I’m tired of paying health insurance costs for people in wheelchairs

I’m not, of course.  But love this Chait  post on how the hard right’s every man for himself ethic on health care.  Doesn’t get more rich than wheelchair-bound Charles Krauthammer complaining about paying maternity benefits:

The single most unifying idea to change Obamacare among conservatives is to eliminate the law’s “essential health benefits.” These burdensome mandates of which treatments insurance has to cover make Obamacare too expensive, conservatives say. Their problem is that the list of required essential health benefits includes actually only, well, essential ones. If the list did include any frivolous treatments, like cosmetic surgery or some goofy alternative-medicine quack scheme, that’s all you’d hear about. But it doesn’t. So the single example conservatives come up with, over and over, is maternity care. Today it appears in Charles Krauthammer’s column

The thing to understand is that mandating covering maternity care doesn’t affect the total cost of insurance. It only changes the distribution of the costs. It’s not like Charles Krauthammer’s insurance forces him to actually go through childbirth. It merely means that his premiums help pay for other people’s maternity care…

It is callous enough that Republicans apply their every-man-for-himself logic to health care, and land on the belief that those fortunate enough to be blessed with good health should not be burdened with the cost of paying for the medical needs of others. But when the advocate of this argument himself has expensive medical needs, the callousness rises to a level of solipsistic barbarism. A paraplegic man resents having to pay for women who need help breastfeeding their babies. Why should those women have to buy insurance that covers wheelchairs?

 If health insurance could sell plans that did not cover childbirth, then young women of childbearing age would be the only people who bought plans that covered it. And having a baby would be extremely expensive. Indeed, in the unregulated market that existed before Obamacare, it was common for women to buy insurance they believed covered their childbirth but in fact did not…

And it is true that, if we let Krauthammer buy insurance that didn’t cover maternity care, that change would, on its own, reduce Krauthammer’s premiums. That reform would make sense if you think of having a baby as some kind of yuppie extravagance…

But while childbirth may be the GOP’s favorite and only example of an unnecessary essential health benefit, eliminating all the essential health benefits, as they propose, will do more than shift the costs of insurance onto prospective mothers. It will allow — and, by the logic of adverse selection, force — insurers to segment their coverage for all kinds of medical risk.

Krauthammer himself has been a paraplegic since the age of 22. That’s an expensive medical condition. Probably he has group insurance through the Washington Post or another institution with which he’s affiliated, allowing him to spread the cost of his expensive medical care onto a risk pool that includes healthier, cheaper-to-cover people. Or perhaps he has a different arrangement. I do not for one moment resent that my insurance helps cover either childbirth or mechanized wheelchairs, even though I personally need neither service, and nothing Krauthammer says would make me reconsider.

Health care– free market or cheap, not both

Terrific post from Ezra this week.  You know, I first discovered Ezra when I got into health care wonkery.  I do love how the current health care controversy is bringing so much good stuff out of him.  Anyway, another excellent piece on the inherent contradictions in Republican health care policy desires:

Republicans in particular, but Americans in general, are confounded by an unusual dynamic in health policy: The health care systems that spend the least rely on government the most. This is difficult for Americans to grok because anti-government rhetoric takes as a given that government services cost more — we’ve all heard the stories of Pentagon procurement gone awry, or some agency somewhere spending absurd sums on pencil trays.

But in health care, the cheapest, highest-performing systems all do the same thing — they let government set prices centrally. That’s true in the UK’s absurdly inexpensive, and fully socialized, health care system; but it’s also true in the Singaporean system, which conservatives often hold up as a model.

Hell, it’s even true in the American system! Medicare and Medicaid pay much less for health services than private insurers…

The other argument you hear is that setting prices means rationing care. In the most stringent systems, like the UK’s, there are worthwhile treatments the government simply refuses to cover, and so patients have to pay for them out-of-pocket. This is an unacceptable abrogation of freedom — we don’t need government telling us what treatments we can and can’t but.

This is true, but it’s less of a difference with our system than people realize. We ration care, too — we just do so by letting individuals who can’t afford it go without it. This rationing by price is a particularly brutal form of rationing, and it’s one reason there’s such persistent political pressure to have the US government ensure access to medical care. It turns out that being free to not be able to afford lifesaving treatments is not a freedom Americans value very highly…

Republicans have failed to resolve these tensions in their own health care ideas. They say they want to build a generous health care system around private insurance — the most expensive form of insurance — but they also don’t want to spend much money on it. So far, they have tended to try to resolve that dispute by cutting back on the “generous” and “insurance” parts.

This is more or less what the American Health Care Act attempted. But as Republicans learned, Americans don’t want a health care system where 50 million people go uninsured and the remainder struggle with higher deductibles and sparer coverage.

I’ve said it before, I’ll say it again.  Free markets are great where they work.  Creating universal, affordable health care is one place they definitely do not work.

Photo of the day

Recent National Geographic photo of the day:


Icelandic horses have a distinctive look and Your Shot photographer Peter Izzard fell for the creatures saying, “they are the most gentle, inquisitive and approachable horses I’d met, and they looked super cool with their fantastic hairdos.”


HB2 Compromise– I’ll take it

So, presumably this should be happening sometime this morning.  Some basic details:

According to a statement from Berger and Moore, the bill would:

▪ Repeal HB2.

▪ Leave bathroom regulation to the state, essentially returning to the status quo before Charlotte passed a 2016 ordinance allowing transgender people to use the restroom of their gender identity.

▪ Enact a moratorium on similar ordinances until Dec. 1, 2020.

Not great.  You know what, though?  Better than the status quo.  Better than anything else we seem likely to get from this bunch of bigots running our state government.  Thus, I’ll take it.  I’m so not a believer in both sides are mad, so this must be a good compromise.  Maybe it just means it’s not good.  I get why the discriminators are mad– they are giving in to some modest degree in the face of pressure.  Not a big fan of the absolutist position of the LGBT advocates, but I get it:

Advocates for the gay community are calling the compromise “a sell out,” while conservatives are equally critical of any move that would negate what they see as a “common sense privacy law.” The latter refers to a highly-debated belief that giving transgender people rights to use the restroom of their choice would allow male sexual predators into women’s restrooms.

NC Values Coalition, which has been a major backer of House Bill 2, is urging state officials to “stand strong” on the widely criticized law. On Thursday, the group was promising to “target” any state official who voted for the compromise “as we did with Governor Pat McCrory.” McCrory lost his bid for re-election last last year, in part due to the HB2 controversy…

The group [Values Coalition] says lawmakers are “scurrying to make concessions just to appease the NCAA,” which has threatened to overlook North Carolina for championship games unless HB2 is repealed by Thursday.

“If the State succumbs to this new form of economic and corporate extortion, North Carolina will be establishing a precedent and illustrating a template for future corporate extortion efforts on any number of legislative issues,” says the coalition.

The Human Rights Campaign and Equality North Carolina, both advocates for the gay community, is urging state lawmakers to reject a backroom “deal” because it offers nothing to improve the life of the state’s LGBT community. In fact, it would specifically prohibit cities from passing policies that give rights to transgender people.

“The rumored HB2 ‘deal’ does nothing more than double-down on discrimination and would ensure North Carolina remains the worst state in the nation for LGBTQ people,” said HRC President Chad Griffin. “The consequences of this hateful law will only continue without full repeal of HB2. Sellouts cave under pressure. Leaders fight for what’s right.”

Chris Sgro, of Equality NC, referred to the proposal as a “train wreck that would double down on anti-LGBTQ discrimination.”

But here’s the thing.  Is there evidence that any amount of pressure will lead to a full, unqualified repeal?  Nope.  None at all.  You know what will?  Voting these rubes out of office.  Okay, work on that.  But the reality is that with this set of Republican “leaders” and this Republican majority, this is almost assuredly the best we’ll get.  I’m all for having good goals and fighting for rights, but I’m also for pragmatism, and that’s what this compromise is.  If it get stop, or at least mitigate, the ongoing damage HB2 is doing to our state, I’ll take it.

A basketball-loving liberal friend, recently posted, “Human Rights > Basketball‬ #HB2.”  Maybe.  But we simply are not going to get full, unqualified repeal.  I’ll take my basketball and economic benefits to the state and a return to the (essentially) 13 months ago status quo when nobody was arguing that NC was a discriminatory hellhole for LGBT people.

What do right-wing populists want?

Love this from Conor Friedersdorf:

Do populist Republicans want a federal government where politicians stand on principle and refuse to compromise? Or do they want a pragmatist to make fabulous deals?

The intra-Republican conflict highlighted by last week’s failure to repeal or replace Obamacare is usefully understood as a consequence of confusion on those questions. Elected officials associated with the Tea Party, or the House Freedom Caucus, believe that they were sent to Washington, D.C., to replace sell-outs who compromised themselves by seeking earmarks for their constituents, buckling to establishment whips, or horse-trading with the Democrats.

Yet many populist entertainers, like Rush Limbaugh and Sean Hannity, who fancied themselves champions of the Tea Party’s no-compromise ethos, morphed, during Election 2016, into cheerleaders for a different kind of populist—Donald Trump—who pointedly declared that he was seeking the nomination of the Republican Party, not the conservative party, and regularly boasted during the campaign that he should be elected in large part because of his prowess as a dealmaker. Forget principle—the art of the deal was the way to make America great again.

The contradiction was lost on many populist Republicans, who’ve been trained for years to use antagonism to President Obama and the media as a heuristic for judging loyalty––having “the right enemies” became a substitute for a positive agenda. Now that Obama is gone, and Republicans are totally in charge of governing, the party is discovering the inevitable tension that ensues when the populist wing of a political coalition elevates legislators chosen for their aversion to compromise, and then a president who intends to succeed via successful negotiating. [emphasis mine]

Even shorter version: A political party held together by hating Obama/Democrats and not much else finds there’s not a lot to hold it together when you can’t rely on hating Obama/Democrats as your main focus.

The Corporate Overlords

To be fair, the Republicans attack on internet privacy is not quite as bad as it may seem.  Timothy Lee with the proper context in Vox:

The good news is that nothing is going to change right away. The Obama regulations [to protect privacy] weren’t scheduled to take effect until later this year, so the Republican bill simply preserves the status quo, which allows ISPs to sell customer data to advertisers. And while the law currently allows ISPs to do this, most aren’t currently doing it.

What the bill does do, however, is open the door for ISPs to sell customer data to advertisers in the future. Which means that customers who don’t want their ISPs sharing this kind of information with advertising networks are going to have to do some extra work to opt out of any programs their ISPs eventually put into place…

Ars Technica’s Jon Brodkin has the most thorough explanation of the Republican bill and the Obama regulations it blocks. A key point he makes is that all the major ISPs have promised that if they start selling customers’ private data to advertisers, they’ll give customers a chance to opt out.

So if you don’t want to participate in a program like this, you’ll need to keep an eye out for announcements by your ISP.

 The problem is that it’s not clear where a program like this might be announced and what customers might have to do to get themselves excluded. It’s possible customers will get an email announcing the change, but it’s also possible ISPs will simply post a notice in an obscure corner of their websites, where most customers won’t notice. We also don’t know when any particular ISP might announce a program like this. So if you’re worried, there might not be a better option than periodically checking your ISP’s website or setting up a Google News alert for your ISP’s name and privacy.

That said, maybe not quite as bad as you thought ≠ good or okay. To hell with Republicans on this. This legislation passed by pure party line vote in both houses. The only people I’ve seen defending this are delusional-level partisans (okay, that might be most partisans), and, of course the internet providers. Yes, they need to compete on equal ground with google, etc., they claim. For one, I’m already paying Time-Warner a bunch every month for my internet. When it comes to google, we have an implicit deal– they provide me an amazing search engine and I provide them data about my searches.

Anyway, what’s amazing about this is what complete and utter disregard they have for the interests of their ordinary constituents as compared to their corporate overlords at TWC, Comcast, etc.  And, obviously, they know they can get away with such a transparently anti-consumer law.  This is a party who’s primary legislative goal is tax cuts for rich people yet has managed to win complete control of government based on scaring people of government, gays, minorities, political correctness, etc.  What’s one more giveaway to the rich guys over the interests of ordinary Americans.

My 11-year old saw me reading this article this morning, and even trying to be as fair as I could (as Lee is here) to the GOP position, my son was just incredulous that Republicans could and would act this way.  He’s got a point.
Image result for corporate overlords

Tax cuts uber alles

Terrific piece from Jacob Hacker and Paul Pierson in Vox.  Short version: GOP obsession with tax cuts for rich people over actually sensible health care policy did them in.  Lots of good stuff:

In fact, the AHCA suggests that Republican elites remain unified (if not completely) around one goal: tax cuts for the rich. The problem for them is that this goal is shared by few outside their donor class. [emphases mine] It is also at odds with another of their core priorities: cutting back the American welfare state…

For years, Paul Ryan has been the chief policy spokesperson for a loose but increasingly formidable Republican coalition with ambitions to fundamentally reorient the American state. For years, he and his allies have argued that if Republicans were given unified control of government, they would forge a new governing contract, embodied most concretely in a series of doomed budget bills that were the main reason for Ryan’s reputation as a serious policymaker.

These bills had three unifying features: They massively cut taxes, especially on the affluent; they massively cut spending, especially on the poor; and they hid the huge deficits they were certain to produce by using budget-scoring sleight of hand…

The AHCA similarly displayed the current GOP coalition’s overarching priorities. And what it showed, first and foremost, was that those priorities were profoundly out of step with public opinion on an extremely visible issue.

Much has been made of the extremism and intransigence displayed by the Freedom Caucus, which occupies the far-right wing of the far-right GOP. And indeed, that intransigence is a serious and ongoing problem for a GOP determined to govern alone. The core problem, however, was the staggering disapproval of the bill itself, which provoked outrage among the public (a mind-boggling 17 percent approval number in a Quinnipiac poll); anger among the organized interests most engaged on the issue; and resistance among Republicans outside of Washington. Tellingly, only eight of 33 Republican governors signed a letter of support for the bill…

Were these ugly outcomes evidence of sheer policymaking ineptitude? Incompetence was certainly a factor, but the main reason for the bill’s flaws was the overriding priority Republicans placed on repealing the taxes on high-income households and on health care companies — taxes that had financed the Affordable Care Act. The AHCA was, above all, intended to deliver a huge tax cut to a narrow set of beneficiaries. All else flowed from this central objective.

Yep.  It is actually an amazing and historically impressive feat for the Republicans to have attained and maintained so much power when their transparently most important policy objective is tax cuts for rich people.  I also think that implies some pretty depressing things about the functioning of our democracy.

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