May 4, 2017--Life Itself Is a Pre-Existing Condition

The current debate about healthcare among Republicans has come down to how the ultra-conservative Freedom Caucus and the so-called moderates disagree about how to deal with preexisting medical conditions--

As House of Representatives leadership scrounges around for votes to repeal and replace Obamacare, the debate focuses on how insurance should work for people who have health issues?

The moderates are concerned that tens of millions currently covered will lose their ability to purchase insurance since individual states can opt out of the requirement to offer coverage to Americans who have, say, cancer or heart disease or can charge many times what equivalent polices cost for individuals who do not have preconditions.

Though there would be some subsidies for low-income people these would be inadequate since the GOP version of healthcare insurance is in essence more free-market, for profit in structure than redistibutional. This means the legislation they are pushing is about two things--first, cutting government costs and, more important to Republicans, conservative or moderate, to repeal the taxes high earners are required to pay to help offset some of the overall cost of the Affordable Care Act.

This would mean that if you have a precondition you either have to come up with the cash to buy insurance or go without it. In a market-driven Darwinian world, c'est la vie.

Talking about this over breakfast yesterday, Rona said that everyone older than 50 has one or more preconditions just from having lived that long.

She meant it as a quip since it is not literally true; but, when we went down the list of our family and friends to see how many have one or more preconditions, we found that this is true for almost everyone we know.

Including the two of us! If we had to, neither one of us would be able to secure much less pay for health insurance.

From TermLife's Website below is a very partial list of preconditions that would be disqualifying if Obamacare were replaced by what is apparently about to be approved by Republicans in the House of Representatives.

At least a third of Americans have preexisting conditions that would not allow them to buy insurance or it would be beyond their means to afford if we move back to a market approach.

Everyone has stories about people being denied coverage. Here are two from Wednesday's New York Times--

Larisa Thomason, of New Market, Ala., remembers how her husband got a letter from Humana informing him that his policy would not cover cancer care because a colonoscopy had turned up several benign polyps.

Also, an insurer in Washington refused to cover any treatment to Alice Thompson's reproductive system because a doctor had written in her remedial record that she should have a hysterectomy to eliminate powerful menstrual periods.

This is a glimpse of the future of health care if Republicans in Congress and the White House have their way.

ACID REFLUX (GERD)

ADDISON’S DISEASE

ALCOHOL ABUSE AND RECOVERY

AMYOTROPHIC LATERAL SCLEROSIS (ALS)

ANEMIA

ANEURYSM

ANGINA PECTORIS

ANGIOPLASTY

ANOREXIA

ANXIETY

AORTIC ANEURYSM

ARRHYTHMIA

ARTHRITIS

ASTHMA

ATRIAL FIBRILLATION

ATRIAL FLUTTER

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

AUTISM

B

BARIATRIC SURGERY

BASAL CELL CARCINOMA

BERGER’S DISEASE

BENIGN PROSTATIC HYPERTORPHY

BIPOLAR DISORDER

BLOOD CLOT

BLOOD PRESSURE

BRADYARRHYTHMIAS

BREAST CANCER

BRONCHIECTASIS

BRONCHITIS (CHRONIC)

BULIMIA

BUNDLE BRANCH BLOCK

C

CANCER

CARDIOVASCULAR DISEASE

CELIAC DISEASE

CEREBRAL ANEURYSM

CEREBRAL EMBOLISM

CEREBRAL PALSY

CEREBRAL THROMBOSIS

CHARCOT MARIE TOOTH DISEASE

CHOLESTEROL

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

CHOLITIS (ULCERATIVE)

CLAUDICATION

COLON CANCER

COLON POLYPS

CONGESTIVE HEART FAILURE (CHF)

CORONARY BYPASS 

CROHN’S DISEASE

April 3, 2017--Jack: "Long Time No Speak"

"Happy April Fools' Day," it was Jack a friend from Maine, "Long time no speak." I girded myself for a prank.

"These days," I said, "every day feels like April fools Day." I hadn't heard from him in a few weeks. "I assume you haven't been calling because your boy is making such a mess of the presidency and you're embarrassed about having voted for him."

"It's your people who are causing all the trouble."

"My people?"

"You know, the Democrats, the media, the socialists."

"Are you confusing socialists with Russians? Because if you are that's one thing we might be able to agree about--how the Trump people were in cahoots with the Russians who helped undermine Hillary Clinton's campaign."

"All three. The Democrats and mainstream media are making a big deal, with no evidence, about alleged Russian involvement in our election. Trump won fair and square. He didn't need any outside help."

"Didn't you listen to FBI director Comey when he said that the Russians were involved? He didn't hint about the possibilities but asserted that in no uncertain terms."

"He should talk. He's the one who undermined the Clinton campaign with his obsessing about her emails. Is he also working for the Russians?"

"These days anything's possible." Again I said, "Every day's April Fools' Day."

"If you're so sure Trump is making a mess . . ."

"Worse than a mess."

"If that's what you think why are his poll numbers going up?"

"What?" I was incredulous. "I know we live in a time when there are no longer any facts, but he's dropped to the low 30s."

"Forty-two percent in the latest poll."

"Have you been drinking because the last numbers I saw are from Gallop and they have him at 35 and dropping. By about a point a week."

"Check out the NBC News Poll."

"You mean the 'Survey Monkey Poll'?"

"If they have him at 42 percent approval, that's the one. But why it's called a monkey poll is beyond me. Everything's crazy these days."

"It's actually a very hip, relatively new poll that is done almost all on line. With so many people without wired phones they've been trying to measure opinions from people who are wirelessly on line all the time."

"Which would suggest that Trump is doing better with unwired young people. Thirty-five percent with Gallop and 42 with the Monkey."

"I'll have to do some checking."

"While you do find out what any of this has to do with monkeys."

"All the other polls have Trump's favorabilites plunging. And while we've been talking I looked up the poll you mentioned--the NBC Survey Monkey--and they also report his numbers are dropping. It's true they have him at 42 percent but he was two-to-four points higher the past week or so. The point is that as he fails to get anything through Congress and we learn more-and-more about his people colluding with the Russians his support is eroding."

"But he's getting a lot done that he promised to do."

"Really? Give me some examples."

"On immigration and regulations for openers."

"You mean his executive orders?"

"Those."

"Well, one has been ruled unconstitutional twice by federal courts and I haven't seen any specific regulations that have been removed. Just generalities. All he wants is to have fancy signing ceremonies in the Oval Office on live TV. Speaking of the Oval Office, have you noticed it looks as if he hasn't moved in yet? The book shelves are basically empty--he's not really a reader--and the only picture on the credenza behind his desk is of father Fred. No Melania, no children or grandchildren, no ex-wives Ivana or Marla Maples."

"Huh?"

"OK, about that I'm kidding. April Fool! But very revealing was the report, I think from Joe Scarborough, about his saying to his senior staff, 'I don't care what's in the bills. What I want are signing ceremonies.' Is this what we expect of our president?"

"That's what I mean by the mainstream press--they, like you, make things up."

"Well, here's something that's not made up--his tweets about retaliating against members of the Freedom Caucus in the House who he thinks killed Paul Ryan's and his healthcare bill."

Freedom Caucus Members

"They did kill it. And what's wrong with his calling them out for it?"

"Do you know what's in that bill?" All I heard was static. "Among other things twenty-four million people losing their coverage. That means a lot more prematurely dead people. You're all right with that?"

"I thought we were talking about the politics, not the bill."

"I can understand why you'd prefer that. But, OK, that was politically dumb. To attack them. He also blamed the Dems, as he referred to them. He bragged about how in 2018 he'll campaign against them and the Freedom Caucus. By then whoever's opposing them won't want him campaigning for them since his approval rating will be down in the 20s."

"About this we really disagree. He's approaching the bottom of his support right now. At the worst he'll end up at 30-35 percent. That's his floor."

"You call that good?" I asked, "That's a disaster for a president. That would mean losing control of both houses in 2018 and assure that nothing gets legislated for at least two years."

"Not necessarily. His people are still with him. Passionately so. Have you heard any of them interviewed? They think the Russian stuff is not important, a made-up distraction to undermine him. What's important to them are jobs, protection from immigrants, hope for their children, and a strong America."

"You think," I asked, "after what he said that any Freedom Caucus people or Democrats will work with him? They're on TV right now saying 'No way.' Even making fun of him. Mocking him. After how many, 70 days or so in office, he's becoming a lame duck. Irrelevant."

"We'll see how relevant he'll be after the Koreans, the North Koreans attack Japan or one of our bases out there. With missiles."

"This is my worst nightmare about him. Worse than anything that can happen on April Fools' Day."

March 27, 2017--The System (Sort Of) At Work

In response to my Saturday blog, "The System At Work," where I argued that the defeat of the Republican's attempt to repeal and replace Obamacare was evidence of the system working and that this should be comforting to the fear many progressives have had that Donald Trump is a crypto-fascist, an American Benito Mussolini, a very good friend wrote--

System working? Sort of. 

They will find other ways to gut Obamacare instead of fixing it. The system is way broken. The American people come last. No one wants to find real solutions which would alienate each sides gerrymandered bases.  

Though I understand this view and acknowledge she may be right, I sent a note back to her in which I said--

For me the system working is more than "sort of." 

I've been arguing here for more than a year, as more and more progressives saw Trump to be our own Duce, that we need to give the system a chance to bring him to ground. So, of course, as a result of the repeal-and-replace fiasco, immodestly I think my predictive ability is being confirmed. 

For example, almost as many "moderate" Republicans as Freedom Caucus Republicans were set to vote "no" because they felt the health plan before them was too severe.  

Even more potent an argument for the system working is the diminishment of Trump's perceived power. His perceived power is at least half his appeal and I expect to see it erode further as more people feel released to abandon him. His approval numbers are already at all time lows. And have been falling. Then of course there is the Russian connection ticking. Wait 'til we hear more about the Trump part of that connection. 

This of course doesn't mean we will see an outburst of progressive legislation and behavior. For me it means very little will get done and all things considered that's a good thing. This may also very well mean that Trump will be a one-term president.  

Further, expect to see Ryan go after the Freedom crazies. Mainly to seek vengeance and also to protect his speakership. Rather than the Freedom Caucus being empowered by what happened they are weakened. Note that "only" 15 of the 29 of them were "no's." That means almost half defied their own leadership. 

I also think Trump will back way away from anything having to do with health care. It never was a priority for him. Too wonky a subject and too divisive  A virtual policy tar baby. Just ask Nixon, Hillary, and Obama. I expect to see him focus exclusively on tax cuts and infrastructure. The two things I think he actually cares about and about which he at least knows something. OK, a little. 

He'll need Dems for both and we'll see if he gets them. I suspect only for infrastructure and corporate tax cuts will the Dems play along. They don't want to prop Trump up or help him become successful. Then Ryan won't need the 14-29 Freedom votes. He can make them irrelevant by working with a handful of Democrats.

My friend also wrote that--

Steve Bannon still wants to try to destroy administrative state. Cabinet departments now have fairly low level loyalist appointees who spy and report back on the civil service professionals.

To that, I said--

Having eyes in the departments is not in any way new. Pretty much every modern president has had his plants in most departments. If I were president, I'd want some loyalists there too to keep an eye on who was working on my agenda and who was freelancing. So I don't worry too much about that.  

I worked a lot in a few federal departments in my day and knew a number of people who were there to report back to the Clinton, W, and Obama White Houses. This sort of thing is also common in corporations and NGOs. Like it or not, this is basic management stuff. A way of trying to maintain control of large, bureaucratic institutions. 

But of course I could be wrong about this and if pushed could make the case that all is perilous and that we are doomed. I'm not wired  that way and thus will continue to keep an eye on the system at work.  

Only 65 days into the Trump admin and I already see progress at whittling down the scary stuff. Including Bannon's agenda which after this debacle has little chance of being realized. Expect Trump to move closer to the advice of the practical people (Jared Kushner--when he and Ivanka return from skiing is Aspen) and less to the ideological Steves (Bannon and Miller). I think Trump's already had his fill of the latter.  

He now has a glimpse of what the far-right are really about. They are not his natural constituency--he ran mainly as a populist. Bannon helped guide him into the healthcare mess since the bill that was finally pulled represented "progress" on reducing the administrative state--the end of Obamacare and the beginning of the end of Medicaid.  

So, in sum, I'm OK with the direction in which I see this headed. I'm optimistic about the rest of the domestic agenda. That is won'r get through Congress. 

To me, if you really want to make yourself crazy think about N. Korea, Russia, far-right crazies in Western Europe, laptop bombs . . . sadly I could go on. 

But in spite of this I plan to have a good weekend. I hope that's true for you as well.

And I know she will also continue to challenge me and keep me in line. That's what good friends are for.

She qualifies.