Category: Uncategorized

On the 45th President Trump.

He claims that he’s priming the pump.

A word to the wise:

Get your story straight, guys.

And still, there’s no sign he’ll be dumped.

One of the principal features of AHCA is its reliance on state governments to improve the health care system.  Sure, Medicaid is being slashed, and protection for pre-existing conditions may be devolved to state high risk pools, but aren’t the states better equipped to solve problems than the feds?  After all, they’re closer to their people, and know their issues better, than the federal government. Just give them a little flexibility, and they can do the job better than a bunch of Washington bureaucrats.

Your response to this will depend on how you perceive the governments of red states.  If you think that the legislatures and governors of red states are predominantly populated by one-world Christian Democrats who genuinely feel the pain of their poor constituents even though they typically vote for the Democratic Party, you might accept this line of reasoning.  On the other hand, if experience tells you that red state governments are usually controlled by Reactionaries who actively despise poor people, oppose all forms of wealth redistribution on principle (particularly to undeserving minorities), and want to make the lives of people relying on the public purse as miserable as possible, you certainly won’t.

No prizes for guessing which camp I’m in.

Not many Americans remember this, but back in 2003, the German economy was stuck in the mud, and there were even suggestions that Germany was the “sick man of Europe.”  Gerhard Schroder responded with Agenda 2010, a pro-business reform program that trimmed the welfare state and reduced labor regulations. The program split the SPD (it has never really recovered) and probably increased inequality, but, along with the vast demand for German products in China, it ushered in a new era of prosperity.  Today, the German economy is the envy of all other nations in Europe.

France didn’t have an Agenda 2010.  While the French economy has grown somewhat, and came out of the Great Recession in better shape than many other European countries, France has fallen behind the Germans, and is no longer taken seriously as an equal partner in the EU.  It is not a surprise, however, that Macron’s platform sounds a bit like Agenda 2010.  What is likely to happen to it?

Macron starts with some advantages;  for one thing, he won’t have to force a right-wing program down the throat of a Socialist Party.  It will be very important for him to portray the program as a means to regain equal status with the Germans;  if it appears that he is just doing Merkel’s bidding, the program will be dead on arrival.

On the ex-FBI man named James.

His firing’s his loss, but Trump’s gain.

Will the Russia probe end?

What’s the message it sends?

At least we all know whom to blame.

Given that he is a young, brilliant, relatively inexperienced politician who plans to govern outside the existing party structure, it is inevitable that Macron would be compared to Obama.  The analogy really doesn’t work well, however, because:

1.  France in 2017 doesn’t resemble the US in 2009.  Obama had to deal with acute problems arising from the Great Recession; Macron will have to address chronic French economic and social issues, which is harder.

2.  Obama could rely on the support of the existing Democratic Party; Macron has invented a new party.  No further elaboration is necessary.

3.  Obama was charismatic; Macron is more wonkish.  No one has suggested that Macron can move an audience the way Obama can.  That will matter as he tries to convince French workers that liberalizing the system is ultimately in their best interests.

4.  Obama was a genuine outsider;  Macron is an enarque.  Macron is the French establishment in a new and fresh package.  The only unconventional thing about him is his marriage.

Wow!  Even for Trump, the audacity of this, and the absurdity of the stated rationale, is breathtaking.

Whether you agree with his actions during the campaign or not, there can be no doubt that Comey politicized the Bureau to an unprecedented and uncomfortable degree, so there is a compelling argument for getting rid of him and making a fresh start.  That isn’t what Trump is trying to do.  Everything about this episode suggests that he is attempting to eliminate an independent check on his powers and weaponize law enforcement in his own interests.

A great deal rests on his choice of Comey’s successor.  If, against my expectations, he selects a respected, nonpartisan law enforcement figure, this could ultimately be for the best.  If, more plausibly, he chooses a Jeff Sessions crony, all hell will break loose.

GOP senators, are you paying attention?

Upon taking office, Macron will be faced with the same issues that so bedeviled Hollande:

1.  What to do with the EU?  Hollande could have been an active supporter of German austerity, or he could have taken up the cause of the Greeks and Italians and demanded more pro-growth policies.  He did neither consistently.  Today, the EU economies are growing (albeit slowly), and the euro is not obviously overvalued in France, so I would anticipate that we would see some agreement on slightly higher deficits after the German election, but nothing more than that. New growth is going to depend primarily on the ever-popular “structural reforms.”

2.  Whither the welfare state?  Hollande took office as a Socialist determined to exact a pound of flesh from the finance industry, but he left it as a sort of moderate right-wing reformer with minimal public support.  Macron’s platform included business-friendly changes to labor laws and the welfare state.  Recent history suggests that the government will introduce very limited reforms, the reforms will meet ferocious resistance, and whatever is ultimately approved will raise suspicions about what will happen next without actually doing much good. Can Macron break out of this cycle?  It will depend on the outcome of the parliamentary election and his political skills, which will be sorely tested.

Faced with the prospect of selling a product that provides less health insurance at a higher cost to the American public, the Trump Administration (including, but not limited to, the man on golf cart) is doing what comes naturally–lying about what is in the bill.

It is exactly what you would expect from the proprietor of Trump University. The problem is that even the poor saps who paid for Trump University eventually figured out they were being scammed.  If AHCA becomes law in anything like its current form, the day of reckoning may be postponed, but it can’t be avoided.

It is an article of faith within the GOP that the way to lower health care costs is to suppress demand by requiring consumers to have lots of “skin in the game.” Relative to European systems, however, this simply isn’t true; the American system is vastly more expensive because unit prices for everything are much higher, not because deductibles are lower.  This in turn is due to the fact that European governments intervene far more aggressively in the health care markets than does the American government, even after ACA.

The few conservative commentators who are honest about this will say that higher unit costs are the price we pay for innovation and a growing and prosperous health care sector, which is true.  The real question is, is the trade-off worth it? Are stagnant wages, high prices for our products, and mediocre health care outcomes on a macro level an acceptable price to pay for cutting edge treatment for rich people and wealthy health care and drug providers?  If not, what are we willing and able to do about it?

That is the health care debate we need to have.  So far, I’m not hearing it.

So the French dodged a bullet this time.  As I’ve noted before, however, it will be difficult for Macron to govern effectively, and if he can’t, it’s easy to imagine an extremist being elected next time.

A lot will be riding on the parliamentary elections to come.  The whole world will still be watching.

On the 45th President Don.

The emperor has no clothes on.

He’s dumb as a rock.

You can go set your clock.

In three years and change he’ll be gone.

Transport yourself back to 2009.  Obviously, the Great Recession was the biggest concern on everyone’s mind, but there was another serious and growing problem:  the cost of health care, and consequently health insurance, was spiraling out of control.  ACA was the Democrats’ response to this situation.

ACA had two purposes.  The first was to reduce the rate of increase of unit costs by creating a variety of experimental cost control mechanisms.  The second was to make health insurance more widely available through a system based on community rating, government subsidies funded primarily by taxes on the wealthy, and the individual mandate.

Did it work?  Not entirely.  The Medicaid expansion was crippled by a Supreme Court decision.  Young and healthy people did not enter the market in the numbers predicted by the Obama Administration.  It was difficult to make the system work in poor rural areas with relatively few providers.  And yet, overall, you would have to say that ACA was a success, because the percentage of uninsured fell to a record low, and the cost curve was bent, if not broken. Medicare, for example, is in much better financial shape today than was expected ten years ago.

Today, the GOP proposes to replace ACA with AHCA.  How do the two stack up?

Obamacare         vs.           Nobamacare

Wealth shift        Rich to poor              Poor to rich

Cost control        Pilot programs          Demand suppression by price

Uninsured          Big decrease               Big increase

Beneficiaries      Poor and sick             Healthy and wealthy

And the winner is . . . What do you think?  People who could already afford insurance, or who don’t need it, are the only ones who stand to gain from AHCA. Even many of the GOP House members who voted for the bill don’t like it.  But hey, it makes Trump look like a winner and facilitates a larger, permanent tax cut for the rich, and that’s what really matters!

 

Admittedly, there were no Mexican-American families in the town in which I grew up, but I don’t remember seeing any widespread national publicity given to Cinco de Mayo during my youth, either.  Today, the airwaves are full of commercials for it, and the occasion is used as the pretext for a big party all around the country. We are not the worse for it.

We are a nation of immigrants.  As a result, the culture is constantly evolving. We steal shamelessly and joyfully from the traditions of other countries.  My favorite example of this is the fact that the Boston Pops always plays the 1812 Overture at the end of its 4th of July concert.  What does a piece of music written to celebrate the expulsion of Napoleon from Russia have to do with us?  Nothing, and everything.

For a Reactionary, this means it is logically impossible to pick a particular time at which American culture existed in its purest form, before it was defiled by the Other.  From what I have read recently, it would appear that the current date of choice is the 1920’s, but you can be certain that the Reactionaries of the day were complaining about all those damn Germans speaking their own language and drinking way too much beer, about southern and eastern European immigrants, and about Irish Catholics.  Going back even further, the anti-immigrant Know Nothing Party was created in the 19th century.  The process has never stopped, and probably never will, which means the efforts of Reactionaries to save a static idea of America from outsiders is ultimately a lost cause.

There is no doubt in my mind that the late October surprise had an impact on the outcome of the election.  I am also certain, however, that Comey’s concern about the effects of nondisclosure after a Clinton victory were completely justified.  To be honest, if I had been in his position, I probably would have done the same thing.

It appears that the Republican leadership’s plan is to get something (anything) through the House today, to subsequently sneak a more moderate version of it past the Senate parliamentarian on a bare majority vote, and then to rely on the pressure of the moment to bring the Freedom Caucus to heel during the negotiations between the two houses.  You wouldn’t want to bet the ranch on it working, but it certainly isn’t impossible.

So we have to imagine how the system would work in states dominated by the GOP, given the new waiver provisions in AHCA.  My home state of Florida is a good example.   To give you some idea of how our state government works, consider that when Rick Scott was elected governor, I only half-jokingly said that he would view the elderly, sick, and unemployed as underperforming assets who should be securitized and sold to unsuspecting German investors.  Our government turned down billions in stimulus money during the Great Recession and refused to expand Medicaid.  That is the attitude that will prevail when the new system is unveiled.

The pertinent questions are as follows:

1.  Will age be considered a pre-existing condition by the insurance companies?  It is my understanding that AHCA waivers apply to pre-existing conditions, but not to age;  insurance companies will still be subject to some limits on their ability to charge higher fees on the nearly old.  From the perspective of the companies, that would make no sense.  In the real world, expect them to scrutinize the applications of the nearly old much more strictly.

2.  How will the system work in states that obtain the pre-existing conditions and essential requirements waivers?  The current version of the exchanges will have no reason to exist, as the fundamental premises behind them will be gone.  It will be necessary for consumers to search individual company web sites on the internet.  Lengthy application forms and physicals will be required again. Anyone with a pre-existing condition who is subject to a massive surcharge will then have to apply to the state for permission to participate in the high risk pool. The state will be free to impose whatever conditions it wants on that participation:   work requirements; drug tests; means tests; low lifetime benefits limits; high deductibles; and so on.

3.  Will states like Florida actually apply for the waiver?  Ideologically, you would expect Scott and his friends in the Legislature to ask for the waiver. Politically, it could be a different story.  The waiver will damage the interests of millions of nearly old people, the majority of whom vote for Republicans.  Will ideology prevail over self-interest?  I’m not sure.

4.  What would the economic impact of the waiver be on Florida?  People old enough for Medicare won’t be affected, at least in the short run, but people aged 50 and above will be.  I suspect you would see the beginning of an exodus of the nearly old from the state, and a reduction in the number of new retirees.  The economic impact would be severe, and completely negative.

Would our government shoot itself in the foot purely for the pleasure of ending an entitlement program that it considers odious, because it redistributes wealth to people it considers unworthy of the benefits?  It’s an open question.