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Archive for the ‘Healthcare’ Category

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

Kevin Drum comments: Blame Hospitals for the Big Spike in Out-of-Network ER Charges

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Drum describes the big scam hospitals are running these days to screw patients. For-profit hospitals and medical care are a big mistake just waiting to happen.

Written by LeisureGuy

24 July 2017 at 7:06 pm

Medicaid Expansion Had a Huge Impact on the Finances of the Poor

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Kevin Drum has an interesting post with this chart:

He notes:

In states that didn’t expand Medicaid, nothing much happened. In states that didexpand Medicaid, medical debt fell nearly 40 percent by the end of 2015. As a check, they also examined overall debt, and found that it varied by only a small amount between expansion and non-expansion states.

Note that this is a 40 percent reduction in total medical debt. Since Medicaid is available only to the poor, it’s a good bet that it’s reduced the medical debt of the poor by considerably more than 40 percent.

Read his post, which includes links.

Written by LeisureGuy

22 July 2017 at 2:10 pm

Quote of the Day: “I can’t even remember why I opposed it”

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Kevin Drum posts:

From Patrick Murphy, owner of Bagel Barrel in Doylestown, Pennsylvania, on why he doesn’t want Obamacare repealed:

I can’t even remember why I opposed it. Everybody needs some sort of health insurance.

I also was struck by the comment. You’d think that if something was so important to a person that they actively opposed it, they would remember their reasons for opposing it. It was a big deal, and the opposition was bitter—and they don’t know why they opposed it?!

Drum provides one answer in his post:

Answer: he opposed it because movement conservatives in the richest country in all of human history created a hysterical atmosphere of cultural doom and fiscal annihilation surrounding the idea of providing a minimal level of health coverage for everyone. Why did they do it? Why do they continue to do it? Even after seven years, I’m not sure I truly know.

Truly I cannot understand the conservative “mind,” using the term loosely. It seems quite obvious that a country has a strong interest in ensuring that its people are healthy and educated, and to that end a sensible country provides healthcare and education, figuring that these, if done well, will provide benefits (including national productivity) far beyond their cost. But the opposition was clearly irrational and driven in part by a hatred of the poor.

Drum includes the results in Oregon of the modest step toward universal healthcare that Obamacare made:

Why would anyone oppose this?

 

 

Written by LeisureGuy

21 July 2017 at 10:38 am

Posted in Government, Healthcare

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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