The Trump/GOP Healthcare Plan: Lie

Indefatigable CNN fact-checker Daniel Dale surfaced this big, fat whopper from last night’s racist hate rally. Warning: the CNN clip contains brief video of Trump speaking at the hate rally, so if you watch it, you’ll see the bloated, sweaty orange shitgibbon chopping the air with his hand as he lies about the nonexistent Republican healthcare plan for about 15 seconds:

Hasty transcript of Trump’s quote for those unwilling to subject themselves to the image:

“Patients with preexisting conditions are protected by Republicans much more so than protected by Democrats, who will never be able to pull it off.”

As Dale points out, Democrats already “pulled it off” with the ACA, which is the only reason preexisting conditions aren’t a thing now, and if the Trump administration gets its way, the ACA will be struck down entirely by the courts, which will not only cause millions to lose access to coverage via the exchanges but also leave every single American with private insurance to the tender mercies of the insurance companies on a whole host of provisions, including preexisting conditions.

A few months ago, Trump started making noises about GOP healthcare reform policies, which Republican electeds played down. That’s because even if Trump is dumb enough to believe his own lies about the nonexistent GOP healthcare plan (debatable), people like Mitch McConnell know releasing a plan would necessitate defending said plan in upcoming elections. But are they going to go into the 2020 election with absolutely nothing? Possibly!

Trump appointed a couple of GOP senators to look into the issue, naming Medicare fraudster Rick Scott as “point man.” But while Scott is definitely a crook, he’s not stupid, so he immediately threw that hot potato right back at the White House on one of the Sunday shows, saying “I look forward to, you know, to seeing what the president’s going to put out.” So did it fall through the cracks? Maybe Jared is working on it?

Anyhoo, regardless of what you think of the various Democratic Party primary candidates’ approaches to healthcare, at least they have policies to debate. The same is true of many other issues, like the phantom wall that Trump lied about last night too. It looks like all Trump will bring to the general election is more lies. Am I wrong in thinking it’ll be harder to pull off a all-lie-based campaign strategy as an incumbent? Maybe, but I ‘m going to choose optimism on this point.

Open thread!

Musical Interlude

He tells a sad story, but the refrain is one to live by:

I’ve been binging Waits while I revise the current tome/albatross.  Something in the rhythm (and the tone) seems to drive the work at a good pace.

Got any songs that make you calm or content, even if a close listen to the lyrics paints a different story?

You may consider this a euphonic open thread.

The impact of policy

The Society of Actuaries went through the Health Care Cost Institute data recently and produced an amazing graphic:

This graph shows the number of inpatient days per 1,000 covered life years.

It shows a few things. First, small group and large group utilization tend to move in parallel to each other with large groups having slightly sicker or higher utilizing populations. This makes sense as small groups are less likely to offer insurance and that offer or not offer decision is non-random; a small group will avoid offering insurance if they know they are extremely likely to have horrendous premiums due to very high expected utilization. People in the job market know that as well so someone who knows that they are likely to be in the hospital a lot will try to stick with a large group employer.

The far more interesting thing is that the discontinuity in the individual market. Pre-ACA market reforms of guaranteed issue, community rating and subsidization, the individual market had perhaps a third of the hospitalization rate of large group and forty percent the utilization rate of small group. As soon as the ACA market reforms went into effect on January 1, 2014, utilization sky rocketed.

This shows the effect of underwriting. Underwritten policies from 2009-2013 were pretty good at identifying and avoiding people with predictable healthcare costs. There is still hospitalizations of people getting hit by buses and being told that they have cancer during a routine check-up but these are mostly random events. As soon as explicit underwriting is banned, utilization sky rockets as people who had been kept out of the individual market moved into it and got services that they needed.

Thursday Morning Open Thread: Back to the Arena

(Tom Toles via

I guess if Rep. Lewis can keep fighting, so can we… even if the well-intentioned members of the DNC seem to be trying to kill me:

And then, if I had my way, the members of the B Ark Tier One would be locked in a nicely stocked hotel annex until mid-November 2020. (Sorry, Sen. Gillibrand.) But nobody ever takes my advice, possibly because they’re afraid of insufficiently sanitized telephones.

It’s not as though this rigamarole is making anyone but the ad salesguys and the Media Horse Race Touts happy. (Seth Moulton, predictably, is making a very public fuss already.)

I hope to Murphy the Trickster God that the Inslee campaign was being sarcastic.

On the Road and In Your Backyard

Good Morning All,

As we move closer to the new site launch, I wanted to remind you to submit things now via the form or to hold off until the new site is live.  The old email address is dead and until the new site is live, there’s no replacement for now. I hope to change that later today.

Ok, it looks like my concern about the new site launching very soon is a bit off, sounds like it will be a week or more, not days. I’ve got some submissions, but please do continue to submit pictures, we’re getting closer.

Have a wonderful day, and enjoy the pictures!

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Repub Venality Open Thread: Rand Paul Stays True to His Principle

He has but the one: What’s in it for Rand Paul?

Rand Paul *and* Mitch McConnell. WHY, Kentucky?

Why now?…

Respite Open Thread

This week has been unsettled for me. I’m getting new kitchen countertops and sink and cooktop. I planned ahead and have plenty of stuff in the refrigerator that can be eaten on paper plates with plastic utensils. Which is a good thing because, surprise, things are not entirely going as planned.

The plan was that the plumber would unhook everything on Monday. The installers would install on Tuesday. And the plumber would hook stuff up again today.

But the order for the faucet got bollixed up. And part of the backsplash still needed to be cut and finished.

With any luck, the faucet will arrive tomorrow, the installers will install the backsplash, and the plumber will finish hooking stuff up. Right now, everything but the sink is working, and the drawer under the cooktop needs to be cut down a bit.

Yesterday was traumatic for the kitties. They were locked in the bedroom because people were carrying heavy pieces of stone around with the doors open. The kitties are getting over it today. And tomorrow everything should be back to normal.

Here are Zooey (left) and Ric (right) being relaxed.

For the Love of Anyone’s Deity, Would Someone Please Donate a Strategist to the House Democratic Caucus!!!!

I’m traveling this week, with lots of 0300 starts and wasn’t planning to post, but I just got into the gym at the airport hotel I’m staying at ahead of tomorrow’s pre dawn flight, and MSNBC is on the TV. And the Democrats are actually voting to table (put it to the side and not take up impeachment) an impeachment resolution of the President. This is happening despite only 89 members of the House Democratic caucus publicly stating they support starting an impeachment inquiry!

I have no idea whose idea this is, but I cannot state loudly or strongly enough how galactically stupid this is. Strategic and political malpractice at the highest levels! When this passes, meaning the House will not move to take up impeachment at this time, and it will pass, the President will spend the next week crowing about how he’s been cleared. He’ll use it to chew up the information space that should be devoted to the spillover onto him from the Epstein case, from his publicly going full in on blood and soil herrenvolkism where racism and anti-Semitism in defense of Judaism and Jews equated with Israel and Israelis is no vice, and the upcoming Mueller hearings in the House.

The motion to table just passed: 136 Democrats for, 93 against, and 1 present (abstaining). 194 Republicans and the 1 Independent (Amash?) voted to table it as well. So for now, the House, with overwhelming bipartisan support, isn’t going to do anything more on impeachment and I expect the President will start screaming about being cleared any time now.

Completely irresponsible political theater!

Open thread!

PS: Before anyone asks, I think the House should have a special select committee on impeachment focusing all the investigations through one point leading to either impeachment or exoneration. That’s not what happened with today’s strategic stupidity.

Open Thread: 50 Years of Apollo 11 Conspiracies

I’m as big a Fortean as you’ll find outside an academic instituion, but sometimes I feel like Buzz Aldrin had the best response. Joel Achenbach, in the Washington Post:

The moon hoax is a classic conspiracy theory — elaborate, oddly durable, requiring the existence of malevolent actors with a secret agenda. The moon-fakers are allegedly so competent they can fool the whole world (but not so competent that they can actually put humans on the moon).

Researchers suggest conspiracy theories are spreading more easily in today’s information universe, with the Internet functioning as a superconductor. A growing science of conspiracism seeks to understand who these people are, why they embrace such ideas, and whether there is anything that can dislodge a really magnetic conspiracy theory from the mind of a true believer.

Polls show that about 5 or 6 percent of the public subscribes to the moon-hoax theory, former NASA chief historian Roger Launius said. That is a modest number, but these folks showed up reliably whenever Launius gave a lecture on the topic: “They’re very vocal — and they love to confront you.”
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What Kind of Fuckery is This?

The USDA is moving 547 researcher jobs to Kansas City — and only 145 of the existing jobholders were willing to relocate:

The agriculture department has argued that moving to Kansas City will put researchers closer to farmers and drastically reduce expenses given the Midwest’s relatively lower cost of living.

But many scientists — including the Union of Concerned Scientists — suspect that USDA’s relocation is meant to diminish USDA research.

The Milwaukee-based Agricultural and Applied Economic Association predicted the move could cost U.S. taxpayers upward of $182 million in lost productivity and research capacity.

And Tuesday’s letter from Democrats claims that it could take as long as two years to build out new office space in Kansas City.

Hundreds of Bureau of Land Management jobs are being moved to Colorado and other offices in the West.  Senator Cory Gardner, who is in big trouble in what’s now at least a purple, if not blue state, pushed for that.  The last BLM move didn’t go so well:

“The agency did not comply with legal requirements; ignored regulatory guidance; and had no documented plan, methodology, or real business case that justified their actions,” the [BLM executive] organization said at the time.

Just more disruption and stupidity running under the radar of Trump’s noise making machinery.  I wonder what else they will fuck up in the next year and a half.

Fake Eyebrows (Open Thread)

As you’ve no doubt heard, NBC News unearthed a 1992 video of a coked-up-seeming Trump cavorting with serial pedophile Jeffrey Epstein at a party held at Trump’s tacky-ass Florida property. Here’s a still photo from the vid:

I apologize for inflicting Trump’s hideous visage on you, which I generally avoid. But I’m hoping someone can explain Trump’s eyebrows in that photo. They look fake, especially when you see them in motion in the video. Can heavy cocaine use combined with tanning bed and hair product exposure cause alopecia? I remember the early 1990s — the hairdos of the women in the NBC video brought on flashbacks — but I don’t remember fake eyebrows being a thing.

Allegedly, many of the women pictured were Buffalo Bills cheerleaders. In the video, Trump grabs one of them from behind by the pelvis and then smacks her on the ass. I took a quick spin through the mainstream news sites, and all have a blurb about the tape, but it’s not the main story on any site I saw, including NBC, which broke the story.

Since its now fairly unremarkable to view tape of a future POTUS leering at women and aggressively grabbing a cheerleader while yucking it up with a notorious pedophile, I thought I’d explore the weird eyebrows angle. What do y’all think of that pair of caterpillars attached to Trump’s ugly mug? Strange, huh?

Open thread.

CBO on surprise billing bans

The Congressional Budget Office came out yesterday with their cost estimates on Senate Bill 1895 which contains the surprise billing legislation.  Their estimate is that this is big money over a decade with most of the effects happening off of the federal budget:

Title I, Ending Surprise Medical Bills. CBO and JCT estimate that, over the 2019-2029 period, enacting title I of S. 1895 would increase revenues by $23.8 billion and reduce direct spending by $1.1 billion, for a total reduction in the deficit of about $24.9 billion over that period.
That estimate accounts for effects on federal subsidies for insurance purchased through the marketplaces and for the effects that arise from lower premiums for employment-based insurance. CBO and JCT estimate that in affected markets in most years, premiums would be just over 1 percent lower than they are projected to be under current law. [MY EMPHASIS]The decline in premiums would occur because the bill would require insurers to reimburse out-of-network providers on the basis of their own median rates for in-network providers (that is, the amount at which half of payment rates are higher and half are lower). Those median rates are  generally lower than the current overall average rates.
CBO and JCT anticipate that under S. 1895, in facilities where surprise bills are likely, payment rates would move toward the median and that insurers’ payments to providers currently commanding in-network rates well above the median would drop to more typical amounts.

$25 billion over 10 years is not nothing in any context except the federal budget. Then it is a rounding error.

However the big news is the 1% change in premiums. 1% is not everything but in this context it is not nothing. Using the 2017 National Health Expenditures data (Table 3), this is worth about $11 billion in 2017. Most of this money will be coming out of the pockets of a few specialist categories. Recent evidence shows that surprise billing is concentrated in only a few tax paying entities within these specialty groups so it is effectively pulling a lot of money out of a very few pockets and creating broad and diffuse benefits.

This is a politically fraught dynamic. It is a core assumption of political science that concentrated pain inflicted on well-organized and coherent interests will produce a much bigger reaction than diffuse and general benefits. I think this is especially true when those benefits are part of the submerged welfare state where people don’t believe that they are getting government benefits to begin with.

I expect that there is a strong sense on the Hill to DO SOMETHING but the space of DOING SOMETHING can range from significant minimization of economic rents like in the example above to arbitration with very high anchor points based on billed charges which are completely disconnected from reality. This is where the political fight will land. How much rent will still be paid in 2021?

** I’m meeting with a couple of potential collaborators to suss out a potential paper and drink good beer on this matter soon enough.

76 Billion Pills

This is a stunning piece of reporting in the Washington Post:

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

I’m assuming most people are like me, who have used pain pills like these, but mostly after a major incident or surgery. I have not been prescribed a pain pill since my shoulder accident and surgery, and that was in 2009-2010. Prior to that, I don’t remember anything for at least a decade. So over the course of a 20 year period, I was probably prescribed 100 pills, if that. And again, I am assuming that most people are like me or have had even fewer scripts. Then you have chronic pain sufferers, who obviously need the meds. But again, I would suspect that while there are probably more people you know who have consistent chronic pain, it is nowhere near accounting for this number of pills.

You also have to take into account how people deal with pain. My shoulder hurts every single day. At least 2-3 times every night I wake up with it locked in place, causing sharp stabbing feelings until I can slowly move it and loosen it up and fall back asleep. I’m eventually going to have another surgery to deal with it. But there are a number of reasons why I don’t ask for or take anything for it, not even otc stuff. I have an addictive personality, I am already an alcoholic, so I just don’t think it is wise for me to introduce a powerful narcotic into my daily life. Second, I don’t like how they make me feel. I feel groggy and cloudy (I remember brushing my teeth with soft soap a couple of times confusing it with toothpaste), I get a horrible histamine effect after a couple days and am itchy and sweaty, they make me constipated, and I found after surgery years ago they don’t actually make the pain go away so much as just get me stoned so that I am not focusing on it. Third, I don’t NEED to be pain free. I’m not digging ditches or lifting boxes for a living- were I exposing myself to that sort of labor every day, like, say, a coal miner with a bad back or an auto worker with bad knees, I might think differently. Fourth, I have found that other things help more- a hot shower, stretching, etc. Finally, and I guess this is just me, but life isn’t pain free. I’m almost 50. I’ve fallen off roofs, been through windshields twice, fallen off of tanks, slipped on ice, beaten up in street brawls, hit over the head with a bottle, played contact sports for two decades, etc. Some things are just going to fucking hurt no matter what I do.

Having said all that, I still find the number of pills to be MIND BOGGLING. The geographic distribution is interesting, too:

Again, that is pain pills PER YEAR. That can not all be explained away by manual labor and populations that have higher numbers of dangerous vocations. It appears (and I am just making shit up here- I have nothing to back this up) that pain pills were dumped in places in lieu of social policies. Again, just amazing.

On the Road and In Your Backyard

Good Morning All,

As we move closer to the new site launch, I wanted to remind you to submit things now via the form or to hold off until the new site is live.  The old email address is dead and until the new site is live, there’s no replacement for now. I hope to change that later today.

Ok, it looks like my concern about the new site launching very soon is a bit off, sounds like it will be a week or more, not days. I’ve got some submissions, but please do continue to submit pictures, we’re getting closer.

Have a wonderful day, and enjoy the pictures!

On a personal/political note -fuck Trump, his nationalist anti-immigrant racist agenda, and all the fuckpukes who follow him and ignore his unsuitability to any public office of leadership, much less the Presidency.

I am the son of an immigrant, and my American mother was raised from age 5-14 in Colombia. On her side, I have pre-Revolutionary ancestors, as well as Confederates, to my shame.

My Swiss father had a green card, and never pursued citizenship. After the death of my mother, I was the sole inheritor of the family documents and photographs, many of which were damaged by a house fire in the oughts. I’m still working through them, but I did find a surprise – an letter from my father’s then-employer in 1969 attesting to his interest in becoming a citizen, but that may have been incorrect, otherwise he changed his mind without taking steps. Although he loved many things about the US, he was also attached to some old-world values that he didn’t see in his beloved new home. (If he’d lived into our time, I know he’d have become one of those embittered old men glued to Fox News and listening to Rush Limbaugh, et al., so although I miss him, I’m glad I didn’t suffer losing him to that toxic stew.)

On top of all of that, I was born abroad, in Africa, and so even though I grew up in the States, I’ve always had a slightly different perspective – born in Africa to a Swiss father and an American mother who grew up in Colombia, and so lacking many of the “normal anchors” that people who grow up here from childhood in second or later generation families natively have. I grew up travelling internationally and it shaped me from infancy.

Even though I’m a white guy, I very strongly identify with immigrants of all colors, backgrounds, and religions and thus feel out of place in places lacking diversity. Needless to say, travel, reading, the internet, shortwave, and international media have been important parts of my life and continuing perspective.

These foul currents coursing through our nation make me fear for my sisters and brothers, both here and on the road.

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Wednesday Morning Open Thread: Now *We* Have “the Bigger Half”

The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.”

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