Wrong Direction

I think it is based on film. Great athlete, arm and accuracy, but he stares down receivers, has a loopy throwing motion and apparently has trouble identifying the blitz. I like the guy and would be happy if we get him, but it's not like he doesn't have warts. I feel like if he was that much of a baller, he'd be a WR. RG3 was fast too, but was stiff as a board. I'm not saying Pitts isn't a great prospect, but if a TE ends up the top player in the draft, something is wrong with this draft class. I doubt I'd pick Travis Kelce, as the top pick in any draft and I have a hard time believing Pitts ends up better. I think people are too caught up on the t-shirt and shorts stuff, tbh. TE just isn't THAT valuable of a position

One thing not mentioned is the value of compensatory picks. In a nutshell, if you lose more than you gain in free agency, you tend to get extra draft picks. SM's approach of signing modest free agents and drafting at positions for the future (WR, CB, QB this time) will eventually pay off in the form of extra draft picks by allowing expensive free agents to depart. Alas, Norman's signing undermined that a bit this year, but this is a small added benefit to valuing extra draft picks and then drafting BPA. Those BPAs will eventually be replacing guys that will be signed by other teams. SM's still catching this roster up to the league in many ways, but with this strategy we'll eventually get ahead of the league in terms of assets, similar to how the Patriots have built. That will result in a younger, more athletic and generally more healthy roster than the aging ones that FA produces.

Your score is: 6614 (GRADE: A-) Your Picks: Round 1 Pick 12 (CLE): Danny Shelton, DT, Washington (A+) Round 1 Pick 29 (IND): Andrus Peat, OT, Stanford (A+) Round 2 Pick 6: Laken Tomlinson, OG, Duke (B+) Round 2 Pick 22 (DET): P.J. Williams, CB, Florida State (B+) Round 2 Pick 29 (IND): Paul Dawson, OLB/ILB, TCU ( Round 3 Pick 9 (ATL): Shaq Thompson, OLB/SS, Washington (A+) Round 3 Pick 25 (CAR): Xavier Cooper, DT/DE, Washington St. (A+) Round 4 Pick 6: Alex Carter, CB, Stanford (B+) Round 5 Pick 5: Shaquille Mason, OG/C, Georgia Tech ( Round 5 Pick 12 (N.O.): Ty Montgomery, WR/RB, Stanford (C+) Round 5 Pick 18 (N.O.): Nick O'Leary, TE, Florida State (A) Round 6 Pick 6: Max Valles, OLB, Virginia © Round 7 Pick 5: Malcolm Agnew, RB, Southern Illinois © Your Future Picks: 2016 Round 1 Pick 2017 Round 1 Pick

I'd like to see that trend starting in about 1880. No agenda, just curious of observed pattern.

Actually I think more people than ever are talking about reforms. This is an intellectual discussion amongst politicians and other think tank/industry types and it's a good thing. Many are just confusing the politics (which are intolerable now but will be somewhat reset with a new POTUS in 2017) with what's happening behind the scenes. I actually think both parties are in a better intellectual position on healthcare issues than they were in 2008.

There's a long history hear that's worth knowing about. In the 70's and early 80's, Medicare had a huge problem with hospital payment. They "solved" this payment by creating a bundled payment system (DRGs) for hospitals. The hospital response to this has been predictable. They maximize DRG payment and also any payments associated with outpatient hospital or ER care. Then they discharge people to post acute care settings and, in many cases, generate financial relationships with those entities. The result has been run-away costs in post acute care settings, SNF and Home Health in particular. One of the almost ancillary effects of this was patients are discharged sooner and thus more likely to be readmitted. Another effect is that by virtue of discharge from a hospital to a PAC setting, patients have seen less of their primary care Drs. So now the government is sort of swinging the pendulum the other way. They want hospitals and physician networks to better manage patients post hospital discharge because they think better management (offering shared savings) will mean patients get the appropriate care but not the crazy overuse that Medicare sees. They also think it'll reduce readmissions. These changes are good, but they're totally missing the point. The government is basically gathering a small share of savings out of a massively overused and overpriced payment system and then declaring victory. The feeling from people on the left and on the right that I've spoken to is that there will need to be major changes to the way Medicare manages benefits because the current system is totally unsustainable. In the next 8-12 years, I think you'll see Medicare start acting like an insurance company rather than a big, dumb payer of any bill that comes in. They're going to have to start using tools like prior authorization and more bundled payments to prevent a ton of this care because this ACO (shared savings) model is very unlikely to achieve meaningful results. If you follow the logic, the Ryan plan to move people to Medicare Advantage makes more and more sense. Why inefficiently make the government an insurance company over the next 20 years when you can reform basic MA payment and get the rest of the benefits much sooner and much more efficiently? This is totally true, but it's also used by big lobbies to slow progress to a halt. The quality measurement process takes years per minor improvement. It's a perfect way for lobbies to give politicians talking points (quality) while knowing all along that the baseline spending will continue to rise even with quality payments. It's important work, but from a payment and budget perspective, it's a political tool to delay or totally forestall the payment reforms that are necessary to fix the budget issues of Medicare.

re: Jindal - I see your point, but I think it's a matter or more explicit language versus intent. I'm pretty sure this particular bill has chosen the fully refundable version, but given the disagreement within the party, I'm sure that could change. Perhaps that's why the language isn't explicit? re: Hospital payment, it isn't just about readmission and quality. Hospital payments are slated to decline relative to the previous baseline in 2016, I believe. The rationale for this was that more covered patients means less uncompensated care provided by Hospitals, so it was apparently a deal between the AHA and the administration back in 2010. Additionally, the MA cuts have already begun, but it seems like the administration is taking a very cautious approach to making those cuts, meaning they've used demonstration authority (and funds) to mute the effects of those cuts to date. There were some articles on this a year or two ago. However, I think the CR deal will further tighten the purse strings, so I'm guessing that'll begin to change next year.

#2. I'm almost certain that the R plan is calling for fully refundable tax credits because it's being compared to Jindal's plan which is not refundable. To Hersh's question, yes, that's basically a direct subsidy. The theory behind a direct subsidy as opposed to just giving eligibility for things like Medicaid OR ACA subsidies is that it gives the poor person more of a choice of plan, which comes with more options for Dr. networks, etc. #3. I'm going by memory here, but I think the R's refer to various scores that CBO has provided on provisions in the past. Those things change over time, but my understanding is that the R's think they're on solid CBO ground even w/o a direct score from CBO on this bill. #4. The ACA is being paid for in many ways, but that includes big cuts to Medicare Advantage and Medicare Hospital payment.

Re: the Republican plan. 1. Peter refers to Medicare changes. It's actually Medicaid that's being reformed, not Medicare. 2. Re: tax credits versus write-offs...this R plan goes for credits because it accepts the argument that a write-off is regressive. Bobby Jindal is arguing for the alternative, signaling a rift within the party. In terms of judging this plan, I prefer credits. However, the rift means the R's would likely have a problem holding their caucus together. That means this plan would likely only pass if D's were heavily pressured to pass something because the ACA wasn't upheld in court. I have no idea how likely that is. I do know that generally D's would definitely support credits over write-offs. 3. Re: linking subsidies to CPI, I think that's a fair argument. The R's would point to their other reforms as part of the proposal which the CBO would score as having a further downward effect on healthcare, so I'm guessing they're relying on a CBO score that would show more people having coverage than the ACA. 4. The tax credit option is actually a great option that Ds could probably get behind insofar as it gives very poor people more options for coverage than just Medicaid. I'd personally like to get rid of Medicaid altogether in favor of one health system treating everyone (over time), so this is a bridge effort that appeals to me. 5. This is actually a credible Republican alternative. One of the important aspects of the ACA that people don't talk about is the fact that Obama paid for it (good) with funds from Medicare (bad). Many on the right think that Medicare will need a massive shift in reimbursements to remain solvent over time. By diverting that money out of Medicare, Obama's essentially reduced the options for a Medicare bail out over time. By offering a cheaper alternative, an ancillary benefit of this R plan is it puts more options on the table to pay for eventual Medicare reforms.

I'm familiar with that line of thinking, but I think it takes too much credit for comparability and really doesn't compare apples to apples. The best apples to apples comparison I can think of is Medicare Advantage, though even that is highly fragmented and doesn't benefit nearly as much as it could from competition or economies of scale. With pretty simple reforms to MA (which may or may not ever happen), I think you'd see it actually become cheaper than FFS Medicare. Right now, MA base premiums are based off of FFS utilization and most recent estimates are still that MA is about 1% more expensive, though offering more benefits. In a vacuum, if you take profit and advertising away, of course you have an opportunity for lower costs. However, you don't have equal management. I really think in the long run that single payer coverage is a net negative over the alternative.

Medicare is about as bad as it gets in terms of efficiency. There are public reports of double paying hundreds of millions per year just for drugs and just during hospice care. The politics are too messy to fix seemingly anything. It's everything that's wrong with single payer. In any case, some R's did formally present an ObamaCare alternative in the Senate yesterday. It's the same guys as the plan I posted above, but updated. Here's an article on it. Much more at the link. http://www.forbes.com/sites/theapothecary/2015/02/05/the-impressive-new-obamacare-replace-plan-from-republicans-burr-hatch-and-upton/ As an aside, Ron Wyden really got smacked down for trying to be bi-partisan a couple of years ago. It's a damn shame. He was one of the good ones, but like the rest he wants to keep his job.

Medical malpractice reform will be part of a bill, I suspect. That's an old TP that won't be abandoned. It's not a major consideration though, and if it meant passing versus not passing the right bill, they'd drop it in a second. I'm really curious about the idea of a tax credit to everyone, versus the differential tax treatment everyone gets now. In the short run, it gives R's cover because their bill would allow everyone who might lose coverage at the SC this year to buy coverage in the absence of a federal subsidy. However, in concept, it gives much more freedom over the long run for the very poor to choose coverage. That's important to me because ultimately I'd like a healthcare system that just has health plans people choose, versus employer, Medicaid, VA, TriCare, FEHB, etc. Neither the R's nor D's would go that far, but removing the differentials in the tax code is a major first step toward a less distorted healthcare system.

http://www.hatch.senate.gov/public/index.cfm/releases?ID=e2ba7198-3031-4a62-992c-42caec55f00e

If medical malpractice reform were the basis of the right's arguments, it would be more prominent. It's a minor talking point at this point, meant to make docs happy.

Right. By making this point, I'm trying to differentiate between the substance of healthcare reform (which I think R's are very capable of engaging) and the politics of it (which I think R's are trying to navigate a minefield). The one strategic saving grace that the R's have is that the ACA already exists. In theory, they could put together a set of reforms that is more conservative than what Obama did and declare victory. However, that would have the appearance of validating the rest of what is by any measure a big government program, and that's where politics come in again. However, it does allow the R's to pick off many lobbies in the process. For example, their bill would likely cost less, but that would allow them to minimize (though not eliminate) new taxes and payment cuts in Medicare. In other words, I suspect they're weighing the offsets to see if they can make the politics work. Boehner says they'll have a bill. I don't believe him, but it would be pretty amazing if they actually got a bill through the House on an actual vote. The politics of the matter are just too dangerous, I think.