying for their care when they get sick or injured and end up in the hospital.

Eventually, Rubin said, Obamacare will become more popular. “People were appalled at Social Security.  They were appalled at Medicare when it came out. I think these major changes take some people aback. But I think we have to be careful not to just rely on the fact that we’re seniors and have an entitlement to certain things,” she said.

Republican scare stories about Medicare should become less effective as seniors find that the Republican claims are false and that in reality Obama has increased, and not reduced, benefits for Medicare recipients.

Quote of the Day: Jon Stewart on Sean Hannity

“I am obsessed with your program in the same way that I’m obsessed with antibiotic-resistant superbugs or the Pacific garbage patch or the KFC Double Down. Because I just can’t believe that in this day and age, with all that we know, this shit is out there — that humanity, that our society, is still weighed down by these burdens of a seemingly more medieval time. Like your show. To see it night after night, serving up the same shit, my god, you’re the Arby’s of news.” –Jon Stewart on Sean Hanity

Conservative Victims And Science Fiction Fandom

robert heinlein

In principle I agree with the general argument made by Glenn Reynolds that politics doesn’t belong in science fiction, but knowing how conservative love to claim to be victims, I am skeptical as to the circumstances he described. He wrote:

That’s certainly been the experience of Larry Correia, who was nominated for a Hugo this year. Correia, the author of numerous highly successful science fiction books like Monster Hunter Internationaland Hard Magic, is getting a lot of flak because he’s a right-leaning libertarian. Makes you wonder if Robert Heinlein could get a Hugo Award today. (Answer: Probably not.)

I don’t know enough about the politics in science fiction fandom to know if this is the case, and wonder if “getting a lot of flak” is simply a daily occurrence in fandom for many regardless of their political views. His books are selling. He was nominated for a Hugo, which hardly makes it appear like he is truly ostracized for his beliefs. Reynold’s view in this op-ed also looks suspicious to me because of his claim that Robert Heinlein could not get a Hugo Award today. I am a huge fan of Robert Heinlein, and know many liberals who share this view.

There are aspects of Heinlein’s work which attracted liberals, conservatives, and libertarians, and most liberal science fiction fans I know do not have an ideological litmus test for enjoying the work of an author. Heinlein died in 1988 which also makes it impossible to categorize him by today’s political battles. His support for individual (and sexual) liberty and opposition to religious dogma and racism would align him with liberals over conservatives on many current issues. Whether he would be categorized as a libertarian today would depend on which of the many strands of libertarianism you are speaking of. I suspect he would only have contempt for people such as the Koch brothers who use government to make money while only being consistently libertarian in opposing regulation of their businesses. Heinlein was even further away from Ron Paul ideologically. While he displayed considerable support for the military in Starship Troopers, published in 1959, I wonder if his support for the Viet Nam war would have changed if he lived longer, and if he would have approved of the misuse of military power to invade Iraq.

Reynolds also cited the ouster of Mozilla CEO Brandon Eich, but again conservatives who desire to portray themselves as the victim generally gave a simplistic and incorrect description of this event. Mozilla is not a traditional company, and those in the Mozilla community who saw Mozilla as more of a cause than a business were responsible for forcing Eich out. Some liberals weighed in with concern over whether it was fair for Eich to be forced out over his political beliefs.

SciFi Weekend: Arrow; Orphan Black; Hannibal; Agents of SHIELD; The Blacklist; The Americans; Fargo; Mad Men; How I Met Your Mother/Dad; Game of Thrones; The Newsroom

Arrow Moira

This week’s Arrow, Seeing Red, deserves the lead for including a change to the show almost as significant as the recent change on Agents of SHIELD and for  psychological horror inflicted upon the main character as disturbing as what we would expect from Hannibal. Initially viewers probably thought that the red in the episode title referred to Roy’s red hood as the Mirakuru had him go on a rampage. Instead the significance of the episode was how it ended with blood.

In retrospect it is clear the episode was both providing a farewell to Moira Queen and making her sacrifice plausible by concentrating on her love for her children. Susanna Thompson will certainly be missed. She dealt with Oliver getting a girl pregnant in a flashback, and in the main story almost dropped out of the race for mayor to try to repair her relationship with Thea. The only reason she remained in the race was the thought that it might help Thea more by being in the role of someone helping the city.

Late in the episode I thought the cliff hanger was going to be the secret Moira was about o tell about Malcolm Merlin when their car was hit, but the real drama of this week’s episode was still to come. Slade recreated the scene in the island with Sara and Shado, this time demanding that Oliver decide between Moira and Thea. Moira spared Oliver from making the decision in sacrificing herself. Slade ran his sword through her heart, telling her that he respected her courage, and saying that one more person still had to die. Is Felicity now in danger?

While Moira’s death was the major change in the show, there were others, such as the change to Roy. Now that it is established that Oliver has a son in Central City, there is no doubt that this will come up again, perhaps creating another connection to The Flash. I found it surprising that Sara would leave Oliver at a time of such danger and perhaps this will cause her to return, hopefully with reinforcements among her assassin friends. I wouldn’t be surprised if Sara dies in the final battle against Slade, or as his final planned last victim, leaving the way open for Laurel to become the Black Canary as in the comics (or perhaps they will differ from the comics on this matter indefinitely).

arrow seeing-red-moira-dead

The Hollywood Reporter spoke with executive producer Andrew Kreisberg about Moira’s death:

“It wasn’t something we were talking about last year. I don’t want to give the impression that [it was like] ‘Welp! Somebody has to die; let’s spin the wheel. And, bad luck, Moira,’ ” he further explained. “Susanna has been with the show since the beginning, and she was one of our big gets early on that really signaled to the audience and to reviewers that this wasn’t your average CW show, it wasn’t your average superhero show. Like with Colin Donnell [whose character Tommy died in the season-one finale], these last episodes are her pinnacle.”

At the end of the day, the decision came down to the finite number of directions Moira’s story could go. From the producers’ perspectives, it seemed they had exhausted nearly all their options. After all, Moira was a part of the Undertaking, went to jail as punishment, ran for Starling City mayor, kept the identity of Thea’s biological father a secret and knew of Oliver’s Arrow life. And that’s just the half of it. “When we were talking about the future, knowing that it was only going to be powerful if Slade was going to change the game by doing something truly monstrous — if Moira wins the mayorship, if she makes up with her kids, what is Moira without a giant secret?” Kreisberg said. “If they all forgive her, and then there’s some other giant secret, for us it felt like we were becoming a soap opera.”

By allowing Moira the opportunity to sacrifice herself for her kids, “she could die a hero’s death,” he said. Even though she’s attempted to turn over a new leaf, just seconds before the car accident, Moira was about to reveal yet another secret. “You can’t change her. She literally goes to the grave despite the fact that she sacrifices herself for her children,” Kreisberg said, hinting that Moira’s final secret plays out “sooner than you think.”

Next week’s episode, “City of Blood,” opens with Moira’s funeral — and Oliver is missing. “There’s a line in the next episode where Walter says to Thea, ‘Your mother showed you how much she loved you in ways few parents can,’ and yet she was still lying,” Kreisberg previewed. “Ending it at this time left you with that great feeling of what a great character she was rather then let her become a caricature.”

As Oliver and Thea head into the thick of the storm, their personal loss drives them for the rest of the series. “That was the math — it was horrible math, it was tearful math but her death has a profound impact on everyone on the series,” Kreisberg promised. “It’s certainly what’s going to drive Oliver in these last three episodes. It’s going to drive Thea, not only in these last three episodes, but also into [season] three. Sometimes the worst thing you can do personally is the best thing you can do professionally.”

But it was Moira’s surprising admission that she knew of Oliver’s secret life as the vigilante that was eyebrow-raising. “We had always talked about the idea that Moira knew Oliver was the Arrow,” Kreisberg said, revealing that there were “a couple of other places” where the producers thought Moira should inform Oliver. But he pointed to a pivotal scene in “Sacrifice,” where Oliver essentially talks to his mother as the Arrow amid the Undertaking, as her moment of revelation. “She’d be borderline low IQ if she wasn’t like, ‘Wait a minute!’ We liked that she had never told him, and everything just felt like it came together in this one episode.”

Arrow wasn’t done with the bombshells. It was revealed in flashbacks that Oliver had fathered a child before his time on the island and that Moira paid the woman $1 million to disappear and lie about losing the baby. “The seeds for season two were planted in season one and again, the best part of the success that the show has had is knowing that we were going to make more and knowing that we could drop these things in and pay them off later,” Kreisberg said. “This is something that will be paid off in season three.”

Orphan_Black_Episode_2_Donnie_Allison

Watching Orphan Black is essentially a matter of finding answers to questions and then having still more questions. Governed by Sound Reason and True Religion had Sarah searching for Kira, Alison looking into the identity of her monitor, and Cosima looking into their genome for explanations about her illness and why Sarah is the only one of the clones who can have children. We also learned more about Helena and the Prolethians.

I was happy to see that Sarah’s search for Kira was resolved without dragging it out for several weeks. They made good use of the relationship between Sarah and Kira by having Kira make the final decision to run after Kira told her things did not feel right. The episode included the return of Mrs. S, who we were given reason to be suspicious of late in the first season. Mrs. S’s motivations appeared questionable at one point, but ultimately it was her “friends” from the old network who previously helped them disappear who were deceiving them and at it does look like Mrs. S really has been on Sarah’s side as she claimed.

Allison looked like she might fall apart after realizing she was mistaken in thinking Aynsley was her monitor and not acting to save her from choking. She wound up working far better with Felix than we would have guessed from Allison’s initial introduction first season. They managed to trap Donnie, who isn’t the brightest of Leekie’s people, by having him overhear a conversation about meeting Sarah, who turned out to be a different Sarah from her community play. I’m not sure about a play with lines such as “We must heed the call, picking the brains off the wall,” but remain glad that it is not Cats.

While Cosima’s major role is to look into the science, her most notable scene was meeting Rachel, who was assaulted by Sarah pretending to be Cosima last week. “I’m Cosima. The real Cosima. Not the one who kicked your ass or whatever.” Rachel acknowledged seeing Cosima kiss Delphine by saying  “So, you’re gay?” with Cosima responding, “My sexuality is not the most interesting thing about me.”

Orphan Black henrik

We also learned that Helena survived a shot to the heart thanks to dextrocardia, or in her case being a mirror image of her twin Sarah. We have a new sect of Prolethians who have a different view of the clones, and no qualms about killing those who do not follow their views. The Hollywood Reporter interviewed Peter Outerbridge, who plays new Prolethian leader Henrik Johansson:

Henrik has a line in this episode where he says Helena’s existence is “God opening a whole new door,” which seems to sum up his motivations, his beliefs and his desires pretty well.

Exactly. He doesn’t see the clones as an abomination at all. He thinks they’re fascinating. In fact, perhaps the next phase in evolution. If that’s the case, it’s all part of God’s plan and he’s going to a part of it.

Is Henrik’s assessment of the clones correct? Is this a question that toggles between right and wrong for much of the season, or is there a gray area?

That’s always the case when you’re talking about big issues like this. The idea of cloning human beings has been on the decade for at least a decade now and the ethics behind it are questionable. Bottom line, if you were to clone a human being in a laboratory, does that constitute a soul? Does that constitute a human being? Or because it’s created by humans it’s a manufactured thing that we can [use] to do whatever we want? Is the clone property because the laboratory made it or once its born, does it have free will and is it its own thing? That’s what the show is exploring. Henrik has cut through the ethics by saying, “Look, the clones are here on the planet, so I’m going to embrace that and I’m going to say that it’s part of the whole plan and I’m going to be its chief advocate.”

We learn at the end of the episode that Henrik’s prime reason for wanting Helena is simple: He believes she can conceive, like Sarah.

One of the definitions of life is something that is able to recreate itself. Something like a rock can’t recreate itself so we say we say a rock doesn’t have a life force to it. But as soon as an organism is able to replicate and duplicate, and recreate itself, we define that as having some sort of life to it in terms of organic life. That gets even stranger when you get into species because in order for it to be a species, it has to be able to procreate. If a clone can’t procreate, it’s not a legitimate species, ergo it’s not really a part of the planet. Henrik is fascinated with the idea that if he can find another clone that is capable of conceiving like Sarah — the whole question is, is Sarah the clone or is Sarah the original and the fact she has a daughter suggests she’s the original — then it’s a legitimate species and a legitimate creation. That’s what he becomes fascinated with and that’s what he finds with Helena.

What is Henrik’s ultimate end goal if Helena can do that?

There is an endgame, but it’s simpler, it’s not so sinister as world domination. It’s more megalomaniac than that. He wants to be a part of the new wave of humanity. Once he finds a clone that’s capable of conceiving — he thinks that’s the spiritual movement — he is going to be the father of all of these children.

Hannibal - Season 2

This week’s episode of Hannibal, Shiizakana, dealt with how Hannibal dehumanizes and manipulates other people, including making them kill. Thanks to this episode I also learned that dire wolves are extinct animals which actually existed, and not just creations of Game of Thrones. Besides manipulating Randall Tier, the protagonist in the case of the week, we saw Hannibal manipulating Margo, who then compared notes with fellow Hannibal victim Will Graham.

Hannibal told Randall Tier what to say to avoid arrest by the FBI and then sent him to his death by having him attack Will. Will saw this as Hannibal repeating his attempt to hill him while Will was in prison. “I sent someone to kill you. You sent someone to kill me. Even Stevens.”I thought that Hannibal’s goal was not to actually have Will killed but to force Will to kill, perhaps to further bring out the monster in Will. Bryan Fuller had this to say about the scene in which Hannibal nods after Will gave the above line, appearing to acknowledge his actions to Will”

AVC: When Hannibal makes that tiny nod at the end of the episode, do you see that as a tacit admission of guilt or is it just him saying, “That’s certainly one theory”?

BF: [Episode] nine really starts an arc that will reach a crescendo in 12, which is one of our best episodes of the season. I just think it’s fantastic and bonkers and hilarious and deeply disturbing. So the end of nine is sort of the beginning of 10, and it’s answered very quickly at the top of the next episode, but it absolutely is an acknowledgment, “Yeah, I sent him to do this. Yeah, you did exactly what I thought you were going to do. And now we can have a conversation,” which we will have at the beginning of the next episode.

The Backlot interviewed Bryan Fuller about descriptions of the show as homoerotic, rooting for the villain on television, and prospects of returning for a third season.

SHIELD Skye Ward

Agents of SHIELD wasted Amy Acker’s talents in a (super) villain of the week storyline, with this mainly serving the purpose of getting a few members of the team away so that Ward and Skye would be alone after Ward killed Koenig (Patton Oswalt). Fortunately Person of Interest makes much better use of Amy Acker.

Ward faked his way through a lie detector exam by doing far more than Nina did in squeezing her anus to pass a more primitive polygraph exam on a recent episode of The Americans. We also learned what each cast member would want if stranded on an island. Simmons had the best idea with the TARDIS. Chloe Bennet did the strongest acting in the episode, quickly progressing from being terrified when she learned about Ward to deceiving him, and setting up the cliff hanger of the two flying off together.

While only half of this episode really worked, the series might be off to a strong finish for the season. Cobie Smulders returns next week as Maria Hill, and is expected to be seen more regularly assuming the show returns next season now that she is no longer busy on How I Met Your Mother. TV Guide summarized the season finale which airs May 13:

Now that Hydra has revealed themselves and S.H.I.E.L.D. has been disbanded, Coulson and his team are on their own to take down the now-missing Clairvoyant. But how will they react when they learn Ward is actually a member of Hydra planted in their group? The finale will address Ward’s true allegiances as well as answer questions about Skye’s lineage, who’s controlling Deathlok and what the Clairvoyant wants with Coulson. “We think the audience is waiting for a showdown between Coulson’s team and Garrett’s team and they’re going to get a satisfying payoff to that epic conclusion,” executive producer Jeffrey Bell says, hinting there could be other sleepers. “If they win, it comes at a price.” Plus: Nick Fury returns!

Blacklist Lizzie Knows

I was happy to see the story advance more rapidly on The Blacklist. Once it was definitely revealed to the audience that Lizzie’s husband is not what he seems, it didn’t take long for Lizzie to figure it out. This week he realized that Lizzie knows, and the episode ended with a major cliff hanger. Speakeasy has some theories as to what Lizzie found in the safe deposit box.

The Americans went to the Contra training base and received so much assistance from Oliver North on the episode that he received a writing credit. Philip also took on the church which Paige has been attending, but I questioned if it was wise for an undercover agent to risk drawing attention to himself in such a manner. There was more of Martha at work. Stan’s biggest scene was in asking American scientists about their secrets to prevent them from being compromised, unaware of how he has become compromised.

I wouldn’t expect the second episode of Fargo to be as good as the first, considering all that happened, but it still left me optimistic that this will be an excellent series.

I did like the second episode of the season of Mad Men better than the first. While Don Draper has his faults, I do hope he recovers, and was happy to see him improve his relationship with Sally by being honest with her.

Last Forever Part One

Alyson Hannigan described a cut scene from the finale of How I Met Your Mother (which I reviewed here):

Speaking with TVLine at Friday night’s Taste for a Cure event in Los Angeles, HIMYM vet Alyson Hannigan said that the finale that aired last month was some 18 minute shorters than the script they worked off of at a “perfect” table read. “But [the full script] was also much more heart-wrenching,” she shared, “which maybe people wouldn’t have liked.”

Among the deleted scenes was what Hannigan described as a “one-second” montage of title character Tracy’s funeral. Instead, viewers only learned from Narrator Ted that the kids’ mother had become ill, then passed away — some time before he decided to rekindle things with their “Aunt” Robin.

“Honestly, if you saw [that] cut, it would be even more heart-wrenching than what the finale was,” Hannigan noted. “They were like, ‘No. It’s just too gut-wrenching.’ And I was like, ‘That’s what I want. I want my heart ripped out and slammed on the floor and, like, stomped on!’”

Hannigan also believes that missing moment “would have been better for the audience, so that then they can process, ‘Oh, [Ted] mourned. He got closure’ — and then they’d be happy that [he and Robin] got together. Rather than be like, ‘Oh, wait. She died? What? They’re together, huh?’ And credits. That’s what I think was too fast.”

Meg Ryan has been cast to be the future voice of the lead character in the spin off, How I Met Your Dad. I’m not sure of the point of a different person playing the narrator. Ted Mosby still had the same voice in the final scene of How I Met Your Mother which took place after telling the story to his kids.

The rape scene by Joffrey’s body in last week’s Game of Thrones was controversial, between the circumstances and the manner in which the scene was changed from consensual sex in the book to rape. I discussed this further in a separate post.

Aaron Sorkin has apologized to those who misinterpreted a decision he made on The Newsroom:

“I think you and I got off on the wrong foot with The Newsroom and I apologize and I’d like to start over,” Sorkin told the audience at a Tribeca Film Festival event Monday, referencing the criticism over his choice to set the show in the recent past. “I think that there’s been a terrible misunderstanding. … I wasn’t trying to and I’m not capable of teaching a professional journalist a lesson. That wasn’t my intent and it’s never my intent to teach you a lesson or try to persuade you or anything.”

Quote of the Day: Seth Meyers And Other Late Night Comics On Chelsea Clinton’s Pregnancy

“The Christian Science Monitor is claiming ‘Hillary Clinton will be a tad less interested in running for president now that she’s about to be a grandmother.’ And if you put a grain of sand in your pocket there’s a tad less sand on the beach.” –Seth Meyers

Bonus Quotes: More on Chelsea’s Pregnancy

“Hillary Clinton is going to be a grandmother. She’s very excited about it. She’s home right now knitting a tiny pantsuit.” –David Letterman

“Congrats to Chelsea Clinton. Last week, she announced that she is expecting her first child. If it’s a girl, it’ll get some of Chelsea’s old hand-me-downs; and if it’s a boy, it’ll get some of Hillary’s.” –Jimmy Fallon

“Chelsea Clinton has announced that she is pregnant with her first child. The baby is expected to crawl after nine months and run in 2055.” –Seth Meyers

“Chelsea Clinton is pregnant. There is another one coming. A little baby Clinton. People are already wondering, is the baby a girl? Is it a boy? Is it going to run for president in 2016?” –Craig Ferguson

A Closer Look At Insurance Cancellations Under The Affordable Care Act

Last fall opponents of the Affordable Care Act made noise way out of proportion to its actual meaning when insurance companies sent out cancellation letters to policy holders whose policies were not compliant with the law. A combination of the initial failings of healthcare.gov and exaggerated reports on cancellations led to much of the negative publicity about the Affordable Care Act which still has many Democrats reluctant to run on the party’s accomplishments. President Obama subsequently allowed these policies to be grandfathered in even if not meeting the initial qualifications for being grandfathered, but questions persist regarding winners and losers under Obamacare. A study in the current issue of Health Affairs provides some information on those whose policies were canceled.

The study’s key finding was that there is normally a high degree of turnover in policies on the individual market, and most of the people who received cancellation letters would have changed insurance even if there were no changes under the Affordable Care Act:

The Congressional Research Service has estimated that 10.8 million people had nongroup coverage in 2012.6 According to my estimates for the sample population, this suggests that 6.2 million Americans typically leave nongroup coverage each year. Presumably some of them do so voluntarily, because they qualify for Medicaid or start a new job with employer-sponsored coverage. Others lose coverage through inability to afford increased premiums, loss of income, or changes in health status that affect eligibility for nongroup insurance.

In this context, reports that recent cancellations of coverage may affect as many as 4.7 million adults (though precise estimates are lacking)6 are likely capturing a great deal of the normal turnover in this market. The findings presented here also suggest that overall coverage rates in the United States are unlikely to fall as a result of these cancellations: Most people who left nongroup coverage in this study acquired other insurance within twelve months, even before the ACA offered increased coverage via the Medicaid expansion and tax credits for Marketplace insurance.

Of course, the ACA’s regulations are presumably leading some people to lose nongroup coverage that they would prefer to keep. The results of this study indicate that certain subsets of people—in particular, those who are older than thirty-five, white, or self-employed—with nongroup insurance are likely to retain that coverage for three years or more. For some people who were covered by nongrandfathered plans, cancellations related to the ACA represent an unwanted change in coverage options that may be quite disruptive.

However, the ACA creates a range of new coverage alternatives via Medicaid and the Marketplaces. In addition, most insurance companies that are issuing cancellations are making efforts to enroll into alternative plans those customers receiving cancellation notices.19 Notably, 65 percent of the sample in this study had incomes below 400 percent of poverty. This suggests that many, if not most, of those who received cancellation notifications are now likely to be eligible for subsidized coverage that may be less expensive than their previous insurance.

This study’s findings are also relevant to the issue of premium “sticker shock”—which occurs when a person has to pay significantly more than in the past to remain covered by a plan—in the nongroup market. Some policy makers have expressed concern that the market reforms in the ACA are leading to significantly higher premiums for many healthy young adults (particularly men)20 and may lead people to drop their current coverage.

In this context, it is notable how rapid coverage turnover was among adults ages 19–35 in this study. Even before the ACA was implemented, nearly 80 percent of these adults experienced a change in coverage within two years. Undoubtedly, some adults in this age range with nongroup coverage will experience premium increases due to the ACA. However, most of them will qualify for lower premiums due to tax credits,21 and many of them will experience even larger declines in total out-of-pocket spending because of reduced cost-sharing requirements. Thus, true “sticker shock” is the exception rather than the rule for younger adults in this rapidly changing market.

While the study did find that most people would have changed insurance polices regardless of requirements under the Affordable Care Act, and the majority of people changing policies wound up paying lower premiums, there was a significant subset of older, white, self-employed individuals who received cancellation notices who otherwise might have kept the same insurance plan. Of this group, sixty-five percent qualified for subsidies.

The thirty-five percent of this group who wound up paying higher premiums might be consider “losers” because of the change, but it is not that simple. As I pointed out last month, one group of actual winners under Obamacare are the satisfied unsubsidized. Many people in this group, including myself, were offered alternative less expensive plans from our insurance companies but chose to purchase more expensive plans because of the added benefits of compliance with the regulations under the Affordable Care Act. These benefits include a cap on out of pocket expenses, coverage of preventative services with no copay or deductible, and, most importantly, being non-cancelable if there is a change in medical condition.

Policies sold in the past on the individual market were often less expensive as they were primarily sold to healthy individuals who the insurance companies did not anticipate having high medical expenses. A policy which must be sold to anyone, regardless of health status, is obviously going to cost more. Policies on the individual market often were severely limited in their coverage, with subscribers often unaware of the limitations unless they developed medical problems and found that their older plans did not cover them as well as they anticipated. For many people, it is to their benefit to replace older policies sold on the individual market with new policies which are compliant with the Affordable Care Act.

Republican Extremism Gives Democrats The Edge

Jonathan Chait looked at demographic and political trends to consider whether the trend towards the Democratic Party is likely to continue. Much of what he wrote is a recap of the conventional wisdom these days, with some disagreeing. He considered multiple factors including the tendency of the young and minorities to vote Democratic. To some degree this could be offset by an increased trend for white voters to vote Republican out of a backlash against the increase in minorities. While Democrats are expected to dominate in presidential elections, there certainly can be exceptions if there is a major occurrence favoring Republicans as the party out of power. Plus Republicans should continue to maintain a sizable portion of Congress due to the higher turnout among Republicans in off year elections as well as structural advantages in each House. Republicans have an advantage in the House of Representatives due to gerrymandering and the greater concentration of Democrats in urban areas, giving Democrats victories by larger margins in a smaller number of states. Republicans have an advantage in the Senate due to smaller Republican states having the same number of Senators as the larger Democratic states. Republicans therefore have a reasonable chance of controlling each House, or come close as is now the case in the Senate, despite a larger number of people voting for Democrats to represent them.

The key point which gives us our status quo, and gives the Democrats the edge, is that the Republican Party is now firmly in the hands of a radical fringe which will always have difficulty winning a national election, but which is unlikely to change in the foreseeable future:

My belief, of which I obviously can’t be certain, is that conservatism as we know it is doomed. I believe this because the virulent opposition to the welfare state we see here is almost completely unique among major conservative parties across the world. In no other advanced country do leading figures of governing parties propose the denial of medical care to their citizens or take their ideological inspiration from crackpots like Ayn Rand. America’s unique brand of ideological anti-statism is historically inseparable (as I recently argued) from the legacy of slavery. Whatever form America’s polyglot majority ultimately takes, it is hard to see the basis for its attraction to an ideology sociologically rooted in white supremacy.

Jonathan Bernstein sees the United States as remaining more of a 50:50 nation as in 2000, also citing George Bush’s victory over John Kerry in 2004. However the Democratic advantage in the electoral college has increased tremendously since 2000 when George W. Bush was able to come in a close enough second to take the presidency due to irregularities in Florida and a friendly Supreme Court. This victory in 2000, along with the 9/11 attack, gave Bush, as an incumbent during time of war, an edge which future Republican candidates are unlikely to enjoy.

The current political divisions won’t last in their current form forever. At sometime there is likely to be a major event which shakes up the current divisions. Chait noted that this might have been the 9/11 attack if the Republicans hadn’t squandered their political advantages by their disastrous invasion of Iraq. I would add to that being on the wrong side of far too many other issues prevented the Republicans from becoming a long-term majority party.

Most likely at some point in the future the far right will lose their grasp on the Republican Party as those who actually want to be able to win an election eventually regain control. Perhaps this will come as a newer generation rejects the most extreme ideas of the current conservative movement. If the Republicans don’t change, eventually a third party might challenge them, as difficult as it is for third parties to compete in our current political system. We might also see the Republicans persisting in their current form as a southern regional party as others battle for political control in the rest of the country.

New CBO Report Shows Medicaid Expansion Is A Better Deal For The States Than Previously Predicted

The trend continues. We have seen predictions regarding costs and benefits of the Affordable Care Act and then receive further data which shows that Obamacare is working even better than expected. The latest news comes from a new Congressional Budget Office report on Medicaid expansion.

Congressional Budget Office (CBO) estimates released last week show that health reform’s Medicaid expansion, which many opponents wrongly claim will cripple state budgets, is an even better deal for states than previously thought.[1]  CBO has sharply lowered its estimates of the costs to states of adopting the Medicaid expansion.

  • CBO now estimates that the federal government will, on average, pick up more than 95 percent of the total cost of the Medicaid expansion and other health reform-related costs in Medicaid and the Children’s Health Insurance Program (CHIP) over the next ten years (2015-2024).
  • States will spend only 1.6 percent more on Medicaid and CHIP due to health reform than they would have spent without health reform (see Figure 1).  That’s about one-third less than CBO projected in February.[2]  And the 1.6 percent figure is before counting the state savings that the Medicaid expansion will produce in state expenditures for services such as mental health and substance abuse treatment provided to the uninsured.

The federal government pays 100 percent of the cost of Medicaid expansion for the first three years with this gradually dropping to 90 percent in 2020. Republican governors opposing Medicaid expansion have claimed that ultimately paying 90 percent will strain their budgets while supporters argue that using this money to care for the uninsured will help the economies in these states and save money in other areas by having the currently uninsured receive coverage.

Republicans have also argued that one result of offering the expanded Medicaid program is that people eligible for the original program but who have not applied will apply for Medicaid as a result of the publicity surrounding the expanded Medicaid program. This would cost the states more as the federal government will continue to match funds for those who qualify for the original Medicaid program at current levels which average 57 percent. This tells a lot about how these Republicans think, seeing it as beneficial for the poor to not receive benefits they qualify for. The CBO has decreased its estimates as to cost to the states as fewer people who qualified for Medicaid but remain unenrolled are now enrolling than projected.

Despite the significant benefits from the expanded Medicaid programs, some Republican states remain determined to block the program. Bills have recently passed in Georgia and Kansas to make sure that they do not wind up with a Democrat getting elected governor and deciding to accept the federal funds to expand Medicaid. This changes the law so that approval would be needed by the state legislature and a governor could not expand Medicaid without their vote.

Rape in Game of Thrones

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For two weeks in a row there has been considerable talk about a scene from Game of Thrones. Due to the questions raised by this scene and all the discussion it has stimulated, I have decided to post on this today rather than waiting until the weekend for the usual weekly review of genre television. Major spoilers ahead for those who are behind in watching.

The scene between Cersei and Jaime Lannister by Joffrey’s dead body was disturbing and raised questions on multiple levels. While some disagree, I clearly saw it as rape, but with all the violence on this show didn’t necessarily find this aspect any more disturbing than many other events on the show. We’ve already seen everything from mass murder at a wedding to chopping off a prisoner’s penis to send to his family. While I don’t mean to minimize it, I also don’t find Jaime raping Cersei to be any worse than Jaime pushing Bran Stark out a window. The denial that the scene was rape is perhaps more disturbing than the portrayal of a rape on a show where violence is commonplace.

I did question why they portrayed Jaime as a rapist here, considering that they seem to have been presenting Jaime in a better light lately, unless they thought that Jaime was coming off too good lately and they wanted to alter this (an idea denied by the director of the show in an interview cited bel0w). Naturally the time and place was questionable. I also wondered why the first sex scene we have seen between Jaime and his sister was presented as rape considering that they have been shown to have consensual sex in the past. The question as to why it was portrayed as rape became even bigger once it became known that the scene was different n the book.

Show runner David Benioff  essentially described the scene as rape with Jaime forcing himself upon Cersei, who was resisting:

It becomes a really kind of horrifying scene, because you see, obviously, Joffrey’s body right there, and you see that Cersei is resisting this. She’s saying no, and he’s forcing himself on her. So it was a really uncomfortable scene, and a tricky scene to shoot.

George R.R. Martin has provided some background, explaining the difference between the situation here and in the book, where the sex was consensual:

I think the “butterfly effect” that I have spoken of so often was at work here. In the novels, Jaime is not present at Joffrey’s death, and indeed, Cersei has been fearful that he is dead himself, that she has lost both the son and the father/ lover/ brother. And then suddenly Jaime is there before her. Maimed and changed, but Jaime nonetheless. Though the time and place is wildly inappropriate and Cersei is fearful of discovery, she is as hungry for him as he is for her.

The whole dynamic is different in the show, where Jaime has been back for weeks at the least, maybe longer, and he and Cersei have been in each other’s company on numerous occasions, often quarreling. The setting is the same, but neither character is in the same place as in the books, which may be why Dan & David played the sept out differently. But that’s just my surmise; we never discussed this scene, to the best of my recollection.

Also, I was writing the scene from Jaime’s POV, so the reader is inside his head, hearing his thoughts. On the TV show, the camera is necessarily external. You don’t know what anyone is thinking or feeling, just what they are saying and doing.

If the show had retained some of Cersei’s dialogue from the books, it might have left a somewhat different impression — but that dialogue was very much shaped by the circumstances of the books, delivered by a woman who is seeing her lover again for the first time after a long while apart during which she feared he was dead. I am not sure it would have worked with the new timeline.

That’s really all I can say on this issue. The scene was always intended to be disturbing… but I do regret if it has disturbed people for the wrong reasons.

I considered the scene a rape scene while viewing considering how Cersei resisted with Jaime ignoring her but  Alex Graves, who directed the show, said it became consensual by the end an interview with HotFix:

Well, it becomes consensual by the end, because anything for them ultimately results in a turn-on, especially a power struggle. Nobody really wanted to talk about what was going on between the two characters, so we had a rehearsal that was a blocking rehearsal. And it was very much about the earlier part with Charles (Dance) and the gentle verbal kidnapping of Cersei’s last living son. Nikolaj came in and we just went through one physical progression and digression of what they went through, but also how to do it with only one hand, because it was Nikolaj. By the time you do that and you walk through it, the actors feel comfortable going home to think about it. The only other thing I did was that ordinarily, you rehearse the night before, and I wanted to rehearse that scene four days before, so that we could think about everything. And it worked out really well. That’s one of my favorite scenes I’ve ever done.

The description as “consensual by the end” raises obvious objections when considering the position of rape victims. Vulture asked Graves about this, along with the motivations behind such a scene with Jaime:

One of my colleagues suggested that the tweak, making Jaime the kind of person who might force himself on Cersei, might have happened to remind viewers that he’s not a morally upright guy, pouring out his heart to Brienne notwithstanding. Was that part of the decision to your knowledge?
No. It’s a very, very complicated scene. The thing about it is that Jaime has come home and is trying to convince himself that things are the same: that he and Cersei are a unit, they’re in love, they have sex, everything comes out of that bond. And he’s desperate to reinvigorate that and it has not been working. That’s part of what’s behind him, that lie he’s telling himself, that seasons two and three didn’t happen. So it’s a last act of stupid clinging to what’s been home for him, because it will never be the same. It’s also setting up something that happens in the finale. For Cersei, she is so blindsided and in the middle of the audacious murder of Joffrey at his own wedding, she’s standing there pondering all this with her other son, her sweet son. And her father comes in and basically says, “There is no way you’re going to have control over this kid” and takes him away. So she’s just empty. She’s decimated. What I said is what we just talked about. It’s just fleshing it out.

You say it “becomes consensual by the end.” I rewatched the scene this morning, and it ends with Cersei saying, “It’s not right, it’s not right,” and Jaime on top of her saying, “I don’t care. I don’t care.” It leaves some room for debate. Were you involved with cutting the scene? Was there a longer version of the scene that might have read more like they were both consenting?
It’s my cut of the scene. The consensual part of it was that she wraps her legs around him, and she’s holding on to the table, clearly not to escape but to get some grounding in what’s going on. And also, the other thing that I think is clear before they hit the ground is she starts to make out with him. The big things to us that were so important, and that hopefully were not missed, is that before he rips her undergarment, she’s way into kissing him back. She’s kissing him aplenty.

Despite how disturbing the scene might have been, there was also a behind the scenes humorous aspect to filming the scene:

Right, and part of what she’s resisting is that this is all happening next to Joffrey’s body.
It’s bizarre, and I highlighted that in how I shot it. A funny behind-the-scenes joke was every time we shot a take, and Lena and Nikolaj drop beneath the table, Jack Gleason would sit up and look down to try and see what was going on.

He really did that?
Yeah, he did! It was hilarious. He would take the rocks off of his eyes and lean over to take a look. He was so funny.

While it remains debatable as to whether changing the scene from the book was a good idea, at least George R.R. Martin did provide an explanation for why this might have been handled different on the television version. Perhaps this decision will make more sense when we see where the relationship between Cersei and Jaime goes from here, and if it also differs from the novels.

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Increased Health Care Spending Just Might Be Buying Higher Quality Care

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Jonathan Cohn has looked at what appears to be a recent increase in health care spending (national health expenditures in the above graph) after a period of decline. Most likely this is due to a variety of reasons, and I don’t find it surprising that a period of decreased spending would be followed by increased spending. This is partially a sign of an improving economy as people are less likely to put off spending on medical problems when they have more money available. The increase in people covered by insurance this year due to the Affordable Care Act should lead to a further increase in spending, but this spending is desirable

Cohn looked at a variety of possible causes but didn’t hit on the key point that increases in medical spending might not necessarily be a bad thing until late in the article:

It’s not always the case that spending more on health care is a bad thing. New or more treatments might alleviate suffering, reduce disability, or extend life—all of which have value. Providing insurance to more people, so that they are more secure financially, also has value. The reason to worry about high health care spending is that the extra money America spends doesn’t actually seem to buy America better health care. But, over the long run, the real goal of health care reforms should be a combination of restraining costs and improving quality.

Traditionally it has been true that we could not see benefits from increased spending compared to other countries, but there are factors in health care which could currently be causing increased spending compared to previous spending in the United States as well as increased quality. There has been a push for Medical Homes, increased payment for primary care services, and for increased attempts at payment of doctors based upon performance as opposed to fee for service alone. If doctors are given incentives to screen more for elevated cholesterol and do more to treat diabetic patients this would lead to increased spending, with this spending being beneficial.

Contrary to the argument that we were not seeing quality for our past spending, The New England Journal of Medicine reports this week that complications among diabetic patients have decreased between 1990 and 2010. The Annals of Internal Medicine also reports that between 1999 and 2010 the number diabetics has increased, with a decrease in the number who have the disease but are undiagnosed, and that treatment has improved. Both having more diabetic patients and providing treatment which results in better control is going to cost more money. It is too soon to have any data to see if there is a correlation between increased spending over the past year and quality of care, but I do wonder to what degree the trends I noted in the above paragraph are contributing to higher costs and how this might correspond with further improvements in the quality of care.