Where In The World Is Richard Simmons?

Something perhaps less troubling than the news about Mango Mussolini in the White House.

The back story: On Feb. 15, 2014, Mr. Simmons didn’t show up to teach his class at his gym, Slimmons, in Beverly Hills, Calif. He stopped answering emails or phone calls. He no longer sprinted out of his home to greet tour buses, delighting onlookers with his glittery costumes. After an article in The Daily News suggested last year that Mr. Simmons might not have control over his life, the mystery took such hold in pop culture that even Donald J. Trump weighed in from the campaign trail, promising to liberate Mr. Simmons if he became president.

“We have to get him out,” Mr. Trump, laughing, said in a radio interview.

Mr. Simmons hasn’t been heard from since phone interviews last March, though the Los Angeles Police Department visited him recently and said he was fine. A spokesman for Mr. Simmons said the same to The New York Times last week.  

The concern is that he is not just taking time off. He’s not just retired. He’s not just stepping away from the spotlight. The concern is that he’s cut off every person he knows. It’s impossible not to be concerned about that. And every person I’ve talked to, every friend who’s known him for years, everybody is concerned.

Watching The GOP Squirm

Who knew health care reform would be so hard for the GOP?   After all they had all the answers in the election season.  I really am having too much fun watching this all unfold–or should that be unravel.

As recently as January, Trump was promising that his Administration would provide “insurance for everybody.” Even for a President whose acquaintanceship with the truth is a casual one, explaining away the figures in the C.B.O. report could be tricky. It was not surprising, therefore, that the White House quickly dispatched Tom Price, the new Secretary of Health and Human Services, to rubbish the C.B.O. analysis. “We disagree strenuously” with the coverage estimates in the report, Price told reporters at the White House. Prince insisted that the G.O.P. plan would “cover more individuals at a lower cost.”

Price didn’t provide any numbers to back up this claim. He hasn’t got any. (In fact, on Monday night, Politico reported that the White House’s own internal analysis of the health-care bill projected that twenty-six million fewer people would have coverage over the next decade.) The only thing that the Administration and its allies on Capitol Hill have to fall back on is the vague promise to follow up the A.H.C.A. with a second piece of legislation that would give insurers more freedom to offer cheaper, lower-quality plans, which, in turn, might persuade more young and healthy people to sign up. But that’s a pie-in-the-sky promise. Changing the rules for insurers would require sixty votes in the Senate, which the Republicans don’t have.

If the Republicans really wanted to fulfill Trump’s promise of insuring everybody—or, at least, preventing a big fall in insurance rates—they could have taken the five hundred and ninety-two billion dollars and used them to maintain the Medicaid expansion. Or to enlarge the new tax credits they want to offer for the purchase of individual insurance, which, in some cases, would be much smaller than the subsidies offered under Obamacare.

To be sure, the way the new system would be set up, not everybody would be a loser. For example, a single forty-year-old with an annual income of sixty-eight thousand two hundred dollars could end up saving more than four thousand dollars a year, according to the C.B.O.’s figures. But, in general, people would pay more, at least in the early years after the measure goes into effect.

In the first few years, as some healthy young people drop their insurance plans because they are no longer mandated to purchase them, premiums would go up fifteen or twenty per cent, the report says. After 2020, average premiums could start dropping, and by 2026 the C.B.O. projects they would be ten per cent lower than under the current law. But that would mainly be because insurers would be offering cheaper, crappier plans to young people, and older people would be dropping insurance because they could no longer afford it. It will be interesting to see how Trump tries to sell that prospect to his supporters, many of whom are older and living on modest incomes.

Wide Disparities Between Rural And Urban Health Insurance Markets

It certainly is not a new  issue that requires being tackled.  The wide disparities in rural and urban health insurance markets have been examined for decades and the answers still seemingly far away. As the troubled and troubling Republican health care bill is top and central to the nation’ news the following is worth a read.

Chief among them is the concentration of doctors and hospitals that offer services to rural residents. In areas where there is just one hospital or physician’s practice for miles in any direction, insurers struggle to negotiate lower prices, but the higher insurance costs get passed on to consumers in their premiums.

“Just like any other market, if hospitals or doctors or pharmaceutical companies or anybody faces less competition, they have higher prices. That’s very simple, and it’s that way if you buy gasoline at the pump, it’s that way with milk, with anything else,” says Martin S. Gaynor, a Carnegie Mellon University professor who focuses on health care competition. “The more expensive is health care, the more expensive and less affordable health insurance is going to be. It’s really that simple.” A 2015 National Bureau of Economic Research study that looked at the costs private insurers pay for health services across the entire country found that even after controlling for factors like demand and local cost-of-living, hospitals that had monopoly power in their markets charged 15 percent more than those in more competitive markets.

That dynamic drives up prices and makes it less attractive for insurers to participate. Insurance companies must build a network of providers that can offer certain services, according to federal and state rules about how many specialists must be “in network” and how far from a given enrollee those providers can be located. It gets much more complicated and time-consuming to build networks in places with fewer providers.

Demographic trends also make rural areas less attractive to insurers. If insurance companies want to make money, they need to attract a balance of healthy customers to offset the costs of people who need a lot of health services. That mix is harder to achieve in rural areas, in part because there are fewer people overall and the low population density makes it tougher to spread out the costs of caring for the sick.