The Laughter

The Wall Street Journal has a headline tonight.

Trigger warning: Talk about rape below the fold. I find this very upsetting myself.

Read more



The 2020 Commission Report – Review

If you want to know what the next nuclear war will be like, read Jeffrey Lewis’s The 2020 Commission Report on the North Korean Nuclear Attacks Against the United States.

Nuclear weapons have been used only once in war, by the United States against Japan at the end of World War II. Nuclear war was imagined many times, however, through the Cold War between the United States and the Soviet Union. As the two countries’ nuclear arsenals grew, the common understanding became that in a nuclear war, hundreds of multi-megaton nuclear weapons would be exploded, and the direct damage would destroy the countries involved. Most of us would die immediately, more in the aftermath. It looked like the end of civilization.

We don’t know exactly how many nuclear weapons North Korea has, but it’s in the tens, rather than the thousands of the Cold War. That changes the leaders’ calculations. If they face a war in which using those weapons is a serious possibility, they must use them before they are destroyed. So they must be alert to signals from their enemies that an attack might be coming.

Unless the United States responded with nuclear weapons and somehow Russia and China also sent their missiles flying, the result would look more like what Lewis describes than the Cold War imaginings.

The 2020 Commission Report reads not quite convincingly as a government report. It too many emotional words. But the format allows a view into how decisions are likely to be made in such a war.

When people write serious articles in serious journals about deterrence or nuclear war, they assume rational, fully-informed decision-making. After a war starts, emotions come into play. Communications are broken. Erroneous impressions or understandings of what the other side may do have been there all along. Read more



North Korea’s 70th Anniversary Parade Was Boring

Sunday is running away faster than I thought it would, so I’m going to contract out the reporting to Josh Smith of Reuters, who was there. The photo is of spectators at the parade, from that article. There are more in the article.

Donald Trump recently received a letter from Kim Jong Un, but we don’t know what was in it yet. There were no big missiles in the parade, and the Orange Emperor thought that indicated that North Korea is going to denuclearize.

So far, to demonstrate good will, North Korea has dynamited the entrances to the tunnels at its nuclear test site, which can easily be reopened; partially disassembled a missile stand; and refrained from showing his biggest missiles in the parade, while presumably continuing to manufacture them and their nuclear payloads.

That word, denuclearize, shows up again. Trump, as far as we can tell, thinks it means North Korea’s giving up its nuclear weapons program. Kim has made clear that he sees it as a long-term goal, when the rest of the world denuclearizes.

And, in case you were sleeping too well, here’s another anecdote from Bob Woodward’s book. Trump wanted to tweet that he was evacuating dependents of military personnel in South Korea. He was talked out of it. That evacuation would be one of the sure indicators of an attack on North Korea, and Kim would have taken it that way.

 



That Op-Ed, Continued

While I take a measure of relief that we now appear to be closer to the beginning of the end than to the end of the beginning, I have some big concerns about that New York Times op-ed by “a senior administration official.”

My concerns are very much like David Frum’s.

Speak in your own name. Resign in a way that will count. Present the evidence that will justify an invocation of the 25th Amendment, or an impeachment, or at the very least, the first necessary step toward either outcome, a Democratic Congress after the November elections.

Clearly this is related to yesterday’s revelations from Bob Woodward’s book. The author of the op-ed may even have contributed to Woodward.

But the author is trying to preserve his/her reputation: I am being a good Republican, helping to execute good Republican policies. I am keeping the country safe from a dangerous president.

That’s a lot of responsibility to take on. The president is elected; the author has been appointed by that president and tells us that he is undermining that president. In the telling, the president is further undermined.

What did the author expect to be the next step? Donald Trump is reported to have freaked out over the Woodward revelations and have started searching for the leakers. This will turbocharge that search. James Jesus Angleton became convinced that there was a Russian mole in the CIA and practically destroyed the agency. Can the author of the op-ed protect us from a storm a couple of categories stronger?

There are a limited number of senior administration officials. We are likely to learn who wrote the op-ed much more quickly than we learned that Deep Throat was Mark Felt. How we will learn is hard to predict.

 



Five years now

Five years ago, I made a serious miscalculation.

I was a low level bureaucrat trying to get Exchange networks to work for UPMC Health Plan.

I was exhausted that first fall as we were scrambling with interim solutions for several months after the ACA individual market went live.  We then had to go crazy to ramp up HealthyPA, a convoluted Medicaid expansion waiver program in Pennsylvania.

I was in Pittsburgh living an anonymous life.

I thought I would only have a couple dozen health insurance related posts spanning twenty or thirty thousand words in me.

Now I’m in Durham.

I’m now at 1,550 + Mayhew on Insurance posts and several hundred other general purpose posts.  My health policy word count is closer to a million words than half a million words.  There is a mostly written book somewhere in these posts and I will sooner or later need to convince myself that I can write a book on health policy.

 

Then, I could never be quoted nor would anyone want to hear what I wanted to say besides a couple of co-workers as we slammed espresso shots before another analysis run cycle.  Now, I’m part of the usual quotable suspects when major ACA news breaks out.

Writing here at Balloon Juice has been and continues to be an amazing experience.  I get to play with ideas that fascinate me, and John gives me the keys to write to an audience.

One of the big changes since I’ve come to Duke, beyond saying good bye to the persona of Richard Mayhew, is that I’ve changed my writing targets.  When I was Richard Mayhew, I had to write at Balloon Juice.  I could and would poke a few people here and there that something big was coming down the pipe but I was limited.  Now, the audience is sometimes all jackals.  Other days, the intended audience is a few score of geeks and policy professionals who need to know about some esoteric corner case.  I apologize when I take over the blog for those purposes as I feel like I am hijacking your attention to pay the cost of entry into conversations that I want to be in.

As I have been drafting this post over several days, I’ve talked to reporters from local and national general interest press, I talked to a reporter from the trade press, I submitted a pair of long and very technical pieces to Health Affairs, and a revise and resubmit just went back to the editors of a good peer reviewed journal.  If you spend enough time reading Balloon Juice, you could figure out 85% of the article excluding some of the regression based analysis.

I feel guilty about this at times.

Last week, was a good example.  I wrote a Medicare shared savings post that I was aiming at a few dozen academics and several dozen think tankers, journalists and very targeted policy wonks. It is a very specific, nerdy, and incomplete idea.  It was not worth an op-ed as it it too geeky. It was not a Health Affairs blog or a journal perspective piece as the idea was not polished enough for that purpose, so I went Balloon Juice. And that post got three comments.  And I was fine with that as this was not a general purpose post but a very small part of a very different conversation that I participate in.

I’ve moved away from some general purpose health insurance and ACA blogging and at times over the past year, I’ve chased personal shiny objects down rabbit holes.  And you guys put up with that. And for that I am greatly appreciative as I love writing here at Balloon Juice.  I have a scratch pad and a place to get first drafts (seldom second drafts as you see my grammar and spelling) of reactions and thoughts.  I can dig into something that fascinates me on my own time and my own schedule until it makes sense to me.  I hope that this is not pointless intellectual public indecency as this entire creative process is extraordinarily valuable for me.

Balloon Juice is a very different form of writing than writing a journal article.  Under the best case scenario, a fast journal timeline from “umm, that is a cool question” to publication is a year or more.  It is very different writing than a multi-author Health Affairs blog where commas can become fighting marks while the critical point that I want to make might be the lead melody or become subsumed as a backing bass line.  It is a very different writing process than pumping out a New York Times op-ed where I first truly appreciated the value of a wonderful editor.  That process makes me sound a whole lot smarter by the end.  The final 750 words are a tight 750 words instead of a 5 post, 3,000 word series here.  But I was worn out both times I went through that process.  This is a fun place to write  and it allows me to get into awesome conversations of a variety of stripes.

But mainly, I just want to thank all of the jackals, the front-pagers and John for a community where I can nerd out on something that I find fascinating.  I’ll figure out what Year Six looks like, but the first five have been wonderful.

 



SATSQ: YES You did

Any political appointee that either accepted their position after the first week of February 2017 and everyone who has not resigned has signed on for this shit.



Sherpas for forensic accountants

The Cohen information sure as hell seemed like it was screaming systemic tax and accounting fraud in the Trump Organization given how he was reimbursed.

And now the Trump Organization CFO has immunity. I bet his future job will be to sherpa forensic accountants hired by both the Federal government and the State of New York through the Trump Organization’s books. But I am neither a lawyer nor an accountant…

Open thread.