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Mitch McConnell and Paul Ryan Are Trying to Kill People For a Tax Cut

[ 0 ] June 28, 2017 |

TrumpCare is a plan to inflict preventable death, suffering, and/or financial ruin on large numbers of people to pay for a massive upper-class tax cut:

The Congressional Budget Office projects that if the Senate Republicans’ health care bill becomes law, 14 million Americans will lose their health insurance in 2018, and, by 2026, 22 million would lose coverage.

Drawing on that work, we estimate that if the Senate bill becomes law, 22,900 excess deaths will occur in 2020 — and the figure will grow over time. 26,500 extra deaths will take place in 2026. Over the next decade, we estimate that a total of 208,500 unnecessary deaths will occur if the law is passed (see Table 1).

We also calculate anticipated additional deaths, state by state, using state-level coverage losses for the year 2026 (see Table 2). The predicted excess deaths by state range from 30 in North Dakota to 2,992 in California in 2026 alone.

Some commentators have argued that it’s inappropriate — beyond the pale — to suggest that people will die as a result of this legislation. To the contrary, we contend that no debate over a health care policy can ignore evidence that it could have negative effects on health and mortality.

In making these calculations, we draw on the scientific literature demonstrating that expanding health insurance reduces deaths. We specifically apply the results of a particularly robust study of the effects of health care reform in Massachusetts on mortality. Massachusetts’ health care reform — which expanded Medicaid, offered subsidized private insurance, and included an individual mandate — famously served as a model for the ACA. The Massachusetts study looked at county-level mortality data in 2001 to 2005 (pre-reform) and 2007 to 2010 (post-reform), and compared the changes to carefully selected control groups in other states that had not enacted health reform.

For every 830 individuals insured, the authors found, one life was saved. In medical terms, 830 in this context is the “number needed to treat.” To put this into perspective, the colonoscopy number needed to treat is 1250; you need to conduct 1250 colonoscopy screenings to prevent one colorectal cancer death.

Overall, in Massachusetts, insurance coverage expansion was associated with a 3 percent decline in mortality from all causes, and a 4.5 percent decrease in deaths from causes that are especially amenable to being prevented by health care — including heart disease, infection, diabetes, and cancer.

That’s it. That’s all it is. Tell as many people as you can.


Today In Our Very Healthy Journalistic Culture

[ 0 ] June 28, 2017 |

Big news! CNN will now be giving a daily evening hour to Chris Cillizza and his exciting new show, Cavalcade of EMAILS:

Chris Cillizza, who bundled up his hot-takes and left The Washington Post for CNN this year, is getting his own “brand.”

According to a press release published by CNN Politics, the news organization is launching ‘The Point with Chris Cillizza,” described as a “multiplatform brand capturing analysis of the day’s news.”

What platforms do we get more Cillizza on, you ask with fevered anticipation: “daily columns, on-air analysis, an evening newsletter, podcast, and the launch of trivia night events in Washington, DC.,” per the statement.

Well, trivia nights are certainly an appropriate cross-promotion of the Cillizza brand! Winner gets two happy face emojis. Second prize is no health insurance, and therefore three happy face emojis.

That this is the latest battle in Zucker’s war on journalism goes without saying. I’m also pretty skeptical that anyone will want to watch this thing. (The market predictions of TV executives have been pretty shaky lately.)

Meanwhile, enjoy this New York Times story, “does taking a trillion dollars from Medicaid with the goal of greatly reducing the number of people on Medicaid constitute a ‘cut’? Views differ.”

All Media Mistakes Are in One Direction, If You Ignore All of the Mistakes That Aren’t

[ 0 ] June 28, 2017 |

Greenwald asserts, in light of the retracted CNN story, that all the media’s mistakes on Trump and Russia advance an anti-Russia/Trump narrative:

But CNN is hardly alone when it comes to embarrassing retractions regarding Russia. Over and over, major U.S. media outlets have published claims about the Russia Threat that turned out to be completely false — always in the direction of exaggerating the threat and/or inventing incriminating links between Moscow and the Trump circle. In virtually all cases, those stories involved evidence-free assertions from anonymous sources that these media outlets uncritically treated as fact, only for it to be revealed that they were entirely false.

Hmmmmm. One of the CNN reporters responsible who left because of the retracted story is Eric Lichtblau. Now that you mention it, he did do some problematic reporting on Trump/Russia:

As we’ve discussed before, this was a Judy Miller-level botch. By October 31 it was definitely the consensus within the FBI that Russia’s interventions were intended to help Trump. Lichtblau just got played by the alt-right faction within the FBI. And what makes it even worse is the context — this false nothing-to-see-here story on Trump and Russia landed during the timeframe when the Times was running one A1 story after another about an actual non-scandal: redundant copies of emails that showed no illegal behavior on the part of Hillary Clinton being found on someone else’s laptop. Odd how Glenn “forgot” about a massively botched story that was more important than any of the ones he discusses.

And, of course, it wasn’t just this — Lichtblau was also responsible for one of the most ridiculous attempts to frame a story involving absolutely no objectionable behavior by anybody into a Clinton scandal because questions raised were casting troubling shadows. Needless to say, not only did Glenn see nothing problematic about this, he was doing the exactly same thing himself.

The media makes lots of mistakes. I think this is important — indeed, I even think it’s a more urgent subject than the campaign tactics of someone who well never run for president again. But the idea that they’re all in one direction is silly. It’s just that when the media errs in a pro-Trump and/or anti-Clinton direction Glenn doesn’t give a shit.

American Conservatism is a Grift All the Way Down

[ 0 ] June 28, 2017 |

The conservative legal activist and Trump goon needless to say Jay Sekulow is another evangelical who understands the central message of the Sermon on the Mount is “it’s immoral to let a sucker keep his money”:

Before Trump hired him, Sekulow had built a powerful charity empire, leading a team of ACLJ attorneys who jump into high-profile court battles over such hot-button conservative issues as religious liberties and abortion. The ACLJ promotes its work zealously, noting that its representation is free of charge and dependent on the donations of supporters.

That brought in nearly $230 million in charitable donations from 2011 to 2015 — and millions of those dollars ended up going to the members of the Sekulow family or their companies, a Washington Post analysis of IRS tax filings and business records in five states and the District found.

Through a complex arrangement involving ACLJ and another charity, $5.5 million was paid directly to Sekulow and five family members in salary or other compensation, tax records covering those years show. Another $7.5 million went to businesses owned by Sekulow and his sister-in-law for producing and consulting on TV, movie and radio shows, including his weekday program, “Jay Sekulow Live!” And $21 million went to a small law firm co-owned by Sekulow, records show.

Donald Trump winning the Republican presidential nomination is a mystery that will truly never be explained.

Racing for Power, Peace?

[ 1 ] June 28, 2017 |

People’s Liberation Army (Navy) ship PLA(N) Peace Ark (T-AH 866) steams in close formation during Rim of the Pacific (RIMPAC) Exercise. U.S. Navy photo by Mass Communication Specialist 1st Class Shannon Renfroe – Public Domain.

Some thoughts on how Sino-Indian naval competition is manifesting in the Indian Ocean:

In a recent article, Abhijit Singh explains how the Indian Navy has stepped up its humanitarian operations in the Indian Ocean since 2004. The purpose of this action is twofold; to simultaneously provide a foundational maritime maintenance function in the region, while also hedging against an increase in the range and power of the Chinese People’s Liberation Army Navy (PLAN). As Singh notes, humanitarian assistance/disaster relief (HADR) has become a core naval mission since 2004, one that all major powers need to take seriously.

Brave New World

[ 256 ] June 28, 2017 |

Let this post serve as a test-bed for commenting.  Please note any problems or bugs; if you can’t login or comment for some reason, just send me an e-mail (far right sidebar).

And remember, I don’t necessarily see any problematic ads that you see.  If you do not send me a URL, then I cannot help you.



UPDATE: Thanks for all of the comments below.  We’re going to be doing an overall template update soon (weeks), so some of the smaller stuff may wait until then, rather than patch up the old template.


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The Skilled Leadership of Donald J. Trump

[ 103 ] June 28, 2017 |

It’s this kind of policy command that will allow Trump  to get the bill over the hump:

Until Tuesday’s meeting at the White House, Mr. Trump had spoken with only a few members of the Senate, according to an administration official. The pace was nothing like the dozens of calls he made to help pass the House’s health bill, aides said.

A senator who supports the bill left the meeting at the White House with a sense that the president did not have a grasp of some basic elements of the Senate plan — and seemed especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy, according to an aide who received a detailed readout of the exchange.

Mr. Trump said he planned to tackle tax reform later, ignoring the repeal’s tax implications, the staff member added.

It’s pretty clear that Trump knows essentially nothing about the content of this legislation. If presidential leadership was as central to policymaking as a lot of people think the bill would be dead. It isn’t; this isn’t a major liability, but it doesn’t help them cobble a majority together, either.

No Vote on TrumpCare In June

[ 293 ] June 27, 2017 |

This really is important:

Facing a rebellion within their own ranks, Senate Republican leaders on Tuesday postponed a vote to overhaul the 2010 Affordable Care Act until after the July 4 recess.

The delay, which came after five Senate Republicans said they could not support a move to bring up the bill this week in the wake of a new budget analysis of its impacts, means that lawmakers will be exposed to a barrage of lobbying in their home states in the coming days. The current proposal by Senate Majority Leader Mitch McConnell (R-Ky.), which would make deep cuts to the Medicaid program while rolling back many of the existing law’s insurance mandates and tax increases, has come under attack from both the left and right.

The war is far from over. But what’s significant about this is that it shows the conflict within the Republican conference isn’t just kabuki. In itself, delay is bad for Republicans — if McConnell had the votes, they’d be voting. This doesn’t mean he can’t get them — he might — but he doesn’t have them now. The pressure needs to be kept up.

The complete inability of the Republicans to do policy might actually save the ACA. I assume McConnell and the rest of the Gang of 13 expected to backload enough cuts to get the CBO uninsured number under 20 million, and using this to get the media to use the House bill rather than the status quo as a baseline, and presto a “the Senate bill is much less mean!” narrative. But the numbers were so close they couldn’t do that. If the arguments being made by conservative “intellectuals” are any indication,  they genuinely don’t seem to understand that poor people don’t have any money and hence aren’t going to buy and maintain plans with insanely high deductibles.

Again, it’s entirely possible that the same process that played out with AHCA will play out here. But passage is not inevitable — it’s a fight that can be won.


Comment Addenda

[ 52 ] June 27, 2017 |

A couple more thoughts on the comment transition…

We are firmly of the camp “if it’s not broke, don’t fix it” with regard to technical updates to the blog. I can appreciate that, from the outside, it does not appear that the comment system is broken. From the inside, however, we’re on the edge of collapse; the tools that we’ve been using for years to manage comments are breaking down and becoming non-functional. This has meant slower (and less effective) elimination of trolls, slower liberation of comments pushed into “pending,” and slow-to-non-existent responses to editorial requests. Our tech people tell us that things will not get better without a significant expansion of our server footprint, which will cost more than moving to Disqus while providing less functionality.

With regards to the complaints about Disqus… I get it. If we loved Disqus we would have moved over years ago. But I honestly don’t see that much of an overall difference for the commenting experience between the system we have now and the system we’ll be adopting. For the administrator, on the other hand, Disqus offers many more management tools than WordPress. It’s not a total lock that all of these tools will be used for good, but at least there’s some reason to expect that they’ll work three months from now.

In any case, I plan to be around all day tomorrow, troubleshooting the problems that can be troubleshot.  As always, thank you for your patience…

The Management

The Infuriating Bad Faith of Arguments That Health Insurance Doesn’t Improve Health Outcomes

[ 163 ] June 27, 2017 |

It’s like, how much more McArdle could this be?

Republicans want to kill you. Worse than that, they want to kill you so that they can give your money to rich people who don’t need it.

Why, yes. This is entirely accurate. Well, actually, “you” should be replaced with “poor people” — the typical McArdle reader isn’t very likely to have their access to healthcare being put at risk. To continue:

If you’ve been reading social media over the last week, that’s the main message you’d take away. It started when the Senate released its long-awaited health-care bill, the culmination of nearly a decade’s promises to repeal and replace Obamacare. This bill was not so much a repeal as an adjustment, and not so much an adjustment as a tweak. But it did propose to eliminate most of the taxes used to fund Obamacare, including the reviled individual mandate. And alter the funding structure of both Medicaid and the premium subsidies to make them somewhat less generous. So obviously: Republicans want to kill you. Their rich donors need your bodies to use as mulch on their diamond plantations.

McArdle think she’s engaging in hyperbole when, in fact, she’s describing the BCRA. It takes more than a trillion dollars in health care funding, mostly for the poor, and gives most of it back to the very rich in a tax cut. The consequences of the cuts will be preventable death, suffering, and financial ruin.

And the thing is, in the rest of a fairly long column, she doesn’t really rebut this, just repeats some Roy-like nonsense about how under the BCRA insurance is a “sweet deal” for the poor which completely ignores the deductibles that would make insurance completely worthless. Here’s the thing: you can’t massively reduce subsidies without massively reducing the number of poor people without insurance, because (although McArdle doesn’t seem to understand this) poor people don’t have any money, let alone 6 grand a year to spend on co-pays. But, then, really a more than trillion dollar cut is just a “tweak.”

One approach, which McArdle has used in the past, is to claim that that the BCRA’s massive reductions in spending and hence in the number of people with insurance are no big deal because insurance doesn’t really have any value. Friend of the blog Avik Roy:

The Senate bill includes and refines the best part of the House bill: its reforms of Medicaid, the dysfunctional government-run health care program for the poor whose enrollees have no better health outcomes than the uninsured.

Ross Douthat — who at least opposes BCRA — makes the claim vaguer and applicable to all insurance:

The best conservative health policy analysis proceeds from the controversial but, I think, correct perspective that much health spending is wasted and that people do not value or benefit from insurance as much as liberal technocrats presume.

The stronger, more specific version of the claim leans heavily on cherry-picking one study about Medicaid in Oregon, which 1)by its nature could not have demonstrated that Medicaid was no better than being uninsured and 2)did no such thing in any case.

Anyway, there is more than one study out there. Does the evidence support the incredibly implausible idea that being insured does little or nothing to improve health outcomes? Of course not. The evidence is overwhelming that people on Medicaid benefit substantially from having insurance. The best evidence indicates that upwards of 30,000 people a year will die preventible deaths if BCRA becomes law. So, while it might sound like Swiftian hyperbole, “Senate Republicans will make poor people suffer and in some cases die to pay for an upper-class tax cut” is, in fact, entirely accurate.

What’s particularly infuriating is that this ridiculous speculation is being engaged in by people who will never themselves be without good insurance. None of these people are going forego anything but ER care the rest of their lives. Conveniently, if Republicans succeed in passing this unspeakably appalling bill, “being uninsured — is it really bad for your health?” is an experiment that will be carried out on other, less privileged people. And if it turns out that lacking insurance leads to pain and suffering and death, as the evidence actually indicates, well, they owe you a coke! (Note: offer of a coke will not be honored, moocher.)

Oppose Any Foe

[ 32 ] June 27, 2017 |

My review of Mark Moyar’s Oppose Any Foe is now up at H-Net.

In Oppose Any Foe, Mark Moyar chronicles the history of American special forces since World War II, casting a critical eye on the development and employment of these units. While Moyar acknowledges the heroism of such forces, and their effectiveness in certain tactical situations, he effectively paints a skeptical picture of their overall impact on warfighting, and on the larger American defense establishment. Moyar begins his account by discussing the prehistory of today’s special operations forces, the ad hoc units developed in the European and Pacific theaters during World War II. He examines both the political and military logics underlying these foundations, which often depended on idiosyncratic assessments of value and the strength of specific personal relationships.

One passage in the review that tragically did not make the cut, but that some readers may find useful anyway:

Finally, some of Moyar’s stylistic choices grate. “[General Dick] Scholtes watched the drunken revelry with the revulsion of the Theban King Pentheus observing his subjects debauched by the wine and carousing of Dionysus” is an analogy that may well work for a few of Moyar’s readers; it will mystify some others, and for most it (along with similar allusions sprinkled across the text) will seem an altogether gratuitous example of flashing classical knowledge to no particular point.

On enormous piles of money surrounded by many beautiful ladies

[ 96 ] June 27, 2017 |

Avik Roy ladies and gentlemen:

It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today.

For reals? How do you figure . . . ?

The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods.

The CBO estimates that 15 million fewer people will buy insurance, because the GOP’s bill will make it impossible for many millions of people to buy “health insurance” in any economically meaningful sense:

Under Obamacare, insurers cover a large portion of out-of-pocket costs for individuals making up to 250 percent of the federal poverty level — about $30,000 for an individual and $61,000 for a family of four. In exchange, the federal government reimburses them for the difference. The theory is that customers in this income range would otherwise struggle to benefit from a silver plan with deductibles of $7,500.

But the House and Senate bills each eliminate these cost-sharing provisions — and the effects would be dramatic, according to a Kaiser Family Foundation analysis. If you’re an individual making around $18,000 a year, your effective deductible would be about $255 under Obamacare. Under the Senate bill, though, that number would jump to over $6,000 — almost 24 times higher.

People who make $18,000 per year have an after-tax income of about $1,250 per month. Under the GOP plan, these people will be required to pay nearly half their total expendable income in deductibles, if they should make a poor lifestyle choice, like getting sick or injured, and then decide to try to get medical treatment.

So obviously they’re not going to buy fake “insurance” under these circumstances.

What Roy points out is that the CBO doesn’t take into account the possibility that the same party that is passing this bill might not subsequently create a bunch of subsidies that will make it rational for these people to buy health insurance. You know, like Obamacare currently does.

Don’t read the whole thing if you value either your sanity or your breakfast.

. . . I see Scott beat me to it.

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