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 in 2016- 2018

Updated: 7/18/19
2018 update: John Bolton, Pres. Trump's new national security adviser, chaired an anti Muslim thinktank that spewed propaganda in 2016 that was amplified by the Russians interfering in the 2016 election.
The Muslim travel ban attempted by Donald Trump in the 2016 election and then via executive orders will be argued in the US Supreme Court:

Some new information re the Sharia law scare:

The third version of Donald Trump's Muslim ban has been ruled unconstitutional by two lower court federal judges(Hawaii and Maryland). The judges ruled it was too similar to the ones before.Judges are ruling the orders run afoul of the US Constitution because it was caused by animus against one religion, Islam. The Supreme Court considering the first two ban versions delayed oral arguments pending lower court rulings on the new version that added a few non Muslim countries to the ban list of countries. The third version ban was in effect allowed to go into effect, but the lower courts' ruling on the third put that one on hold, as well.

The root of the Muslim ban goes back to the 2016 campaign and it reflected fear of anything Muslim and Islam that has been brewing among a segment of our population . Fear of terrorism is one factor. But since at least 2004 a wave of fear spread across the South that Islam's religious Sharia law would soon be coming to their state.. That has been one element feeding that blanket hatred of anything Muslim and a desire to keep their followers out of the US. Fear of Sharia is a form of  Islamphobia that cropped up again in Grand County with a controversial speaker recently at Constitution Week in Grand Lake. as reported in the Sky Hi News ( The story resulted in a heated exchange of letters to the editor, attacking and defending the point of view expressed at the event.

Those raging against Islam and Muslims often  promote  fear that Sharia law will become the law of the US, or they ask it  in terms, "do you want your neighbor to practice Sharia law and be able to beat their wives ".
Practically speaking  we are in no danger of having Sharia law  imposed on Americans.  American  Muslims have little  political clout since adult Muslims comprise  2% of our population. 58% of those are immigrants. 42% are US born.

There is also a constitutional angle to the Sharia law issue  Thanks to our Constitution, we cannot establish any state religion."  In 1791, the First Amendment was adopted. The "Establishment Clause" forbade Congress (and later, the states) from passing laws which adopt a state religion or to favor one religion over others. In Everson v. Board of Education (1947), the U.S. Supreme Court explained:
The "establishment of religion" clause of the First Amendment means at least this: Neither a state nor the Federal Government can set up a church. Neither can pass laws which aid one religion, aid all religions, or prefer one religion to another "... That decision works two ways: Sharia laws clearly cannot be established as the law of our land and  state laws attempting to ban Sharia law have been ruled by courts as  unconstitutional because they harm Muslims or are redundant.

 Banning Sharia law has been a hot topic in legal and political circles, and often fueled by fear of Muslims. Anti Muslim sentiment erupted in the 2016 election in the form of Trump's Muslim ban. Its chief anti-Muslim fear and cheer leader was Mike Flynn, the general who briefly served as Pres. Trump;s national security advisor, but was fired for not being truthful about conversations with Russians. It later was learned that he was working for the Turkish government, ironically a Muslim country.

Ignorance of the practice of Islam fuels much of the anti Muslim hysteria.. Sharia law is interpreted and applied  many different  ways in many different countries. Physical   spousal abuse  is not condoned by all Muslims and clerics, and Islamic scholars, either.  The practice of Islam varies from country to country and cultural and customs are as much an influence as the interpretation of their  theology.  Attitudes toward Sharia law as official law  also vary widely per a PEW research poll. Even in the Middle East, less than 30% of Muslims in Lebanon support Sharia law. In Bosnia, 15% support Sharia law; Turkey 12%. Highest support of Sharia law outside the Arabian peninsula   is in Iraq, Afghanistan, and Pakistan and to lesser extent in some Southeast Asian and  African countries..

The Sky Hi News reported  that the speaker felt confident she could be  safely outspoken against Islam  because there were no Muslims in Grand County. She feared for her life because she  was  working  undercover  for a Christian ministry. I wonder how many in Grand County have ever met a Muslim. Such one sided, extreme  opinions can easily  find  fertile ground to grow here.

I have spent a good part of my life interfacing with Bosnian Muslims beginning with  my travels in their region with them in the late 1950's, influencing  my academic studies and a lifetime fascination with the history and impact of Christian/Muslim interface. What I have learned over the years  is that those who practice Islam are  diverse in their application of their theology. 

The danger of a blanket indictments of all Muslims based on  experience with immigrants limited to those from more extreme traditions  is that it feeds divisive  bigotry . It makes us look like hypocrites who do not practice what we preach  about democracy nor do we understand the concepts  of freedom of religion and anti discrimination  protected by our Constitution. It weakens our ability to get along with a major part of the rest of the world and our own Muslim neighbors.  

Our Islamphobia makes us vulnerable to being duped by adversaries such as Russia. .As we have learned through news reports and Congressional hearing testimony ,  Russians saw  an opportunity to weaken  US world influence, sow internal dissent and hatred, and interfere in our elections by  hyping  anti- Muslim hysteria that supported Donald Trump's anti Muslim oratory. One tool the Russians used was social media to organize a Muslim hate rally in Twin Falls, Idaho in 2016. A Russian originated Facebook site promoted an anti Muslim rally in Houston, last year, as well, posing as a Texas organization.

For more on the subject, visit and search Sharia law.

The PEW poll can be found at


Everson v Board of Education explanation source: Wikipedia Search Sharia Law in America for more details about States' attempt to ban Sharia law.

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.