Public Policy and Governance – Page 231

The Unarguable Benefits of Universal Healthcare

As political posturing over the Affordable Care Act (aka “Obamacare”) continues, the fiscal and social benefits of expanded access to healthcare become steadily more obvious.

The journal Health Affairs recently reported an 8 percent increase per year in the number of early-stage colorectal cancer diagnoses since passage of the ACA. Extrapolated across the country, the researchers estimate the ACA led to approximately 8,400 additional early-stage colorectal cancer diagnoses among seniors between 2011 and 2013.

A 2015 study published in JAMA found that the ACA had increased the number of early-stage cervical cancer diagnoses in women aged 21 to 25.

Early diagnosis doesn’t just increase the likelihood of successful medical intervention; it significantly reduces healthcare costs. When cancer is caught earlier, it is cheaper to treat.

America’s healthcare costs have long been far higher–and our outcomes considerably worse-– than in countries with universal systems. The lobbying clout of Big Pharma and Big Insurance continue to make a cost-effective “Medicare for All” politically impossible, but even with its problems, the ACA has vastly increased the number of Americans who are insured while significantly slowing the rise of healthcare spending; last June, Fortune Magazine reported

The United States will save about $2.6 trillion on health care expenses over a five-year period compared to initial projections made right after the passage of the Affordable Care Act.

While health spending spiked briefly in 2014, evidence shows that it has once again slowed down and will help save Americans trillions between 2014 and 2019, according to a new study by the Urban Institute and Robert Wood Johnson Foundation.

Spending declines will happen across both private health insurance as well as Medicare and Medicaid. Centers for Medicare and Medicaid Services actuaries predicted that total Medicare spending between 2014 and 2019 would be $455 billion lower than the ACA baseline forecast. Projected Medicaid spending over the same time period is expected to be $1.05 billion lower than previous ACA estimates, while private insurance spending projections declined by $664 billion.

I simply do not understand the Republicans’ hysterical opposition to the ACA. Both health outcomes and cost controls have improved, and problems with the program can be fixed with relatively minimal tweaking. The program’s popularity has also improved. (According to survey research, approximately half of those who do remain unhappy with Obamacare complain that it doesn’t go far enough–they would prefer a single-payer system.)

It isn’t just the ACA. Paul Ryan and the GOP are threatening to dismantle both Medicaid and Medicare–programs with low overhead and proven effectiveness– and they are intent on defunding Planned Parenthood, which delivers critical medical services to millions of poor women.

It isn’t as though a free market system could work for healthcare. Market transactions require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction. Equal bargaining power doesn’t describe real-world doctor-patient relationships. In that real world, insurance companies have virtually total control over the options available to those fortunate enough to have coverage.

It seems inconceivable that Ryan, et al, simply do not see the multiple fiscal and social benefits of universal–or at least expanded–access to healthcare. So what accounts for their persistent hostility to programs that have proven their effectiveness? Why are they intent upon substituting block grants for Medicaid, turning Medicare into a “voucher” system, destroying Planned Parenthood and eviscerating the ACA?

If the answer to that question is what I think it is– slashing social programs that benefit millions of Americans will allow them to subsidize the insurance and pharmaceutical industries even more generously and deliver more tax cuts to their wealthy patrons–I wonder how they sleep at night.

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Yes We Can–But It Won’t Be Easy

As I read news, articles, blogs–the stuff that comes across my screen every day–I often save articles that might merit a blog post at some future time. One that I saved was a column in the Washington Post reacting to President Obama’s farewell speech.

It was surprisingly upbeat. (Also thoughtful, literate, coherent…elements I miss more than I ever thought I would…)

“Our democracy is threatened whenever we take it for granted,” Obama said, in his best line of the night. “All of us should be throwing ourselves into the task of rebuilding our Democratic institutions.” At another point, he noted: “We all have to try harder.”

To that end, Obama urged people to volunteer. To organize. To run for office in their own right. To swap social media fights for in-person conversations.

Obama’s warning against taking democracy for granted made me think of the old story about the little boy who never talked. As a baby, he didn’t babble; at two and three his parents took him to specialists, none of whom could find anything wrong with him. He simply never talked.

One morning, when he was nearly five, his mother was giving him breakfast when he suddenly blurted out “This toast is burned.” His mother was amazed. “Why haven’t you ever said anything before!” To which he replied, “So far, everything’s been okay.”

We Americans have been a lot like that little boy. As long as our toast wasn’t burned, we’ve ignored the signs that the toaster was malfunctioning, and left the job of tending our democratic institutions to others. We can’t afford to do that anymore. We can’t afford to simply commiserate with like-minded friends and criticize those who dismiss the threat to our Constitutional system and the rule of law.

Discussion is important, but ultimately insufficient.

I’ve mentioned the Activism Engine site before. It’s important because it is a way to turn information into engagement. As the site has undergone its “beta” rollout, it has been made even easier to use–and specifically, easier for people to share information about concrete actions that can be taken.

Now anyone can go to the site and post an item about proposed legislation or an upcoming direct activity–no account or training needed.

Try it! To add information about legislation, go here. For other kinds of direct action, post here. And even if you don’t have an action to suggest, make checking it a part of your routine to see what actions you can take.

In the month since “no drama” Obama turned the White House over to “all drama, all the time” Trump, many of us are no longer taking American democracy for granted, but there is a difference between concern (okay, panic) and consistent, constructive action.

We know the toast is burned. Now we need to fix the toaster.

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Fear–The Demagogue’s Friend

When people are afraid, they do unfortunate things.

As recent paper from the Brookings Institution points out, fear is a demagogue’s best friend. That’s why so many of Donald Trump’s actions in just the first few weeks of his disastrous presidency have been so dangerous.

President Trump’s Executive Order severely restricting visa-holders and refugees’ freedom to enter the United States is not only immoral and un-American—it’s also likely to fail on its own terms and lead to an increase in terrorist attacks against Americans. Yet if terrorism does increase, support for Trump and for harsh and self-defeating policies are likely to grow.

Although I doubt Trump is capable of that level of strategic planning, Actual-President Bannon clearly is.

The paper was written before several courts interrupted enforcement of the Order. As a number of observers have noted, should there be a terrorist attack during that interruption–or after the Order is finally invalidated, as I expect it will be–Trump has already telegraphed his intention to blame the courts and “so-called” judges.

The article reiterates many of the well-known criticisms of the Executive Order–the fact that zero terrorists have come from the countries subject to the ban, and –coincidentally, I’m sure (cough)–the countries that have produced terrorists and whose citizens weren’t banned happen to be countries where Trump has business interests; and the fact that refugee screening is exceptionally thorough, even draconian.

Refugees get the most scrutiny and Syrian refugees get the most scrutiny of all. So the vetting procedures are working. Refugees from other countries affected by the ban—Iran, Iraq, Libya, Somalia, Sudan, and Yemen—have been involved in few plots since 9/11.

In different ways, all these countries have a terrorism problem, but that’s not the same as saying that the people visiting America are terrorists. Indeed, residents of these countries know first-hand the evils of terrorism and loath the groups accordingly. Some of the fiercest anti-Communists came from Cubans fleeing Castro or Russians fleeing Stalin: should we be surprised that Muslims who experience evil firsthand have a visceral loathing of it too? If you don’t believe me, go to an Iranian-American neighborhood in Los Angeles and praise the Iran’s ayatollahs and see what happens.

As the article also points out, saying a country has a terrorism problem is not the same as saying that the people visiting America from that country are terrorists. Quite the contrary: people who have experienced the evils of terrorism are the people most likely to hate and oppose them.

Some of the fiercest anti-Communists came from Cubans fleeing Castro or Russians fleeing Stalin: should we be surprised that Muslims who experience evil firsthand have a visceral loathing of it too? If you don’t believe me, go to an Iranian-American neighborhood in Los Angeles and praise the Iran’s ayatollahs and see what happens.

And there’s those pesky little things…I think they call them “facts”–that suggest most terrorist attacks in the U.S. come from home-grown, white right-wing extremists.

So we have alienated the allies around the world on whom we depend for intelligence information, we have sent a message to moderate Muslims that we make no distinction between the millions of peace-loving adherents of that religion and the radical fringe, and we have dramatically increased the likelihood of a terrorist attack that can only help Donald Trump.

The horrible reality, however, is that a terrorist attack, especially one at home, is likely to “prove” that Trump is right. Terrorists’ successes are always a bit random, but at least some low-level attacks would be likely regardless of who was president. Trump, however, ran a campaign of fear and dishonesty about the terrorism threat and the attitudes of U.S. Muslims (for example, the false claim that thousands of New Jersey Muslims cheered the 9/11 attacks). Polls show fears of terrorism were at near-record levels before the election despite the small number of attacks and deaths in the U.S. since 9/11, and this fear increased support for Trump’s candidacy.

Once an attack happens, Trump will probably tweet that he called for vigilance and tough measures only to be opposed by bleeding heart liberals, the failing New York Times, and Muslim-lovers naïve to the true danger. The fact that his policies made the attacks more likely will be lost in the uproar.

Nothing will please President Bannon more.

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Are We the Poisoned Darts?

Vox recently had a good analysis of an increasingly pertinent question: is the chaos emanating from Washington part of a diabolical plan to generate social unrest that can then be used to justify the imposition of martial law or its equivalent, or is it evidence (as if we needed any) of the incompetence and ignorance of the embarrassing buffoon sitting in the Oval Office?

That argument is already taking shape around Trump, as he ham-handedly issues executive orders poorly understood by his own bureaucracy and fires members of his administration. It is aptly captured in two recent essays.

The first is by Yonatan Zunger, a Google privacy engineer. It’s called “Trial Balloon for a Coup?” and it reviews the news of the past day or two through the lens of a unifying theory: By putting confidant Steve Bannon on the National Security Council, cutting agencies out of rule-making, and defying a court order, Trump is systematically attempting to reduce any checks on his power. He’s trying to concentrate power in a small counsel of trusted advisers (the “coup”) and avoid legal review.

The second essay is by political scientist Tom Pepinsky, in response. It’s called “Weak and Incompetent Leaders act like Strong Leaders,” and it makes a simple point: The very same actions Zunger interprets as a devious, coordinated plan can also be interpreted as the bumbling, defensive moves of a weak leader who doesn’t know what the hell he’s doing.

As Pepinsky points out, all we have to go on is “observable” action. For example, perhaps Trump put Steve Bannon on the NSC to consolidate power, part of his intent to sideline the establishment figures who actually know something about American foreign policy. On the other hand, perhaps he brought Bannon into the NSC because he doesn’t understand the discussions occurring in that venue (or perhaps everyone in the foreign policy establishment is dragging their feet and otherwise trying to keep him from doing something that will trigger a diplomatic crisis or a war), and he brought in Bannon because he felt the need for a loyal “interpreter” he could trust.

The former is a sign of strength. The latter is a sign of weakness. Both have the same observable implication.

The author of the article, Dave Roberts, prefers the latter explanation; as he notes,

[N]arcissistic, paranoid tribalists are rarely geniuses, because genius requires a certain detached perspective, an ability to step outside oneself, which is precisely what narcissists lack.

In any event, Roberts says that the consequences of Trump’s behavior will be determined not by his intent, but by the strength of the institutions that have shaped our ability to resist.

If we’re looking to understand the course an authoritarian takes through a country and its history — what’s he’s accomplished, what’s likely to happen next — the place to look is not his intent, but the institutions and norms of the country he seeks to dominate. They, not his ultimate goals and desires, are what most determine the ultimate shape and consequences of a regime.

Think of a bull loose in a china shop. How much damage will it do? The relevant variable is not the bull’s intent. A bull’s gonna bull. The relevant variable is how equipped the china shop is to stop the bull. How many tranquilizer darts does it have, or, I don’t know, nets? (I didn’t think this analogy all the way through.)

The point is, how far an authoritarian can blunder forward, violating norms and degrading institutions, is determined by the strength of the norms and institutions he encounters. They determine when, or whether, he is constrained….

What will happen next depends not on Trump, but on America’s institutions and norms — the courts, the military, Congress, civil society, journalism. It is their strength, not his, that will determine how this story ends.

I like this analogy, muddled or not.

Trump is a raging bull. (As Jon Stewart memorably told Stephen Colbert a few nights ago on the Late Show, the “official language” of Trump’s America is bullshit.)

We the People must be the poisoned darts.

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This Does Answer a Common Question

Each time Trump announces a new nominee for a position in his administration, the same question arises: where does he get these people? (The ones who aren’t family members, that is. Family may be equally unfit, but we do know where he gets them.)

Really, who knew there was a vast pool of corrupt, unqualified, mean-spirited people willing and eager to work with Donald Trump?

Juanita Jean points out that Texas is one good source of appalling folks.

You guys remember Yachting Randy Neugebauer – the west Texas congressman we love around here. Randy bought a yacht with his campaign funds which is kinda strange since he lives in the desert, was the guy who chewed out the national park service ranger on tv for doing her job during the government shutdown that he voted for, yelled “baby killer” at a Democratic congressman during a debate, and called US border detention centers the lap of lovely, and a whole mess of other stuff including how the hell did his son, Toby, become a billionaire.

“Yachting Randy” had retired from Congress, but it appears he will be joining the Trump Administration. In a match most definitely not made in heaven, he is being considered for a job as the head of the Consumer Financial Protection Bureau.

Donald Trump is considering Randy to head up the Consumer Financial Protection Bureau, Elizabeth Warren’s old job. Did you hear me? The Consumer Financial Protection Bureau. Why aren’t you hollering and stomping?

Hell, people, you could not trust that guy with a dime. He will steal the gold out of your teeth. Plus, he’s crazier than an internationally syndicated Donald Trump tweet. He’s got loco camped out in his eyeballs.

So “Yachting Randy” joins the growing parade of “you’re kidding, right?” nominees….

Not long ago, I was having lunch with a friend; we were glumly assessing the various harms likely in a country governed (if you can call it that) by this collection of truly appalling choices, and we concluded that their very incompetence might be our salvation–that most of them were too inexperienced and uninformed to be effective. The Trump Administration seemed likely to resemble the Keystone Kops.

But people like “Yachting Randy” and “Oops Rick Perry” and (most terrifying of all) “Sheriff” Jeff Sessions do have government experience. Their prior performance wouldn’t exactly recommend them for positions in a competent administration, and they may not be the sharpest knives in the drawer, as the old saying goes, but they may actually be able to do a considerable amount of harm.

I keep telling myself I’m just having a nightmare…..Could someone please wake me?

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