Open Thread: Pizzagate — You Can Fix Ignorant, But You Can’t Fix (Deliberately) Stupid

Pizzagate, possibly to become the textbook example of how inventing “fake news” can lead to “real, tragic consequences”. I’ve been ignoring it — I suspect a lot of us have — because it seems one of those wingnut-shit-dumps designed, like cholera, to spread its contagion further with every mention. But given that one of its deluded proponents has managed to push the argument from banned-on-reddit to national news outlets, I’m gonna recomend Gizmodo‘s “Pizzagaters Aren’t Giving This Shit Up“:

For months, 4chan and Reddit users have delved deep into the emails of John Podesta as they were released by Wikileaks and concluded that the emails contained coded language about a secret child-trafficking ring operating out of Comet Ping Pong, a Washington DC pizzeria—a ring ran by Podesta and former presidential hopeful Hillary Clinton. The theory was known as “Pizzagate,” and until recently it was just another of the internet’s outlandish conspiracy theories. Two of pizzagate’s loudest mouthpieces have backed off their support after a man armed with a AR-15, a Colt. 38, and a shotgun entered the restaurant to “investigate.” And yet, pizzagate somehow trudges on, without them.

(Pizzagate has been debunked by Snopes and the New York Times, and one of its biggest communities—r/pizzagate—was booted off Reddit for the repeated release of personally identifiable information, as Gizmodo reported last week.)

Two of the most vocal (and visible) entities propping up pizzagate’s absurd claims were, predictably, arch-troll Mike Cernovich and the Alex Jones’ Infowars….

There have always been people on the fringes making unsubstantiated claims and then covering their asses, just as there have always been angry, confused people willing to believe and forgive them. And while connections have been drawn by other outlets to Welch’s associations as a possible motivation for entering an otherwise unassuming pizzeria with a small arms cache, the connection is unprovable. But, hopefully the risk of having emboldened a gunman might cause Cernovich, Jones, and their ilk to reconsider fueling the fires of internet conspiracies.

What we’ve all been learning during Trump’s ascendence, though, is that the fringes are closer than ever to the center of power in this country. Among the pizzagate truthers, as Politico reported yesterday, is Michael Flynn Jr., close adviser to his father Lt. Gen. Michael Flynn—Trump’s pick for national security adviser…

Maddison Welch has the excuse of being a petty-criminal substance abuser with nothing more pressing on his calendar than investigating the ‘basement sex tunnels’ in a building with no basement. But what’s Alex Jones’ excuse — or Lt-Gen Flynn’s? Lulz nothing matters?

George Orwell would’ve been so impressed! All human knowledge and history accessible at the click of a few buttons, and people are using it… to embed themselves, and each other, further and further in a matrix of unbreakable, shatterproof STUPID.

Cynicism confirmed

Balloon Juice in August:

Aetna was profitable in 2015 in the individual market in Pennsylvania. It is projecting to be profitable in 2017. The filing memo was drafted in late May and submitted to the Pennsylvania regulators in early June. Conditions have not changed enough to make Pennsylvania a money loser in under two months.

My wee bit of cynicism bears fruit. Aetna is trying to logroll an anti-competetive merger with on-Exchange political consequences. If it works for Aetna/Humana it burns a bridge to get the merger, and if it fails, it puts Aetna on the shitlist of any Democratic administration. That is a very interesting strategy when it is highly likely that there will be another Democratic administration…

So in all years Aetna’s individual market operations in Pennsylvania were either profitable or projected to be profitable. Something stinks worse than a wrestling team’s locker room after two-a-days.

USA Today on Sunday afternoon:

When Aetna announced in August that it was leaving the exchanges in 11 of the 15 states it sells in for 2017, it said it had a pretax loss of $200 million on its individual insurance plans in the second quarter of this year and total pretax losses of more than $430 million since January 2014 on its individual insurance plans. Nearly all of these policies are sold on the ACA exchanges. At the time, CEO Mark Bertolini said the move would “limit our financial exposure moving forward.”

But Aetna made nearly $12 million on individual ACA plans in Texas and more than $8 million in Pennsylvania, according to financial filings with state regulators, and is exiting the exchange in both states anyway. Asked to comment on decisions to leave states where it was making money, Aetna spokesman T.J. Crawford said, “We don’t discuss performance at the state level.”

Nice to know that I am occasionally cynical enough.

Repeal and Delay with the Norquist problem

Right now, the current Republican plan is Repeal and Delay as the NY Times reports:

Republicans in Congress plan to move almost immediately next month to repeal the Affordable Care Act, as President-elect Donald J. Trump promised. But they also are likely to delay the effective date so that they have several years to phase out President Obama’s signature achievement.

This emerging “repeal and delay” strategy, which Speaker Paul D. Ryan discussed this week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive.

The mechanics of the repeal bill are fairly straightforward. A reconciliation bill would be written to sunset subsidies and Medicaid Expansion money after two (or three) years while a Replace bill is cobbled together. The individual mandate tax would be dropped to zero even if it was not technically repealed and all of the taxes that fund the ACA would be dropped immediately. This blows up the insurance market fast. There are discussions and rumblings that some Republican wonks are trying to make this point to Republican leaders. Someway of shoveling a massive amount of cash to insurers would be needed that would perform the same function as risk corridors and reinsurance but called something else is the most likely response.

And then there would be some type of Replace bill that would offer skimpier subsidies and much higher cost sharing than current law.

That Replace bill will cost money. It won’t cost as much money as the ACA but it will cost money.

That is a major problem as the major funding streams from the ACA (Cadillac Tax and high income tax surcharges) are gone. Nicholas Bagley at the Incidental Economist flagged this very early on:

You’ve got to bear in mind that passing the reconciliation bill would represent an immediate $346 billion tax cut over ten years to the wealthy—$123 billion from the Medicare tax surcharge and $223 billion from the tax on investment income. All of that money—every dime—will go to people making more than $200,000 a year.

The other major source of funding for the ACA is the Cadillac tax in the out years and Medicare Advantage payment equalization. The Cadillac tax is popular with health economists who, when they concentrate for an annual convention, might have sufficient political power to elect a county commissioner in an NFL market and no one else. The Republican Replace plans use modified Cadillac plans that usually apply regular income tax rates to health insurance benefits at far lower thresholds than the Cadillac tax. But I digress.

The Replace plan will cost money. And here is where we run into the Norquist problem. It is Republican orthodoxy that once a tax cut is passed it can never be re-enacted. The Replace Bill would not be signed for at least six months (absurdly optimistic case scenario) after the Repeal bill that wiped out the high income taxes that fund the ACA. The Congressional Budget Office (CBO) would score Replace based on current law which means no high income surcharges as offsets. Republicans can’t vote for higher taxes per Norquist even if those are taxes that just got cut.

Assuming Norquist is still a major political enforcer of Republican orthodoxy, my best bet is that any Replace Bill will be like the 2003 Medicare Modernization Act (MMA) in that it is almost completely deficit financed.

Late Night Nightmare Reads: The San Bernadino Shootings, A Year Later

The Washington Post, doing journalism:

… “The brutality of the attack’s perpetrators could not have been in starker contrast to the selflessness and generosity that characterized those taken from us,” the White House said in a statement marking the anniversary Friday and honoring the victims of the attack. Using another acronym for the Islamic State, the message continued: “In the year since this tragedy, we have mourned those we lost, just as we have continued to confront the violent ideology behind this attack as well as the terrorist groups, including ISIL, that propagate it.”

In a new interview broadcast this week, the police chief in San Bernardino said authorities believe that the specifics of the attack — targeting that particular gathering at that time — may have been motivated by the holiday party set to take place in the same room after the training ended. The chief, Jarrod Burguan, cited comments made by the female attacker before the shooting.

Malik had said online “that she didn’t think that a Muslim should have to participate in a non-Muslim holiday or event,” Burguan told ABC News.

The room where the training occurred — the same room where the health department had held active-shooter training earlier that year — was filled at the time with Christmas decorations, including a large Christmas tree, ornaments and items on the walls….

If it weren’t for all the dead people, jokes would be made about the virulence with which many of us regard enforced holiday ‘jollilities’ at our workspaces. Or discussing the weight of microagressions.

But this is the real heartbreaker — again, from the WaPo:

Maybe the child would be hers one day, so Saira Khan began preparing the house for her niece’s next visit. She sanitized the baby toys and double-checked the child safety locks. She cleaned the nursery where the girl had never been allowed to spend a night and tidied the crib that had been recovered and moved from a crime scene. It had belonged to the baby’s parents, and it was in the apartment where they had left her one morning last December before driving to an office party in San Bernardino, armed with pipe bombs, handguns and AR-15s.
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Blue State solutions

Two valued community members raised good points yesterday in comments:

Raven Onthill:

the blue states can build their own plans. Romneycare might be the model, and some states might try something else; perhaps some sort of single payer system. I suppose they will pretty much have to.

And Martin:

There’s an opportunity now in California, however. The 6th largest economy on earth and 1/6 of the US economy. Dems have supermajorities in both chambers and have the governorship. We’ve twice passed single-payer and Brown has indicated he’d support it if the finances work out. If there is going to be a widespread national privatization effort, CA now has renewed incentive to make it go. Yes, its hella complicated as Richard has noted, but CA also has the most actively managed exchange in the country, one of the most competitive health care marketplaces in the country, and some of the best health policy folks around Kaiser Family Foundation.

The big problem with both of these cases is that state healthcare policy will interact with federal healthcare policy. That means some type of waiver will be needed. That could be a major blockage.

However, the core point is very strong and very valid. Blue states if they want to take care of their own citizens while allowing the Red States to race to the bottom can do so. If there are massive high income tax cuts, there will be fiscal space from high income Blue state taxpayers to fund local social insurance programs. California has the size and the expertise to make a go at something that could work. My bet is that they would go multi-payer in a tightly regulated market and build from the fairly successful Covered California exchanges with higher subsidies and tweaked eligibility but that is a guess purely informed by speculation before my first cup of coffee.

The next big challenge is getting traditional Blue States with super majorities in the Legislature back to Trifectas by retaking governorships so experimentation can move forward with motivated stakeholders. But that is a discussion for a different day.

Time to call Congress

Okay, now that Tom Price will be Secretary of Health and Human Services, we know that the medical and social insurance system that we have had in place since 1964 and expanded dramatically in 1999 and 2010 is under severe threat. Elimination can be mostly done through reconciliation but modification needs to go through regular order. That means there is some leverage. Three GOP Senate defectors need to be pressured and pressured hard.

So let’s get calling. There are two objectives to these calls. The first is to make sure that there are no Democratic cross-over votes in the Senate. The second is to make the vulnerable Republicans who rely on an increasingly old base to get re-elected know that they can’t kill Medicare, Medicaid, CHIP or the ACA quietly.

Democrats who need a call to remind them that their base has their back:
Claire McCaskill (D-MO)
John Tester (D-MT)
Heidi_Heitkamp (D-ND)
Sherrod Brown (D-OH)
Joe Manchin (D-WV)
Bob Casey (D-PA)
Bill Nelson (D-FL)
Joe Donnelly (D-IN)
Debbie Stabenow (D-MI)

All of these Senators represent states that voted for Trump. Let’s get them some support and pushback.

The pressure list is much shorter
Dean Heller (R-NV)
Jeff Flake (R-AZ)

These Senators are up for re-election in 2018. Heller is actually vulnerable, Flake is a stretch goal.

The next round of Republican calls are to either the old line establishment (Bob Corker, Orrin Hatch) or to Senators who represent a lot of retirees (Shelly Moore Capito, Marco Rubio, both Georgia Senators, both North Carolina Senators)

So get calling.

UPDATE 1: Tell Joe Donelly thank you:

Distributional Impacts of Price Plan (Reprise)

Now that we know Rep. Tom Price (R-GA) will be the next Secretary of Health and Human Services, it would be a good idea to look at the mechanics of his Obamacare Repeal and Replace bill. We did this in 2015 for HR2300 and I am reprinting the post on distributional impacts below. The mechanics of the plan are described in this post:

TLDR: The plan is good if you are healthy and wealthy as there are a ton of tax breaks and tax shelter expansions through HSA expansions. If you are chronically ill or poor, you are significantly worse off. And now for the moldy oldie:
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