Tag Archives: politics

Health Care One More Time

Public Policy and Governance, , ,

Republicans love to accuse government of waste and fraud while pointedly ignoring waste and fraud in the private sector. (I always think of that biblical phrase about ignoring the beam in one’s own eye...if you want to talk about fraud, Senator Scott….).

That disconnect is particularly obvious when it comes to America’s incredibly wasteful insistence on private sector health care. Several years ago, I was on a university research team looking at certain aspects of Indiana’s health care environment. I no longer recall the outlines of our investigation, but I do still remember my shock at learning that–at that time–seventy percent of all American health care costs were being paid by some level of government.

It wasn’t just Medicare and Medicaid, or the CDC, or the numerous federal programs aimed at specific diseases. State and city governments support local hospitals for the indigent, and other local programs; more significantly, the millions of people in the U.S. who work for a government entity–universities, police and firefighters, schoolteachers, etc. etc.–have health insurance paid for by tax dollars.

What really blew my mind was the realization that the money government was already spending would be enough to cover almost all of the costs of a national health care system if we simply reduced the enormous amounts spent–wasted– on duplicative paperwork and insurance company marketing and overhead.

What made me think about that long-ago epiphany was an article from The Fulcrum sharing “shocking statistics” about American healthcare.

The first was the number of people on Medicaid. (Not Medicare–Medicaid.) Most of us think of publicly funded healthcare as something offered by Canada and countries in Europe, not the adamantly “private” U.S.

The shocking truth is that most of the U.S. population will soon be on some form of government-sponsored health insurance. Right now, 158 million Americans (nearly half of the nation’s 330 million population) are covered by a combination of Medicare, Medicaid and subsidized enrollment in the state and federal exchanges. Experts predict that percentage will climb.

Within that population is an even-more shocking statistic: According to the Centers for Medicare & Medicaid Services (CMS), enrollment in Medicaid surpassed 90 million in 2022.

This program, traditionally linked to a small population of Americans in poverty, will serve more than 100 million people in fiscal year 2023 (or 1 in 3 insured Americans). Since 2020, Medicaid enrollment has jumped 30% thanks to expansion programs in several more states under the Affordable Care Act and Covid-19 public health emergency funding.

The article highlighted several problematic consequences of that staggering figure, especially the difficulty experienced by enrollees in finding primary care doctors.

The second statistic concerned individuals who aren’t on either Medicare or Medicaid.

Since 2000, medical costs have risen each year by 4.85%, significantly outpacing the 2.85% annual increase in GDP.

With healthcare premiums rising at a faster rate than revenue, businesses have made up the difference by transferring the financial burden to employees in the form of high-deductible health plans.

In 2022, despite below average healthcare inflation, U.S. employees paid a shocking 10.4% more in out-of-pocket healthcare expenses than the year before.

Already, medical costs are the No. 1 cause of bankruptcies in the United States. If a recession ensues as many economists predict, millions more workers and families will suffer economic hardships.

Number three? Forty-eight percent of those eligible for Medicare choose Medicare Advantage.

“Traditional” Medicare, enacted by Congress in 1965, continues to use a fee-for-service reimbursement model—one that pays doctors and hospitals based on the quantity (rather than quality) of medical services they provide.

In 1997, Congress created an alternative program called Medicare Advantage (MA). Unlike traditional Medicare, this option is “capitated.” That means the federal government pays healthcare providers an annual, up-front fee based on the age and health status of the enrollees.

Supporters of MA say that capitation incentivizes doctors to keep patients healthy without over-treating and over-testing them.

However, there are some downsides. Although seniors enrolled in MA enjoy more predictable annual costs and added benefits such as eyeglass coverage, they have fewer choices when selecting doctors and hospitals.

I found that last observation interesting, since most people who oppose national healthcare insist that Americans value choice more highly than cost. Apparently, we don’t.

The article concludes by reminding readers that healthcare inflation has exceeded GDP growth for half a century. The U.S. spends more than twice as much as the next most expensive nation for health care, and the last time I looked, American healthcare was ranked 37th. Meanwhile, employers and families are increasingly finding the costs out of reach.

These statistics just confirm that ideology can kill. (If you doubt that, look at the disproportionate number of Republicans who died of COVID because they refused to be vaccinated.)

Clinging to the belief that we aren’t already “socialized”–and very inefficiently– costs all of us a lot of money.

 

 

Some Positive Harbingers

Random Blogging, , ,

These days, there is so much to complain about, to worry about–and thanks to the Internet, so many voices (including mine) pointing to our social deficits and failures. But there is also good news “out there,” and anyone who isn’t fixated on what’s going wrong can’t help but acknowledge positive harbingers as well as dire predictions.

I receive a number of publications that focus on science and the environment, for example, and reports of breakthroughs are a consistent–for that matter, a daily– feature. Let me just share a few examples of the sort of positive news that rarely makes the front pages of The New York Times or The Washington Post. These are from just one source: Euronews:

A Belgian NGO is using human hair clippings to absorb environmental pollutants.The hair is turned into matted squares, which can be used to absorb oil and other hydrocarbons. The mats can be placed in drains to soak up pollution in water before it reaches a river. They can also be used to deal with pollution problems due to flooding and to clean up oil spills.

In the EU, solar power soared by almost 50 per cent this year (2022).

The IEA reported that the world is set to add as much renewable power in the next five years as it did in the past 20.

London-based start-up Notpla believes it has an answer to our plastic waste problem: a plastic alternative made from seaweed and plants. It’s totally natural, completely biodegradable and can be used to make a range of packaging from bubbles to hold liquid to linings for food containers.

Here in the U.S., despite GOP resistance, President Biden signed the Inflation Reduction Act–a  historic bill that makes the single largest investment in climate and energy in America’s history.

There are many, many more stories of progress, including the important breakthrough on nuclear fusion, which may eventually provide humanity with unlimited–and non-globe-warming–power.

It isn’t just science, or medical science (where equally impressive progress continues to be made). Even in our fraught politics, there are bright spots. The election of Lula to replace climate denier Bolsonaro in Brazil may save the rest of the  critically-important Amazon rainforest from further destruction.

Fareed Zakaria argues that there are signs that the coming year will finally see a decline in the global populism that threatens democracies worldwide.

Zakaria begins by describing the current travails of the GOP, which are likely to prevent the party from doing anything substantive, including damage. He then writes:

The Republican Party’s troubles are severe. Newt Gingrich told Axios that the party is in its worst shape in almost six decades. But it is not alone. In many countries around the world, populists are flailing.

Look at Britain, where Brexit — perhaps the ultimate 21st-century populist cause — has caused havoc within the Conservative Party, which used to be described as the world’s oldest and most successful political party. Britain has had five prime ministers in the six years since 2016; the prior five prime ministers spanned more than 30 years. The self-defeating decision to exit its largest market, the European Union, continues to depress the country’s economic prospects, and it remains the weakest of the Group of Seven economies. In the Group of 20, only Russia is projected to do worse than Britain in the near future…

In the recent elections, Australia’s conservatives suffered their worst loss ever, and the even more extreme United Australia and One Nation Parties did poorly as well. The new Labor prime minister enjoys an extraordinarily high approval rating.

Even in Argentina– a hotbed of populism since Peron–the populist movement is at its lowest ebb.

Zakaria explains these setbacks for the movement by reminding readers that populism is essentially an opposition movement. Populist politicians denounce the “establishment” or the “elites,” encourage fear and promote conspiracy theories. Their  promises are emotional rather than practical–build a wall, ban immigration, stop trade.

But once in government, the shallowness of its policy proposals is exposed, and its leaders can’t blame others as easily. Meanwhile, if non-populist forces are sensible and actually get things done, they defang some of the populist right.

Look at the United States, where President Biden’s moderate style, serious demeanor and practical policymaking have given him large legislative accomplishments without triggering a massive electoral backlash. Now, he does benefit by being an old, White man. Had Barack Obama enacted the same policies, I have a feeling we would be hearing much more talk of Obama’s dangerous socialism and un-American policies, complete with racial innuendos.

As Zakaria notes, the world’s problems are complicated, and there will always be activists proposing solutions that are “simple, seductive and wrong.” But there are hopeful signs; 2023 could be the year the fever begins to break.

 

Telling It Like (I Think) It Is

Random Blogging, , ,

I can’t decide what I think about the relatively recent phenomenal growth of Substack newsletters. I’m one of the thousands–millions?–who regularly reads Heather Cox Richardson’s “Letter from an American,” and after my sister strongly recommended Robert Hubbell, I subscribed to his daily newsletter as well.

On the one hand, these transmittals afford writers much more scope than they would have if confined to more traditional columns or “op-ed” pages. On the other hand, an individual reader’s ability to pick and choose who to follow–and to disregard arguments from people with contrary perspectives–rather obviously adds to our ability to construct and inhabit “bubbles” that protect us from conflicting points of view, and thus reinforce our own biases. 

Newsletters–and not just those from Substack–are part of the significant and growing fragmentation of our current media environment–a fragmentation that has many Americans living in incommensurate realities.

I am one of those Americans, and despite the foregoing admissions, I will admit that I enjoy getting a newsletter that expresses my own views in language I find particularly apt. That was the case with Robert Hubbell’s reaction to Donald Trump’s announcement that he is once again running for President. I am sharing his response–which includes observations with which I heartily agree–but with the admission that people like Richardson and Hubbell have become essential parts of my bubble (and that I’m not proud that I inhabit one despite genuine efforts to access contrary perspectives…)

Hubbell focused less on Trump’s rambling and low-energy speech and more on the “about faces” of some of those who have previously been prominent Trump supporters. The former President’s announcement met with a marked lack of enthusiasm from major GOP donors, and from Fox News, the NYPost, and the WSJ –a lack of enthusiasm that has been widely reported.

With respect to Murdoch’s media empire, Hubbell wrote

Each was a staunch ally of Trump through two impeachments, insurrection, bribery and sex scandals, and Trump’s criminally negligent handling of the pandemic. The fact that each has changed its news coverage and editorial policy on forty-eight hours’ notice demonstrates that they are not independent news organizations… Rather, the supposed “news organizations” are extensions of Rupert Murdoch’s ego and desire for personal power. It is a disservice to maintain the fiction of their legitimacy. It is a pretense that insults the democratic tradition of a free press.

Then there was the seeming defection of a number of those all-important major donors.


So, too, with Trump’s major donors. The media is ticking off each announcement by a hedge fund billionaire or captain of industry who will no longer contribute to Trump’s campaign. See, e.g., Axios, GOP megadonor Stephen Schwarzman defects from Trump after 2024 announcement, and Fox News, GOP megadonors want to move on from ‘three-time loser’ Trump, look to back DeSantis in 2024 presidential bid.

It is shocking that billionaires are casually mentioning their switch in loyalties as if they are describing their preferences in wine or cigars. Their corruption of the political process is grotesque and yet they are unashamed and unrepentant for their role in funding a man who attempted a coup and incited an insurrection. No apology; no “Mea culpa;” just “Next!”

 In a particularly pithy phrase, Hubbell suggests that the lesson these donors took from their support of an aspiring fascist was that they needed “a better-educated, more articulate aspiring fascist to support.”

Hubbell is quite correct in pointing out that the current exodus from Trump–even assuming it isn’t transitory– isn’t the story. The story–the lesson we observers should take away from the current spectacle–is that

the enablers and co-conspirators who nearly prevented the peaceful transfer of power have learned nothing—except that they can make more money and acquire more power by creating another Frankenstein’s monster. We cannot treat them as if they are legitimate participants in the political process. They are not. They are vultures looking for carrion.

While I appreciate his felicitous turn of phrase, what really makes Hubbell’s newsletter valuable–at least to me– is that he consistently includes suggestions for actions citizens can take. He provides answers to the recurring question: what can we citizens do? It was that aspect of his newsletter that most appealed to my sister, and now appeals to me–a roadmap of sorts that helps dispel the feelings of powerlessness that periodically overcome and depress us.

My newsletters: Richardson for historical context. Krugman for economic wisdom. Nichols for biting commentary. And Hubbell for positivity and–despite occasional lapses into legalese (he’s a lawyer)–intermittent rays of sunshine….. 

The Power Of Resentment

Random Blogging, , , , , , ,

Every once in a while, as I wade through the onslaught of emails, newsletters, solicitations and media transmissions that clog my daily in-box, I’m brought up short by a sentence that seems profound. (Granted, the degree of profundity often varies with the amount of sleep I had the night before…) The most recent such experience was triggered by an Atlantic newsletter from Tom Nichols, who wrote that “resentment is perhaps the most powerful political force in the modern world.”

The context of that observation was in the newsletter’s lede

On October 7, the Republican House Judiciary Committee cryptically tweeted, “Kanye. Elon. Trump.” The tweet was, predictably, ridiculed—especially after Ye (as Kanye West is now known), just days later, threatened “death con 3 on JEWISH PEOPLE” on Twitter. But, intentionally or not, the committee had hit upon a basic truth: The three are alike.

What unites these successful men—and, yes, Trump is successful—is their seething resentment toward a world that has rewarded them money and influence, but that still refuses to grant them the respect they think is their due. And if we should have learned anything since 2016, it is that resentment is perhaps the most powerful political force in the modern world.

Nichols writes that the movements that historically motivated large numbers of people have dwindled, while today, it is “social and cultural resentment” that is driving millions of people into what he describes as a kind of mass psychosis.

I will leave aside Ye, who has his own unique problems (although I will note that his early career was marked by his anger at being shut out, as he saw it, from hip-hop and then the fashion world). Prominent and wealthy Americans such as Trump and Musk, along with the former White House guru Steve Bannon and the investor Peter Thiel, are at war not so much with the American political system, whose institutions they are trying to capture, but with a dominant culture that they seem to believe is withholding its respect from them. Politics is merely the instrument of revenge.

As Nichols reminds us, Trump has spent his life “with his nose pressed to the windows of midtown Manhattan, wondering why no one wants him there. He claims to hate The New York Times but follows it obsessively and courts its approval.” Elon Musk, who has put people in space and who claims to be a free speech purist, has blocked and suspended twitter users who made fun of him. “As one Twitter wag noted, Musk’s acquisition of Twitter is like Elmer Fudd buying a platform full of Bugs Bunnies.”

The great irony is that Musk’s other achievements might have vaulted him past perceptions that he’s a spoiled, rich doofus, but buying Twitter and making (and then deleting) jokes about self-gratification while telling people to vote Republican has pretty much obliterated that possibility.

Nichols is absolutely correct when he notes that the people who do support Trump are people with whom he would never, ever want to associate.

He is also correct when he notes that the people most likely to act out their resentments aren’t the poor–they are the “comfortably off populist voters” who were “never invited into the” top universities, the biggest firms, the major corporations.”

The January 6 rioters were, by and large, not the dispossessed; they were real-estate agents and chiropractors. These citizens think that the disconnect between material success and their perceived lack of status must be punished, and if that means voting for election deniers and conspiracy theorists, so be it…

And finally, look at the Republican campaigns across the nation. Few are about kitchen-table issues; many are seizing on resentment. Resentment sells. The GOP is running a slew of candidates who are promising that “we” will make sure “they” never steal an election again, that “we” will stop “them” from making your kids pee in litter boxes, that “we” will finally get even with “them.”

Voters in the United States and many other developed countries can lie to themselves and pretend that a one-year hike in the price of eggs is worth handing power to such a movement. Human beings need rationalizations, and we all make them. But voting as responsible citizens requires being honest with ourselves, and I suspect that we will soon learn that more of us are gripped by this kind of sour social irritation than we are by the price of gas.

Nichol’s essay is well worth reading in its entirety, and I encourage you to click through. I think his diagnosis is absolutely correct.

The problem is, he neglects to prescribe a remedy. And I can’t come up with one.

 

Men, Women And Politics

Random Blogging, , ,

What was that book about women being from Venus and men being from Mars? Recent polling data suggests that tongue-in-cheek title may reflect real differences. (And no, I don’t mean “differences” in the “viva la difference!” sense.)

Thomas Edsall’s columns in the New York Times are always heavily indebted to academic research. In a recent one, he considered what research tells us about the political gender gap. Here’s his lede:

In one of the most revealing studies in recent years, a 2016 survey of 137,456 full-time, first-year students at 184 colleges and universities in the United States, the U.C.L.A. Higher Education Research Institute found “the largest-ever gender gap in terms of political leanings: 41.1 percent of women, an all-time high, identified themselves as liberal or far left, compared to 28.9 percent of men.”

While there is a lot of research confirming the existence of that gender gap, a problem with surveys of this sort becomes apparent from Edsall’s description of another poll. This one asked the following  question: “If you had to choose, which do you think is more important, a diverse and inclusive society or protecting free speech rights.”

Male students preferred protecting free speech over an inclusive and diverse society by a decisive 61 to 39. Female students took the opposite position, favoring an inclusive, diverse society over free speech by 64 to 35.

There are all kinds of things wrong with this question, not least the absence of a third option that would allow respondents to indicate they found these values to be equally important. But the biggest problem with using this framing to demonstrate that men and women are politically different is what we know about levels of civic literacy.

I am absolutely confident that few of those surveyed really understand how communications are protected by  the Free Speech Clause of the First Amendment, and against whom.

And that brings me to a persistent gripe I have about Americans’ love of labeling opinions “left” and “right” based on questions of this sort. Not only have the definitions of liberal and conservative changed rather markedly over the past decades (I have the same basic political philosophy that made people label me “very conservative” in 1980, and now I am routinely identified as liberal/pinko/socialist), but a number of policy preferences don’t neatly fall into a black and white, liberal/conservative framework.

I will concede that–at this time– there is a significant political gender gap, and it seems to be growing. Differences in party identification have been evident since the early 1980s, and as Edsall says, we can now see that “the political engagement of women is having a major impact on the social order.”

When Edsall asked a couple of scholars to be more specific about the nature of that impact, most responded that most women are less violent and warlike than most men.

“We find that the evidence is consistent with the view that the increasing enfranchisement of women, not merely the rise of democracy itself, is the cause of the democratic peace.”

Put another way, “the divergent preferences of the sexes translate into a pacifying effect when women’s influence on national politics grows” and “suffrage plays a direct and important role in generating more peaceful interstate relations by altering the political calculus of democratic leaders.”…

There are broad value differences between men and women. Women score higher on values defined by care, fairness, benevolence, and protecting the welfare of others, reflecting greater empathy and preference for cooperative social relations.

The column highlighted gender differences with respect to the use of force–differences in how the sexes approach conflict and competition, and how, as more women have entered the political realm, the lived experience of those women has contributed to what scholars term “the feminization” of government and politics.

I don’t want to quibble with the scholarship displayed in this column, which is sound, but permit me a  caveat.

As with all studies and polls, these conclusions are  at best snapshots–accurate (assuming that they are) at a particular point in time. As women enter more fully into national life, including political life, we tend to get more like the men with whom we interact.( I’ve run across some pretty belligerent/warlike women…)

And of course, this goes for the men, too, who benefit significantly from interacting with us. (I don’t like the term “feminize”–sounds wimpy. How about “humanize”?)

I don’t think women are necessarily more “liberal.” I think our life experiences may have made at least some of us a bit more human--and I think we’re making you guys a bit more human too.

And unfortunately, there’s probably not much of a gap when it comes to the ability to accurately describe the operation of the Free Speech Clause…