Later On

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Archive for the ‘Congress’ Category

Two stories about the transgender ban Trump dictated

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First, the why: “Inside Trump’s snap decision to ban transgender troops” in Politico.

Second, the pointlessness of it:  “The Pentagon spends 5 times more on Viagra than transgender services.”

I sure wish the US had a competent Congress, but I think that’s asking too much.

Written by LeisureGuy

27 July 2017 at 1:19 pm

How healthcare is delivered in the US

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Nicholas Kristof provides an example in the NY Times:

For a man who needed 18 teeth pulled, Daniel Smith was looking chipper.

Anxious, too, for he was facing a pair of forceps. But Smith, 30, a contractor with no health or dental insurance, who hadn’t seen a dentist in more than 20 years, was looking forward to an imminent end to the pain and rot in his mouth.

“I’ve always worked, since I was 14, but I’ve never had dental insurance,” Smith told me. After his teeth are out, he has a lead on low-cost dentures.

“I’d like to have a straight smile,” he said. “I’ve never had one in my life.”

All around Smith were uninsured patients receiving free dental or medical care, including dozens of men and women in side-by-side dental chairs in the open air. Organizers mercifully arranged the long line of people waiting to have teeth pulled so that they were facing away from those currently enduring extractions.

The patients swamped the county fairground here for a three-day health extravaganza of free care organized by Remote Area Medical, an aid group that holds these events across the country. This one involved about 1,400 volunteers serving 2,300 men and women who needed care of every kind.

Some patients camped out for three days at the fairground gate before the clinic opened to make sure they would be treated.

The health fair reminded me of scenes I’ve witnessed in refugee camps in South Sudan. But here in America?

The sight is a wrenching reminder of how many Americans slip through the cracks. No other advanced country permits this level of suffering — and if the G.O.P. health care plan goes through, millions more will lose their health coverage.

“Walking around, listening to people, it breaks your heart,” said Gov. Terry McAuliffe, a Democrat, whom I encountered on the fairground. “We need a healthy work force, and this is a disgrace.”

“Shame on us as a nation,” McAuliffe added. “This is an embarrassment to our country.”

That’s what I feel, too: humiliation that Americans need to be rescued by a group originally intended to help people in the world’s poorest countries (mixed with pride at the altruistic spirit that attracted so many volunteers, paying their own expenses to come here). To me, the fundamental lesson is that even under Obamacare, too many people don’t have coverage, and we urgently need a single-payer universal health care system along the lines of Medicare for all.

Remote Area Medical is the brainchild of Stan Brock, 81, a onetime British cowboy who in the 1950s managed one of the world’s biggest ranches, overseeing 50,000 cattle in Guyana in South America.

When he was badly injured by a wild horse, Brock was told it would be a 26-day hike to the nearest doctor. So he recovered on his own — but began to think about supplying health care to deprived areas.

Brock ended up founding Remote Area Medical to work in places like the Amazon, Haiti and Uganda. But then one day he had a call from Sneedville, Tenn., where the hospital had just closed and the dentist moved out. “Can you come here?” the caller asked.

Brock loaded a dental chair on the back of a pickup truck and brought in a dentist as well — and 150 people lined up, desperate for oral care. The result is that while it continues some international work, Remote Area Medical also treats people in the world’s superpower.

Brock is a character: He discovered a species of bat that is named for him, and today he has no home but unrolls a pad each evening and sleeps on the floor of Remote Area Medical’s permanent offices in Tennessee. At 5 a.m. on the first day here, Brock opened the gate and began admitting people eager for care.

As they surged past, many stopped to thank him; one man had tears in his eyes as he did so.

“I wish Mr. Trump would come,” Brock told me. “The health of these people is appalling.” . . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 11:59 am

A Longtime Republican Senate Staffer, on John McCain

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James Fallows has an interesting post with remarks by Michael Logren:

I’ve had my say about John McCain’s decision to support the rushed consideration of the Republican drive to repeal Obamacare. Installment one was here, and two was here. The theme of both was that McCain missed a historic opportunity to match the scolding-and-uplift of his much-praised words, about the need to avoid simple fights for partisan victories, with the weight of his actual votes, which in the crucial showdown this week supported just such partisan warfare.

Now Mike Lofgren, who spent 28 years as a Congressional staffer mainly working for Republicans, and has since then become a noted author of The Party Is Overand The Deep State, writes in about the McCain he came to know from long observation on Capitol Hill. I’ve learned over the decades to take what Mike Lofgren says seriously, and in that spirit I invite close reading of what he has chosen to say:

Let us respectfully acknowledge John McCain’s past sacrifice to the United States and his present health struggles. Still, the media’s fawning over both his return to the Senate and his sanctimonious jeremiad against partisanship is difficult to bear. He rightly excoriated a grotesquely unfair Senate process, but then became the deciding vote allowing that process to move forward. Compounding his duplicity, he claimed he could not support the underlying legislation, but a few hours later voted in its favor—although nine of his Republican colleagues found the courage not to, defeating the measure.

Regardless of his vote on subsequent health care measures, should one of them pass and deprive millions of Americans of health insurance, McCain will have been the key enabling factor. The “Conscience of the Senate” would deny to those Americans the blessing which he takes for granted. But this chasm between his pretenses and his behavior has been a consistent feature of his Senate career.

His rhetorical denunciation of torture during the Bush years was loud and long—yet he never followed up, despite the fact that his moral prestige as a former POW would have carried great legislative weight. A ban on torture came only with Obama’s executive order. Likewise, a persistent feature of his career has been to bitterly scold pork-barrel spending in defense bills.

Yet, invariably, he fails to offer amendments to remove those offending provisions; nor does he vote against the underlying bill. As a staffer, I recall that almost all Senate Republicans, hardly a sensitive and swooning lot, really couldn’t stand his moral preening. But his tactics were a mechanism by which McCain got cheap credit from a lazy press looking for the One Righteous Republican they could lionize.

None of us vain creatures can bear scrutiny of the gap between our words and our deeds—but few, I fear, would suffer from that scrutiny more than John McCain.

His present obeisance to the reptilian Mitch McConnell, his strange non-reaction to Trump’s sliming of his wartime service, and his curious passivity towards the Bush campaign’s scurrilous attack on his family (later supporting Bush’s reelection as he stood by while Karl Rove defamed fellow Vietnam vet John Kerry), are all inexplicable incidents if one believes the standard narrative about McCain. The man who inflicted Sarah Palin on our suffering country and started us on the inevitable slide to the nightmare of Donald Trump is a far more complex, interesting, and fraught human being than the heroic caricatures depicted in the establishment media. . .

Continue reading.

Written by LeisureGuy

27 July 2017 at 10:20 am

John McCain Makes His Choice: To Eat the Cake, But He Wants to Have It, Too

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In the Atlantic James Fallows has an excellent column on McCain’s smokescreen to hide his actions behind a tapestry of words:

The effort to repeal Barack Obama’s health-care bill is not over, and neither presumably is the public career of John McCain. But each crossed an important threshold yesterday, and Senator McCain gave us a clearer idea of who he is and what he stands for.

The repeal effort isn’t over, because debate and further voting is now under way to determine whether the bill will pass and, more basically, to define what it would actually do. McCain will have more votes to cast, on this measure and others, and it’s possible that in the end he will turn against this bill because of its provisions (whatever they turn out to be) or because of the rushed and secretive process that led to it. Just this afternoon, McCain voted No on a “straight repeal” bill that would eliminate Obamacare without any replacement.

If in the end John McCain makes as decisive a stand against this proposal as he did in favor of it last night, then the historical verdict on this stage of his career will be more complex than it would be right now. As of the moment the story would be that McCain, soon after his diagnosis and treatment for aggressive brain cancer, responded to this memento mori by flying back to Washington to help take medical coverage away from other people.

There’s still time. But yesterday was important, for the bill and for McCain.

* * *

Not even U.S. senators are often in a position where just one of them, strictly on his or her own, can directly affect the welfare of tens of millions of people. John McCain was in that position yesterday. By definition, in a vote this close, every vote is the “decisive” one. But McCain built drama by holding his vote until the very end. He wanted to take center stage. And he did so—by voting Yes, to let this bill proceed.

He voted to keep alive a bill opposed not by some but by all major medical-professional and health-related groups. A bill that an organization of nuns called “the most harmful legislation to American families in our lifetimes.” A bill with absolutely no across-the-aisle Democratic amendments, as compared with well over 100 Republican amendments in the original Obamacare plan, and with virtually no open hearings or debates. A bill whose support level in opinion polls is roughly half that of Donald Trump himself. A bill—well, the litany is familiar, all leading up to the point that it’s a bill that John McCain could have chosen to stop yesterday, and didn’t.

If he had stayed home in Arizona, the bill would have died. If he had voted No, at least this effort at repeal would have ended. Of course, perhaps Senate Majority Leader Mitch McConnell could have squeezed either Susan Collins or Lisa Murkowski, the two Republican defectors, to switch their votes, so he could still eke out a 50-50 tie, allowing Mike Pence to make it 51-50. Perhaps if McConnell had failed yesterday, he would have kept looking for some other way to get an anti-Obamacare “win,” despite the distortion the crusade is causing in everything else the Senate has to do. Perhaps McCain thought he was saving his influence within the GOP for later—later stages of deliberation on this bill, later encounters with Trump. Perhaps, perhaps. For certain, McCain made a choice yesterday, and he did something no one looking back on this moment will admire.

(Whenever I hear about politicians saving influence “for later,” I cannot help thinking of the unfortunate Ricky Ray Rector, the man whose name is a shorthand for the most heartless thing Bill Clinton did in his drive for the presidency. Rector was a murderer who tried to blow his own brains out when about to be captured by police. He survived but with profound mental disabilities. An Arkansas jury nonetheless convicted him and sentenced him to death; the U.S. Supreme Court declined to hear his case. Young Arkansas governor Bill Clinton, then in a very tight contest in the Democratic primaries of 1992, and all too aware that only four years earlier Michael Dukakis had been badly hurt by a “soft on crime,” Willie Horton race-baiting campaign, approved the execution and went to Little Rock to be in the state when it occurred. When Rector was offered a last meal before being put to death, he told the jailers that he wanted to save his dessert “for later.” When politicians talk about “saving” their influence, this for later is what I hear.)

* * *

John McCain himself went out of his way to highlight why his choice was so sad, and so hypocritical. As David Graham noted yesterday, McCain immediately followed his vote with one of his trademark speeches on the need to take the high road in politics—the need to stop doing things in a rushed and secretive way, to stop simply looking for partisan wins. Elevated words, of the kind McCain is accustomed to being complimented on. But the words were entirely at odds with his actions of just minutes before—when he had the chance to stop a rushed and secretive push toward a partisan win, and he whiffed. Later that same evening, just hours after he somberly declared that “I will not vote for this bill as it is today,” McCain went right ahead and voted for that bill as it was yesterday, one of only 43 Republicans to do so.

And he didn’t need to do this, any of it.  . .

Continue reading.

McCain is a Republican. That is significant, and tells us a lot.

Written by LeisureGuy

26 July 2017 at 4:10 pm

A clear-eyed view of the Republicans in Congress

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Jennifer Rubin concludes a column today with this pointed remark:

In sum, the consolation for a meltdown in legislative order, rationality and responsible government is that we now know just how incapable the GOP is of governing. Years of antagonism toward government have made them cavalier about the harm they can do to ordinary citizens in their quest to avoid blame. What a shabby group they are. Let’s hope they don’t do real damage before they lose their majority.

Written by LeisureGuy

26 July 2017 at 10:39 am

Trump can’t make a health care deal because he doesn’t understand health care

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Ezra Klein reports in Vox:

The blame in the Senate’s health care omnishambles is attaching to Majority Leader Mitch McConnell, and understandably so — he wrote the bill, he designed the process, he owns the result. But the absence of President Donald Trump from the story is, itself, an important part of the tale.

For better and for worse, policy leadership in the modern era tends to come from the White House. Take the Affordable Care Act. Though the bill was written in Congress, President Obama and his staff were involved at every step of its construction — they set the policy vision, used the technical resources of the executive branch to work through trade-offs, were deeply involved in the legislative process, and led the communications effort on the bill’s behalf.

The apex of this was the Blair House summit. As the bill was floundering, Obama invited congressional leadership from both parties to the Blair House to debate the legislation on live television for hours. Obama was trying to prove to congressional Democrats that they could win the argument on health care, that he could win the argument on health care, and that they should trust him and pass the bill. It really is worth watching a few minutes of Obama’s performance in this, and contrasting it with Trump’s role in the replacement effort:

[watch the video at the story]

Obama’s performance was effective because it was, to Democrats, persuasive. Obama knew the details of the legislation, he knew the issue, and he knew how Democrats thought — and so he made arguments they believed, and persuaded them that even if the Affordable Care Act was a dangerous vote to take, it was still a vote worth taking.

What happened publicly at the Blair House happened privately every day. Obama and his team were constantly working to sell wavering Democrats on the bill, to persuade them that the trade-offs made were the right ones, to convince them this was a historic opportunity to achieve the Democratic Party’s 80-year dream of universal health care. It’s no accident that Obama’s health care address to a joint session of Congress ended by wrapping the bill in the legacy of the late Sen. Ted Kennedy, and framing it as the “great unfinished business of our society.”

The campaign worked. In the Senate, Democrats had 60 votes, they needed 60 votes, and they got 60 votes.

The Affordable Care Act was a heavy lift, and there are many who deserve credit for its passage — notably Nancy Pelosi and Harry Reid. But I don’t know anyone involved in that effort who thinks it could’ve been done without Obama and his White House.

The GOP’s repeal-and-replace effort was also a heavy lift, and it’s been done without the productive involvement of Trump and his White House — in fact, Trump often made the process considerably harder.

The core problem is Trump has no idea what he’s talking about on health care and never bothered to learn. “Nobody knew health care could be so complicated,” he famously, and absurdly, said. His inability to navigate its complexities meant he couldn’t make persuasive arguments on behalf of the bills he supported, and he routinely made statements that undercut the legislative process and forced Republicans to defend the indefensible.

Trump’s post-election promise of “insurance for everybody” with “much lower deductibles” set up a standard Republicans had no intention of ever meeting but kept having to answer for. At his occasional meetings with wavering members of Congress, he’s made superficial political arguments to people who had deep policy concerns. The discussions left legislators feeling insulted and annoyed that the president hadn’t bothered to do the barest amount of homework.

Because Trump doesn’t understand the legislation or the trade-offs it made, he can’t make persuasive arguments on its behalf in public or private, and so he mostly doesn’t try. Trump and his team are not frequent presences in the public debate trying to sell the legislation they’re so keen to sign. That’s one reason the various bills routinely polled around 20 percent — without Trump using the bully pulpit to argue on behalf of the legislation, critics, terrible Congressional Budget Office reports, and news of congressional infighting filled the void.

When Trump does weigh in, it’s often a disaster. . .

Continue reading.

Written by LeisureGuy

19 July 2017 at 2:38 pm

Why Canada Is Able to Do Things Better

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Jonathan Kay writes in the Atlantic:

When I was a young kid growing up in Montreal, our annual family trips to my grandparents’ Florida condo in the 1970s and ‘80s offered glimpses of a better life. Not just Bubbie and Zadie’s miniature, sun-bronzed world of Del Boca Vista, but the whole sprawling infrastructural colossus of Cold War America itself, with its famed interstate highway system and suburban sprawl. Many Canadians then saw themselves as America’s poor cousins, and our inferiority complex asserted itself the moment we got off the plane.

Decades later, the United States presents visitors from the north with a different impression. There hasn’t been a new major airport constructed in the United States since 1995. And the existing stock of terminals is badly in need of upgrades. Much of the surrounding road and rail infrastructure is in even worse shape (the trip from LaGuardia Airport to midtown Manhattan being particularly appalling). Washington, D.C.’s semi-functional subway system feels like a World’s Fair exhibit that someone forgot to close down. Detroit’s 90-year-old Ambassador Bridge—which carries close to $200 billion worth of goods across the Canada-U.S. border annually—has been operating beyond its engineering capacity for years. In 2015, the Canadian government announced it would be paying virtually the entire bill for a new bridge (including, amazingly, the U.S. customs plaza on the Detroit side), after Michigan’s government pled poverty. “We are unable to build bridges, we’re unable to build airports, our inner city school kids are not graduating,” is how JPMorgan Chase CEO Jamie Dimon summarized the state of things during an earnings conference call last week. “It’s almost embarrassing being an American citizen.”Since the election of Donald Trump, there’s been no shortage of theories as to why America’s social contract no longer seems to work—why the United States feels so divided and dysfunctional. Some have focused on how hyper-partisanship has dismantled traditional checks and balances on public decision-making, how Barack Obama’s rise to power exacerbated the racist tendencies of embittered reactionaries, and how former churchgoers have embraced the secular politics of race and nationalism.

All of this rings true. But during my travels up and down the American East Coast in recent years, I’ve come to focus on a more mundane explanation: The United States is falling apart because—unlike Canada and other wealthy countries—the American public sector simply doesn’t have the funds required to keep the nation stitched together. A country where impoverished citizens rely on crowdfunding to finance medical operations isn’t a country that can protect the health of its citizens. A country that can’t ensure the daily operation of Penn Station isn’t a country that can prevent transportation gridlock. A country that contracts out the operations of prisons to the lowest private bidder isn’t a country that can rehabilitate its criminals.The Organization for Economic Co-Operation and Development (OECD), a group of 35 wealthy countries, ranks its members by overall tax burden—that is, total tax revenues at every level of government, added together and then expressed as a percentage of GDP—and in latest year for which data is available, 2014, the United States came in fourth to last. Its tax burden was 25.9 percent—substantially less than the OECD average, 34.2 percent. If the United States followed that mean OECD rate, there would be about an extra $1.5 trillion annually for governments to spend on better schools, safer roads, better-trained police, and more accessible health care. . .

Continue reading.

The GOP does not believe in investing in the US. For example, for the US as a country to be competitive and productive, it’s vital to ensure that its citizens are (a) healthy, and (b) educated. Thus if the country took its own interests to heart, there would be universal healthcare, and well-funded at that, including treatments and hospitals for the mentally ill (rather than simply having the police shoot them, or putting them in prison), nursing homes for the incapacitated and elderly, and investments in seeing that more medical professions (doctors, nurse practitioners, nurses, pharmacists) are trained—and not allowing any forced shortages to arise as might happen if some specialty set informal limits the supply of new doctors in the specialty. I don’t think this is happening—some specialties just don’t have that many people in them. So the government should institute programs, subsidies, new medical school, so that the supply of doctors, nurses, pharmacists, and so on could be increased to serve the greater demand resulting from a broader national effort to achieve the goal of a healthy citizenry.

And having an educated citizenry requires paying teachers a lot more to increase the talent supply, and funding of most effective teaching practices, with a constant search for better teaching practices, and building a database of documents and on-line videos to make available nationally courses for teachers and would-be teachers on what those best practices are. This might take the form of watching a video recorded live of a master teacher teaching one class session, then that video with commentary, the master teaching stopping the action at certain points to explain what’s happening: why s/he made the choices and said the words s/he did, how it might be done better, and so on, then back to the next teaching moment.

In other words, apply ingenuity and resources to ensure that our nation’s teachers are great at their jobs. That will make those future generations more capable.

And obviously the nation is better for everyone—you might say it would improve the general welfare—if the infrastructure were well-maintained and kept in good shape. And those jobs would be most welcome, but obviously money is required.

What I’m talking about, I suddenly realize, is artificial selection in meme evolution, exactly as we used artificial selection in lifeforms in order to domesticate plants and animals (and ourselves, in the sense that tribes rid themselves of uncooperative members). The goals (healthy citizenry, educated citizenry, good infrastructure) are sufficiently broad that many memes can be selected to drive toward those goals, just a not littering became a thing when Lady Bird Johnson took on the campaign to beautify America. Very quickly, littering was socially unacceptable and by and large people stopped littering. (This was helped by very young children being able to understand what littering is and that it’s bad, so not littering became a basic value adopted in childhood.)

And in fact the GOP will never approve of taxing the public to the point where all these benefits could be delivered to the public, because the goal of the GOP is to enable a select few to become wealthy by looting the country: skimping on healthcare, skimping on education, skipping on infrastructure, and thus being able to keep much of that money for themselves through the eternal demand for more tax cuts.

The US could do it right, but I think it is unlikely at this point. Still, perhaps the public will awaken to the fact that the wealthy are shortchanging them:

The US is not, though Donald Trump continually says it is, the most heavily taxed national on earth. Quite the contrary: U.S. taxes are quite low—and we’re getting what we pay for. Chart above is from this page.

Written by LeisureGuy

18 July 2017 at 9:06 pm

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