Thursday, 30 March 2017

Take Two of These, and Call Me in the Morning. They're Great. Really. Terrific.

The Doctor Will See Your Pay Stubs Now

The Trump administration swung and missed again last week with its failed attempt to shepherd its key Bill to "repeal and replace" the Affordable Care Act through a somewhat dubious House. The failure is being seen as a serious whiff for the new administration as it seeks, desperately, to find its footing two months in.

It was, despite the bluster of the new president, always a long-shot. The ACA is quite honestly terrible legislation that is on the express tracks to collapse; if I were even more cynical than I am, I would call it a piece of Machiavellian art in its cleverness, so poorly conceived and so obviously headed to failure that the only rational explanation is that its authors, sensing that our current system of providing health care coverage was teetering, decided to give it a shove to hasten the day that the whole house of cards collapses, creating the final crisis that will allow the implementation of a single-payer scheme similar to one of the current systems in Europe. 

I'm guessing, something along the lines of the way medical care is funded in Germany.

To be clear, the problem in the US is not about health care. It's never been about health care. The problem is how to pay for medical care, who will pay, and what services will be delivered and to whom. 

I've been asked what issues I have with the ACA; why, specifically, do I think it is the tire fire of the nation. Why does it need to be replaced?

It is actually not one thing, but a series of rather obvious ones. 

The first is that the Affordable Healthcare Act in general is that it is a bold face lie.

Think back to 2008 (or earlier, if you prefer). What did the American public actually ask for? They asked for affordable healthcare. 

Health care itself, as available in the US, is pretty damned good. We have among the best hospitals in the world; we have the top doctors. We have greater access to cutting edge medicines and lead the world in research.

So, we asked for affordable care - hence the name. Did the ACA deliver?


The most important is this: the whole point of health care “reform” was ostensibly to make health care more affordable and thus, increase the access of poor/lower-middle class to basic health care.

Simply expanding the pool of coverage by raising taxes on a chunk of people (which is what happened - taxes on employer-funded policies were raised, as were taxes on higher incomes, plus the “penalty” for those who did not want to participate, which is also a very regressive tax) while putting nothing in place to curb costs in my opinion combines the very worst parts of our previous, “private” (sic) system with the worst elements of the public-payer options in Europe.

Namely, there is no attempt to enhance negotiation of drug prices or fees.

Here is a key point - you've been and you continue to be lied to. Despite the bullshit you hear from the likes of Bernie Sanders, “big pharma greed’ is not what is driving health care costs - medicines account for less than 10 per cent of health care spend - so while allowing Medicare to negotiate drug prices would of course help, doctor and hospital fees simply have to be reduced. There is no mechanism to assess long-term comparative effectiveness (early attempts to include, e.g, approches like Dartmouth-Hitchcock were quickly shot down). EVERY European system does some sort of health technology appraisal before medicines and procedures are considered for re-imbursement. These were quickly eliminated due to arguments about “death panels”.

For costs to be contained, Americans are simply going to have to accept that you will not get every new, cutting edge treatment. This is already the case in Europe.

Next, special-interest giveaways, such as exempting certain union contracts was just naked political payback. Why should one person get a special perk because he belongs to, say, the UAW, and that union gives money to the Democrats? The arguments about exempting union “Cadillac plans,” and other theivery like the “Cornhusker Kickback” make the result unpalatable.

Combining all of this, the ACA is just a mess. At some point, it is going to collapse.

For the ban on “pre existing condition” piece (very popular) to hold, young people need to accept that yes; you are going to have to pay.. “Insurance” is risk sharing. It needs a huge number of healthy people to pay for (and not use) medical care. Sorry; that is just a fact.

The biggest problem both in the US and in Europe is not about delivery. It is about money. We all want top quality health care. Well, that costs money.

For the system to be sustainable, it needs to be funded. This should not be controversial. And sorry; while I accept that “the rich” need to pay a bit more, the system will not work unless taxes are raised, significantly, on the middle-class.

Bernie Sanders argues (quite convincingly) about how well systems like the Nordic social democracies work well. I have lived in France, and there is a lot to be said about “socialism” (sic), once we abandon dismissing ideas because we do not like the labels. Frankly, there are things in Europe done well, and Americans should consider them objectively. But the flip side is that taxes on lower-middle and middle class Europeans are far higher than similar taxes on Americans. Middle and top marginal rates in Europe kick in at levels that you would probably find surprising.

If we want a good system, every one of us is going to pay more. Period. Paragraph.

Finally, I think that in the long run, the only real solution if we want real “affordable” health coverage with access for all is a single-payer scheme, funded equitably by all (including, especially, those who will benefit), with the power to decide which procedures, medicines, and hospitals will be covered and which will not.

The ACA does not address any of these in a realistic way.

As I said, I think it was almost designed to fail.

Now, the Republicans have been talking about getting rid of the mess for years. Donald Trump was elected, partly promising first to repeal, then to repeal and replace the ACA. Once he got the keys, he discovered, driving a rickety, 70 year old stick-shift with a cracked head gasket, failing clutch, and a near empty-gas tank is difficult.

He and Paul Ryan failed. Utterly.

So, how big a black eye is this? What does it all mean?

It is a very big deal, but I think not for the reason many will say.

As I see it, the biggest impact of the failure of the Republicans to pass the AHCA is this: 

It reveals that Donald Trump is not a king. 

There are many, many people (friends of mine, included) who argue that Trump is going to ‘destroy America,’ and that he is some dangerous, criminal master mind along the lines of Lex Luthor who is going to dismantle first the US government, then civil society, and then ultimately, the world itself.

Well, with the colossal failure to secure votes to pass the AHCA, it should now be obvious (if it was not before) that, despite the claims to the contrary, Donald Trump is not a king.

For those of us who paid attention in civics class, we understand that, with a few exceptions, the executive branch has extremely limited legislative powers. I know that President Bush and President Obama used executive orders to basically write legislation, and I know that the congress essentially abrogated its responsibility to push back on the increasingly imperial presidencies. I understand that the press, whose job it is to hold our elected officials accountable, basically ignored the power grabs and cheered it on.

But the fact is, if the press hold the president accountable, and the congress does its job, then the president is not going to be able to get very much done.

FINALLY, the free press are asking questions rather than cheering in the stands. FINALLY legislators in the president’s party have discovered that they do not have to go along with the guy in the White House.

This failure of Trump and Ryan to even bring to a vote a bill that many agree was a mistake should put an end to the nihilistic fantasies that have captured the fevered minds of too many.

Trump lost this round; but in the end, the discussion is slowly turning from "Trump is Hitler" to "Trump is incompetent."

Trump, of course, was never Hitler, but he is likely to be inept at managing the presidency. The fact that he cannot rule by fiat should disarm some of his critics, and I a suspect, may force the president to trim his billowing sails just a bit.

Wednesday, 15 March 2017

Oh, My Grace

I confess up front: I am a numbers guy. Philip K Dick wrote the novel on which the film Blade Runner was based: it was called Do Androids Dream of Electric Sheep? I don't know the answer, of course - and I am an extreme sceptic of artificial intelligence. But in any case, I dream at times about systems of linear equations, which is perhaps the next best thing.

I came across a link today in my daily feed from the aggregator The site purports to provide "uplifting" news and information. In this case, the site asks the rhetorical question:
Don't Believe In The War On Women? Would A Body Count Change Your Mind?
I've long been critical of the talking point about a "war on women," created in the 2012 election cycle by the Democratic party to draw support from female voters, who are a fairly reliable demographic for them.

Previous attempts to frame political debates about wars on women had focused on policy - restrictions on access to contraception, opposition to federal laws regulating pay, Title IX in the schools. One can debate the motivations and implications of these policy differences, but calling murder a "war on women," with a specific reference to body counts, is a measurable quantity. The data can be examined, sifted, and assessed.

In the analysis offered, between 2001 and 2012 (the time of the article), just short of 12,000 American women were killed by their husbands or boyfriends.

That is, of course, a shockingly high number. That more American women have been killed at home by partners than the Iraq and Afghanistan wars combined is shameful, to say the least.

But is it a "war on women?" Does violence in America have an exaggerated impact on women? What do the numbers say?

As it were, the FBI collect data on all sorts of crime in the US - homicide among them - and it is possible to look at the makeup of the victims and the offenders.

Based on the 2015 data from the FBI in the Uniform Crime Report for that year, men were the victim in just under 80 per cent of the homicides for which data are available. That is to say, men are four times more likely to be killed than women. At least where "murder" is concerned (justifiable homicides are not included;given that violent crime is overwhelmingly the domain of men - males committed 62% of the murders in 2015, based on the same data source - and thus it's likely that these killings skew more extremely).

The "upworthy" link does not describe how many men are killed by their wives/girlfriends for context, but the FBI data indicate that wives are more likely than husbands to be the victim of the crime by about 5-1. Similar trends are seen comparing boyfriends/girlfriends, where women are about 3.5 times more likely to be the victim of a murder than a man is.

So, the specific charge about domestic violence is correct - women are far more likely to be killed by a partner.

On the other hand, sons are more likely than daughters (50%) to be the victim, brothers 3x more likely than sisters. Not sure what to make of that.

The US is a violent country - far more violent in terms of murder than other western democracies (there were more murders in the city of Chicago in 2016 (762) than in the whole of France (682). By comparison, France is a nation of 65 million people, whereas Chicago is home to just under 2.7.

But a "war on women?" Using a "body count?"

Doesn't add up.

Tuesday, 7 March 2017

Can You Hear Me Now?

Another day, another tweet, another scandal.

To say that President Trump is off to a rocky start is at this point rather like complaining that your white shoes got a bit wet on the deck of the Titanic.

I've made no secret that I am not a big fan of Trump. I didn't vote for him, which given that I feel his prime opponent in 2016 was just about the most awful candidate for president in forever should indicate how unready I thought (and think) he is.

The most recent scandal involves a week-end tweet in which Trump claims that former President Barack Obama tapped his phones in an effort to spy on him. Apparently, to try to get some dirt to put on the new president for purported collusion with shadowy Russian figures who were trying to "hack" (sic) the election.

THAT is an entirely different story, and yes, I agree with Trump that the claim of Russian election hacking is fake news.

Of course, the press have rushed to defend the old administration, once again portraying Trump as a lying, paranoid madman who is dangerously wobbling on an ever more eccentric axis. The accusation that the ex-President would order spying on the new seems, well crazy.

But is it?

Much of the noise stems from accusations leaked in the press about conversations between former security head Michael Flynn and the Russian Ambassador, Sergey Kislyak. According to a series of reports in the Washington Post (new motto: Democracy Dies in Darkness).
The FBI in late December reviewed intercepts of communications between the Russian ambassador to the United States and retired Lt. Gen. Michael T. Flynn — national security adviser to then-President-elect Trump — but has not found any evidence of wrongdoing or illicit ties to the Russian government, U.S. officials said.
The calls were picked up as part of routine electronic surveillance of Russian officials and agents in the United States, which is one of the FBI’s responsibilities, according to the U.S. officials, who spoke on the condition of anonymity to discuss counterintelligence operations.
Nonetheless, the fact that communications by a senior member of Trump’s national security team have been under scrutiny points up the challenge facing the intelligence community as it continues its wide-ranging probe of Russian government influence in the U.S. election and whether there was any improper back-channel contacts between Moscow and Trump associates and acquaintances. (emphasis added)

Somehow, the FBI did "intercept communications" involving not Trump himself, but one of his top operatives. How did the FBI come into possession of this "communication?" It's instructive to note that the FBI at the time decided that there was "no evidence of wrondgoing." They just happened to listen in on a conversation involving an American citizen.

There is an interesting treatment of all of this in the Ezra Klein's blog Vox.
Questions about Flynn’s relationship with Russia go all the way back to the campaign, where he served as one of Trump’s top national security staffers. 
Another report, CBS news, quotes an un-named former national security advisor that the Obama administration back in July (and again in October) went to the FISA courts to obtain wiretaps, not for Trump himself but perhaps for key figures in his campaign. The July request was denied, but no comments were made about the October request.

It's instructive to recall that, during the George W Bush administration, the president was widely attacked from the left for abusing wiretaps outside of the jurisdiction of the FISA. Then Attorney General Alberto Gonzales faced a court case against the liberal Electronic Freedom Foundation. President Obama sought to continue the surveillance, which eventually was deemed unconstitutional.

The bottom line is this: IF the FBI try to wiretap a "foreign agent," and a U.S. citizen is on the line, they must have a warrant to continue listening. Did the FBI have a warrant to listen in on the conversations including Flynn? Or Jeff Sessions, for that matter?

It seems very unlikely that President Obama himself ordered the phones to be tapped; it seems equally unlikely that Trump Tower was bugged.

There is a quite provocative piece on the whole mess today at National Review Online. Granted, National Review is a fairly partisan Republican journal, but in the article, Kevin McCarthy raises the right questions about the proper role of the Justice Department, the FISA courts, and surveilling our citizens.

President Obama's defenders reacted to Trump's tweet with the typical sturm und drang, including the defence that the president would never order "surveillance against American citizens," which is rubbish. The president himself ordered the killing of American citizens with drones during his time in the White House without so much as looking at a judge.

If the FBI - or anyone else - have any evidence that the Trump campaign colluded with Russian operatives to steal and distribute damaging emails from the Clinton campaign, then I think it's time we hear it. Specifically. That is what is behind all of this. As they say, it's about time to put up or shut up. And I am not talking about Trump shooting his mouth off sarcastically about how Putin might find Hillary's deleted emails.

Am I concerned that, perhaps, the president is too cozy with the Russian government? Of course, I am. But I am far more concerned that people within the government, for partisan reasons, have spied on American citizens, obtained information that isn't criminal but does support a flimsy narrative of stolen elections, and then illegally leaked that information to a complicit media who, for eight years, basically acted as apologists for the government but have now "discovered" that it's the role of the press to challenge the president, not suck up to him.

So no - the tweets do not concern me. They are not chilling attacks on the First Amendment. Rather, the behaviour of unelected agents within the government seem a direct assault on the Fourth and the Fifth Amendments.

And it really troubles me that people who, until recently, seemed to care about protecting us from the watchful eye of big brother are now waving their pom-pons on the sidelines cheering it on.

Perhaps Trump is paranoid, but maybe the old maxim that even paranoids have real enemies has a whiff of truth?

Monday, 6 March 2017

Take Your Base

Just a couple of weeks ago, pitchers and catchers reported to spring camps; last week, spring baseball began (the Blue Jays are off to an awful start, having lost 7 of 9 games). Those of us who are baseball fans have weathered the always seemingly interminable gap between the last out of the World Series and the first pitch of the season. And for those of us who find American football at best boring, it's an especially long, cold winter.

I yesterday came across this story, a proposed rule change to baseball. It proposes to shorten the length of games by allowing teams to conduct an "intentional walk" merely by intimating that the batter would receive a free pass, and off to first base he would go. Pitchers would no longer be required to throw four wide pitches.

The Major League Baseball commissioner's office has proposed a rule change to have the pitcher forgo actually throwing four balls — instead, the bench would simply signal to the umpire that the batter will be intentionally walked.

I personally hate the intentional base on balls; mainly because teams are turning the rules on their heads and using them as a weapon. The entire reason that a batter is allowed to take first on four pitches outside the strike zone is that it is supposed to force the pitcher to throw the ball over the plate, and give the hitter at least a chance to swing. 

In short, the base on balls is supposed to be a penalty to the defending team, not a weapon for it to deploy. I am not sure who the first manager was to recognise that he could take the bat away from a threatening player on the opposing side, but I reckon that it happened pretty early.

Walks are, in short, boring. And that pitchers would use them as a strategy seems a bizarre consequence. It is a bit like how fouls are used in basketball at the end of a game to try to get the ball away from the offensive team, when your own side are behind but still relatively close. IF the other team can make its free throws, of course, then the foul does not help you. And, if your side commits too many fouls, the opposition gets two rather than one automatic free throw. And players can be excluded for racking up too many of them.'

There is really no such parallel in baseball,

But the main point here is this: WHY do they need to make it easier for teams to abuse the base on balls? At least if the pitcher is forced to make the pitches, he can still make a wild pitch. Or commit a balk. Or perhaps get a pitch a bit too close to the plate, where the batter can hit it.

The argument that the game needs to be "speeded up" is silly - if baseball really wanted to speed the games up, then stop all the dithering around. Force the hitters to stay in the box and not step out, adjust their batting gloves, take swings, etc. And stop with the ridiculous cacaphony of music - the "walk up" music as the players meander to the plate. 

Baseball is a game more than it is a spectacle; the rules of course should be fine-tuned when needed. But it is not a spectacle like football or basketball. 

As an aside - last weekend the local NBA team (the Golden State Warriors) faced off in a contest at Madison Square Garden against the Knicks. Oddly, the Knicks tried a little experiment in the first half - the game would be played without music, or phony clapping noises, or other "in game entertainment." 

Does anyone else find it ironic that at a sporting event, the term "in game entertainment" itself was used? I thought that the game itself was the entertainment. 

Warriors forward Draymond Green was having none of it. 

It was ridiculous. It changed the flow of the game. It changed everything. You get used to playing a certain way. It completely changed it. To me, I think it was completely disrespectful to everyone from [NBA senior VP of entertainment and player marketing] Michael Levine to [Warriors president and COO] Rick Welts and all these people who've done these things to change the game from an entertainment perspective.

I am not a fan - at all - of the NBA; in terms of basketball, I far prefer college games. Perhaps it's because there is no so much effort to make the game interesting "from an entertainment perspective." The focus is on the players, not some artificial noise, inducements to tell the fans when to cheer, or ridiculous music piped in.

Baseball fans - real fans - generally do not need to be told when to cheer. We don't need hyped up noise or "walk up" music to enjoy the game. 

With all due respect to Draymond Green, I would prefer if the adolescent need to be entertained all the time were left to NBA fans.
Let the rest of us enjoy our game more or less the way it's supposed to be played.