Category: Politics and Government

Learning the Hard Way (Or Not Learning at All)

Throughout the presidential campaign, Trump repeatedly called out the Obama administration and US military for announcing their plans to target an area. Tipping off the enemy, he said. No reason for it, he said. All manner of politicians, military strategists, and people who bothered to think about it for a few minutes explained the rational — there are a LOT of civilians in the area we will be targeting. We would rather not incur civilian casualties as part of our military campaigns — if for no other reason, it’s bad PR. Either the advanced warning drives them out of the area or they are still there to be hit. Driving them out of the area still disrupts their operations.

So now Trump is in charge – I am sure we’ve stopped advertising where military strikes will occur. And non-combatant civilian deaths have skyrocketed. Something like 1,000 reported in March — I’m sure there’s inflation involved in this reporting. The old Soviet instantaneous statistic modification was half anything good, double anything bad, which would still be 500 civilians killed in a month that is not yet over. Gee, if only there was some way we could let these civilians know ahead of time.

The Story Within The Story

There have been a lot of instances in the past few months where a story about Trump contains a throw-away line that seems more important than the story being conveyed. Not reading EOs in a NYTimes piece not long after the inauguration, for instance.

Today’s reporting on Paul Manafort seems to be following this trend. The guy had a multi-million dollar contract with Oleg Deripaska … who is, in turn, a friend/ally of Putin. There’s a lot of focus on the money involved, the farther involvement of Trump associates with Russians, and the speeches and policy changes that were made pre-convention last year. But the scope of the work seems to be overlooked. He provided strategies on how to advance Russian interests around the world and undermine Putin’s political rivals. Which sounds a lot like advancing Russia’s interests by undermining rivals … or hacking the DNC and releasing information that negatively reflects on Clinton. And releasing more when she still looked to be leading in the weeks prior to the election.

The campaign chair potentially came up with the strategy that may or may not have involved collusion from Trump’s team. Even if they’re a bunch of stooges … the fact that the chap who consulted on the policy in the first place then took a high-level position with the campaign looks REALLY bad.

Coverage does not equal access

Coverage does not equal access — this political quip used to argue against the ACA is indeed true. Not sure why the answer is not that *no* coverage pretty well ensures no access.

It was a little silly to say that no one would need to change plans or doctors with the new law. Each new annual enrollment period at work, we have different plans and, yeah, I have to change plans even though I liked the one five years ago that had WAY lower deductables, lower out of pocket expenses, and lower cost to purchase. It isn’t available. I remember my mom changing doctors a number of times in the 80’s because her doctor no longer accepted whatever insurance she had at the time. Why one would claim the ACA would change facts that have been true as long as insurance has been about is beyond me. But the claim was made, so it’s a point of criticism for the law.

I guess the implication is that the AHCA will provide both coverage and access. I’ve read the bill … and not heard anyone explain how the changes even provide coverage let alone access. I guess if fewer people can afford coverage, the lucky ones who can don’t compete for appointments anymore. But that’s hardly a selling point for a bill — a bit like saying we’ve increased selection at the grocery store by making sure 18% of your neighbors can no longer afford food.

There’s a balance in the ACA that I don’t really like. But I *understand* that if we are going with the insurance model of health care and don’t want insurance companies to refuse to cover pre-existing conditions, we’ve got to ensure they’ve got customers who aren’t sick. In this light, the proposed changes to the AHCA allowing states make up their own list of essential services makes a bad bill even worse. I’d be able to have “continuing” coverage (and thus not be someone who could be charged a surcharge from an insurance company) by buying the cheapest policy available that covers only sprained left wrists. Then when I *actually* get sick, buy a good insurance policy that covers actual medical care.

Read Your Constitution

I hear a few people hopefully speaking of impeachment as the FBI investigates Trump and his campaign for possible collusion with Russia during the 2016 election. Does anyone seriously think impeachment would nullify the election?! So Trump gets impeached. Now we have Pence. Trump minus the populist bits (infrastructure funding, trade protectionism) but with a heaping side of religious zealotry. I don’t care if the dude would personally never be alone in the same room with a woman other than his wife. People have all sorts of out-there principals that they uphold; so long as they don’t expect *me* to follow their dictate … who cares. But legislation banning sex ed, restricting access to birth control, bring back the sodomy laws – homosexual marriage isn’t illegal (so saith the Supreme Court) but so doing will meet the evidentiary requirements for a surveillance warrant at your local PD. Hell, even if you lived in a local and state jurisdiction where they just fail to investigate (and, don’t worry, the feds will threaten to withhold money from these ‘sanctuary cities’ too) … watch out where you vacation. Scrutinize your connecting flights. Hope there isn’t an emergency landing. Point being, Pence isn’t actually better. He has discipline and knowledge of government. He has a shot of getting pet legislation through Congress.

Maybe they’re hoping that Pence goes down with the ship too – great, now we’ve got Ryan. May be a win on the legislating fundamentalist Christian morality front, but we’ve seen his health care plan seven years in the making. Anyone seriously think his tax plan, regulatory plan … are going to be any better.

Then we’ve got Hatch – might be an improvement. Tillerson: government run by what’s best for oil companies! Of course next in line is Mnuchin: government run by what is best for mega-banks. Eventually one of these people will stick around – several were not involved in Trump’s campaign.

From Russia, With Love

The more I hear about Flynn communicating with Ambassador Kislyak, the stranger it seems. Why the subterfuge? Surely the Russians knew Trump won the election, and they knew when he took power. Even if they didn’t think Trump would remove any sanctions put in place (why object to something you know is going to be rescinded in a few weeks?), the strategic move would be to wait for an inexperienced administration before taking any retaliatory action. There was absolutely no reason to tell the Russians “hey, don’t worry about the sanctions being put in place by the current administration. we’ll get you sorted in January”.

Learning From History

It is not yet hurricane season, but there are other sorts of natural disasters that aren’t so predictable. And there is not a director of FEMA. Some directors have a great deal of experience in disaster management, and some (GW’s guy who couldn’t manage to run the Arabian Horse Association) are sweet jobs given to friends or political supporters. After FEMA’s performance during Katrina, I expected the office to become the exclusive domain of people with disaster management experience. Folks from the Red Cross, or National Guards, or disaster response agencies from states prone to disasters. For some time, that expectation was realized.

Then came Trump. Like many facets of government where Republicans think government is just wasting money or causing problems … well, he hasn’t even managed to nominate a political hack to serve as the agency head. There’s no one. I have a lot of experience in M&A – any time your department doesn’t get a manager in the new org, update your resume. Your functionality is not going to be around much longer. Because, like we don’t actually ‘need’ the DOE (an agency that keeps track of nuclear materials and intercepts it on the black market) … evidently we don’t need FEMA??

Alternative Facts: Maths Edition

Alternative Fact: From Mick Mulvaney (Director of the Office of Management and Budget) on CNN:

“But you could have a long conversation, when you have got a numerator and a denominator, how to arrive at a percentage.”

Real Fact: When you have a numerator (call it X) and a denominator (call it Y), you arrive at a percentage using the formula:

( (X/Y) * 100) %

If this involves a *long conversation*, either you are teaching someone a new concept or they are screwing with you (let’s debate the pros and cons of Excel, long division on paper, the calculator on my phone).

Health Care Re-Reform

I am rather shocked that Congressional Republicans did not have an ACA replacement written and ready to go on day 1, but it’s here now. Scott and I were discussing the proposed changes, and he was all for making older pay more to allow younger people to pay less. Because, fairness.

That’s viewing insurance premiums in yearly increments instead of over an entire lifetime. ACA isn’t making younger people pay more for other older people. It is making younger people pay more so they can pay less as they age. The electric company has a level billing option often utilized by people on a fixed income. Instead of having a 150$ bill in winter and summer with 50$ bills in spring and autumn, you have a 100$ bill each month. If viewed as just April’s bill, yeah 100$ is high. But it isn’t like your extra 50$ is going to someone else’s electrical consumption. It’s paying for electricity that you are going to use for AC in August or heat in February.

Young people don’t get screwed in the deal, really. Over an average lifetime, they are going to pay about the same amount. It’s just level billed throughout their entire life. The only way you really get screwed in the ACA system is non-medical early death (a drawn out medical problem, covered by insurance, may well offset insurance premium prepayments). Spend fifteen years paying middle aged kinda healthy person premiums in your youth and then die in a plane crash … never attaining the offsetting bonus of not paying old people premiums. But, seriously, if you die in a plane crash and the biggest downer is the money you’ve essentially wasted on pre-paying health insurance … get some priorities!

Sure, current old people got a steal (same as the first social security payments — the recipient hadn’t spent decades paying into the fund). Old people paid young healthy people premiums forty years ago. They paid middle age kinda healthy people premiums twenty years ago. And maybe they paid a couple of old people premiums before ACA became law. But they’re not looking at paying twenty years of old people premiums. They get 10-20 more years of middle age kinda healthy people premiums. Middle age people get an advantage too — they paid their twenty years of cheap young healthy person premiums and have forty years of middle age kinda healthy people premiums.

 

Health Care Is Complicated

Aside from the silliness of declaring the whole health care thing just harder than people think — which doesn’t give much credence to people, a lot of public discourse on healthcare tries to avoid sounding insensitive. But the challenge of health care is cost. Not routine costs – even if you do not believe preventative care can reduce long term expenditures, I think we can all agree that a couple of hundred dollars a year is nothing compared to the cost of chemo, or pills taken daily for decades. Arguing about preventative care is like trying to discuss the budget without addressing military spending or entitlements. Lot of people do it, but they’re by design unable to make significant impact.

The big question in the health care debate is how much money should be spend on keeping any one individual alive? I have a friend who had a premature baby (two, actually, but the first time she worked at a med school and basically had unlimited free services through the med school). She incurred neigh a quarter million dollars in bills during the difficult pregnancy. The baby – before he was a year old – had incurred more than a quarter mill himself. Now this was before the ACA removed lifetime insurance caps, and most plans had a million dollar limit. For someone accustomed to dealing with annual physicals and the occasional course of antibiotics, a million dollars seems beyond generous. For a nine month old kid who has already used up a quarter of his lifetime limit? Not so much.

From a purely economic health care perspective, the kid should have died. Even from a general economic perspective, it is statistically unlikely that any individual will contribute millions of dollars of excess value to society (i.e. my work may contribute to society, but I also extract from society). Yeah, there’s the black swan guy who invents computers or cures cancer. Or the whole chaos theory a guy who ran a traffic light and ran over someone’s grandmother prompted a young student to choose a medical degree. The med student identifies a cure for cancer … but would he have even entered into medicine if not for the car accident? But there’s no way to assign a value to an individual’s life before it is over.

Are we OK with letting someone’s premature child die? Are we OK with telling cancer patients that they either come up with a couple hundred grand or they an languish away at home?

And if we are not OK with heartlessness in the pursuit of fiscally rational decisions, how is anything other than universal public funded health care acceptable? Health care isn’t difficult, convincing people that their own values dictate public health care … well, that’s nearly impossible.

Maintaining the role of private insurance in healthcare is hard — in an area where it is impossible to act as a rational decision maker, capitalism in health care is difficult enough to manage. Adding a couple of layers of administrative costs makes it much worse. Having two companies looking to profit makes it much worse. Spending somebody else’s money isn’t a way to make customers cost conscious. Having a system that does not encourage price shopping — often times makes it impossible to price shop — is not a way to drive efficiency or reduce costs. Company paid insurance hid the true cost of private health care insurance … until recently when companies realized they could greatly restrict wage increases because they are paying so much more for health insurance. How many employees actually sat down and calculated if they would have been better off with a real raise than 0$ and whatever the premium increase was. You can see how much your employer spends on health care — I doubt that amount has gone up 1% of your salary in the past year, and a 1% annual raise isn’t spectacular.

Budgeting

There is an incredible amount of money spent on the American military. Trump thinks NATO countries should be spending more on their militaries … and when I first heard this, I assumed it meant he wanted the US to reduce its military spending. Now that some details of his first proposed budget are floating around, it seems he wants to increase American military spending. INCREASE!?! So we’re lowering taxes, increasing military spending, and not touching entitlements (at least not for the elderly, maybe he’ll completely get rid of services for the poor to make up for spending increases and tax cuts?). Basic math fail. I get that Republicans have an odd belief that reducing taxes increases income so much that it offsets the tax reduction … but that’s a gamble (an odd governing methodology for a group claiming to be ‘conservative’). You might get lucky and hit the lottery if you sink next month’s mortgage/rent payment into lottery tickets too … but few will have any sympathy for you when the likely outcome occurs.