Wednesday, September 27, 2017

Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives

Heads up. GOP's dire plan to repeal/replace Obamacare is a cat with 9 lives. It just needs calling up for a vote by the Senate leaders  or being rolled into tax "reform" during  the next budget reconciliation opportunity..There is one coming up. Flipping Rand Paul's vote with special considerations is always possible. Sen. Lisa Murkowski of Alaska went from a leaning "no" vote to neutral after the GOP offered her special deals.  Likewise, those GOP Congresspeople who claimed they opposed Graham-Cassidy because it did not "do it by regular order", hearings, CBO scores, etc., would not  use that excuse to oppose it again.  Regular order in theory would free more GOP members to support whatever comes out of committee. 
The Congressional committees must demand CBO scores on any health care repeal/replace/fix bills they are considering at the bare minimum so that the number of those losing affordable insurance, including Medicaid, will be known to the public.  That is part of regular order. 

 The battle for 2018 Congressional makeup should be started now by Democrats. They have a rich opportunity to force their opponents to tell how they would vote on any repeal/replace/fix bill or to justify why they voted as they did. It will be a very hot issue whether it is  sneaked through sooner or closer to the 2018 midterms.  The only way consumers can be assured they will not lose their insurance will be to flip the House to a Democratic majority and to protect what Democratic Senate votes they have. The GOP plans so far have only garnered 17-24% approval by voters and voters see this as family pocket book issues presenting a direct threat and loss to them. It is even much easier to understand than tax reform which will only relieve them (or not) of a  marginal tax burden. Putting money in a pocket is always politically easier than taking money/benefits  away.

Pres. Trump just announced he will issue an executive order to allow consumers to buy insurance across state lines, Rand Paul's proposal. Watch what Rand Paul does. Will he switch from "no" to "yes"on a promise?   It is going to be after Friday or  January,  February, or March Trump  says, putting the question into "regular order".and/or requiring 60 votes and bringing along some Democrats.  He says is fine  to go through regular process and still have a vote on Graham/Cassidy or others like them.

 Buying insurance across state lines is a mirage. The CBO has already scored it as only helping 3 million people more to  afford insurance under Obamacare. . Furthermore, under Obamacare,  multi- state  group plans were permitted, and they never took off.  There are reasons. Consumers lose easy appeal if they have a complaint about of state insurers since they would have to register and fight for  appeal in  the insurer's  home state. . Furthermore, big insurers  with affiliates  in many other states like Blue Cross and United can collude to set prices  across state lines since insurance companies are exempted from  federal anti trust laws. They could hike prices in other states . Without essential benefits being required, there would be .a full out race to the price  bottom of useless,  deceptive insurance with few benefits.

Expect, too, that the political problem of doing end runs around each state insurance commissions may create another potential opposition group.  State Insurance Commissions are long, old political plums and state by state control would be lost.

Saturday, September 23, 2017

The GOP's problem with Obamacare replacement, failure to recognize: shifting sands of public opinion

A version of this was published in the Sky Hi News Sept. 27, 2017

Listening to GOP apologists on TV , their explanation for the unpopularity of their replacement plan for Obamacare is "people do not like change" or "they like the devil they know better than the devil they do not know". The latter is probably more true than the former except the public knows both devils and understands the difference. The GOP in Congress has underestimated the intelligence of the public in general and they failed to understand that there has been a dramatic shift in public opinion since the election. Promises made then have not taken that into account.The GOP's stubborn pursuit of keeping campaign promises as the singular motivation and strategy shaping their bills fails to realize that public opinion had shifted under their feet.
Polls have shown that voters' approval of the GOP replacement plans are approved by a measly 17 to 24% of voters.(May to November 2016, country was somewhat evenly split) The cost of health care is a fundamental pocket book , a quality of life , or even a life and death issue for those families who have low to average income. If their incomes were high enough to cover the costs of health care, there would be no issue. It does not; that is reality. Illness and disease hit families where it hurts or could hurt. They may gripe about Obamacare, but they know it would be worse if they did not have it .The opponents of the GOP plan, ranging from every stakeholder, from insurance companies to patient and disease related advocates to every facet of providers, have verified that their fears are justified, that the GOP plan would hurt them, their families, and their fundamental economic well-being.. .. The expression of their fears in marches, protests, sit ins and other contacts with their Senators and Congresspeople, may not have moved every GOP representative in Congress, but the message these actions convey has served to educate everyone else.
The public has also been educated to know that there are a variety of choices besides the take it or leave it GOP bills. The menu ranges from credible ways to fix and improve Obamacare to Medicare for All . They do not have to make the choice just between Obamacare and the bitter lemon of the GOP bills. There are other ways to save and improve their health care coverage.
Sarah Huckabee Sanders, the press spokesperson for Pres. Trump, made a broad statement recently that called Medicare for All, a single payer system being promoted by Bernie Sanders, a "terrible" idea. I distinctly remember early in the Tea Party movement angry older persons parading, protesting, and holding signs reading "Don't let government take my Medicare away from me". This big bit of ignorance that Medicare was a government program, was was put to rest as those Tea Party folks realized that. What most of the public has not yet realized is that both Medicaid and Medicare are single payer systems, but nonetheless support for those programs is driving the opposition to the GOP plan to cut Medicaid by large amounts. That Medicare will have financial difficulties in the future is true. Like Obamacare, there are fixes. Obamacare had cut the cost of health care enough so that costs did not increase as projected before Obamacare, so that twelve years were added to Medicare's solvency. . So popular is Medicare, Trump pledged not to touch that program during the campaign. However, he also pledged to replace Obamacare with something better , a promise he has not kept. He has supported the truly "horrible" GOP plans to leave 30 million without affordable insurance.
What is true is that there is no free lunch in health care, and if Medicare for All is too expensive to be self funding, tax payers will have to make up the difference. On the other hand, there is a tradeoff with lower out of family and individual out of pocket costs. There is a realization that the US is needlessly paying two and a half times more than other countries in the world who have embraced single payer programs. That is a debate worth having. It should be held in public and in Congress. That process is called "regular order". It should not be rammed down throats without knowing the impact as the GOP just tried to do with their Graham/Cassidy bill..
Medicare for All may not win out in that debate. Switzerland has a system similar to Obamacare , subsidizing private insurance to make it affordable. It differs from the US in big ways, though, since it takes the place of Medicare retiree and employer plans and it mandates all to have insurance through their system. They have strict price controls, too. Recently, when the Swiss had a chance to adopt a single payer system. they voted to keep the private insurance based status quo, even though their costs are the highest in Europe.

Wednesday, September 20, 2017

Graham/Cassidy health care: block grants for blockheads

Their bill does everything that the worst ones defeated earlier did, except puts funding into "block grants" to states, which is more like grants for "blockheads" who believe this will lower premiums or provide any meaningful or affordable  coverage for those who had insurance under Obamacare. .It removes subsidies of premiums in the exchanges killing the exchanges which was the mechanism form lowering the costs of premiums to middle America. It reduces both expansion and traditional Medicaid funding  and those premium support funds by a third before it goes away entirely in 2026., It removes any standards or even requirements for employers to provide insurance. It removes requirements that anyone have insurance,   and  permits irresponsible and freeloaders to count  on charity care  should any unforeseen illness or accident occur.  This leaves the responsible and  the sick  in the pool to pay super high premiums .   It allows   states to charge more to seniors and for everyone who has a  pre-existing condition.  It removes any requirements  to offer any essential benefits, including annual physicals and cancer screenings.
. If consumers swallow their soothing reassurances, they are in for a shock as 30 million lose their insurance, not because they were forced to buy it, but because they cannot afford the premiums without the subsidies or were covered by Medicaid. To say otherwise is sheer BS and those who swallow the GOP line will be much wiser in a year or two...and angry as well that they were bamboozled.   

Colorado Gov. John Hickenlooper and Ohio Gov. John Kasich asked the Senate to not consider an amendment put forward by Sens. Lindsey Graham of South…

Tuesday, September 19, 2017

Why Islamphobia again in 2017?

This is an update of at least two prior postings.  However, the subject has arisen again in my own county. An organization in Grand County sponsors a week to celebrate the Constitution and to understand it, a noble undertaking usually, but often they have a speaker that is quite controversial, usually not a mainstream Constitutional scholar and often from the fringes of political positions and they did it again this year.  I have updated this posting to reflect this.

Every once in a while there is a flurry of Islamphobia coming into my Facebook pages.  Islamphobia cropped up again in Grand County with a controversial speaker recently at Constitution Week in Grand Lake.  I did not attend nor did I hear the speaker, but I am relying on the report in the Sky Hi News.

 I first noticed anti-Muslim shout-outs  in 2011 and blogged about it then and several times since .  The viewpoint  mostly promotes fear that Sharia law will become the law of the US, or it is asked in terms, "do you want your neighbor to practice Sharia law and be able to beat their wives ".  The newest wave seems to have started with Donald Trump's proposal for a Muslim ban.  However, it has risen to a new pitch since the November elections.  Why?  I have, I think, found the key: It had to do with Donald Trump's appointment of General Michael Flynn to one of his close advisers in the White House. (Flynn  since resigned in the midst of controversy and is a major figure in the Russian connection investigations). He had made statements that condemn all Islam as a cancer that needs to be excised and ginned up fear of Sharia law. Fact checkers of similar statements and postings in the past by others rated this "pants on fire".  Ironically, General Flynn did  not let his anti-Muslim  sentiments stand in way of his being an agent of the Turkish government and is under fire for not having registered as a foreign agent.

First, my answer to such postings and sentiments.  Yes, of course Sharia law is not compatible with our Constitution.  But also thanks to our Constitution, we cannot establish any state religion. Religious practices which contradict US criminal law are also considered criminal and subject to prosecution, including domestic violence and assault. Our own US criminal laws punish assault, domestic violence regardless of religious motivation, including those who assault anyone claiming "my religion made me do it", Christian or Muslim. Sharia law is interpreted many ways in many different countries and this type of abuse is not condoned by all Muslims and clerics, and Islamic scholars, either.

Practically speaking Sharia law will not be imposed on Americans. Not only is it alien to our culture and not a part of our traditions, American Muslims have no political clout since they number 2% of our adult population and have a long way to go to reach significant numbers to have any real impact. Many are here because they fled such religious extreme practices The only purpose I can see to these kinds of postings and featuring these kinds of speakers is to promote hatred of all Muslims and somehow to excuse bigotry and bigots and to legitimize and justify anti- Muslim policies.

What was interesting as reported by the Sky Hi News, is that the speaker felt confident she could be as safely outspoken against Islam as she could because there were no Muslims in Grand County. I wonder how many in Grand County have ever met a Muslim. That may explain why such one sided,
extreme  opinions have such fertile ground to grow here.

 I have not learned about Muslims just  from books.  I have spent a good part of my lifetime interfacing with Bosnian Muslims, since my encounter with them in the late 1950's. Bosnian Muslims   are closer to the Turkish more moderate practice since they were a province of Turkey for five hundred years.
I translated that personal experience into independent study of Islam's interface with the West  in my senior year in Northwestern and I have followed the subject closely, writing about it frequently in my blog.  Those who practice Islam are  more diverse in their application of their scriptures  and theology than even Christianity.

The practice of Islam varies from country to country and cultural and customs are as much an influence as the interpretation of theology.  Sometimes oppressive invaders take over a country and bring with them different interpretations of Islam, such as happened to Afghanistan. In Bosnia support for Sharia law as the official law  among Muslims is among the lowest in the world, at 15%, similar to Turkish attitudes (12%). For a detailed poll country by country of Muslim attitudes toward Sharia law, visit

 Even within those predominately Muslim countries, there are debates and sects about the role of government in enforcing and applying Sharia law. There are extremists and moderates and secularists  (separating religion from government)  throughout the Islamic world. The largest numbers of Muslims are in India and Indonesia, not those encountered by the Constitution Day speaker.  Extreme applications of Sharia law are concentrated in a minority of countries, such as Saudi Arabia and Afghanistan and Pakistan.. In the Middle East, the lowest support for Sharia law among Muslims is in Lebanon at 29% per PEW.

Nonetheless, there is a  recent move toward  establishment of more Islamist practices and adaptation of Sharia law to  the law of the land in some countries, but the movement  has not been evenly successful.  The Muslim Brotherhood was thrown out by the military when they tried to impose Sharia law in Egypt.  Turkey, a secular state since Kemal Ataturk ruled  in the early 1900's has had its share of political turmoil as a dictator with Islamist designs is seizing control. Donald Trump gave Erdogan, the Turkish dictator, "high marks" in the midst of Erdogan's crackdown on dissidents.  Indonesia's application of Sharia law has been watered down and moderated, though it does have strong support in that form.  PEW also found most people in several countries with significant Muslim populations have an unfavorable view of ISIS, including virtually all respondents in Lebanon and 94% in Jordan..

Blanket indictments of all Muslims and their practitioners are part of  the current wave of Islamphobiacs  who  want you to believe the exceptions are the rule. Their viewpoints  are often  based upon ignorance, political bias,  and/or  limited personal experience, or, evangelical  Christian zeal (the perspective of the Constitution Day speaker). The danger is that divisive hate and bigotry are increased by them and then get translated into domestic and foreign policy that harms our ability to get along with a major part of the rest of the world. The Muslim ban is the most obvious outgrowth of  such sentiments.

Also, not to repeat other of my  blog postings on the subject, and additional links to the subject  visit:

During the presidential campaign, much of hot headed statements about Islam came from the mouth of Michael Flynn connection. He hae made statements that condemn all Islam as a cancer that needs to be excised and ginned up fear of Sharia law. Fact checkers of similar statements and postings in the past by others rated this "pants on fire". Instead of just repeating his hate speech and his bigotry myself, visit

Thursday, September 14, 2017

Graham-Cassidy health care bill: Beware a wolf in states rights clothing:

A version of this was published  in the Sky Hi News, 9/20/17

 Senators Lindsey  Graham and Bill Cassidy, are jamming through a bill that  is a wolf in states rights clothing.  It will eat alive your ability to buy affordable health insurance and eventually cripple  Medicaid.To beat the  September 30  deadline to pass bills through the budget reconciliation process, the two Senators are making a last ditch efforts to kill/replace Obamacare.  Budget reconciliation permits the Senate  to pass repeal-replace Obamacare legislation  with 51 instead of 60 Senate votes that would need some Democrats to join in.

 Graham/Cassidy  would give states block grants to administer Obamacare. These block grants are designed to take federal money from blue states who have expanded Medicaid and directs the funds to red states.  It is a strategy to overcome red states opposition that sank  the prior bill. It a) does not repeal or replace Obamacare:  it reduces funding by a third and changes the way money is distributed; b) would leave millions without health insurance . It has not yet been "scored" by the Congressional Budget Office that  to estimates costs and impact,. c)It  would lead to the collapse and affordability of whatever insurance is left since it removes mandates of healthy individuals and   businesses to participate and provide   health insurance, leaving mostly  the expensive to treat  sick in the pool. d) It would hasten the single payer system due to its failure and and causing suffering and harm, making even Medicare for All look even better; e) destroys federal  Medicaid and federal block grants by 2026, leaving states to shoulder the costs.f) It removes essential benefit requirements including coverage of preexisting conditions. 

Graham/Cassidy  has never gained much traction until now. It has been on the Senate table during the summer so that it has had  some scrutiny.    While its impact has never been scrutinized by the Congressional Budget Office, other green eye shade authoritative non-profit  groups did in July. Digging into it  the Center on Budget and Policy  Priorities found that the Graham-Cassidy plan would 
  • "Eliminate premium tax credits and cost-sharing reductions that help moderate-income marketplace consumers afford coverage and care, and eliminate the ACA’s enhanced match for Medicaid expansion starting in 2020.
  • Replace the marketplace subsidies (premium tax credits and cost-sharing reductions) and Medicaid expansion funding with a block grant set at levels well below what would be provided under current law.  States apparently could use these funds for a broad range of health care purposes, not just coverage, with essentially no guardrails or standards to ensure affordable, meaningful coverage.  After 2026 block grant funding would end altogether.
  • Maintain the Senate bill’s provision to convert virtually the entire Medicaid program to a per capita cap, with large and growing cuts to federal funding for seniors, people with disabilities, and families with children.  "  
 There are some temporary  fixes to Obamacare  being examined by Congressional committees now. The Kasich/Hickenlooper repair bill now in a Senate committee would retain mandates for Americans to buy health insurance but would give tax exemptions for insurers that offer plans in underserved counties  and give them access to existing federal plans and create a reinsurance program, propping up and stabilizing the insurance market to keep premiums from soaring..  

That Bernie Sanders and large number of Democratic Senators have signed on to his Medicare for All is significant.  While it has no chance of gaining 60 votes to pass, it is now a serious alternative  that is on the table and close  to becoming a Democratic party platform plank in the  near future.  The more GOP legislation takes insurance away from those who need it, the more likely the public will turn to single payer. However, in the process many people will be harmed and will suffer.  Democrats should beware that the GOP is trolling, hoping to split the party over the issue by putting Sander's plan as a bogey man, a "horrible" plan (per Pres. Trump's press person).  In the short term, Democrats will only feed success of  the truly  horrible  Graham-Cassidy bill  if they tie themselves in knots over the issue.

Monday, September 11, 2017

Be careful what you wish: Trump hurricane budget; impeachment downsides

A version of this was published in the Sky Hi News, September 13, 2017; additional footnotes were added during week

The political world is not a Disney movie. Not all stories end with  a handsome prince or finding true love.  Sometimes politics  gives you the wicked witch instead.  Hurricane relief  and the specter of impeachment are two cases risking the witch effect.

The role of government suddenly had a new meaning to those who believed no good comes from Washington, DC.  Those who once shouted states rights and were  and deficit hawks,  suddenly found themselves demanding federal money no matter what the impact was to federal finances. Harvey  and Irma gave them  a dose of reality.  Sometimes only the federal government has resources to deal with the magnitude of a disaster.

Ideologically driven  dreams  pre Harvey and Irma proved foolish when the Administration advocated  reducing the ability to respond to natural disasters as part of budget  and regulation reductions. President Trump presented his budget wish list to begin October 1 in the form of a “blueprint”. In it, he asked for. $667 million to be cut from  from the  FEMA pre-disaster mitigation grant program and require all grants to be matched by non-federal funds.. Even before Harvey, there was evidence that $1 in mitigation saves  $4 in later damages. The budget proposed by the Trump administration  for forecasting hurricanes  has a 17% cut.

More foolishness: Trump’s proposed budget called for the elimination of the federal flood insurance program which made flood insurance affordable. I recall  a good  friend who survived Katrina and  who had that flood insurance and was able to rebuild even though his home was severely damaged.. While only 20% of Harvey’s victims have flood insurance, it will be their welcomed salvation. It is not only coastal areas that benefit , but  in Denver parts of the neighborhood in which I once lived were on floodplains that qualified for the subsidized, underwritten insurance. Floods are not unknown in Colorado like  Boulder and northern Colorado experienced in 2013.  

The left’s dream is  that Donald Trump will be impeached.   Reasons I suspect are mostly politically stop  Trump’ agenda of dismantling the Obama legacy,  his racism,  or a contempt for his persona. Alone these are not  the “high crimes and misdemeanors” standard for impeachment in the Constitution. Whether he is fit to serve refers to the 25th Amendment and the process to determine fitness..  Former  Director of National Intelligence  James Clapper added gravitas to the  impeachment movement when he questioned Trump’s fitness, calling Trump’s Phoenix  post Charlottesville divisive   speech “downright scary and disturbing”. . Heavyweight Democratic leaders have differed from impeachment advocates.  In August  Sen. Dianne Feinstein (D) California   proposed “ patience” for Donald Trump to learn  and  said  he could  become a “good “ president..  David Axelrod,  former Obama adviser, opined  that with  30% plus  of voters still supporting Trump, an attempt to impeach him could be viewed as a  bloodless  coup  and a danger to the constitutional process. In June, House Minority Leader Nancy Pelosi told impeachment talkers to “calm down” and wait for “solid proof”.  That makes sense. . The   most credible proof of misdeeds  or exoneration is Special Counsel Robert Mueller’s  investigation of the Russian connection. Any sabotaging of  the investigation by Trump or the GOP should be fought tooth and nail.