Letâs see…New Crown Prince in Saudi, Democrat lost in Georgia, and UBERâs CEO kicked to the curb. What did Wrongo miss? Oh yea, Trumpcare:
Get your health problems fixed while you still can:
Trumpcare may look familiar to some:
GOP plans to include certain pre-existing conditions:
New Saudi Crown Prince gives Trump an idea:
The Dems strike out (again) in Georgia:
The CEO of UBER is kicked to the curb:
Itâs Fatherâs Day. Here is Wrongoâs tribute to his own dad, now gone for 19 years. Steve Goodmanâs song, âMy Old Manâ:
https://www.youtube.com/watch?v=N6BB1FbCA2I
Those who read the Wrongologist in email can view the video here.
Takeaway lyric:
I miss my old man tonight
And I can almost see his face
He was always trying to watch his weight
And his heart only made it to fifty-eight.
For the first time since he died
Late last night I cried.
I wondered when I was gonna do that
For my old man.
Happy Fatherâs Day to all who qualify!
On to cartoons. This week, itâs hard to decide where to look first. How long will the current era of political good feeling last? We can be hopeful, but cracks have already appeared, and the urge to score political points has already begun:
The DC shooting reminds us that Congress still plays the âol ballgame:
NOW we need some protection?
While Americaâs busy looking at the Russian drama, the GOP has had a breakthrough:
Trumpâs team ruminates on replacing Mueller:
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 â one that would give the stateâs 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 âMedicaid for Allâ, not âMedicare for Allâ, 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 canât afford the Obamacare monthly premiums. More from Sarah Kliff:
Nevadaâs 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 donât qualify for credits would be able to use their own money to buy in. It is likely that the plan would be sold on Nevadaâs 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 couldnât get the entire Democratic caucus behind the idea. Health insurers fought aggressively against the idea, which disadvantages insurers by reducing their market share.
After Trumpâs 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 Medicaidâs 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 donât 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 Nevadaâs 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 â which has proposed slashing the Medicaid budget in half â 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 shouldnât 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 thatâs fun:
Those who read the Wrongologist in email can view the video here.
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 âWoodstock for capitalists.â 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 Trumpâs 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 wasnât talking about the cost of health insurance, which is a fraction of the total cost of health care. He suggests that todayâs 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, theyâre 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 itâs 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 â a tax by another name â 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, theyâre 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:
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 donât talk about it. A final quote from Warren:
Itâs very tough for political parties to attack it…itâs basically a political subject…
In fact, Buffettâs 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 â 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. Itâs a single payer program funded by the Federal government. So itâs bitterly ironic that the Republicanâs 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.
The House Republicansâ passage of the Trumpcare Bill dominated the news last week. Sometime later today we will learn the results of the French presidential election, but the hacking of Mr. Macroâs servers and emails sounds depressingly familiar.
Americaâs âunsolvable problemâ with health insurance led us to Obamacare, and now, to the botched GOP effort to replace it. We should remember that this unsolvable problem has already been solved in dozens of countries.
Trumpcare is an event of domestic terrorism:
GOP will need a different pitch to the public:
How the GOP defines âpre-existingâ:
Preexisting conditions also include political health:
GOP thinks health insurance is only for people who make good choices – like being born rich:
Stay unhealthy my friends:
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. Itâs 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 isnât 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 donât 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 donât 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.
â 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: Israelâs 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 âSpringâ, from Vivaldiâs 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 MĂ©dran 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 âGet Your Insuranceâ from 1959:
Those who read in email can view the video here.
The Daily Escape:
Lavender in Provence â 2017 Photo by Fabio Antenore
This week, Wrongo wrote that 50% of US births are paid for by Medicaid, and how worry about hunger and homelessness has never been higher among Americans. Both of these issues are symptoms of how our economy fails low-income and lower middle class Americans, and neither political party is truly interested in addressing the problems.
Trump won because he led people who used to vote for Democrats to believe that they had nothing to lose if they voted for him. Below-median income voters had long ago lost faith that Democrats, and Hillary in particular, would ever do anything to change their plight.
Trump said he would look out for them. Whether he does or not, remains an open question, but even before Trump, Democrats had already lost a big swath of America. From the American Prospect:
In the race for the White House, the Democratic presidential candidate has won…fewer US counties with average incomes under the national median and with populations that are more than 85% white in every general election since 1996. Concentrated in the Midwest, Appalachia, and the upper Rocky Mountains, there are 660 such counties today. Hillary Clinton won two of them.
Think about that: The Democratic Partyâs influence in mostly white, lower-income America has eroded to nearly nothing since Bill Clinton was president. This chart documenting their fall is stunning:
The Parties basically split below-median income counties that were 85% white in 1996. Over a 20-year period, the erosion of the Democratsâ control was steady, and complete. This isnât just the result of a poor 2016 presidential candidate, it is an indictment of the Democratic Party, its leadership, and its strategy.
The American Prospect article is about Montanaâs Democratic Governor, Steve Bullock, who won his state by 4 points while Trump was beating Clinton by 20. Bullock is a rural populist in a party of technocrats. Obama lost Montana by 2 points in 2008. Bill Clinton won Montana in 1992.
But, the electoral failure of Democrats is worse than its showing in these below-median income white counties. The following graphically illustrates the abject failure of Democrats to be competitive in political contests at all levels:
Nothing that Barack Obama did by holding on to the White House for that entire period compensates for these terrible losses.
Democrats remain divided about their Party strategy, many clinging to the thought that if Hillary could have turned about 80k voters in Michigan, Pennsylvania, and Wisconsin, where white working-class people are abundant, she would be president.
But she would not control either legislative branch, and she would have had to propose Supreme Court Justices similar to Neil Gorsuch to get one confirmed by the Senate.
The question is where will the DNC be taking the Party in 2018? In a 2018 mid-term election where the president has a historically poor approval rating with independents and Democrats, like Trump has now, victory is possible.
If Democrats want to win back Congress, and the White House in 2020, they need to field candidates who believe in jobs and economic growth first. The candidates need to be authentic people, who listen more than they talk. And when they do speak, they should use PIE as a metaphor for Americaâs economy, as in: (H/T Seth Godin)
When voters think the economy isnât growing, things begin to feel zero-sum. People begin to think that they may permanently lose their place in our society.
If the Democrats want to win back Congress, they need to describe concretely what they plan to do when they say they support their working-class constituents, regardless of color.
They need to get to be better than Trump on jobs, economic growth and finding a peace dividend.
All of that, and Medicare for all. In Wrongoâs Thursday column, Gallup found that health care concerns ranked highest across all income cohorts.
Shouldnât these principles be credible with working-class peopleâincluding whites?
A song about pie: Here is DâAngelo with âDevilâs Pieâ from 1998. Itâs a dystopian vision of capitalism, where everybodyâs fighting for more of the tasty, materialistic dish. All is fair in pursuit of a bigger paycheck:
Those who read the Wrongologist in email can view the video here.
Takeaway Lyric:
Fuck the slice we want the pie
Why ask why till we fry
Watch us all stand in line
For a slice of the devil’s pie
The Daily Escape:
(Street art, Panama City Panama, 2015 â photo by Wrongo)
A report by the Kaiser Family Foundation is an eye opener. The 2016 Kaiser Family Foundation Medicaid Budget Survey asked states to report the share of all births in the state that were financed by Medicaid in the most recent 12 month period for which state data were available.
The results are staggering. Half of the states in the country reported that 50% or more of births were financed by Medicaid, with New Mexico reporting the highest number of births financed by Medicaid, 72% in 2015. New Hampshire was the lowest at 27%. Eight states said that 60% or more of births were financed by Medicaid, while in another eight states, Medicaid had financed between 27% and 37% of the births. These figures show how important and widespread Medicaid is and what it means to people from low-income families. For those who are not on a Medicaid plan, they may want to see here about how to do that, so that they can make sure their health and wellbeing is taken care of.
Kaiser provided no analysis for their survey, and an interesting question to answer would be the demographics of Medicaid-financed births. Kaiser did include this map showing percentage of births financed by Medicaid:
(Source: Kaiser Family Foundation)
The map shows us the states which would have been hurt the most by the proposed cuts in Medicaid that the GOP tried to enact in the failed Trumpcare bill. Of the 14 states with more than 54% of births financed, only New Mexico and Nevada voted for Hillary in 2016.
So, Trump and the GOP will have plenty of explaining to do if Medicare is cut deeply on their watch, since these are many of the states that helped elect Trump, and put both houses of Congress in Republican hands.
One question is, what will be different if the government cuts Medicaid? We have an indication from Texas. The state cut off money to Planned Parenthood clinics in 2013, and that led to thousands of women failing to get birth control. Medicaid pregnancies subsequently increased by 27%, according to a research paper published in The New England Journal of Medicine last year.
The time for an economic reset in America is long overdue. Conservatives will blame the poor, or Obamacare, or both for the surprising data on government-financed births. Liberals will say it is a failure of the social contract. But, when 50% of births occur to people who can’t afford them, it is clear that our economic system needs fixing.
OTOH, it is good thing that we encourage pre-natal care for all, which gives these babies a better start in life.
Our unequal economy rolls along unchanged, because the comparatively well off middle and professional classes keep electing politicians that defend the current system against the 50% who are America’s working poor. Creating a war between the have some’s and the have little’s has worked throughout history.
This is the new America. Many in the former middle class are living on the edge of poverty, and we know it. Is inequality changing America? You bet.
It is incumbent on both parties to deal with Medicaid-financed births.
Time for a tune. Here is Madonna with “Papa, Don’t Preach“, released in 1986. At the time, the song caused discussions about its content, with women’s groups and those in the family planning field criticizing Madonna for encouraging teenage pregnancy, while anti-abortion groups saw the song as having a pro-life message. Decide for yourself. Here is “Papa Don’t Preach“:
Those who read the Wrongologist in email can view the video here.
Takeaway Lyric:
Papa I know you’re going to be upset
‘Cause I was always your little girl
But you should know by now
I’m not a baby
The one you warned me all about
The one you said I could do without
We’re in an awful mess
And I don’t mean maybe, please
Papa don’t preach I’m in trouble deep
Papa don’t preach, I’ve been losing sleep
But I made up my mind, I’m keeping my baby,
I’m gonna keep my baby
Lots of news this week, and the cartoons can speak for themselves.
North Carolinaâs bathroom ban wasnât really repealed:
Trumpâs climate change order isnât popular everywhere:
Trumpâs executive order adds jobs:
Trump has lost more than his ball:
How did the GOP blow it with Trumpcare?
Devin Nunes repeats (some of) what he hears:
The Daily Escape:
(Stranded bull shark found after flooding from Cyclone Debbie in Australia â photo from Reuters)
In an interview with “CBS This Morning” House Speaker Paul Ryan says he doesnât want to negotiate with Democrats on health care. Ryan, speaking to co-host Norah OâDonnell:
I donât want that to happen. You know why? I want a patient-centered system, I donât want government running health care…The government shouldnât tell you what you must do with your life, with your health care. We should give people choices.
Ryan centers his defense of the failed Trumpcare bill on the notion of individual freedom. He said he fears that Trump might move to work with Democrats so that he can make good on campaign promises to redo Obamacare, and âthatâs not, thatâs hardly a conservative thing.â
Ryanâs idea of freedom for the American people is the right to choose whether to have health insurance or not, and if they choose health insurance, to be free to choose expensive or cheap insurance.
But he sees life as a monetary transaction. In this appearance on Face The Nation March 12, 2017: (hat tip Ed Walker)
DICKERSON: How many people are going to lose coverage under this new â
RYAN: I canât answer that question. Itâs up to people. Here â hereâs the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country. So the question is, are we providing a system where people have access to health insurance if they choose to do so…Weâre not going to make an American do what they donât want to do. You get it if you want it. Thatâs freedom.
Ryanâs freedom will get rid of the Essential Health Benefits that are mandated under the ACA in his Trumpcare bill. The Essentials set the minimum coverage for any policy offered on the exchanges. They include lab tests, drugs, maternity care, treatment for substance abuse and mental illness, and others.
If insurance companies can issue policies that donât cover these mandated benefits, policies will be cheaper. That will increase the number of people with policies that wonât cover treatment they suddenly need.
So when Ryan says âfreedomâ he means: You have the freedom to give money to an insurance company to buy any policy you can afford; you can shop around for a policy that may or may not provide the coverage you eventually need; or you can take the risk of bankruptcy and/or denial of health care when you get sick.
But, in Ryanworld, individual freedom to choose doesnât extend to abortion, despite it being the law of the land.
Ryan assumes that if the government were involved, it couldnât negotiate better drug prices. He assumes government wouldnât regulate against the predatory excesses of health insurers, health care providers, and drug companies. Government involvement does violence to his Randian wish for a perfect and omniscient free market. He assumes that people with limited resources would choose to forego rent, food, or education to buy inadequate health insurance.
Letâs give Paul Ryan the benefit of the doubt: Say he knows that this is horseshit, but he needs to legislate. The alternative is that he is the worst kind of ideologue.
Conservatives spill the word âsocialismâ like beer at a frat party. They think it coats everything and makes everything smell, at least politically.
Itâs hard to believe that the GOP has a true notion of what socialism is, or how it works.
Itâs all around us, and Republicans are expert practitioners. Their negative talk about socialism is another example of their constant projection onto Democrats and progressives. Is it socialism when Ivy League admissions favor the rich? Or when the rich help other rich people get into the country club? Or when they all appoint the same people to corporate boards?
They despise it when the rest of us use collective action; when voters get their government to combat anti-labor and anti-monopoly practices, when voters work together for better schools, safer foods, clean water and safe working conditions.
Thatâs bad socialism, not the good socialism practiced in Bostonâs Back Bay or on NYCâs Upper East Side.
Itâs good socialism when companies work together in the US Chamber of Commerce, share information, and spend millions influencing government to increase their bottom lines.
Its bad socialism when people fight for practical affordable access to health insurance.
Paul Ryanâs vision of freedom has a lot in common with Kris Kristoffersonâs âMe and Bobby McGee“:
Take away lyric:
Freedomâs just another word for nothinâ left to lose,
Nothinâ ainât worth nothinâ but itâs free.
Those who read the Wrongologist in email can view the video here.