AHCA DOA

As of March 24, the Republicans cancelled their vote on the repeal of Obamacare, after almost cancelling the vote on the 23rd, in a candy-assed attempt to avoid admitting defeat by having the bill fail passage on the floor. Allegedly the main reason the drama got prolonged another day was because Donald Trump insisted that a vote be held, because that was going to be the last time he would push for a healthcare bill. His idea of pushing apparently included reminding them that leaving Obamacare as-is would mean that Planned Parenthood would still be funded, and threatening Republican congressmen that he would campaign for their primary defeats if they voted against the bill. The fact that his bluff was called indicates he’s not so great at the Art of the Deal. It also indicates that Republican congressmen had more reason to worry about their seats if they DID vote for the bill.

The official name of the Obama Administration plan was the Affordable Care Act, or ACA. The new proposal was officially the American Healthcare Act. As in, “you thought you still had coverage? AHA!” Some wags have also referred to this as Trumpcare, deliberately reminding Republicans how they loved to brand the ACA as Obamacare. The difference being that Obama in the wisdom of time came to accept that label, whereas, Trump, who would put his name on 99-cent condoms if somebody paid him a lot of money for the privilege, refuses to have his name associated with the Republican plan. So in honor of House Speaker Paul Ryan, some critics were calling AHA “Ryan Care.” Or even blending Trump and Ryan to create “Tryan Care.” Pronounced, “try and care.”

There were many issues with the new plan, to the extent that it actually existed.  Not only did hardcore conservatives wish to destroy requirements for “essential” coverage for women’s healthcare (not just abortion), but the plan was touted as saving money by making subsidies dependent on age rather than income such that it would create an “age tax” on older working adults while younger taxpayers would be incentivized to get health insurance by greater subsidies.  This naturally caused a lot of liberal objections. But then it’s not like they weren’t going to object anyway. Complaining that the new bill shifted the benefits from older and poorer Americans (who create a loss to the system) to younger, well-off Americans (who are better able to pay for the insurance market) sort of assumes that that isn’t the point, or indeed that there isn’t a virtue to having a system that pays for itself better than the ACA does. The problem is that not covering those who can’t afford care defeats the purpose of “the Affordable Care Act.”

This ultimately reveals the whole problem with the use of the insurance industry as the paradigm for coverage. For one, there’s a difference between health insurance and insurance for other services. When you get an auto insurance policy, for instance, you aren’t expecting to get into a car accident that week. When you get a life insurance policy, you aren’t expecting to die next week. (And if you are, the company may be investigating your insurance risk.) Insurance is exactly that: coverage in a matter of last resort, not a basic support where you are expecting to collect on the policy immediately. Whereas for people with chronic conditions (like type II diabetes, for example), you get an insurance policy on the expectation of “collecting” on it immediately. And that’s because in this country, costs of medical care are such that for all practical purposes, health insurance is how you GET medical coverage.

But this still means that medical care is covered through the private insurance market. And insurance companies survive and profit through what’s called a “risk pool.” Basically a company selling life insurance, for instance, has a majority of its policyholders continuing to make payments for the duration of the time that they do not need to collect on their policies (in this case, until death). This works because the majority of people paying into the system do not die shortly after taking out the policy. The risk pool is big enough to cover the risks of collection. But if a majority of people with health insurance plans had to collect because of expensive and chronic conditions, the companies could not continue to profit and survive. So of course they were going to decide that “pre-existing conditions” were a barrier to getting coverage, and of course they were going to conjure rationales against anybody collecting on a policy once one actually needed to do so. So you had Obamacare. But in order for Obamacare/the ACA to cover everybody without the “pre-existing condition” barrier, you had to make the risk pool nationwide, which is why the hated individual mandate (forcing you to get coverage or face a tax penalty) is baked in. If the government forces insurance companies to take all patients and does not force those who do not currently need coverage to get it, no one would be covering the expenses of those at-risk people.

But all that just reveals the ultimate problems with the ACA. It does do one of the two things we needed a healthcare reform to do: It eliminated “pre-existing conditions.” But to do so it mandated coverage without sufficiently subsidizing the costs to the consumer, who was forced to take out a service with no regard for economic conditions, which defeated the other purpose of the Affordable Care Act- making healthcare affordable. But that was because the system is built around the private insurance industry, whose economic model is based on NOT providing a necessary service in order to profit.

The difference is that the ACA doesn’t cover people because it doesn’t render healthcare affordable, while AHA doesn’t cover people because it elides the difference between theoretical “access” to care and practical availability of care to the average income level. As one pundit put it, we all have access to Ferraris, but how many of us own them?

Even beyond that, if we had the dream of many liberals – single-payer, or Medicare for all- we would run into the limitations of the current system. The real reason healthcare is unaffordable, even with (or arguably because of) insurance, is because costs are out of control. Having government cover those costs would simply mean that they get transferred from the private sector to the government, and when government runs a deficit, that has effects on the private sector.

You have that situation because unlike most countries that have single-payer (the rest of the First World, really) we don’t put cost limits on what medical providers and drug companies can charge for covered services.

For instance, when Medicare was given a prescription drug benefit (Part D) via the Medicare Modernization Act in 2004, the Act specifically forbade Medicare from negotiating bulk prescription prices, as opposed to the Veterans’ Administration, which is able to do so, and whose patients pay far less for drugs. The MMA was largely written by Rep. Billy Tauzin (R.- Louisiana), who resigned from Congress on February 2004, the same month the legislation was passed. The year afterward, once he was legally able to do so, Tauzin became head of the Pharmaceutical Research and Manufacturers of America.

So if you’re a senior citizen and you want to know why your drug coverage has a “donut hole”… that’s why.

In my Internet discussions, I eventually got converted into advocating for single-payer, and I did so on fiscal conservative grounds: It is illogical that the US, of all the developed nations, pays more for healthcare and gets worse results. But again, simply changing the system to a public one will not necessarily work if we do not correct the real problem with the system, which is that American medicine is predicated around a bureaucracy in which the government caters to industry interests more than the consumer.

It’s for these reasons that a lot of providers not only rejected Obamacare but the insurance system altogether. This is referred to as cash-only or direct primary care.  Another reason that some doctors took this path is that costs actually decrease due to the reduced overhead for not having to do billing and coding through insurance companies. This also means there is more price transparency, which makes it easier for consumers (patients) to determine costs. There is of course still going to be an out-of-pocket issue, which is part of why insurance companies cover health care in the first place. But as we have seen, the current system is often counterproductive for the purpose of getting medical care at affordable cost, and without transparency, there is not even as much concern for the Law of Supply and Demand as there would be normally in the medical system. Reform should thus focus on the “demand” (consumer) end instead of the provider, otherwise a public system would suffer the same long-term problem as the current public-private hodgepodge we have, where the costs are so high that neither government nor employers can sustain them without increasing liability.

If conservatives and libertarians had been bitching about Obamacare for more than six years, you would think that they would mull all this over and come up with some concrete proposals to transition away from Obamacare, as opposed to what we got, which was the Republican Party acting like the kid who partied until 3 am the night before a test and suddenly realized he had to do homework.

But that just leads to the political issue. For all the public attention paid to the dysfunction of Donald Trump, he is a reflection of the Republican Party that nominated and elected him. Their relationship is a quid pro quo: They let him get away with what he wants so that he could give them what they want- a signature on items like an Obamacare repeal that they say they’ve wanted since 2010, and had always been shot down before now by Obama’s veto. The problem was that Republicans were free to “repeal” Obamacare all they wanted with no consequences because they knew there would be that veto. But now that they allegedly have everything they want, the problem is that any bill they agree to would be passed by this president – and they would have to deal with the consequences of that.

It’s almost as if the Republican Party was simply a grievance industry that survives on stoking public hatred and resentment, and cannot even try to formulate constructive policy, let alone attempt to implement it, because if they did, they would lose their reason for existence.

And if Republican congressmen were willing to call Trump’s bluff on policy, is it possible that their voter base may call their bluff in turn?

 

 

REVIEW: Logan

The previews for Logan made it look like a road trip/buddy movie starring Hugh Jackman and Patrick Stewart, which would have been worth the price of admission with no superpowers involved whatsoever.

In promotions, Hugh Jackman (now along with Stewart) has said this will be his last movie playing his “X-Men” character. In a way, the X-Men movies are victims of their own success. See, years ago when Marvel Comics was in financial straits (and producing truly sucktastic movies), they sold Sony Pictures the movie rights to their most prominent superhero characters – X-Men/Wolverine, Spider-Man and the Fantastic Four. But shortly after the first X-Men movie, Marvel created its own movie studio and made a very successful run of films using Iron Man and other titles. And for every very good Sony superhero movie (like X2) there was at least one “whatever” movie like X-Men: Apocalypse that didn’t improve the reputation of the brand. This is important because of intellectual property rights; not only are the X-Men movies in a different setting than the Marvel Cinematic Universe, legally, any new characters Marvel creates for its X-Men comic books will be owned by Sony Pictures for movie purposes, meaning that Marvel has no reason to create new characters and storylines for what is now a rival studio. So even though X-Men comics have made a TON of money for Marvel Comics, in recent years they eliminated most of their X-Men titles and killed much of their mutant lineup, including Wolverine himself, who has since been succeeded by his female clone. This roughly parallels the situation in this movie.

Logan is set several years in the future, after an unexplained event has killed off most of the mutants on Earth. The X-Men are a distant memory (ironically, now used to sell comic books). Logan, no longer calling himself Wolverine, has started to lose his healing factor, which means he is finally starting to age and feel the effects of injury. He supports himself as a limo driver in Texas, but is basically killing time. However, his old mentor Charles Xavier (Stewart) has learned of the existence of the first mutant child to be seen in years, who must be rescued from those who would exploit her. However, Xavier’s own advancing age is causing his psychic powers to malfunction, with tragic results.

Logan was directed by James Mangold, who also directed the other stand-alone Logan movie, The Wolverine, which actually had a similar premise where Logan loses his regeneration power and has to face the idea of being vulnerable. However in that movie, Wolverine’s power loss was temporary and a plot device driving the story. Here it is part of the overall theme. The movie’s depiction of old age and decline is that much more heart-wrenching when Logan is compared to Xavier, given that Professor X was always the father figure and conscience of the X-Men.

But if you see this movie, you won’t have time to be depressed by the tragedy, because it is violent and foul-mouthed AS FUCK. That’s right, you will get to hear Captain Picard say the word “fuck.” In various conjugations. And there was one chase scene where I could have been watching the next Mad Max movie.

Now, again, it isn’t explained whether this is the true future of the movie X-Men universe, and given that that future has been retconned at least once, it doesn’t particularly matter. Superheroes are corporate property: If the studio wanted, they could just recast these characters and start the story over, as Sony has done with Spider-Man no less than three times by now. But it’s clear that Hugh Jackman, as a real person living in the temporal universe, realized he couldn’t play an immortal warrior forever. So if you’re going to go out, go big. And fortunately Mangold has given us both a very exciting and very affecting movie as a literal burial of the X-Men movie series.

And the moral? Sometimes guns DO solve all your problems.

REVIEW: The Lego Batman Movie

My friends were still not ready to see Logan this weekend, so we went to the other movie we were interested in: The Lego Batman Movie.

This is of course, a spinoff of 2014’s mind-altering The Lego Movie, where for some reason Batman was made into the romantic rival of the lead character.  And this was one of the better parts of the movie.  Because Batman, as voiced by Will Arnett, is not much like the character as presented in recent movies or comic books.  The joke is that rather than ask the question, “What would Batman do?” this version presents the question, “What would YOU do if you were Batman?”  Because as it turns out, being trained to physical and mental perfection AND having practically unlimited wealth can make life a lot of fun.

The thing is, however much fun it may be to be Batman, this character doesn’t want to be Bruce Wayne,  to the extent that he avoids removing his mask except when absolutely necessary.  Because when he isn’t being Batman, Bruce Wayne doesn’t have much of a life, is mostly alone except for his butler Alfred, and is so invested in being uber-competent that he has to do everything by himself, because at core he is still an abandoned orphan.  So even in this weird interpretation of the character, the producers “get” Batman at least as well as more recent DC Comics movies.

And of course, Batman’s isolation eventually becomes something he has to grow out of with the help of the supporting cast, ironically including The Joker (Zach Galifinakis).  This is also a kids’ movie in other respects: not only are the guns non-lethal energy weapons, but gunfire is actually replaced by the actors making “pew-pew” noises.  And the final crisis ends up being resolved by what can only be called “Lego physics.”

The Lego Batman Movie is a good choice for a family movie that was also clearly made for adults, in that it includes a LOT of fan service and in-jokes that would require an in-depth knowledge of comics in general and Batman in particular, making reference to all the phases of Batman’s history, including “that very strange period in 1966.”  But like The Lego Movie, it’s something that might actually be better in a DVD release, since the special effects and sight gags come so fast and furious you would probably need to freeze the screen to catch them all.

What I Learned From Watching Buffy the Vampire Slayer

  1. You can never be too thin, too pretty or have too many weapons.
  2. Having a teenage sister can be a real drag, especially when she didn’t exist three years ago.
  3. There is no such thing as a happy ending.  If you have a boyfriend, chances are he is a monster who can’t control his evil side (Angel, Oz, Spike) and he will have to leave.  If you get a stable partner (Riley), chances are you will get bored and push him away, and he will get pissed off and join a black-ops unit in Central America.  If you have a girlfriend, chances are she will get killed (Jenny, Tara).  If you get a stable partner (Anya), chances are you will chicken out of marriage at the last minute, and she will get pissed off and (re)join the Vengeance Demons.
  4. Coming back from the dead is EXTREMELY overrated.

Here’s An Idea

I was thinking of doing a review of the Logan movie, but my friends didn’t want to see it on a crowded opening weekend, so for this week I’ll go back to political observations.

Of course if you have a full-time job and only so much free time for an unofficial blog, you can’t really keep up with the news when King Donnie, the First of His Name is steadily leaping to greater heights of fuckuppery every single day. Apparently on Saturday March 3, he had a panic attack after realizing that he wasn’t in the news for a few hours and excreted an epic Twitstorm  starting with the statement that he “just found out” that Obama was wiretapping Trump Tower just before the election. The problem was that people who actually know, like, government stuff started responding on social media, including Trump’s own feed.  And they pointed out, first and foremost, that the president can’t order a wiretap. In an official Twitter response, Senator Ben Sasse (R- Nebraska), a conservative AND Trump critic, said that “(wiretapping) was either with FISA Court authorization or without such authorization. If without, the President should explain what sort of wiretap it was and how he (Trump) knows this. It is possible he was illegally tapped. On the other hand, if it was with a legal FISA court order, then an application exists for surveillance that the court found credible. The President should ask that this full application regarding surveillance of foreign operatives or operations be made available, ideally to the full public, and at a bare minimum to the US Senate.” (i.e. Sasse)

In other words, if Trump deserved the benefit of the doubt (which he has completely pissed away by now) then an accusation that Obama was acting against him for partisan reasons is deeply serious and needs to be investigated. It’s also true that if there was cause to investigate, the government agents would not have been able to get to this point unless existing evidence had caused a judge to agree that a warrant should be issued. This is not the sort of thing you want to bring up if you’ve got something to hide. And it would have been hidden, except that it was also pointed out on Saturday that only the president would have the authority to reveal such an investigation, which, unofficially, he just did.

So Saturday March 4th was officially Trump’s STUPIDEST DAY EVER. And as you know, stupid by Trump standards is like “Communist by Stalin standards.”

This all gets to a point I made after the election. There is a second worst case scenario besides the one happening now, where Trump is re-enacting tragedy as farce. The other worst case scenario is that the Republicans really are going to turn America into a one-party state. That one party being the Democrats.

Because either Trump is going to succeed in his goal of turning America into his personal banana republic, or he will fail and fail spectacularly. Even if he succeeds, his regime will last only until he gets a piece of well-done steak lodged in his throat and he ends up choking to death because no one at the table will give him the Heimlich Maneuver. Either way, the Republicans’ experiment in getting everything they want is doomed to end, and depending on how badly it all blows up, being Republican will be associated in the public mind with treason and/or subnormal intelligence.

Or maybe not. Despite their increasing unpopularity, Republicans controlled the vast majority of state governments and used that position to reinforce their advantage by gerrymandering districts to increase the number of “safe” seats. Of course liberals who point this out to me are blanking out the point that Democrats needed to lose the seats they had for this to happen in the first place. If all the voters (many of them conservative) who came to yell at Republican congressmen at their recent townhall meetings actually went to vote against them in 2018, the Party of Trump would be in deep, deep shit. That is, IF Democrats present challengers who are not so boring or repellent that they make even the incumbents look good. Aye, there’s the rub…

But given that each party wants to cement its position as soon as it gains a majority, I would have to suspect that when, not if, Democrats regain control, they’re going to try to switch off the edge Republicans currently have. Franklin Roosevelt broke the previous unwritten tradition of only running for two terms as president, and when he died, Republicans in Congress passed the 22nd Amendment forcing term limits on the office. And FDR was MUCH more competent, much more humane, and much better loved than Trump is. Once Trump/Pence is no longer in the picture, Democrats are going to going to look at some of the other unwritten traditions whose violation by Trump led us to this point, with an aim of banning them on the grounds that we can no longer give politicians benefit of the doubt.

For one thing, Trump’s expenses. During the campaign, it was pointed out in news articles that Trump used accounting maneuvers to make a profit for his businesses by having them cover things like campaign events and rent, using Trump campaign funds. It was pointed out at the time that if a campaign uses the services of a corporation, federal law requires that they be paid. “Federal election law, however, does not contemplate a mega-wealthy candidate like Trump.”

Since the election, Trump has gone on weekend getaway at least four times (January 20 was only five weekends ago). First Lady Melania Trump has decided, for some reason, not to live with Donald at the White House, so she and her son Barron are still at Trump Tower, requiring extra security from New York police (apparently $500,000 a DAY). Trump himself used private security in addition to Secret Service on the campaign trail. The Washington Post has assessed that Trump’s first three trips to Mar-a-Lago have cost the treasury about $10 million. If you take $500K for the New York expenses per day and multiply it by 365, it equals $182.5 million a year. If you take $10 million and multiply it by 12 months, you get 120 million dollars a year. Thus, over 300 million dollars to cover the Trump family over one year.  Whereas that liberal rag Breitbart says that the conservative group Judicial Watch estimated Barack Obama’s personal travel expenses at 96 million dollars. Over eight years.

If you are a Trump, you are at core a grifter. Your goal is to pass off all your liabilities onto someone else so you can do as you please. It is quite possible that the man’s primary reason to run for president was to have the American taxpayer cover the expenses of his lifestyle. (And then he got upset when he found out the role requires, y’know, work and stuff.)

So this is my idea.

It’s a maximum income rule. That is, in order to qualify for the protection of the Secret Service, Coast Guard, et al., the president cannot make more in a year than a certain amount (for the sake of the proposal, let’s cap the president’s income from assets, salary, et cetera, at 1 million dollars a year). If you make more than that maximum amount, you don’t get those services. This is on the logic that if you’re Donald Trump and you’re rich enough to hire your own private security in addition to the Secret Service, then you really don’t need the Secret Service.

But, if this limit is based on a known income, how do we determine whether a president exceeds the limit? That’s the other part of the proposal. I Am Not A Lawyer, and someone with qualifications is going to have to review this idea, but the other part of the legislation establishing the maximum income rule would be that the president is assumed to be in violation of the rule if he does not report his income, and this law would also apply to all presidential candidates before they are elected. In other words, for a candidate or president to apply for Secret Service protection or reimbursement of expenses, HE HAS TO RELEASE HIS TAX RETURNS SO WE KNOW WHAT HIS INCOME IS. So if you’re too rich to live on the public dime, then you pay for all that stuff yourself, as we know (or assume) that Donald Trump is able to do. If it turns out your income is less than (say) 1 million a year, you get the services. But covering all this stuff or paying back the government shouldn’t be a big deal if you’re an honest-to-goodness billionaire, right?

To me, this is an essentially libertarian principle. Government should not be in the business of punishing the rich, but neither should it go out of its way to give them more advantages than they naturally have. Nor should it be imposing undue burdens on the private citizen, but if you are to be a public servant, there should be less benefit of the doubt, not more, especially if the public is paying your tab.

Just an idea. I propose it to the Libertarian Party, and also to the Democrats, assuming they could seize a good idea if it smacked them in the face, which they haven’t so far.