Thursday, February 27, 2014

I Am My Brother's Keeper

(from with Christian Campagne from BAM)

A gathering and presentation like this shows the astonishing authenticity of this man. These can be tricky waters for him, as his early Beer Summit and his more recent comments on Trayvon Martin have shown. Adversaries are always waiting for him to "play the race card": They want to hear him complain about institutional racism and how it prevents minority progress (presumably due to white prejudice and dominance); and they especially want to find ways he is trying to provide special programs and privileges for the "victimized" minorities, at the expense (presumptively) of whites. And we shouldn't forget the GOP trope that being your "Brother's Keeper" leads you into the dreaded territory of communalism and away from the sacred ground of becoming a "job creator". And, finally, there's the always lurking possibility that this will be one more Obama effort to enlarge the domain of Big Government at the expense of individual and family.

All of these needle eyes were "seamlessly" threaded. A bravura performance, and even Bill O'Reilly rose at the end to shake the President's hand.

But I want to highlight something else: the tangible, visible-while-invisible connection he establishes and demonstrates with Christian from BAM (Becoming A Man), and with all the boys/young men gathered behind him. Watch how the President listens to Christian's introduction of him, making occasional gestures or expressions, but mostly holding himself quietly, so the attention wouldn't shift from young Christian to him. Notice both of their movements and expressions when Christian tells the audience what the President had shared a year ago "in Circle" with the young men from BAM - that he had, in fact, goofed off from time to time in school. Notice the quiet dignity and diligence with which the President connects with each young man, including a touchingly long head-on-the-President's-shoulder hug with one boy, before he leaves the room.

This is pure Presence - being right here, right now, and nowhere else, with a Beginner's Mind and an Open Heart, focusing so completely that the small "s" self (the Ego, the Busy Mind) drops away, and Big Mind/Big Heart is what is there. The pure and utter Mastery of the Peaceful Warrior. Our President as Integral Leader.

And I haven't even talked about the program itself! Wonderful public-private partnership with multiple, and varying players, depending on the location (city by city). $200MM in new Foundation support, over and above the initial $150MM commitment. A great call to minority families, particularly fathers. And a powerful call to each young man present (and those watching at a distance) to personal responsibility and hard work.

In and through it all, we see and experience our President demonstrating great personal mastery.

Wednesday, February 26, 2014

I am Privileged, So Some Learning is Hard

That's my picture. Pretty well sums it up. More precisely, it sums up a certain dimension of "me": white, male, physically large and strong, probably affluent and well-educated (sort of looks that way and it's true) - in short, privileged. I have never faced "negative" discrimination, where I was treated badly because of what my outside appearance "said" to people I would meet. Lots of "positive" discrimination - special preferential treatment, most likely because the experience of power, of being powerful, becomes a habit, an assumption, that is somehow carried in the body, and people recognize it. Also, I look like an overweight, but still passable linebacker - someone you don't mess with if you don't have to. And yes, I have resources. I am part of the 1%.

I simply have no idea what it's like to be looked at and immediately disliked, despised or merely diminished because of what my appearance communicated to the onlooker about my status, my relevance, my power. In business deals through the years, I have experienced being looked at as an object, with certain measurable assets those I was negotiating with wanted; but this was a game, a ritual that had a beginning, middle and end - and I was doing some of the same myself. I really have no idea what it is like to be looked at as an object all the time, an object with presumably desired functions (sexual pleasure - a woman; physical or mental output - workers as mere inputs to production; and the like).

It's not that I haven't experienced vulnerability and, from that place, fear: My Mom was ambivalent about herself, and therefore me. My Dad always was, and remains (as an active, still curious 97 year old) like a god. I grew up suspecting Mom was right and I would never measure up. Failing terrified me and was not an option; so I did what I was good at (academics) and avoided what I wasn't so good at (sports, social life/friends). Girls were difficult, but sex was terrifying, and remained so for a long time. So I have experience of vulnerability, but none of discrimination based on "outside stuff".

So learning to enter the mind-space of people who face discrimination as part of their daily life is hard. And that's why this article in yesterday's by Ta-Nehisi Coates is so important. TNC is talking with Lucia McBath, the mother of Jordan Davis, who was gunned down by Michael Dunn because his music was too loud. TNC, using his own words and those of Jordan's mother, recreates for us the mind-space of the black, male teenager with language and images that first bring me into his head, then Lucia McBath's, then Jordan Davis' , then TNC's own 13 year old son who came with his Dad to the interview, and then into the lovely and mysterious mind recesses of our own children and grandchildren - those spaces we take and have some responsibility in forming, defining, and inspiring. Reading TNC's article I was at once a bit ashamed, in awe, and deeply grateful; because we one per centers have a lot of work to do, and we cannot easily do it by ourselves. We need the firm hand and inspired guidance of Ta-Nehisi Coates and those amazing soul teachers like him. Excerpts:

Last Thursday, I took my son to meet Lucia McBath, because he is 13, about the age when a black boy begins to directly understand what his country thinks of him. His parents cannot save him. His parents cannot save both his person and his humanity. At 13, I learned that whole streets were prohibited to me, that ways of speaking, walking, and laughing made me a target. That is because within the relative peace of America, great violence—institutional, interpersonal, existential—marks the black experience...

She stood. It was time to go. I am not objective. I gave her a hug. I told her I wanted the world to see her, and to see Jordan. She said she thinks I want the world to see "him." She was nodding to my son. She added, "And him representing all of us." He was sitting there just as I have taught him—listening, not talking. 

Now she addressed him, "You exist," she told him. "You matter. You have value. You have every right to wear your hoodie, to play your music as loud as you want. You have every right to be you. And no one should deter you from being you. You have to be you. And you can never be afraid of being you."

She gave my son a hug and then went upstairs to pack.

Monday, February 24, 2014

I have Tears in my Eyes


Watching Michelle Obama talk to the cast of "The Trip to Bountiful" and to the assembled young college students, moved me to tears. What is it about the "zone" in which the First Lady spoke, and that same zone she easily evoked in me, that moves me so? Such hope. Such confidence that this will all work out. Her energy. Her call to action to the students: (more or less, she says) "To carry on the work (of Cicely Tyson and Carrie Underwood), you must get right. You must get right in the head (pointing to her left temple). You've got to be clear, solid, centered. And you will be. You will take up this banner, taking the mantle from us, and carry this work forward..."

How utterly marvelous!

Friday, February 21, 2014

Obamacare: The Central Objective


This is the most recent enrollment status from the remarkable Charles Gaba, who appears to have put his entire life on hold for 6 months to provide really good reporting of the ACA numbers. We are all blessed indeed that Charles has made such a generous commitment. Today I want to focus on the Medicaid numbers - the big purple section in the middle of the graph.

Conservative pundits have attacked the gross Medicaid enrollment numbers (reduced only by renewals, which Charles has been able to separate out) - 7.16MM shown above - saying much of the volume comes from already eligible people signing up, not the newly eligible under the ACA Medicaid expansion. So he strips out all enrollment in the non-expansion states plus numbers of those enrolling in expansion states who were already eligible before ACA, and simply "came out of the woodwork", and gets a rock bottom number of 2.60MM. For a number of reasons, I think something closer to the 7.16MM is closer to the mark. Take a look at this chart from Kaiser:

Looking at this, I would have predicted a 55.5-56.0MM forecast for 2014, based on extending past trends. So anything over, say, a 1MM increase in enrollment for 2014 must be due to the ACA's impact: some people signing up will be newly eligible under the new ACA eligibility rules; but many will be listening to the national debate, paying attention, and finally signing up, though they had already been eligible.

So let's take 1.0MM off Charles upper range number, and we get 6.16MM for Medicaid through mid-February and 3.31 on the Exchanges (excluding unpaid and off-exchange). Where will that leave us by March 31? My guess: Exchanges - 5.5-6.0MM, Medicaid - 8.5-9.0MM (after deducting 1.0MM for normal growth). In other words - short of target on the Exchanges (7MM target) and pretty close on Medicaid (9.0MM target).

But here's what I learned today: Medicaid enrollment continues throughout the year through the Exchanges and direct to state Medicaid offices. Larry Levitt at Kaiser said a drop off in monthly enrollment is expected for Medicaid, but that the signup process will continue through the year.

So how many will signup by year end? Very hard to tell, but how big would that number have to be to make the original goal of reducing the number of uninsured in 2014 by 14MM? If 5.5MM is the Exchange result, and 2.0MM of these were previously insured on the individual market, then this is a 3.5MM reduction in uninsured. To hit the 14MM original target, Medicaid would need to generate 10.5MM new signups by year end. And this looks to me to be very achievable.

This is a big deal and my guess is that very few people know about it: Medicaid enrollment numbers will keep coming in after 3/31, and we may well be hitting the original overall target of reducing the uninsured by 14MM in 2014 around the November election day.

This should help Democrats in the coming midterms.

Friday, February 14, 2014

Is the Light Breaking Through?

I must say that Avik Roy's Forbes article surprised me a bit. I am so used to conservative pundits not engaging the facts honestly, so when one of the ACA's most severe and continuing critics puts out the above, I stop and take notice.

Now that the GOP has failed to stop or significantly change the ACA legislatively, there are only a few ways the law could be thwarted:
  • If nobody signs up.
  • The howl from those hurt by the bill ratchets up big time.
  • A premium "death spiral" - premiums continuing up and enrollment down.
Enrollment looks solid. We will probably top 6.0MM, which is the CBO's revised forecast. Right now 20% haven't paid month one's premium. Suspect we'll be in the 5-10% unpaid range by the end of April. So we'll end Open Enrollment with solid numbers, a bit behind forecast, with no reason to change the forecast for 2015. At least that's the CBO's determination.

Medicaid numbers are confusing: How do you count new enrollees in non-expansion states? How about people who enroll in expansion states but were actually already eligible? Should the ACA get credit for raising awareness such that already eligible folks finally come in and sign up? These are good and legitimate questions. The way is doing it is to show a range, which right now goes from 2.5MM up to 7.7MM. I end up about splitting the difference, saying 5.4MM signups (expansion states only, includes enrollees who were already eligible). Original CBO forecast was 9.0MM, now revised to 8.0MM. We should hit this number, though conservatives will argue loudly for a lower number, stripping out the already eligibles. For Mediacid as for the Exchanges, the CBO has not adjusted forecasts for 2015 and beyond.

So enrollment looks fine. How about the complaint level? Conservatives have been waiting for another shoe to drop when small businesses have to renew their coverage for 2015, moving up to the often stiffer requirements of the ACA. They have also been expecting blowback when the employer mandate goes into effect for 2015 and employers have to "face the music". So when the Administration recently delayed the employer mandate for companies with under 100 employees for another year, conservatives were beside themselves. Given all that, here's my best guess:
  • The small business move to ACA compliant plans will cause some problems, but no significant disruption. Unlike the individual market where people receive cancellations directly, for small businesses there will be some HR individual who will plan for and mediate this change. Employees will often have to pay somewhat more but this bump will be absorbed.
  • Delaying the medium-sizes employer mandate was good strategy - spread out the sometimes painful ruffles and give companies more time to plan and adjust.
  • Large companies will not make substantial changes with their mandate kicking in for 2015. Almost 95% of these firms are already offering ACA-compliant plans; so no need for wholesale changes. Company costs will go up and part of this will be passed on to employees; but this is nothing new. And when Home Depot or Target cut some of their part-time workforce loose, it's because they know that with subsidies, the Exchanges will provide a better deal for their people.
So what about the dreaded premium/enrollment "death spiral"? As I've been saying for some time, and now Roy is agreeing, it won't happen. Since there are 50 different state marketplaces, we will most likely see some places where premiums spike, or insurers pull out of the market. But it seems that most of the insurance industry agrees with the Wellpoint CEO, who told a recent conference that he was pleased with the numbers coming in, that pools seem pretty balanced versus their estimates, and that they believe these Exchanges represent a great opportunity for the future. My guess (unchanged): 2015 premiums will be up 5% or less as an overall average.

Will the GOP come together on a plan and push it out as an ACA replacement as Roy advocates? The Coburn-Burr-Hatch plan in the Senate is a possibility; but I don't think they'll organize behind it - they just don't want to give Dems a way to shift the conversation away from the ACA.

Will this work? It might and it might not. The real question for the midterms is who will show up? The normal midterm skews older with fewer minorities, a mix that is favorable to Republicans. In 2010 this is the electorate that showed up, with a fired up and angry white working class base, leading to the GOP wave victory. What if the ACA is generally thought to be working by summer, and no one is really being pummeled, and the economy is improving - might the "angry base" stay home? Could Dems convince more Hispanics, other minorities and single women to show up more than they normally do?

It's possible - not likely, but possible; which is why I forecast the Dems to hold the Senate and gain a few in the House.

Thursday, February 13, 2014

Faith and the Integral Leader

Be sure to read Nancy's post first.  A wonderful look into our President's faith life. The question I think Nancy is asking is: "How does Obama's description of his interior faith life align (or not) with your understanding of how other integral leaders describe their faith?" In other words, are there characteristics of faith that integral leaders have in common and does Obama "fit the model"?

My answer to both questions is: Yes - there are ways of being in faith that integral leaders share, and President Obama is clearly an exemplar. But before going to Nancy's question, I want to put down some basics of integral developmental theory. For a much better view, read Ken Wilber, particularly (to begin) his A Brief History of Everything; or visit his website, and/or spend some time browsing at the extraordinary

The idea of levels of development comes from the fields of developmental psychology and education. 
To summarize briefly:
  • There are stages/levels of consciousness development that are potentials for everyone, related to but not synonymous with the stages of life (infancy, childhood, adolescence, adulthood, older age).
  • The stage/level names vary somewhat from one theorist to another, but there is broad agreement on the following six developmental levels: 
  1. archaic (the infant; self/reality fused; no differentiation); 
  2. egocentric (the child; self is differentiated but world is self-centric; can't take perspective of another; pre-operational, often magical thinking; tribal social structure; gangs); 
  3. traditional (the adolescent; can take another's perspective;  group membership is central; black and white/concrete thinking; authoritarian/hierarchical structures; the time of myth in religion; truth is "revealed" and absolute; low tolerance for deviance from the true faith; witches and heretics are burned; Europe's dominant mode of thinking before the Enlightenment; American exceptionalism as absolute (no bowing to dictators); fascism; terrorism; fundamentalism; Tea Party) ; 
  4. modern (the adult; formal operational/what if-as if/reason-based thinking; can take multiple perspectives; one's role is key to self concept; the Enlightenment perspective; universal rights/the Rights of Man; democracy; the scientific method; "Does it work?" is the value test; interiors are split off and diminished; systems are seen and studied; the "Invisible Hand"/free market capitalism; competition; Darwin/Social Darwinism; American exceptionalism (based on US as Superpower); winning matters; Wall Street; Republican Establishment; some/many Democrats);
  5. plural/postmodern (cultural creatives; holding many perspectives but privileging none; aperspectival; interiors are back; the sensitive/spiritual self; "I am spiritual but not religious"; hierarchy detested; organizations distrusted;  marginalized groups are seen/supported; civil rights; feminism; environmentalism; LGBT rights; deconstruction of universal truths and meta-narratives; rewriting "Eurocentric" history to focus on groups marginalized by the "dominant" power structures; all truth is relative (except the rule that truth is relative; that rule is absolutely true); anti-war; anti-surveillance; world centric with no enforcement-capable governance structure;  America is not exceptional (we have much to apologize for);  many Democrats; all strong liberals); and 
  6. integral (vision/logic as mode of thinking; searching for patterns and emerging wholes; the Deep Currents/not the Surface Storms; the "parts" (blown apart in the prior period) cohere again and now form "emerging wholes" this level can discern (not invariably, but consistently); truth returns - not as static absolute, but as evolutionary process; evolution is "going somewhere" - towards higher levels of complexity, broader and deeper levels of awareness, greater human interconnection; strange attractors (the Good, the Beautiful, the True), lying in our future - not in an archetypal past, call/urge us forward; for the first time, evolution becomes aware of itself and participates consciously in cocreating the emerging future; deep acceptance of transcendence, of Spirit/God as both Source and Destination; the mystical level of all the world's religions (little dogma, many spiritual disciplines and practices, focus on values - but as a way of being, not merely rules); complexity is welcomed; paradoxes are not solved - they are embraced as spaces of interior tension where new insights can emerge; the Warrior returns as Master Peacemaker who desires Peace and understands that War is sometimes necessary to ensure it; a self-enforcing world governance structure is now possible).

Thursday, February 6, 2014

CBO Report - Budget Outlook 2014-2024

This is the Cover Page of the recently released CBO 10 year Budget Outlook. Most of the talk you have heard has focused on the effects the ACA might have on jobs. Conservatives claimed the CBO Report documents that Obamacare is a job-killer. Progressives quickly, and accurately responded that giving hard-working folks a chance to work less, because their healthcare is no longer tied to their work, does not represent any reduction in jobs. It signifies a voluntary decrease in the labor supply, which might even tighten that supply in some markets, and improve wages for those staying in the market to work. The Conservative case is very weak, which many now admit. So will not comment further on this. The CBO did reaffirm its earlier enrollment forecasts, while acknowledging that Year One might be a little short:
  • 6MM Exchange and 8MM Medicaid enrollees expected in 2014 down 1MM in each category.
  • Years 2 and 3 will see the shortfalls made up with total Exchange enrollment reaching 25 million and new Medicaid hitting 13MM.
  • As originally forecasted, employers over time will reduce insurance coverage for 7MM workers and the Non-Group market will shrink by 5MM.
  • The pool of Uninsured will shrink from 55MM to 31MM, a 24MM drop.
So nothing in the CBO forecasts has changed, except for timing. This is great news.

What I want to focus on now is the 2014-2024 forecasts and what they say about the country's economic health and financial stability. Here are some summary comments.
  • As the above cover image shows, deficits will drop in 2014 and again in 2015, before starting to move back up.
  • Mandatory expenses (Social Security, Medicare, Medicaid) go up as a percentage of GDP. Discretionary spending goes down as a percentage an equivalent amount. What causes the deficit to start growing again in 2018 are interest costs, which are returned to their "normal" levels of 3-4% on 90 day Treasury Notes and 5% on 10 year Bonds. I think the CBO is probably wrong here, and will show you what happens if we cap the average rate Treasury pays at 3% (mix of short notes and long bonds).
  • Believe CBO has accepted the fact that a transformation of the healthcare delivery system is well underway and that it will continue for the foreseeable future. Real healthcare costs per capita are forecasted to grow at just 1.5%, well below the growth of real GDP per capita. This is great news, and should result in a solid improvement in the deficit and debt picture, when the CBO publishes their Long Term Outlook, most likely in June.

Monday, February 3, 2014

Warriors-in-Training: Study This

Warriors need to be unflappable. If they do demonstrate anger, it's their choice. They are never triggered by events (including aggressive interviewers) outside themselves.

I am 72 years old and retired. I have studied the Warrior's Path of mindfulness and presence for more than 20 years. In many respects, I have achieved a certain mastery. But watching the President stay inside his center of silence and peace, I know I still have a long way to go. This is Mastery. Not a type of personality given at birth. Self awareness. Non attachment. Beginner's mind. Holding the paradox that there is no enemy and I am facing a dedicated adversary. Remembering Jesus; "Be gentle as a dove and shrewd as a serpent." Both - at the same time. 

Staying fully present within the embrace of your larger commitment, your North Star. Can you feel the internal power of the President's words, saying (more or less), when stuff happens, I/we stay focused on doing what I/we can to help the average person do a little better? His mantra. It's what he would say under truth serum. It's the central beat of his mental and spiritual heart. This North Star of his organizes even his internal spaces, and provides an energy shield or buffer when missiles are incoming. Yet "shield" is the wrong image. Nothing is defended. What happens is you become transparent, frictionless, and the arrows pass right through you. You don't contract around the arrow, so it doesn't dig in and impale you. You are fearless. Fully and always present. You see the arrow coming. And you relax, open yourself even further up. No tightening. No contraction. And the bad stuff passes right through you.

Mastery, as the President demonstrates it, is what poet Jack Gilbert called "...the edited conclusion of being, the normal excellence of long accomplishment."

Mastery is earned, not given. Ever.

Beautiful Indeed!

Our ability to celebrate diversity is America's greatest asset. Now and for the long term.

Saturday, February 1, 2014

Morning Notes to Myself

I just finished writing these down in Notes, then concluded that they are reasonably intelligible, so here they are:

What’s Going On?
  1. Economy is strengthening: removal (relative basis) of fiscal drag (4th qtr showed .98 % Governmentt drag - this will go to 0); good consumer spending; continued improvement in Net Exports, based partly on falling oil imports; fair investment levels (slowdown in housing), plus ACA. GDP growth in the 4th quarter was 3.2%; 2014 could average 4%. This will have the US as the fastest growing developed economy (China, an emerging market, will slow down to 5-6% range).
  2. Obamacare-Announcement from US’ largest insurer-Wellpoint: enrollment good, pool as expected, holding earnings forecast-takes most of the uncertainty out-ACA is on track.Ezra Klein’s point this am in Bloomberg: many signups from folks who had insurance; the big deal, not yet focused on, is that our total healthcare delivery system is moving from “quantity to quality, coordinated care vs. isolated procedures, and data driven, evidence-based medicine vs. intuition and individual experience only”. Part of the conversation may shift to this larger perspective. Just released Health Affairs/CUNY study of red state/no Medicaid expansion showing 7-17,000 increased deaths, hundreds of thousands of increased depression cases, missed diabetes treatment, missed pap smears/mammograms, missed cholesterol screenings, missed blood pressure tests. Plus ACA cuts uncompensated care payments to hospitals in these states; hospitals must cover uninsured in ER; lower uncompensated care reimbursement puts pressure on hospitals. This could be an election issue in red states.
  3. GOP P CARE: No Medicaid expansion, so poor (<100% FPL) adults w/o kids have no coverage. Subsidies to cover catastrophic events for 100-300% FPL offered to small business employees and people w/o employer coverage; presume this will change to all folks w/o employer coverage, but perhaps not. Auto enroll ensures big signup. No preexisting conditions if continuous coverage maintained. Uninsured will have one time open-enrollment period where they will get this benefit. ESI exclusion capped at 65% of cost of Cadillac plans: this will either be a tax increase on workers with big plans, or those plans will be cut way back. If a tax increase, this means middle class is funding the plan (not wealthy or business); if no tax increase results, no funding. No coverage for poor adults w/o kids. Near poor only get catastrophic coverage, w/o prevention services. Middle class is funding the uninsured through tax hikes. If not, plans reduced and no funding. Medicaid shifted to defined contribution/block grant program. Preexisting gets handled only through continuous coverage. If this is seriously pursued by GOP, will give Dems big ammo:”Which do you want, our plan or the GOP’s? You must make a choice.” Will GOP push this? Don’t know. Possible.
  4. Immigration-Everyone will describe GOP plan as just a slower path to citizenship (legalization). That’s why Dems might accept it. This could pass the House with a lot of Dem votes. If Boehner rules out going to Conference with the existing Senate Bill, then Senate could take up a version of the House Bill, presumably closer to their own, and Conference on that. I’ll go 60-40 that this happens before November. What election impact? Primaries will be more divisive. And this might cause primary losers to stay home.
  5. GOP will back down on debt ceiling. Compromise will be reached on UI. Dems will launch state-by-state effort on Minimum Wage.
  6. Election forecast: Same. Dems will hold the Senate; pick up 3-5 in the House.
  7. Iran - there will be a deal.
  8. Syria - discussions will continue sporadically. CW will eventually be removed. Some agreement by year end.
  9. Israel-Palestinians - 50-50 for a deal by year end
  10. Polls - Obama-back to 50% approval by election; Obamacare - 50% approval by election.