08 September 2017

On my high horse about medical billing practices

I wrote this to the administrator of a for-profit Catholic medical group (which is well-known and widespread in the Pacific Northwest and also operates a chain of for-profit hospitals that are known to be a bit on the "pricey" side).

------------

 Dear Dr. XX, 


I am writing to you about a matter of great concern to me, as a patient and spouse of another XX Medical Group patient. This is a concern that affects much of the for-profit and even non-profit private health care delivery system in this country, and I believe that it is a specific area where financial practices which are immoral and unethical are being commonly not only tolerated but actively engaged in, including by your organization. It is an area where I strongly believe that right-thinking medical administrators can and should voluntarily institute a simple reform for the good of all the citizens of our country, but most particularly for those who are unfortunate enough to have inadequate or no health insurance at all. I hope to at least suggest to you that this is something worth thinking seriously about. While the ultimate resolution of our ongoing national health care reimbursement policy crisis will almost certainly be political in nature, in the meantime, there are specific actions which providers can take which would increase equity and reduce the adverse impact of our medical cost crisis, especially on those least able to shoulder the burdens. Until our nation faces up to the necessity of ensuring health care as a right not a privilege, it is unfortunately incumbent on health care providers to ensure some degree of equity, to see to it that costs do not fall disproportionately on those least able to bear them.

 

I need hardly belabor the point that health care expenses are a major source of anxiety and stress for the shrinking middle class in our country. In some ways it is they, as opposed to the actual poor (who receive Medicaid), who are most affected by the problems I am talking about. Unexpected and inadequately insured medical expenses are the leading cause of personal bankruptcy in our country, as I'm sure you know.

 

The practice I am referring to is that of billing uninsured patients far more than would be reimbursed if they had insurance. I know that your organization offers to work with patients, but merely receiving a bill for $500 when the insurance would pay $350 (or even less) for the same services is a shock and assault on people's well-being. And this doesn't even address the fundamental inequity of the default expectation, contrary to any ordinary sense of fairness, that patients who lack coverage should pay, or at least be presented with the expectation that they pay, more for the same services than those who have coverage. And we should not pretend that it's easy or routine to secure reductions of these "full ride" costs. The entire burden of trying to get out from under enormous medical debts falls on the patient, when frequently the patients are at a point in their lives where they are least able to cope with such considerations and the necessity of negotiation and wrangling over medical bills. People routinely get unexpected bills in the mail that cause them huge distress, only to have to spend time, effort, and mental anguish trying to figure out how to cope with them.

 

And this is just plain wrong. My attention was drawn to this situation again, when, recently, my spouse went in for a wellness visit, and apparently the insurance was slow to adjust the billing. Upshot: we received a bill for $527, the non-discounted sum, with no explanation, no attempt to call us to explain that there was a delay with the insurance, just a bill. And it turned out that the EOB had crossed in the mail, and the insurance had already paid in full: $398 (the insurance discounted amount). My spouse presented as an insured patient, and even so was billed the full amount. Patients who have no insurance, or coverage problems, who are typically people with fewer financial resources than more fortunate insured patients, are expected to shoulder more than their proportionate share of health care costs. Of course some cannot pay, but that doesn't make it ethical to expect and dun people of limited means to pay more than others who have more resources. I put it to you, Dr. XX: such practice is both immoral and contrary to the tenets of every traditional religion, not least Christianity. I say this flatly and bluntly, and I hope you will consider seriously what I am saying. It is wrong to perpetuate a system that shifts greater financial burdens onto the less well off and the sick. Period. What must be done is that a program be instituted to make sure patients whose costs are not reimbursed receive bills which are no more than the typical insurance reimbursement. No other practice can be tolerated.

 

In our case, the matter was resolved, and we are not victims of the anomalous inequity I am complaining about, although we were exposed to it. We are fortunate enough to be adequately insured, even if the claim administrator was slow to process the claim. But many people are not, and bills like this are a serious burden on the finances of many who are least able to afford those burdens. Health care providers should never bill uninsured patients more than what insurers would ordinarily pay for the same services. Period. It's wrong, and it's one of the immoral practices that have tainted the entire profession of medicine in our country.

 

To the counterargument that health care providers as squeezed in all directions and costs for them are spiraling too, I can only say, this may be true, but it does not excuse disparate billing practices that disadvantage the less well off and the sick. Some other ways of meeting expenses simply must be put in place, because this practice is wrong.

 

Thank you.

Sincerely,  XX

 

06 September 2017

Oregon fires

I haven't read any scientific analysis, but is sure seems to me that Oregon's climate is rapidly transitioning to a hotter, dry summer, colder, wet and snowier winter regime. The summer is more like California, the winter more like someplace like Arkansas. In comparison to formerly I mean. I can't but assume that if this persists the forest environment here will change, because I don't think it can withstand three months without rain (like this year) every year. 

Not to mention the wildfires, which are truly terrible. Fortunately, it's finally cooler and moist air from the ocean has moved in, to mitigate the smoke. What we need though is a drenching rain, and that's not in the forecast. 

02 September 2017

Three Laws of AI ? Nah

I read this article in the NYT with some bemusement. (It's an attempt to codify a more modern version of Asimov's "Three Laws of Robotics," which were his attempt to imagine how a superior artificial life form might be permanently controlled by its creators, us).

As someone who spends a certain amount of mental energy thinking about the future, and the future of technology, let me propose a truism:

The possible manifestations, both for better and for worse, in terms of human outcomes, of any new technology, will eventually emerge, regardless of any attempts to control or regulate them.

So, control genetic manipulation, even the creation of new species? Forget it. That ship is on its way out of the berth. And that means that future human evolution, way on down the road, perhaps, but inevitably, will be artificially guided. A very discomfiting thought, but count on it.

But I don't worry about AI robots taking over and supplanting us. If I'm wrong, well, they will, and RIP human race, our successors will be cyborgs. Get over it. But I don't think it will happen. And here's why.

Despite what people like Ray Kurzweil and Marvin Minsky say, I don't know of any evidence that artificial machines have ever been developed that have ANY self-awareness. Complex computational ability, yes. Modeling ability, which can look like an internally aware system, sure, but there is no suggestion that there is awareness "behind the eyes." The idea that a sufficiently complex, recursive computational system inevitably becomes self aware is actually just an assumption, a bias, even, for which, to my knowledge, there is not only scant evidence, there is NO evidence.

We really don't know what consciousness is. The problem of studying it objectively is not trivial. B. Alan Wallace and Daniel Dennett have grappled with it, but not come up with any definitive empirical view. The problem is that it's virtually impossible to examine something that is definitionally subjective and internal by using methodologies (Western scientific procedure) that are definitinally objective and external. So our only real knowledge of consciousness is experiential. We do know that artificial computing systems work very, very differently from biological ones, and that an advanced working model of a biological type brain is not even close to having been created artificially.

So, I don't worry about robots taking over. As long as we remember to always install a kill switch.



A casual report


Things are odd, as usual, en Amerique. Yesterday in San Francisco was the hottest day ever recorded there, 106° (41° in real). But the Russian consular annex, having just been given 48 hours to vacate, as part of the ongoing retaliatory tiff (wherein the Russians slashed American embassy staff in retaliation for sanctions which were in retaliation for the most serious cyber attack on another country in history, so somewhat asymmetrical, but I digress)...anyway, they started a fire in an outside bin and an inside fireplace. The fire department was called but was told "Zdes' nechegto smotret" ... "nothing to see here..." the Russians were obviously burning sensitive documents. Don't they know about shredders? 

The West Coast's epic heat wave (not yet arrived in the Portland or Seattle areas but expected shortly), is yet another instance of extremes of weather that climate scientists like Michael Mann and James Hansen are no longer equivocating over: they are definitely being caused by increases in atmospheric CO-2 over the last century or so in particular. 

This all contrasts with the continuing obsession of Toddler/Man president, who still has never actually criticized Putin or his government in public since declaring his then seemingly quixotic run for office now more than two years ago.  Toddlerman is now widely expected to cancel the DACA orders put in place by Obama in 2012... despite strong support among even many Republicans (such as Dippy Paul of Janesville) for keeping them. Apparently just out of spite. He delayed the announcement just to keep hundreds of thousands on edge over a holiday weekend. Former (R) Sen. John Danforth of Kansas put it quite bluntly the other day in an op-ed:  "Our party has been corrupted by this hateful man." 

Meantime the Mueller investigation continues apace. They have brought in CI, the elite criminal investigations unit of the IRS to help untangle financial crimes (probably focusing on Manafort). They also, weirdly, apparently unsolicited, received briefs from Trump's defense lawyers as to why firing Comey wasn't obstruction of justice (presumably under the specific circumstances, because without them it's kind of an empty issue). Jill Wine Banks, a Watergate era prosecutor, commented that the Trump defense people appear to be "on their heels." We don't actually know what evidence there is of actual collusion with the Russians, but the circumstances and timing of the release of the hacked emails to Wikileaks is looking really suspicious, and the conduct of the president, including his comments to Lester Holt about the Comey firing and repeated conversations with various people where quid pro quos were broadly implied viz. the Russia investigation, looks more and more like a plausible bill of particulars for impeachment. If the Republicans in the House ever get to the point where they have any stomach for that. At least Mueller will likely give them a report that will be damning in the extreme and if they don't impeach, their failure to do the obviously right thing will be there for history's judgment. 

I still don't think it's the right strategy for Democrats to put a lot of stock in the Mueller investigation to "save us." We have, as a party, failed miserably, and we must rebuild our message and present candidates, especially for the House, who present an obviously superior alternative to the chaos and corruption of the Republicans. If we do not do this, and just rely, as Clinton did, on "they're awful, and we're not so bad," we will lose many of these elections and our democracy, which I really believe is currently in greater peril than at any time in the last 150 years, will remain in great and increasing peril. This isn't tiddlywinks: we should be fighting for our political lives as a Center Left political movement. Fortunately, there are many in our party who see it in just these terms, and things are happening. I am optimistic. 

30 August 2017

Secular Buddhism

Anyone who has made any real effort to practice or understand Buddhist doctrine (Dharma) will acknowledge that the traditions of Buddhism can be very complicated, and frequently challenging, both intellectually and in terms of putting them into practice. But I think it's fair to say that for many in the modern western context, there are hangups that frequently interfere with success in either of those endeavors that arise from what you might call the supernatural aspects of the traditions, particularly any even modestly literal view of the doctrines of karma and rebirth, both of which seem to lack any plausible mechanism consistent with modern objectivist, or empirical, or scientific, thinking. These paradoxes have caused many a well intentioned practitioner to stray from Buddhist practice, even though they may have experienced an overarching truth in the teachings of compassion, lovingkindness, meditation practice, and the doctrine that our discursive thought and focus on, and concern for, ourselves and our own well being, are largely based on active and malignant delusions. We may feel that these insights are true, but get bogged down on other things that are incorporated into Buddhist tradition which seem, well, impossible.

There are a couple of relatively new books out that try to grapple with these issues, reviewed recently in an essay/review by Adam Gopnik in the New Yorker. (See their website, you can read it free). The first is Robert Wright's Why Buddism is True: The Science and Philosophy of Meditation and Enlightenment, and the second is Stephen Batchelor's After Buddhism

As a "secular" Buddhist myself, I find these attempts to define what it means to be a Buddhist without resort to nonscientific beliefs very interesting and helpful. I do agree with the letter writer to the New Yorker who says (paraphrasing) that Gopnik focuses too much in his essay on the wisdom aspect of Dharma (emptiness, or the illusory nature of clinging to a particular view of reality), as opposed to the equally important role of compassion, which is often most thoroughly experienced in the practice of what in Tibet is called Tonglen, or more generally "exchanging self with others," i.e., recognizing the essential truth that we are all the same in our essential view, and that suffering is pervasive. Without compassion, we are lost. But the good news is that when Gotama taught not to accept what he said on faith, but to try the recommended practices and see if they work for you, he was creating a tradition that sill lives, and still works. Because what is objectively real is that you can in fact learn to drop story lines, and see the present moment as it is, and you can learn to practice compassion. There are simple techniques, and they aren't magic, they're just method. And they work. In those techniques lie the essential "truth" of Buddhism, which we "secular Buddhists" contend is not a religion but a practicum, which requires no faith, but rather trust in a system that has been shown to work over a very, very long time by a large body of serious and dedicated practitioners. 

22 August 2017

Eclipse set up


This is our set up near Antelope, OR for the eclipse. It was extraordinary. Eerie. Spooky. Truly a once in a lifetime experience. We got up at 3 AM to drive out to central Oregon, and found this spot; clear skies except for the smoke visible to the South. Coming back was an epic traffic jam (partly due to poor choice of exit route), but it was worth it. 

Antelope was formerly (temporarily) known as Rajneeshpuram. And if you've forgotten or never knew that amazing and sordid tale of the 80s, look it up in Wikipedia. We were a good 15 mi. from the Big Muddy Ranch, which was their desert city for a time. 

09 August 2017

Prognostications

People never give up trying to predict the future though. So test me on these. 

By 2025 (hey, even folks born in the 1950s stand a good chance), over 50% of all new cars will be electric. The cost of electric transportation will drop to less than the cost of fossil fuels, and since the cars are simpler and last longer, the long term transition to carsharing as the norm, with the coming on line of driverless technology, will mean that the paradigm where people will order a car to their house per use rather than own them will have begun to transform transportation, at least in urban and suburban areas. This process will take some time but will be evident by 2025. 

It's already the case that solar and wind energy is cheaper than fossil fuels in some markets. This presumes new plants; it will take a long time for existing infrastructure to be replaced. But by 2025 in the US, which will lag the developing world, especially China, all new electric generating capacity will be solar or wind, with minor hydroelectric and tidal. Nuclear will be phased out, because it's way, way more expensive, never mind waste considerations. (The nuclear industry doesn't like anyone to point this out, but the truth is that no nuclear plant has ever been built without government subsidies, anywhere). Fusion will still be the perennial "ten years away." I actually do imagine fusion energy will eventually be developed, but the Earth receives more theoretically usable solar energy in an hour than the human race uses in an entire year, so the perfection of solar technology (essentially already here), coupled with continuing improvements and cost reduction in battery and other storage technologies, will be the main drivers of the energy economy post 2025 worldwide. 

Combining these two trends, fossil fuels (and not just coal, but oil and gas, too), will be in the beginnings of a long term decline to near zero by the end of the century. Oil and coal will be used essentially entirely for materials, not energy, by 2100. (A use for them that has a bright future long term; we will not stop using plastics anytime soon, and fossil carbon is a great source of raw materials). All energy production will be carbon neutral by 2075 or so, everywhere on Earth.  

OK, enough. 

25 July 2017

Doin' what I can to preserve the ACA

I emailed this to every single Republican in the Senate who I thought could conceivably be influenced to vote no. Portman, Capito, Heller, Flake, McCain, Rubio, Collins, Murkowski, Moran... any others ? This is important... and this is make or break. They've now gotten past the firewall whereby the bills are on the floor of the Senate. If McConnell can convince 50 of his colleagues to vote for any one of the many versions of this unimaginably horrible legislation, it's ALL OVER. Please help by contacting Senators, especially Republicans' in their offices home and in Washington and urge them to vote NO.


It is increasingly clear that there is no version of the Republican health care bill which does NOT make huge cuts to Medicaid, impose unacceptable premiums and deductibles on older moderate income Americans, and destroy the important reforms that help to ensure meaningful and genuine health insurance for almost all Americans. Estimates for all versions range from a loss by 15 to over 30 million Americans of health insurance coverage. Along with the vast majority of American citizens, I STRONGLY urge you to vote no on all of these destructive and terrible bills. Kill the bill, not your constituents. VOTE NO. Thank you. 

19 July 2017

Messaging Trump over ACA

For all the good it will do, I posted this on the White House contact line.

«I want to urge the president to set politics aside and do everything possible to make existing health care laws WORK to provide health insurance for the American people to the fullest possible extent. The president took an oath of office to take care that the laws of the United States be faithfully executed. That means NOT doing anything to undermine, reduce the effectiveness of, or sabotage the Affordable Care Act. Thank you. »

Presidential leadership

That's presidential leadership for you. Promise sweeping, "really good" health care reform, do nothing to achieve it, watch the ridiculous and cruel efforts of your party's attempt to pass a huge tax cut and call it "health reform," then, instead of saying, "Folks, we tried, but we will just have to make the current ACA system work, and my administration will do everything possible to make sure every American gets the best health care possible under existing law," you say "We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it. We'll let Obamacare fail, and then the Democrats are going to come to us." (And the hell with my constituents and all the rest of the American people who rely on a functional government). Read that statement again and let it sink in. The president of the United States said that.

This man is unquestionably the worst president in the history of America. I'm not religious, but I can only PRAY we get through this time without critical injury to our nation's very means of continuing to exist. No rational person can possibly support this monster any longer in good faith; which leads to the conclusion that the only people who do are incapable of distinguishing propaganda from reality, or, in the case of the more well heeled among them, they are lying crooks themselves.

It won't work, though, their plan to devastate health care by sabotaging the Affordable Care Act, and then wait for "Democrats to come to us." REALLY? When the Republicans have both houses of Congress, the presidency, the Supreme Court majority, and they 100% excluded Democrats from ANY participation in their discussions of their bill? No, GOP, you will own this. And we will defeat you in 2018 in large part because of this.

And the main reason for that is what will turn out to be the signature achievement of Pres. Obama and the ACA: we have ESTABLISHED in the hearts and minds of the American people that health care, as a social compact, is a RIGHT NOT A PRIVILEGE, and we will see to it that that promise is DELIVERED to the American people. We will leave the legacy of the Radical Right in the dust, fatally wounded by their own incapacity to govern. 

They have lied to voters on a massive scale, and manipulated the government's "operating system," with all its flaws, to achieve minority rule of our major institutions. But they have fundamentally failed to deliver because their governing philosophy is complete crap, totally nonfunctional and out of accord with realities of economics and how public policy actually works. Their failure was inevitable, and it is now absolutely manifest. I truly believe that a huge paradigm shift is about to change the way large majorities of Americans think about trusting the Right to govern, and not in a good way for them. 

But of course, it all depends on our ability, as Democrats, to present a coherent, values-driven alternative, that all Democrats can espouse and make real for people. And this we have yet to achieve. We simply must rise to this occasion. Cajole your Democratic leaders, make your views known. Tell them: "Majorities say Democrats don't stand for anything other than opposition to Trump, and that's NOT GOOD ENOUGH. Articulate the Democratic alternative, and appeal to the common sense, decency, and morality of the American people. Do that, and we will win."

13 July 2017

What the Hell is Wrong with Democrats (posted to Facebook)

What the hell is wrong with Democrats? With the Republicans in FULL MELTDOWN, here is a historic opportunity to create a new policy consensus. But you GOTTA HAVE A POLICY, and YOU GOTTA COMMUNICATE IT.

There should be a ten point agenda that Democrats universally stand for. Any one of us of the "Sandersista" wing could give you a pretty good approximation of what's needed, both in terms of policy and how to promote it. So let's get busy! Seize the day! Every time Trump or the stupid Republicans fall flat on their face, as with this horrible tax cut masquerading as a health bill, we DO MORE than point out how bad it is. WE ELUCIDATE CLEARLY what alternative we stand for (in that case, MEDICARE FOR ALL).

DEMOCRATS failed by being lukewarm Republican-light. WE WILL SUCCEED by offering a convincing and specific alternative.

06 July 2017

Voice of Evil

Here is the voice of evil. (Paul Ryan in this case). 

"If you're not going to force people to buy something they don't want, then they won't buy it," House Speaker Paul Ryan (R-WI) said on Fox News. "So it's not that people are getting pushed off a plan. It's that people will choose not to buy something they don't like or want."

Bloody hell. 

29 June 2017

Re: Hillary at ALA - Fantastic!

Clinton is smart, and capable, and it's tragic that she didn't become our president due to an archaic flaw in our Constitution. (Why, o why is the Democratic Establishment not pushing the National Popular Vote Compact harder!? It's currently FAILING here in Oregon!!) Having said that, I can't really look at her without thinking, why did we let this happen? Clinton was the wrong candidate, beset with baggage and neoliberal associations that are exactly wrong for our current political milieu, with a terrible, very poorly thought through campaign, and a tepid, uninspiring message. Just when our party needed a bold, charismatic leader and agenda, we got "Trump is unthinkable, and I'm the sober one." Didn't work, and we should never have thought it would. We lost an election we could not afford to lose, and it's impossible not to hold her partly accountable for that. History certainly will. 

We must turn the page and embrace a much bolder approach. I recommend Naomi Klein's No is Not Enough: Resisting Trump's Shock Politics and Winning the World We Need or listening to Robert Reich's Resistance Report podcast for some ideas about where the Democrats need to go if we are to reverse the Radical Right AntiDemocratic Takeover, which is now terrifyingly close to complete victory. (And if you doubt that, take a look at Democracy in Chains, by Nancy MacLean). 

On Wed, Jun 28, 2017 at 7:03 PM, Jim Heidt <jimh6951@gmail.com> wrote:
A great presentation at the AmerLibr Assn meeting.    Jim H

---------- Forwarded message ---------
From: Charles Hanson <chanson449@gmail.com>
Date: Wed, Jun 28, 2017 at 4:00 PM
Subject: Hillary at ALA - Fantastic!
To: Jim Heidt <jimh6951@gmail.com>



28 June 2017

Democracy in Chains

My next major political history nonfiction book will be Democracy in Chains: 
The Deep History of the Radical Right's Secret Plan for America  by Nancy Maclean, a historian at Duke University. There was a good interview with her by Sam Seder on Majority Report yesterday (podcast). She recounts the origin and strategy, now very close to victory, by the Libertarian ("Virginia School") Right Wing to completely hijack and destroy American Democracy. (Make no mistake, and it's no joke, people like Hayek, Murray Rothbard, Charles Koch, James Buchanan (not the 15th president and not Pat Buchanan, but one of the most sinister political philosophers of modern times)... these people do not believe in Democracy. Their goal is to seize power and change the constitution to protect the rights of a single minority, and their final coup will be an Article V Constitutional Convention (they're only 6 states short already). Whereupon they will proceed to destroy what's left of Democracy in America forever. 

This is a serious threat. Not a joke. Not a polite disagreement. It's war, or revolution. And we are losing. We must organize to resist this movement before it's too late, and a good place to start is by reading this book, along with George Lakoff's The Political Mind, in order to understand exactly what it is we're up against. 

23 June 2017

Utterly despicable evil that is the Republican Tax Cut Plan Masquerading as a Health Care Plan

I oscillate between black rage and pernicious, gnawing despair at the pure evil which is the Republican Tax Cut claiming to be a Health Care Plan. And my emotional response is largely fueled by the intellectual realization that it will most likely become law, and its dreadful, actually murderous, effects are very likely to actually occur. People I know very well will be terribly hurt by this. People in my own family will be faced with terrible dilemmas, and restrictions of choices. And, far worse, many, many thousands of Americans will needlessly die and suffer from lack of needed health care because of the cruelty and vicious disregard for their fellow humans that is the hallmark of today's Republicans. This isn't some difference of opinion among civilized people. It is a dichotomy between common decency and outright barbarism. 

I understand the need to focus on what can be done to change the political trends, and I do believe that the Democratic Party, if it embraces a genuinely progressive agenda and comes up with people who can promote that agenda as a program for positive change, not a stop gap of damage control (which is never very inspiring), can prevail in 2018 and 2020. It will take work, but it can be done. 

I cannot deny it: my hatred for the policy is also personal. The prospect of the terrible, truly incredible human suffering that these people are willing to wreak while they yet wield power, just to eke out a little bit more in unfair tax breaks for their richest constituents, simply appalls. Truly. I can not help but feel genuine, fulminating hatred for these people. I am committed to nonviolence and peaceful political action. But that does not change the fact that, while try always to practice compassion and lovingkindness, I am not capable of it in this context: this action is so evil that I cannot help but personalize it, and feel hatred and utter disdain for those who are promulgating it. 

I can only hope that others who feel as I do will try, as I will try, to channel that energy into action to actually do something to change this situation, through peaceful democratic political processes. 

The details are largely unimportant. The overriding principle is at stake. Everywhere in the advanced world, except here, the principle that citizens are entitled to reasonable, first world health care, and the the society must structure a system to pay for it, is accepted. There is no reason, other than greed and arrogant contempt for humanity, that we can not do this. And this bill will take giant steps backwards, to a status FAR WORSE than what we had before the Affordable Care Act. This is simply fact, and arguing over this or that detail, as they do on Vox's The Weeds and other forums, is pointless. This policy is especially cruel to the poor who depend on Medicaid (which is largely slated to be destroyed, so that it cannot work at all), as well to lower to middle income older people, who face costs for woefully inadequate health coverage so cripplingly high that many millions will opt not to pay for it. Instead, they will risk catastrophe and go bare, without insurance. Many of those people will suffer sickness and death, without care, as a result. This is evil, pure and simple. Not bad policy. EVIL. 

We must fight this, now, and until this evil is excoriated from our body politic. 


20 June 2017

I am Polyanna, but . . .

I just emailed this to Sen. Schumer: 

Dear Sen. Schumer: 

I believe that we Democrats have a historic opportunity in 2018 and 2020 to reverse course in a major way, but that a bold, clearly articulated agenda is needed. Democrats should call a CONVENTION, next year, not to nominate a candidate but to forge a platform, a broadly agreed upon Progressive "contract with America" (need another name). Democrats will then run on this, as a unified party that stands for something that is clearly what the American people want, in contrast to tax cuts for the rich and huge cuts in programs that benefit everyone else. And I think the fact that in broad outlines Democrats win by turning their backs on neoliberalism and supporting a "Bernie Sanders agenda," in the main, is now established fact. 

But the immediate plank in the platform that should be put forward as soon as possible, even if the horrible Senate Republican tax cut masquerading as a health care bill is rammed through, is a DEMOCRATIC health care alternative. Even if it can't gain any legislative traction, it can be out there. Promoted and published, written about, summarized, even touted in TV commercials as what we will do when we get the chance, so give us the chance. And what it should be is the "fix not repeal," but really more than that. It should include smart ideas about how to make the exchanges work, but what its real core should be are two things:  an immediate, real, sustainable and adequate public option, and an opt-out phase in of Medicare for All, with enhancements to make Medicare eventually function as a single payer system of good quality and efficient health care, with some kind of Medicare Advantage system for those who want to pay more for private, enhanced coverage. I think such a plan is already a compromise from pure national health service type coverage that would be all but impossible to pass. Sure, even this kind of plan is a long way from where we are, but our party NEEDS TO STAND FOR SOMETHING, and that something should include real universal health care. 

Democrats across the country are champing at the bit to unify around a boldly progressive party agenda, which recognizes that we have to get there from here, but also recognizes that the challenges on the environment, health care, economic inequality and skewed tax system that favors the rich, all need to be addressed with strong, sweeping, and INSPIRING policy initiatives. Wall Street will be fine; they will adapt. It's Main Street we need to worry about. 


17 May 2017

Schadenfreude?

I would be lying if I said that, since Trump started his long, slow meltdown, I have not had my moments of Schadenfreude. But the present crisis, although it really does look like the turning point that will likely end in the premature end of his horrible, horrible presidency, is nothing to celebrate. Our country is wounded by these events, and we will be lucky to emerge on the other end without damage that will be very, very hard, and take a long time, to repair. And that's not even addressing the damage Republican policies will inflict, to the extent they are able to enact them. That, in fact, is about the only silver lining: Trump's corruption and ineptitude will have derailed a good deal of the Right Wing agenda. 

14 May 2017

Petition: Tell Senate Democrats to REFUSE business as usual until a fully independent special prosecutor is appointed

I just signed a petition telling Senate Democrats to refuse to allow business as usual until a fully independent special prosecutor is investigating Trump, and I
​'d like to suggest you do so​
, too.
https://act.credoaction.com/sign/Comey_Shutdown?sp_ref=303655619.4.180932.e.576211.3&referring_akid=.11044146.X86oP0&source=mailto_sp 

New York Times translation

Digital automatic translation (such as Google Translate) is already useful, but it isn't the equivalent of human translators yet, and may never be (although I'd bet it will). So, when a publication like the New York Times has to decide which languages are important enough to translate the contents of the daily digital edition immediately so it can appear timely, they obviously can't do dozens. You might expect French, German, Italian, Russian, Japanese, Hindi, maybe. But they only do two, probably because of resource limitations. And which two? Spanish. Not surprising. Chinese. Which even a decade or two ago would probably have seemed very odd. But now, well, it's the obvious choice.

10 May 2017

This cannot just be allowed to happen without consequences!

Look, we always knew McConnell was and is a party hack who cares nothing for something even as basic as the Rule of Law. But saying there's no need for additional investigation is so outrageous that I truly hope and expect there will be an enormous backlash. Folks. We CANNOT let this just go by as if nothing had happened. Trump and his thug cronies MUST be called to account. And if the institutions of our government fail, we must take to the streets to demand that this matter be investigated impartially and the law be enforced.

No Compromise.
No normalization.
No cooperation till this happens.
No let up on our own party until they have the spine to stand up for our country.

09 May 2017

Stupid Party and the plan to destroy Medicaid

If the Stupid* Party, despite clangorous pleas from their own Governors, hospitals, medical associations, doctors, and even many health insurers, goes ahead to gut and destroy Medicaid, they will create such an ungodly mess that the ONLY SOLUTION will be Enhanced Medicare for All, aka Single Payer. I don't hope for that, because literally millions will suffer, and hundreds of thousands will die, as a direct result of Stupid Party stupidity, but that is what will happen. And in the process the Stupid Party will lose the White House, both houses of Congress, and if their current extreme stupidity continues, eventually even control of the Supreme Court. And that will serve them right, but at what a price!

(* Definition of Stupid, in case you doubt it: quality of a person whose habitual actions harm others, despite little or no appreciable net benefit to himself or his community. I submit that the fact that one party in this country overwhelmingly practices stupidity, while the other, by and large, does not, is well nigh irrefutable. And which is which should not even be a question).

08 May 2017

Old White Male Power's last gasp

I guess I am somewhat insular... nearly everyone I know is appalled by the retrenchment of White Male Power symbolized by the news photo this past week of a bunch of old white men gathered around the Old White Man in Chief to celebrate the meaningless passage of their huge Tax Cut and Ruination of Health Care Act of 2017... in only the House... with no chance that anything like it will become law. But if you sometimes have difficulty articulating to others the BIG PICTURE of why this is terrible, and OBJECTIVELY, FACTUALLY bad for America, I highly recommend this website, and, for an introduction, the excellent Ian Masters interview from yesterday with Stephan Schwartz.

02 May 2017

Trump supporting elimination of Filibuster even for Legislation?

So now we read where Trump supposedly favors eliminating the Senate filibuster even for legislation.

Of course, the fear is, if that were to come to pass, that the Republicans, who now control both houses, the presidency, and the Supreme Court, could simply legislate their entire agenda without impediment.

But I'm not extremely worried (just somewhat). For several reasons: 1. McConnell is unlikely to go along with this, for his own reasons, and increasingly members of both houses are not that intimidated by Trump's bloviation. 2. See 1. For the same reason, and because the Republican party is sharply ideologically divided, they are unlikely to unify around a systematic policy agenda. (Although they could indeed do a LOT of damage, which would take a good long while to fix, so No. 1 is a critical line of defense). 3. Although there is a pretty serious short term downside risk of very bad consequences, in the long run, eliminating the filibuster for legislation is both good for progressive policy outcomes, and probably inevitable, now that the confirmation filibuster has already been permanently trashed. And, after all, it IS totally undemocratic, so with the future in mind, its demise should be accepted if not, immediately, celebrated.

If they do end up doing this, our resistance will have to kick up into War Emergency Overdrive. Resistance, including making it clear to Republicans in the House and Senate that they could well lose re-election if they destroy the social safety net that so many of THEIR constituents and supporters take for granted, has so far saved the ACA and prevented a massive tax cut from taking shape and sailing through (which was feared, and which may still happen). Resistance, even in the face of a simple majority Congress, could prevent the evisceration of Social Security, Medicare, Medicaid, Progressive Taxes, and Fundamental Environmental Protections. But it will require truly MASSIVE activism on a scale dwarfing even the AntiWar movement of the Vietnam era.

Ready?

Republican Dithering may indeed kill the ACA Exchanges

It is unbelievably frustrating, as TPM reports, that the sheer ineptitude and dithering of the Republicans is creating so much uncertainty in the ACA Exchange marketplace that it will likely turn into a self-fulfilling prophecy: the exchanges will fail for the same reason stock markets often crash. Which is artificially induced uncertainty about the future of the "rules." If they would just quit messing with a system that works more or less (since they clearly have no intention of making the PROGRESSIVE fixes it actually needs), it would probably work OK until we can get rid of them in the next round of elections. But that may well not happen. Thanks to the uncertainty as to whether the critical subsidies will still be there for the next few years, the ACA likely WILL enter a death spiral, but not because of inherent flaws; rather because the government is not reliable. Sheesh. Now, in all likelihood, when the time comes, we'll have to start all over. And create Medicare for All. Which is a good thing. But in the meantime, people will suffer and die. And the blame goes nearly 100% to Trump and the Republicans in Congress.



28 April 2017

One grows weary

One grows weary.

The Republicans are a tripartite unholy alliance of Far Right Wingers (Tea Party), Ayn Randian Libertarian Ideologues who basically actually believe the kool aid that "low taxes and minimal government" is best for the people (ignoring that it is ALWAYS hijacked by the rich and powerful), and purely self-interested billionaire oligarchs, whose ultimate icon is Trump himself. These people seek to DESTROY the postwar prosperity for the great mass of the people that most Americans are still clinging to, at least as a myth.

Take this ridiculous, but fundamentally SINISTER proposed pair of huge cuts to the taxes the very richest pay. The first, dishonestly labeled "health care reform," is really nothing but a massive tax cut, eviscerating the taxes on the very rich and health care corporations that funds the subsidies that make Obamacare work (to the extent it does). The cuts are made up for by "something really great" all right, for BILLIONAIRES. Ordinary people get totally unaffordable health care, and at least 25 million will end up with no insurance. It also, stealthily, effectively ends MEDICAID, on which tens of millions of Americans depend for health care. People will die. Republicans don't care.

The second, the truly breathtakingly dishonest, mendacious and nakedly greedy 1-page "plan" Trump touts as tax reform, is the polar opposite of what he promised. It amounts to an enormous tax slash for people like him, with almost no tax benefit to ordinary people. It would explode the deficit by $5 trillion over ten years. Which will come out of essential government services. Only the military will escape massive cuts. Any idea that "growth" would offset these massive cuts is lunacy; we have seen repeatedly that just the opposite happens.

And as if that weren't enough, the Randites like Paul Ryan are working on a truly nefarious plan to eliminate payroll taxes. Sounds great, huh? But their motive isn't to help the middle class. It is to ELIMINATE SOCIAL SECURITY AND MEDICARE. Don't believe anything else. Of course they won't try to do it all at once, but that is their game plan.

These people are EVIL. Period.

RESIST.

Peace.

24 April 2017

Trump / Le Pen

Trump has made it pretty clear he favors the overtly racist, fascist Le Pen in the French presidential election. The shame of that is almost unbearable to those of us who actually believe in American democratic traditions.

20 April 2017

Newsflash: Donald Trump is a moron

Trump's moronic comment about the worst (and least likely to pass) tax cut called a health care bill yet ("Really, really good") proves it. This man is not only deranged and incredibly, dangerously ignorant, he is JUST PLAIN STUPID. I guess he's good at a kind of assholery that can be useful in extorting money out of people (y'know "the art of the deal"), but does he really believe that throwing 30 million people or more off of health care, and allowing health insurers to sell stinking turds that cover absolutely nothing and call them health plans will go over with people who were promised "something much, much better" than Obamacare? I mean there are diehard Trumpists, but people NOTICE when Pa comes home from the hospital with a $1 million unpayable hospital bill because his "insurance" allowed by the Republicans' idiotic law, for which he paid a huge chunk of his income, was really nothing more than a scam. And they talk to their neighbors. And pretty soon EVERYBODY KNOWS it's just a piece of shit designed to cut taxes for the richest and screw everyone else.

16 April 2017

Uh, no to CalExit

I toyed with the idea of a CalExit initiative (expanded to include the whole West Coast)... just to send a message. (Obviously, there is virtually no chance of successful secession, and if there were, it would be fraught with so many problems no one should even consider it unless the situation became a whole hell of a lot worse than it is). But in any case it turns out this effort is a deliberate distraction, actually being backed by a Russian oligarch! So, uh, no. Never mind.

10 April 2017

Williams and Zakaria have crossed the line of no return with Trump Sycophancy

Let me just call out the fawning of, in particular, Brian Williams and Fareed Zakaria, over TRump's preposterous Tomahawk stunt. These (among many other lapses) disqualify both of these men from ever being taken seriously again.

24 March 2017

Calexit?

I wish I could say I take this seriously, because I really would support it (with a caveat that I would want the Petition to explicitly state that California intends to invite other Western States to join a new union of Pacifica), but I don't think there's any chance at all this could actually happen. 

A Brief History of Secession (Why Calexit might not be as crazy as you think)   by Richard Striner 
from American Scholar, Spring 2017 

(Attached) 

22 March 2017

Demanding a Bipartisan Commission with Subpena Power and a Special Prosecutor

And I just sent this to my two senators and my Congressman: 

Dear. []: 

The questions being raised in the Comey hearings and more generally constitute a constitutional crisis. Democrats must present a united front, and demand a bipartisan commission, with subpoena power, and the appointment of a special prosecutor to get to the bottom of all the issues raised, including tax returns, Russian influence, any collusion with the Russians, emoluments and conflicts of interest of the president and all top executive officials, and any other related issues. The cloud of suspicion and probable cause to believe multiple impeachable offenses may have been committed is not serious enough that Democrats should say that UNTIL these processes are in place and functioning, they will not consent to any routine business, confirmations (including of Gorsuch), or legislation not actually an emergency. If they want to proceed on their own, so be it, but I don't think they can. This situation is grave and cannot go on. 

Thank you. 

Rejecting Gorsuch on Legitimacy Grounds

I keep pluggin' away. This is what I sent to my two Senators just now. 

Dear (Sen. Wyden): (Sen. Merkley): 

I believe Democrats must stand against any Supreme Court nomination of this president for two reasons: 

1. The seat was stolen. This hurts the court, as Dahlia Lithwick has stated. Democrats should say that they will not consent to any nominee other than Mr. Garland. Let them approve the nominee on their own... if they can... and if they kill the filibuster, that's on them, and we lose nothing from it anyway. They will do it eventually regardless, and in the meantime we get nothing. 

2.  There is a serious cloud over this presidency and its legitimacy. The Republicans refused to even hold hearings on the flimsy idea that the president had only a little MORE than a year to go. Well, this president has called into question his legitimacy, his fundamental mental health, and whether there is probable cause to believe he may have committed multiple impeachable offenses. No nominee for the SCOTUS from this president should even be considered until these issues are resolved, and Democrats should say so in a united front. 

PLEASE DO NOT SUPPORT THE CONFIRMATION OF GORSUCH AND PLEASE DEMAND RESOLUTION OF THE TRUMP CRISIS. 

Thank you. 

[signed]

21 March 2017

Trump like Tyler

My friend Sam says Trump will go down in history like John Tyler (who became president when Harrison died suddenly). Weak, despised, unpopular, and ineffectual. 

I kinda hope he's right. 

20 March 2017

It's time to say it ~


 


DONALD TRUMP MUST RESIGN IMMEDIATELY. 

Trump's Divisiveness

    It's absolutely amazing that Trump's approval is as HIGH as 37%.

    It is also significant that it remains the case that a very large majority of Republicans still supports him. That will probably rule out impeachment. I hate to acknowledge that, but I think it's true. The Republicans in Congress will not do it, because they can't see that it will help their re-election prospects. The era, if there ever was one, of responsibility in American politics, is over.

    Still, think about it. Almost 75% of Republicans support Trump, but his national support is only half that. That means almost everyone else doesn't support him. (Remember, nonvoters and Independents outnumber both Republicans and Democrats). It also means our nation is divided more sharply not only ideologically but regionally, in terms of social class, and, to varying lesser degrees racially and ethnically, as never before.

    What a dreadful situation. We must strive in every way, being more active than ever, to bring about change from the bottom up!

National Popular Vote Interstate Compact

I just mailed a whole slew of postcards to state representatives and senators here in Oregon urging support for the National Popular Vote Interstate Compact. Already passed in Washington, California, New York, Illinois and enough other states to combine to 165 electoral votes, the uniform statute, when enacted by enough states to amount to 270, will take effect, requiring those states' electors to be pledged to vote for the candidate who WON THE POPULAR VOTE, as tallied in the official vote tally. The law is expected to pass muster in the courts as a proper Interstate Compact, because under existing case law where powers of the Federal Government under the Constitution are not involved, interstate compacts do not require Congressional approval. The governing portion of the Constitution, a mere 17 words, is very clear in granting the exclusive power to the states to determine how their electors would be chosen. (In fact, the current winner take all in 48 of the 50 states is not in the Constitution, and did not come to predominate until the 1880s).

If your state has not already passed NPV, please get involved in getting it passed. 2 of the last 5 elections did not result in the person who won the vote of the people becoming president. This must never be allowed to happen again.

PLEASE GET INVOLVED to make sure that is the case.

REJECT GORSUCH

Democrats must vote against Gorsuch. Period. That seat was stolen, and the theft must not be ratified. He could be Jesus Christ and I would still maintain this as a matter of principle. (And he isn't... he is a very, very misguided human being, as even the slightest examination of his record will show). 

16 March 2017

What the future of American Health Care should look like

It's not too early to assume that we will win. On every front. Specifically, on health care: I believe that, at minimum, a public option added to a somewhat tweaked ACA (with, for example, built in negotiations for pharmaceutical prices and medical equipment prices), plus lowering the enrollment age for Medicare to 55 and adding Vision and Dental, all paid for by increased taxes on the wealthier among us, is what we must fight for. (Since people in the higher end of Middle Class will be paying less in health care premiums, the increased taxes will be largely or even entirely offset; only the very rich will pay dramatically more, AS THEY SHOULD).

Then, gradually, Medicare enrollment can be narrowed from both ends. First, Medicaid for children can be rolled into Medicare (to age 18). Then the enrollment age for Medicare can be reduced to 45 and increased to 25, then, a few years later, Medicare for All can be rolled out.

Private Insurers will be impacted, of course, but Switzerland, France and Germany have a regulated NONPROFIT private insurance system, and so do we (minus the nonprofit part, but that can be mandated), even for Medicare. It's called Medicare Advantage. Personally, I think a pure socialist system is better, but the entrenched interests in this country probably preclude that for some time at least. And Medicare for All with ZERO SUBSIDY Medicare Advantage would work out pretty well. In the long run private management can't really compete with public options for paying for medical care, and fewer and fewer people will elect to pay high added premiums for relatively little value. (Right now, thanks to Republicans, Medicare Advantage amounts to a large subsidy for those people well enough off to pay a portion of the added cost for private plans... Medicare Advantage patients cost about 20% more than baseline Medicare patients. You rarely hear that mentioned in all of this). But if it does compete, then fine, I have no objection to private management. Many state Medicaid programs are managed by health insurers already.

Health Care Debate

This op-ed in the NY Times reflects the intellectual bankruptcy of the Right on the health care debate. 
 

Titled " Don't try to fix Obamacare, Abolish It," it purports to stand on the "principle" that what Republicans should do is to address costs, not coverage numbers, to make health insurance more affordable. It includes a single paragraph to morally justify the position taken (because ultimately, as a moral imperative, a health care policy must be about providing health care to the citizens, not reducing costs falling mainly on ultra-wealthy high bracket taxpayers). 

"Increasing competition and choice would lower prices for all kinds of insurance. Lower prices would free up corporate dollars for other things like innovation and jobs. Lower prices would also make it far more affordable for Americans to buy their own insurance than wait for government to subsidize it."

​But this is BS. Any honest economist will admit that health care is intrinsically a case of market failure. There is no health care delivery system in the world, never has been, never will be, that operates on free market rules. It simply does not work. Health care is not a profit center. It is a necessity, that must be paid for from the productivity of the economy as something that simply must be provided. Like clean water, electricity, sanitation, roads, bridges, railroads, air travel... all of these, to one degree or another, are not pure free market systems, but are subsidized by public wealth transfers. 

And there is absolutely no evidence that "free market principles" have ever resulted in lower health care costs. Just the opposite. The market incentive in health care is to deny sick and infirm people health care, so that they will die and rid the system of unprofitable cost centers. Unregulated or minimally regulated private insurance has much higher administrative costs, and most of its man hours are spent trying to minimize the delivery of health care, which is ultimately counterproductive. 

We need publicly financed health care, with sensible regulation to focus on prevention and health outcome, not maximized services delivery, and reasonable standards to avoid excessive costs. This works in many other countries, and it's time for us to admit that our system, even under Obamacare, does not work very well. We spend 20% of our GDP on health care, while most developed countries spend more like 10%. 

This Right Wing voodoo economic view of health care will make matters worse (as will the half-measures of the current Republican health plan, which is more a tax cut than a real health care plan). We must face facts and move towards an Enhanced Medicare for All system as soon as possible. ​