Friday, March 22, 2013

Two Differences Between Obamacare and Medicare

Congressman Richard Neal of Mass. illustrates a difference between Obamacare and Medicare and wants to fix it:
Currently, Medicare waives cost-sharing for any colorectal cancer screening recommended by the U.S. Preventive Services Task Force. However, should the beneficiary have a precancerous polyp removed, the procedure is no longer considered a ``screening'' for Medicare purposes. The unintended consequence of this is that the beneficiary is obligated to pay the Medicare coinsurance. This is an unexpected and unwelcome ``sticker shock'' that does nothing to promote screening or improve patient care. The Administration announced in February 2013 that private insurers participating in state-based health insurance exchanges must remove all cost sharing for colon cancer screenings where a polyp was removed. We must have a similar policy in the Medicare program.
To translate this out of healthcare speak, and into English:

  • Under the law governing Medicare, a colonoscopy is reimbursed at 100%. However, a colonoscopy that finds a polyp, and removes a polyp, becomes a medical procedure, and the patient is liable for a co-payment.
  • Under Obamacare, a colonoscopy is reimbursed at 100%. HHS, in regulations, forbids insurance companies from imposing a copay when a polyp is found and removed. (Current practice of insurance companies, incidentally, has been to follow Medicare.)
Leaving aside the merits of the Congressman's proposed legislation for a second, let's take a look at what Mr. Neal also illustrates:
  • Changing Medicare's benefit package takes an Act of Congress;
  • Changing Obamacare's benefits package only takes a change in regulations

How you feel about this question is probably a good way to figure out the question -- Republican or Democrat?

Tuesday, March 19, 2013

An Apology For All Past and Future Posts

In the great International Attic that is www.archive.org, I have found the apology that now applies to all my posts, past or present:
I fear, I shall be thought to have treated the question in too diffusive a manner. I have not, indeed, laboured to be concise. But if the memoir is more extensive than was necessary, I flatter myself, it will be admitted that it, at least, contains some new and interesting facts. I submit it to its fate.
Please content yourself with this apology, dear reader, because it will be a chilly day in Hades before we issue another one.

I have also found a quote in the same delightful 18th century treatise on the alleged powers of rattlesnakes that I think I will feel impelled to use in some post about climate change, because it seems to apply, oddly enough, to the grim lot who insist that the globe is warming drastically, and that we are doomed to floods and drought (likely at the same time), unless we turn the thermostat down at the house low enough so that we will pray for some drastic global warming...

In any event, the quote, which is too good to waste:
The human mind, unenlightened by science, or by considerable reflection, is a foil rich in the weeds of superstition  and credulity. It is ever prone to believe in the wonderful, even when this belief, as is often the case, brings with it fears, and cares, and misery. The bondage of the mind in superstitious credulity is great and heavy. Neither religion nor virtue can give it its freedom. This it obtains from science. How important, then, even in this point of view, is the enlargement of the mind by science
It is a sad irony that this quote seems to apply to the scientists who can't quite accept that things are not quite as hot as their models predicted.


A Course In Civics

America had just emerged from a war many thought was an ill-advised foreign adventure, and many were persecuted for saying it was an ill-advised foreign adventure. Europe was acting irresponsibly. A deep recession plagued the nation. And America had just elected its first bi-racial president (maybe).

Obviously, in such a tense national atmosphere, there was a need for high school education that provided a course designed "to give the pupil an intelligent conception of the great society in which he is a member, his relation to it, what it requires of him, how it is organized, and what functions it performs." But this course should recognize "that in the field of social studies all roads lead through government. No matter whether the topic under discussion be finance, banking, public health, poor relief, transportation, or labor problems, we must at all times reckon with governmental organization,
policy and action as great factors in the situation. The study of governmental organization and the functions of public authority ought therefore to be the center or core of any high school course whose chief aim is to inculcate sound ideals of citizenship, to emphasize the duties of the citizen, and to afford any grasp of public problems."

So therefore, in December, 1920, the American Political Science Association, appointed a committee  which set about establishing a curriculum for a course in civics, designed to "to impress upon the pupil the fact that he is a member of the community and ought to be an active, constructive member of it. The teaching of the subject ought to point continually towards civic duty as well as civic rights. Scope and methods should be adjusted to this purpose, which means that social and economic forces which directly affect the activities of citizenship ought to receive adequate emphasis."

The curriculum, taken from the February, 1922 edition of the Journal of Political Science follows. The questions to the reader -- is this what we should be doing today? Is this much of what we do today? Or are the biases inherent in this curriculum (besides the racial stuff and the push for assimilation of immigrants)  much of what poisons the teaching of social science? Or is this (besides the racial stuff) indicative of a long-forgotten golden era of education about our society.



Part 1-The American Environment

I. MAN AND SOCIETY
Why men organize. The social instinct. The doctrine of evolution as applied to society. Heredity and environment. Individual and social heredity. The physical and the social environment of man. The chief social groups (family, tribe, community, state, etc). Individual liberty and social control.
II. THE UNITED STATES
Geography as a factor in national life and progress. The chief geographical areas of the United States. The soil. Harbors and waterways. The newer territories. Alaska and the insular possessions. Influence of geographic features upon past development. Geography and the future.
III. THE PEOPLE, RACES AND RACIAL PROBLEMS OF THE UNITED STATES.
The growth of population. How the population is now distributed. The drift to the cities, its causes, extent and results. Principal occupations of the people. Immigration; its history and causes. Nature of the immigration. Present racial distribution. The negro problem. Other racial problems. Assimilation.
The effects of immigration, social, economic and political.
IV. THE AMERICAN HOME AND COMMUNITY
Importance of the family as a unit. Influence of the home in training for citizenship. Marriage as the basis of the family. The divorce problem. The community; what it is. How communities are formed. The needs and functions of the community. The community spirit. The community and the school. How the schools train for citizenship. The relation of good citizenship to community service.
V. ECONOMIC FACTORS AND ORGANIZATION
The economic needs of man. Economic motives. The subject-matter of economics. The consumption of wealth. Production. The factors in production. Land and natural resources. Rent. Labor. The division of labor. Is labor a commodity? Wages. How rates of wages are determined. Capital and interest on capital. The forms of economic organization. Partnerships and corporations. Profits. Government as a factor in production. The distribution of wealth. Transportation as a factor in distribution. Exchange, value and price. Competition and monopoly. Natural monopolies. Freedom of contract. The institution of private property.

Part II. American Government

(a) The Foundations of Government
VI. THE NATURE AND FORMS OF GOVERNMENT
Definition of the state. Definition of government. The purpose of the state.Origin of the state. Various theories as to its origin. The basis of the state's authority. Classification of states. Relation of the state to government. The branches of government. The functions of government. Characteristics of American government. Written constitutions. Separation of powers. Federalism.
VII. THE CITIZEN; HIS RIGHTS AND DUTIES
Who are citizens? How citizenship is acquired. Naturalization. The rights of the citizen. Are corporations citizens? Civil liberty; what it means and how it grew. Privileges which are not civic rights. The obligations of citizenship. Hindrances to good citizenship.
VIII. POPULAR CONTROL OF GOVERNMENT
The channels of popular control. Public opinion; its nature and limitations. The election of representatives. The appointment of officials. Election vs. Appointment. Appointments with and without confirmation. Partisan appointments. The spoils system. The rise of civil service. Nature of the civil service system. Its value and limitations. Popular control through direct legislation and the recall. Origin and spread of the initiative and referendum. Direct legislation in practice. Merits and defects of direct legislation. The recall. The recall of judicial decisions.

(b) The Electoral Mechanism
IX. SUFFRAGE AND ELECTIONS
Citizenship and suffrage. Development of the suffrage. Woman suffrage. Present qualifications for voting. Educational tests. Taxpaying requirements. Disqualifications. How voters are registered. Nominations. History of nominating methods. The caucus, convention and primary. Merits and defects of the primary. Election methods. The ballot. The short ballot movement. The preferential ballot. Proportional representation. Corrupt practices at elections. Absent voting. Compulsory voting.
X. PARTY ORGANIZATION AND MACHINERY
Why political parties are formed. Nature and functions of political parties. History of American parties. What the leading parties stand for. Party platforms. The minor parties. Economic and social influences on party divisions. Party organization in nation, state and community. The machine. Rings and bosses. Party finance. Practical politics. How parties are financed. The reform of party organization.

(c) Local and State Government
XI. COUNTIES AND RURAL COMMUNITIES
Early types of local government. The county; its legal status, organization and officials. Duties of county officers. The reform of county government. City and county consolidation. The county manager plan. The New England town; its organization and the functions of its officials. The township. County districts. Incorporated communities. Problems of local government.
XII. CITY GOVERNMENT
Growth of cities. Relation of cities to the state. Municipal home rule. Different types of city charter. The mayor. The heads of city departments. Municipal officials and employees. Civil service in cities. The city council. Boards and commissions in cities. The reconstruction of city government. The commission plan. Its extension, nature, merits and defects. The city manager. Other recent changes in city government.
XIII. MUNICIPAL PROBLEMS OF TODAY
City planning. Streets and public works. The protection of life and property. Parks and recreation. The city's share in public health and welfare problems. Congestion of population and its relief. New sources of revenue for cities. Other municipal problems.
XIV. STATE GOVERNMENT
The early state constitutions. How state constitutions are made. General powers residing in the states. The governor. Officials of state administration. The state legislature. Legislative procedure. The states as agents of the nation. Relations between the states. Full faith and credit. Extradition. Limitations upon the states. The reconstruction of state government.

(d) National Government
XV. THE NATIONAL CONSTITUTION
American government before and during the Revolution. The earlier attempts at union. The Confederation; its weakness. Preliminaries of the Constitution. Personnel of the convention. The convention's work. The compromises. General character of the Constitution. Methods by which it was adopted. Growth of the Constitution by amendment, interpretation and usage.
XVI. CONGRESS AT WORK
Organization of Congress. Merits and defects of the bicameral system. The Senate; its organization. Its special powers. Confirmation of appointments. Ratification of treaties. Impeachments. Its concurrent powers. Its influence. The House of Representatives. Method of election. Procedure. The Speaker. The committee system. Powers of the House. Relations between the Houses. The general powers of Congress. Congressional finance.
XVII. THE PRESIDENT AND His CABINET
Nature of the presidential office. Method of nomination. The college of electors. Why great and striking men are not always chosen. The President's powers. Appointments. The veto power. Other prerogatives. Relation of the President to Congress. The President's relation to his party. The Cabinet
and the administration.
XVIII. THE COURTS AND THE LAW
Judicial organization in outline. The Supreme Court. The subordinate courts. Jurisdiction of the federal tribunals. State courts. The common law. Statutory law. Equity. The jury system.  Constitutional limitations relating to the administration of justice. Due process of law. The unconstitutionality of laws. The law's delays. Reforms in judicial administration.

Part III. The Civic Activities


(a) Economic
XIX. NATURAL RESOURCES, CONSERVATION, AND THE PUBLIC DOMAIN
The chief natural resources; their value and the danger of exhausting them. Conservation. The forest policy of the United States. National reservations. History of the public lands. Sales of land and the homestead system.
XX. THE AGRICULTURAL INTERESTS
Importance of agriculture. Chief types of agriculture in the United States. Agriculture and the law of diminishing returns. Exhaustion of the soil and its prevention. Relation of agriculture to transportation. The problem of agricultural credit. The federal farm loan banking system. Agriculture and the labor problem. The work of the department of agriculture. The state agricultural
authorities. Experimental farms. The county life commission.
XXI. THE ENCOURAGEMENT AND REGULATION OF COMMERCE
Purposes of commerce. Local, interstate and foreign commerce. How commerce is regulated. The interstate commerce commission and its work. Railroads and the Sherman Act. The railroads in war time. The Transportation Act of 1920. The future of the railroads. Foreign commerce; its scope and value. Government aid to shipping. The shipping laws. The merchant marine; its history. The consular service. International commerce and international exchange. Foreign commerce and the tariff. The tariff policy of the United States.
XXII. INDUSTRY AND LABOR
Modern industrial organization. Corporations. Combinations in industry. The control of industrial combinations. The federal trade commission. The general relations of government to industry. Labor's part in the industrial order. History of labor organizations. The American Federation of Labor; its organization and program. Methods and policies of labor. Collective bargaining. The right to strike. The closed shop and the open shop. Conciliation and arbitration. Compulsory arbitration. Industrial accidents and employers' liability. Child labor laws. Minimum wage laws. The problem of unemployment.
XXIII. CURRENCY, BANKING AND CREDIT
Money and its origin. The functions of money. The coinage of the United States. The double and single standard. Paper money. Legal tender. The functions of banks. National banking system. Federal reserve banks. Some practical operations of banking. The relation of credit to money. Credit and prices. Workings of the credit system.
XXIV. PUBLIC UTILITIES
Nature of public utilities. The need of public control. Franchises. Methods of public utility regulation. Public service commissions; their organization and powers. Public ownership; its merits and defects. American and foreign experience in public ownership. Public utility problems at the present day.
XXV. PUBLIC FINANCE
The cost of government. Taxation, its forms and incidence. Leading principles of taxation. Local taxes. State taxes. National taxes. Economic and social purposes of taxation. The division of the taxing power between national and state governments. Suggested reforms in taxation. Government expenditures. How appropriations are made. The new national budget system. Public debts. Methods of public borrowing. Debt limits. How public debts are repaid.
(b) Social
XXVI. PUBLIC HEALTH
The chief problems of health protection. Quarantine. The prevention of epidemics. Vital statistics, their nature and use. Some instances of progress in preventive medicine. Public sanitation. Public water supplies. Milk inspection. The inspection of food and drugs. Housing regulations. The work of local health boards. State health organization. The U. S. Public Health Service.
XXVII. POOR RELIEF, CORRECTION AND OTHER WELFARE PROBLEMS
The problem of poverty. Old and new methods of dealing with it. The causes of poverty. Its prevention. Social insurance. Crime and its causes. Crime prevention. Prisons and prison reform. The care of mental defectives. Social amelioration and reform.
XXVIII. EDUCATION
The public school system. State and local school authorities. State control of education. Educational work of the national government. School finance. The newer demands in education. Vocational education and vocational guidance. The Gary system. Wider use of the school plant. Americanization.

(c) International
XXIX. NATIONAL DEFENSE
Defense as a function of government. Militarism. The causes of war. The prevention of war. Preparedness. The regular army. The national guard. The national army during the World War. America's part in the war. Universal military service. The navy. The problem of disarmament.
XXX. FOREIGN RELATIONS
The nature of international law. The control of foreign relations. The diplomatic service. Secret and open diplomacy. Treaties. Extradition. Outstanding features of American foreign policy. The Monroe Doctrine. American contributions to international law. The war and international relations.
XXXI. THE UNITED STATES AS A WORLD POWER
Traditional foreign policy. Why isolation is no longer possible. Relations with other American states. Relations with Europe. American interests in the Far East. Interests acquired during the war. Pending questions of foreign policy. The loans to European powers. Mandates and special privileges. Other diplomatic problems.
XXXII. THE LEAGUE OF NATIONS
The idea of a league of nations in history. Purposes of the Versailles covenant. Its chief provisions. America's objections to the League. The League as a scheme of government. The League at work. What it has accomplished. The position of the United States in the new world order.
XXXIII. WORLD PROBLEMS AND DEMOCRACY
Results of the war on political, social and economic organization. The growth of radicalism. The soviet system. Plans for socialist commonwealths. Direct action. The reconstruction of government by constitutional means. Can democracy solve the problems of today? American contributions to democracy in the past. The ideals of democracy. What America can contribute in the future.