Percy Alban via ZUMA

Cassidy-Graham, the last-ditch effort by Republicans to replace Obamacare, is probably going nowhere. But how about a more modest bipartisan bill to authorize Obamacare’s CSR subsidies? No dice, apparently:

Meanwhile, a bill aiming to bring the parties together to shore up insurance markets is in jeopardy, people close to the negotiations said…GOP legislators have been open to authorizing the funds, and insurers have warned they would have to raise premiums or pull out of insurance markets if the funds disappear. But Republicans say that in return, they want to offer states more flexibility in implementing the ACA.

…Even if Senate Republicans and Democrats bridge their differences, [White House legislative-affair director Marc] Short suggested in an interview last week that Mr. Trump was extremely unlikely to sign a bill that guaranteed insurer payments without other changes in the health-care system. “The president has no interest in bailing out insurance companies,” he said.

Trump is doing everything he can to force Obamacare to fail, even though it’s fundamentally in good shape. One way or another, he refuses to be embarrassed by the spectre of a functioning health care program that provides insurance to millions at a reasonable cost. That would be more than he could bear. It’s not his program, after all.

Tampa Bay Times via ZUMA

Yesterday I wrote about freezing your credit records, so I guess I should stay up on the latest news. Via the New York Times, here it is:

You howled in protest, and Equifax had no choice but to respond.

On Tuesday, the company said it would waive all fees until Nov. 21 for people who want to freeze their Equifax credit files. It will also refund any fees that anyone has paid since Thursday, though the company would not say whether this would be automatic.

Why do I hate credit reporting agencies? Let me count the ways. It’s beyond unbelievable that Equifax didn’t do this immediately, since there’s certainly no reason that anyone should have to pay for a freeze that they need only because of Equifax’s own negligence. But this level of imperiousness is par for the course for these guys.

For any normal company, a fee like this would have been lifted instantly. They’d understand immediately that anything else would be an epic PR disaster. But the thing is, you aren’t a customer of Equifax. They don’t give a rat’s ass about you. Nor do they care about a PR disaster. It’s not as though they’ll lose your business, after all, since they never did any business with you in the first place. All they do is collect all your financial data without your permission and then sell it to other people.

(Actually, that’s not all they do. They also make your life hell if you have the gall to find an error in your credit record and ask them to fix it.)

Needless to say, Equifax declined to talk to the Times reporter about any of this, because why should they? However, he did hear something from a reader:

A reader named Kimberly Casey forwarded me an email exchange between her and Mr. Adams where he apologized and said that a service to “lock” Equifax, Experian and TransUnion files simultaneously would be coming soon.

This is beyond belief. There are three credit reporting agencies, and if you want your credit records frozen you have to order a freeze from all of them. This was outrageous when I wrote about it twelve years ago, and obviously nothing has been done about it since then. Why? Because none of the credit reporting agencies care about you. Their customers are the businesses who request credit checks, and their attitude toward everyone else is that they should pound sand. Congress lets them get away with this because—well, who knows? Probably because Congress doesn’t really care either unless their reelection is threatened somehow.

Where are Bernie Sanders and Elizabeth Warren when you need them? They should be screaming about this. The credit reporting agencies have gotten away forever with treating consumers like bothersome children: screwing up their credit records, ruining their lives, making it deliberately difficult and expensive to lock accounts, and making money off the whole thing by offering “insurance” against problems that they themselves cause. Someone in Congress who allegedly cares about ordinary working folks should introduce a bill to regulate the hell out of these folks. Not only is it the right thing to do, but it’s hard to think of any industry that more richly deserves it.

What kind of duck is this? Is it just a common duck type of duck that happens to be gray? They seem to hang out with our white ducks a lot. Does that mean they’re young ducks who will grow up to be white ducks? Or maybe white swans like in the fairy tale? Or is this just a breed of duck that happens to be gray? We’ve never seen ducks around here like this, so it’s all new to us.

Here is professional technology enthusiast David Pogue on the big Apple product rollout today:

You can feel the excitement here at the Jobs theater—even though every single person here already knows most of the details! #AppleEvent pic.twitter.com/3o8wuVa11j

— David Pogue (@Pogue) September 12, 2017

It turned out that everyone was right. The new iPhones have wireless charging, faster processors, and, in the ultra-luxe iPhone X, edge-to-edge screens. In other words, all the stuff that my Samsung 8 already has. And yet everyone is so excited they can barely sit still.

I like to make fun of this because I’m an Apple cynic, but honestly, kudos to them for keeping up their marketing mojo long after their actual products have ceased to be very interesting. Compare this to Microsoft, which—well, let me tell a story about that.

I’m a Surface tablet junkie. I love my Surface 3.¹ And my Surface 4 Pro. And my Surface Pro 2017, which I bought a couple of weeks ago. But wait. Why did I only buy it a couple of weeks ago? It was announced in May and began shipping in June. What took me so long?

Answer: I didn’t know it existed. I’ve been using Windows since 1991 and I’ve purchased two Surface tablets since 2015. The first one was purchased at a Microsoft store. I adore Surface tablets. I would appear in commercials for Microsoft if they asked me. And yet I had no idea that a new one was out. I didn’t get so much as a single email about it.² My Twitter feed had nothing about it. None of the media outlets I read bothered to highlight it enough that I saw it.

Is this because it was boring? In a way, yes. It’s the same size as the previous model and has all the same ports. Basically, it has better battery life, a faster processor, and a new stylus that’s considerably better than the old one (which was pretty good to start with).³ It’s definitely evolutionary. But the longer battery life was enough to suck me in.

If Apple had introduced this, everyone on the planet would know about it. The battery life would be a category killer for laptops. The pen would be an artist’s dream come true. The faster processors would do wonders for gaming and 3D rendering. The miscellaneous updates in the operating system would be game changers. It would be the greatest upgrade in history.

I dunno. Some people can get away with nonsense like this. Donald Trump. Kanye West. Apple. Everyone plays along because it’s part of the act. But no one else can do it because, after all, it’s also pretty ridiculous.

Still, you’d think Microsoft could at least do ordinary boring marketing for their new tablet. There’s no reason to almost literally keep it a secret, is there?

¹This is now Marian’s Surface 3.

²In fairness, it’s possible that this is because I opted out of getting emails from Microsoft. If so, kudos to them for keeping their word. Still, you’d think they could figure out some kind of workaround to target folks who obviously like Surface tablets.

³It also has the same ridiculously paltry storage options as the previous model. Someday I need to have a long talk with the Surface product manager about that. What’s the deal with 128 GB on a tablet that supposedly can “replace your desktop”? You can upgrade to 512 GB, of course, but only if you upgrade to the top-end model, which will cost you about an extra thousand dollars. Seriously?

The Toronto Star via ZUMA

I wrote yesterday about opioids and pain treatment, and along the way I mentioned that the trend toward more opioid prescribing was blessed in 2001 by The Joint Commission, an accrediting agency for medical facilities. That year they issued new guidance about pain management, which required hospitals to treat pain “aggressively” if they wanted to remain accredited.

I had a strong recollection that the commission’s recommendations had been heavily influenced by lobbying from the pharmaceutical industry, but I didn’t trust my memory about that and wasn’t able to immediately find confirmation. However, Dr. Anna Lembke is an expert about this. She’s the author of Drug Dealer, MD, a book about the forces that have driven our nationwide opioid addiction. Here she is in an NPR interview a few months ago:

On what Lembke means when she says that big medicine and Big Pharma “were in cahoots”

The pharmaceutical industry realized that they can no longer directly go to doctors to get them to prescribe their pills. Various regulations were put in place to prevent them giving gifts and pens and hats and things that we do know can influence doctor prescribing. So instead they took a kind of Trojan horse approach and infiltrated regulatory agencies and academic medicine in order to convince doctors that prescribing more opioids was evidence-based medicine, and evidence-based medicine means medicine based on science, and that’s something that all doctors are supposed to practice. …

So for example, what they did was Purdue Pharma joined forces with the Joint Commission, and the Joint Commission is an organization that accredits hospitals, and Purdue Pharma gave all kinds of teaching material to the Joint Commission and said, “You really need to make doctors treat pain more aggressively and that needs to be a quality measure.” So the Joint Commission said, “You know what? You’re absolutely right, and we’re going to do that and we’re going to take your videos that you made that tell doctors that opioids aren’t addictive as long as they’re treating them for pain.” …

So it became a kind of groupthink where it looked like treating pain aggressively with opioids was something that was based on science, when in fact it was based on Big Pharma’s influence of these major regulatory bodies.

As I said yesterday, there’s plenty of blame to go around. But there’s no question that Big Pharma deserves a big share of it.

Stuart Palley via ZUMA

On the East Coast, the big danger comes from hurricanes, which are becoming ever more intense as ocean waters continue to warm. Here on the West Coast, we worry about wildfire season, which lasts longer and longer as summer temperatures linger into fall:

Despite record-breaking rain and snowfall across the West in 2017, this year’s fire season has been unforgiving….“Typically by the third week of September we see not as much fire activity,” said Jessica Gardetto, spokeswoman for the National Interagency Fire Center. “But we just haven’t had that relief.” The blazes have been responsible for the deaths of eight firefighters and have destroyed more than 500 homes.

….What makes the fires burning across the West so extreme? One aspect that sets this year apart is the length of time the fire season has lasted, in part because of dry air, conducive for sustaining wildfires. Lightning strikes in Oregon and Washington have sparked many of the wildfires still ravaging large swaths of land, while drought-stricken Montana continues to battle several large fires.

Rising sea levels. Bigger hurricanes. More drought. Longer wildfire seasons. This is global warming, folks.

The Census Bureau has finally gotten around to calculating household income for 2016, and the news is good: adjusted for inflation, income was up 3.2 percent last year. In fact, household income is now at an all-time high:

And now for the buzzkill portion of this post: this means household income has increased a whopping 0.6 percent since 1999. That’s $22 per year.

On the other hand, this is better than the top .01 percent has done. According to Piketty and Saez, their income peaked in 2000 and is down 4 percent through 2015 (with some spikes in between). Will 2016 be the year that they too beat their 20th century high? P&S take even longer than the Census Bureau to make their calculations, so we’ll have to wait and see. But I’ll bet they do.

A few days ago, Equifax, one of the Big Three credit reporting agencies, admitted that the personal data of 143 million consumers had been compromised. This is not the biggest data breach ever, but it might be the worst. After all, Equifax is not just any company. It’s a company whose main job is collecting masses of private financial data—and it does this even though it has neither a business relationship nor explicit permission from the people it monitors. This is a massive and unprecedented FUBAR.

(For more on why the Equifax breach is even worse than you think, Michael Hiltzik explains here.)

I am no fan of the credit reporting business, one of the most arrogant and anti-consumer industries imaginable. Twelve years ago I wrote about them for the Washington Monthly, and it’s startling how little has changed since then. I could republish the story today with only the most cursory changes.

For example, part of my piece was devoted to “credit freezes,” something you may have heard a lot about lately. This is an action you can take to protect yourself in case of identify theft: if you ask for your account to be frozen, credit agencies will furnish a credit report only after they’ve confirmed that it really is you who applied for credit. This stops identity thieves in their tracks: if they apply for a credit card in your name, the credit agency will call you first. When you tell them you never applied for the card, it doesn’t get issued.

But this really shouldn’t be an option you have to request. It should be routine for all credit transactions. The reason it isn’t is because it’s inconvenient for the credit reporting agencies, who have fought regulation on this topic tooth and nail. It’s also because they literally make money on identify theft—no, that’s not a typo—and therefore don’t have much incentive to do anything about it.

Still, as much as I think all accounts should be frozen by default, my solution to the problem of identity theft isn’t to force the credit reporting agencies to freeze or unfreeze accounts—or to force them to do anything else. It’s to make them responsible for all damages related to identity theft and then let them figure out the best solution. Here’s what I wrote in my Monthly piece:

There is a successful precedent for this type of approach. In 1968, Congress passed the Truth in Lending Act, which imposed a variety of regulations on the lending industry. One notably simple provision was that consumers could be held liable for no more than $50 if their credit cards were stolen and used without their authorization. For anything above that, it was the credit-card issuer who had to pay. The result was predictable: Credit-card companies have since taken it upon themselves to develop a wide range ofeffective anti-fraud programs. Congress didn’t tell them to do it, or even how. It just made them responsible for the losses, and the card issuers did the rest themselves.

The same method should be used for identity theft. There’s no need to create mountains of regulations, which are uniformly despised by the credit industry. Instead, simply make the industry itself—and any institution that handles personal data—liable for the losses in both time and money currently borne by consumers. The responsible parties will do the rest themselves.

There’s more to say about this, but sadly, my piece is no longer available at the Monthly site. The great linkrot plague has devoured it. Luckily, I’m a magazine packrat and I still have a dead-tree copy. So I scanned it and turned it into a PDF. Click here to read it—and to find out just why I hate the credit reporting agencies so intensely. It’s worth your time, especially considering how little has been done about this over the past decade. It represents one of the all-time abject surrenders to Big Finance, and it’s something the Elizabeth Warren wing of the Democratic Party should be all over. The time for small-bore proposals is over. It’s time to make the credit agencies—and others—pay for their flagrantly careless behavior. When they allow someone to steal your identity, they’re the ones who should pay the price, not you.

UPDATE: The Wayback Machine also has a copy of my article. I shoulda checked! Click here to see it.

Chapin White of RAND tells us that hospitals are expanding every which way in Indiana:

Indianapolis was historically characterized by geographically distinct hospital submarkets, with a dominant system controlling each area. Those geographic divisions have broken down in the last two decades, with systems building new facilities and encroaching on each other’s territory, particularly in suburban areas with concentrations of privately insured patients. As in the rest of the country, hospitals in Indianapolis have established and tightened their relationships with physician practices and used those relationships to drive referrals within their systems.

Recently, observers have speculated that the breakdown of hospitals’ geographic territories, as well as the expansion in the number of facilities, might lead to greater competition and lower hospital prices in Indianapolis. But that speculation has not been tested empirically.

In theory, this means that Indiana hospitals are competing more. At the same time, they’ve been consoldiating into a small number of big chains, and as Chapin says, they have “tightened” their relationships with physicians. This means that most physicians no longer refer their patients to different hospitals for different things. They always refer them to the same place. So what’s the upshot? Here’s a chart showing how much above the Medicare reimbursement rate Indiana hospitals charge private insurers:

There are two takeaways here. First, these hospitals charge private insurers a lot more than Medicare. The average for outpatient care was 258 percent more. For inpatient care it was 117 percent more.

Second, there’s stunning variation in prices. This is an old story, but it’s an old story that never gets old. The least expensive hospital charged private insurers 71 percent more than Medicare for outpatient services. The most expensive charged 396 percent more than Medicare for the same basket of services.

What accounts for the difference? Did big hospitals with economies of scale, lots of competition, and tight relationships with physicians charge less? In a word, no. In two words, hell no:

At the bottom of the price distribution are the independent CAHs [critical access hospitals, which are all small and rural] and three small systems….Although CAHs are, by definition, geographically isolated and have no nearby competitors, that lack of competition does not correspond to higher negotiated prices. The upper end of the price distribution is dominated by five large hospital systems, with Parkview Health standing out for having exceptionally high prices. Hospital systems and consolidation among hospitals have been cited as drivers of high and increasing prices, and these findings are consistent with that argument.

This is the not-so-hidden story of exploding medical costs. We’ve become so accustomed to hating on insurers that we hardly notice that hospital consolidation is a much bigger villain. When a big insurer has a local monopoly, it can usually negotiate lower prices from hospitals because the hospitals have nowhere else to go. But when there are lots of insurers and only one or two local hospitals, it’s the hospitals that have the upper hand. They can charge high prices because the insurers have no choice except to do business with them. As hospital systems get steadily larger and rope in more and more physicians, their effective competition decreases and they have the ability to demand ever higher prices.

Insurance companies are hardly innocent bystanders in the health care system, but if you want to really target the drivers of higher costs, look to the source: the actual providers of medical services. That means doctors, hospitals, pharmaceutical companies, and medical device makers. That’s where the real money is.

Admission Day came on a Saturday this year, so the official Lunchtime Photo commemoration of California’s statehood has been delayed until today. Happy 167th birthday, California! Vive la résistance.