Through the Looking Glass: Hope is Not a Strategy

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The short course for strategy and policy is really quite quick and simple. To make policy one determines what your ideal objectives are, establish how much risk you are willing to assume to achieve them, and then either decide to attempt to achieve those objectives or a less than ideal, but still perfectly acceptable, but less risky alternative. Once this is done, in order to further minimize that risk and to ensure the maximum likelihood of success, you determine what ways and means you have, what additional ways and means you may need, how to bridge the gap between the two, and then you execute: applying your ways and means to achieve your ends. Finally, personalities matter and relationships matter. Congratulations! You now know more about strategy and policy than any elected or appointed official pushing for the Leave position that I saw on the BBC News coverage of the Brexit vote from 8 PM EDT last night to 3 AM EDT this morning.

It didn’t matter if the official was from the Conservative Party or from the Labor Party or from the UK Independence Party. They knew what the ends they wanted to achieve – leave the EU on terms negotiated to be the most favorable to Britain, but that was it. None of them expressed any real idea of how to achieve this beyond Vote for Leave, Article 50 now or later, return of sovereignty, and a better future for Britain. I don’t mean to make light of what happened or what anyone tuning in witnessed. A number of these ladies and gentlemen were quite articulate, had a clear grasp of how the Article 50 of the Lisbon Treaty process worked, and in some cases actually were quite aware that the real issues were poor outcomes for average, and often rural/small town/village British people that resulted from the failures of British government and governance, not because of anything specifically involving the EU.

What we have watched today is emblematic of this failure of strategic vision, clarity, and understanding. Nigel Farage, the leader of the UK Independence Party, made it very clear that former Mayor of London Boris Johnson and Conservative MP and Leave Leader Michael Gove’s assertions about investing the money that will not be sent to Brussels into the National Health Service is unlikely. He also said that he 1) never said it and 2) had he had any official capacity in the Leave Campaign he would not have said it. This was one of, if not the, central themes of the Leave Campaign.

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(Mayor Johnson speaking adjacent to one of the central Leave Campaign Themes**)

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(Mayor Johnson and MP Stuart speaking in front of the official Leave Campaign bus)***

Farage disparaging his more conventional fellow travelers, and being brutally honest about their false promises was a ray of sunshine compared to what we heard from the formal leaders. Johnson, MP Gove, and EU immigrant to Britain MP Gisela Stuart**** are all now calling for calm, patience, time, and space arguing there is no need, nor rush to invoke Article 50 and begin the exit immediately. While this mirrors remarks made by some of the elected officials in the Leave camp that appeared on the BBC last night, others argued that the separation must begin immediately. What no one seems to have prepared for, what no one seems to have considered, is that the EU itself gets a vote. EU officials weighed in this morning by immediately calling for Britain’s invocation of Article 50 to prevent a dragged out process, uncertainty, and the possibility that the nationalist fervor could fully take hold in other parts of the EU.

What Johnson, Gove, Stuart, and their fellow Leave supporters also failed to consider was what would happen if the United Kingdom was not united in the referendum. On the BBC last night, Former Scottish First Minister and Scottish National Party MP Alex Salmond explained to the panel that this concern was brought up to Prime Minister Cameron before the referendum was set. And that the recommendation was that it should require not just a popular vote win for Leave, but a win for Leave in all four constituent portions of the United Kingdom to trigger the Brexit. Salmond explained, with a fair degree of amusement, that Cameron didn’t think that would be necessary, rejected the recommendation, and was probably now regretting doing so. Regardless, and despite Johnson’s call for calm, unity, and no need to or worry that this might lead to the dissolution of the the United Kingdom, that reality has already begun. Scotland is preparing itself for a second independence referendum as they wish to stay in the EU. Republican officials in Northern Ireland have raised the possibility of a referendum to leave the UK and unite with the Republic of Ireland. And Gibraltar’s status is unclear, with Spanish officials calling for shared sovereignty. It is not clear that Labour’s Leader, Jeremy Corbyn, has any better strategy for dealing with what the Leave vote has wrought, and a motion of no confidence in his leadership was quickly submitted this morning. It is also not clear that anyone else could successfully lead the currently internally divided Labour Party any better or effectively challenge for a Parliamentary majority.

Despite planning by the Bank of England in case things went wrong, the Vote Leave Campaign leadership, official and unofficial alike, did not seem to have a plan for the effect of victory on the British, European, and global economies. The pro Brexit vote demonstrates the failure of elected and appointed officials who do not have a firm grasp of policy, strategy, and their potential effects – positive and negative. It is quite ironic that a successful referendum campaign partially based on anger at elites, notables, and experts to run things effectively has shown that the elites, notables, and experts running the Vote Leave movement and campaign do indeed not have the foggiest idea of how to run things effectively. Nothing says “I understand and empathize” like a Vote Leave Tory Member of Parliament, who graduated from public school and the Oxbridge system and has been an MP for his entire professional career, explaining to BBC anchors that the average British person is fed up with the failures of the elites and the experts running Britain and that is why the country must leave the EU.

The chaos seen today clearly demonstrates the failure of strategy and policy among the Vote Leave campaign leadership. We can clearly see that they don’t really have any ways and means to achieve their stated end: a negotiated departure from the EU that provides Britain with the best possible terms. Nor do they have any idea what they should be. They have destroyed their relationships with the EU leadership who want the separation done immediately and are in no mood to bargain, let alone allow Britain off the hook easy. And they have no leverage with the EU as a result. Johnson, Gove, Stuart, Farage, and others are now the dog that caught the Vauxhall. Unfortunately they clearly have no idea what to do with it.

* Image from here.

** Image from here.

*** Image from here.

**** Stuart is now under formal inquiry/investigation for failing to disclose a financial interest in a company that has promoted financial planning as a result of the Leave campaign winning.



Obamacare is a job killer

Finally, the evidence is in.  Obamacare is significantly hurting a segment of the US economy.

From Bloomberg:

Early evidence suggests that the Affordable Care Act is working — at least in one important respect, according to researchers at the Federal Reserve Bank of New York.

Analysts Nicole Dussault, Maxim Pinkovskiy, and Basit Zafar state that the primary purpose of this law “is not to protect our health per se, but to protect our finances.” And they’ve found a big difference between indebtedness trends in states that embraced the Medicaid expansion versus the ones that did not…

U.S. counties that had a particularly high uninsured rate prior to the implementation of the Affordable Care Act have seen the per capita collection balance fall if their state embraced the Medicaid expansion. If not, the collection balance continued to climb:

Will someone think of the debt collectors… Ohh the humanity.

 



Late Night Horrorshow Open Thread: Christianist Hypocrites Embrace the Combover Caligula

Or, as the Grey Lady mealymouths it, “Social Conservatives, However Reluctant, Are Warming to the Idea of Trump”

Activists and leaders in the social conservative movement, after spending most of the past year opposing and condemning Donald J. Trump, are now moving to embrace his candidacy and are joining the growing number of mainstream Republicans who appear ready to coalesce around the party’s presumptive nominee…

“Oh, my, it’s difficult,” said Penny Nance, the president of Concerned Women for America, a group that has openly campaigned against Mr. Trump. “He’s not my first choice. He’s not my second choice,” she added. “But any concerns I have about him pale in contrast to Hillary Clinton.”

And Mr. Trump — whose litany of offenses against cultural conservatives include support of Planned Parenthood, past positions on abortion rights and his more accepting views on gays and lesbians — is winning over this once deeply skeptical constituency.

He has made overt moves, such as suggesting last week that he would name Supreme Court justices who would overturn Roe v. Wade, and sent subtle signals, like employing people for his campaign who are well known in the movement.

Mr. Trump has, to a large extent, placated a vocal and powerful element of the Republican Party’s base, whose backing he will need if he wants to wage a general election campaign leading a united conservative movement.

The support of social conservatives is not just symbolic. It means getting assistance from groups that plan to spend millions of dollars mobilizing voters, people who lead influential faith-based organizations and Republican activists who will help craft the party’s platform at the national convention this summer…

“They love a convert because it’s what their faith is all about,” said Ralph Reed, founder of the Faith & Freedom Coalition and a friend of Mr. Trump.
Read more



Is Trump Lying About His Bankroll Size, Too?

Well, the reactions to this analysis should be interesting. The Wall Street Journal goes there — “As Trump moves to raise big sums, an estimate of his 2016 income shows it short of the big money needed for general election run”:

… When his campaign began last summer, a financial disclosure Mr. Trump filed said he had between about $78 million and $232 million in cash and relatively liquid assets such as stocks and bonds.

That would go fast if Mr. Trump spent an amount close to the $721 million President Barack Obama spent in 2012 up to Election Day, or the $449 million Mitt Romney spent in the same stretch.

This would leave hundreds of millions to be made up. And Mr. Trump’s businesses don’t produce that much in a year, a Wall Street Journal analysis shows. His 2016 pretax income, according to the analysis, is likely to be around $160 million.

The Journal analysis is based on 170 items of “employment assets and income,” such as real estate, golf courses, management companies and licensing deals, listed in the financial disclosure form Mr. Trump filed last July. The Journal estimated how much pretax income each item should yield this year, relying on public documents and interviews with dozens of former and current Trump Organization executives and people who are familiar with his businesses.

In the absence of Mr. Trump’s tax returns, which he has declined to release, the analysis helps answer a question many wonder about: just how much the candidate earns…

The cash issue looms now because the political season is growing more expensive. The Trump campaign spent about 50% more in March than in February, facing higher expenses for field workers, telemarketing and voter-data operations.

Mr. Trump noted that once the general election campaign begins, the Republican National Committee will be spending heavily on his behalf. The RNC spent $386 million during the 2012 presidential campaign. A clutch of other entities such as political-action committees spent $419 million to back Mr. Romney.

This year, officials at some big Republican PACs are saying they are going to turn their funds toward keeping the Senate and House in the Republican hands, meaning their support for Mr. Trump could be diminished.

On the other hand, legal changes since 2012 make it possible for political parties to raise larger individual donations, via joint fundraising committees with their presidential candidates. Such a joint fundraising committee is what Mr. Trump said in early May that he planned to set up with the Republican Party…

And aren’t the Permanent Repub Party bigwigs with their hands on the purse strings — not to mention the ones required to fill that purse — going to enjoy giving the short-fingered vulgarian their money to waste on futilely challenging Hillary Clinton?

The whole article (I found it by Googling its title) is replete with the sort of details that will fascinate wonks, but it reinforces what non-Trump-partisan observers have been saying since Deadbeat Donald first rode that gilded escalator to announce his run: While $160 million (more or less) would be a more-than-satisfactory income to you or me or most normal human beings, it’s nowhere near enough to qualify Trump for “Really Rich Person” status. Assuming he started this shitshow in the first place to enhance his brand/salve his Obama-wounded feelings/bigly assert his yoooge hand size, the media response to this it will not be fun for him. Watching his noisy rage should provide some tasty schadenfreude for the rest of us, though!



Not observing games

PPACA has been attempting to bend the cost curve by penalizing stupid and avoidable errors.  One class of errors that has been amenable to reduction has been Medicare beneficiaries getting  re-admitted to hospitals  after their initial admission for a set of circumstances.  As soon as data started to be collected and before penalties started to be imposed, the readmission rate crashed.  Since penalties have been imposed, the rate is still going down but at a slower pace.  This does two things to the cost curve.  First, it reduces direct Medicare expenses as Medicare is not paying for another hospital day.  Secondly, changes in practices and procedures that result in lower Medicare readmission rates tend to diffuse throughout a hospital and all of its patients so people who are not covered by Medicare also benefit from the improvement in practice.

This sounds great.  We save money, save Grandma as hospitals are where old people die, and get better quality care.

However, wonks have worried that any quality measure that has real money attached to it can and will be gamed.

The easiest way to game a re-admission measure is to redefine admissions.  Hospitals have the ability to put people on “observation” status where to anyone but the billing and quality metrics department, the person looks like they are admitted.  They get the uncomfortably flimsy robe, they get the wrist band, they get poked and prodded and monitored just like an admitted patient.  They can stay in observation status for a time period including one midnight.  Yet these individuals are not part of the “admitted” or “re-admitted” population universes.

There was a possibility that a significant chunk of the seemingly great decline in readmission rates was really a bureaucratic shift of people getting moved from short term admissions to observation status.

That is not the case.

The New England Journal of Medicine  * has an interesting study on this matter:

Read more



Open Thread: Antonin Scalia, Still Roiling the Political Waters

scalia mcconnell vs voters morin

(Jim Morin via GoComics.com)
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From the Washington Post, “Battle over Scalia’s replacement already spilling into Senate races”:

… One consideration that may force Republicans to recalibrate their strategy is the prospect of political damage to some of the embattled Senate incumbents up for reelection this fall. Sens. Kelly Ayotte (N.H.), Ron Johnson (Wis.) and Rob Portman (Ohio), all Republicans in swing states, have called for the Senate to disregard any Obama nominee. Other Republicans in tight races have remained silent so far…

Americans United for Change, a group closely allied with the White House, is trumpeting an article written by now-Senate Majority Leader Mitch McConnell (R-Ky.) in 1970. McConnell wrote that “the Senate should discount the philosophy of the nominee” and that “the president is presumably elected by the people to carry out a program and altering the ideological direction of the Supreme Court would seem to be a perfectly legitimate part of a presidential platform.”

Gawker has collected a potpourri of “The [Scalia Murder] Conspiracy Theories, Explained” — ranging from the obvious (President Obama’s minions) to the tabloid (recalling Nelson Rockefeller) to the… well, that chupacabra tweet was probably tongue-in-cheek. I hope.

Things I did not know: Michael Dukakis was Scalia’s law school classmate. Man was a revanchist pest, even then…

… I didn’t know who Scalia was until the last semester of my last year, when I took a class called Federal Courts and the Federal System, with a great man named Henry Hart. It is 1960. We are in the middle of the civil rights revolution. And there’s this guy in class who begins engaging Professor Hart every day in these long dialogues over whether it was appropriate for federal judges to reach in and take cases away from Southern criminal courts, in cases where, as everyone knew, if you were a black defendant, forget it. And this went on for about three weeks. [Laughs.] I finally turned to the guy next to me and said, “Who the hell is that guy.” He said, “That’s Scalia, he’s on the law review.” And I said, “Does he know what it’s like to be black in the South?” A bright guy—yeah. But he was to the right of Marie Antoinette for Christ’s sake. There was no consistency in his so-called philosophy…

Golden oldie… Read more



Health insurance across state lines, coercion or consent

As of last week, states could form interstate health insurance compacts to allow for a single state to approve insurance that can be sold in all compact member states.  This is part of PPACA, as Charles Gaba has been digging into this week.  Kimberly Leonard of US News and World Report has details:

The little-known provision, found in section 1333 of the roughly 1,000-page Affordable Care Act, allows for states to create “health care choice compacts” permitting insurers to sell policies to consumers in any state participating in the compact, as long as they follow specific rules. Five states – Georgia, Kentucky, Maine, Rhode Island and Wyoming – already have enacted interstate compact statutes,according to the National Conference of State Legislatures.

An interstate compact is a voluntary agreement between states that has the approval of Congress. The most common compact type according to WIkipedia is some type of watershed and littoral water management compact such as the Port Authority of New York and New Jersey or the Great Lakes Commission.

There could be several potential compacts.  Massachusetts may decide that they are happy with the regulatory approaches of Rhode Island, New York, California and New Mexico and those states could form a compact.  On the other hand, Texas could join with Oklahoma and Louisiana for a de minimis compact.  The key aspect is that each particular state could choose what the minimal regulatory level would be appropriate for the home state.  It is a compact of consent.

This is markedly different than the Republican idea of selling insurance across state lines.  In that idea, the federal government would proclaim that a license in a single state is a license for all states.  The insurance industry would become an isomorph of the credit card industry.  The state with the weakest and most easily bought regulatory structure would have 98% of the viable insurance companies headquartered there within nine months of the law being passed.

It would be a race to the bottom for coverage requirements.  Currently, some states require insurers to cover a single wig for people who are receiving chemotherapy.  That requirement would still be in effect for any policy initially approved in that state, but no policy would be approved there.  Instead, a Plains state would have not have a wig coverage requirement.  More commonly, states vary in the required length of state after a non-complicated vaginal birth.  Some states may require 24 hours, other states require 36 hours, while other states require 2 midnights and a few states require 48 hours in the hospital after delivery.  Under the Republican schema, all these requirements would remain on the books, but the only plans offered across the nation would have either no maternal stay requirements or the shortest possible maternal stay requirement.

It is coercive federalism that sets the national standard at the lowest and least protective level as determined by a single state which is easily bought out.  Massachusetts would be regulated by Mississippi or South Dakota or Wyoming or Delaware.