Is America Prepared For the Coronavirus?

The Daily Escape:

Coronavirus or not, it’s always business as usual – credit: Dave Note

The photo demonstrates why the coronavirus won’t be contained. 21st century humans will do what they want, when they want, and how they want. They’ll trust that their government will sort out the consequences.

We need to take a hard look at resilience, which is defined as the ability to recover quickly from illness, change, or misfortune. We talk about it for individuals, markets, governments, and society. In truth, it applies to every system on earth.

We had our first wake-up call about American resilience with 9/11, followed in 2005 by Hurricane Katrina. We watched the news, and saw that America was unable to snap back quickly, that we were powerless in the face of incomprehensible disaster.

There are still scars in New Orleans 15 years later.

We have ignored that the Covid-19 virus is at least as infectious, and possibly more than, the normal flu virus we see every year. But the mortality rate of Covid-19 is about 2%, or about 20 times as deadly as the normal flu, which has a mortality rate of around .1%.

Thus far in 2020, 19 million cases have been reported to the CDC, with 10,000 deaths and 180,000 hospitalized. Multiply 10,000 by 20, and that’s 200,000 deaths in the US, and following the flu model, perhaps 3,600,000 incremental hospitalizations.

We need to think about our resiliency. According to the American Hospital Association, there are 924,107 staffed beds in hospitals, down about 53,000 beds since 2000. Of the 2020 total, 792,417 are in community hospitals. The national occupancy rate for all of those beds is about 65%, based on the latest figures from 2017, so perhaps we have sufficient beds, assuming all hospital beds are equally capable.

Logistics will drive our resilience response. There is much to learn from the Chinese response. Wuhan didn’t have enough beds when the Covid-19 virus struck, and built two new hospitals in an attempt to have a place for all victims who needed to be in a hospital setting. They quickly had shortages of sterile gowns, masks and gloves. Then they had a shortage of health care professionals, and moved some professionals to Wuhan to deal with the explosion of cases.

They quarantined cities, something that we can’t do effectively without declaring martial law.

But, it gets more difficult. Covid-19 is a severe respiratory illness. Victims need the kinds of breathing therapies equipment that are usually in limited supply in each hospital. The NHS in England only has 15 available beds to treat the most severe respiratory failure in the entire country. They say they will struggle to cope if there are more than 28 patients who need them.

Testing is an issue, because without tests, we can’t be sure that the patient has the virus, and test kits are in very short supply. Iran reported on the BBC that it had just 14 test kits in the country at the time of the outbreak.

Live Science reports that in early February, the CDC sent testing kits to labs across the US, but a glitch in the kits made them unusable. Now, just five state health departments: California, Illinois, Nebraska, Nevada and Tennessee, as well as the CDC, have the ability to test for the virus. As of Feb. 26, just 445 people have been tested in the US, not including the travelers who returned on evacuation flights. In contrast, the WaPo reported that as of Feb. 25th, South Korea had tested more than 35,000 people for the virus.

How will America scale up?

We need tests that work, equipment to treat respiratory failure, hospital beds, sterile gowns and gloves, along with trained healthcare professionals. Where will they come from? These are the questions the media and politicians should be asking Mike Pence, the new Covid-19 Czar.

Don’t count on answers. The administration has already told the federal government that all communication to reporters and others, is to go through Pence. That’s even more dangerous, because there is no one who will tell Trump or Pence anything they don’t want to hear. And Pence is muzzling the scientists who really know what’s going on.

The economic consequences are even greater than the blood-letting in the stock market this week would lead you to believe. The health consequences are enormous.

What about the political consequences? We’re in the middle of a presidential election, so we’re bound to hear the right and left version of this story. Wrongo doesn’t want Democrats to try and exploit the government’s less-than-adequate efforts to contain the virus.

They should be rational. They should invite scientists to testify to break through the administration’s spin. They should pass a supplemental spending bill aimed at containing the crisis based on the scientists’ advice.

This is a time for good policy that will turn out to be good politics.

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Coronavirus in China Is Spreading Fast

The Daily Escape:

Sparhawk Mill, Yarmouth ME – photo by Benjamin Williamson

Should we be concerned about the new Chinese coronavirus? Given developments in the past few days, we need to focus on it. The CDC announced on Monday that a total of 110 people in 26 US states are under investigation for possible infection with it. But officials continue to believe the immediate health risk to the US public remains very low.

OTOH, the increasingly stringent measures taken in China to contain it sure make it look like Chinese officials are at least worried, if not yet panicked.

China is suffering from shortages of test kits and personnel to confirm that suspected cases are indeed the coronavirus. We know there are no special anti-viral medications that work, people can only rely on their own immunity.

The World Health Organization (WHO) has increased its estimate of global risk of the coronavirus from moderate to high. It’s now clear that this coronavirus is very contagious. The estimates of the reproduction rate (number of new infections caused by someone with the disease) is between 2.6 and 2.9. If that is true, the reproduction rate would be higher than for the 1917 Spanish flu, but lower than for measles, which is between 12 & 15. The reason is that it’s a large pathogen. From Foreign Policy:

“The coronavirus is a physically large virus—in relative terms…too big to survive or stay suspended in the air for hours or travel more than a few feet.”

So far, this coronavirus has a mortality rate of 2.2%: The latest data is 4524 confirmed cases, with 106 deaths. This observed level isn’t good, but it’s far lower than for SARS (9.6%), and is similar to the Spanish flu, which was 2.5%.

These are the reasons for the current freakout. Governments have started evacuating staff from Wuhan. CNN reports that:

“About 240 Americans being evacuated from Wuhan Wednesday morning local time…arriving in Ontario, California. About three dozen Wuhan-based US diplomats and their families are also expected to be on board…”

CNN mentions that Australia, France, Hong Kong, India, Japan, South Korea and the UK are also evacuating their government employees and families.

Won’t evacuations just be another way to spread the disease unless the evacuees are quarantined for the 14 day incubation period? So many practical questions.

It’s a little early to speculate, but the impacts can go well beyond just public health. We’ve already seen a one-day negative impact on Mr. Market, who momentarily panicked.

A pandemic would severely affect Chinese economic output. With public transportation halted, commerce grinds to a stop as people avoid public places and thousands of employees can no longer go to work. Who pays their wages while the city is locked down?

We know cities can’t truly be isolated for longer than a few days. And we know people can’t live without food, water, fuel, etc. and money to buy these essentials.

The realities leave officials with an impossible choice: Either truly isolate the city (which isn’t possible) for more than a few days, or allow the flow of goods required to sustain millions of city residents. The second option creates uncontrollable vectors for the virus to spread beyond the city as transport workers and those fleeing the lockdown illegally, move on to other cities.

How would America cope with this virus if it gained a foothold here?

We had that experience 100 years ago. One of Wrongo’s grandfathers died in the 1918 flu pandemic. Of the estimated 500 million people in the developed world to be infected, the recorded mortality rate was 50 million, with about 675,000 occurring in the US. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of the 1918 pandemic.

Today, our elites would retreat to their country homes while demanding that their companies stay open. We’ve seen panic buying in Manhattan before blizzards that would only affect the city for two days. Logistics being what they are, local distribution centers absolutely do not have enough food to last through a prolonged shutdown. And Amazon won’t be delivering you toilet paper.

In times like these, it’s useful to remember that there is a never-ending attack being waged by the forces of privatization to take over America’s public health system, turning it into another monopoly profit center.

So far, we’ve held this effort at bay, but the lobbyists and the monied class keep working to convince Washington that this government system represents “waste, fraud and abuse”. The fight goes on.

Sadly, our leaders are immune to the coronavirus infections, because it is transmitted through the head (eyes, nose and mouth), and they generally have their heads up their asses.

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Random Tuesday Thoughts

(Wrongo and Ms. Right are away until July 9th visiting our CA family. Expect the next column to be posted then.)

The Daily Escape:

White Sands National Monument, NM – 2019 photo by Bernard-F

#1: Wrongo watched the video of Trump walking across the Korean DMZ. While most foreign policy professionals will have a cranky reaction to the event, it represents progress. Both sides had stopped negotiations and in fact, were not even talking, after Trump walked out of the Hanoi meeting.

Whether it is a breakthrough that leads to a deal remains to be seen. OTOH, Trump took his daughter Ivanka and Tucker Carlson to the DMZ, while sending John Bolton (who he called “Mike”), and Mike Pompeo on to other tasks. Anything that drives the GOP neocons crazy can’t be all bad.

The incoherence of Trump’s global strategy shows itself in extending himself to North Korea, a country that has nuclear weapons, and the means to deliver them. The US has no agreement with NorKo to contain its weapons of mass destruction. We don’t even have a peace agreement after the War that ended in 1953, but we’re talking.

Contrast that with Trump’s walking away from the signed Iranian nuclear deal, which was negotiated to prevent an exact North Korea-type situation from happening. Inexplicable.

#2: Forbes has a very interesting article on new solar power capacity in California:

“Los Angeles Power and Water officials have struck a deal on the largest and cheapest solar + battery-storage project in the world, with a prestige solar battery supplier, at prices that leave fossil fuels in the dust and may relegate nuclear power to the dustbin.”

Cheaper than fossil fuels, the new plant will be built north of LA, in Kern County. LA officials said that it will be the largest and lowest-cost solar and high-capacity battery storage project in the US. When up and running, it will operate at half the estimated cost of power from a new natural gas plant. The plant is expected to deliver its first megawatt by April 2023.

#3: Reuters reports that Trump’s “deal” with China may not be a deal at all. In their article, China warns of long road ahead for deal with US after ice-breaking talks, Reuters quotes the official China Daily, an English-language daily often used by Beijing to put its message out to the rest of the world. It warned there was no guarantee there would ever be a deal: (emphasis by Wrongo)

“Agreement on 90 percent of the issues has proved not to be enough, and with the remaining 10 percent where their fundamental differences reside, it is not going to be easy to reach a 100-percent consensus, since at this point, they remain widely apart even on the conceptual level.”

#4: Next, it’s that time of year again where Americans camp out for days in order to visit with a pop-up rural clinic nurse. Why? Because we have the most expensive “health care” on earth, and a system absolutely designed to keep it that way:

“They were told to arrive early if they wanted to see a doctor, so Lisa and Stevie Crider left their apartment in rural Tennessee almost 24 hours before the temporary medical clinic was scheduled to open. They packed a plastic bag with what had become their daily essentials after 21 years of marriage: An ice pack for his recurring chest pain. Tylenol for her swollen feet. Peroxide for the abscess in his mouth. Gatorade for her low blood sugar and chronic dehydration.”

A view from the volunteers:

“…a clinic volunteer….patrolled the parking lot late at night and handed out numbers to signify each patient’s place in the line. No. 48 went to a woman having panic attacks from adjacent Meigs County, where the last remaining mental-health provider had just moved away to Nashville. No. 207 went to a man with unmanaged heart disease from Polk County, where the only hospital had gone bankrupt and closed in 2017.”

With Republicans doing everything they can to break the Affordable Care Act, and then refusing to fix it, this is what their actions have caused. Rural hospitals are closing, people in rural counties have no health care. And the GOP tells them to blame Democrats. The reality is that Republicans in these states have cut funding for the programs that kept red state rural clinics and hospitals operating.

#5: Columbia University reported that scientists have discovered a gigantic aquifer of relatively fresh water trapped below the Atlantic Ocean. This undersea aquifer stretches from Massachusetts to New Jersey, extending more or less continuously out about 50 miles to the edge of the continental shelf.

The water was trapped in mile-deep ice 15,000 to 20,000 years ago. When the ice melted, sediments formed huge river deltas on top of the shelf, and fresh water got trapped there. It would have to be desalinated for most uses, but the cost would be much less than processing seawater.

See you next week!

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A Strategy for 2020 Emerges

The Daily Escape:

Fall in Hopkinton, MA – November, 2018 photo by Karen Randall

The 2020 election campaign has already started, regardless of whether we are ready.

“Big Idea” strategies are in the air. And the large group of potential Democratic presidential candidates are being discussed.

And we no longer have to chew on the failure by Democrats in 2016. We can now talk about lessons learned in the 2018 midterms, and how they may apply in 2020. Wrongo wants to highlight three Democrats who won in deeply Republican districts. Max Rose, who won on Staten Island in NYC; Kyrsten Sinema, who won the open Senate seat in Arizona; and Lauren Underwood, who won a Congressional seat in Illinois.

Rose won a district that went heavily for Trump in 2016. He beat a long-time incumbent Republican. He did it by asking for a chance to reshape the fortunes of working people. From the NYT:

He offered a simple, unifying message that was progressive in substance but relatively neutral in its delivery: that the system is rigged to benefit special interests, that the little guy is getting stiffed over and over, that we need better infrastructure and stronger unions.

Demographic change helped. Rose’s district covers parts of Staten Island and Brooklyn, where Millennials who have been priced out of living in Manhattan and trendy Brooklyn are now locating.

Kyrsten Sinema’s story is different on the surface, but similar in what got her elected. A three-term member of Congress, she campaigned on her biography. She was homeless for three years as a child. Sinema is an openly bisexual former Green Party activist who moved to the political center.

Sinema promised to be a nonpartisan problem-solver. She campaigned on health care and protections for people with pre-existing conditions. Sinema treaded lightly on immigration, but probably looked pro-immigrant versus her opponent Martha McSally, another member of Congress who was very anti-immigration. 2.1 million Latinos live in Arizona, and after Trump’s visit in October, there was a spike in Latinos returning early ballots. Most Arizona residents vote by mail, and many Latinos voted for Sinema.

Lauren Underwood won an Illinois Congressional seat held in the past by the infamous Denny Hastert. The 32-year-old African-American nurse, unseated four-term Rep. Randy Hultgren in a district that is 86% white. The district was gerrymandered after the 2010 census to make it an even safer Republican seat. She won by stressing health care for all Americans.

These three candidates were successful in traditionally Republican places. They each had great personal stories. They each ran as problem solvers who wanted to help working families. This shows there are two threads that mattered in 2018: The candidate, and a message that addressed the things that were alienating people in their districts.

If we widen out our view to America today, alienation is behind the rise of Trumpism, and the rise of populism across the world.

The leading cause of people’s alienation is economic inequality.

Candidates can win as centrists if they are willing to fight economic inequality, because everybody knows that the system is rigged to benefit special interests.

Progressives can also win on economic inequality, because the largest divide in our country is between the 98% and the 2%. This idea can unite us, because nowhere in the US do the capitalists outnumber the salaried and hourly wage people.

Remember what Franklin Roosevelt said in his acceptance speech: (emphasis by Wrongo)

Throughout the nation men and women, forgotten in the political philosophy of the Government, look to us here for guidance and for more equitable opportunity to share in the distribution of national wealth… I pledge myself to a new deal for the American people. This is more than a political campaign. It is a call to arms.

Today, Democrats need working people to vote for them if they want to win decisively. But since they govern like mainstream Republicans when in office, they must change to an FDR-like call to action.

It is possible to build voting coalitions that pick off a few red states in 2020. In fact, the midterm results were a terrible leading indicator for Trump in 2020. Without Hillary heading the ticket, Midwest states like Michigan and Wisconsin appear to be returning to Democrats. Pennsylvania is already back.

The Dems need to convince voters that governing the country in a manner that benefits everyone is a better idea than governing the country in a manner that benefits only a few.

The potential new votes for Democrats by following this strategy is largely the pool of non-voters. They are the majority in this country, and they are alienated.

They also outnumber the small percentage of persuadable Republican voters.

Nominating high quality candidates and fighting alienation are the keys to success in 2020.

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Last Day In Budapest Teaches a Valuable Lesson

The Daily Escape:

Liberty (or Liberation) Statue, Budapest, Hungary. The statue was erected in 1947 in remembrance of the liberation of Hungary by Soviet troops. Many recalled the period of  Soviet control as a time when they were “under liberation” – 2018 photo by Wrongo

Sometimes a person-to-person experience can jolt you from your comfort zone, and provide insight into a wholly different life experience. On Monday, we visited Tabitha House, a pediatric hospice and palliative care facility in Hungary. As its name implies, it provides end of life care for terminally ill children or for those kids with chronic and life-shortening conditions.

We spent time talking with Judit Hegedus, head nurse of Tabitha House. She told us that Tabitha House is the largest pediatric hospice in Hungary. It has five beds.

Just five beds.

There are 9.8 million people in Hungary, of which 2.1 million are children. The first Hungarian hospice started in 1991, and insurance coverage for adults in hospice began in 2004. But it took until 2017 before there was any government financing for pediatric hospice and palliative care.

As of 2015, the most recent year with data, there were only 215 hospice/palliative care beds in Hungary. If this seems low, the World Health Organization’s recommendations for a country with a population of 10 million like Hungary is that a minimum of 500 beds are needed.

Tabitha House has a mostly part-time staff of 15, including pediatric and hospice nurses, a psychologist, a physiotherapist and a physician. There is a problem recruiting sufficient professionals because some misunderstand the value of palliative care, and they share society’s fear of childhood death.

Obviously, there is a large unfilled pediatric hospice need in Hungary. The most cost-effective way to expand assistance to terminally ill kids would be by offering home care services. Judit says that in-patient costs average about $72/day, low by US standards. In-home care costs about $16.50/visit.

While funding expansion is an issue, she hopes to initiate offering home care services later in 2018.

When we arrived at Tabitha House, we expected to be moved by the struggle of kids fighting for their lives. Of course that happened, but the biggest emotional wallop came from listening to Judit, and watching her staff deal with the impossible situation they face. In their country, there is an overwhelming need for pediatric hospice services, and totally insufficient resources to meet that need.

You leave feeling that these people are saints. They are a happy team, persevering despite having to make do with less-than-the-best equipment, and fighting the long odds facing their patients.

It was touching to stand with Judit in front of their “family tree”, a wall mural of a tree with many branches. At the end of each branch was a photo of a child. Judit would pause with her finger over each, say the child’s name, and offer a short memory of him or her.

There are wonderful people in the world. People who are not playing the angles, who are not reaching for wealth. People who exclude no one from their care and concern.

People who do good simply because it is necessary.

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Is a Single-Payer Experiment on the Horizon?

The Daily Escape:

Breaking the Ramadan fast, Dubai – photo by Francois Nel

From Sarah Kliff:

Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status.

This is “Medicaid for All”, not “Medicare for All”, which several Democrats have proposed over the years. Medicare for all has always fizzled out, due to a lack of political support.

Medicaid for all offers an interesting alternative. Medicaid coverage generally costs less than Medicare for all because the program pays doctors lower rates. This could make it cheaper for low-income price-sensitive consumers who can’t afford the Obamacare monthly premiums. More from Sarah Kliff:

Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.

Under the Nevada bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for credits would be able to use their own money to buy in. It is likely that the plan would be sold on Nevada’s health insurance marketplace, making it a public option that competed against the private health insurance plans selling there.

Early versions of the Affordable Care Act included a buy-in provision. But the Senate was forced to drop the Medicare buy-in from its bill when it couldn’t get the entire Democratic caucus behind the idea. Health insurers fought aggressively against the idea, which disadvantages insurers by reducing their market share.

After Trump’s election, health policy experts started to explore whether it might make more sense to build a national health care system around Medicaid rather than Medicare.

Medicaid and Medicare are similar programs in that they are large and publicly run, covering 62 million and 43 million Americans, respectively. They use their large membership to negotiate lower prices with hospitals and doctors. Medicaid tends to have the lowest payment rates. On average, Medicaid pays 66% of what Medicare pays doctors. In Nevada, Medicaid pays 81% of Medicare rates.

This means Medicaid is a relatively lower-cost program, but some doctors do not accept Medicaid’s lower rates. A recent federal survey estimates that 69% of doctors are accepting new Medicaid patients, compared to 85% accepting new patients with private insurance.

States have significant control over how their health insurance programs work and whom they cover. Thirty-two states participate in a Medicaid buy-in program that lets certain disabled Americans who don’t otherwise qualify for coverage, buy into the program.

This flexibility provides an opportunity for states that want to experiment with a public program by tacking on a buy-in option. If Nevada’s bill does become law, it will show other states how such a program might work, and if it works well, other states may be inclined to try it.

States that want to enroll new populations into their Medicaid programs will need permission from the federal government. This means that the Trump administration — which has proposed slashing the Medicaid budget in half — would need to get on board with a significant expansion of the program, perhaps a doubtful possibility. But as Kliff says: (brackets by the Wrongologist)

The Nevada idea in theory shouldn’t expand federal costs. Individuals would be responsible for paying their own way onto the program, although it will likely be a challenge to set the right premium [rates] to ensure this outcome.

California is considering a single-payer bill as well. Whether other states might follow the Nevada example will depend on what outcomes it produces.

Here is another tune from the One Love Manchester concert. Watch “Happy” by Pharrell Williams and Miley Cyrus, who turn the song into a soul number, something closer to Motown than to Disney. They make it something more than it was when it was so popular. Also, the whole audience sings along, and that’s fun:

Those who read the Wrongologist in email can view the video here.

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Buffett: Focus on Lower Health Care Costs, Not Corporate Taxes

The Daily Escape:

Ribbon Chapel, Onomichi Japan – photo by Koji Fujii

Andrew Ross Sorkin wrote about Warren Buffet and the Berkshire Hathaway annual meeting in Omaha. Thousands of people attend these meetings, which are known as “Woodstock for capitalists.” Sorkin reports that Buffet made this comment:

The tax system is not crippling our business around the world.

Sorkin said that Mr. Buffett, was blunt and pointed, implicitly rebuking his fellow chief executives, who have been lobbying the Trump administration and Washington lawmakers to lower corporate taxes. Buffett said that those who have been single-focused on seeking relief from their tax bills would be smart to shift their attention to health care costs, which are growing and swallowing evermore corporate profits. The Kaiser Family Foundation reports that 49% of Americans, about 156 million, are insured by their employer. More from Sorkin:

The need for corporate tax relief has become the lodestar of the corner office, with CEOs rhapsodizing  over President Trump’s plan to try to stimulate growth by cutting tax rates for businesses.

But as Mr. Buffett pointed out, these chief executives are missing the bigger issue: As a percentage of our GDP, the cost of maintaining our American health care system is rising at an alarming rate. And Corporate America pays a big (and growing) chunk of that bill.

Buffett wasn’t talking about the cost of health insurance, which is a fraction of the total cost of health care. He suggests that today’s corporate tax rates are a distraction, not a true impediment to growth:

If you go back to 1960 or thereabouts, corporate taxes were about 4% of GDP…And now, they’re about 2 % of GDP.

While tax rates have fallen as a share of gross domestic product, health care costs ballooned:

About 50 years ago, health care was 5% of GDP, and now it’s about 17%.

Buffett is a smart guy. He raises an argument for focusing on the underlying costs of our health care system, something that goes far beyond the debate around the Affordable Care Act, or what will replace it. Buffett says that our global competitiveness has fallen largely because our businesses were paying far more for health care — a tax by another name — than those in other countries.

As Buffett said: (brackets by the Wrongologist)

When American business talks about [corporate taxes] strangling our competitiveness, or that sort of thing, they’re talking about something that as a percentage of GDP has gone down…While medical costs, which are borne to a great extent by business, have swelled.

Here are the facts:

  • In 1960, corporate taxes in the US were about 4% of GDP. The percentage fell steadily, reaching a bottom in 1983 before rising slightly over the last few decades. Today, it is 1.9%.
  • In the meantime, health care costs as a percent of GDP have skyrocketed. Today our health care costs are 17.1% of GDP, up from 13.1% in 1995.
  • Germany’s cost is 11.3%, up from 9.4% during the same period. Japan’s is 10.2%, up from 6.6%. Britain’s health care costs are 9.1% of GDP, up from 6.7% percent in 1995.

That makes our health care cost disadvantage far greater than our tax differential. It harms American companies in particular, since they bear such a large share of those costs, which firms in our competitor countries do not. US Corporations spend $12,591 on average for coverage of a family of four, up 54% since 2005, according to a study by the Kaiser Family Foundation.

But Congress avoids the issue, and CEOs don’t talk about it. A final quote from Warren:

It’s very tough for political parties to attack it…it’s basically a political subject…

In fact, Buffett’s partner, Charlie Munger, is the rare Republican (Buffett is a Democrat) who has advocated for a single-payer health care system. Under his plan, the US would enact a sort of universal type of coverage for all citizens — perhaps along the lines of the Medicaid system.

Which brings Wrongo to his final point: Medicaid expansion is the one part of Obamacare that can be said unequivocally to work. It’s a single payer program funded by the Federal government. So it’s bitterly ironic that the Republican’s reaction to Obamacare is to assault and roll back an existing Federal program, from LBJ days.

Of course, kicking poor people who benefit from Medicaid will always be popular with Republicans. So, Republicans, by making Medicaid worse, will try to restore their natural order of things.

Lazy, uninformed voters = Lazy, uninformed legislators = Lazy, uninformed policy.

It’s that simple.

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Saturday Soother – May 6, 2017

The Daily Escape:

Tulips, Lisse Netherlands, April 2017 – photo by Peter Dejong

We ended the week with Republicans in the House passing the latest version of Trumpcare by a vote of 217-213. All Democrats voted against it, with 20 Republican members defecting to join them. The changes Republicans made to get this version of bill through the House will not be what passes in the Senate. It’s up to Mitch McConnell to craft a bill that can get through the Senate using the budget reconciliation process, which will require 51 votes to pass.

That will most likely be the “real” bill, and then the negotiations between the House and Senate versions will begin.

The problem for America is that the Senate has to pass something awful enough that the House will still vote for it. We are a long way from replacing Obamacare, but Republicans now own the process whereby tens of millions of Americans losing health insurance.

If that isn’t enough to worry about, Buzzfeed has a long read about tiny drones that can be used in a swarm to kill people:

A very, very small quadcopter, one inch in diameter can carry a one- or two-gram shaped charge. You can order them from a drone manufacturer in China…A one-gram shaped charge can punch a hole in nine millimeters of steel…You can fit about three million of those in a semi-tractor-trailer. You can drive up I-95 with three trucks and have 10 million weapons attacking New York City. They don’t have to be very effective, only 5 or 10% of them have to find the target.

The concept is achievable, while the potential consequences are unthinkable:

There will be manufacturers producing millions of these weapons that people will be able to buy just like you can buy guns now, except millions of guns don’t matter unless you have a million soldiers. You need only three guys to write the program and launch them. So you can just imagine that in many parts of the world humans will be hunted…This is the ever-present cloud of lethal autonomous weapons.

They could be here in two to three years.

— Stuart Russell, professor of computer science at the University of California Berkeley

They are called lethal autonomous weapons systems (LAWS); weapons that have the ability to independently select and engage targets once a human releases the machine to perform: no supervision, no recall, and no stop function.

Can we prevent them? Nope, they already exist. Many countries including the US already have (much larger) systems with autonomous modes that can select and attack targets without human intervention: Israel’s Harpy and second-generation Harop, can enter an area, hunt for enemy radar, and kamikaze into it, regardless of where they are set up, as long as the radars are operating.

The Pentagon now is testing drone swarm technology: Weapons moving in large formations with one controller somewhere far away on the ground clicking computer keys. Think hundreds of small drones moving as one, like a lethal flock of bees. You can see a YouTube video of a US drone swarm test here. 103 mini drones were released from two US fighter jets during the test. The drones operate autonomously and share a distributed brain. These drones will make it economical to target people (troops?) in other countries, en masse, without having to send in our own soldiers, or declare war.

Why are we wasting even more human potential devising even more ways to kill each another?

Sorry, this story adds to your stress levels after a tough week, but Wrongo thought you should know. OTOH, with all that is going on, you really need soothing. Wrongo is going for some Stumptown Colombia El Admirador coffee and a listen to “Spring”, from Vivaldi’s Four Seasons, arranged for four pianos.

The pianos are played by Yuja Wang, Emanuel Ax, Nelson Goerner, and Julien Quentin. The performance was recorded at the Salle Médran in Verbier, Switzerland, in 2009:

Those who read the Wrongologist in email can view the video here.

Bonus video in honor of Trumpcare: Jimmy Reed singing “Get Your Insurance” from 1959:

Those who read in email can view the video here.

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Sunday Cartoon Blogging – March 26, 2017

From the NYT: (brackets by the Wrongologist)

33 Republicans stopped the [Trumpcare] bill. 15 were from the “Freedom Caucus,” 10 were “moderates” mostly from the Northeast (the “Tuesday Group”), some of whose districts went for Clinton, and 8 were miscellaneous (“One said he was concerned about its changes to Medicaid expansion, another preferred a full repeal and a third said he was worried about the bill’s impact on treatment for opioid abuse”).

Republicans control 237 seats of the 435 seats in the House. It requires 218 votes to pass a bill. When Paul Ryan and Donald Trump lost 33 Republican votes, the bill couldn’t pass, and had to be withdrawn. That means the GOP really doesn’t control the House, and that’s unchanged since John Boehner was Speaker.

The Republicans have majority control of the House and the Senate. They also have the self-proclaimed greatest deal-maker sitting in the Oval Office.  They have been talking about repealing Obamacare for seven years since it was signed into law, and they couldn’t get their own party to fall in line.

But Trump isn’t a deal maker, he’s a salesman.

And that’s a huge difference. Savvy business people seem willing to buy whatever he is selling. He seems to have the charisma and persuasiveness that in his prior life, made him a top earner as a real estate mogul.

But there’s a difference between making a sale and making a deal. Deal making is hard; you have to build trust, you have to establish real relationships, you need a mastery of your deal points and those of the person on the other side. It can be slow, grinding work.

Trump doesn’t do that, he’s never done that. His entire career is a lurch from one deal to the next, and his Presidency is no different. Trump closed the sale with the American people, but once elected, his job is to make deals.

On to cartoons.

A funny thing happened on the way to the Obamacare execution:

GOP’s Health Care March Madness bracket is now busted:

Boehner shows Ryan how to cope with Freedom Caucus:

Expect the GOP to keep trying to replace Obamacare until we all do this:

Sen. Menendez (D-NJ) burns the GOP:

Sadly, Menendez is also a joke of a Senator. He is about to go on trial for public corruption. Still, the tweet is funny.

Gorsuch epic head-fakes are now a required course in sports:

Trump’s Poodle, Devin Nunes can’t be counted on to keep secrets well, secret:

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The CBO and the Ides of March

The Daily Escape:

(Provence – Photo by Veronika K. Ko.)

The Ides of March are today. The Netherlands holds its parliamentary election, the US debt ceiling agreement expires, and Trump is gonna get a ton of postcards.

Congressional Budget Office estimates for Trumpcare (AHCA) came out on Monday, and they’re worse than expected.  Sarah Kliff, Vox’s healthcare reporter, has this:

  • CBO estimates 14 million would lose coverage in 2018. The report projects that much of the early coverage loss would stem from repealing Obamacare’s mandate that all Americans purchase coverage or pay a fine.
  • After that, increases in the uninsured would be from Medicaid cuts. After 2018, CBO thinks that most of the increase in the number of uninsured would stem from changes the AHCA would make to Obamacare’s expansion of Medicaid, an expansion that allowed many more low-income adults to enroll in the program.
  • The bill would “freeze” enrollment in that program on January 1, 2020. Medicaid enrollees would trickle off the rolls as their incomes changed. And this would lead to another big decline in coverage.
  • The number of uninsured, CBO projects, would rise by 21 million in 2020 and hit 24 million in 2026.
  • The CBO projects that as the individual market shrinks, premiums would rise between 10% and 15% as some healthy people flee in 2018. But over the next few years, the agency expects premiums to go down to 10% lower than under Obamacare.
  • CBO thinks more young people will come into the market, as the GOP plan offers incentives to make the market more appealing to younger, (healthier) enrollees.
  • AHCA would be a huge cut to Medicaid. CBO estimates it would reduce spending on the health program for low-income Americans by $880 billion over the next decade. This helps explain why AHCA would reduce the deficit: The bill spends a lot less money on entitlement programs.

When Paul Ryan’s talking points are that their plan will reduce the deficit, and that premiums will go down by 10% OVER THE LONG TERM, you know that he doesn’t care that 24 million people will lose healthcare insurance.

That the GOP is choosing deficit reduction over covering American citizens is what the public will remember. When you kick out the poor and older folks, of course premiums will go down. But premiums will remain high for those in the 50-64 age bracket, and their premiums will be higher than currently.

The CBO report also finds that this legislation will provide massive tax relief, and make the most fundamental entitlement reform in more than a generation, if throwing people off Medicaid truly is “reform”.

Even before the CBO report was released, the Trump administration began laying the groundwork to discredit the agency and their report. White House press secretary Sean Spicer:

If you’re looking at the CBO for accuracy, you’re looking in the wrong place…they were way, way off last time in terms of how they scored and projected Obamacare.

Since this is the Ides of March, you should have expected some stabbing.

Their criticism is centered on the fact that CBO previously overestimated the number of people who would enroll in the marketplaces. That’s true: Earlier CBO reports estimated that the Obamacare marketplaces would have 26 million enrollees this year. Last year, CBO revised that estimate to 15 million.

Critics don’t mention that the CBO also underestimated how many people Medicaid expansion would cover. The overestimate and the underestimate essentially cancel each other out: Obamacare is covering just about as many people as CBO expected back in 2013.

Curiously, Trump said his health care plan would cover EVERYONE, and it would be much cheaper and much better. Except it won’t.

When you think about bad data, remember that Trump said we shouldn’t trust the Bureau of Labor Statistics numbers on monthly employment last year, he said they were fake. Now, Trump says the numbers in this month’s data release are real. You be the judge:

Obama in February 2016 — 237,000 new jobs
Trump in February 2017 — 235,000 new jobs

Trump: Making America a Slightly Less Great Again.

Your daily musical interlude appropriately is from the group the Ides of March. Here is “Vehicle”, their only hit, originally published in 1970, and performed live at the Chicago House of Blues in 2014:

https://www.youtube.com/watch?v=2aHe5-2SsJY

That 70 year-old guy can still sing.

Those who read the Wrongologist in email can view the video here.

Sample Lyrics:

Well, I’m the friendly stranger in the black sedan

Won’t you hop inside my car?

I got pictures, candy, I’m a lovable man

And I can take you to the nearest star

 

Kinda like the GOP promises on healthcare.

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