A Facebook friend from Florida posted this advisory to everyone, about the reduction in the open enrollment period for the ACA to 45 days for 2017:
Here it goes:
“Congratulations, Americans!! 😏
“The 2018 ACA (Affordable Care Act) enrollment period has been shortened to 45 days (Nov 1-Dec 15). Fortunately, your friends are posting this and using the word “congratulations” so it gets posted more frequently in Newsfeed by Facebook algorithms.
“Please copy and paste (don’t share) on your own timeline, if you want to help spread the word. Finally, if you don’t have coverage, get coverage. Too many people have fought for the ACA for you to be uninsured in America.
The particular friend probably is not in any dire straits, and I don’t know whether Facebook thinks it’s OK to just copy posts as if they were original with metatag keywords like “Congratulations”. (I think of “Greetings” for the draft, previous post). So I rewrote it and added a link of my own from Health Affairs, here.
Sarah Kiff of Vox shows and tells why our “free market” (sic) healthcare prices are so high, along with this cardstack explainer.
Dave Bier of the Cato Institute has a new detailed analysis of all the flaws in Trump’s Faustian demands (call it a “wish list“) on Congress before he’ll go along with letting most of the DACA “Dreamers” stay after six months, as in this link.
The most conspicuous demand was overbuilding “that Wall”, much of which might be ineffective or relatively unnecessary.
But another demand is practically requiring asylum seekers to prove their cases on entry. This would sound like it could shut down most LGBTQ asylum seeking.
Furthermore, overstayed visas would be treated much more harshly.
At the same time, there is a lot of attention to the “new” (?) travel ban. Jason Dzubow, normally very cautious in his blog posts, takes a cheerier approach on the affect on asylum seekers (in his most recent post), which in many cases, he feels, won’t be important. People who have already applied and getting some sort of legal and perhaps housing assistance in the US will not fare worse than before.
My own reaction would be to imagine myself in the shoes of a “dreamer” (maybe Jose Vargas in the 2014 film “Documented”). I would feel that, while the president has claimed a big heart and that somehow things will turn out OK personally, my own life had been made into someone else’s political bargaining chip. It’s easy to imagine that if I were a member of a racial minority in a poorer community subject to police profiling. As a white gay man with some of the typical troubles in the distant past, it is not so clear cut. I did not perceive myself, when younger, as a member of an oppressed “group”, but rather as someone who individually had difficulty conforming to some of the gender-related expectations made of me which were more understandable in the Cold War world in which I grew up.
Likewise, I’m disturbed that Trump sounds willing to play with the existing health insurance of disadvantaged Americans to claim he is keeping a promise to some people in his base.
AOL has a discussion of the Supreme Court’s actions today allowing one of Trump’s travel bans to stand; likewise Politico. It’s hard to give much reaction because the sands keep shifting. Here’s the June 2017 opinion for Trump v. International Refugee Assistance Project.
(Posted: Tuesday, Oct. 10, 2017 at 11 PM EDT)
Update: Thursday, Oct. 12, 2017
Jason Dzubow has a 9-part piece “DACA Reform and it’s Hostages (i.e., Asylum Seekers)” which seems to be a change in tone and alarm level. I would particularly wonder if the application of concepts like “membership in a social group” or “political opinion” would be tightened in a way to affect LGBT asylum seekers already in the U.S. (possibly some in detention seeking parole), especially from non-Islamic countries, including Russia (Chechnya) and Central America.
Sessions says he will ask Congress to tighten the rules on asylum seekers, claiming asylum fraud is widespread, Washington Post story by Sari Horwitz, link. The Center for Immigration Studies had made claims like this in a session reported here May 10 (q.v.)
I just wanted to make a note about the effectiveness of online petitions to contact politicians in “emergency” situations to block all kinds of harmful bills.
A recent good example was a call in the New York Times for public “blowback” by David Leonhardt, “Citizen Action on Health Care”, which came out right before the Senate was voting on a Repeal-only bill.
I generally do post petitions on by blogs or social media feeds. Usually I don’t personally respond to them.
I feel that sending elected representatives form letters written by others (even if the non-profit has provided tools for personalizing the letter) wastes “speech capital”, and lessens the impact later when a more substantial and constructive approach on a bill of more relevance to e would really work.
Opposition to many “bad” bills is often well-founded on anticipated unintended consequences. But frequently the likelihood that the harm will really happen is speculative, and predicated on associated failures of other layers of government or lack of trust in companies.
For example, much of the opposition to the various health care bills is predicated on the idea that down the road the states will refuse to do their jobs for less fortunate constituents. In a federal system, it is always an issue how far the federal government should go to protect citizens within states. But I know from gay issues, as with the history of sodomy laws (and a particularly disturbing close-call in the Texas legislature in the 1980s) that even I can be wanting that “federal” consideration. And we certainly know that with southern states and civil rights in the past.
So rather than opposing every bill that gets proposed because somebody gets hurt, I’d like to see us solve the problem. How to we cover everybody, keep health care costs reasonable, avoid the waiting lists, handle the pre-existing conditions? Subsidies, reinsurance, policies about end-of-life? You have to do the math.
Opposition to other bills in my world is speculative. On the network neutrality petitions, I’m asked to believe that telecom companies really do have an incentive to cut off smaller businesses from even being reachable through them. This doesn’t make much business sense, and flies against what trade associations say. Yet, still, I’m concerned.
On the recent Backpage-driven erosion of Section 230, I’d be more concerned about the hype (which the major media haven’t quite caught on to yet). There’s an existential problem if indeed states (federalism again) could force every service provider or hosting company to prescreen every user poser for sex traffkcking, and I wonder how well the public understands this – it takes a certain level of cognition. There’s also the idea of “subsumed risk” or shared responsibility, as I’ve hinted before. The apt comparison would be to use measures that work for controlling child pornography now – it usually requires that a service producer have knowledge, when then creates a duty to report. It isn’t perfect (and could lead to framing of people) but it seems like a balance.
Even so, an emergency call-in campaign at some point in the future to defeat SESTA sounds unlikely to work. (I do remember SOPA in 2011-2012.) We do have to figure out how to solve this problem.
I can imagine the petitions that will go around if we have a debt ceiling crisis at the end of September. But, no, it’s not as likely seniors stop getting Social Security as the doomsday sayers claim.
I wanted to note also that I don’t usually have a direct relationship with most of my readers, so I don’t do mailing lists, subscriptions, tip jars, giveaway contests, fund raising for organizations (illustration), or various specific marketing campaigns often (I have done some for the books through Facebook and through the publisher). Part of the reason is that my content is about “connecting the dots” and covers very broad areas. I’m not anybody’s life coach. Yet, when you put yourself out there, people approach you as if they expected you to be. In this FEE article by Richard Ebeling, point 3 seems applicable. Real immediate needs of consumers ought to matter, too.
Two mornings before North Korea fired an apparently successful parabolic missile test of its longest range device to date, President Donald Trump announced a ban on transgender service members in the US military by a 3-part tweet, limited by the 140-character limit (until you embed).
Trump didn’t even “bother” to craft an Executive Order, maybe having been burned by the multiple travel bans. Presumably he can do that, or he can give the Secretary of Defense Mattis direction to implement what he said in the tweet.
In fact, Mattis was apparently blindsided by the tweet, having expected to have until January 2018 to issue a report on the financial and practical issues about accepting transgender people into the military and possibly offering them sexual reassignment care during their military careers. The Pentagon will take no action without formal action of some kind from the White House.
As a practical matter, it sounds, off hand, that the Pentagon could stop allowing people to enlist who say they are transgender, and could refuse to continue to pay for surgery. But existing transgender personnel probably could stay in only if they did not start new treatment. Even before Bill Clinton started the whole “don’t ask don’t tell” policy regarding gays in the military, there had been at least one case where a male-to-female enlisted person in Naval Intelligence had been honorably discharged, had surgery on her own, and (under Bush) been hired back into almost the same position as a civilian with the same security clearances.
There was no immediate talk that the measure indirectly threatened the repeal of “Don’t Ask, Don’t Tell” for (cis-gender) gay men and lesbians in the military. In fact, the talk even from most Republican members of Congress now was that LGBT people (cis and trans), including John McCain (who had resisted the repeal at the end of 2010) should continue to serve without discrimination.
Previously Missouri congresswoman Vicki Hartzler had introduced a rider to ban transgender troops, claiming that they cost too much money (KCMO, Politco). Rand (which had authored a huge volume on gays in the military in 1993 which I had used writing my first DADT book) had estimated the annual cost to be something between $2.4 million and $9 million, very small. Various pundits referred to earlier writings, even by Mattis, critical of social experimentation in the military. That made me wonder in the back of my mind about the 2011 DADT repeal.
Arguments about military readiness and unit cohesion, and the compromised privacy of servicemembers who don’t have the same opportunity for double lives as civilians, have shifted over time. Generally the military has been less concerned about it during times of real need, as the Army even quietly dropped asking about sexual orientation at draft exams as earlier as 1966. “Asking” returned after the draft ended (although Selective Service continues, male-only and based on birth gender, although recent bills to require registration of women complicate the debate). Then we all know “The Strange History of Don’t Ask, Don’t Tell”. Privacy and unit cohesion were touted as big issues in 1993 by Nunn and Moskos, but in actual practice (as the 1991 Persian Gulf War had already reinforced) these seemed to be non-issues for younger soldiers, and the same flexibility has included respect for transgender troops. While in actual practice distraction of troops by diversity was minimal in an authoritarian command environment, socially conservative pundits have always made these “privacy” arguments, even for civilian fire departments back in the 1970s in response for proposals to end gay employment discrimination.
My own personal take is that one of the biggest reasons why discrimination by the military (outside of clear-cut fitness and medical issues and age) is a moral problem is that the rest of the world sometimes looks at all civilian citizens as potential combatants. This goes back to my own experience with the military draft in the 1960s, when the ability to field a conventional ground force was possibly a strategic component of deterring nuclear war, part of the domino theory. Today the theory gets reinforced by the idea of asymmetric terrorism, as well as the fact that that Internet (and “online reputation” issues) have made double lives impossible. But in historical perspective, it’s nothing new. Consider the Battle of Britain, which followed Dunkirk (where civilians rescued soldiers) by a few weeks.
Transgender plastic surgeon Christine McGinn, who has experience as a Navy doctor, appeared on Smerconish today on CNN.
Did Trump simply play a cheap-shot to his base, which he has not been able to enlarge? In a less elite world, indeed there is a sense that gender conformity is needed to defend against external threats, as “common sense”, the way that phrase was used against me during my own Army Basic. But in a modern world that can evolve into something new, it is not so simple. Trump doesn’t want to move into the hypermodern world, and neither do a lot of other people, who would be left behind. Gay conservative Milo Yiannopoulos had some harsh comments about trans in the military and women in combat, as quoted in another Washington Post article.
I’ll add as of this writing Trump expressed glee at the idea of “watching” Obamacare implode after the GOP failed to pass the Skinny Repeal. “Watch. Deal”. And there are reports he wants to cut off some subsidies now.
There are also reports that new chief of staff Kelly will try to force Trump to stop using his personal Twitter account altogether. That raises new questions of how he could wage war on the media. So far (contradicting my early fears) he hasn’t disturbed the standalone bloggers.
I saw a Facebook post recently from Arvin Vorha, a mathematics educator and Libertarian Party candidate for the Senate from Maryland, which read “If you didn’t produce a particular child, your financial responsibility to that child is zero.”
Oh, is that the real world? How often to childless people wind up raising the kids of siblings after family tragedies? (That was the premise of the WB series “Summerland” that started in 2004.) Or there is the premise of “Raising Helen” where raising a child is a requirement for a inheritance, although that sounds fair enough.
There is also a practical issue that, for a family or for a “people”, having children and being able to raise them is an important capacity. A lot is said about population demographics or “demographic winter”, especially by the alt-right, which warns that populations with foreign values (read Muslim) will take over the political lives of western countries because they have more kids and at younger ages, without waiting for ideal circumstances (education and perfect job) according to narrower libertarian notions of personal responsibility.
In the workplace, at least back in the 90s, there were a few occasions where I worked overtime without pay when someone else had family issues or was having a baby. How does that play into the paid family leave debate?
And then, when I talk on Facebook about how cheap my own health insurance was when I was “working” in my long track IT career, and I was flamed about my own privilege, for having my establishment employers subsidize my insurance with tax-free benefits. Well, they could have paid me more instead, Then the flamethrower wrote something like “You must not have kids.”
Right, not having procreative intercourse with the opposite sex is indeed an indication or moral inferiority, a lower deserved size in life? Is that what this means? Is that what the equality debate is about?
Indeed, the backside of the demographics debate is the “cost” of eldercare of an aging population. I found out two decades ago how easily I could be “conscripted” into this world, and then play the privilege card by hiring immigrant caregivers.
Then there are all the debates about race and genetics, which some see as offensive (Wade’s “Troublesome Inheritance” and Murray’s “Bell Curve”). But it seems that things cancel out if better-educated people have fewer children.
I do have to add one extra detail: Susan Collins (R-ME) has mentioned “my” idea of using reinsurance in the revised health care play (to cover pre-existing), and Rand Paul (R-KY) wants individuals to have the same bargaining power by getting together as employees of big companies or union members today. Trump, as a businessman, has to have pondered these ideas, right?
Here’s a legacy post about the demographic winter issue, referring back to a 2007 “Manifesto” (decree from “on high”) by Carlson and Mero, “The Natural Family” as well as Phillip Longman’s “The Empty Cradle“.
The New York Times ran an op-ed by Eitan D. Hersh, “Political Hobbyists Are Ruining the Country” in the Review Section Sunday July 2 Online, the title is “The Problem with Participatory Democracy is the Participants”. This sounds like a series of choices on a “My Weekly Reader” reading comprehension test in grade school, “the best title for this story is ..” Oh, that was third grade (1951) when the smartest girl in the class only got 44 out of 60 and poor little Bill got 16. There’s a similar story in the Boston Globe “The Most Dangerous Hobby” by Hersh, inspired by the WB classic film “The Most Dangerous Game” based on a story by Richard Connell. We read and watched that in 2005 when I was substitute teaching, in the middle of an incident caused by my own political hobbying.
So I’m one of the problem hobbyists. OK, when do I “pay my dues” and do my part? I do vote in all elections, including primaries. I have worked as an election judge three times in retirement, although not recently. I do talk to neighbors about elections. They’re both conservative to libertarian.
But I don’t raise money for candidates or issues. I don’t knock on doors. And don’t take orders from party operatives or pressure groups on what it is OK to say in a book, social media, or a blog. And some of the mail I get for partisan contributions (I got one from Donald Trump) is plainly ridiculous. (Back in 1984 I got a very bossy letter from the Dems on how much money I “owed” to help Walter Mondale.)
And I generally don’t respond to urgent pleas to text or call law-makers about very narrow, niche issues. I feel that if I did, that would dilute my effectiveness on when I have something unique to say. Sometimes I do sign online petitions. I think I signed one to free Chelsea Manning, which Obama did.
What’s more significant is that I have never run for public office. I can’t imagine asking people for money. But in 2000 I almost ran as the Libertarian Party candidate for the Senate from Minnesota. Another candidate, a gun enthusiast, would run instead and get himself arrested at Mystic Lake to make a point on the right to bear arms. You see how polarizing this gets.
We don’t encourage the right people to run. If someone like Anderson Cooper were president right now, the country would be just fine, with no scandals. I think Anderson would listen to Lindsey Graham and become hawkish enough on North Korea and ISIS (and Russia).
I don’t join mass movements for revolution right now, although I can never say never. Rather than put all my eggs in some revolutionary idea like single payer, that I know won’t pass, I try to solve problems within the existing system. Like, if you want to allow a barebones health plan for the young and healthy, accept the fact that you have to subsidize the already sick a lot more, and reinsure them, to deal with the anti-selection problem. If we already had single payer, it wouldn’t be controversial or debated – except that we would have to deal with waiting lists and sometimes end-of-life decisions. There is no way to escape the math. Life is not a zero-sum game, but you can’t get something for nothing. E is still M-C-squared. So, yes, I am a conservative. And gay. Welcome to Milo’s world.
The real problem is probably the gratuitous nature of my speech. I report to no one. I try to play devil’s advocate for everything, bring up all possible arguments. I would be more useful, say, working in intelligence, which might have been my career had I grown up in a later, more tolerant or accepting time.
As Milo has pointed out, a lot of times the Left especially (and sometimes the populist alt-right) doesn’t want to allow constructive counter arguments to be made, especially by intelleculoid “Uncle Tom’s” in their midsts. What partisan leadership sees is resurrecting old chestnuts that could be brought back to oppress or marginalize less competitive individuals in their groups. After all, at a certain moral level, almost any goal can be “rationalized”. A good example of this problem has occurred with HIV issues, when public health arguments, while valid (up to a point) can be used as an excuse for stigmatization or exclusion of gay men, a problem we had in the 1980s. Leadership of activist groups want obedience and consistency of messages among supporters, not people who ask (and particularly self-publish) analytic policy questions on their own.
But that is what I do. I want to keep an eye on the big picture, especially civilization -changing threats, not just local issues tied to my own identity groups. That is how I make a difference, in the long run. At least now Maybe not forever.
Let’s think a moment about how mandatory insurance can work, in different areas, like health, auto, property.
Generally, you have to have auto insurance to have a driver’s license (how it’s required varies by state) you need property insurance for a mortgage, and with Obamacare (and previously Romneycare in Massachusetts) health insurance. And Medicare and single payer in most other countries can be viewed as mandatory health insurance, paid for by much higher taxes.
Obamacare (the Affordable Care Act) is partly driven by requirement that “healthy” young people will buy coverages they as individuals are almost certainly not going to need, to support otherwise much higher premiums for people who do need them. I’ve said here that we probably need publicly funded props (subsidies — not just tax cuts — and reinsurance, to help pay for health care for the sickest people), which would affect the deficit and maybe require cuts elsewhere (maybe in Social Security, for example, slowly increasing age eligibility) to control spending. I may be OK with some of the aspects of “community rating” – that is, men have to buy pregnancy coverage because it takes two to tango – and we want, as a policy matter, some sort of gender equality. (It wouldn’t hurt me some day if PrEP were covered, although at my age it’s not real likely.)
But requiring people to buy add-on coverages for other people’s risks (“moral hazard”) is generally a dangerous idea, that can set up a bad precedent for other misuse. That’s one reason why I am somewhat behind “TrumpCare” or “RyanCare” or “PriceCare,” if you really get serious about covering everybody somehow. The Republicans want the states to take more responsibility for this area. Under a federal system (compared to a unitary system like China’s) that seems appropriate. We no longer trust the states to manage their own ideas of “equal protection” (from the 14th Amendment all the way to the Civil Rights Movement of the 1960s, ending with Stonewall) but we generally allow states a lot of leeway in just how they want their residents to pay for services or how much to privatize some services. States vary on whether or not they have their own income taxes, and to what extent they want to charge user fees or tolls. As California found out in the late 1970s, they can have their own battles on using property taxes to fund public education. So, yes, the OMB is appropriate concerned about how the reddest states will handle a block grant approach to health care. But our Constitution and federalism limit just how much coercion the federal government can use, even for worthwhile policy goals.
In the past twenty years, auto and property companies have been combining normal property or physical liability (and damage loss, from accidents and storms) with cyber liability from Internet use. The latter liabilities can include the cost of defending frivolous defamation suits (as with review sites) and copyright or even incidental trademark or patent infringement (from trolls), but they can also include losses due to identity theft or cybercrime (recently, ransomware). In some cases, the higher limit auto policies are available only in umbrella policies that have all these other coverages (which have nothing to do with the likelihood of causing an auto accident or of being hit by a tornado). In fact, as we know from the attempts around 2001 or so by the National Writers Union to buy media perils coverage for its members (and another push for this in 2008, shortly before the financial crisis), the risk for an individual consumer of being sued for Internet behavior is extremely hard to underwrite and predict, compared to the risks in the physical world.
I can imagine (especially from the “Left”) pushes to make cyber insurance mandatory components of property policies, and I hope the GOP would apply the same skepticism to this idea it has to health insurance mandatory coverages. You can imagine the pressures: because I have an unusual last name, I’m not as prone to identity theft as someone with an Anglicized name, but should I have to subsidize the premiums of someone more likely to experience it? Because of the “gratuitous” nature of my self-publication (it doesn’t pay its own way) activity “in retirement” (maybe that’s like “in relief” in a baseball game’s bullpen), I don’t face the same risks as other people who actually need to support families with their writing, but I face my own unusual perils (mostly related to “implicit content” as I found out with a bizarre incident in 2005 when I was working as a substitute teacher – the concept has to do with attracting politically or socially motivated targeted risk to others connected to “you”). The main prevention is to know what I am doing. (I do; for example, I know how to recognize scams.)
But the permissive legal environment that has allowed user generated content to flourish does raise serious questions for me, involving some personal matters (how I place value on interactions with others who have more intrinsic need, and how I am willing, with volunteerism, to fit in and belong to a group and speak for its needs – accept “partisanship”). The legal props include Section 230 and DMCA Safe Harbor, all of which makes me wonder how the Web still works in Europe, where these kinds of protections are weaker and where there is even an enforced “right to be forgotten” (and where, as Trump points out, defendants have to prove they told the truth in libel cases). The permissiveness seems to have led to an world where there is a lot of recklessness and abuse, ranging from cuberbullying or stalking or revenge porn, to outright terror recruiting — largely because writers with sincerely put arguments wind up preaching to their own choirs, created by news aggregation. Again, I could be silenced if I had to be insured, because my speech is not “popular” enough to pay its own way, especially in a mandatory insurance world.
In Terry Gilliam’s artsy futurist film “The Zero Theorem” (2013), precocious and charismatic teen Bob (Lucas Hedges) tells the besieged computer operator Qohen Leth (Christoph Waltz), “I’m nobody’s tool”. (Hedges would play a similar role in “Manchester by the Sea”.)
It’s true, I “went public” with a controversial persona narrative with my first “Do Ask, Do Tell” book in the 1990s – specifically striking a nexus between the past history of conscription with the debate over gays in the military (as it had evolved then under Bill Clinton). I would wrap every other issue, mapped onto the tension between individualism and the need to belong to the group, around it and become a commentator, a pundit, someone who, however, needed to keep a certain objectivity and distance (even emotional aloofness) expected of journalists.
As President Trump complains, it’s too easy to criticize when you sit on the bench ad don’t play.
So, in the “aftermath” of the book(s), websites, blogs and now social media accounts, I have made it absolutely impossible for me to earn money (in “retirement”) by selling somebody else’s message, or being someone else’s spokesperson. No, I can’t have Sean Spicer’s job.
After my layoff and forced retirement from old-style mainframe I.T. as a post 9/11 sequel at the end of 2001, at age 58 (73 now), I learned “the truth” about what the world seemed to expect of retirees: Sell! One of the earlier interviews (while I was still in Minnesota) as with PrimeVest The interviewer became defensive about my questions over his presentation, even though I agree that for some consumers, converting whole life to term is a reasonable strategy. But a $40 trillion market? The interview was concerned over how “analytical” I seemed. I checked and investigated everything. “We give you the words,” he said. To a writer who has followed his own direction, that phrase sounded very insulting, like throwing an inadequate tip at a bartender (which I once did).
There would other attempted offers to throw husckerism at me. True, life insurance agent or financial planner sounds legitimate enough. But I don’t want to troll people’s Internet ad hits in order to cold call them.
I also find myself resisting attempts to get me to “join a resistance”. HRC is on my regular donation list, but I felt a little taken back by a recent email inviting me to be trained to become a grassroots activist or part of a resistance. I know that Barack Obama was a “community organizer” in Chicago at one time, I have my own message set. I don’t need to have an organization tell me what to say.
Even worse was a similar ploy from the political right. GOP candidate for a runoff in a Georgia House race, Karen Handel, writes, addressing me personally (by an automated plugin – again insulting) “This is the email I didn’t want to have to write. But after seeing the latest public polls – I have no choice.” She whines that bigwing Democrats have raised so much money for her opponent, so “Will you help me fight back?”
No, I like to think of myself as better than that (including any public participation in overtly partisan politics). But of course I know the argument. I saved well when I was working. But I also have some of what the left-wing considers a poison pill, inherited wealth. I don’t have to make everything I do pay for itself. I don’t have to sell other people’s messages for a living. But I can imagine people thinking, if there weren’t people like me around to dilute them, they could make a living by “selling” because everyone else would have to.
I’ve railed about identity politics here before, but the way I argue policy issues is relevant here. Of course, I agree that current GOP plans for health care (variations of the Americam Healthcare Act) could, as structured now, throw millions off affordable health insurance, while solving problems of premium hikes for unneeded coverages for some people adversely affected by Obamacare’s implementation (and probably exacerbated by some states). I agree that the changes could affect racial minorities adversely. They could also affect gay men (depending on what happens with PrEP and protease inhibitors). But I don’t argue something because it hurts “me” or anyone as a “member of a group” (even though “belonging to groups” has become, unfortunately, the legal cornerstone of the way equal protection of the laws works). One of the reasons AHCA would affect people in certain groups is the way it would shift the responsibility for Medicaid back to the states. So it becomes a federalism problem. States should do the right things, but we know from the history of Civil Rights through the 1960s that sometimes they didn’t (and we lost young men like Goodman, Schwerner and Cheney as a result in what was the moral equivalent of crucifixion).
I don’t respond personally to “Leftist” appeals for “resistance” because this policy hurts members of their particular client groups (even if I belong to one of them, and everyone belongs to something). I think you have to solve the problem analytically. Some countries, like Switzerland, have kept an effective private health care sector in a way that works, and we could do that. I think you can have assigned risk pools again, so that rich people with pre-existing conditions can pay their own way (an inherent advantage of the GOP setup) but you have to subsidize the premiums of people in the middle class and below (tax cuts alone aren’t enough, you need subsidies, but you don’t need to use Medicaid as the vehicle for subsidies), or use reinsurance for excess claims. You have to be determined to make it work, and you have to pay for it. So maybe you can’t give the rich all their tax cuts.
Likewise, I reject group-oriented resistance politics on an issue like police profiling. I understand Rudy Giuliani’s claims about how “broken windows” policing in the 1990s made New York City much safer than it had been in the 1970s when I lived there. But I have so say, that particularly a couple of independent films (“Whose Streets?” and “The Prison in Twelve Landscapes” and well as “I A Not Your Negro”) have pointed out that in some communities, police departments have regularly extorted fines from black residents with the “garbage jail” approach. This is illegal and even criminal and not acceptable. Why won’t the usual system of litigation put a stop to this?
I’m left to ponder the mentality of the doomsday preppers, who think that civilization cannot be depended on, and that it is morally imperative for everyone to learn to become self-sufficient locally and within the family.
Early Sunday afternoon, in between rounds of the Maryland Film Festival, I walked up Charles Street in Baltimore and walked into a grill, which I will not name for search engines, hoping to have lunch. I had about 40 minutes before I needed to be heading for the nearby Parkway Theater.
There was a sign said to wait for seating, and the place was almost full. Two employees were fixing a machine and attending to a handicapped customer. For ten minutes no one saw me, or even looked in the direction of the entrance. Finally I was seated and an order taken. But the order (for a simple benedict) had to be cancelled when it was apparent it would not get cooked in time.
I walked into a McDonald’s on North Street, next to the Parkway, and even here there was no one behind the register for a moment. Finally, I got a pre-cooked McMuffin and swallowed it and went to the movie just in time.
Lesson, you may have the money to pay for food, but somebody still has to be paid to cook it and bring it to you.
I see that Baltimore is looking at minimum wage laws, and that right now the Maryland min seems to be $8.75, probably much less for tipped workers. But in both eateries, there was obviously less help available than needed to serve the demand that obviously existed. I think there were only three employees in the grille; maybe someone didn’t come to work, or maybe no one will work at the wages offered. I even wondered if we were seeing the immediate impact of Donald Trump’s ICE undocumented immigrant crackdown. Suddenly, there is no help in places you count on for “service”.
It’s easy to blow this up into a moral lesson about privilege, class, and depending on the underpaid labor of others.
Underserved wealth and station in life can become preoccupations of leadership on both the far Left and far Right, but with different parameters. It seems so negative to become so preoccupied with “grading people”, yet we need to see people earn rewards that are commensurate with what they deserve. Is this like grades “according to ability” as on one grade school report card, or is it an absolute thing?
Consider how scattered “those Republicans” are with respect to who should pay for the excess health claims of the sick, and those with pre-existing conditions. I’ll lay aside the claims that Trumpcare is set up to support a tax break for the very rich. I’ll also note a comment I added yesterday. That Obamacare apparently does have the reinsurance scheme that would help with this problem if only Republicans would allow it to be used (the fourth comment on the previous post, about an MIT economist).
Yes, it’s easy to blame bad behavior on a lot of health care issues. You can say that about smoking, alcohol, drug abuse, and now opioids. Vox has added eliminating sugar – all of it – to the mix (although plenty of us don’t get obese or diabetes from normal sugar consumption). I’d have to throw in the sexual behaviors in the male gay community – remember the moral debate over “amplification” and AIDS in the 1980s? Indeed, you look around, it often seems that the healthiest people usually have been the most intact from adolescence through adulthood.
Social conservatives often place the responsibility of learning to take care of others, the less-well off, with the “natural family” as in that 2007 manifesto by Carlson and Mero. Courtship and dating, and then marriage – making it contain sexuality – and the rearing of children, teaching them to care for younger siblings – and caring for the less well off in an extended family – is supposed to teach everyone to learn attachments to others who do have real needs. They can point out that inherited wealth often comes with strings attached – taking are of other family members or raising deceased siblings’ kids.
But I suppose their idea of health care parity could extend to social media. To their way of thinking, someone in my shoes should feel morally obligated to respond to new “GoFundMe’s” for money for protease inhibitors or PrEP in my own community. (Seriously, paying for the latter is probably a big issue in college-age health care for gay men.) Or maybe you should respond to all Facebook friends who talk about losing coverage for stuff like MS medication, diseases that no one can avoid with “behavior”. Particularly if you have wealth you didn’t earn.
Vox, in a piece by Matthew Yglesias, explains how Medicaid expansion works under Obamacare, and the consequences of GOP’s gutting it. In the 1970s, I worked on New York State MMIS (through Bradford) so I should have known to pay more attention to this.
I think you could make the GOP plan work if you pump enough money (through the states) to support increased premiums for those in the group, with subsidies that most people (except the wealthy) would need to make the premiums reasonable. They would need to be actual supports or payments, not tax credits (as many have no taxes). But for the most extreme cases (like the hemophilia case mentioned) would also need public reinsurance to cover the claims. Even people without pre-existing conditions can have extreme claims from accidents (the Christopher Reeve problem), so a reinsurance mechanism sounds necessary
The fact is, in a society that values human life, it has to be paid for somehow. The general experience with other western democracies is that most people are more comfortable with the idea of funding the more extreme and misfortune-driven needs with taxation, or public funds. If we had a Canadian single payer system, health care wouldn’t be so controversial. We’d be used to it.
Otherwise, we have to face the issue of “moral hazard”. In the insurance world, it’s always problematic to force companies to group coverages to force people to add coverages that they personally will never need, to pay for someone else’s risks, when they buy an insurance product. I think there is a good analogy with property insurance (homeowner’s and autos). Imagine if umbrella insurance (covering identity theft and social media liability risks) were required to be part of every homeowner’s policy. But that’s where Obamacare-style thinking could have been headed.
Yes, there are counter arguments when it comes to healthcare, such as gender parity (and it takes two to tango). At the end of life, women tend to live longer and need more services (although this is complicated by Medicare and all other issues in eldercare).
I had first rate health group insurance when I worked for ReliaStar and fell in a convenience store in 1998 in Minneapolis. I kept full salary, got the experimental surgery I needed immediately at the University of Minnesota (and a medical supply company donated the device because it wanted to demonstrate it), recovered completely, as back to work in 3 weeks, and walking without crutches at an Oscar party in about two months, and was covered 100%. Yes, insurance companies do a better job than average of taking care of their own employees, almost as if we were professional sports players. Yes, there is some cherry picking.
So, as a song(Yul Brynner singing) in “The King and I” reads, this is all “a puzzlement”. Trump, Price, McConnel and Ryan have some more work to do and more problems to solve. But Donald Trump has insured his own employees for years, as do his two sons now. I would think he would be familiar with how reinsurance works.
On Trump’s religious freedom EO, allowing religious organizations more freedom to endorse political candidates: Most of “us” are relieved it does not contain the provocative language pandering to the most extreme religious notions, which make other people’s personal lives everyone’s business. My more detailed story is on a legacy blog here.
TrumpCare (or “Repeal and Replace) would have to deal with touchy situations like lifelong HIV medication and even PReP.