Battle over Mandatory (aka “Entitlement”) Spending

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Healing said:
Medicaid also covers a lot of home health, like infusions, wound care, fall and home safety consults (including for acquired and developmental disabilities), and swallowing evals. Good luck in the sticks. Prevalence of Disability and Disability Types by Urban-Rural County Classification – United States, 2016:
  • According to this study, the prevalence of adults with a disability in the United States is significantly higher in rural areas compared to large metropolitan areas. These findings, along with a recent study showing that the percentage of adults having at least four of five health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining a healthy body weight, and meeting aerobic physical activity recommendations) was lowest in noncore counties,3 indicates the need for rural public health interventions to be inclusive of people with disabilities.
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Many of those rural disabilities are actually rural unemployment payments. There's no reason rural folk should be more disabled. There is a reason why rural docs would certify more disabilities.

But that's neither here nor there. I'm not interested in digging into the disability scams at the moment. Let everyone who has a "disability" keep it. Let's save health care.
 
breepf said:
Ezra Klein pitches the problem as follows: Musk's strategy of radical cuts might work in business, where the feedback is quick and the fixes are more straightforward. But the federal government does not have the same mechanisms for rapid feedback and it oversees processes whose downstream effects won't be apparent until the mid- or long-term.
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Ezra's not wrong, but I'm not sure it applies to the situation here. Musk's strategy of radical cuts DIDN'T work in business. That's one reason twitter fell apart.

I'd say the better descriptor is that the "move fast and break things" slogan was meant to apply to other people's things. You know, the way Uber broke taxicab regulation -- to its benefit and the detriment of local taxi providers. But when moving too fast, Elon has a tendency to break his own things. With twitter. With DOGE. Now with Tesla. (breaking his own thing in DOGE isn't quite the right analogy; I guess in that context it means undermines his own effectiveness)
 
superrific said:
Many of those rural disabilities are actually rural unemployment payments. There's no reason rural folk should be more disabled. There is a reason why rural docs would certify more disabilities.
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I disagree. Higher incidence of poverty can drive a lot of other factors that can contribute to disabilities - less educational attainment and adherence to recommended workplace safety precautions, less access to qualified treatment and rehabilitation for injuries, greater need to take on tasks better suited to professional, even roads that are less safe than in urban areas. I doubt any one of those alone is a major contributor or that fraud isn’t a factor, but it’s a far cry from no legitimate reason for the higher rates.
 
superrific said:
Many of those rural disabilities are actually rural unemployment payments. There's no reason rural folk should be more disabled. There is a reason why rural docs would certify more disabilities.

But that's neither here nor there. I'm not interested in digging into the disability scams at the moment. Let everyone who has a "disability" keep it. Let's save health care.
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Yes, and.

Rural communities have measurable issues with health literacy, risk factors, and access to education and healthcare.
 
superrific said:
More than inner-city communities?
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socioeconomic and demographic factors play significant and obvious roles. Access to pcps doesn’t tend to differ much, but specialist access (the kind Medicaid cuts likely further concentrate in urban centers) is notably different, as are markers of health literacy and access/knowledge of health education resources.

I’ve seen statistics suggesting disability rates are 15% or more in rural communities. Fraud, as you suggest, could count for a considerable portion of the difference, but unlikely most.

 
Healing said:
socioeconomic and demographic factors play significant and obvious roles. Access to pcps doesn’t tend to differ much, but specialist access (the kind Medicaid cuts likely further concentrate in urban centers) is notably different, as are markers of health literacy and access/knowledge of health education resources.

I’ve seen statistics suggesting disability rates are 15% or more in rural communities. Fraud, as you suggest, could count for a considerable portion of the difference, but unlikely most.

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All right. Thanks.
 
superrific said:
More than inner-city communities?
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I have not read every post-but if the data shows "Urban vs Rural" it could be "inner city " is buried by the larger Urban numbers. Si "inner city " alone may well have equallly depreseeing numbers ??
 

DOGE Plans to Rebuild SSA Code Base in Months, Risking Benefits and System Collapse​

Social Security systems contain tens of millions of lines of code written in COBOL, an archaic programming language. Safely rewriting that code would take years—DOGE wants it done in months.

www.wired.com

DOGE Plans to Rebuild SSA Code Base in Months, Risking Benefits and System Collapse

Social Security systems contain tens of millions of lines of code written in COBOL, an archaic programming language. Safely rewriting that code would take years—DOGE wants it done in months.
www.wired.com www.wired.com

“… The project is being organized by Elon Musk lieutenant Steve Davis, multiple sources who were not given permission to talk to the media tell WIRED, and aims to migrate all SSA systems off COBOL, one of the first common business-oriented programming languages, and onto a more modern replacement like Java within a scheduled tight timeframe of a few months.

… Under any circumstances, a migration of this size and scale would be a massive undertaking, experts tell WIRED, but the expedited deadline runs the risk of obstructing payments to the more than 65 million people in the US currently receiving Social Security benefits.

… This proposed migration isn’t the first time SSA has tried to move away from COBOL: In 2017, SSA announced a plan to receive hundreds of millions in funding to replace its core systems. The agency predicted that it would take around five years to modernize these systems. Because of the coronavirus pandemic in 2020, the agency pivoted away from this work to focus on more public-facing projects.

… In order to migrate all COBOL code into a more modern language within a few months, DOGE would likely need to employ some form of generative artificial intelligence to help translate the millions of lines of code, sources tell WIRED. “DOGE thinks if they can say they got rid of all the COBOL in months, then their way is the right way, and we all just suck for not breaking shit,” says the SSA technologist.

… “This is an environment that is held together with bail wire and duct tape,” the former senior SSA technologist working in the office of the chief information officer tells WIRED. “The leaders need to understand that they’re dealing with a house of cards or Jenga. If they start pulling pieces out, which they’ve already stated they’re doing, things can break.” “

——
Moving from COBOL to JAVA seems like a very reasonable goal but it’s the kind of thing that needs to be done with care and oversight, not dashed out as fast as possible before anyone can examine the process or impact.
 
nycfan said:

DOGE Plans to Rebuild SSA Code Base in Months, Risking Benefits and System Collapse​

Social Security systems contain tens of millions of lines of code written in COBOL, an archaic programming language. Safely rewriting that code would take years—DOGE wants it done in months.

www.wired.com

DOGE Plans to Rebuild SSA Code Base in Months, Risking Benefits and System Collapse

Social Security systems contain tens of millions of lines of code written in COBOL, an archaic programming language. Safely rewriting that code would take years—DOGE wants it done in months.
www.wired.com www.wired.com

“… The project is being organized by Elon Musk lieutenant Steve Davis, multiple sources who were not given permission to talk to the media tell WIRED, and aims to migrate all SSA systems off COBOL, one of the first common business-oriented programming languages, and onto a more modern replacement like Java within a scheduled tight timeframe of a few months.

… Under any circumstances, a migration of this size and scale would be a massive undertaking, experts tell WIRED, but the expedited deadline runs the risk of obstructing payments to the more than 65 million people in the US currently receiving Social Security benefits.

… This proposed migration isn’t the first time SSA has tried to move away from COBOL: In 2017, SSA announced a plan to receive hundreds of millions in funding to replace its core systems. The agency predicted that it would take around five years to modernize these systems. Because of the coronavirus pandemic in 2020, the agency pivoted away from this work to focus on more public-facing projects.

… In order to migrate all COBOL code into a more modern language within a few months, DOGE would likely need to employ some form of generative artificial intelligence to help translate the millions of lines of code, sources tell WIRED. “DOGE thinks if they can say they got rid of all the COBOL in months, then their way is the right way, and we all just suck for not breaking shit,” says the SSA technologist.

… “This is an environment that is held together with bail wire and duct tape,” the former senior SSA technologist working in the office of the chief information officer tells WIRED. “The leaders need to understand that they’re dealing with a house of cards or Jenga. If they start pulling pieces out, which they’ve already stated they’re doing, things can break.” “

——
Moving from COBOL to JAVA seems like a very reasonable goal but it’s the kind of thing that needs to be done with care and oversight, not dashed out as fast as possible before anyone can examine the process or impact.
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Plus would rather have a team doing this whose sole intention is to update the SSA system. Do not trust DOGE to do this for multiple reasons, one of which is their intent. No telling what they will add to the coding.
 
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