Threats To Republican Dogma From Same Sex Marriage To The Environment And Economy

Gallup Same Sex Marriagew

Gallup has found that support for legalization of same sex marriage has reached a new high at 55 percent. The upward trend is supported by both changing views among all age groups and increased support among the young. Support for gay marriage by those between the ages of 18 and 29 has increased to 78 percent suggesting that the overall trend will continue.

There is considerable weakening of support for the agenda of the religious right, and Republicans cannot count on support for their agenda from all religious groups. Pope Francis contradicted right wing views on the environment and climate change waring that, “if we destroy Creation, Creation will destroy us!” Earlier in the month he contradicted Republican economic dogma by calling for “the legitimate redistribution of economic benefits by the state, as well as indispensable cooperation between the private sector and civil society.”

Reports Indicate Predictions Of Massive Premium Increases Under Obamacare Are Unlikely Due to Greater Competition In 2015

There is further evidence that another Republican prediction regarding the Affordable Care Act is not likely to take place. A study by the Robert Wood Foundation predicts that premiums will not increase greatly next year due to an increase in the number of insurance companies entering the market, with greater competition acting to lower prices. The Hill reports:

Fears that insurance premiums will spike next year are premature, according to a new report that argues market competition will likely keep costs from rising.

Critics of the Affordable Care Act have long warned that premiums for the ObamaCare plans would skyrocket in 2015 as insurers scrambled to make up for setting artificially low prices this year. Researchers at the Robert Wood Johnson Foundation argue those fears are misplaced.

“In competitive markets, unless all insurers behave similarly, those that increase premiums will suffer the loss of a market share to those that continue to price more aggressively,” said the authors of the report released Monday. The competitive pressures mean insurers are unlikely to risk raising their premiums too high for fear of losing customers, the report says.

Researchers compared data on premium costs in eight states around the country and found competition in the insurance markets was typically high, especially in the cities. They say the same competitive factor that led to low premium rates this year is likely to keep prices in check next year.

However, the report says some rural states may see higher premium prices because there are fewer insurers and therefore less competition.

The report also said the number of enrollees in ObamaCare will grow as the years go on, spreading the amount of risk insurers have to bear and relieving the need for price hikes.

Besides adding more of the uninsured, there are an estimated 3.2 million people who continued on health plans this year which were not compliant with the Affordable Care Act. These people were either grandfathered into their old plan under rules in the Affordable Care Act or were allowed to keep non-compliant plans after the rules changes in response to the publicity regarding cancellation letters last fall.

A study by The National Bureau of Economic Research found that prices in 2014 where higher than they might otherwise have been as many insurance companies only offered limited plans, or stayed entirely out of the market for the first year. Kaiser Health News reports that in increase in the number of insurance companies planning to offer coverage in 2015 should help keep premiums lower:

What if every insurer selling individual plans in at least some portion of a state had decided to offer 2014 exchange policies throughout that state? Average premiums on healthcare.gov for the second lowest-cost silver plan would have been 11.1 percent lower, the researchers found.

That level of competition would have saved federal taxpayers $1.7 billion in subsidies, they reported — not to mention substantial amounts for consumers.

Competition varied sharply according to state and locality. Consumers in many markets saw only one company offering coverage while others saw eight or more. In general, the more competitors, the lower the premiums.

Carriers that stood aside or tread lightly in 2014 have said they may expand next year. That could increase competition and dampen premium increases.

UnitedHealthcare has “a bias to increase that participation in 2015,” Gail Boudreaux, the insurer’s chief executive, said recently.

More on this topic at Think Progress

 

Massive Spending On Anti-Obamacare Ads

If you feel that you are being bombarded by political ads about Obamacare, and most, are negative, you are right according to a new study showing that spending on negative ads was fifteen times spending on ads supporting the Affordable Care Act:

A new analysis finds the nation’s health care overhaul deserves a place in advertising history as the focus of extraordinarily high spending on negative political TV ads that have gone largely unanswered by the law’s supporters.

The report, released Friday by nonpartisan analysts Kantar Media CMAG, estimates that $445 million was spent on political TV ads mentioning the law since the enactment of the Affordable Care Act in 2010. Spending on negative ads outpaced positive ones by more than 15 to 1.

The ads have also kept the fact checkers busy, as they frequently contained false information regarding matters such as the cost of plans obtained on the exchanges. Often it turned out that the people showed in the ads could actually receive health coverage at a lower cost than claimed in the ads, and had plans available to them which their current doctor participated in.

Much of the misinformation being spread was paid for by the Koch brothers via their group, Americans for Prosperity. While it is undoubtedly an intentionally negative view, Huffington Post reported on revelations in a new book on the Koch brothers,  Sons of Wichita: How the Koch Brothers Became America’s Most Powerful and Private Dynasty.

SciFi Weekend: Hannibal; Orphan Black; Person of Interest; The Blacklist; Arrow; Agents of SHIELD; The Americans; Revenge; Alison Brie; Emelia Clarke; Porn Stars in Game of Thrones; Billie Piper; Nebula and BAFTA Award Winners

Hannibal Mason Face

The penultimate episode of Hannibal for the season, Tome-wan, wrapped up the current Mason Verger storyline and set the stage for next week’s confrontation between Jack and Hannibal, already shown in the season premiere. The scene in which a drugged Mason Verger was feeding his own face to Will’s dogs was among the more gruesome of the series. The episode also included fantasies of Hannibal being fed to Mason’s pigs.

Last week we learned that Will was working with Jack and was not really a murderer under Hannibal’s spell. This week they walked this back a bit, leaving Jack not entirely clear as to whose side Will was really on. I suspect that Will is still interested in helping take Hannibal down, but is not above keeping things from Jack, and was willing to work with Hannibal to see Mason Verger receive the punishment he felt he deserved after what he did to Margot. I also wonder if questions over Will’s loyalties leads to Jack setting himself up as bait and is the reason the two wind up fighting, as opposed to an organized FBI arrest.

The episode also included the brief return of Dr. Bedelia Du Maurier. Gillian Anderson managed to come in for six hour for filming between plains concluding Crisis and leaving to begin filming on The Fall. As a consequence, it was necessary to only briefly have her tell about her back story in which Hannibal persuaded her to kill a patient (partially in self-defense) as opposed to actually showing this, and it appears she has a much smaller role in the final take down of Hannibal than I previously predicted. While I wish we could see more of her on Hannibal, it was good news that she was finally going to film the second season of The Fall.

Fortunately Hannibal has been renewed for a third season and it won’t be necessary to shop the show around to other networks which might consider it, such as the Food Network.

Bryan Fuller discussed the conclusion of the Mason Verger storyline for this season, and the motivations of the characters involved:

Let’s talk about Mason’s drug trip. How was that conceived?
Fuller: 
It was directed by Michael Rymer, and it was fascinating to sit down and figure out how we were going to film this enhanced state of mind. Michael Pitt’s performance is so infectiously fun. I find it immensely enjoyable and very f—ed up in a thoroughly giddy way. I think the thing that Michael Rymer brought to the scene was a similar infectious sense of fun. He wanted it to be a carnival of sorts. He wanted to light sparklers in the room to create the things your retinas do when you’re under that much chemical oppression. He was the right guy to bring the drug trip to life and has the humor to make sure it is as fun onscreen as it can be.

Mason certainly seemed to be enjoying himself even though he was cutting off his own face!
Fuller:
 [Laughs] Michael Pitt was having the time of his life with this performance. And there’s something between Hannibal and Will in that moment that is very playful, which is perhaps a strange word to use in that context. But there’s a gamesmanship afoot because Hannibal essentially says, “I got him to cut off his face. Your turn.”

However, Will needs Hannibal to commit this murder so they can arrest him, but Hannibal only breaks Mason’s neck. Is Hannibal on to Will or is he keeping Mason alive because of Margot’s financial dilemma?
Fuller:
  Hannibal’s response is all of those things. It’s a gesture toward Margot to give her some control in her life. And also, he doesn’t kill him completely because, as he has said and will say again to Margot, the best therapy for her is to kill her brother.

And I assume Mason doesn’t tell Jack the truth because he too has some of his own twisted plans for Hannibal.
Fuller:
 Mason does not want Jack Crawford to deliver justice to Hannibal. He wants to deliver justice his own way. This is all now a very particular game for Mason, which I am hoping to explore much more of in Season 3. Episode 12 completes the Verger arc for Season 2 and sets up the Verger arc for Season 3.

Orphan Black Sarah Helena

Ipsa Scientia Potestas provided more information on the development of the clones and, as usual for an episode of Orphan Black, raised more questions than it answered. Rachel joined characters on shows including Agents of SHIELD, Revenge, and The Blacklist with presumed dead fathers who are or might be alive. We found that Rachel has a monitor just like the other clones, but she is in a special position giving her more power. Paul, after not being seen much this season, has become more important after Rachel chose him to replace Daniel as her monitor, among other things. While Orphan Black doesn’t compete with Game of Thrones in terms of rape scenes, the scene in which she forced Paul into having sex with her will remain one of the more memorable scenes of the series. Paul does now have three notches in his clone belt. I’m hoping they manage to find a way to get him involved with Alison next (who was totally absent from this week’s episode). Paul’s motivations remain unclear as he is being blackmailed into cooperating. This week he went along with the plan to frame Felix for murder in order to gain control over Sarah but in future episodes it would not be surprising to see him help Sarah against Rachel if the opportunity were to present itself.

You can never be certain as to which side a character is on. Helena has been transformed from crazy murder to crazy murderer who does care about her twin sister Sarah. Leekie looks far more like an ally for the Clone Club, even being at odds with Rachel over some matters, compared to last season. I suspect that he intentionally sent Delphine the email on the stem cell tests to help Cosima, contrary to Rachel’s view of Cosima as expendable. It has become clear that, as suspected, Cal is hiding something after we saw his stash of weapons, cash, and fake ID. However, for the moment I trust Kira’s intuition and if she trusts him I will assume for now that he can turn out to be helpful to Sarah.

On the other hand, the Proletheans are clearly evil. If there was any doubt, this was eliminated when they sewed Gracie’s mouth closed for telling a lie. Now it looks like Gracie will become the surrogate mother following Helena’s escape.

The Hollywood Reporter interviewed Bruce Dylan (Paul) about his character’s motivations and the sex scene with Rachel:

The episode’s big “wow” moment was Rachel and Paul’s sex scene.

When I read it on the page, I had never seen anything like this on television before. It’s amazing how quickly Tatiana [Maslany] jumps into all these different characters and how immersed she is in each character she’s playing. Our director for this last episode, Helen Shaver, she’s very good in the realm of sexuality. She knows how to bring the sexy out of her actors. A lot of the moving parts in that scene were added by her. It’s almost like Rachel’s inspecting Paul like he’s a derby horse — looking at his teeth, making sure that he’s clean and worthy of her. It seems like she has a lot of suppressed sexual energy and very kinky as well. I was anticipating that they’d have whips and chains in the room. (Laughs.) I called her Fifty Shadesof Rachel. I thought she would have some sort of sex room with a swing or something. That scene was absolutely brilliant. It’s very sexy on a completely different level than other sex scenes that I’ve seen on television. It’s weird and sexy at the same time.

How is Paul adjusting to his new role as Rachel’s monitor? Will he be taking advantage of his current position?

He’s in a situation right now where it’s definitely to his advantage. The fact that Daniel is out of the picture, Paul’s not a disposable asset anymore. Now he can become a usable force. That helps him out and helps him progress his own cause. It seems like he’s being blackmailed into doing this, but there is something much bigger that this guy is involved with. That’s about all I can say about that. He would want nothing more than to burn the Dyad corporation to the ground, I think.

There’s an interesting power struggle between Dr. Leekie and Rachel and Paul’s stuck in the middle of it. Out of the two, who does he have more allegiance to?

Neither. This is another great thing for him. He can answer to two masters. That allows him to play both of them at the same time, but it’s a slippery slope. He has to walk that tightrope between the two of them. It’s almost like he’s waiting to see who comes out on top. He’s maintaining that guise where he’s tied to both of them, but in reality, his allegiance is going to lie with the one who wins in the end. He’s not going to pick a losing team, that’s for sure.

Speaking more specifically about the Felix matter. Does Paul have any ounce of guilt over putting him in jail?

When I read [the scene], I thought “Oh my god, this is going to be really hard to play with Jordan [Gavaris]” because I love Jordan so much and I love the character of Felix. The way I was playing it, I was trying to show the least amount of emotion because Paul’s a pretty stoic character. [Paul] was not pleased at all with having to do what he had to do. That was a necessity to do that. When he takes the gun out of the bag and Felix is like “What are you doing Paul?” it was more like an air of disappointment. If Paul didn’t do it, [Rachel] would have gotten rid of him herself.

It was dropped in that Paul has slept with three clones: Beth, Sarah and now Rachel. Is that notable?

When he slept with Beth, he was blackmailed into being her monitor and her boyfriend, or he could have faced military trial or the death sentence or life in prison or who knows what. When he slept with Sarah, she initiated the intimacy and now he sleeps with Rachel, she again initiates the intimacy. So he’s definitely not a prude but he’s definitely not the aggressor in the situation. (Laughs.) I don’t know how much you can say “Paul gets around” because it seems these clones are the aggressor in these situations. It’s so empowering because we have a brilliant female lead and all these brilliant female characters, it’s almost like a role reversal.

You’ve hinted several times that Paul has an agenda. How soon before what he’s been plotting is revealed?

You’ll find out this season tidbits, just snippets of it. That will [lead] to the next season. He’s very mysterious, isn’t he?

Another interview with Bruce Dylan at TV Line gave more evidence of Tatiana Maslany’s acting talents:

TVLINE | What was it like to film that scene? You’ve worked with Tatiana [Maslany] before, but it was as Sarah. Now you’re working with her as Rachel, and she’s this completely different animal.
You’re absolutely right. We all know how brilliant Tatiana is and how great she is. But when she is in these characters, she is firmly immersed in that character. You don’t feel as an actor, acting opposite of her, that she’s Tatiana playing a different character. She is Rachel. She is Sarah. It’s very easy to act opposite her because she is 100 percent into her character at that time. It’s a wonderful thing for an actor to do, because she’s so easy to react off and she’s so spontaneous.

That scene, how it was written on the page was actually different than how we performed it. Our director, Helen Shaver, she’s wonderful and she’s very good at bringing the sexy out of her actors with wonderful notes and directions. There were a lot of moving parts to that scene that she added in for both Tatiana and me. It made the scene a lot creepier than how it was on the page. And it made it a lot steamier at the same time. I’ve never seen a scene like that on television before.

TVLINE | Is it bizarre having love scenes with the same actress, but as two different characters?
She’s so good – that’s the first time anybody’s asked me that question, which is amazing – that has never once entered my mind. She is so into that character, it’s so easy to differentiate between the two. I don’t feel like it’s Tatiana playing a character. I actually feel like “Oh, this is really a person. [Laughs] This is really Rachel.” It wasn’t hard at all.

While Tatiana Maslany deserves most of the credit for making each clone seem like a distinct character, she does get some help. Yahoo interviewed the makeup and hair stylists for Orphan Black who explained how they make each clone seem different. Rachel takes the longest, and they use the most expensive cosmetics on her. As I had expected, it is intentional that Helena’s dark roots show despite her bleached hair.

Deus Ex Machina

There were several season finales last week. Person of Interest has totally changed the character of the show. Instead of achieving a true victory, Root had to settle for creating seven blind spots in Samaritan for herself, Shaw, Reese, Finch, and the three tech nerds. They had to separate, but Samaritan could not identify them. Presumably some of them will find a way to reunite to work together in some way next season. It is more questionable if they will continue to have episodes based upon a number of the week received from the Machine. Carter was already killed off last season when the show became less of a police procedural, and there also appears to be less of a role for Fusco. He was at the center of the stories related to HR, but he is not even aware of the existence of the Machine which drove so many of the cases he was involved with.

I wasn’t completely surprised, but was somewhat disappointed, that Vigilance turned out to have been created by Decima to create a false crisis to convince the government to go ahead with Samaritan. Greer might be deceitful, and his actions dangerous, but his motivations are not totally evil. Rather than seeking power for himself, he seems to truly think that it would be a good thing to place a super computer in charge of humanity. At the end, rather than giving Samaritan his orders, he told Samaritan it was about what it commanded. Clearly nothing good could come out of this.

Over the course of the first few seasons of Person of Interest, the real world caught up with the show as we learned about NSA surveillance. Now the show has leaped ahead of where we currently are, enabling it to provide a warning about where we might wind up.

In an interview with IO9, Jonathan Nolan talked about plans for next season and explained why New York is actually a good place to avoid surveillance:

In the first two and a half seasons of the show, New York and the city’s politics were a big part of the narrative. We had HR and the deputy mayor, and Elias and the gangs. Are we ever going to circle back to that? Are we going to get back to the politics of New York in this new surveillance dystopia you’ve created? Is Elias going to be back?

JN: Absolutely. We’ve always — hopefully in a good way — vacillated back and forth between the more metropolitan storyline and the Machine, or kind of global, storyline. Because the great thing about New York is that it’s both. It’s the kind of center of the world, in so many ways. But it’s also its own rich kind of arena. And Finch and Reese and Shaw, and now Root, and Fusco, are going to continue to be inveigled into local politics, and certainly local crime, every bit as much as they have up to this point. The people they’re trying to save every week. That storyline continues. That Machine still spits out numbers. And it’s going to be spitting out even more of them. So we’re doubling down on both fronts. We’ve always taken with, and fascinated by, the idea that within New York City, you have a bounded infinity of stories. So we never want to step away from that. We just want to keep raising the stakes on both levels.

And in this new A.I.-enabled world, whoever rules the big cities like New York has more power, because the big cities are where the infrastructure and the intelligencia are. So it becomes even more of a microcosm of the global power struggle.

JN: Yeah, absolutely. And ironically, New York, which is the most heavily surveiled place in the world, becomes one of the few places in the world to hide from surveillance. There was this awful but fascinating story from three years ago, when we were shooting the pilot in New York. There was a serial killer operating out on Long Island — in fact, I think this was the same one who was dumping his bodies not far from where we were shooting a stunt sequence. And this is awful, but he was making phone calls to some of the victims’ relatives using their cellphones, but doing it from Times Square. Because he or she, or whoever this villain was, understood that Times Square is one of the few places in the whole wide world where you can make a phone call on a cell phone that’s being trace. And when the authorities try to match up that phone call to surveillance footage to see who made the call — and try to match a person to a phone call, essentially — it’s impossible. Times Square is filled with hundreds of thousands of people on any given afternoon, all of whom have a cellphone. So it’s that hiding in plain sight. New York ironically becomes the only place in the world where you can hide from the surveillance state, even while being the very epicenter of it. So for us, the perfect arena for this fight that’s going to take place.

I was less excited by the first season finale of The Blacklist as it essentially reset the show back to where we were, with a new villain. There was little drama in Lizzie saying she would no longer work with Reddington as I had no doubt that she would not hold to that. Besides, why was she so surprised to learn that Red is a monster when he was telling her that he is one all along? The show is entertaining and worth watching due to the terrific job done by James Spader, which more than makes up for the weak job done by Megan Boone. The scenes with Alan Alda are an additional plus, even if it is not clear who exactly he is and why he was able to order that Reddington be allowed to escape in the finale.

ARROW

Arrow had the spectacular comic book ending that was expected, managing to bring back many of the characters seen over the course of the series. They did add some questionable drama to an already difficult situation by having ARGUS threaten to blow up the city to contain Slade’s army. As there were only fifty of them, and Oliver did ultimately get the cure, it would have seemed more reasonable to guard the exits to prevent any from leaving, and then moving in with enough force to overpower them should the cure fail.

Previously when we learned that Oliver had a cure back on the island, there was speculation that Oliver’s decision to kill as opposed to try to cure Slade might have been the real motivation for his vendetta against Oliver. In the flashbacks it was clear that by the time this occurred Slade’s views were already set, and this really was all about Shado.

The cure did work on Roy in the present, leaving him in a situation to work with the Arrow next season. When he had super powers, even before going insane, I had questioned how it could have worked to have the sidekick be more powerful than the lead. This will no longer be a problem. Sarah left with the League of Assassins. She might return, but she also left her leather jacket with Laurel. Is this the first step in her becoming the Black Canary as in the comics? Their father was restored to the rank of Detective, but it is not clear if he will survive into next season.

The flashbacks on the island seemed to have concluded their story, but the episode ended by showing how this will be handled next season. Oliver woke up in Hong Kong to be greeted by Amanda Waller. This could provide for some interesting stories in flashbacks. Eventually we know that Oliver has to wind up alone on the island to be rescued as on the pilot. Perhaps he really became stranded there again, or perhaps this was set up to allow for him to be rescued without any ties to ARGUS.

Felicity has become a huge favorite among fans since she was added to the show during the first season. The two of them tricked Slade, taking advantage of the cameras he hid in the Queen mansion earlier in the season to have him see Oliver say that Felicity is the one he really loves. Both Stephen Amell and Emily Bett Rickards have told E! Online that they don’t think this was entirely an act. Of course there is little doubt that they will drag this out for a long time before ever having the two get together.

Agents-of-SHIELD-Season-1-Finale-Coulson-Writing-on-Wall

I was glad that there was no redemption scene for Ward, as many feared would occur in the season finale of Agents of SHIELD. While he couldn’t bring  himself to outright kill Fitz and Simmons last week, like he couldn’t kill the dog he was stranded with, he did leave them in a situation which Fitz may or may not survive from. My bet is that Fritz will survive considering how Coulson and Skye came back after being in even worse shape. Their rescue once they got off the bottom of the ocean was too simple, but I doubt that many viewers cared at that point once distracted by the appearance of Nick Fury. There was no explanation as to where Fury got that medical team.

I wonder where the show will go next season with SHIELD disbanded. Nick Fury did  make Coulson the new head with instructions to restore the organization, but it is not clear how much that really means with Fury no longer having any authority (and presumed dead). At least the group has a new base, already supplied with a new Koenig, played again by Patton Oswalt. Is he a twin or a Life Model Decoy?

Much of the back story about TAHATI has now been explained, but there are still mysteries with Marvel fans tying the alien blood into other areas of the Marvel universe including the Kree and Inhumans. We will have to wait until next season to learn the meaning of what Coulson was drawing. Syke’s back story should also be explored more, especially now that it appears her father is alive.

The Americas s02e12

On The Americans, it is not entirely clear why Larrick is after Jared but he is close to finding him. Most likely he knows that the last tie to Emmet and Leanne will either allow him to find those helping him or be useful bait for those he is really after. Regardless of Larrick’s plans, there is no doubt to Elizabeth and Phillp that Jared is in danger because of his parents, potentially placing their own children in the same type of danger.

It is rare to have a show where the storyline involving secondary characters can be every bit as interesting as when the leads are on screen. This is the case with Stan and Nina. Instead of turning to Stan to save her, we learned that Nina was still working with the Russians to trick Stan into turning over the Echo program. If Nina was smarter, and not currently as loyal to Russia, she might have immediately told Stan that he had to get her elsewhere to hide as opposed to allowing Arkady to put on his show. Contrary to how he initially appeared, Oleg has turned out to be the one most concerned with saving Nina. If Stan doesn’t turn over Echo, it is questionable if the Russians would give her an opportunity to get away with the money which Oleg gave her.

Other characters were very perceptive this week. Henry was right to be concerned about how The Wrath of Kahn would turn out after the first Star Trek movie, but he will learn there was nothing to worry about. Two other characters showed that they aren’t completely fooled. Paige questioned what type of emergency Elizabeth could have as a travel agent requiring her to run out at night. It is hard to believe that she won’t eventually figure out what is going on. Will she accept what her parents are doing as Jared has regarding his parents? Martha figured out that Clark wears a toupee, even if she is foolish enough to turn all those documents over to him. Perhaps she will ultimately take the blame for the documents which Stan gave to Oleg, helping Stan to remain above suspicion.

Revenge

Revenge did a reboot as major as that on Person of Interest. It was about time, as they had dragged out the storyline about Emily seeking revenge on the Graysons for framing her father for far too long. Reducing the number of characters should also help as things have become far too convoluted. It will take a good story to explain how Emily’s father has been alive all these years, and it will be interesting to see her reaction to finding that he is alive. He better have a good explanation for not contacting her before now. E! Online has an answer to the bigger question as to where the show is going next season:

That #Revenge finale was INSANITY! Is the show really going to be Victoria as the revenge-seeker now?
From what we know, yes. Emily will be living in Grayson Manor and Victoria will be the one narrating the show and out for revenge, wanting to take down Emily/Amanda and make her pay for everything she lost. Pretty big game-changer! And by the way, we hear another main character will be written out next season. Perhaps the biggest cast departure yet.

Of course Emily will still have reason to see revenge after the murder of Aiden, and it is hard to imagine a bigger departure than Conrad (assuming he is really dead). More on Revenge at The Hollywood Reporter.

Alison-Brie

There is a huge amount of other news this week regarding renewals, cancellations, and new shows in addition to all the finales. I’ll hold off on news related to next season for another week when there isn’t so much other material to write about and end with just a few briefs.

Unless they manage to revive Community for a sixth season on another network, it appears we will not see more of Alison Brie on television now that it appears that Pete Campbell moved on to California without her on Mad Men. Alison Brie will be staring with others better known for their television roles in an upcoming movie Sleeping With Other People:

Former “SNL” star Jason Sudeikis, “Community’s” Alison Brie and “Parks and Recreation’s” Adam Scott are assembling for the upcoming comedy from Sidney Kimmel Entertainment.

Amanda Peet, Jason Mantzoukas and Natasha Lyonne will also star in the film from producers Adam McKay and Will Ferrell.

“Sleeping” centers on two chronic cheaters — played by Sudeikis and Brie — who attempt a non-sexual relationship in order to conquer their lustful ways. The press release says it’s “in the vein of ‘When Harry Met Sally’…but with assholes.

Update: Pete Campbell made a trip to New York this week and Alison Brie did appear.

Emilia Clarke of Game of Thrones and Nicholas Hoult of X-Men: Days of Future Past  will play Bonnie and Clyde in Go Down Together.

A former porn star writing at The Daily Beast gave some reasons why Game of Thrones might like to use porn stars:

1. A porn star is always willing to take off her clothes and there will never be a nudity clause in her contract.

2. They’ve put in their 10,000 hours and know how to fake passionate sex with the best of ‘em.

3. It’s sad but true: porn stars work cheap! Since nude is their norm, they won’t ask to be paid extra to be naked.

4. In a way that mainstream actresses sometimes fail to capture, porn stars always look very comfortable sitting around nude for the duration of a scene.

5. With all of that skin-on-skin action, things, well, pop up. Porn stars aren’t squeamish about their fellow actors getting aroused. They tend to be very understanding.

billie-piper-penny-dreadful-460x624

In somewhat related news from another premium cable network, former Doctor Who star Billie Piper promises “loads of sex” in Penny Dreadful.

The winners of the 2013 Nebula Award winners have been announced. Ancillary Justice by Ann Leckie won as best novel. Gravity won the Ray Bradbury Award for Outstanding Dramatic Presentation. While Gravity beat The Day of the Doctor for this award, the episode of Doctor Who did win a BAFTA Television Award for Radio Times Audience Award (Voted For By Members Of The Public). Broadchurch won a BAFTA as Best Drama. Richard Ayoade and Katherine Parkinson won awards for their roles in The IT Crowd.

Terra Nova was one of many science fiction shows which did not survive long on Fox (including Almost Human this season). Those interested in dinosaurs in the real world as opposed to the fictional world of Terra Nova might be interested in this report on the biggest dinosaur ever.

Two Polls Give (Limited) Hope For A Democratic Upset In November

Gallup051614

There are two recent poll findings which you might think should help the Democrats in November but most likely will not. Gallup found that the Democratic Party had a favorable rating of 44 percent while the Republicans have a with 34 percent favorable rating.

Unfortunately this type of lead has not necessarily translated into election victories in the past. It also doesn’t help the Democrats that, while leading the Republicans, they are still under 50 percent.

Republicans also have an advantage in House elections due to gerrymandering, and due to the concentration of Democrats in urban areas, leading to a larger margin of victory in a smaller number of districts. Democrats are defending several Senate seats in red states where they would not enjoy this lead over Republicans.

Brendan Nyhan looked at a recent Washington Post-ABC News poll which showed that more people agree with the Democrats on the issues:

More Americans say they trust Democrats than Republicans on the “main problems the nation faces over the next few years” as well as a number of key policy issues, including the economy, health care and immigration. Members of the public also typically indicate that Democrats are closer to their opinion than Republicans on specific issues like abortion, same-sex marriage and raising the minimum wage.

This apparent political advantage is less important than it might seem, however. For instance, Democrats had greater advantages on several major issues at comparable points in the 1994 and 2010 electoral cycles, which both resulted in Republican landslides…

Why haven’t these issue advantages translated into electoral success? First, the midterm electorate is not representative of the American public. The public’s preferences for Democrats on the issues may diminish or disappear once you look at registered voters or those who claim they are “absolutely certain” to vote, as Jaime Fuller of The Washington Post has noted. The Democrats’ edge on the issues is likely to dissipate further among the older, whiter group of Americans most likely to vote in November.

In addition, the importance of the issues in congressional elections is typically overstated. Structural factors like presidential approval, the state of the economy, the type of election (midterm or presidential year) and the composition of the seats that are up for election tend to matter more.

Most likely, based upon fundamentals in a midterm election the Republicans should do better than the Democrats. However, if the Democrats are seeking to significantly beat historical expectations, they sure have a better chance at the upset if they are the party which a majority support than if they did not have this support. How they do will depend a lot on whether the Democrats can get more of their supporters out to vote than is typical in midterm election years.

While the Democrats face a difficult task in holding onto Senate seats in the red states, there is an advantage to incumbency which should allow some to win. This might be enough to allow the Democrats to maintain control of the Senate until 2016 when the fundamentals are in their favor, including having an election year electorate and it is the Republicans who will be defending Senate seats in several blue states.

The Republican War On Science: From Climate Change To Reproduction

Fertilization and Implantation-MU

There is good reason that, going back to the Bush years, only six percent of scientists identify themselves as Republicans. For several years Republicans have promoted views contrary to facts as demonstrated by the scientific method, and commonly distort science to justify their positions. We have seen more examples of this with Marco Rubio’s denial that human action is responsible for climate change despite overwhelming evidence that this is the case.

Some on the right have come to Rubio’s defense. One of the more absurd defenses of Rubio came from James Taranto who questioned whether appeals to authority are fallacious. In scientific matters it only makes sense to rely on authorities in the field, and ninety-seven percent of climate scientists agree that human action is responsible for climate change. Taranto dismissed this by arguing that, “The trouble for global-warmist journalists like Marcus and Lapidos is that an appeal to the authority of a distrusted source undermines rather than strengthens one’s argument.” That is a rather circular argument that conservatives are apparently right in dismissing arguments based upon the views of  climate scientists because conservatives already distrust the source.

Rubio defended his earlier statements by pivoting to yet another area where conservatives promote pseudo-science to promote their views–reproduction. Rubio tried to portray liberals as not accepting settled science in an interview with Sean Hannity, but Rubio got the science wrong:

“All these people always wag their finger at me about ‘science’ and ‘settled science.’,” he told Hannity. “Let me give you a bit of settled science that they’ll never admit to. Science is settled, it’s not even a consensus, it is a unanimity, that human life begins at conception. So I hope the next time that someone wags their finger about science, they’ll ask one of these leaders on the left: ‘Do you agree with the consensus of scientists that say that human life begins at conception?’ I’d like to see someone ask that question.”

Philip Bump turned to the American College of Obstetricians and Gynecologists for their response to Rubio’s scientific claims. The response:

Government agencies and American medical organizations agree that the scientific definition of pregnancy and the legal definition of pregnancy are the same: pregnancy begins upon the implantation of a fertilized egg into the lining of a woman’s uterus. This typically takes place, if at all, between 5 and 9 days after fertilization of the egg – which itself can take place over the course of several days following sexual intercourse.

There are points in human reproduction which are defined scientifically, such as implantation and fertilization. Other points, including the time of intercourse and birth, have clear definitions. When life begins is not such a point:

There’s a blurry line between “pregnancy” and “life” in this discussion. When we asked ACOG if the two were interchangeable, we were told that the organization “approach[es] everything from a scientific perspective, and as such, our definition is for when pregnancy begins.” On the question of when life begins, then, the scientific experts we spoke with didn’t offer any consensus.

“Life” is something of a philosophical question, making Rubio’s dependence on a scientific argument — which, it hardly bears mentioning, is an argument about abortion — politically tricky. After all, if someone were to argue that life begins at implantation, it’s hard to find a moral argument against forms of birth control that prevent that from happening. If that someone were, say, running for president as a conservative Republican, that could be problematic.

Asking for the moment when life begins is a phony conservative frame which has no scientific validity, used to promote their viewpoint. The process of human reproduction is a continuum. The abortion issue involves matters beyond defining when life begins, such as the right of a woman to control her own body. The same is true with contraception, with some conservatives apparently choosing a point before the true onset of pregnancy as when life begins in order to justify opposition to forms of birth control which interfere with implantation.

Think Progress has more on conservative junk science being used to violate reproductive rights.

Health Care Policy Briefs: Early Retirement, The Two Americas, Sabotaging Obamacare, Marijuana Not A Gateway Drug, And The Pentagon’s Plan For The Zombie Apocalypse

zombies_01

Five  health care policy items today:

Goldman issued a report on how availability of health insurance allows people the option of retiring early (or as Republicans would put it, become takers) as opposed to waiting until they qualify for Medicare. The found that “the annual probability of retirement–i.e., what share of workers of a given age will retire within the next year–is on average between 2% and 8% higher when retiree health insurance is available.” Early retirement is seen more between the ages of 60 to 64, than in those who are age 55-59.

With Republicans blocking Medicaid expansion in twenty-four states, The Commonwealth Club looked at the healthcare differences in the two Americas:

The Commonwealth Fund’s recently released Scorecard on State Health System Performance, 2014, finds big differences between states on measures of health care access, quality, costs, and outcomes. What’s more, its authors warn that these differences could very well widen in the future. Many of the lowest-performing states are choosing not to expand their Medicaid programs under the Affordable Care Act (ACA). Some also are discouraging eligible uninsured citizens from purchasing subsidized coverage through new ACA marketplaces, though some uninsured are signing up nonetheless.

The fact that so many low-performing states are spurning the ACA’s benefits, while high-performing states are rushing to embrace them, raises profound questions for the future of our country. What would it mean if different parts of the United States find themselves on radically different health care trajectories, with some enjoying progressively better health and health care and others falling further and further behind? In other words, what would it mean if the two health care Americas grow further and further apart over time?

This is unexplored territory for health care researchers and policymakers, but we know enough to point to some possibilities.

To begin with, we know that when people have health coverage they live longer, healthier lives. Widening gaps in rates of insurance coverage between low- and high-performing states will almost certainly lead to growing differences in life expectancy and health status. This is worrisome and regrettable, but probably only part of the story.

An equally important—but much less explored—question is whether differing health care trajectories also will lead to differing economic and social trajectories. All else equal (of course, it never precisely is), will regions with poorer health care and health status suffer economically and socially as well? Will they have less productive workforces, less productive economies, and, as result, lower quality of life overall? Will they become less attractive places to live, work, and do business?

Several lines of evidence suggest that diverging regional health care systems could lead to diverging general welfare. First, untreated physical and mental health problems increase workers’ time off from work, reduce performance while at work, and lower rates of employment. In the early 20th century, infections such as yellow fever, malaria, and hookworm greatly hindered the economy of the American South. In his memoir, Jimmy Carter recalls that, while growing up in rural Georgia, “almost everyone was afflicted from time to time with hookworm,” a parasite that causes anemia, malaise, and fatigue. Eventually, public health measures and improved living conditions brought this and other health problems under control, contributing to a burst of economic growth.

A century later, chronic illness is the equivalent of the infectious illness that once disproportionately taxed the economy of the American South. In the United States, annual productivity losses from diabetes and depression alone exceed $100 billion nationally. And we know this burden can be lightened through good primary and preventive care that will be less available in regions with large uninsured populations.

Second, health insurance boosts economies by protecting people against catastrophic out-of-pocket health care expenses. These costs can lead to bankruptcy, which raises the cost of borrowing for the rest of society as lenders take into account the risk that they will not be repaid. Those avoiding bankruptcy often incur substantial medical debt, with far-reaching consequences. A 2012 Commonwealth Fund survey found that 61 percent of uninsured adults ages 19 to 64 reported problems paying their medical bills or said they were paying off medical debt over time. Among these individuals, more than half said they received a lower credit rating as a result of unpaid medical bills, 43 percent used all of their savings to pay their bills, and 29 percent delayed education or career plans. The 2006 Massachusetts health reform, which has led to nearly universal health coverage, has also led to fewer personal bankruptcies and bills past due and improved credit scores, particularly for those with limited access to credit before the reform…

The report continued to discuss further differences resulting from differing access to health insurance.

Besides blocking Medicaid expansion, conservatives are reducing the number of insured with misinformation campaigns and campaigns to outright dissuade people from obtaining coverage in the exchanges. This has led many uninsured people to fail to obtain coverage through the exchanges to based upon misconceptions spread by conservatives, such as that the cost would be much higher than it actually is. Jonathan Cohn wrote:

About half of the people who McKinsey surveyed did not end up buying insuranceeither because they shopped and found nothing they liked, or because they didn’t shop at all. When asked to explain these decisions, the majority of these people said they thought coverage would cost too much. But two-thirds of these people said they didn’t know they could get financial assistance. In other words, they assumed they would have to pay the sticker price for coverage, even though federal tax credits would have lowered the price by hundreds or thousands of dollars a year.

With a little education and outreach, many of these people will discover that insurance costs less than they thought. When next year’s open enrollment period begins, they are more likely to get coverage. But the idea was to help more of those people this year. And if the administration deserves some blame for this shortfall, its adversaries deserve more. Republicans and their allies did their best to taint the lawand, where possible, to undermine efforts to promote it. Without such obstruction, even more uninsured people would probably be getting coverage right now. As Sprung quipped in his post, “Those who deliberately spread disinformation about the ACA and actively encouraged the uninsured to remain in that blessed state of freedom can be really proud of themselves.”

Or as I put it in a recent post: Fox Lied, People Die.

The National Bureau of Economic Research looked at the effects of legalization of medical marijuana on drug use:

21 states and the District of Columbia currently have laws that permit marijuana use for medical purposes, often termed medical marijuana laws (MMLs). We tested the effects of MMLs adopted in seven states between 2004 and 2011 on adolescent and adult marijuana, alcohol, and hard drug use. We employed a restricted-access version of the National Survey on Drug Use and Health (NSDUH) micro-level data with geographic identifiers. For those 21 and older, we found that MMLs led to a relative increase in the probability of marijuana use of 16 percent, an increase in marijuana use frequency of 12-17 percent, and an increase in the probability of marijuana abuse/dependence of 15-27 percent. For those 12-20 years old, we found a relative increase in marijuana use initiation of 5-6 percent. Among those aged 21 or above, MMLs increased the frequency of binge drinking by 6-9 percent, but MMLs did not affect drinking behavior among those 12-20 years old. MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21, where there is also a spillover effect of increased binge drinking, but there is no evidence of spillovers to other substance use.

If marijuana turns out not to be a gateway drug, this would be another reason to reevaluate current marijuana laws. Further discussion at Vox.

The Pentagon has contingency plans for any emergency, including the Zombie Apocalypse. It isn’t as ridiculous as it sounds as it is actually a model plan using a fictional situation, as reported by Foreign Policy:

“This plan fulfills fictional contingency planning guidance tasking for U.S. Strategic Command to develop a comprehensive [plan] to undertake military operations to preserve ‘non-zombie’ humans from the threats posed by a zombie horde,” CONOP 8888’s plan summary reads. “Because zombies pose a threat to all non-zombie human life, [Strategic Command] will be prepared to preserve the sanctity of human life and conduct operations in support of any human population — including traditional adversaries.”

CONOP 8888, otherwise known as “Counter-Zombie Dominance” and dated April 30, 2011, is no laughing matter, and yet of course it is. As its authors note in the document’s “disclaimer section,” “this plan was not actually designed as a joke.”

Military planners assigned to the U.S. Strategic Command in Omaha, Nebraska during 2009 and 2010 looked for a creative way to devise a planning document to protect citizens in the event of an attack of any kind. The officers used zombies as their muse. “Planners … realized that training examples for plans must accommodate the political fallout that occurs if the general public mistakenly believes that a fictional training scenario is actually a real plan,” the authors wrote, adding: “Rather than risk such an outcome by teaching our augmentees using the fictional ‘Tunisia’ or ‘Nigeria’ scenarios used at [Joint Combined Warfighting School], we elected to use a completely-impossible scenario that could never be mistaken for a real plan.”

But do they have plans in case of a Dalek invasion?

One Way Obamacare Is Lowering Insurance Premiums

While insurance policies purchased through the exchanges and Medicaid expansion (or blocking it in many red states) have obtained the bulk of the publicity regarding the Affordable Care Act, there are many other aspects to the law. (No, Sarah Palin, establishment of death panels is not one of these). In the last post I looked at the benefits of enabling students to remain on their parents’ insurance plans. An even less discussed change is the regulations on medical loss ratios, which require that the bulk of premiums paid in be used for health benefits. Business Week explains that, “Expenses for marketing, fees to brokers, administrative costs, profits, and the like can’t take up more than 20¢ of each premium dollar (or 15¢ for large-group plans). Any amount collected above that threshold must be returned to customers.”

The Commonwealth Club looked at how this is working:

For the past two years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in the form of medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2012 were $513 million, half the amount paid out in 2011, indicating greater compliance with the MLR rule. Spending on quality improvement remained low, at less than 1 percent of premiums. Insurers continued to reduce their administrative and sales costs, such as brokers’ fees, without increasing profit margins, for a total reduction in overhead of $1.4 billion. In the first two years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to more than $3 billion.

These rules are one of the reasons that the insurance industry is unhappy about the Affordable Care Act, even if they do profit from expanding sales to the currently uninsured. The rules do punish them if they set premiums too high while  there are no benefits to the insurance company from setting premiums below the expected medical-loss ratio. Insurance companies are responding by setting their rates as close to the medical-l0ss ratio as possible. This is beneficial for consumers, who benefit from lower insurance rate and from receiving rebates if the insurance premiums are set too high.

Young Earning More Due To Obamacare Thanks To Remaining On Parents’ Insurance Plan & Conservatives Distort Report On Narrow Networks

Two health care items today, one on a benefit of the Affordable Care Act and another on a news item which conservatives are distorting to attack Obamacare. First the positive news.

I have discussed the benefit of the Affordable Care Act freeing people from the “insurance trap” in which they take jobs they otherwise would not want to work at purely to obtain health insurance. Allowing people more options to obtain insurance coverage independent of large employers allows people to retire earlier if they desire, go to work for smaller companies, or even start their own companies. The Journal of Health Economics considered another group of people freed from the “insurance trap” by Obamacare–young people who are allowed to remain on their parents’ insurance policies until age 26. They found that those who lived in states with similar laws were able to go to school at an older age and this also resulted in higher wages.

Health Economist Austin Frakt looked at this study for The New York Times:

One of the earliest pieces of the health-care law to go into effect — and one of the easiest to understand — was the one that allowed adults under age 26 to remain on their parents’ insurance plan. It has long been clear that the policy has somewhat increased the insurance rate among young adults. Now a new study suggests the effects may be much broader, also leading to increases in educational attainment and the wages of young adults.

The findings suggest that the health law has given young adults more flexibility to make decisions they think are best for them financially, rather than making decisions simply to obtain health insurance. With coverage from their parents’ plans, they can remain in college or graduate school, rather than leaving to take a job that provides health insurance. The cost of college is also potentially lower for such students because some colleges require health insurance coverage, which raises the cost of attendance.

With coverage in place, once students leave school, they can consider a broader range of jobs, including some that do not offer good health insurance or any health insurance. This finding is consistent with the academic literature on “job lock,” which has consistently shown that people who do not need to take a job with employer-based coverage have more flexibility, resulting in better employment matches with higher wages on average.

The Affordable Care Act appears to have increased health-insurance coverage among people under 26 by about 3 to 7 percentage points, academic research has found. The new study, published in the Journal of Health Economics, does not directly examine the health-care law, though. (It’s too recent to know its long-term effects.)

The study instead examines the earlier state-based laws with similar requirements that adult children be able to remain on their parents’ plans. It found that for people who were at least 18 at the time a coverage law was passed, wages earned after age 22 increased by about 2 percent. An increase in education drove the wage boost for men.

No similar educational effect was found for women, yet their wages increased as well. Those wage gains may stem from the new employment flexibility the law gives young women, allowing them to avoid job lock.

If anything, the Affordable Care Act may have a bigger effect than the state-based laws, because it has a broader mandate. While the state laws don’t apply to all types of employers, the federal law does. The new study estimates that the law will lead to sustained wage increases for affected young adults closer to 4 percent.

The New York Times also has an article on the trend for insurance companies to use narrower panels of physicians to cut costs. While several conservative sites are quoting this article to attack Obamacare, the article points out that this trend actually started in the 1990’s and has become increasingly common in all forms of insurance, not just plans sold on the exchanges. The article specifically points out that  “Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.”  It also notes that “In 2010, 24 percent of the largest employers offered smaller networks, chosen for their low costs or quality. Last year, 27 percent offered them and 44 percent said they were considering them…”

The Affordable Care Act preserves the dominant role of private insurance companies. As a result, it does not prevent private insurance companies from continuing the trend towards smaller networks, but this is also not something developed because of the Affordable Care Act. The difference is that there are new regulations on insurance companies requiring that they maintain an adequate network of physicians. There are also a variety of policies available on the exchanges. Many people chose the less expensive plans (often free to those who receive subsidies) with narrower networks, but also have a choice of other plans which would give them a greater choice of physicians and hospitals.

Republican Scare Stories Of Doctor Shortages Under Obamacare Failing To Come True

We are well into the year and none of the Republican horror stories about Obamacare have come true. There are no death panels. Enrollment through the exchanges has exceeded expectations. Over 80 percent of those purchasing insurance are paying premiums as the Obama administration predicted, and ultimately this might exceed 90 percent. Premiums are not expected to increase next year any more than is traditional on the individual market. The Hill even reports that Republicans are holding off on attacking the Affordable Care Act, although I wouldn’t count on that to continue.

Republicans have also predicted that the Affordable Care Act would lead to a shortage of doctors as more people obtain coverage, contradicting their claims that the uninsured were not signing up for coverage. Opposing health care reform because it might lead to shortages because of more people becoming covered is also a rather cruel answer to the millions who were uninsured. Some Republicans even predicted that doctors would not accept people in the new exchange plans, which is especially absurd considering that these private insurance plans pay doctors more than government plans such as Medicare and Medicaid.

Kaiser Health News reported today that there has not been a problem with shortages of doctors due to the Affordable Care Act:

The headlines were ominous: Good luck finding a doctor under Obamacare. Not enough doctors for newly insured. Obamacare, doctor shortage could crash health system.

Despite these dire predictions, the nation’s primary care system is handling the increased number of insured patients without major problems so far, according to interviews with community health centers, large physician practices and insurers nationwide.

Five months into the biggest expansion of health coverage in 50 years — with about 13 million people enrolled in private insurance and Medicaid under the Affordable Care Act — there are few reports of patients facing major delays getting care, say officials from more than two dozen health centers and multi-group practices, as well as insurers and physician groups in nine big states.

There are some exceptions, particularly in parts of Colorado, Kentucky and Washington state, which had some of the biggest gains in coverage…

Many of the concerns about people experiencing delays grew out the experience in Massachusetts after that state adopted near-universal coverage in 2006. Wait times for a doctor’s appointment rose to an average of 50 days with some as long as 100 days, according to a Massachusetts Medical Society report in 2008.

But Glied notes that Massachusetts’ residents historically had long waits for primary care visits so their experience is not a good indicator.

And unlike the Massachusetts law, the Affordable Care Act gave health providers more than three years to prepare. In that time, the federal government has spent billions expanding community health centers while private practices have added nurse practitioners and physician assistants and adopted electronic health records.

“Despite the widely publicized shortage of primary care physicians, primary care capacity does exist in each state,” said Karin Rhodes, director of the Center for Emergency Care Policy & Research at the University of Pennsylvania School of Medicine.

Rhodes was the lead author of a study published last month in JAMA Internal Medicine in which researchers posing as new patients called about 8,000 primary care practices in 10 states. The vast majority quickly secured appointments although those with Medicaid had a tougher time.

I also discussed that study in a post last month.

Some of the anecdotal reports of difficulty seeing a physician are probably erroneously being attributed to the Affordable Care Act, especially as an already existing shortage in some areas has been exacerbated by other problems recently. As a large number of the newly insured didn’t sign up until late March, I am quite skeptical of those claiming to have experienced problems due to shortages beginning in January. Before blaming the Affordable Care Act, keep in mind the fact that health care utilization began to rise in late 2013 due to factors such as improvements in the economy. People who had been putting off medical expenses were thought to have more money to spend while others obtained new jobs with health insurance.

In addition, new requirements for electronic medical records and the conversion to ICD-10 billing codes have been very time consuming for physicians over the past year, resulting in many doctors not being able to see as many patients as in previous years. Fortunately the conversion to ICD-10 has been postponed another year, but time-consuming transition programs are continuing. While computerization theoretically will increase efficiency, the conversion, with many onerous new requirements, initially results in a considerable drop in productivity.

While many of the Republican scare stories are easily dismissed as ridiculous, there is legitimate reason for concern that increasing the number of people with insurance will worsen already existing physician shortages in many areas, especially in the future when even more people are insured. That would certainly be the case if the Affordable Care Act didn’t also include measures to increase the number of primary care physicians to offset this. Some of the measures in the Affordable Care Act which will help increase the number of primary care physicians can be seen here.

Often people are unaware of how new physicians in an area are a result of the Affordable Care Act. While researching this post I stumbled across this press release for a new Family Medicine Residency Program in San Diego, which has been designated a health shortage area for several years. It reports that, “The training program was made possible by the Affordable Care Act, which created the new Teaching Health Center Graduate Medical Education Program (THCGME) to establish physician training programs in underserved community-based settings.” I was glad that the ACA received credit for the establishment of this program.

Those who studied the Affordable Care Act did not take the Republican scare stories of shortages seriously. In December, Scott Gottlieb, who advised George W. Bush, and  Ezekiel J. Emanuel, an adviser to Barack Obama on the Affordable Care Act, jointly wrote an op-ed in The New York Times entitled, No, There Won’t Be a Doctor Shortage. They explained how changes in health care delivery will offset the increased demand both from the newly insured and an aging population.

The physician shortage has been studied extensively and while increased demand due to newly insured is expected to play a role, other factors are expected to be far more important with regard to the physician shortage. For example, The Manhattan Institute concluded, “Ultimately, the impact of Obamacare on the primary-care physician shortage, rather than just the increase in demand for primary-care physicians, is relatively minor: the insurance expansion will require about 5,000 more doctors in 2025, compared with about 25,000 more physicians who will be required because of demographic changes and population growth.”

The National Center for Health Workforce Analysis found that the aging population is by far has the greatest influence on future projected shortages, accounting for 81 percent of increased demand. They also project that many of the shortages can be alleviated by increased use of nurse practitioners and PA’s, increasing from 23 percent of primary care services in 2010 to 28 percent in 2020. This would still leave physicians as the primary providers of care, decreasing from 77 percent of the primary care services in 2010 to 72 percent in 2020. I don’t think that there is any doubt that NP’s and PA’s can handle this amount of routine primary care. This would reduce their projected shortage of 20,400 physicians in 2020 to 6,400.

While the number of newly insured has already been accounted for in projections (often assuming full Medicaid expansion nation wide), the number of new programs to expand primary care, and other ways to transform health care to make it more efficient, can still be increased over time. Increased government involvement in health care can lead to additional solutions which would not occur if we continued the old, inefficient system. The Affordable Care Act also has provisions requiring insurance companies to maintain panels with an adequate number of physicians. While such requirements might be meaningless if there aren’t enough physicians available, they do protect consumers from problems such as insurance companies limiting the size of their physician panels too drastically in order to reduce costs.

We already have a shortage of primary care physicians in many areas and will face challenges in the future, but the Affordable Care Act should not be blamed for this problem. The impact will vary in different areas, but overall the result of the newly insured should not create major problems for the health care system.