Senate health care bill: bad for humans

Or, as Ezra Klein so wonderfully put it: “The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick.”  The sad truth is, that many conservative Republicans simply hate the protection for pre-existing conditions.  Seriously.  It’s like some sick, twisted worldview where healthy people are virtuous and only unvirtuous people get health problems before age 65.  Ezra explains how this plan would very likely destroy protections for pre-existing conditions even while superficially pretending it didn’t:

Included in the new bill is a version of Ted Cruz’s amendment allowing insurers to offer plans that don’t comply with Obamacare’s insurance regulations so long as they also offer plans that do comply with Obamacare’s insurance regulations.

So imagine you’re an insurer. As long as you offer some Obamacare compliant plans, you can also offer plans that deny people coverage for preexisting conditions, that don’t cover mental health benefits or pregnancy.

What will happen here is clear: The plans that have to offer decent coverage to anyone who wants it, no matter their health care history, will become a magnet for the old and the sick or the soon-to-be-sick, as they can’t afford, or perhaps can’t even buy, the other plans. That will drive premiums in those plans up, pulling younger, healthier people into the non-compliant plans.

The Senate bill thinks it has a fix: a roughly $200 billion fund to offset the costs of sick enrollees. So, in short, what the GOP bill attempts to do is to rebrand high-risk pools as Obamacare plans and make them subsidized dumping grounds for the sick and the old, while everyone else buys insurance in a basically unregulated market.

This is a very bad idea for anyone who is sick, has been sick, or is likely to get sick. It attacks the core changes Obamacare made to build insurance markets that serve the sick, the well, and, crucially, everyone in between.

Prior to the Affordable Care Act, insurers in the individual market worked to sign up healthier people and avoid sicker people. They did this in ways that were crude, like simply refusing to insure people with preexisting conditions, and ways that were subtler, like designing plans that made sense for the healthy but didn’t cover key services needed by the sick.

The Affordable Care Act ended all that. It standardized the benefits insurers had to offer, so they couldn’t design plans that didn’t work for the sick, and barred them from turning the sick away, or charging them more.

The BCRA reverts individual health insurance markets to their pre-Obamacare days. Under this legislation, an insurer who had some Obamacare-compliant plans could also craft plans that were, say, great for 30-year-olds with a low risk of cardiovascular disease, but terrible for 53-year-olds with high blood pressure and cholesterol, or that simply denied coverage to anyone over age 60 with a history of health problems.

The GOP’s answer to this problem is to try to quarantine sicker people off to the side in subsidized plans. But sickness is not a binary state. Yes, the sickest people, the ones who need health insurance most, will do whatever is necessary to get insurance, and the high-risk plans might work for them. But what about young women who insurers consider demographically likely to be pregnant in a few years? They’re not sick enough to be willing to pay the exorbitant premiums of the high-risk plans, but they’re also going to be up-charged by insurers scared of their future costs.

Or how about the 42-year-olds who aren’t sick now, but had health scares in the past? To insurers, they might be basically uninsurable outside a high-risk pool. But to the healthy-feeling 42-year-old, the cost of the high-risk pool may be exorbitant. And so they go uninsured, and then disaster hits. [emphasis mine\

Of course in Ted Cruz’s world, you probably did something to deserve that medical disaster.  It is truly amazing and stunning that people with such narrow and warped views of the world hold the keys to health care policy in our country.

It’s not all relative

Paul Waldman with an important reminder on the latest iteration of the Republican Senate health care bill:

Senate Republicans are releasing the latest version of their health-care plan today, and there’s a temptation to focus solely on what’s changed from the previous iteration. The changes are important, and we have to understand them. But what we shouldn’t do is allow a relative judgment (maybe it’s better in this way but worse in that way) to distract us from the big picture, because what’s still in the bill from before is even more important than what has changed.

The big picture is that this bill is an absolute nightmare that would cause a spectacular amount of human suffering — and yes, even deaths — if it were to pass. It would mean fewer people with coverage, more people having trouble affording coverage, less protection and less security.

Let’s go through the major provisions in the bill…

  • The bill would utterly eviscerate Medicaid, which is relied on by tens of millions of poor, elderly and disabled Americans. It would roll back the Affordable Care Act’s expansion of Medicaid and cut hundreds of billions of dollars from the program. It would also transform the program into a block grant, for the first time allowing states to kick enrollees off their coverage and cut back benefits.
  • The bill allows insurers to sell bare-bones plans that go by the name “insurance” but cover very little, as long as they also offer a plan that meets the “essential health benefits” requirement of the ACA. This in effect sets up two pools, one containing young and healthy people, and one containing people who are older or who have more serious health needs. The insurance industry, along with many analysts, predict that this could produce a death spiral of skyrocketing costs for those with preexisting conditions…

If your Republican senator votes for this plan, he or she is supporting gutting Medicaid, taking away health coverage from at least 20 million Americans and potentially the end of real protections for those with preexisting conditions, higher deductibles, less help for those with modest incomes, potentially the return of lifetime limits on coverage (outlawed by the ACA), which turn a health-care challenge into a financial calamity, and an attack on women’s health choices.

In short, this bill is an abomination. No one should be able to get away with saying, “Well, it’s a little better than it was before.” All that does is obscure how spectacularly cruel it is. [emphasis mine]

Of course, that’s what many “moderate” Republicans will surely say.  At this point, the really big question is just how many.

It’s not just extinction

I recently posted an interesting Atlantic piece arguing that, while we obviously have some serious problems, the evidence is just not there for us undergoing a true extinction event.  That said, very nice piece from Ed Yong that emphasizes looking at only extinction can be a misleading metric as to the threats to our environment:

Imagine if every animal and plant on the planet collapsed into a single population each, says ecologist Gerardo Ceballos. If lions disappeared except from one small corner of Kenya, the prey they keep in check would run amok everywhere else. If sparrows were no more except in one Dutch forest, the seeds that sparrows disperse would stay in place everywhere else. If honeybees became isolated to one American meadow, the flowers that they pollinate would fail to reproduce everywhere else. None of those species would be extinct per se, “but we’d still be in very bad shape,” says Ceballos.

He uses this thought experiment to show that fixating on the concept of extinction can lead scientists to overestimate the state of the planet’s health. Extinction obviously matters. If a species is completely wiped out, that’s an important and irreversible loss. But that flip from present to absent, extant to extinct, is just the endpoint of a long period of loss. Before a species disappears entirely, it first disappears locally. And each of those local extinctions—or extirpations—also matters.

“If jaguars become extinct in Mexico, it doesn’t matter if there are still jaguars in Brazil for the role that jaguars play in Mexican ecosystems,” says Ceballos. “Or we might able to keep California condors alive forever, but if there are just 10 or 12 individuals, they won’t be able to survive without human intervention. We’re missing the point when we focus just on species extinction.”  …

“The real trouble with mass extinctions, from a modern perspective, is that it’s really hard to know you’re in one before it’s too late,” says Jacquelyn Gill from the University of Maine. “By the time you compile the casualty list, the damage is done. What’s really powerful about [Ceballos’s new] study is that it focuses not on the losses, but on the early warning signals. Population declines are a common precursor to extinction, and it’s a process we can actually do something about.”

Alright, then, let’s do something about it.

Photo of the day

Closest ever photo of Jupiter’s great red spot:

NASA / SwRI / MSSS / Gerald Eichstädt

Why politics is not a job for amateurs

Really excellent post from Julia Azari in Mischiefs of Faction:

Imagining a political outsider coming in and curing what ails politics is fun and romantic, and it’s not new. On its face, this idea seems very democratic — what could be closer to the ideals of democracy than casting the bastards out and infusing political leadership with new blood, with people who know life outside of the profession of politics? Like many things, this is intuitive but incorrect. Political amateurism presents a threat to democracy.

Democracy is hard. It’s not as simple as picking an election date and site and counting up the votes. It also requires thinking about how different perspectives and stakeholders will be integrated into a system, what to do with the losers of a particular process, and how to balance individual freedom with community concerns. The practice of democracy requires dealing with the reality that disagreement is bound to crop up anytime you get more than one human being in a discussion…

Movements like WTF embrace the pernicious myth of populism that beneath elite squabbles there exists widespread unity of principles. It is true that most people want broadly similar things: peace, safety, prosperity. But there’s a lot of disagreement about how to achieve those things. Productive approaches to politics acknowledge this — denying it won’t make it go away.

Some nice commentary from Alex Theodoridis when he shared this on FB:

This is an important argument from Julia Azari. There was a time when political scientists lamented the fact that reforms to the nominating process had opened the door to candidates like Ronald Reagan and Jimmy Carter (both governors of sizable states) who lacked Washington experience. John F. Kennedy was once seen as inexperienced when he ran for president (he had been in Congress for 13 years). Obama (with < 1 full U.S. Senate term under his belt) took inexperience to a new level, and Trump (with zero government or military experience and whose resume basically consists of expanding the family business and grooming himself into a reality television star) has made Obama look like a seasoned pro. I’ve long thought the growing willingness (even eagerness) to embrace candidates without experience was a very troubling development. Experience has always been part liability. In gaining it, you build up a record to attack, make enemies, say things that can be used against you, etc. So, if voters impose no electoral penalty for lack of experience, they set the stage for a neophytocracy.

This New Yorker cartoon nails it:

Image may contain: 1 person, smiling

Belated Trump Jr and the Russians post

Sorry, between reading too obsessively about this and trying to get some research done, not posts.  Some of the better stuff I’ve read:

1) If nothing else, DJTJ is stunningly incompetent:

If Trump Jr. had wanted to get the materials being offered but cover himself, he would’ve emailed back to say he was appalled at the suggestion, but then used a more secure means of communication to contact Rob Goldstone, who was offering the files, and set up a meeting.

Trump Jr. didn’t do that. He just conducted business over email. Easily hackable, subpoena-able email, during a campaign that centered on his father’s opponent’s poor email management skills.

The incompetence extends from the initial crime to the subsequent cover-up. Trump Jr. kept telling easily debunkable lies, and then changing his story when these lies were exposed. First, he said he’d never met with Russians when he was “representing the campaign in any way, shape or form.”

Then, when this meeting came to light, he told the New York Times that, oh, actually, he did meet with Russians, to discuss “a program about the adoption of Russian children that was active and popular with American families years ago and was since ended by the Russian government.”

Then when the New York Times found that the meeting was about getting information on Clinton, Trump Jr. admitted that this was true, but failed to mention that he had been promised information as part of a Russian government effort.

And then, to preempt yet another Times scoop, he posted all his highly incriminating emails about the meeting on Twitter.

None of this actually made him look less involved or guilty. It just served to erode his credibility and confirm that he had something to hide all along.

Trump Jr. appears to have not taken even basic steps to defend himself and his administration as the scandal unfolded.

2) Clearly a judgment call for whether he actually broke federal law.  I think there’s a pretty good case for why he did.  Here’s Hasen.  A round-up of legal experts from Vox.

The statute in question is 52 USC 30121, 36 USC 510 — the law governing foreign contributions to US campaigns. There are two key passages that apply here. This is the first:

 A foreign national shall not, directly or indirectly, make a contribution or a donation of money or other thing of value, or expressly or impliedly promise to make a contribution or a donation, in connection with any Federal, State, or local election.

The crucial phrase here is “other thing of value,” legal experts tell me. It means that the law extends beyond just cash donations. Foreigners are also banned from providing other kinds of contributions that would be the functional equivalent of a campaign donation, just provided in the form of services rather than goods. Like, say, damaging information the Russian government collected about Hillary Clinton.

“To the extent you’re using the resources of a foreign country to run your campaign — that’s an illegal campaign contribution,” Nick Akerman, an assistant special prosecutor during the Watergate investigation who now specializes in data crime, says.

Here’s the second important passage of the statute: “No person shall knowingly solicit, accept, or receive from a foreign national any contribution or donation prohibited by [this law].”

The key word from Trump Jr., according to University of California Irvine election law expert Rick Hasen, is “solicit,” which has a very specific meaning in this context. To quote the relevant statute:

A solicitation is an oral or written communication that, construed as reasonably understood in the context in which it is made, contains a clear message asking, requesting, or recommending that another person make a contribution, donation, transfer of funds, or otherwise provide anything of value.

 Trump Jr. was clearly soliciting information that he knew was coming from a foreign source. Given that political campaigns regularly pay thousands of dollars to opposition researchers to dig up dirt, it seems like damaging information on Clinton would constitute something “of value” to the Trump campaign.

The solicitation bit is why it doesn’t matter if Trump Jr. actually got useful information. The part that’s illegal, according to the experts I spoke to, is trying to acquire dirt on Clinton from a foreign source, not successfully acquiring it. And his statement more or less admits that he did, in fact, solicit this information. [emphasis mine]

3) Dahlia Lithwick’s survey of legal experts likewise finds plenty of case for being criminally responsible (and one notable dissent).   And here’s another lawyer making the case for not breaking any laws.

4)  Regardless of whether crimes were broken or not, the case for attempted “collusion” is sure as hell clear.  TPM summarizes Krauthammer:

He said the Trump team’s defense of there being no evidence of collusion with the Russians to influence the 2016 election was one that he supported for six months, until news broke that Trump Jr. met with a Russian lawyer to find out information that the Russian government wanted to give the family as a sign of support for the Trump campaign.

 “There was nothing to show that the Trump administration was aware of or supporting the Russians interfering in our election and this just showed up today in black and white, released by Don Jr. himself,” he said. “This is not released in the anti-Trump media. So you see it in black and white. This is not to say that collusion is a crime. It never was. But it is to say that the denial of collusion is very weak right now because it looks as if, I don’t know if there’s any other explanation, Don Jr. was receptive to receiving the information.”

Krauthammer said that Trump Jr. claiming he didn’t get any useful information out of the meeting with a Russian lawyer is “not a very good defense.”

“If you get a call to go to a certain place in the middle of the night to pick up stolen goods and it turns out the stolen goods don’t show up, but the cops show up, I think you’re going to have a very weak story saying, ‘Well, I got swindled here,’” he said. “Look this is incompetence, they got swindled.”

5) Or, as Chait puts it, “The ‘Did Trump’s Campaign Collude’ Debate Is Over. The Only Question Now Is How Much.”

This is a very simple test of the common English understanding of the term “collusion.” Your campaign is told that Russia wants to help you win the election. (“This is obviously very high level and sensitive information but is part of Russia and its government’s support for Mr. Trump.”) If you refuse to take the meeting, or perhaps take it only to angrily tell your interlocutor you want no part of the project, then it isn’t collusion. If you take the meeting on the proposed terms, you are colluding. If somehow the information on offer turned out to have no value, and the contacts went no farther, then the meeting was ineffectual collusion. But Donald Trump Jr.’s response clearly indicates that he accepted the meeting in order to collude. (“If it’s what you say I love it.”)

This is the scope of the unresolved question now. How much collusion happened?


6) Just to be clear, Trump Jr (and very likely his father) have lied and lied and lied and lied about this.

7) David Graham on “what is if it’s all true?”

Yet with Donald Trump Jr.’s release of self-incriminating emails on Tuesday, the nation learned that the wildest of fantasies was all too real: Granted the chance to take what he believed to be damaging information about Hillary Clinton from a Russian government official, provided because the Kremlin wished to aid his father, Trump Jr. eagerly seized the opportunity. “If it’s what you say I love it,” he wrote to an intermediary. Not only that, but he brought along his brother-in-law Jared Kushner and Trump campaign chairman Paul Manafort.

The disclosure of the emails raises a host of questions: Did anyone tell Donald Trump, and if so, when? (The White House and Trump’s attorneys both say he did not attend and was not aware.) Did lawyer Natalia Veselnitskaya actually hand over any incriminating information at the June 9, 2016, meeting at Trump Tower? (Both she and Trump Jr. say she did not.) Why release documents that, according to some analysts, already implicate Trump Jr. in a federal crime? And why do it now? …

If Trump really knew nothing about the June 9 meeting, one wonders what it was that he was so eager to suppress in his calls to the intel chiefs and his firing of James Comey. And as the collusion scenario that once seemed so implausible is verified by an email trail, which of the other allegations are true, too?

8) My favorite part of this Benjamin Wittes post is his emphasis on the stuff we already knew before the latest revelations:

The problem with dwelling too much on the covert forms of collaboration, which we have come to call “collusion,” is that doing so risks letting Trump at least a little bit off the hook for what is not meaningfully disputed: that the president publicly, knowingly, and repeatedly (if only tacitly) collaborated with a foreign power’s intelligence effort to interfere in the presidential election of the country he now leads. Focusing on covert collusion risks putting the lines of propriety, acceptable candidate behavior, and even (let’s be frank) patriotism in such a place where openly encouraging foreign dictators to hack your domestic opponent’s emails falls on the tolerable side. It risks accepting that all is okay with the Trump-Russia relationship unless some secret or illegal additional element actually involves illicit contacts between the campaign and Russian operatives. Yet it’s hard to imagine how any scandal of illegality could eclipse the scandal of legality which requires no investigation and has lain bare before our eyes for months. [emphasis mine]

But it is this very distinction, in which Trump’s own defenders are so heavily invested, that now appears poised to crumble. Over the past two weeks, two major stories have developed suggesting that there may, after all, have been covert contacts, meetings, and agreements between the Trump campaign and the Russians.

How colleges are the ruin of America

Sometimes, at a very select few, over-zealous students with insufficient respect for the values of free speech, protest speakers.  Oh, yeah, and lots of liberals work there.

So, just set aside the fact that American higher education is the envy of the world and is hugely important for producing a knowledgeable, skilled, productive workforce, clearly on the balance, colleges are bad for Amerrrica– right?

Well, sadly, that’s what a majority of Republicans now seem to believe.  Ugh.  Nice write-up in Insidehighered based on a recent Pew survey:

The partisan stratification is apparent even within the GOP. Nearly two-thirds of conservative Republicans (65 percent) said colleges have a negative impact, compared to 43 percent of moderate and liberal Republicans.

Viewers of right-leaning news media might not be surprised by Pew’s findings. Virtually every day Fox News, Breitbart and other conservative outlets run critical articles about free speech disputes on college campuses, typically with coverage focused on the perceived liberal orthodoxy and political correctness in higher education.

For example, Breitbart on Monday riffed on a report from The New York Times about a 35 percent enrollment decline at the University of Missouri at Columbia in the two years since racially charged protests occurred at the flagship university.

Bogus right-wing outlets also often target higher education. A fictitious story about California college students cutting off their genitals to protest Trump’s Mexican border wall plan recently made the rounds on purported news sites and social media.

In addition, Republican politicians in recent years have pushed back on the four-year degree, saying that not all jobs require the credential. Some also question the value of four-year degrees and criticize increasing college tuition levels.

Whatever the cause, a wide range of Republican voters are buying in to skepticism about higher education…

“Is the precipitous drop in conservative regard for postsecondary education reflecting a decline in confidence in higher education attainment as a sure path to socioeconomic mobility, or is this more about perceptions of ‘liberal bias’ in higher education among conservatives?” she said via email. “Are these attitudes more an expression of backlash against rising cost of college and student debt load, and the accompanying belief that colleges are businesses that care more about their bottom line than students (as we’ve found in our research), or is this about the rise of an emboldened anti-intellectualism in the wake of the last presidential election?”

More data would be nice, but I’m going to pretty confidently hazard this is about symbolism and cultural signifiers rather than dissatisfaction with college affordability and as a pathway for social mobility.  Especially, given the sharp shift, “emboldened anti-intellectualism” sounds about right.

And here’s an excellent tweetstorm on the matter from a Princeton professor:



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