The Sure Fire Failure Republican Health Plan

One would think that last week’s passage of the Republican version of the American Healthcare Act, the bill to “repeal and replace” Obamacare, would be met with jubilation on the right.  Instead it’s been met with a mostly “meh” attitude.  Unlike Obamacare, which Democratic activists enthusiastically defended every step of the way, Republican activists aren’t happy with this bill. When the bill is taken up in the Senate, they are likely to be even less happy. Probably the only positive feature that Republicans will agree on is that it’s likely to be better than Obamacare.

Some of the features of the Republican bill include:

  • Ends the mandates and tax penalties of Obamacare.
  • Changes the subsidy system to a system of tax credits
  • Allows states to get waivers to the old Obamacare coverage requirements
  • Blocks Planned Parenthood payments for one (?) year.
  • Stops and begins the rollback of the Medicaid expansion.
  • Changes Medicaid from an entitlement to a block grant.

If, through some miracle, this bill were to sail through the senate unscathed, and become law as currently written, it would destroy healthcare in this country and do to Republicans what Obamacare did to Democrats; Reduce their numbers to a shrill minority in the House and Senate and forfeit the Presidency to the Democrats for the foreseeable future.

Why am I so glum about the results of the bill?  Changing the subsidy to a tax credit is a positive step, one that Republicans have supported for years, but the range of tax credits, $2,000 to $4,000, and the method of doling them out, is a disaster.  First, the tax credit amounts are ridiculously low.  John McCain’s 2008 health reform plan was better than that, and I thought that was a bit low at the time; $5000 for families and $2,500 for individuals. Also, the amounts are more based on age rather than income. There may be a rationale for that, but the Republicans in the House have not attempted to explain why basing tax credits on age will be more helpful to people than basing them on income. The average family employer insurance plan cost for 2015 was $ 17,322.00. To buy an equivalent plan on the individual insurance market, the tax credit should be anywhere from a third to half of that (to provide somewhat equal equivalence to the employee cost that employer plans have); way more than the Republican bill is offering.

The other issue is Medicaid.  Changing Medicaid from an entitlement to a block grant is probably the single most important long term feature of this bill, and one that does the longest term good. However, depending on where you get your estimates, more than 84% of the increase in health insurance coverage is due to Obamacare’s increase in Medicaid expansion coverage.  That’s coverage that, to the recipient, is free, with no premiums or co-pays.  Almost 12 million people will lose the Medicaid Expansion coverage over time. To offer them a replacement of a $2, 000 tax credit (with no mandate to force coverage) will leave a result that almost all of those people will lose coverage and not get a replacement plan.

However in terms of media coverage, the GOP elephant in the room has been pre-existing conditions.  The way the House bill handles pre-existing conditions is described in Time this way:

“The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.”

So if you have a pre-existing condition, your health care costs are likely to go up, even though you’ll still be able to purchase insurance.  We are currently in an Obamacare death spiral; a death spiral which probably represents a good portion of the Obamacare exchange market. Next year it will be worse. So in this way at least, things are likely to continue under the House bill the same way they are currently under Obamacare-higher prices and fewer choices.

Of course there is an answer to the Pre-existing conditions conundrum, one I touched on back in 2012 during the Obamacare discussions. But I think that’s probably an entire post on its own, so stay tuned…

So to summarize, the House bill is an unworkable mess as currently written and is less a repeal and replace than an optional opt out of Obamacare, while taking away the features of Obamacare.  So Congress is keeping the Obamacare rules and regulations, but taking away the features that made them workable. States can opt out of those requirements, but Medicaid Expansion is going away anyway.  If you have a pre-existing condition, you may be no worse off, but certainly no better, than if we do nothing and let Obamacare death spiral into the ground.

Some reform.

Ultimately, none of this will probably matter. The Senate is likely to so alter the bill that it will be unrecognizable.  But the struggle and fight over the House bill is a precursor to the fight in the Senate.

Syrian Dead Babies and all the other Dead Babies

Oops they’ve done it again.  Syria has launched a chemical weapons attack against its own people, with of course the main casualties being, “the children.”  In fact those dead babies may have totally overturned US foreign policy.  As the Guardian reports:

“I will tell you that attack on children yesterday had a big impact on me – big impact,” Trump told reporters in the rose garden. “My attitude toward Syria and Assad has changed very much … You’re now talking about a whole different level.”

This was the first alleged attack by the regime using sarin since 2013, when the nerve agent was dumped on an opposition-controlled area of Damascus. More than 1,000 people perished. This latest attack – after a deal brokered by Russia, in which Assad agreed to give up his chemical weapons stockpile – “crossed a lot of lines for me”, Trump said.

He went on: “When you kill innocent children, innocent babies, babies, little babies, with a chemical gas that is so lethal – people were shocked to hear what gas it was. That crosses many, many lines, beyond a red line, many, many lines.”

So a defining characteristic of Donald Trump’s foreign policy, to stay out of the Syrian Civil War, is now seemingly overturned by dead babies.  Now, I’m anti dead babies myself, particularly babies dead due to a sarin gas attack, but these are not the first dead babies in the Syrian Civil War, and I’m a bit of a skeptic that we should allow dead babies to control US foreign policy.

So considering Trump’s past positions on Syria…

…I admit I’m disappointed that a pretty firm twitter and campaign position has been overturned by “…innocent babies, babies, little babies…”  There were dead babies in 2013 too.  In fact all civil wars, civil strife, famine, plague, and every other malady that smacks mankind upside the head has plenty of dead babies in them.  But it’s not the first time dead babies have altered policy.  Remember this little tyke?

Of course, the real story was a lot less desperate fleeing-from-civil-war and a lot more dad-wants-free-dental-care.

So although Trump disappointed me by launching a cruise missile attack because of dead babies (and made himself look easily manipulated), there is an upside for him.  Politically, this attack against Syria appears popular.  When McCain/Graham, the neocon establishment, and the Democrats, are all praising the President, for many the first time ever, that will probably help polling for the next few days.  And who knows, maybe this action will actually give Trump some leverage with China in dealing with the North Korea situation.  In my opinion, what happens in North Korea is far more important than anything that’s happening in Syria.

Meanwhile, there were more dead babies piling up like cordwood all over the world, but we don’t care about them, only the dead babies that feature a frantic western newsman or are nicely photographed for Western media consumption.

No matter our new Dead Babies Foreign Policy, Syria remains intractable. As I wrote almost two years ago, the only reasonable solution for Syria is partition, which is an impossibility as long as the Russians are standing beside their ally Bashir Al-Assad.

Hopefully this is a one off attack and US foreign policy, and Trump’s attention, doesn’t get strangled by trying to figure out how to do the impossible and wipe every tear from every Syrian eye.

 

Ryan Care taught me one thing…

The collapse of Ryan Care was probably the first big failure of the young Trump administration (not counting the tweets-4D chess and all that). And to that, as on many things, I’m of two minds.  For all of its flaws, being able to block grant Medicaid funds to the states and capping its growth would be a major victory; a major reform of a major entitlement program.  Just that would have been a major administration accomplishment.

On the other hand…the bill was seriously flawed in virtually every other way and didn’t meet the President’s goal of providing coverage for everyone.  And even worse than the flaws of the bill, it revealed how amateurish the Republican House was.  It was like they had not even considered the idea of writing a health care bill until a few weeks ago.  And when they did, they repeated every bad Democratic mistake in doing it by keeping the bill writing secret to exclude… not Democrats but the real enemy; other Republicans.  And in fact, it was Republicans that ultimately killed their own reform plan.  Democrats just had to sit by and eat popcorn.

This of course, is yet another example of why the GOP has the amply deserved moniker of the stupid party.  Democrats usually have a handy bill just sitting on the hard drive of Democratic Congressional servers just waiting for a crisis.  You know, so they cannot waste it.  School shooting?  Just hit print and run out to the House floor waving a fully written Gun Control bill, “for the children.”

With Republicans, after passing multiple repeal bills during the Obama years, including having a full replacement bill in committee in 2013, the Options Act, suddenly became the proverbial deer in the headlights; “Wait we won?  That wasn’t supposed to happen!”

So after thinking that the GOP had at least a draft of a consensus plan tucked away waiting for its own opportunity, it soon became obvious that there had probably been not a single meeting or discussion on it until recently.  So after crafting a bill in secret with zero input from any effected groups, it turned out there was no constituency for the bill.  Even the late lamented Options Act had buy in from several conservative think tanks, and Tea Party groups.  No conservative groups even had a peek at it until it was unveiled.

Sorry, but that’s not how you do things.

But…none of that was the “one thing” that Ryan Care taught me.

Have you ever noticed that you never hear the left clamoring for Medicaid for all? Since Medicaid has no premiums, co pays, or deductibles, it’s truly free healthcare (from the consumer point of view). Meanwhile regular Medicare has an 80/20 cost share. Medicaid has lower provider reimbursement rates than Medicare so in theory it should be cheaper. Why shouldn’t the left/liberals/Democrats like Medicaid as the basis of a national healthcare plan over Medicare?

The other day I was on a forum discussing the late, unlamented Ryan plan, and how it weans off Medicaid funds to the states with a different formula over the years. Some left leaning poster complained that means the states would have to raise taxes to make up the difference!  Well duh, but if you’re liberal, shouldn’t that be a feature rather than a bug?  Don’t those guys love taxes, the higher the better?  How could increasing taxes be a flaw in a health care reform plan if you’re liberal?

Epiphany time. Unlike Medicare, which is fully federally funded, states have to pitch in for the cost (not counting the expanded Obamacare version) for Medicaid. Medicare, or any fully federal plan is paid for by deficit spending, so no one is really paying for it (yet) but the states have to tax real money to pay for things like expanding healthcare for people in their own state.  That’s why even the bluest states don’t have their own universal healthcare plans. Vermont tried to do it and spent three years trying to make it work before abandoning it because of taxes.  California is attempting to do it now, and the lessons of its attempt on this regard will be instructive.  I’m not sure any state can afford both a 50 billion dollar bullet train to nowhere and single payer health insurance.

So the lesson?  That’s how you defang the left: Make them pay for it.  A Balanced Budget Amendment would do more to rein in the Democratic Party than any comparative cluster of policy reforms that will be undone by the next Democratic administration.  The basic tools in the Congress and in statehouses across the country are all there to make it happen. Democrats love the rhetoric of raising taxes on the rich but the reality is that the rich are much of their constituency, and it’s not clear how far that constituency is willing to go if every single thing the Democrats want they had to pay for up front.

I’d like to find out.

Who Watches the Intelligence “Experts?”

The other day my wife had me check out an interview she was watching on Hannity since she wanted my feedback.  The interview was with William Binney, a former NSA official who worked for the agency over 30 years.  You figure, a guy like that, with that kind of background, should have some sort of credibility right?

Maybe not.

Just a few observations, other than the obvious one that Hannity really should shut up for a second and let his guests speak.  At 6:20 Binney, in response to a question by Hannity, “so every phone conversation I’ve had in my life you believe has been taped?” Binney responds, “Without warrants, yes that’s right.”

Color me skeptical, but I find it hard to believe that a lifetime of Sean Hannity phone calls has been recorded and are sitting in storage out in Utah, or anywhere.  Maybe I’m naive, but that seems implausible to me.  I just can’t imagine that the technology and storage capacity was there, starting in the 1970’s to record and store every single phone call of a teenage Sean Hannity.  Now? Possibly, but going back decades?  Or maybe Binney didn’t really mean Hannity’s entire life and misunderstood the question.  Or maybe, since he has 30 plus years with the NSA I should shut up since he should know what he’s talking about.

But then at 6:28 he blows any credibility I might have given him when he references the story of former military linguists Adrienne Kinne and David Faulk, “whistleblowers” who made the claim that the US Intelligence Community was deliberately targeting US military and civilians working in Iraq.  This blew up into a big national story for a few days in 2008. And although it’s mostly forgotten now, every so often it’s trotted out in the media as an example of the US Intelligence Community spying on innocent civilians as a routine fact of life and this incident just happened to have been outed by brave whistleblowers speaking truth to power.

I happen to have some peripheral knowledge of that incident and know that the media narrative of it is false.  So why should I trust Binney if he’s bringing that issue up?  More to the point, Binney was out of government by then, so what particular insider knowledge would he have of that incident?

This of course, is just one example of a problem I’m seeing with National Security and Intelligence experts, who go on cable news and, depending on the network, take totally opposite positions on an issue from other National Security and Intelligence experts. It’s by no means unusual for commentators to disagree on cable TV.  I mean, that’s the business model right?  But unlike other commentators and so called experts, commentators on Intelligence issues are trading on their exclusive access to the Intelligence Community and their access to classified information.  But rather than being honest brokers of that kind of access and expertise, they seem to be doing the same thing other cable news talking heads do: exploit their credibility to please the host of whatever show they’re on, in order to get more bookings.

Another “National Security Expert” guest of Hannity’s is LTC Tony Shaffer. Shaffer seems to be more of a wild card than Binney.  He’s claimed that President Obama watched the attack on the consulate at Benghazi from the situation room.  Explosive news if true, but how would Shaffer had known?  It sounds like something he just blurted out.  But Shaffer’s most recent wild eyed claim was that retired NSA and other IC types did the actual hacking of the DNC and gave the information to Wikileaks. Another earth shaking claim if true, but where’s the evidence?  What’s even the basis of the claim?

Another one who plays that game is Malcom Nance, a former Naval Cryptologic Technician and Arabic linguist.  He is also billed as an all-around National Security expert.  He actually has an impressive resume, but when you want to be called to be on panels on MSNBC or the BBC, you have to pick a side, which lead to this tweet a few months ago after the Wikileaks release of John Podesta’s emails:

Now there were no “obvious forgeries” in the Podesta emails.  Even months later, all the information we have on them is that they are authentic. But if a “National Security Expert” tells you they’re “obvious forgeries,” why wouldn’t the average person just accept that? But calling them forgeries, backed up by Nance’s resume, makes good copy; particularly on MSNBC.  That was the kind of national security expertise they want on that network.

Like Nance, John Schindler got his start in the Navy as a Cryptologic Warfare Officer and was a professor of National Security Affairs at the Naval War College until yada yada yada, and now he runs a National Security blog The XX Committee. Schindler isn’t a cable news whore, but he uses social media in much the same way.

Now…is this just an old friend who is a crusty old liberal and hates Trump, or is this an indication of some cabal in the Intelligence Community that has the goods on Trump and is just waiting for their moment to strike?  Clearly Schindler wants us to think the latter, but who knows?

My point is, I’m not sure that we can take these Intelligence and Security experts at face value.  They all seem to have agendas, whether commercial or personal, and because of the nature of their expertise, they are more or less unchallenged.  They are usually the only ones on a cable news panel that have held a security clearance so it makes them hard to challenge.  And frankly, that even goes for me too.  I dismissed Binney because of his take on the Kinne and Faulk story but I’m not willing to share anything about my issues with it.  So why trust me?

Don’t trust me, but you’re better off not trusting any of these “experts” until you can discern their real motives and agendas. And even then…

Is Demography Still Destiny?

A friend who is aware of my interest in the link between demographic change and political change slipped me this article, Why Demography Does Not Equal Destiny.  You don’t hear much these days about demographics in politics since last November 9th, other than the talk about that new group that politicos recently discovered; the white working class.  Who are these guys and where did they come from?

So it’s no surprise there is a lot of handwringing among the Demographics=Destiny crowd.  The article summarizes its main points:

  1. Demographic change is not evenly dispersed in states and voting districts throughout the country.
  2. Voting behavior is not static. Voters more readily change which party they support than the demography-is-destiny models anticipated.
  3. Despite the large change in the demographic composition of the electorate, most voters still do not self-identify as liberals. In fact, liberals remain bronze medalists in the ideological breakdown of the electorate—ever since the question was first asked decades ago.

I don’t disagree with the generalities of these points.  In fact I share them to a degree and wrote about the snags and hiccups on the way to permanent Democratic rule over two years ago. Most voters are not liberal, at least they are not self-identified ones, and the purging of the moderate wing that began in 2010 has left the Democratic Party with few moderates for mainstream Americans to identify with.  Political decisions matter too, and President Obama’s decision to go make Obamacare, rather than “comprehensive immigration reform” his first massive push doomed his party to an easy opening for attack.  The Tea Party sprang up to fight Obamacare and the political cost for moderate blue dog Democrats to vote for it was the loss of their seats, leaving a smaller, and more left leaning Democratic Party in its wake.

So for the past few years, the Democratic Party has been hurt more by stupid political decisions than helped by Demographic change.  Nobody told them that they had to make a granny with 30 years of criminal investigations and corruption behind her the party’s nominee.

However…

Even though the Democrats nominated the worst candidate possible she still won the popular vote by 3 million votes.  That really brings truth to the old saying about yellow dog Democrats; they would vote for a dog if it was running on the Democratic ticket. But that goes to Point One; demographic change is not evenly dispersed.  No it isn’t.  Particularly when you consider that the Hillary’s popular vote lead is entirely attributable to California.  Without California, Trump won the popular vote by 1.4 million votes.  That’s the power of demographics.

California is the textbook case, and the canary in the coal mine on unbridled Demographic change. The Center for Immigration Studies did a study comparing California from 1970 to 2008. Just a few observations:

Legal and illegal immigrants went from 9 to 27%.

Went from 7th most educated workforce to 50th (that’s dead last for the California educated!).

Went from 25th in income inequality to 6th.

Conclusion?  If you try to replicate Latin America in California, don’t be surprised if you get something that looks very much like…Latin America; high income inequality, with a very wealthy and educated elite with a large poor and uneducated mass of people, and of course, one party rule. California has successfully duplicated the Mexican model. And California, which has for decades been the early adopter of future American trends, shows us what the entire country will look like in a few decades.

So yes, other things matter too, not just demographics, however as California demonstrates, all things being equal, over time demographic change is probably the largest single determinate.  Demographically speaking, as Ann Coulter pointed out, “If the same country that voted in 1980 had voted in 2012, Romney would have won a bigger landslide than Reagan did.”

In the Trump, Black Swan era, it’s easy to dismiss demographic change as having an effect on our politics, but there it is, chugging along, year after year, turning the United States into California.

 

 

 

Giffords Anniversary: It’s Gotten Worse Since Then

On this day in 2011, Congresswoman Gabby Giffords was shot and seriously injured by a crazed gunman.  As the anniversary that kicked off one of the most vicious media smear campaigns in recent media history, probably unrivaled until 2016 when Donald Trump became “literally Hitler,” it’s worth looking back and just how corrupt the media can be.

The day following the assassination attempt I wrote a post about the absolute insanity that erupted from the left/main stream media in the wake of that shooting.  I went back to read it to see if, 6 years later, it still holds up.  It does.  Just a brief excerpt:

“With the Tucson shooting of Arizona Representative Gabrielle  Giffords, the mainstream media  and the leftie blogosphere wasted no time in drawing conclusions and blame for the shooting:  The Tea Party, Sarah Palin (of course!) and the climate of heated political rhetoric.  Of course, any examples used are borrowed strictly from the right.  Although I heard comparisons to Timothy McVeigh, for a bombing that occurred in 1995, I’ve yet to hear mention of the Discovery channel gunman, who actually credited a left political agenda to his rampage; when that occurred only last September.

But… that’s the nature of our biased news environment.  It’s so ubiquitous that most viewers wouldn’t even question that Tea Party inspired heated political rhetoric is at root of this shooting.  Why should they?  Every Sunday morning news show I watched today asked that same question.  Any soul searching required will be requested of the right, not the left.  Their overheated political rhetoric is just fine.  Of course the new media and the internet make that more difficult to pull off.   Now, there are multiple voices.  People aren’t limited to what the big three networks think are the right questions, and what they think of as newsworthy. 

And the Democrats have been fairly explicit on where they want to put the blame for this shooting:

One veteran Democratic operative, who blames overheated rhetoric for the shooting, said President Barack Obama should carefully but forcefully do what his predecessor did.

 “They need to deftly pin this on the tea partiers,” said the Democrat. “Just like the Clinton White House deftly pinned the Oklahoma City bombing on the militia and anti-government people.””

Of course the whole thing got started off by Paul Krugman’s infamous post at The New York Times:

“A Democratic Congresswoman has been shot in the head; another dozen were also shot.

We don’t have proof yet that this was political, but the odds are that it was. She’s been the target of violence before. And for those wondering why a Blue Dog Democrat, the kind Republicans might be able to work with, might be a target, the answer is that she’s a Democrat who survived what was otherwise a GOP sweep in Arizona, precisely because the Republicans nominated a Tea Party activist. (Her father says that “the whole Tea Party” was her enemy.) And yes, she was on Sarah Palin’s infamous “crosshairs” list.

Just yesterday, Ezra Klein remarked that opposition to health reform was getting scary. Actually, it’s been scary for quite a while, in a way that already reminded many of us of the climate that preceded the Oklahoma City bombing.”

At the time that post and all the subsequent reaction seemed unprecedented, but now of course, particularly after the past election season and current soft coup attempts by the media, it seems business as usual.  We have a new phrase to describe the Jared Loughner-Sarah Palin connection: Fake News.

It was an issue of great personal eye opening disappointment for me as well.  As a long time science fiction fan, I grew up reading the likes of Robert Heinlein, Poul Anderson, Larry Niven, and Jerry Pournelle.  They were generally right leaning libertarian types, with a lot of rugged individualism thrown into their stories, although their stories were nonpolitical. I read of course left leaning science fiction writers as well, such as Isaac Asimov, Kurt Vonnegut, Kim Stanley Robinson, Joe Haldeman, and Fredrick Pohl. These guys told great stories and didn’t let their personal politics get in the way of that.  So I just didn’t expect the world of science fiction to so reflect the utter debasing of our political discourse.  I expected it to be above that.

Well it turns out it isn’t.  Or it least these days it isn’t.  I used to be a regular reader of SF author John Scalzi’s website Whatever.  At the time, I thought it would be fun to be on a site with other science fiction fans, but the Giffords shooting quickly disabused me of that.  The comments from Scalzi on the shooting can best be described as Krugman lite.  In other words: despicable.  I can understand Krugman being Krugman, but I honestly and naively expected Science Fiction writers to be better than that.

They’re not.

Now days Scalzi gets a lot of mockery from the Alt Right on their sites.  It’s richly deserved.  And Scalzi, Krugman, and the media in general have only gotten worse.  So far, there is no bottom.

Did Russia Hack the Election?

In the continuing post election fake news trend, “Russia hacked election” gets over 45 million hits on Google. Russian hacking as been going on for quite a while and it would be no surprise that the Russians would want to hack both political parties. They are bad actors on the world stage and they are adversaries. However, just a couple of points:

* The hack allegedly occurred in the March-April time frame. Long before Trump was assured of the nomination and when almost every talking head, poll, and jackass was proclaiming it would be impossible for him to win. So the intent could hardly be to help Trump.

* The Wikileaks data was not a hack; it was an inside job according to the people who would know, Wikileaks. Assange has said this for months.

* That doesn’t mean the Russia hack didn’t happen, just that it’s not the source of the Wikileaks material. This makes sense as I would imagine that Russia would rather keep that info close to the vest rather than devalue it by releasing it.

* So Russian hacking (which is a big issue) and the Wikileaks data dump, seem to be unrelated issues. I’m open to new information on this, but when the CIA refuses to brief Congress on the issue, forcing a cancellation of a scheduled hearing, my BS meter goes off.

* Hillary Clinton actually won the popular vote by 2.8 million votes.  So, in what sense was the election hacked?  Were the Wikileaks disclosures designed to only affect certain counties in 4 or so States?  Good Grief…

I honestly have a hard time believing anything the media says anymore; particularly when they are trying as hard as they have been to push this narrative. It’s like the #fakenews nonsense. Simultaneously every major newspaper and every major news network suddenly made this non story of fake news a 10 day long major blockbuster.

My Prediction:  Now that the Electoral College Debacle is over, the next fake news spasm will be “conflicts of interest.”  Stay tuned to your local fake news media outlet for further coverage.