Come for the politics, stay for the snark.

Gastritis broke my calculator.

What fresh hell is this?

Screw the Judean People’s Front. Splitters.

… down to kool-aid drinkers and next of kin at the trump White House

We have all the best words.

The willow is too close to the house.

Shock troops for the Unitarian Jihad.

There’s some extremely good trouble headed their way.

This really is a full service blog.

Wow, I can’t imagine what it was like to comment in morse code.

All your base are belong to Tunch.

Sitting here in limbo waiting for the dice to roll

Wetsuit optional.

The house always wins.

Let’s delete this post and never speak of this again.

Peak wingnut was a lie.

This blog will pay for itself.

I’m going back to the respite thread.

Shallow, uninformed, and lacking identity

Since when do we limit our critiques to things we could do better ourselves?

This is a big f—–g deal.

The math demands it!

Tick tock motherfuckers!

Technically true, but collectively nonsense

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World's Best Healthcare (If You Can Afford It)

Friday Evening Open Thread: World’s Best Healthcare (If You Can Afford It)

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Good thing for him the Oval Office Occupant is on the Gold tier of the public dole…

I don’t want him to die (at least not until November 3rd), but the Goddess of Consequences knows he’s earned whatever he’s due to endure.

Also, it looks like the “President’s” physician doesn’t run his own twitter account:

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The President Announced He’s Signing an Executive Order To Cover Pre-Existing Conditions: If You Think It’s a Joke, You’ve Missed the Point!!

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During his press conference yesterday at his golf club, the President announced he’d be signing s series of executive orders (EOs) over the next several weeks. Almost all of these are actions that are outside his authority to take. One in particular, however, has drawn a lot of derision.

It was then trumpeted by several surrogates in both the administration and the campaign:

The response have ranged from the humorous to the fully sarcastic:

This is not a joke, nor should it be treated as one. If you think it is a joke, you’ve missed the point. This, like so many other things I keep pointing out here, is a type of influence operation. What most Americans, even those of us who are hyper-vigilant when it comes to political news and information about health insurance because we’ve got Dave Anderson keeping us informed here every day, either don’t know or don’t remember is that THERE ARE A LOT OF HEALTH INSURANCE PLANS THAT WERE PITCHED AT BOTH TRUMP SUPPORTERS, LOW INFORMATION AMERICANS, AND LESS AFFLUENT AMERICANS THAT DO NOT COVER PRE-EXISTING CONDITIONS!!!!!!!

And the reason that these health care plans exist is because Republican elected officials complained about them not existing from the time the Affordable Care Act, now doing business as ObamaCare, passed. They had a screwy version of them in their nebulous replace plan that they were allegedly going to pass after they passed repeal, which would then, supposedly, force them to actually introduce something that could be called a replacement bill. And they exist because the President signed an executive order allowing for them when the Republican efforts to repeal and replace the ACA failed in 2017.

President Donald Trump signed an executive order Thursday directing federal agencies to consider expanding health-insurance coverage in low-cost plans that are not subject to Affordable Care Act rules, a move that could raise costs for sicker people.

The order is designed to provide what the White House calls “alternatives” to plans offered through Obamacare markets. It comes after the implosion last month of Republicans’ latest attempt to dismantle President Barack Obama’s signature health-care law, a chief policy goal that Trump and GOP lawmakers campaigned on.

Speaking before signing the order at a White House ceremony, Trump said consumers “will have so many options.”

“People will have great, great health care,” he added.

Everyone who is making fun of the President’s announcement or his administration, campaign, and media surrogates doing victory laps about this on social media because they think it is a joke since it is already the law because of the Affordable Care Act need to sober up because they have missed the point. It is not a joke, it is a psychological operation aimed by the President, his administration, his campaign, and his surrogates, included Republican elected officials at Americans (emphasis mine):

Psychological operations (PSYOP) are planned operations to convey selected information and indicators to foreign audiences to influence the emotions, motives, objective reasoning, and ultimately the behavior of foreign governments, organizations, groups, and individuals.

The real objective of this executive order is not to ensure that insurance plans cover people with pre-existing conditions. Rather, the objective is to convince Republicans and conservatives who have hated the ACA/Obamacare, especially those that don’t know what is in it because they don’t want to because it is Obama’s plan. It is also targeted at less affluent and lower information Americans who have internalized the misinformation and agitprop about the ACA/Obamacare that Republican elected and appointed officials and conservative elites and notables have been pushing through conservative news, digital news, and social media for a decade and, as a result, actually believe that any plan that they could purchase through the ACA/Obamacare is both prohibitively expensive and does not actually cover anything because the policies are full of loopholes! And who were gullible enough to then buy one of the short term plans created by the President 17 October 2017 EO. This is the target audience. The better informed ones don’t care that the Administration is supporting the Republican Attorneys General’s lawsuit trying to have the entire ACA struck down, which would actually remove the pre-existing condition protections in the law for everyone in the US not on one of these short term plans. And the low information ones simply don’t know. What they know of current political events, including what is going on with health insurance, is either very little or is filtered through their local news, where Sinclair has an overwhelming influence and impact, or their or their families’ and friends’ social media, which means it is highly influence by Fox News, OANN, Breitbart, Gateway Pundit, the Daily Caller, and dozens more purveyors of misinformation, disinformation, and agitprop.

This is NOT A JOKE! It is an influence operation intended to further solidify a base that the President’s campaign leadership is worried might get shaky, the larger Republican party and conservative movement, which is a bit wobbly right now, and less affluent and low information Americans, especially low information voters, who will see or hear or read this and think the President has done something good for them.

That’s not the joke, that’s the point.

Open thread!

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So About That Third Party Spoilers Thing… The Libertarian Presidential Candidate And A Possibly Rabid Bat Edition

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What effect might his have on Ms. Jorgenson’s views on the US healthcare system? Well let’s just say kvetching was involved!

There is, as of 11:10 PM EDT, no word on the condition of the bat and whether it has contracted anything serious or life threatening from coming into contact with Ms. Jorgenson.

Open thread!

Obligatory:

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Republicans–and Republicanism–Kill Americans…Pandemic Update

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One of the benefits of throwing a few bucks at Charles Pierce at Esquire is getting on the list for his weekly email. This week it featured an interview with Ken Starnes, a physician working along a rural stretch of the  Arkansas-Missouri border.

Republicans--and Republicanism--Kill Americans...Pandemic Update

Starnes’ experience provides a natural way to observe what happens when insane ideological commitments trump obvious public policy wins.  He sees and accesses hospitals in both states. His patients come from the same demographic in both states.  There is only one key difference between them: Arkansas came up with a Rube Goldberg way to implement Obamacare’s Medicaid expansion, while the people he sees from the Misery side of line are governed by GOPsters so doctrinaire that they refused the Black-President-tainted free money rather than deliver care to their citizens.

Stearns:

…there is a big difference between the way I treat people in Arkansas and the way people I treat in Missouri because of that. Here in Arkansas, I could probably get you to follow up with somebody, or you’re on your medicines. I was in medical school when they expanded Medicaid, and all of a sudden you have people coming in who were bad asthmatics, who had not had inhalers for years. Or diabetics who had not been on medicine for years. And the numbers turned out that these people were getting better health outcomes in Arkansas.

In Missouri, they have not done that—take the free money as you said—and the health outcomes are different. When I’m working in the emergency department, a lot of what I’m looking for is, I may not have to put this guy in the hospital, but what am I gonna do with this? If he’s not sick enough to come in, but this can’t be ignored. If I can’t get you in for a follow-up with a primary-care doctor because you don’t have insurance, or you do, but there’s not one available to you, I can’t really fix your problem. I’m just going to wait for it to get worse and for you to come back and see me. That’s the frustrating part.

Republican AGs are suing to eliminate the ACA altogether, including, obviously, the Medicaid expansion. The Trump administration supports that effort.  If they win, Missouri will be the model for the US. The Supremes will hear the case in October. I hope (and expect) that Biden and Democrats all the way down the ticket will be ready to go with the appropriate message when that happens. (Remember–whatever folks think they think about Obamacare, that other thing, the ACA, and specific benefits like having health care at all, remain popular to very popular.)

But what about the GOP Obamacare replacement plan, you ask?* That has remained consistent since 2010, at least. It’s only virtue is that it is simple:

Die sooner.

Which looks way too damn likely is what’s about to happen in a bunch of places that for ideological reasons have neither extended the reach of their health care systems nor taken seriously elementary public health techniques in the face of a pandemic.

This thread: it is as open as Trump wants his convention to be.

*You don’t…because you know better. But roll with me.

Image: John Constable, The Hay Wain, 1821.

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Repubs in Disarray! Open Thread: The Hydroxy– Y’Know

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Look on my works, ye mortals, and despair!

Granpa started talking like this, you’d take away his car keys & checkbook. Even the Media Observers are beginning to doubt the ‘long con’ theory:

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Monday Morning Open Thread: Murphy the Trickster God Help Us All

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Coronavirus-a-lago? Covid-19-a-lago?…

Send in the spinmeisters!

Speaking of the Official Trump Tax Residence, could we line every possible entry route with ‘Miss Me Yet?’ Obama billboards? (The rest of us sure don’t need the reminder, but it would irk the living daylights out of Lord Smallgloves… )

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Our New Pandemic Reality: ‘Harm Mitigation’

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Emergency physician & former Baltimore health commissioner Leana Wen, in the Washington Post — “We’re retreating to a new strategy on covid-19. Let’s call it what it is”:

… At the beginning of the outbreak, the United States had a chance to contain the novel virus by identifying each person bringing the infection into the country and stopping it before it spread in the community. We failed, with a lack of testing largely to blame. Instead of individual-level containment, which would have had minimal effect on the economy, we had to employ societal-level lockdowns to slow the explosive spread of the virus and buy us time until we developed the capacity to rein it in. The idea was that restrictions would be lifted once we reduced the number of infections far enough and built up the public health infrastructure needed to find new positive cases, trace contacts and quarantine those exposed.

Unfortunately, due to a late start, inconsistent state actions and a lack of federal direction, most states have yet to see a consistent decline in cases, much less reduced them to low enough levels for this to work. No state has achieved sufficient testing and contact tracing. Reopening under these circumstances means we are giving up on containing covid-19.

What’s next, then? The administration has yet to use these words, but it appears that we’re adopting a strategy that I recognize from other aspects of public health: harm reduction.

Harm reduction was initially developed as a public health approach to reduce the negative consequences of drug use. It recognizes that while stopping drug use is the desired outcome, many people won’t be able to do that. For those individuals, needle-exchange programs can reduce their risk of acquiring HIV and hepatitis and transmitting these infections to others. Such programs do not promote or condone drug use, as some critics contend. Rather, they face the reality that if a behavior with harmful consequences is going to happen regardless, steps should be taken to reduce the risk for both individuals and others around them. Think, too, of safe-sex campaigns, or motorcycle helmet laws.

And this seems to me where we are with covid-19: We’re no longer trying to eliminate the virus. Instead, we are accepting that Americans will have to live with it.

If that’s the case, then our efforts should pivot from justifying why reopening is a good idea to figuring out how best to reduce the harm it is certain to cause. If employees have to go to work, let’s at least come up with evidence-based practices that help them do so more safely. Should workplaces all get regular deep cleaning, close off any communal areas and meet new standards for ventilation? Can employees be mandated to wear masks, work six feet apart and keep a contact diary?

We know that covid-19 is most likely to be transmitted when a lot of people are in an enclosed area for a prolonged period. I would not have advised that hair salons and gyms open for business, but since they have in some states, we should aim to stop the highest-risk practices — prolonged treatments and crowded indoor fitness classes, for example. If people are going to get together in large groups despite the danger, we should at least advise that they do so outdoors, for shorter periods of time, and avoid practices with a higher likelihood of disease transmission, like sharing utensils and group contact sports…

I wish the United States had taken a different path. We could have contained the virus earlier, and we still had a chance to do it until we reopened against the guidance of public health experts — including the Trump administration’s own top doctors. But now that we are where we are, we should at least be honest and call our new strategy what it is. It’s our best hope left for saving lives.

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