Inexplicable, Costly and Wrong; An “Extra” Blog

Okay, I defy anyone to explain this to me.

As regular readers know, I’m in the hospital recuperating from a nasty fall. I broke my pelvis and my clavicle. I’ve been here 8 days, although the doctors wanted to send me to acute rehab three days ago. (Acute rehab is apparently more intensive, appropriate for people who have been active and can be expected to respond to longer sessions of physical therapy–and thus leave for home more quickly.)

This morning, I was finally supposed to be transferred. But then, Anthem, my “insurance” company (note the quotes) rejected the doctors’ advice and denied the move. According to the caseworker, since the first of the year, insurers have been denying approximately 50% of requested moves to acute rehab. Without seeing the patients, without consulting with their doctors. The hospital can and does appeal, and about half of those “peer to peer” appeals are granted–we’ll see what happens with mine–but even the appeal process evidently becomes a game; calls are routinely returned after hours, for example, when the insurance company knows the physician won’t be available, prolonging the process.

But here’s what is insane: keeping me in the hospital costs more than sending me to rehab.

Why would a company that should want to keep costs down opt for a placement that (1) is medically inappropriate; and (2) costs more? Why did the approval process suddenly become more arduous at the beginning of the year? What is the larger game being played in which I find myself a pawn? And what therapy will Anthem pay for? Anything? Or is my 83-year-old husband supposed to drag me up the stairs at our home and help me in and out of bed when nature calls?

Tell me again how horrible single-payer systems are…

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Political Choices and Imperfect Information

We’re deep into presidential primary season, and Americans are taking our imperfect knowledge of the candidates to the polls.

Given the sheer amount of ink–digital or real–devoted to American presidential candidates, you’d think voters would have ample, detailed information about those competing for our votes and contributions. But it doesn’t seem to work that way. Verifiable information is “supplemented” with rumor (scurrilous or fawning, depending upon the source and its motivation), and what we do read or hear is filtered through a partisan lens.

Unless we actually know a candidate–or know someone who does–we have only imperfect impressions on which to make judgments about character and intellect. That’s one reason why, in a more perfect world, voters would pay more attention to a candidate’s positions and less to the hype. Marco Rubio’s desire to outlaw all abortions–even in cases of rape and incest–tells you more about his character than softball interviews or even hardball debates.

I remember when George W. Bush was first running for President. He came across as more personable than Al Gore, and the meme was that here was a guy you’d enjoy having a beer with. At the time, I was working with an IUPUI professor whose (very Republican) doctor husband had practiced many years in Midland, Texas. When a dinner party conversation turned to the campaign, he mentioned that he’d gone jogging three or four times a week with George W. and a couple of others for several of those years.

“Really!” I said. “What’s he like?”

The doctor thought for a couple of minutes, then said “Dumb and mean.”

I don’t offer this as irrefutable evidence of George W’s intellect or temperament; I have no idea what their relationship might have been, or how accurate the doctor’s assessment. But it is evidence that widely shared impressions of public figures do not necessarily saccord with assessments by people who actually know and work with those figures.

I thought about that conversation when I read this description of Hillary Clinton at the Political Animal.

As President Obama’s former speechwriter (including during the 2008 primary), Jon Favreau admits that he was not always a fan of Hillary Clinton. He writes about how his view changed while he worked with her in the White House.

“The most famous woman in the world would walk through the White House with no entourage, casually chatting up junior staffers along the way. She was by far the most prepared, impressive person at every Cabinet meeting. She worked harder and logged more miles than anyone in the administration, including the president. And she’d spend large amounts of time and energy on things that offered no discernible benefit to her political future—saving elephants from ivory poachers, listening to the plight of female coffee farmers in Timor-Leste, defending LGBT rights in places like Uganda.”

Given the sustained assault on her character over the years, many of us have had a less-than-enthusiastic response to Hillary’s candidacy. She is clearly the most knowledgable and experienced, but she has also been the most tarnished–sometimes fairly, often not. People I’ve met who actually know her tend to share Favreau’s impressions.

Who’s right, who’s wrong? Who knows?

At least she isn’t arguing about who has the biggest penis.

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The Question Is: Now What?

Will Saletan has a must-read essay at Slate. 

Saletan is responding to a bizarre accusation making the rounds on the Right to the effect that President Obama is really the reason for the rise of Donald Trump. (I notice that I use the word “bizarre” more frequently these days.) The American public, according to this “analysis,” is rejecting the extreme leftism of the Obama presidency.

As Saletan notes, this is bunk. In saner times, President Obama would have been a liberal Republican or, at most, a moderate Democrat. Saletan ticks off the policies of this administration and the place of those policies on the political spectrum, and forcefully rejects the thesis.

No, Obama didn’t cause Trump. What caused Trump was the GOP’s decision to negate Obama in every way, and thereby become the party of Trump….

If Obama had been a leftist, the GOP’s policy of negating him on every issue might have positioned Republicans in the mainstream. Instead, because Obama was a moderate, the GOP’s negation strategy pushed it toward the fringe. Obama was for fiscal responsibility and compromise, so Republicans were for absolutism and drama, risking a federal shutdown and a credit default. Obama was for respecting the Supreme Court, so the GOP was for defying judicial orders. Obama was for using sanctions to pressure Iran into a nuclear deal, so Republicans were for scrapping the deal and daring Iran to provoke a war. Obama, like Bush, was for drawing a clear distinction between terrorists and Muslims. So Republicans were for blurring that distinction.

In Trump, Republican voters have found their anti-Obama. Trump spurns not just political correctness, but correctness of any kind. He lies about Muslims and 9/11, insults women and people with disabilities, accuses a judge of bias for being Hispanic, and hurls profanities. Trump validates the maxim that in presidential primaries, the opposition party tends to choose a candidate who differs temperamentally from the incumbent. Obama is an adult. Therefore, Republicans are nominating a child.

You really should click through and read the entire thing–these few extracts don’t do it justice.

Here’s the conclusion:

So, yes, Obama led to Trump. But that’s only because the Republican Party decided to be what Obama wasn’t. And what Obama wasn’t—insecure, bitter, vindictive, xenophobic, sectarian—is what the GOP, in the era of Trump, has become.

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Mike Pence: Embarrassing Indiana Yet Again

Nothing like picking up the New York Times, “the nation’s newspaper,” seeing an editorial titled “Judge’s Message to Xenophobes,” and realizing it’s all about Indiana Governor Mike Pence.

The editorial was in response to the stinging decision by Federal Judge Tanya Walton Pratt, in which she not only found what every first-year law student already knew–that federal government, not the state, has jurisdiction over the resettlement of Syrian refugees–but that Pence’s move to withhold resettlement funds was “in no way” justified by his claim that his main concern was the safety of Indiana residents.

Resettlement lawyers said the ruling was the first to address substantively the attempt by some governors, mostly Republicans, to exploit the terrorism issue. The presidential candidates, of course, have been vying furiously to keep up with venomous nativism coming from Donald Trump and from Gov. Chris Christie of New Jersey, who told a conservative radio interviewer that “I don’t think orphans under 5 are being, you know, should be admitted into the United States at this point.”

I had no idea those five-year-old Syrian kids could be so dangerous….but of course, they’re Muslims….

According to the State Department, 67 percent of the Syrian refugees referred to the United States for asylum are women and children under the age of 12. Mr. Trump has falsely suggested that federal officials steered Syrian refugees to states with Republican governors, when in fact resettlement decisions are made by mainstream social agencies like the United States Conference of Catholic Bishops. Mr. Trump’s claim was one more example of propaganda being used to distort the truth on the refugee issue.

Governor Pence’s willingness to make political points by inflicting unnecessary harm on children who are already in dire straits simply confirms what even the most casual observer has seen: a self-important, self-described “Christian” more interested in pandering to his party’s fundamentalist base than in governing the state of Indiana.

What is even more unbelievable is that Mr. Posturer insists he will appeal the decision. He will expend taxpayer resources to appeal a judicial application of settled law, further announcing to the nation and the world that Indiana is an unwelcoming and discriminatory state.

That ought to be almost as good for business as his defense of homophobia.

I know where you can buy a “Pence Must Go” sign.

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Well, This is Terrifying…

According to a study of voter participation in primaries thus far, Republicans are turning out in unusually high numbers, even for them.

And worse, Democrats aren’t. (Despite all the hype about “feeling the Bern,” turnout isn’t reflecting a groundswell for Bernie Sanders, and Hillary is widely considered competent but uninspiring.)

Turnout has long been the GOP’s ace-in-the-hole. According to both voter registration rolls and polling results, Democrats outnumber Republicans nationally by a comfortable margin. Granted, both gerrymandering and what has been called “residential sorting”–the fact that Democrats tend to cluster in urban areas while Republicans are more numerous in rural and suburban precincts–operate to favor Republicans. Republicans have also been much better at voter suppression tactics like Voter ID.

But Republicans’ real advantage has been turnout. For whatever reason, the party has been able to get more of its voters to the polls than the Democrats.

Scholars at the Brookings Institution have suggested that McConnell’s Supreme Court obstruction is largely about turnout.

This approach [total obstruction].. breathes fresh life and fresh fight into the conservative base and serves as a potentially unifying issue after a divisive Republican presidential primary season.

In other words, obstruction and partisanship motivate the base.

This year, if Republicans once again turn out in greater numbers than Democrats, the disparity could give us the unthinkable—President Trump.

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