[Photo by Piron Guillaume via Unsplash]

Another Kind of Recovery: Post-Maria Puerto Rico and Health Care Critical Infrastructure

I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.

Pay Now and Pay Later: What Losing CHIP means to America

 

Let me tell you something you (most probably) secretly believe, secret even from yourself,  because you are an American: poor and sick children aren’t going to amount to anything. This is true whether you’re a Republican or a Democrat. The two sides will argue it’s for completely different reasons, but the conclusion is the same. We all know that poor and sick children aren’t going to live lives of note or interest.Nevertheless, we all want to be good people, and that’s why CHIP has bipartisan support. CHIP is the Children’s Health Insurance Program, originally SCHIP, a Clinton-era expansion of social security specifically for children who were too poor to get insurance, but not able to be covered by Medicaid.

CHIP’s Congressional authorization expired in September. The program is slowly running out of money, with just under nine million children potentially facing life without access to healthcare.

Americans talk a lot about the cost of healthcare. The cost of not providing healthcare to children in a world with failing environmental protections and failing schools is impossible to calculate. It is very high, it lasts lifetimes and generations.

I am taking breaks as I write this. My neck and shoulders are making typing hard, and I am coughing up a yellow sputum, very much the same as I have been coughing up since I was a child, and I will have to see the doctor soon about it. I am an active 44-year-old woman, lifelong non-smoker, with a healthy BMI who has been receiving healthcare in Europe for the last three years. But for my life before my 40s, I was mostly an uninsured low-income American, born and raised in Los Angeles.

I was an active child and an avid dancer. When I became a teen I slowed down a bit, there were times when I would cough and cough for weeks, sometimes coughing up little solid and foul smelling lumps of material from my lungs. I threw up involuntarily a lot when I exercised. I didn’t talk about it much, there didn’t seem to be any point.

I dealt with mental health issues, which were treated by the school district. That treatment was not only substandard, but deleterious, always pushing poor children to see themselves as the source of their troubles, even at times when the troubles were obviously medical in nature. Everything was always in our heads, everything, even throwing up involuntarily and migraine headaches were something I was doing to myself.

Los Angeles in the 1980s was a time of intensive personal responsibility and very poor air quality. It was the Reagan years, and we were all self-reliant cowboys. There was always a cadre of depression-era grandparents around, calling themselves the Greatest Generation, and telling us that no matter what happened we had it easy and our complaints were just whining. The drug war was at fever pitch, and the world was made up of Good Guys and Bad Guys, and you sure as shit did not want to be one of the Bad Guys. And the air that I grew up in was so bad you could live next to a mountain range and not know it for months.

CHIP was created in 1997. The Clintons were pushing the nation towards centrism, the air in LA was getting cleaned up, and I was 24 — far past the age where it could have helped me.

I was used to making due by then anyway. Poor kids aren’t allowed to be sick, it’s a moral failing, and I’d learned to compensate and sneak to get what I could. But still, even after some kind of insurance became available, it was never because we deserved it. As children we’re burdens on the struggling poor. As students and eventual adults, we’re no better. We’re making it up, we’re lazy, we’re difficult, we cost too much and are worth far, far too little. The political debate has never been about letting us find our potential, for we have none. The debate has been about whether it’s more moral to help us or let us die quietly.

Of the 9 million kids insured on CHIP 3 million are, like me, chronically ill. Not all of them would die without medical treatment, I’m sure they could move on, scarred, struggling to survive, out of childhood and any realistic chance of being cared for. I know how it feels to be one of those children. I try to be a generous and caring person and see all of humanity as my family, but there is a part of me that really doesn’t care what those children decide to do to the rest of you. You have it coming.

Being uninsured when you’re a chronically sick child isn’t just the lack of care. It’s the constant and unrelenting sense that you are not valued, not desired by your society. It is the rejection of your ability to live itself, the feeling that you can never be more than lice on the body politic. Any self-esteem you can grab back from the way society treats you comes with a hate so dark it makes ISIS look like a summer camp.

But the truth is these children mostly won’t do anything. They’ll wander desperately through life, looking for hope, going to the ER for rescue inhalers, and trying to score many kinds of drugs to dull the pain both physical and mental. Some will escape up the socio-economic ladder, but they’ll hide where they came from because you think we’re all worthless. That’s what I did for years. Statistically, we’ll die younger than you, probably uninsured, in a hospital. The commentary on our lives won’t be: What have we done? How did we fail these fellow humans so terribly? What have we lost in creativity and talent? Instead the political story of our lives will be: This causes healthcare costs to rise.

There are sick children all over the world. There is only one country that blames them for making healthcare costs rise because we won’t give them care as children.

CHIP passed in 1997. In 1998, I got my first employer healthcare. The diagnoses started rolling in. Migraines, Irritable Bowel Syndrome, Major Depressive disorder. GERD with Barrett’s Esophagus. It wasn’t caused by weight, but because my esophagus doesn’t close. It just doesn’t. Weird, huh!? That would have been handy to know sooner.

That diagnosis wasn’t a surprise, as least not after I understood the context. I tended to throw up if I bent over too far. I was a high school gymnast, and even back then the contents of my stomach would regularly come out of my nose on the uneven parallels. My coach would send me home sometimes, but no one ever suggested I see a doctor. It was in my head, I was doing it to myself somehow, being a burden on everyone.

After the ’98 round of medical diagnoses and treatment, I came back and yelled at my mother for never believing me. I cried, I apologized later. She’d been a child herself when I was born, and she was trusting authorities who were telling her I was broken, and so was she. She apologized too, we cried and screamed and stomped off and hugged and cried some more.

This is how we cope. To try to think about this not personally, to see it as part of politics and society and an economic plan is too big and too painful to contemplate. Even now, it makes my throat tighten and a wave of nausea pass through me. It is so evil.

The diagnoses kept coming in the new century, and I became ineligible for any kind of insurance that wasn’t employer-based. EDS Hypermobility type, Cervical Dystonia, PTSD. The last one I crowdfunded to pay for, the old-fashioned way. I passed the hat amongst my friends and raised the money to pay the PTSD therapist. It was a difficult and sometimes humiliating decision, but it was the right one. I emerged from my therapy not fixed, but healing. I had tools I hadn’t had before. I went back to work. My friends had passed up dinners and presents and special things to help me get that therapy, but it worked.

GoFundMe brags about raising $5 billion in crowdfunding for medical care in America. Of course there’s more than that over the years; families that sell their houses for each other, friends that skip vacations to give the people they love a chance at life. Leonard Pitts wrote rather viciously about a conservative man trying to raise money to retain his sense of sight. This man was politically unworthy, socially irresponsible, and medically suspect; he smoked and owned a house. How could he ask for help? This is America, and even the people who believe in universal healthcare balk at care for those they deem Unworthy. We don’t even know how to imagine a system that just cares for people because they are people.

It’s been two years, and I hope that man is not blind, and I hope his loved ones haven’t suffered too much. Between people who love each other, there is no better use of these little monetary tokens to express love than paying so they may live and live well.

From an economic perspective, it’s a disaster. Every meal and trip skipped to pay for medical expenses slows down the stimulus that money could provide. The medical payments funnel money into the upper echelons of society where is slows down, sits, and ossifies. It is a disaster in every way.

But Congress is full of good people who are the somebodies who think of the children, and so CHIP is bipartisan. But it’s so expensive, and it’s hard for Congress to find the ~$14b it will cost. When it comes to funding stupid planes perfect for types of wars that don’t exist anymore, Congress has no problem finding the budget to switch from the disastrously stupid F-22 fighter (>$70b) to the next stupendously expensive F-35 fighter (>$400b for R&D). The F-22 finally saw action in two countries several years after being discontinued: against ISIS in Syria, and the Taliban in Afghanistan, both military forces more known for fighting out of the back of pick-up trucks than dogfighting with jets. More money goes to the federal employee travel budget than goes to CHIP. (According to Hatch and Coburn) More money goes to the black budget devoted to spying on everything and everyone on the net than goes to CHIP, but most of Congress probably doesn’t know how much more, it’s a secret. Congress can even find billions to make stupid fucking pennies no one wants.

A sick kid doesn’t realize the money that could help them is going to something as stupid as fighter jets no one needs or black budgets that may be straight-up illegally spying. But they do know that they’re a burden, they know that the world doesn’t want them. It makes them sad and angry, and everyone around them scrambles to find billions of dollars in spare change to take care of the people they love because Congress is so bad at finding things.

When you don’t treat the minds and bodies of children, it isn’t just those children who are affected. Something as simple as getting check-ups, interceding on basic problems early, and making mental and sexual health resources easy to access can stop a lifetime of expensive and heart-rending problems that weigh down families and communities and echo through generations.

Programs like CHIP, or universal healthcare as provided in Europe, are not about handing things to the worthless poor. They are about the epidemiology of the whole of society. Treating your neighbor’s kid now is about not having to treat them later, and not living with the consequences of their illness in your environment or tax expenditures. It is choosing to not live in a society of desperation and constant quiet anger. Programs like CHIP, and the proposal for Medicare For All, are fundamentally selfish, just a long-sighted form of selfishness that Americans are kind of bad at.

Without a program like CHIP, we are in the position of hoping parents bring their children into the ER for routine needs, jacking up our healthcare costs to ever more ridiculous heights, because the alternative is somehow much, much, worse. Untreated children don’t just infect other children with their diseases, they drag down schools, divert the resources of their families, increase crime and even lower property values. They spend so much time struggle to find their own worth, they deny the world their talents. If you don’t want to treat poor sick children, you might be better off going all Sparta on us and throwing us off cliffs than just letting us struggle along in society.

By the way, Sparta was a terrible place to live, despite what you’ve seen in 300. It was miserable and authoritarian and full of legally-required slavery and child rape and never really developed or got better. The Persian Empire, and even Athens, were better societies on every count, including military. Sparta wasn’t good at infrastructure and tended to steal what they did have. Infrastructure is what makes society nice to live in, and worth the bother. This is a fact Americans used to get; we like our highways and dams and standing armies and power lines, but apparently the water’s edge is schools, pollution, healthcare and paying taxes. Those are, for some reason, not infrastructure.

I never accepted my worthlessness, I never stopped fighting. I also never shot anyone or became a drug addict. I did a lot of sketchy things to get medical care. I’ve taken a lot of other people’s leftover drugs, and coordinated with other people to pass around drugs and advice from medical professionals who may have never known where it was going, and probably didn’t want to. And I rebelled and rejected society, sometimes violently, so that I could do worthwhile things not in keeping with my station in life.

Now I live in a place that provides me care. I haven’t had to prove my economic worth, which is good because it’s likely I never will. But now, after my expenses, I still have a little money left over. And every Saturday morning after food shopping, I go get myself a good cappuccino in the city center, and sit for a while enjoying the light, watching people go by, and little children chase dogs and birds. I’m not in paradise, there are plenty of problems here, like everywhere. But none of them are sick children hiding the yellow sputum they cough up from their parents because no one can afford a fucking inhaler.


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.


Some of my sources were:
https://www.kff.org (many articles, it’s a treasure trove of information)
8.9 million children enrolled, cost is around $14 billion. 35 million children are enrolled in CHIP or Medicaid or both.

https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-care-crisis-is-a-gold-mine-for-crowdfunding
https://www.vox.com/2017/12/3/16730496/orrin-hatch-chip-tax-bill

More information on children on Medicaid: https://www.medicaid.gov/chip/downloads/fy-2016-childrens-enrollment-report.pdf

Spaced In Time Trash Talk

Welp, moving from KIller Trash Talk to the things that are this weekend takes a lot. Insanity abounds, and is all around. Your healthcare? Yes, that is getting screwed hard. JCPOA (the Iran anti-nuke deal) yes, that too. If it affects the world in at least semi-positive way, the current President is blowing it all up. The fact that a black man might have even touched on any subject seems to infuriate the dementia ridden sundowning asshole in the West Wing even more.

It is who and what we life forms are now. And it is sickness in every regard, domestically and internationally. Trash Talk was designed to be a refuge from such things. I just cannot anymore. So, if that is a problem, I am sorry. Hopefully we will not stand by, and will not back down, while assclowns like Donald Trump cravenly politicize even common sports entertainment to soothe the 30% base they so cherish.

Nope.

Puerto Rico is dying in their own streets. Northern California is burning. People are trying to ride out the fire in swimming pools as their houses burn around them. While the Trump Administration and GOP sit on their hands, when they are not actively trying to make the entire situation worse. The fuckers are flying on jets, flying flags and making coins in their own image.

But, hey, the NCAA is moving on. Not sure anybody thought anything different would happen in Chapel Hill. Begging the question as to what happens to Louisville, another legacy NCAA basketball program. The NCAA under the terminally lame leadership of Mark Emmert will never change.

In the pros, it is getting hard to figure who is the bigger asshole. Is it Goodell and the NFL, or is it the, at this point, ignorant scorched earth strategy of Jeff Kessler and the NFLPA? The NFLPA is making an ass of itself in trying the everything and the kitchen sink theory as to Zeke Elliot. The NFLPA had a sympathetic plaintiff, Brady, and a supremely tenuous case by the NFL based on simple physics and chemistry. But then the NFL won in the 2nd Circuit. Zeke Elliot is not an all American kid with multiple championships. He is an abusive punk from Ohio State that is lucky the NFL did not find an aggravating act from when he pulled down a woman’s blouse in public during a parade. If you think Elliot has the better case here, you don’t try cases in real courts.

The thing is, whether under federal or state law, and in this case collectively bargained law, the arbitration rules….and the rules ARE “relaxed”….and control. It is about the process, not the facts. I, and a lot of others, tried to argue in the face of this in both Brady and Peterson. Same in Bountygate prior to those two cases. Those arguments were all made in cases with far more appealing clients than a repetitive malefactor like Zeke Elliot. He will serve the suspension, it is only a question of whether he and Jeff Kessler are smart enough to do so soon, or make it later, when it will really hurt a likely playoff team. We shall see whether the NFLPA scorched earth insanity prevails over the inters of Homer Simpson, er Jerry Jones and the Cowboys.

The games go on. The Natinals really ought to still be around, but the Cubs put them to rest. The Yankees somehow overcame Cleveland. Hard to not think the Tribe was the better team, but they didn’t close the deal, and the Yankees did. That said, the conference championships look truly awesome. I think the Astros are not only a better team, but have some juice right now as opposed to the Yanks. Not betting a lot of real money on that, but I think so. The Dodgers are what the Yankees used to be. The best team that all the money in the world can buy. But Chris Hayes made a Trump for Cubs deal with the devil last year, and I hope it still holds, and the Cubs win. If we “have” to have Trump, let the Cubbies win again.

Syracuse obliterated Number 2 Clemson already. Man, that was ugly. So was the job an average Cal did on Pirate Mike Leach and Washington State. Utah at USC should be interesting. Washington at ASU here might be as well, but Chris Peterson is a light years better coach than ASU’s Todd Graham, so ASU likely to get blown out, even at home.

Back to the pros: Philly already topped the Panthers, thanks to a good game by Wentz and a horrible one by Newton. Won’t always be that way, Panthers are dangerous if they get in the playoffs. Skins host the Niners. Will Kirk Cousins be playing on the other team next year? The Pack at Vikings looked really interesting when it looked like Sam Bradford was returning. Less so now, but Case Keenum can produce and they are in Minneapolise with that damn horn they blow. I’ll take Rodgers and the Cheese, but may be a great game.

My game of the week is the Buccos at Cardinals right here in the Big Toaster. Debut of Anthony Peterson at RB for Phoenix. Carson Palmer has quietly played superb QB so far this year for the Cards….when he is not getting murdered from bad, nee atrocious, O-Line play. If Arizona’s constantly remade O-Line can gel and protect the old man, it will be a hell of a game. Not going to bet on that, but just saying. Rams at Jags might actually be interesting. Glad that matchup is, for once, not in London. Other game of the week is unquestionably Scribe’s Steelers at Arrowhead to see the Chefs. I don’t for one second think Big Ben has lost a step, even if he may finally be maturing. But I am not sure that other forces in that locker room are unified the way past Steeler teams are. This will be a HUGE game for Pittsburgh, and less so for KC. I’ll take the upset on this one.

Okay, that is that. Another week. Another dime. Another dollar. Thank you for being here, and send some love to Puerto Rico and Napa.

Three Things: So Many Questions, September Edition

It’s been a little busy in my neck of the woods, trying to tackle a long accumulation of honey-dos. But questions piled up, needing answers, so much so that I had to take time out to put bits and pixels to digital paper. Let’s begin, shall we?

~ 3 ~
PUERTO RICO POST-MARIA

Where the hell is the USNS Comfort, dispatched in 2010 to help after Haiti’s earthquake, and why isn’t it docked in San Juan, Puerto Rico, right the fuck now?

Why did we send 24,000 military personnel to help Japan after the 2011 earthquake but can’t muster them for a U.S. territory with a former navy facility and an active facility at Fort Garrison in San Juan?

Is Trump deliberately ignoring Hillary Clinton’s plea to send the USNS Comfort to PR because — well, it’s Hillary? (Yeah. Check that link. Even Fox News noted Hillary’s request.)

Has Trump deliberately ignored Puerto Rico’s urgent plight out of personal pique over the bankruptcy and losses from a Trump-branded, Trump-managed golf course located in Rio Grande, PR? He was trying to prop it up on Twitter back in 2013.

Are Trump’s tweets complaining about Puerto Rico’s debt yet more projection, since the failed golf course was built with government-issued bonds?

Why did the Senate approve as FEMA director — who only left to tour the island FIVE GODDAMNED DAYS AFTER MARIA MADE LANDFALL — the man who was the Hurricane Program Manager for FEMA under the Bush administration during Hurricane Katrina?

This, from The New York Times:

The head of the Federal Emergency Management Agency, Brock Long, has received widespread praise for his handling of the federal response to Hurricane Harvey, the first major natural disaster faced by the Trump administration.

Somebody get me a concrete citation of a real accomplishment attached to some of this “widespread praise” for anything besides being “a calming presence in press briefings.” Has the bar slipped this low that calmly stringing together cogent sentences is worthy of accolades? Can the NYT stop fluffing Trump and his band of co-conspirators?

Because right now American citizens are suffering and likely dying as a result of this administration’s gross ineptitude and negligence, if not outright malignance.

Now Trump says he’s going to Puerto Rico next Tuesday. That’s TWO WEEKS after the storm. Can’t disrupt his golf game over last or the next weekend, don’t you know. What I particularly despise about Trump’s response to this crisis is that he makes this guy’s fly-by two days after Katrina look so much better.

Call your members of Congress and demand action. Yeah, that’s not a question. Suck it up; you’ve got electricity, communications, and access to clean water if you’re reading this. Millions of your fellow Americans in Puerto Rico don’t. Let’s fix this.

~ 2 ~
GRAHAM-CASSIDY-HELLER-JOHNSON NOT-A-HEALTH-CARE BILL

Have you called your senator and asked them to vote NO on the debacle Sen. Bill Cassidy can’t explain and over which Sen. Lindsey Graham is ruining any cred as a rational human being, while disabled health care activists recover from being hauled away by capitol police yesterday before the Senate Finance Committee’s hearing on the bill?

Have you documented and shared publicly your senators’ position on Graham-Cassidy, especially if they are up for re-election in 2018?

The number is (202) 224-3121 if you don’t have it memorized already.

Need a script to make it easier? Here you go.

As wretchedly bad as this obscene joke of a bill is, I can’t help wonder if GOP members of Congress and their staff are gaming this. Have they been working on something even worse than previous attempts at ACA repeal just to game the stock market and make a few bucks on the backs of worried citizens?

[graphic: Health Insurance stock chart, via Google Finance]

For grins you should look at Aetna’s chart for last Friday and note the jump it took when Sen. McCain expressed his reluctance to support Graham-Cassidy. Price jumped about the same time capitol police arrived to arrest protesters. Easy money, that, conveniently ahead of the market’s close.

~ 1 ~
IRAN ~AND~ PUERTO RICO

What question do these two disparate places prompt?

First, Trump tweeted about an Iranian missile launch as if it had ~just~ happened, within 24 hours of a reconstituted travel in which Iran is listed. But the missile launch ~didn’t~ just happen; it took place more than six months ago but was mentioned only this week in Iranian news.

Second, Trump took his fucking sweet time ensuring FEMA went to Puerto Rico; Hurricane Maria made landfall on September 20th, visible to anyone who watched weather networks, NOAA, and NASA reporting.

Is Trump ignoring any and all U.S. intelligence and government experts on matters foreign and domestic, relying instead on some other criteria for responding to events, including cable TV? Should we believe for a second he’s simply and accidentally flooding his source of information?

In the case of Iran’s missile program, it looks more like he deliberately used stale news to defend a new travel ban while making propagandistic false statements to the public. The Supreme Court canceled hearing the travel ban after the travel ban was rejiggered — does this suggest his manipulation of perception worked, not only on the public but on the Supreme Court?

~ 0 ~
One more time: call your Senators to ask NO on Graham-Cassidy and get their position on the record. Call your members of Congress to ask for urgent response and funding for aid to Puerto Rico. The number is (202) 224-3121. Put it on speed dial.

Viajar bien, mis amigos y amigas.

Financing Medicare For All

If you only read mainstream media you’d think Bernie Sanders’ Medicare for All bill was terrifyingly expensive. An opinion piece behind the paywall in the Wall Street Journal cites a couple of studies with huge headline numbers like $2.5 trillion dollars in the first year, from the Urban Institute. Taxes will soar, government takeover of health care blah blah blah. It comes from centrist Democrats like Jonathan Chait and Ezra Klein who I saw in an appearance on Seth Meyer’s show. Here are two things to bear in mind in self-defense.

1. In 2015, we spent about $3.2 trillion on health care in the US. There is a cool graphic here showing where it was spent and who paid that amount. Maybe the cost of health care covering everyone for the kinds of things the Affordable Care Act requires would cost more than that. (The Sanders Plan covers other services as well as those under the ACA, but let’s ignore that because I can’t find numbers.) We calculate the additional amount we would need by adding the cost of all uninsured people and the cost of the care that people with insurance can’t afford because of deductibles and other co-pays, and subtracting the savings from the new plan. Any analysis that doesn’t start with this is bullshit.

It’s true that the Sanders plan would change who pays and how much, so someone would have to redo that cool graphic I mentioned. Some businesses would pay more, others less, and there would be a change in corporate taxation as deductible costs of insurance change. Some individuals would pay more and others less. But whatever those changes might be, the amount we need to raise isn’t frightening, and practically everyone will be better off.

It’s easy to see the savings from negotiating drug prices, lowering the reimbursement to doctors and hospitals, reducing excess profits from the health insurance companies, and reducing the costs of administration throughout the health care business.

It’s also easy to see that the additional costs are not that high. Approximately 9.1% of us were uninsured in 2015, so the cost might be as high as 10%, or $320 billion. That doesn’t seem too terrible when the savings are deducted. It will be easy to finance that if we want to. I have a long list of things to cut if anyone cares, starting with dismantling the carceral state.

2. We need to think clearly about taxation. We live in a fiat money system; the US is sovereign in its own currency and cannot go bankrupt. I’ve read Modern Monetary Theory by Randall Wray and many shorter pieces and I am convinced. I could make an interesting argument from MMT about this whole matter, but I won’t and I not going to focus on that. If single-payer a hard sale, convincing the devotees of Econ 101 (course title: My Neoliberalism) about MMT is hopeless. Actually with the excellent Stephanie Kelton as a teacher and leader I could well be wrong. Check out this on the Twitter, and follow her if you don’t already.

I agree with Warren Mosler, another MMT theorist, that taxes for revenue are obsolete. But that doesn’t mean that taxes are obsolete. Quite the contrary. Mosler quotes from a 1945 speech by Beardsley Ruml, chair of the New York Fed, to the American Bar Association. Ruml gives four grounds for taxation other than revenue:

1. As an instrument of fiscal policy to help stabilize the purchasing power of the dollar;

2. To express public policy in the distribution of wealth and of income, as in the case of the progressive income and estate taxes;

3. To express public policy in subsidizing or in penalizing various industries and economic groups;

4. To isolate and assess directly the costs of certain national benefits, such as highways and social security.

We can make a case for taxes and other measures to support Medicare for All relying solely on those four principles, without explicitly discussing MMT. If we do that, we lay a foundation for future tax issues, and for a sensible discussion of tax reform more broadly. I have a list of tax changes that will meet those standards. How about that NASCAR deduction for a starter. We raise a bit of money and get rid of a bit of corruption with one change.

This is a great teachable moment for MMT, just as the government shutdowns were with the heated arguments about the trillion dollar coin. I know Kelton and others will push on the MMT side. We need to win this, and we can’t afford to fight on two fronts. In particular, it isn’t helpful to attack people who don’t want to argue about MMT on the way to fixing our health care system. People like me.

Three Things: In the Debris Field After Health Care ‘Freedom’ Act

I still don’t have enough caffeine in my system and it’s nearly noon here. An entire pot of java may do the trick. As I rouse and read the hot takes after the failure of H.R. 1628 last night, a few thoughts stick with me.

~ 3 ~

All the think pieces — most written by white men lauding John McCain’s maverick move by departing from the party line — are evidence ‘the show’ worked.
McCain called it that when asked before the vote last night which way he was going. “Watch the show,” he said.

Meanwhile, the two women senators who have been firm all along they couldn’t vote for a bill causing damage to their constituents receive far fewer plaudits from the same mostly-white-male pundit class. Murkowski had been threatened by the Interior Secretary at Trump’s request. I haven’t heard for certain, but I’ll bet Collins received threats as well, probably from Trump-supporting constituents.

McCain won’t get those kinds of threats. He made his point last night about the power he wields within GOP Senate caucus as the final A/B switch on legislation. But the GOP Senate already knew this.

What McCain did was give the GOP a face-saving way to vote for a piece of shit they didn’t want to pass, without the repercussions Collins and Murkowski (and at varying times, Heller and Capito) have faced for rejecting a POS bill.

This is why they waited until the last goddamned minute to draft a meager eight-pages, slapping in some egregious stuff to ensure Collins and Murkowski couldn’t vote, adding the 20% annual premium increase as a coup de grace.

Because McCain would do the maverick kabuki for them, slap on his mask and robes, make big gestures and kill the bill for them.

And it worked not only because all the white male pundit class got suckered by their usual privileged blindness, but the white male Tweeter-in-Chief bought it, hook, line, sinker. He blamed all the Democrats and three GOP senators. All the other senators are off the hook.

Bonus: McCain’s legacy is salvaged with the patriarchal punditry.

Great ‘show’, maverick.

~ 2 ~

Scaramucci is nothing more than a highly-animated automaton on a stage; nothing he says is real. Why? Because the real communications are being run out of house by Steve Bannon, and likely in violation of federal law.

What is it and to whom is Bannon really communicating for the White House?
This operation may be in violation of the Antideficiency Act, but is it also in violation of the Presidential Records Act? What about any other regulations regarding FOIA?

Don’t believe me about Scaramucci’s role? Take a look at your news feed and point to any announcement about his firing or resignation. You know damned well had a communications director acted like he has under any other previous administration he’d have been walked out the White House’s fence.

p.s. Some say Scaramucci’s lowering discourse. Come the fuck on. He talks the way all of Wall Street’s white males do. The misogynist crack about Sarah Huckabee Sanders’ appearance? Par for the course.

~ 1 ~

Recommended lunch hour read for you: a book review by Andrew Bacevich in London Review of Books on The General v. the President: MacArthur and Truman at the Brink of Nuclear War by H.W. Brands. Bacevich’s background here.

Putting this book on my shopping list after this review, given how much power Trump has given and is likely to give to the military, breaking with civilian control.

~ 0 ~

That’s it for now. I’m stewing on something else but it’ll be dedicated and not an open thread like this one. Hasta pasta.

[Photo by Piron Guillaume via Unsplash]

Three Things: #KillTheBill, Kill It Dead, Die Already [UPDATED]

[UPDATE at end] Following the Senate today has been like watching an impeding train wreck. The track’s out just ahead, the conductor knows it, as do all the rest of the crew aboard. Not one of them has the smarts or spine to stop this crazy train.

So while this post was supposed to be about three things, it’s really all just one: the abject failure of Congressional Republicans to fashion effective health care legislation which meets their oath of office by calming the public’s worries to insure domestic tranquility, providing for the common defense against illness and injury, and promoting the general welfare through improved health.

~ 3 ~

Anthony Scaramucci was hired to be a circus act, a distraction from whatever the White House is trying to get away with. Clearly he’s good at that. Screw that. I’ve muted his name on Twitter; you’ll be surprised what you see when you do the same across your social media and news feeds.

~ 2 ~

This, from the rally on Capitol Hill tonight:

It’s this simple. Congress’ health care plan is America’s health care plan. Strip away everything else, start from the ground up, fund it, legislate and launch it.
But sadly the party leading Congress is incapable of vision. Get some, stat.

By the way, for you anti-Democratic Party folks: the Senate Dems are solidly unified behind killing all iterations of Repeal-and-Replace, and tonight, the ‘skinny repeal’. There are no defections. They are willing to work on a good faith bipartisan solution which fixes the ACA’s challenges. Senate GOP could meet them on this, but no — scoring a political win is more important to them than doing the right thing by the American public.

~ 1 ~

If you want to stay on top of this, here are a few key accounts on Twitter:

Andy Slavitt (see his summary of tonight’s expected Senate action on Trumpcare)

Adam Jentleson

Ben Wikler

Ben Jacobs at The Guardian

Right now the Senate is headed toward a vote around 2:00-3:00 a.m. on a bill for which is no text or a CBO score. Paul Ryan will follow suit as soon as possible, no matter what bullshit you hear about not wanting the so-called ‘skinny repeal’. They are doing this in the middle of the night to hide from the public, literally on a Friday late in summer which in the past has been news dump zone. It’s a fraud, a total sham.

~ 0 ~

That’s it. Call Congress now — start with your senators, then your representative. The life you save may be your own. (202) 224-3121 or (855) 712-7845.

UPDATE — 10:35 P.M. EDT —

All eight pages of the ‘skinny repeal’ bill have now been posted.

EIGHT. FUCKING. PAGES.

Read them here.

[Photo by Piron Guillaume via Unsplash]

Call to Action: Senate Vote Ahead – Stop Trumpcare

I’m going to let Senator Chris Murphy (D-CT) explain what’s going on in his eight-tweet thread from last evening — and then we are getting down to business.

@ChrisMurphyCT tweet thread dd. 23JUL2017

Here’s HuffPo on status of this latest iteration of Repeal-and-Replace-ACA. Sen. Susan Collins (R-ME) said, “It appears we’ll have a vote on Tuesday but we don’t know whether we’ll be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill,” sounding very unhappy about being kept in the dark.

Agreed — this is not how a democracy is run.

Two more things you need to know:

— Trump’s administration is trying to crash the ACA; it terminated contractors in 18 cities to help with signups. Think of this as the equivalent of voter disenfranchisement by eliminating polls, only in this case, it could have deadly affects on citizens.

Trump “asked” Navy service members to call their senators to vote to repeal ACA. This is an abuse of power; an “ask” by the commander-in-chief is an order, and in this case it’s an order to U.S. military to take action against their own interests and against their fellow citizens. This may already have had a negative effect on counts based on reports last night on Twitter.

What’s next?

CALL YOUR SENATOR NOW before the vote and ask them to vote NO on the Motion to Proceed, and NO on any subsequent vote to repeal and/or replace ACA.

Tools you can use:

Here’s calling scripts prepared by the ever-helpful @Celeste_Pewter, one each for GOP and Democratic senators. (Celeste has an updated status on the impending vote, too.)

No on BRCA (GOP) via @Celeste_Pewter

No on BRCA (Dem) via @Celeste_Pewter

Switchboard telephone number: (202) 224-3121

Free fax by internet to Congress by Faxzero: https://faxzero.com/fax_senate.php

Help keep track of responses at: https://5calls.org/ (not for use on mobile)

For more information on BRCA vote:

Follow  @benwikler – MoveOn’s Washington DC director, who is all over this legislation.

Follow @make5calls

Follow @icalledmyreps

If you have any more resources to follow on the health care vote(s) this week, please share them in comments.

Lastly, if you live in Alaska, West Virginia, Ohio, Maine, you are a Most Valuable Player right now because your senators are on the bubble. Please make calls to your senators — thanks!

IMPORTANT: This is NOT an open thread. Health care comments here only; all other comments may be posted in the last open thread. Thank you.

Three Things: Shocker, Badger, Vapor

Summer doldrums are hitting hard here; it’s too steamy today to do much but watch the garden grow and the ‘hot takes’ bloom. Let’s breeze through these.

~ 1 ~

Shocker: The White House had its ass handed to it last night, alongside a serving of vanilla ice cream and peach cobbler. While it was kissing up to some über conservative Senators, Utah’s Mike Lee and Kansas’ Jerry Moran announced they would not support the Motion to Proceed on the latest POS edition of AHCA.

Excellent work on the dual tweets dispatched simultaneously at 8:30 p.m., by the way (see this one and this one). Live by the tweets, die by the tweets, Littlehands.

What I find particularly interesting is the secrecy this announcement revealed. Not just the discreet collaboration between two senators from very red states, taking advantage of the additional time afforded them by John McCain’s personal health care challenge. Apparently Senate Majority Leader Mitch “Yertle” McConnell has had such a tight grip on the legislative process that even his wingman, John Cornyn, doesn’t know what’s going on until McConnell’s office emails his deputies.

Not exactly a way to win friends and influence enemies, that.

(For some reason McConnell’s super-secret hyper control makes me think of the compartments Washington Post wrote about with regard to the Russian election hacks and the subsequent investigation. Why is that?)

~ 2 ~

Badger: Russia is pissed off about its dachas-away-from-home, threatening retaliation if they’re not returned. Uh, right. Like the U.S. suddenly decided to boot Russian occupants out of the Long Island and Maryland digs for no good reason last year. Russian Foreign Ministry “reserves the right to retaliate based on the principle of reciprocity,” forgetting that Obama took a too-measured response to repeated incursions by Russia into U.S. information systems — including hacks of the White House and Defense Department in 2015 — not to mention the ‘Illegals Program‘ spy who worked at Microsoft circa 2010. (Let’s also not forget an ‘Illegals Program’ spy worked their way close to Hillary Clinton’s 2008 campaign co-chair.) The U.S. could and should have been far more aggressive in its response; Russia isn’t entitled to reciprocity.

This is a test for Congressional Republicans. Either cement sanctions against Russia including the ‘foreclosure’ on these two compounds, or admit complicity in the undermining of democratic process last year. The GOP needs to revisit a CRS report on U.S.-Russia relations and Executive Orders 13660, 13661, and 13662 before they give any ground. [EDIT: See also EO 13964, issued April 1, 2016 in response to “malicious cyberactivity” — this EO the GOP will probably ignore just as it has all signs of Team Trump collusion as well as Russian interference in the 2016 general election.]

If there are truly compelling reasons in the nation’s interest for conceding these compounds, give them back — but only after the buildings have been razed and permits for reconstruction are denied under sanctions. The Russian government can work out of trailers on the property, or on boats from the dock. They do not need to be any more comfortable than they have been.

~ 3 ~

Vapor: No longer a ghost — we  now know who the eighth attendee was at Donnie Junior’s June 9th meeting at Trump Tower last year. Lucky number seven is believed to be a translator — and wow, so is number eight!

Which seems kind of odd — in the information Junior dumped online, there was no mention that Veselnitskaya didn’t speak English and needed a translator, or who would be the translator. Doesn’t it seem strange that there would be no concerns about security clearance into Trump Tower or a meeting with a presidential candidate’s son and/or campaign team given the meeting requester was a foreign national?

Perhaps because there was little concern, Body Number Eight, Ike Kaveladze, purportedly showed up as Veselnitskaya’s translator only to learn she had brought her own, Body Number Seven, Anatoli Samochornov. It’s not clear from USA Today’s reporting who asked Kaveladze to attend; did Junior just let any Russian in the neighborhood attend the meeting? Aras Agalarov sent Kaveladze “just to make sure it happened and to serve as an interpreter if necessary,” Kaveladze’s lawyer told NYT. Why so many witnesses?

The room must have been a little crowded with Junior, Jared Kushner, Paul Manafort, Rob Goldstone, Veselnitskaya and two translators as well as Rinat Akhmetshin.

Given the two translators, Akhmetshin’s presence seems even more curious. Why was he there if there were two translators?

~ ~ ~

That’s that. I could go on but it’s too damned hot here. Refresh your iced tea and settle yourself in front of the fan. This is an open thread — behave.

AHCA: GOP and its Ugly Poke

One of the most immoral and unethical episodes of American government unfolds today as the House votes today on the American Health Care Bill (AHCA) H.R. 1628, a bill which violates the GOP’s promise to allow three days advance notice before a vote, the text of which had not been made publicly available before last night and will only receive an hour’s debate, and the economic impact of which has not been analyzed and scored by the Congressional Budget Office.

Today the GOP-led House votes blindly on a purported pig in an ugly poke.

Nothing about this GOP-spawned atrocity serves the public’s interests — not even the estimated 2% who will obtain tax cuts from this legislation if it clears the Senate. The financial benefits for these über-wealthy who, already owning more than most of the rest of the country combined, do not need them. These cuts will eventually be neutralized by degradation of the overall economy after consumer spending tanks. Short-sighted gains yielding long-term losses.

Utterly stupid. Highly unethical.

In B-school I was taught that an ethical business decision was one made for long-term shareholder value, with reasonable decency and distributive justice.

If this is the business of American government, AHCA fails to meet those criteria.

For the über-wealthy there is no long-term improvement in value.

For Congress, there is no reasonable decency in cutting benefits — even when demanded by a minority of voters — to those most vulnerable in order to hand over money to those who do not need it. They are literally taking money from babies and mortally ill to hand over to rich people who will never even feel the weight of the addition to their bank accounts, amounting to little more than a rounding error for billionaires.

There is no decency in voting for legislation which most certainly will result in American deaths in the thousands from cancer and other diseases. Nor is there decency in signing away lives in some unacknowledged Malthusian attempt to limit population growth — a great permanent amelioration of their condition — by increased mortality rates.

There is no decency in voting for a bill which treats women as disposable annoyances instead of the font of America’s future, treats sex crimes against them as excuses to hurt them further.

There is no decency in cutting funding necessary for students requiring health-related aids in special education.

And there is absolutely no decency whatsoever for Congress to place itself above shared suffering. They are exempting themselves from the worst effects of AHCA on those with pre-existing conditions by voting for Amendment to Public Health Services Act H.R. 2192 while slipping in threats to working American’s employer-based health care insurance.

There is no decency, only shame, in Congress’ scuttling off into the shadows at the end of the day to avoid dealing with the repercussions of these offenses against their constituents.

For the average American — and most average Americans will be directly affected by the AHCA — there is no justice.

Not until November 2018.

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