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76  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: December 18, 2016, 06:17:58 am
As someone who's never had to use any form of US healthcare my knowledge is very much weighted towards outcomes rather than the actual process of getting healthcare.

Gets back to the vague post I made in Scott's thread about learning just how long the road is.


When it comes to outcomes, and especially outcomes relative to cost you are dealing with three things that interconnect.

1. Availability of qualified professionals
2. Availability of Technology
3. Pricing Mechanism (Pay for services rendered or overall outcomes)

Also the combination of technology and transparency of cost/quality allows (in some instances of healthcare) to expand choice and the range of options for their care, just as much as this bill does with choice in coverage.

I think we are going to end up having 3 to 4 bills on healthcare. 1. Access and related Cost concerns (This Bill), 2. Healthcare Delivery and Quality (Includes 3 point list above), 3. Healthcare IT, and 4. Liability Reform.
77  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: December 18, 2016, 06:10:10 am
I will acknowledge that the one component of the 2014 bill that I had "least understanding" of was exact mechanics of the CIEP and risk pools. Yes, I can read what it says but my feel for how that would function practically was never as strong as the portions I wrote myself or had influence over. If memory serves me that was largely the work of Duke and Lumine, so people who generally know what they are doing.

I might hazard to suggest that having them, might alleviate some of the problems that Obamacare experienced regarding who was signing up and was not, but relative improvement in that regard is not something that I could speak to directly.


78  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: December 18, 2016, 06:06:42 am
Oh okay that makes more sense; I was worried that the majority would piggyback onto that part of the plan.

I think we're looking at a very strong piece of reform, especially in regards to the amount of choice that consumers have

I agree, it is certainly heading in a strong direction, at least structurally.
79  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-045 - Ballot Integrity Act (Debating) on: December 18, 2016, 05:55:43 am
    So this act includes both a Constitutional Amendment and a statutory bill? Has that ever happened before?

Yes:
Regional Legislative and Constitutional Amendment Authority Act of 2013

Though both amendments were rejected at ratification if memory serves me.
80  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-044 - Deputy Game Moderator Act (Voting) on: December 18, 2016, 05:51:17 am
Assuming the Deputy GM is active, hopefully this can smooth out smooth out the functionality, either by spreading the load or filling in when the GM is unavailable.
81  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-043 - Gas Tax of 2016 (Debating) on: December 18, 2016, 05:49:15 am
I would once again restate (in shorter terms) my recommendation for investment in cleaner/safer energy extraction methods to replace fracking.
82  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-043 - Gas Tax of 2016 (Debating) on: December 18, 2016, 05:48:22 am
I guess I put them to sleep. Tongue

This is why I'm considering recesses during the Holidays Tongue

It is not a terrible idea, but I would recommend not recessing for more then a few days. Granted, it might be exceedingly difficult in the intermediate period between the holidays to get people on the site, we could potentially get some stuff done during that time and give people both Christmas and New Years off (perhaps a day either side of them as well).
83  Atlas Fantasy Elections / Atlas Fantasy Government / Re: Senate Confirmation Hearing: Ted Bessell for Secretary of State (Confirmed) on: December 18, 2016, 05:42:08 am
Congrats Ted! Smiley


Blinded by the light of Kek? Tongue
84  Other Elections - Analysis and Discussion / Congressional Elections / Re: Theory on Why Coats Retired on: December 18, 2016, 05:05:28 am
I figured he was likely to retire after just one term from the time he got elected in 2010.
85  Presidential Elections - Analysis and Discussion / 2016 U.S. Presidential Election / Re: How much of vote was in in Ohio when you knew trump had the state won? on: December 18, 2016, 05:00:32 am
Hillary's early lead concerned me, but once it evaporated, I knew then.


Also the counties quickly were telling me Trump was doing well. Romney massively under performed in NW and South Central OH, two key areas where Republicans need to run up the margins. Trump killed it in both areas, was outpacing Romney in the SE and was collapsing the Democratic bastions in the NE corner of the state.

86  Presidential Elections - Analysis and Discussion / 2016 U.S. Presidential Election / Re: Describe a Trump/Cooper voter on: December 18, 2016, 04:57:29 am
This is nothing new. A far more extreme case existed in 2008. With a lot of McCain/Perdue voters, but McCrory compensatin with a lot of Obama/McCrory voters in Charlotte leading to that race still being within 3%.


Of course, by 2016, that ship had sailed.

87  Presidential Elections - Analysis and Discussion / 2016 U.S. Presidential Election / Re: Trump's surprise showings in the deep south during primaries on: December 18, 2016, 04:49:58 am
Class

Trump had appeal to evangelical, nominally evangelical and non-evangelical WWC voters in the deep South while Cruz's Evangelical base was more high end. This meant it dominated the activist base completely enough to win or compete in closed and/or Caucus states, but Trump could swamp him in Southern primaries, especially open ones.

It also helped that the earliest and likely one of the most hostile states (South Carolina) had an incredibly divided field allowing Trump to win with only getting into the 30's and was likewise open.

On the other hand he did rather well in states like TN and AL, rural GA, and areas close to the Appalachian mountains, particular those with a hollowed out feel economically (The rust belt doesn't stop at the Mason-Dixon Line hence Trump killing it in Buchanan Co, VA), large populations of white working class voters, or both. These voters have been streaming into the GOP since the 1990's thanks to Clinton's scandals, Bush's cultural conservatism and the continued shift of the Democratic Party to the left on the social, environmental and gun issues and in those states that were open, Trump could augment those with even more of the same group that remained as Democrats or Independents.

Also this:
http://politics.blog.ajc.com/2015/12/26/that-time-when-donald-trump-saved-a-georgia-farm/

Discovering this article the day after Christmas on AAD, is what made me realize that Trump could beat Cruz in the South.
88  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-043 - Gas Tax of 2016 (Debating) on: December 14, 2016, 01:29:46 am
I guess I put them to sleep. Tongue
89  Presidential Elections - Analysis and Discussion / Presidential Election Trends / Re: Vermont could become a swing state. on: December 14, 2016, 12:50:06 am
As for Vermont, come on board! Tongue  It'd be great to have the historic bedrock of party support back on the team!  Though, the VT that voted Republican is a much preferable state politically than this current manifestation that has little or no resemblance demographically, economically or politically to the VT that rejected FDR.

You might get Maine, though (if current trends keep up)! Smiley That should be good enough (at least IMO) and they also rejected FDR.

As Maine Goes... Tongue
90  Other Elections - Analysis and Discussion / Congressional Elections / Re: MT-AL, MT-Sen: Trump picks Zinke as Sec. of Interior on: December 14, 2016, 12:04:16 am
Reminds me of when Bush plucked Johanns for Agriculture when he was immensely popular in Nebraska removing him as a possible challenger to Ben Nelson.
91  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: December 12, 2016, 03:02:08 am
When it comes to the Medicare buy-in, am I to assume there will be premiums attached especially to the higher ends of that $90,000 spectrum?

I'd think there would be.  That will probably need to be clarified in future amendments to the bill.  In essence, Medicare parts A, B, C and D are scrapped as all Medicare recipients are covered for the same services (which are drawn from Fritzcare).

I don't see that transition clearly established in the text, so yea I guess amendments are needed. Tongue

Quote
Medicaid charges no premiums, portions of Medicare charge premiums but others do not. While Medicaid is in the worse shape, I am unsure of taking it and dumping it wholesale into Medicare, which has its own problems largely driven by the generalized healthcare cost issue as well as aging demographics.

If the federal government is going to offer public plans to most people on a means basis, why would we need to maintain two different single-payer systems?

Both Medicare and Medicaid face serious but slightly different problems. If they are going to be consolidated and I am all for consolidating them, but there has to be a transition process both to protect those currently in the programs and to alleviate the stresses that both systems are facing.

This is by design not a single payer system, unless I am mistaking. Section 2 creates co-ops that will compete with this system and the bill also references private for-profit insurers in that section as well. Section 4 gives authority to states to adopt a single payer system and the use of the term "means" based, likewise. Also Medicare is not a single payer system because Parts of it charge premiums.

But in terms of what I think you mean, not merging Medicare and Medicaid doesn't necessarily imply keeping two "gov't" systems.

You could accomplish Medicaid's mission in multiple ways, especially if you are creating non-profit competition. Medicaid's target audience is not barred from the market except for reasons of affording access. For instance, an "adequate" (as in adequate enough to accomplish the objective) subsidy to by private insurance could provide the same level of coverage as medicaid with people using the subsidy to buy private or federal co-opt, federal public option, regional public option, regional co-opt or any number of alternative insurance providers.

Medicare's target audience provides you with less flexibility because their age makes it difficult to insure them through the private market and possibly even with non-profit co-ops.

If you want to consolidate the whole healthcare system, I would make three recommendations:
1) Don't call it Medicare because the structure is fundamentally different
2) Have complete lateral competition or at least the potential for competition across all categories of healthcare. So a Senior could buy a private plan or a co-opt plan, likewise a lower income person could as well. At the same time Bill Gates could opt for the Gov't plan.
3) Have all players charge premiums and then focus the means based coverage on the premium side as opposed to the benefit side (biggest difference between the 2009/2012 plan and the 2014 bill). Bill Gates would pay 100% of his premium, even if he opted for the Gov't plan. There would be variance to the formula for Seniors, vets and the like. I think a premium based system is critical because it allows for higher reimbursement rates, as well as stability for the gov't plan to an extent that solves the crisis of doctors not accepting gov't plan patients, which is a problem with Medicaid currently and becoming a bigger one for Medicare as fears of its insolvency loom. Another factor in this problem (which I discussed with Blair in a PM last night), is the excessive amounts of red tape, which is also a problem with Obamacare. We have to simplify the paperwork and minimize the work load that is keeping doctors in their office and treating fewer patients.

Quote
I am also uncomfortable with completely removing people from experiencing the costs of their healthcare decisions. If anything, we need to front load the future costs down the road of health decisions made now, like diet/smoking etc, so as to reduce the generalized inflation these form a contributing factor towards. You could also price in the usage of preventative care, versus lack thereof. This way the incentives push in the right direction and even if they don't change behaviors at least they are paying for the costs of their decisions as opposed to it being spread across all healthcare consumers like in real life, or in this case, it would be tax payers.

Also selecting a single cutoff leads to what is known as a coverage cliff at $90,000. This issue came up in 2014 and was the primary reason why shua recommended and formulated the sliding scale premium subsidy to gradualize the drops off in coverage. I have experienced these first hand in both Medicaid and the Food Stamp program and I can tell you they are very disruptive and often force people to decide between two bad options.

The public plans won't make services free of charge.  I would be fully on board with incentivizing preventative care.

If we want all Medicare plans to cover the same things as Fritzcare (we can consider whether to offer specialized plans instead, of course), then a sliding scale premium could work here.  Do you remember the formula shua had written up in 2014 or where he posted it?

Well we did have equalization of covered items. Plus it helped that previous bills pretty much nuked private coverage unintentionally so that was starting from scratch, making it easier. That being said, if we want to contain costs, we shouldn't be opposed to specialized plans tailored to a particular person.

As for the formula here it is:

Quote
x = household income  (measured in terms of poverty line)
y = subsidy (measured in terms of full cost of public option coverage)

y= 1 when x <= 1.5 (150% of poverty line),
y= -.4(x - 4) when x >= 1.5



Co-pays and Deductibles were capped for all providers at 5% of income.

This was a truly consolidated system we were dealing. So the formula was applied differently for certain groups and the public option (ANHC or Fritzcare) was favored as the primary option for care for Vets, Seniors and Active Duty Military:
Quote
Part III: Coverage for Special Populations

Section 1: Coverage for Military and Veterans.

1. All active duty military personnel shall be eligible for full coverage under ANHC, fully paid for by the Atlasian Department of Defense with no premiums, co-pays or deductibles.

2. All Veterans shall be eligible for full coverage under the ANHC, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act.  Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
  
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.

Section 2: Pre-existing Conditions and High Risk Populations

1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within the ANHC so that those with pre-existing conditions can receive affordable care without discrimination.  Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under ANHC at the same cost to the consumer as those without these conditions.

2. The CIEP shall be subsidized out of funds derived from the healthcare payroll tax to the extent necessary to achieve cost parity to the consumer.

3. The CIEP shall have open enrollment periods determined by the ANHC Health Directorate.  Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through ANHC or another insurer prior to such change in condition.

4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.
92  General Discussion / History / Re: What killed the democrats in the white south? on: December 12, 2016, 01:50:01 am
https://www.youtube.com/watch?v=lHdXQAQHjd8


People who could appreciate this message from first hand experience died off.

By 1990, they would have been 60 or above, with the median probably in the mid 70's. By 2010 they were mostly gone.


Prior to the 1950's everyone who could vote, voted Democratic in the South save for a few enclaves. Beginning in the 1950's Republicans began to win over middle class voters in metropolitan areas, once the Bilbo generation was no longer around to chide them at Christmas Dinner over the fact that Bill Sherman burnt daddy's barn to the ground and killed Uncle Johnny at Chattanooga. A large number Midwestern and Northeastern people of similar class moved to places like Tampa, Charlotte and Dallas as well. Together, this created the suburban base for the GOP in the South that became its backbone for decades. This was evident in 1952 and the voting power of these places grew over the next 40 years. Civil Rights issues like busing were of major concern but it is hard to claim they flipped just because of Civil Rights. At best, it just padded the margins among this group.

Rural and Working Class members of that same generation, though (GI and Silent largely) were helped by the New Deal and therefore remained Democratic but for different reasons then their parents and grandparents (Civil War Legacy voting). This allowed for the rise of the New Democrat in the 1970's and 1980's, like Terry Sanford, Jimmy Carter and Bill Clinton.

Their children and grandchildren though were alienated yes by the Civil Rights issue as well as the general social issues that motivated Boomer voters and late Silent voters all across the country. Thus the rise of God, Guns and Gays (as well as life) becoming strong motivations that finally tipped many rural districts in the 1994 elections, in conjunction with the Supreme Court requiring a higher concentration of African Americans in districts. This ruling thwarted Democratic Gerrymanders in GA and other places built around spreading out the African American vote to prop up White Democrats who needed that 30% or so to get close enough so their aging Yellow Dog support was enough to win.

By 2000, FDR seniors were largely being replaced by Ike seniors (President they came of age with). This is considered to be why Gore fell flat with Seniors compared to the numbers he was expecting to obtain with the Lock box messaging.
93  Other Elections - Analysis and Discussion / Gubernatorial/Statewide Elections / Re: Brandstad Leaving in Iowa? on: December 12, 2016, 01:17:56 am
Why does King always seem interested in anything Reynolds is looking at running for? Do they have a feud or something?
94  Atlas Fantasy Elections / Voting Booth / Re: December 2016 House Election on: December 11, 2016, 11:59:21 pm
OFFICIAL BALLOT
[ 6 ] 1184AZ (Federalist-FL)
[ ] Cashew (Labor-CA)
[ 3 ] Enduro (Federalist-PA)
[ ] NeverAgain (Labor-VA)
[ 9 ] Peebs (Labor-NC)
[ 4 ] Republitarian/Goldwater (Federalist-UT)
[ 1 ] Santander (Federalist-AL)
[ 2 ] Secure America/Heisenberg (Federalist-NM)
[ 7 ] Siren (Independent-PR)
[ 8 ] Southern Gothic (Labor-LA)
[ 5 ] tedbessell (Federalist-CA)
[ ] wolfentoad66 (Labor-CA)
[ ] Write-In
[ ] None of the Above
95  Presidential Elections - Analysis and Discussion / 2020 U.S. Presidential Election / Re: Generation Z on: December 11, 2016, 11:13:50 pm
A large part depends on how Trump does.

96  General Politics / U.S. General Discussion / Re: Drain the swamp (lol) on: December 11, 2016, 10:35:23 pm
The right views the Federal bureaucracy as the swamp. The left regards Wall Street as the swamp.

A large number of Trump supporters probably view both as the swamp.
97  Other Elections - Analysis and Discussion / Congressional Elections / Re: CA should start gerrymandering better on: December 11, 2016, 08:36:40 pm
I don't believe in unilateral disarmament, so CA should start Gerrymandering. There is no point in not having Gerrymandering in one state, but having it in the others. There needs to be a broad bill for the whole of the country to ban the practice.

At the same time, I don't think Congress should mandate that Iowa change its system to a complete commission or something because 1) Iowa's mixed system works and 2) Commissions have failed like in AZ.

The problem is in big and swing states. California and Florida have largely removed fixed their problems. New York and Colorado got great maps in court.
98  Atlas Fantasy Elections / Voting Booth / Re: December 2016 - Southern Senate Election (Class II) on: December 11, 2016, 07:50:26 pm
SOUTHERN SENATOR
CLASS II



[ 1 ] Leinad of Georgia
Independent - Federalist Party



[ 2 ] Siren of Puerto Rico
Independent
99  Other Elections - Analysis and Discussion / Congressional Elections / Re: CA should start gerrymandering better on: December 11, 2016, 04:28:10 am
California is or at least was an unintentional Democratic gerrymander simply because the way in which the Commission operated. Of course a lot of that was because they used several elections as benchmarks but the GOP has been eroding more and more with CA voters rending them obsolete models.


Republicans won the House Popular Vote in 2010, 2014, and 2016.

stop being hypocrites and realize that it is ok for both sides to want to gerrymander states they have electoral control over.

I don't think gerrymandering should be legal, period.  It's horrific that Democrats can win 55% of the vote nationwide, or thereabouts, and still fail to control the House, and I would have that opinion even if Dems were on the winning end. There should be a constitutional amendment forcing every state to set up a nonpartisan redistricting commission.

Until something like that gets implemented, I'm okay with any approach California takes.  Ideally, they would retain their nonpartisan commission in perpetuity, but if the lower chamber of congress transforms into a permanent Republican bastion, then the state may need to take drastic measures.
Why would it be horrific that they win 55% nationwide and still lose? That doesn't necessarily equate to a gerrymander, but indicated severe regionism and sectionalism. Democrats rack up votes in big cities, but almost nowhere else nowadays...that's a strategy problem not a system problem.
Or it says that the Republicans gerrymander the house and you as a republican are trying to make excuses for it.   

Aside from the initial effect of knocking off the entrenched Dem incumbent, all Gerrymandering does is pad the GOP margins in the marginal districts giving them a point or two cushion versus the NPV.

The bulk of the differential is the concentration of Democratic voters.

Instead of demanding reverse gerrymandering to counter this (ILL style) what Democrats should be calling for is to enlarge the House of Representatives according to the Cube Root Rule or even Wyoming Rule. This would give more seats to the biggest and fastest growing states and make it difficult for Republicans to drowned out hostile cities/counties with the sea of 55% red territory (Because the districts are too small to do that).

100  Other Elections - Analysis and Discussion / Congressional Elections / Re: ND-SEN: Cramer likely to run on: December 11, 2016, 04:17:54 am
Great news! All aboard the Trump train!

Link

Trump reportedly will name US Sen Heidi Heitkamp (D-ND) as Agriculture Secretary. Under ND law, a special election will be held for seat.

That Twitter account's only source is Politico, which says that she is his top choice but not that she will accept.

Obviously Trump wants her out of the Senate. No surprise there.

Steve Bashear did it in Kentucky back in 2011, and with more then one Republican if memory serves me.
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