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What does the affordable in the Affordable Care Act mean? It means exactly what the IRS says it means and now the IRS has had its say in that regard. See here for the NYT news report on this IRS ruling.
Quoting the NYT article:
"In deciding whether an employer’s health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family. Family coverage might be prohibitively expensive, but federal subsidies would not be available to help buy insurance for children in the family."
Affordable means affordable coverage for the individual employee not for his or her family. If the employee share of the employer subsidized coverage exceeds 9.5% of the family's annual income then the family would be eligible for a federal subsidy.But,the percentage applies only to the cost of coverage for the employee and not for the entire family and the cost of family coverage is significantly higher than for single coverage. So if the company insurance does not include the family many employees will be faced with costly insurance with no government subsidy.
This interesting brand of social justice administered by the IRS was countered by the Secretary of HHS exempting folks screwed over by this ruling from any penalty (or tax as Justice Roberts might say) resulting from this IRS ruling.
Many, if not most large, companies which already provide health insurance do so for the entire family not just the employee so no one has a good estimate regarding how many would be affected.The Times article claimed millions.
Speaking of affordable,the IRS has released educational material explaining how the penalty (they apparently have not read Justice Robert's decision that made the penalty a tax) for failure to buy health insurance.First, they say that in 2016 the cheapest insurance allowable (bronze plan) will cost $ 20,000 for a family of five.See here for news article.
Next they reveal in typical IRS language how the "penalty will be computed.
"(ii) For each month in 2016, under paragraphs (b)(2)(ii) and (b)(2)(iii) of this section, the applicable dollar amount is $2,780 (($695 x 3 adults) + (($695/2) x 2 children)). Under paragraph (b)(2)(i) of this section, the flat dollar amount is $2,085 (the lesser of $2,780 and $2,085 ($695 x 3)). Under paragraph (b)(3) of this section, the excess income amount is $2,400 (($120,000 - $24,000) x 0.025). Therefore, under paragraph (b)(1) of this section, the monthly penalty amount is $200 (the greater of $173.75 ($2,085/12) or $200 ($2,400/12))."
If you had wondered about the role of the IRS in health insurance ,that quote should give a flavor.What did you expect?
6 Şubat 2013 Çarşamba
Social Justice quote for the day from Anthony De Jasay
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The Hungarian economist Anthony De Jasay in his commentary posted in the Library of Economics and Liberty takes on the issue of social justice and wonders if the adjective really fits the noun and if what sense it is justice.See here for his entire comments.
"Justice is a property of acts. Just acts conform to certain rules, unjust ones violate them. A state of affairs is just if it is the outcome of just acts. If we want to claim that a state of affairs, say, a particular distribution of material advantages, is an injustice, it is incumbent upon us to show that it results from unjust acts. Otherwise, talk of injustice is just talk. This is where the problem of the identification of social justice as supposedly a branch of the general body of justice must be faced.
Stripped of rhetoric, an act of social justice (a) deliberately increases the relative share (though it may unwittingly decrease the absolute share) of the worse-off in total income, and (b) in achieving (a) it redresses part or all of an injustice. (Note that “income” is used in a broad sense to include stocks and flows of all material goods or claims on same that are transferable). This implies that some people being worse off than others is an injustice and that it must be redressed. However, redress can only be effected at the expense of the better- off; but it is not evident that they have committed the injustice in the first place. Consequently, nor is it clear why the better-off should be under an obligation to redress it, even though if they do not, no one else is left to do it."
So, if the better off did nothing wrong, where is the justice in forcing them to pay; would it not actually be an injustice to force them to redress something for which they were not responsible? John Rawls's contractarian theory seeks to support a negative answer to that question arguing that they, quoting Jasay," have agreed in a hypothetical but prima facie sane contract to bear the burden in their own interest". In this formulation redistribution would be the remedy for an unjust situation and there need not have been any unjust acts committed. Comments regarding this hypothetical,fictitious social contract are deferred to a later posting.
Jasay's comments resonate with FA Hayek's characterization of the modifier "social" as a weasel word which like a weasel sucking a egg allegedly without collapsing it can suck the meaning out of the word it modifies. Question for the day: Has the Physician Charter (Medical Professionalism in the New Millenium) sold the medical profession a bill of goods for the next thousand years based on a weasel word?
"Justice is a property of acts. Just acts conform to certain rules, unjust ones violate them. A state of affairs is just if it is the outcome of just acts. If we want to claim that a state of affairs, say, a particular distribution of material advantages, is an injustice, it is incumbent upon us to show that it results from unjust acts. Otherwise, talk of injustice is just talk. This is where the problem of the identification of social justice as supposedly a branch of the general body of justice must be faced.
Stripped of rhetoric, an act of social justice (a) deliberately increases the relative share (though it may unwittingly decrease the absolute share) of the worse-off in total income, and (b) in achieving (a) it redresses part or all of an injustice. (Note that “income” is used in a broad sense to include stocks and flows of all material goods or claims on same that are transferable). This implies that some people being worse off than others is an injustice and that it must be redressed. However, redress can only be effected at the expense of the better- off; but it is not evident that they have committed the injustice in the first place. Consequently, nor is it clear why the better-off should be under an obligation to redress it, even though if they do not, no one else is left to do it."
So, if the better off did nothing wrong, where is the justice in forcing them to pay; would it not actually be an injustice to force them to redress something for which they were not responsible? John Rawls's contractarian theory seeks to support a negative answer to that question arguing that they, quoting Jasay," have agreed in a hypothetical but prima facie sane contract to bear the burden in their own interest". In this formulation redistribution would be the remedy for an unjust situation and there need not have been any unjust acts committed. Comments regarding this hypothetical,fictitious social contract are deferred to a later posting.
Jasay's comments resonate with FA Hayek's characterization of the modifier "social" as a weasel word which like a weasel sucking a egg allegedly without collapsing it can suck the meaning out of the word it modifies. Question for the day: Has the Physician Charter (Medical Professionalism in the New Millenium) sold the medical profession a bill of goods for the next thousand years based on a weasel word?
Will Obamacare encourage more business to "go protean" ?
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What does "go protean" mean? See here for this WSJ article on the phenomenon. Basically a business would outsource many of its functions to other corporate entities, not to individual contractors, which is often what out sourcing means.
Quoting WSJ:
" Like a protozoan single-cell organism, the protean corporation has the ability to "shape shift," rapidly adapting to internal and external forces in the market and the company. At the heart of a true protean corporation is a tiny number of core employees surrounded by a large cloud of resources, generally contracted or outsourced talent that does most of the work."
To get under the fifty employee ACA head count threshold, a business might ofter that some of its employees form a corporation and then contract with that business to do whatever functions at that business. Now you have one corporation doing business with another and there is no longer the employer-employee relationship which is one that is controlled and regulated in many ways by local and federal governmental entities (e.g.OSHA,Fair Employment laws of various kinds,Etc)
H/T to Michael Cannon at Cato who closed his commentary on this issue with this:See here for his entire comments.
"Keeping the core company below 50 full-time employees will allow such companies to avoid the employer mandate. But it will also drive up Obamacare’s cost, because most of the workers in the new corporate entity will be eligible for government subsidies through the health insurance “exchanges.” This will drive up the cost of Obamacare wherever those subsidies exist."
The list of unintended consequences of Obamacare continues to grow.The protean corporation scheme may or may not catch on,and the IRS or some other governmental entity may or may not have some regulatory counter move and since folks respond to incentives we can expect to see more ways for businesses to avoid or minimize the effects of Obamacare and counter moves by the government.The IRS has already issued proposed rules to restrict some of the self protective actions of businesses in regard to how full time employees are counted and how to calculate full time equivalents.
Quoting WSJ:
" Like a protozoan single-cell organism, the protean corporation has the ability to "shape shift," rapidly adapting to internal and external forces in the market and the company. At the heart of a true protean corporation is a tiny number of core employees surrounded by a large cloud of resources, generally contracted or outsourced talent that does most of the work."
To get under the fifty employee ACA head count threshold, a business might ofter that some of its employees form a corporation and then contract with that business to do whatever functions at that business. Now you have one corporation doing business with another and there is no longer the employer-employee relationship which is one that is controlled and regulated in many ways by local and federal governmental entities (e.g.OSHA,Fair Employment laws of various kinds,Etc)
H/T to Michael Cannon at Cato who closed his commentary on this issue with this:See here for his entire comments.
"Keeping the core company below 50 full-time employees will allow such companies to avoid the employer mandate. But it will also drive up Obamacare’s cost, because most of the workers in the new corporate entity will be eligible for government subsidies through the health insurance “exchanges.” This will drive up the cost of Obamacare wherever those subsidies exist."
The list of unintended consequences of Obamacare continues to grow.The protean corporation scheme may or may not catch on,and the IRS or some other governmental entity may or may not have some regulatory counter move and since folks respond to incentives we can expect to see more ways for businesses to avoid or minimize the effects of Obamacare and counter moves by the government.The IRS has already issued proposed rules to restrict some of the self protective actions of businesses in regard to how full time employees are counted and how to calculate full time equivalents.
23andMe Buyer Beware, The Internet doesn't equal hippocrates
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Ok, ok. I am not gonna tell you I told you so. But, I did.
Did anyone read my article in Nature Biotechnology? Did ya?
Here is your freaking reality check. 23andME has your DNA. It has it hostage and it has your datapoints. And it can do whatever the hell it pleases. Including locking or cancelling your account.
They have enough data points for their robust database. They only need you sheep to keep paying 9 dollars per month or 108 dollars per year and 99 to start. 10 years? 1080 dollars. Even more than the first 999 USD they started with.
Well guess what? People everywhere are waking up to the charlatanism that was peddled by Silicon Valley Overlords.....
They have you, you are stuck. You have to pay FOREVER!!!!! BWAHAHAHAHAHAHAHAHAHAHAHA!!!!!!
Even if you quit, they don't care. They Pwned you. And they still do.
So what did the Sherpa say all of those years? Huh? No, not that their health reports are bull $hi!. But I did say that. No not that I was done posting on 23andMe. Clearly I am not.
But I told you about the Master Plan!
Even if you pull out your data, they still have it. End of story. You are powerless and have been duped. I am sorry. I wish you had listened
The Sherpa Says: Buyer Beware web sites giving you tests and testing your DNA. 23andMe and its company are not to be trusted. Sorry, but the web has not take the hippocratic oath!
Ok, ok. I am not gonna tell you I told you so. But, I did.Did anyone read my article in Nature Biotechnology? Did ya?
Here is your freaking reality check. 23andME has your DNA. It has it hostage and it has your datapoints. And it can do whatever the hell it pleases. Including locking or cancelling your account.
They have enough data points for their robust database. They only need you sheep to keep paying 9 dollars per month or 108 dollars per year and 99 to start. 10 years? 1080 dollars. Even more than the first 999 USD they started with.
Well guess what? People everywhere are waking up to the charlatanism that was peddled by Silicon Valley Overlords.....
They have you, you are stuck. You have to pay FOREVER!!!!! BWAHAHAHAHAHAHAHAHAHAHAHA!!!!!!
Even if you quit, they don't care. They Pwned you. And they still do.
So what did the Sherpa say all of those years? Huh? No, not that their health reports are bull $hi!. But I did say that. No not that I was done posting on 23andMe. Clearly I am not.
But I told you about the Master Plan!
Even if you pull out your data, they still have it. End of story. You are powerless and have been duped. I am sorry. I wish you had listened
The Sherpa Says: Buyer Beware web sites giving you tests and testing your DNA. 23andMe and its company are not to be trusted. Sorry, but the web has not take the hippocratic oath!
What's the Sherpa Up To?
To contact us Click HERE
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling.
I was able to preview a copy and am very excited.
But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say.
"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."
This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.
I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.
I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.
I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.
You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.
A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.
The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling. I was able to preview a copy and am very excited.
But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say.
"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."
This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.
I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.
I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.
I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.
You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.
A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.
The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!
5 Şubat 2013 Salı
What's the Sherpa Up To?
To contact us Click HERE
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling.
I was able to preview a copy and am very excited.
But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say.
"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."
This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.
I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.
I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.
I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.
You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.
A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.
The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling. I was able to preview a copy and am very excited.
But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say.
"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."
This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.
I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.
I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.
I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.
You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.
A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.
The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!
Dealing with other people's pregnancies
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This is something I've been asked about a few times, and something I was just thinking about, so thought I'd share. In the months after Joshua's death, some people were hesitant to tell us they were pregnant in case they upset us, some tell us before anyone else because they want to tell us in person rather than on the grapevine. That really didn't bother me, I'm generally excited to hear about friends pregnancies. Ultrasounds were hard to look at, and baby showers were hard to go to, and still are. Joshua died 2 days after our baby shower, so baby showers just don't have that same level of fun anymore, memories of our loss just come flooding back.
The other thing that's hard to deal with is other people's loss, but for a slightly different reason - my heart just aches for them. A very close friend had an early miscarriage a few months ago, and my heart ached for her. Another good friend who has also had a rough year has just suffered a 2nd trimester loss, and it breaks my heart. I don't want anyone to ever feel the weight of loss like we did. I know a loss earlier in the pregnancy is probably a bit easier to deal with, but it's never easy, and once you start planning names, planning how the room will look, what you'll need, changes you'll need to make, and start thinking about the future they're going to have, it's so hard to have it all ripped away.
It's something that really affects you for a long time, and I think it's important for people to understand that.
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