Link Roundup, 2/22/2017

From The New Yorker: Our new fear-based immigration policy.

From Gizmodo: A look at the president’s unsecured phone.

From Aeon: Great piece on how archeology gets distorted to meet nationalist or religious agenda, with a focus on Masada.

From the Washington Post; Just for fun, here’s a count of all the country’s “structurally deficient” bridges by county.

From The Atlantic: An interview with David Frum – Is the US becoming a banana republic?

How about some music?

147 Comments

  1. Watching the puppet tyrant now at CPAC. I know it has already happened many times, but I wonder how many more historians are scrambling to get footage of 1930’s Germany to compare to what is happening right now.

    That chant of the stupid and ultra-nationalist: “USA! USA!”, which as been around for decades, has reached a new far more sinister level.

  2. Those interested in understanding the so-called alt-right should read this. The author doesn’t use that term, I think because he explains why right and left are not so much the issue as he sees it. (“The new division in politics is those who favor the current global hegemony and those who are against it.”) His attitude towards this movement is kind of sympathetic, in large part because he realizes that but for the grace of God there goes he, and he connects that movement to lots of stuff we can see around us if we look, particularly if we’re familiar with young people.

    https://medium.com/@DaleBeran/4chan-the-skeleton-key-to-the-rise-of-trump-624e7cb798cb#.hobm4yj2k

  3. Just a thought
    One of the advantages of a public health service is that there is almost no paperwork!
    The admin people still need to track you for your treatment but there are no forms to fill out – my doctor does not have two ‘billing assistants” – working to extract money from insurance companies
    No bills – no worry about being able to afford it

  4. Got to cap your day off with this piece of enlightenment: “Republican state Rep. David Simpson of Longview argues marijuana comes from God and therefore shouldn’t be banned by government. The tea party stalwart has repeatedly championed what he calls the “Christian case” for legalization.”

    The bill passed the TX house committee and is headed to the floor where we will get to witness the most delicious debate ever……

    Now we know why the religious right is filled with so much fervor

    …..http://dfw.cbslocal.com/2015/05/06/marijuana-bill-passes-texas-house-committee/

  5. It’s nice to see a rational discussion about health care, and acknowledgement that Obamacare may not be so great after all.

    It saddens me to recall how in the past I’ve brought up this possibility and I was immediately accused of not caring for the uninsured, it was demanded that I come up with a replacement plan, and I was criticized for being naive in thinking that health care could be made more simple.

    I guess it depends on the people involved in the discussion. I like how Fifty just came right out and admitted that he had not made up his mind yet about what plan would work best, that he needed time to think about it. I think that’s the most honest answer.

    1. I’m sorry you felt you were being attacked, Tutta. My recollection of the discussions always included acknowledgement that the plan had (has) flaws but that we should address the flaws rather than repeal the whole plan. That is not acceptable to many on the right but it is a practical way to transition to getting to a better health care plan.

      1. One more point about the ACA – With ALL of its flaws, the fact that so many people were able to obtain health care coverage for the first time (due to all the factors that eliminated them from before) is an incredible accomplishment. As a result, Americans are healthier than they ever have been because people were able to get treatment, diagnose problems, obtain medication. For all those people who are showing up at town halls and protests, health care access is not something they want to ever go without again. Nor should they have to.

      1. Thanks to everyone here. I was referring to the old crowd back on the Chronicle. It was a lot more contentious then.

        I have a lot of ideas swimming around in my head with respect to health care but I haven’t made the time to organize them, so I usually just throw out disjointed thoughts.

    2. Tutta – I think we sometimes speak past each other. Most defenders of the ACA immediately concede problems that need correcting. If we had a working government after 2010 maybe it would have been fixed. Concerns about problems were spoken by the proponents but not heard by the critics.

      But instead, the ACA is an abomination as objv says. When you say it has to be torn out root and branch, a reasonable question is required. And replace it with what?

      It does a relatively good job at what it was meant to do. That is, provide quality health insurance to more people. But there are several million people who it has made a huuuge difference in their life. Note the town halls.

      Any replacement must implement all the structures of the ACA. If you believe it should not be mandatory, explain how a new system fixes the free rider problem.

      Conservatives should make a few changes, call it RepublicanCare and go with it. After all it was concocted by the best and brightest of the conservative movement.

      This will fix the health Insurance problem and then we can work on the problems in the healthcare provider system.

      1. Free rider: if a person can’t be turned down for coverage, they simply wait until they need it before buying. That means the ones who have purchased insurance will be on the whole sicker and more expensive, driving up costs for the insurer and premiums for the insured. The insurance mandate is supposed to eliminate the free rider problem and make premiums lower for everyone.

      2. Creigh, don’t know if you’ve seen this yet:

        https://taxfoundation.org/kansas-sends-tax-overhaul-governor-brownback/?

        3 votes. Note the US map that assigns reserves and that with the exception of IL (which is a mess), the other states in the “red” are all GOP….It’s an interesting visual. George Will has a column today about the looming pension shortfalls most states have. This Tax Foundation article puts all of that into perspective – visually.

      3. Right Creigh. Mary, if you agree pre-existing conditions should not keep you from insurance, how does this sound? “Hello, is this Bob’s Health Insurance Company? Yes, I would like to buy insurance for my 40 year old son. He has always been in good health so he never had insurance. He had a motorcycle accident a few minutes ago. It doesn’t look good. No helmet required state. Might be on life support for years. ”

        So, to remove the mandate, Republicans are suggesting that continuing coverage will suffice. That is you can not be refused coverage if you have been covered, with some minimal lapse allowed. Which does not solve the problem above and is only slightly less intrusive than mandated coverage.

      4. I would prefer that everyone be issued health insurance at birth. If someone isn’t covered, gets a diagnosis or suffers a debilitating injury prior to seeking coverage, that doesn’t seem fair to insurance to have to sell them coverage. But, why go there? Cover everyone and these abuses won’t be a part of the equation. There will still be costs.

        Let me ask you a question. Repubs are talking about excluding pregnancy. What about high risk activities under your scenario? Again, I’d cover everyone so just posing a hypothetical.

      5. We know that pre-natal care is very important. So insurance that covers this seems obvious to keep cost down at birth and for a lifetime. Talking about costs seems cold and it is, it is also the right thing to do. And most of the time the actual birth does not require a doctor and is inexpensive, or should be. For the times when things do not go right, I don’t mind paying a higher percentage of tax, err, I mean insurance premium.

        High risk activities like riding a motorcycle without a helmet? Or riding motocross bikes and getting a bone set every season? Interesting question. After giving this a few seconds of thought, I don’t think I would try to single out people who are into high risk activities. For example, skydiving accidents cause little in healthcare costs, I assume. Even those with habits that cause health problems usually go faster than healthy people with a strong urge to live. Weird thoughts. Hope no one is offended.

      6. Was just curious. My position for full coverage from birth pretty well covers all bases…

        Pregnancy is one of the areas that is likely to be excluded from coverage except as a rider on a policy. Contraception is another area that is going to be limited and will not be “free” as it is at present. Abortion, obviously, will not be covered or offered as a rider. There are so many contradictions with the GOP POV…but, I know you know them.

      7. The Heritage Foundation concocted the model for ACA. Given their agenda, I can’t say I agree with attributing them as the “best and brightest” minds. After all, if one assesses the ACA progeny of the Heritage model, they have to get credit for the many problems inherent in the structure (mandatory participation, etc) as well….

        Just sayin’ .

    3. Once I finally had a chance to sit down to understand the Affordable Care Act, I literally laughed out loud. Here was a plan only a Republican could love — a plan that forced citizens into buying private business products. And the Republicans HATED it and called it socialism — because a black man introduced it.

      Nobody liked or should have liked the ACA, but it’s such a perfectly American answer to something: complex, multifaceted, complicated, misunderstood, full of literally thousands of pages of legalese, some of which do pretty popular things, many of which try to create some fictional balance between ‘public’ and ‘private’ services in the hopes of a blanket compromise that pleases nobody.

      Only Americans come up with shit like the ACA. Other countries develop single payer, either insurance or the whole damned health industry.

      During my Physicians for a National Healthcare Program meeting where they broke down types of healthcare provisions across various countries along a left/right political paradigm, the Affordable Care Act came in just left of NOTHING: total free, unregulated market insurance like we had before the ACA. This is one reason why the Republicans literally can’t figure out what to do: there’s nowhere rightward to go but nothing, or some sort of newfangled ACA-lite. That’s what we’re going to end up with, I guarantee it.

      For all the pomp and drama, the difference between a Republican legislative branch and a Democratic legislative branch as regards health insurance reform post-ACA are just matters of tinkering and building on top of the complex, enmeshed ACA base. Clinton’s plan was to add policy wonkery to it to fine tune hundreds of little plot points, Congress’s plan is most likely to soften or deregulate sweeping parts of it in the hopes that ‘private insurance’ will adjust and fix it for them.

      Nobody should be happy with the result in either case. The ACA, like so many American inanities, is built as a compromise between the false premises that there’re any fundamental moral or ethical differences between ‘private’ and ‘public’ products and services, instead of the realistic premise that some institutions are better than others for certain needs in both sectors.

      1. As long as health insurance is private, it relies, by the nature of private institutions, on profitability. Profitability necessarily means certain human beings will not be able to have access to it. It necessarily means certain human beings will not have access to it, because the one guarantee every single human being has is that he or she (or it or zhey) will get sick and die.

        Insurance is not profitable when every single item insured is guaranteed to require claims.

        End of story.

    1. The most effective speakers were the community Mexican residents who spoke to the fear and abuse they and members of their families and neighbors are experiencing. In our community, there are some very wealthy Mexican homeowners who bought property in direct response to a marketing campaign in Mexico promoted via the lure of an EB-5 visa. These are ultra wealthy Mexican families who invest per their visa requirement and whose children come and stay and raise families here…These families travel a lot and with the infamous round up in January in US airports, one of these very wealthy families were detained and treated poorly. Now their children are here through the same visas, they have grandchildren who were born here, known America as home, but they are feeling very unwelcome and vulnerable, not knowing if their visas will protect them.

      This kind of personal story is important for elected officials to hear. Our county sheriff is “considering” participation in the 287g ICE program and this along with what they hear daily from potus and others who share his views, is causing great concern for these affluent families. They have made huge investments in America and feel as though they have been duped. The families also spoke about comments made to their children in school, on FB, telling them to “pack their bags”, etc. As you can imagine, those who mimic potus’s views and attitude can be very ugly in their personal actions. At least they have the resources to leave. Most don’t. Those who fear the raid, being pulled over, reported, etc. have a great deal to fear. When it touches children and divides families, that is really tough, and it appears that potus is committed to removing everyone he can despite his waffling on the DACA issue.

      It’s a tough situation because laws need to be obeyed but the broader problem is the lack of a comprehensive immigration plan and such ugly, harsh tactics to round peopl up. The focus is purely punitive, which yesterday’s NBC poll reported is supported by 50% of Americans surveyed.

      The chairman of the board met after the meeting with those who could stay (I couldn’t) and agreed to place an item on the agenda to look at the problems and try to find ways to work together as a community to address it. That was a very positive outcome. One suggestion from the Mexican speakers was to have a collaborative day/week event that celebrates inclusion and diversity, much like is held downtown with the international program. I hope to be able to attend the meeting where this is discussed. Such a shame to even have to have this discussion but hope something good comes from it.

      My role was to speak in support of our Hispanic neighbors and friends and to the damage that the harsh rhetoric and actions of the immigration process has caused for them. Specifically, I spoke to the damage of TX SB 4 (forbids sanctuary cities in TX with financial and felony penalities) and the expansion of the 287g order which essentially coops local law enforcement and deputizes the deputies as ICE surrogates to perform screening, apprehension, detention, etc. There is no reported significant problem in our community nor county which begs the question as to need and justification. There is significant financial benefit to the sheriff but hidden cost to the community (housing expenses, judicial pile up, etc). I asked the board to use their influence to speak against this bill (passed Senate, going to House) and to speak with the county sheriff and ask him not to participate in the 287g program (as he is purportedly considering). Hopefully they “heard” and learned more about the SB4 and 287g but I think the comments from the Mexican families were far more important. My role was purely housekeeping.

      Thanks for asking. We’ll have to see how things turn out. I’ll keep you posted.

      1. That is an interesting account. There is pressure on the sheriffs from the state government in Texas, right? Wasn’t there a problem with the sheriff in Austin bucking the new orders? I hope your sheriff can stand strong.

        Most of the immigrant families in my neck of the woods are from the Caribbean (especially Haiti) or countries in Africa, so the issues are a little different. Many are Christian. Still, many of them are scared about what the future holds.

        On an unrelated note, it was unexpectedly good to see Betsy De Vos stand up for transgender students the other day, even if she was forced to go along with Trump’s crap order in the end. Don’t get me wrong–I’m still very wary of her, but I’ll take any good news coming out of this administration that I can get!

      2. I’m not so sure what DeVos motivations were. There wasn’t much detail here about her position and comments other than she differed with potus and withdrew so as to not conflict with his EO. If you have background, I’d like to read it, because, like you, I’m trying to find something positive about her.

      3. Here’s some detail on DeVos’ actions. She does deserve praise for her stand and her beliefs; however, it didn’t matter as Sessions went around her directly to the WH and potus backed off. The article predicts Sessions is going to be a powerful ally for social conservative rights interests.

        Jeff Sessions is going to be bad news all the way around.

        https://www.nytimes.com/2017/02/22/us/politics/devos-sessions-transgender-students-rights.html?emc=edit_th_20170223&nl=todaysheadlines&nlid=41048410

      4. Mary, your account regarding the wealthy Mexican families is very interesting and much to the point. That they were treated very poorly is not at all surprising. Nevertheless, their situation will get the attention of authorities, since they are wealthy.

        My post, below, regarding the background of ICE was meant to point out that ICE will not differentiate between legitimate Mexicans and illegitimate Mexicans. To them they will all be “bad hombres”. Furthermore in so far as ICE is concerned the particular nationality will not make any difference. If they fit the profile, they are “bad hombres”, period. That is inherent for any law enforcement agency that has gone rogue and has no respect for individuals who fit a particular profile. It is the very problem that has surfaced time and again in this country. It is the very problem that is being made so apparent by the Black Lives Matter movement. It is the very problem that resulted in the Seattle Police Department being forced to reform via a consent decree. The LAPD went through that process and Baltimore and Chicago have just agreed to decrees as well.

        In so far as I am concerned all individuals deserve respect and have certain human rights regardless of their race, sex, creed, ethnicity and religion. Law enforcement agencies need to operate that way. IMO, ICE personnel in particular do not, regardless of the official position. There is too much evidence supporting that conclusion. That situation is being aggravated considerably by T’s executive orders and the associated memoranda.

      5. MassDem – Re DeVos, she spoke out strongly against the LGBT and transgender issues at CPAC…Again, friendly audience…During her career, her family donated millions of dollars to lobby against LGBT legislation.

        She must have been “off her meds” when she made her initial call on the transgender issue…no coherence with her prior history which was confirmed at CPAC with her statements.

  6. Trump’s danger isn’t in that he’s going to become an autocrat or that he’ll try acquire power in the mold of such. Trump is a well-oiled machine of destruction who is perfectly conditioned to engage in a sort of positive feedback loop of doom that will continue until forces outside his control stop him.

    Other may argue differently, but Trump is terribly simplistic. He has not come into the White House with any Machiavellian scheme to undermine the Republic (see Steve Bannon for that), and so, based on what we’ve seen of him, we can reasonably presume him to go down one of two general paths:

    Trump notches a perceived victory => Credit/Favor given to those who helped => Trump is happy for a minimal amount of time => Onto the next battle

    And then there’s the other one…

    Trump is handed a defeat => He rationalizes, blames others (the media, the courts, etc.), perceiving them as enemies who must either be stopped and/or destroyed (“The media is the enemy of the American people!”) => He lashes out however he can through whatever powers he can exercise to feed this rationalization => He either succeeds or is handed yet another defeat, which starts the cycle all over again, only in an increasingly escalating, irrational and chaotic manner.

    Compounding this man-child’s problem is the fact that he has intentionally built a fractured power center in the White House where there is not a single person that can go to him, tell him he’s wrong and put a stop to whatever he’s doing. Ultimately, the only person Trump listens to is Trump.

    And this is where we have to be wary. Ready and willing to fight as we all must be for the daily slog against Trump, it’s his defeats that we have to be on guard for. In the most optimistic scenario, we go through these next two years without any serious domestic crisis or significant terrorist attacks, Trump does horribly and Republicans get wiped out in the ’18 midterms, Democrats retake the House and impeachment proceedings are filed five minutes ago fast.

    The worse-case scenario is that a serious crisis does happen and Trump utilizes it as a means to push through powers that trample all over civil liberties and freedoms (think W. Bush after 9/11, only a helluva lot worse), all as a means to exact his perceived vengeance against those whom he feels have wronged him. This is the nightmare scenario many fear Trump is laying the groundwork for when he tells people to blame the courts when and if a terrorist attack happens.

    Beware the man who feels he’s been backed into a corner.

    http://www.vox.com/policy-and-politics/2017/2/22/14658062/donald-trump-illiberalism-losing

    1. Trump is mean. He is also revengeful. Look at the ploy of inviting Romney, Cruz to his lair with lots of hype but ultimately rejecting them. Note: he rejected them.

      This is a man whose ego and sense of self worth are impossible to satisfy.

      As for his plans and who he listens to. I think he is preparing the way for his son in law, Jared Kushner to run for term two. I don’t think potus will want to stay any longer than that but he doesn want to have the keys to the throne still in his pocket. Plus, Ivanka will make a splendid first lady….

      I have nothing positive to say about this person. He doesn’t just offend me, he alarms me because he represents the views of so many people in our country. Even when he is gone, we still have to deal with them. Though extremes can be marginalized, it’s never a pleasant process.

      1. In all the time he took to play reality-show games with his former adversaries, he could have had people working on nominations for lower positions. His administration is way behind; not solely the fault of Democrats that staffing the government is proceeding like molasses in January.

    2. Here’s news on how potus is going to solve his immigration ban order, and it’s causing a ruckus. He’s doing an end-run around some forces within his administration – again, intelligence types. I guess the plan now is to cut out anyone who would normally be in the vetting loop and control the process from friendlier, controlled sectors. Sessions is going to be a real problem.

      http://www.cnn.com/2017/02/23/politics/white-house-effort-to-justify-travel-ban-causes-growing-concern-for-some-intel-officials/index.html

      I did read that a judge has ruled on the unlocking of personal devices issue. HEre’s the ruling. Those here who travel abroad may wish to read this in its entirety. Fires are having to be put out one at a time…………..

      https://drive.google.com/file/d/0B1h4jlD75yShMTlPUWhZUS1qWFk/view

  7. A lot of conversation regarding ICE and properly so. However, we need to remember that ICE and its predecessor agencies have been roque law enforcement agencies for years. The enforcement division of ICE was originally the Immigration and Naturalization Service (INS). It had a reputation for being very ham handed and treating immigrants, particularly Mexicans, like animals. It was folded into ICE following 9/11. A rogue agency attracts law enforcement personnel who behave similarly and who profile, disregard individual rights, will routinely lie and are highly subject to corruption. ICE had issues of corruption previously, when they tried to expand rapidly under the Bush 43 Administration. That could happen again.

    As has been the experience whenever the DOJ has forced reform in a municipal police force, it takes years to achieve the minimum goals and even then constant vigilance is required to prevent relapse. That has been the case here in Seattle, as I described in previous remarks. For ICE there has never been an extended period of reform. Even though Obama placed restrictions on their operation, he was not able to actually implement a substantive reform effort for numerous political reasons. The personnel have just been waiting to resume normal operation. Now Trump has removed all restraints and ICE is going to take full advantage of the opportunity. Ethics and professionalism be damned! If someone is brown skinned and obviously Hispanic, they have much to fear.

  8. I always thought that the idea of shopping for health care based on value is just a Republican’s wet dream, not something that’s actually possible.

    In this country, we don’t even know how much a procedure — or even a day in the hospital — actually costs, never mind what it is priced at.

    Every aspect of our health care system is muddied by whether or not you have insurance.

    If you don’t, you pay more because you have no insurance company to contract a particular price with the doc or hospital. Which may work fine if your medical needs are minor.

    Get really sick, and you’ll quickly see why medical costs cause bankruptcy here.

      1. Mime – You seem to be in reference to single payer. I’ll not argue with you on this point, as I’ve not formed a complete opinion on this extremely complex issue, and can imagine no other reasonable alternative. Which doesn’t mean one doesn’t exist – simply that I can’t think of one.

      2. No, I’m not referring to single payer which is government administered. Universal health coverage can include more than one vehicle for delivery of health care, single payer is one but it can be private as well. Chris’ post that I recopied in this thread has alink to France’s health care. I’ve cited a book that looks are existing health care delivery systems in major industrialized nations, entitled: “The Healing of America” by T.R. Reid. There are others but this one (released in ’09) presents a highly readable view of how other countries health care plans work. Might want to give it a look as well as the wiki link in Chris’ comment.

      3. Mime – There are a few hybrid systems. (And BTW, Canada is not amount them). All are fundamentally different than the ACA. Some variation of one or the other might be appropriate here. But the fact remains that the solution is far from as simple as you suggest.

        To quote 1mime, just fix it is “not an answer”.

      4. It is when you’re pissed. No, it’s not simple as Repubs are finding out, but there are many fine working parts and if elected officials were thinking about the American people, they would have been using the past decade to develop a plan ready to replace the ACA. Why haven’t they? Because they’re used this issue as a whipping post to inflame their base.

        Once health care is deemed a right and a priority with our elected officials as it obviously is with the public, a solution can be developed. My point was that there are working models out there that can be used to incorporate those parts of the ACA that are worthy. It’s frustrating to have fought this for so long.

      5. Mr. peon of the “simplicity” argument….it’s not that simple. Remember, I’m on board in support of a universal health care plan – that covers everyone (not just blue folks (-;) and I want everyone who receives benefits to help pay for them by using a VAT tax. That ought to simultaneously make everyone mad at me which means that it’s a good start!

      6. >] Mr. peon of the “simplicity” argument….it’s not that simple. Remember, I’m on board in support of a universal health care plan – that covers everyone (not just blue folks (-;) and I want everyone who receives benefits to help pay for them by using a VAT tax. That ought to simultaneously make everyone mad at me which means that it’s a good start!

        Lol, that’s probably true.

        Counterintuitive as it might seem though, I think the peticulars of American politics when it comes to healthcare say, to me at least, that we’re not going to get to a true universal system unless it’s tied into a larger narrative, like enacting a UBI. We have to create a broader narrative where everyone, regardless of their political affiliation or what state they live in, has a real, personal stake in the outcome so they’re actively involved in getting it passed by Congress and signed into law so we can move onto bigger and better things.

        This is what I mean when I say counterintuitive. Healthcare is a herculean lift all on its own, so anyone who heard that I wanted to do not just that, but a complete reshaping of the social compact in America via a UBI more or less at once would tell me I’m batshit crazy, but I honestly believe that that’s the only way it happens. If it’s just left up to Washington, even an incredibly skillful, charismatic president with a supermajority of his/her party in power will, without question, fail. This has to be a true calling from all of America saying to all their elected representatives that if they don’t get this done, they won’t be sent back to Washington. Period.

        It’s a herculean task that requires a shitload of preparation, the very least of which includes gerrymandering reform, easier access to the ballot box and other measures. It’ll take time, but I believe we can do it, one step at a time.

  9. There’s also something in medicine known as “just because you can, it doesn’t mean you must”. What I find objectionable about the US and other healthcare systems where people are charged at the point of service for healthcare is the temptation to indulge in the law of diminishing returns. Diminishing returns for the patient, that is, but plenty of money for the health provider. There was a very interesting book written by Ivan Illich in 1978 called “Medical Nemesis”, which used to be required reading for British medical students, in which he debated the escalating cost of each unit of healthcare past a certain degree of complexity, with very little in terms of return both is length and quality of life for the patient.

  10. Sorry obj but anecdote is not data. You state that the US is superior at handling more complex medical problems. I’m afraid you’re going to have to back that up with facts. All advanced economies have or should have, primary, secondary and tertiary healthcare systems. So you’ll have to tell me what the actual data is in terms of standardised hospital mortality rates, surgical league tables, success rates of surgical procedures etc. If what you mean is that in tax-payer funded healthcare systems like Norway and the UK there are things known as waiting times for surgery, that is not an indication that they are “inferior” to the US system, where people pay to jump the queue. Everything that occurs in the UK for example, has to be approved by NICE, which sets the standards for best practice. I don’t buy that the US is better for complex medical problems, sorry, because I haven’t been given any actual data that it is

    1. Well – Two close friends, Canadians both and neighbors at the summer house, needed cardiac catheterization procedures. The first, we’ll call her Jackie, (because her name is Jackie), had afib, and needed an ablation. For the 2 1/2 years she was on the waiting list, she was drugged up like a zombie to prevent fibrilation, and essentially unable to walk or even think straight. The procedure finally (on the third try), fixed the problem.

      The next, we’ll call him Alan for the same reason, needed a stent. Two years later he was fixed, with the intervening interval replete with 12 trips to the ER from the symptoms.

      These patients were essentially warehoused pharmaceutically for years at substantial cost to their quality of life, while awaiting a slot in a cath lab.

      Now, do I think that our far shorter wait times justify a factor of two difference in costs? No, I do not. But it should not be implied that “free” nationalized healthcare is without costs.

      1. About the time the ACA was being passed my company was putting in a demineralization system bought from a Canadian firm. The start up engineer was a Canadian and I asked him about his health care system. He told me he got his health care in a reasonable timely matter and what he told me completely counter the prevailing propaganda against the reform. A co-worker from England pretty much admitted our health care system was not nearly as good as England’s was. Worked with many people from Latin America and many went home for health care procedures telling me it was cheaper and better. And they had access to our system having top notch insurance. Those other systems were usually paid by a tax and the cost was much cheaper than what we pay. One of the advantage of living in Central Florida is you rub shoulders with people from all over the world. I am firmly in the camp of fixing the ACA. And more and more Americans are moving to that camp.

      2. Stephen – If you have a child, or break a leg in Canada, you’re fine. In fact, for about 95% of stuff that befalls most of us, you’re fine. (Like your colleague.). The problem is if you fall outside this scope, as I illustrated in my examples. Again, I am not saying any advantage we might have in this regard justifies the cost. We as a people pay 2X per capita as our Cannuck brethren. Our system is hosed for many reasons. All the ACA has done for me is cost me money. Even that fact though, does not convince me to get rid of it. It’s simply a bad solution to a bad and worsening problem that doesn’t do a thing to address the central issue of cost. That is all.

      3. So, FIX IT! We can figure out how to go to the moon and mars and we can’t design a health system that works cost-effectively and for everyone? When there are successful programs (France) operating that could be models? Could it really be that Ds got there first with “any” universal health care plan and it was passed under Obama?

        This is such BS. People are dying, their children are sick and politicians can’t figure it out?

      4. Well, “people and children sick and dying” is hyperbole. (Remember, the ACA is the law of the land). Were the issue only as simple as you intone… Remember, we’re talking about completely changing fundamentally about a sixth of the entire economy.

      5. You are right, nationalised healthcare does have it’s problems. The one you mentioned, is a chronic issue here in the UK ( and from your description, I’m guessing Canade, too ), where underfunding by central government leads to an increasing length in waiting times for procedures, graded according to their severity in terms of threat to life. The solution is however, not to replace it with a privatised service, but to fund them properly. That’s a whole other issue, with roots in the broken monetary system in the advanced economies

      6. Right. Health care has to become a national priority and then, and only then, will it be funded adequately so that it can perform properly. How many times do we see funding cut for agencies for political reasons, but justified on the premise that the agency is not needed or performing properly. If I am given 40 children in a classroom, there is no way even the best teacher can do the quality job she is capable of under reasonable circumstances. That’s simplistic, of course, but your point is “on the money” that funding must be adequate for care to have quality outcomes.

      1. Mime – Obviously affirmations without any possible bias. If you think that healthcare in Canada is without any issues, and is “just fine” based on this, you’d best reconsider your standards of evidence. BTW: my Cannuck pals think it’s “just fine” as well. What does that tell ya?

      2. I would cite names except for confidentiality. Our conversation on this topic was deep and long. How many people? 5 – all born in Canada, living now in US. Are there flaws? Certainly, but as you noted, pretty good care for 90%+ of health issues….and for less than half the cost with better health outcomes as measured against the US and other countries.

      3. Ok, I’m *from* Canada, lived there full time until age 21, and both my parents (one still living) lived there their entire lives. I’ve seen how the Canadian system treats patients of all ages with major and minor issues. It’s far superior to the US system in terms of cost and far superior in terms of delivering a good first-world standard of care to everyone, so you don’t have poor people dying of easily treated diseases or people never getting preventative care because they can’t afford to visit the doctor at all. It does have waits for non-urgent issues, but my appendix and my Dad’s triple bypass had zero wait (urgent!) and my Mom’s hip replacement happened pretty quickly. There are also places where it’s hard to get a primary care doctor if you just moved there because there’s a bit of a shortage. That’s fairly recent – was never a problem for me. Those are pretty minor problems for a system that covers every single citizen and permanent resident for half the per-capita cost of the US system that leaves 10%-20% of people uncovered.

      4. Kaiser Foundation reported that at the end of signups for the ACA, that only 8.8% of Americans lack health care coverage. Of course, as to the adequacy of the coverage, that’s another issue. The 20% coverage loss figures are generally associated with the loss of coverage with the ACA replacement proposals.

        Estimates are that the replacement plans being considered by Republicans will see huge reductions in coverage especially in the population presently being served via Medicaid. GOP plans are to block-grant Medicaid services to the states while reducing the overall funding for Medicaid…amount not yet stipulated publicly. The $$ will come down either in a set lump sum or a per capita set allocation, neither of which are expected to meet the full cost of prior allocations. States are going to have to “do more with less”, which in medical care (as Hoonteo recounted) usually resorts to “less” care. OR, the state taxpayers will have to fund the difference, which we in our county do via a line item in our property taxes called “the hospital district”.

      5. Actually, a close reading of Greg’s comment shows him stating 10-20%, not solely 20%. As I already stated, newest figures show 8.8% lack coverage, which is solid, especially given all the threats to even the existence of the ACA for most who enrolled.

      6. An extraordinary story. I opened the link within the story that profiles Rumana Ahmed’s experience transitioning from the Obama administration to that of potus. It is a sobering read. Contained within it is a deeper look at her superior to whom she had to tender her resignation. This man, Michael Anton, is still the chief of communications for the National Security Council. The two stories need to be read in sequence to better appreciate them. Every time I think it can’t get worse, I read something like this and realize how little I really know about the depth of this situation.

        https://www.theatlantic.com/politics/archive/2017/02/rumana-ahmed-trump/517521/?utm_source=nl-atlantic-daily-022317

        http://www.huffingtonpost.com/entry/michael-anton-trump-essay-publius-decius-mus_us_589ba947e4b09bd304bff3c8

      7. Yeah, I said “10%-20%” in reference to before the ACA. IIRC, it had been creeping up for decades and I thought it had gotten over 16% (and the trend was continuing) before the ACA kicked in. This link says 15.1% vs 9.1% recently under the ACA. (And it would be lower if not for the states that refused the Medicaid expansion.) http://www.cnbc.com/2016/05/17/obamacare-brings-record-low-for-us-health-uninsured-rate.html
        So under pre-ACA law, we’d now be somewhere between 15% and 20%. Under full ACA with Medicaid expansion we’d be below 9%, maybe 7% or so.

        Canada: essentially zero.

    2. Hoonteo, You are right in questioning me. I admit that everything I’ve said is anecdotal. I would very much like to find out what works and doesn’t work in other countries.

      The reason I feel that patients with complex medical issues get better care in the states has to do with the care my husband received.

      In 2007, an arteriovenous fistula burst in my husband’s brain. It was tricky to diagnose since the vessel was quite small and didn’t show up on a MRI. He was life-flighted to Memorial Hermann at the Medical Center in Houston from our local hospital after a scan showed bleeding in his brain.

      At Memorial Hermann, he received aggressive treatment to determine where the problem was originating. During the two weeks he was in intensive care, he had many different tests done using the latest and best medical equipment. The AV fistula was found after my husband underwent a cerebral angiogram and his doctor was able to do an embolization procedure to stop the bleeding.

      Thanks to his doctor’s skill in doing the embolization, the bleeding was stopped immediately, but my husband was half paralyzed and half blind. He spatial reasoning was so compromised that he didn’t know were he was if he was wheeled out of his room and he didn’t recognize that his left arm was his own and kept trying to throw it out of his bed.

      He spent an additional week in hospital rehab and then months at TIRR. (The place they sent congresswoman Gabby Giffords.)

      He received excellent physical, occupational and psychological therapy to help him regain movement and help him adjust back into the real world.

      He was eventually able to go back to his job as an engineer – first part-time and then full-time.

      During his time at the hospital and afterwards, my husband received the most advanced care using the latest technologies and methods of treatment. Yes, he did have insurance, but many patients at the hospital and TIRR did not, and yet they received the same level of care.

      So while I do admit that my experience is anecdotal, I wonder if my husband would have survived, let alone thrived, if he were in a different place.

  11. The Trump Administration just announced that it’s going to rescind an Obama-era rule that bars schools that receive federal funds from discriminating against transgender students. Education Sec. DeVos was reportedly against the decision at first, but was reportedly coerced into signing off on it since both the Justice and Education departments need to agree in order to go forward.

    Sean Spicer then said that this is a “states’ rights issue” and shouldn’t be left up to the federal government.

    “States’ rights” huh… now why does that sound so revoltingly familiar…

    https://www.nytimes.com/2017/02/22/us/politics/devos-sessions-transgender-students-rights.html?mtrref=www.huffingtonpost.com&gwh=8C2CB3165A2B30DFC3C8D0C7A60A76CF&gwt=pay

    1. States Rights as a constitutional concept is not, in and of itself, a bad thing. The problem occurs when the idea gets contorted into this sort of BS.

      Now having said that and to the issue at hand, it is a bit of a stretch to suggest transgender students were ‘discriminated against’ prior to that ruling. This is not a states rights issue – it’s a goddam common sense issue. Nobody gives a crap what toilet a kid uses. Who is going to check birth certificates at the door? That this is a national debate in the first place is silly beyond reason. It’s about as stupid as the ‘pronoun’ debate. Don’t we have more pressing matters to attend to?

  12. So I just watched NASA’s webcast re: the incredibly cool Trappist-1 system. Now, my question is, what has the bannon-trump regime said about their plans for NASA? I do know I heard rumblings of near space being left to pure commercial, while NASA / big government focuses on deep space, but nothing concrete.

    What happens to the Webb Telescope and its successors under this clown car show? Will their theocrat buddies attempt to shut down any research on extraterrestrial life and exoplanets? While I have no doubt the religious crazies could spin the Christian theme to say that a 10 mile long ship showing up tomorrow above Chicago was written about in the bible, every little bit more science discovered that points to life somewhere else in the universe is more dent in their religion’s armor.

      1. It’s the Earth-science program they really want to target – get rid of all that pesky evidence for global warming from various types of satellite observations.

        But yeah, everything else will suffer too when cuts are made, and it will be worse if they try to force a move from science to “Put a man on Mars so he can plant a flag, rah, rah, USA #1…”

    1. Profile photo of EJ EJ

      The European Space Agency has been getting a lot more job applications recently. Some of them are Americans, but most are from extremely talented people in the third world who would ordinarily have been hired by NASA.

      Whether or not the writing is on the wall, people have started to behave as though it is.

  13. Tutt and I had shared comments on how health care costs were reasonable when we were kids. The following is related to the discussion on how to make medical care affordable again. Pure genius. I’m definitely going to sign the petition mentioned in the article.

    “To fix the system, providers must be required to bill all patients, insured and uninsured (other than where rates are fixed by law) the same amount for the same service.
    Hospitals, physicians and labs should have continued freedom to set their own prices, but predatory pricing — a different rate for each patient — must be prohibited.
    With real prices, patients would be empowered to shop for value and never face punitive out-of-network charges. Health providers would be forced to compete based on price, quality and service.”

    Read more here: http://www.miamiherald.com/opinion/article59829766.html#storylink=cpy

    1. OV, that makes perfect sense, but how do we untangle a billing system that has become so complicated, to the point that people have gotten so used to it that it’s assumed that “complicated” is the norm for medical care?

      We need transparency, but the system is so complex that providers wouldn’t even know where to start.

      1. Tutt, I agree that it would take a period of time for doctor’s offices, hospitals and other providers to assess what the true costs are, but to some extent health providers already have a rough idea.

        For example, my husband made an appointment for a sleep study last week. He told me the person he talked to said it would cost $2500 since we had a deductible of $6000 which we hadn’t met for the year.

        Of course, I had a little freak out moment and called the sleep study office to cancel. They reassured me that although they would bill insurance for the full amount, the most they would try to ever get from us was $500.

        My husband went in for the sleep study, we paid the $500, and I saw the doctor’s office billed our insurance. What a convoluted system. If we would had already paid our deductible, we would have been responsible for “only” 20% – exactly what we paid outright! Our insurance company would have been on the hook for the rest.

      2. Mary, the problem is unless universal health care does something to control how much services cost, it will be as useless as Obamacare when it comes to sky high, nosebleed prices. The sales tax would have to rise to astronomical levels to pay for care that is more expensive than it should be.

      3. No, you don’t know that. The experience of other industrialized nations documents again and again that they can provide better health outcomes for half or less cost per person. That is fact. I won’t digress into how much money will be saved from higher productivity due to a healthier population, nor quality of life, nor rights as citizens. Universal health care as Chris has pointed out in the past, can be a combination of means but it can and does work. Once the realization dawns that removing concerns about health care coverage from the shoulders of every American dawns, think of how freeing that would be to people’s lives. I come down squarely on the side of health care being a right not a privilege. America simply has to decide what priorities are most important. To me, health care is at the top along with defense, education, and infrastructure.

      4. @Tuttabella & objv >] OV, that makes perfect sense, but how do we untangle a billing system that has become so complicated, to the point that people have gotten so used to it that it’s assumed that “complicated” is the norm for medical care?

        We need transparency, but the system is so complex that providers wouldn’t even know where to start.

        It doesn’t make any sense at all, in face it’s contradictory on its face. OV quotes charging all people the same amount for the same service, which is a laudable goal, no doubt, but then quotes that hospitals, labs and the like should have the freedom to set their own prices. Wut?

        That said, I’m in complete agreement that predatory pricing should be done away with, but these are two completely separate issues. Let’s not get them confused.

        Getting back to the main issue though, what would be the enforcement mechanism for cost controls like that? Are we going to have some new bureaucratic board in Washington keeping a watchful eye out for any hospital that seems to be charging too much? Secondly, what’s to stop insurers from simply increasing their costs to make up the difference? This all just sounds like some half-baked attempt to try and divy up the proverbial healthcare pie some other way that’s inevitably going to fall flat (no pun intended).

        >] With real prices, patients would be empowered to shop for value and never face punitive out-of-network charges. Health providers would be forced to compete based on price, quality and service.

        Nothing about that changes the fundamental flaw in our current healthcare system in that you’re still trying to treat it like a market when, again, it is anything but that. Leverage will still remain on the side of insurers, people will still be left out in the cold and, inevitably, lobbyists and the industry will find a way to get around these so-called “real prices”.

      5. Hey Ryan … don’t have much time left. From the article:

        “Perversely, the Affordable Care Act’s requirement that insurers spend roughly 80 percent of premiums on patient care, has legally enshrined higher medical costs as the only means for the insurance industry to keep growing profits. The higher medical bills climb, the higher premiums rise and the higher the insurance industry’s 20-percent share goes. Insurers, on whom the system relies to negotiate deals with providers, actually benefit from higher costs, while consumers can’t protect themselves because of the lack of real prices. Nobody is watching the store.”

        Ryan, I’m not a lawyer or an accountant, so I don’t know the legal ins and outs of trying to set up a system to check for uniform pricing of services.

        I do know that when I’ve paid for some medical costs without going through insurance, they’ve been reasonable.

        Last year, my doctor suggested I get a coronary calcium score test done since I have genetically high CRP levels. My doctor told me to go to the hospital and just pay for the test outright since it would be less than expensive than going through insurance even though we had met our deductible. The cost was $99 (and I found out that my heart arteries are as clean as a whistle).

        The hospital near us also offers a multitude of tests including bloodwork at nominal fees to those who don’t have insurance or don’t want to use their insurance. I’m assuming that they do not lose money when they offer these tests to the public.

      6. Can I ask a really basic question? What is so objectionable about tax-payer funded healthcare systems ? ( like the ones that exist in Europe ). I happen to be a consultant anaesthetist ( or anaesthesiologist ) in the NHS, that’s my day job. The NHS is struggling more through the ideology of the ruling Tory government ( privatise everything ) rather then any intrinsic defect, and most of the European was-payer funded systems work well.

      7. Ryan, … one more thing …

        I can’t claim to be an expert on health care. I freely admit I may be wrong on many points. Health care is an extremely complicated issue.

        My only expertise come from having a husband who has had cancer, multiple surgeries, chemo, a brain bleed, and a heart attack – all at a relatively young age.

        Our medical bills have been a nightmare to wade through. Luckily, unlike many people (for example, my sister who I mentioned last week), we’ve had insurance and we’ve had a hefty income to pay our out of pocket costs.

        The capricious pricing of medical care is completely out of control. While my family has been protected from financial to some degree, the outrageous costs are borne by individuals, companies and yes the government paying into the system.

      8. hoonteo, I guess I will have to make time to give a short answer …

        I’m not sure universal health care wouldn’t be such a bad idea if it were more like Europe’s.

        I do wonder if many Americans would have to make an adjustment in their expectations if we went that way.

        A few years ago, a guy was transferred from Norway to the State and was working on the same project as my husband. His wife was having seizures due to a brain tumor. The wife was told that she would have to wait six months to have the surgery done since the tumor did not appear to be malignant and was slow growing. In the meantime she was still having seizures!

        Her husband was able to manage a transfer to the US where she had surgery soon after she arrived at M.D. Anderson.

        I lived in Norway a long time ago. Even at that time US health care was more expensive but superior in treating more complicated medical needs.

        Norway was much superior in meeting routine conditions and preventative care.

        The trade off is one that needs the input of what best meets the needs of American people and may need a more uniquely American approach.

      9. I am sharing this link from an old article 2009 in NYT. Its as close to a primer on how hospitals operate that I’ve encountered. I am a research accountant so was never on the patient care side but worked around and in the finance offices of hospitals which are consumed managing relationships and cash flow while reconciling with 3rd party carriers and represent anywhere from 14-21% of all operating costs at hospitals and medical centers depending on the number of insurance carriers they work with.

        In addition to “actual cost” which gets lost when your relationship is based on “reimbursement schedules” for services and those vary with every insurer you include…we also need to seriously discuss the rationality of paying physicians 2 to 4 times more than they make anywhere else in the world. I’m sure doctors will be the first to scream about their 175k-300k student debt (not uncommon) but then we digress to why education costs more than our homes. I can tell you that the problem is complex/intricate due to the number of players on the field.

        Visiting friends in Croatia I was shocked by the ease and good level of care both preventative and in house with no paperwork and minimal cost to patients…they pay 6-8% more in tax but then people start calling me a commie. We are the only nation in the world that treats hospitals and patient care as a for profit enterprise and traded on exchanges.

        https://economix.blogs.nytimes.com/2009/01/23/how-do-hospitals-get-paid-a-primer/

      10. All that you say is true. It is a “well kept” secret. Medicine has always provided a good livelihood but it didn’t used to put physicians in top earning tiers. I fear its financial rewards have drawn some into the profession for the wrong reason.

      11. The reason physicians get paid roughly 180k/yr for hospitalists, 150k/yr or less for family practitioners, about 200-220/yr for emergency doctors, is partly due to school loans (they have higher interest rates on average), and factor in malpractice insurance-NOT CHEAP. My wife was an ER doc in Ohio, before we moved to New Zealand 4 years ago. Now, we can defninitely discuss why the hell cardiologists are able to make 500k-1mil/yr based on tons of unnecessary procedures, or orthopods giving in and just doing tons of meniscus repairs (https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/) But yes, being a doctor is financially rewarding. You know what isnt rewarding? The shit hours, the shit treatment from patients and administrators, the massive amount of responsibilities outside of work (aka “non-clinical hours”). And done even get me started on how criminally underpaid nurses are, even when we top out at 30-40 dollars an hour. Which leads me to a main point. Healthcare is a right AND a privilege. You have the right to healthcare, but not to our labour. You have the privilege of our expertise, which is paid for via our salary. Here’s the thing: hospitals arent restaurants; imagining heathcare as a market where things are bought and sold is ridiculous, if the doctor does not see the need for a specific treatment, and then the next three doctors tell you the same thing, maybe you need to stop wasting our time trying to get an unnecessary procedure/drug (all while taking up time that could have been spent on other patients). To enact universal healthcare, with healthcare as a right, we need to give the autonomy back to the physicians and providers. “The customer is always right” helped give us the opioid epidemic, time to maybe shift back the other way a bit. And yes I know I’m treading into the tort-reform waters, where but the brave few dare to venture 🙂

      12. Several members of my family + spouses are health care providers…anesthesiologists, dentist, RN, RN + admin, radiologists….They did have to spend a lot of money to get through college and med school. One of the biggest surprises my brother and his wife experienced (both anesthesiologists) was that upon choosing the town to set up practice, the banks were willing to loan them so much more money than they thought they’d get given the amount of combined student debt they had plus the home loan they were considering…Bank said: no problemma. Hours are crap, lifestyles (after debt paid off) very good for docs…as you noted, nurses never earned as much as they should. I have always felt that here is a place in education where government should heavily subsidize cost of schooling without repayment obligations unless it were tied to service in an area of great need. That would reduce student debt, meet physician shortage in critical areas (mostly rural) and keep docs from feeling they had to earn 6 figures just to survive.

        When we travelled in Europe, my husband’s cousin was a doctor in Italy and there doctors do well but not six figure incomes. In America, doctors expect to earn handsomely. They are being squeezed now between Medicaid, Medicare with absurdly low payments and insurance companies are follwoing suit. I don’t know where this goes but NZ sounds like a nice place to live while they work it all out (-;

      1. OV, speaking of health care, I get on the nerves of medical staff because I always insist on reading EVERYTHING and asking questions before I sign. If there’s something anywhere in the text that is not clear or not true or that I am not in agreement with, I refuse to sign.

        I don’t like the pressure to “just sign on the yellow-highlighted spaces.”

      1. Mary, I’m a little more open to universal health care than most of my conservative brethren (and sisters). That said, I have some concerns about the government setting the prices for health care.

        Government officials are notoriously known for catering to outside interests and lobbyists. I don’t trust them to make good decisions and the bureaucracy adds another layer of complications to an already complex system.

        Having lived in Venezuela, I’m not a fan of the government setting caps to the price of services. It drives people out of business when they can’t deliver a service or product at the set price.

        I’d really prefer a hybrid system where predatory pricing and practices are dealt with but there are still some market factors in play.

      2. Chris Ladd, 1/12/17:

        “There are two comments I’d like to add. First, I suspect that the general attachment to single payer on the left might have more to do with not understanding the options, rather than truly preferring single payer. And there really are a lot of options.

        Among the major European players and Canada, you really only get single payer in the UK and Canada. In a single-payer system, the state ends up owning the entire system. It amounts to full nationlization. That can work, but it is bulky and these systems seldom rank among the best either in terms of cost or results.

        Switzerland has a kind of modified version of the ACA. Germany Holland and France use a sort of hybrid, with private or semi-private insurance and private health care providers. Health insurance is funded through a combination of income and payroll taxes. Everyone gets what amounts to a voucher to purchase a policy, with deductibles and copays.

        It’s worthwhile to take a closer look at the structure of the French system in particular, since it is consistently regarded as the best in the world.

        https://en.wikipedia.org/wiki/Health_care_in_France

        Why can’t we have this, even at the level of a single state? For the obstacles you describe (which are real and substantial), this is probably the worst – Americans who have policies through employers today do not understand how much those policies cost, and they don’t even realize how much they are individually paying.

        Almost any potential universal health care plan would result in less out of pocket cost for the average family of four on an employer sponsored plan today. But when you start throwing around the numbers, people faint. You know what might fix this glitch? The repeal of the ACA and the implementation of a GOP plan.

        Most GOP plans would strip the employer tax deduction and replace it with a tax credit. Most version talk about a credit of something like $2500.

        My employer spends about $21K on my health plan. That’s a bit above the average, but not by much. Our deductibles run about $4000. Under the Republican plan, most employers would drop that plan altogether. I’d lose a 25,000 insurance policy that I previously got for $4000. Instead Republicans would give me and millions of current Republican voters a measly $2500 to go replace it.

        See what this might cause?

        Thing is, if they did that people would scream bloody murder. But you know what would come next? Massive public support for a properly-funded plan that would deliver adequate coverage levels. That could even happen at the state level, and it likely would. We would already have a system structured like the French system, just underfunded. All we would need is funding and we’d have millions of middle and upper income Americans screaming for that funding.

        The GOP is about to accidentally drop everyone who isn’t on Medicare into the same miserable sinking boat. This may break things wide open. Maybe. We’ll see.

      3. Mary, I think you and Chris are both wrong about single payer meaning that the state owns the entire system. In my mind, Medicare is a single payer, using private providers (doesn’t own the entire system, just pays bills). Alternatively, the VA is both the payer and the employer of providers and owner of the hospitals (owns the entire system).

      4. Creigh, we have a somewhat hybrid system in NZ, where the national govt funds regional District Health Boards who provide ER, ICU, most surgeries, rehab, in-home nursing care, social care, OT/PT, but then we also have private hospitals (Southern Cross is the biggest), priovate physiotherapy practices, even some private family doctors (these just dont take any govt funds, and have like 300$ co-pays, cater mainly to wealthy) . If you don’t feel like waiting to get your non-emergent hip replaced? With a bit out of pocket, as well as some private health insurance, you get it done privately. Our orthopedic surgeons have public and private practice, kind of a compromise with them. And they make huge amounts of money off this scheme. So there is a bit of the market factors that objv mentioned.

      5. Daniel, there is a trend in the US for doctors to utilize the “concierge” model of practicing health care. Fee for service – on monthly basis for “privilege” of being seen by this doctor. It takes many different forms, but fundamentally, it is for those who want/need a particular doctor who is not “in network”.

    2. First off, It seems we always confuse health insurance with healthcare costs. The two are obviously related but they are not the same thing. Obamacare has flattened out rising costs but I don’t think it was intended to be used for cost containment.

      Reducing actual healthcare costs can come from efficiency, but it may also mean reducing doctor’s pay and hospitals profit.

      IMO, the complicated pricing arises from having health insurance industry trying to maximize profits by getting in the middle of the patient/provider market.

      objv, wants the government to control gouging but not really cause the government always creates bad outcomes.

      It could come down to local governments to create fair markets for their constituents. (as some do) Cities and states could provide competitive services and information about those services that would lower prices.

      1. Another item in the health care cost issue is economic rent seeking, more simply known as monopolistic gouging. That is particularly true with pharmaceuticals. Recent examples are the steeply rising costs for anti-allergy injectors this last autumn. I forget the brand name right now. But the military had developed the basic technology for automatic injector devices way back in the 1950’s and 1960’s for use against chemical attacks. I was trained in the use. Of course, there have been improvements, but the reason the cost increased so much was rent seeking. The same is true of numerous other drugs. However, the pharmaceutical industry has prevailed upon Congress to severely limit the competition that they might face, by several means, including making it easier to extend patents.

        This rent seeking includes insurance companies, particularly in the individual market, hospitals, medical devices, etc. It is rampant throughout our health care cost structure.

      2. It extends to drug re-importation. Funny, Repubs are all in for selling insurance across state lines but they refuse to legalize re-importation drugs. Of course, spineless MoC have refused to stand up for the American public in this regard either. But, let’s build a $12B wall. And, defund NPR, because those things are….well one is important, the other is a liberal news mouthpiece so let’s get rid of it…

  14. With respect to the president’s unsecured phone . . . maybe that phone is just a red herring, a sort of burner phone, to serve as a distraction with those tweets, while he conducts the real business of the nation in secured privacy.

    I keep reading contradictory messages about our new president — criticized for being an open book and unsecured on the one hand, and suspected of conducting mysterious, clandestine meetings with the Russians on the other hand.

      1. Nope. No excuses. He’s been warned by the Intelligence community and others. The fact that he is exposing everyone who responds to his tweets or follows him and makes them vulnerable to hacking is of no concern.

        I lack technology skills but I do not lack common sense or concern for others. No excuses.

  15. I have been asked to attend a local government meeting tonight to speak in support of members of the Hispanic community (as one of 4 speakers) who oppose local law enforcement participation in the voluntary 287g provision of the Immigration and Nationality Act. Fear is rampart. Hispanic people are worried about neighbors, friends, children, personal investments in home and businesses, and the possibility of getting swept up in a process that offers vague rules for arrest and detention. I will post my experience tomorrow. My position will not validate the illegality of the undocumented, but to speak to the chaos, fear, costs, and conflict local law enforcement authorities will encounter if they decide to involve their agencies in this voluntary effort.

    At present, only 4 county or municipalities in TX are actively engaged with ICE in the 287g process. The promise by potus to hire 10K new ICE officers, 5K new deputies plus attendant staffing, is not accompanied by a defined cost in federal tax dollars and it certainly doesn’t include local expenses and difficulties which will range from housing, adjudication, assessment, equipment, deportation costs, etc. IOW, it’s one big fat BLANK CHECK.

    Meanwhile, how do these added duties impact law enforcement’s primary responsibilities to local residents and taxpayers? If resources are deployed in a massive immigration effort, what happens to “normal” criminal enforcement?

    How will our schools be affected? Will our teachers and principles be the next level of those pressured to turn in innocent children? What happens to these children that are DACA eligible with undocumented parents or those who were born in the US, are legal with undocumented parents? There are means to deal with all of these problems but in an atmosphere of hate, quotas, and dubious, broad, vague criteria, it is also a situation in which a great deal of harm will be done.

    The solution, of course, is comprehensive immigration reform. Just as with health care, the solution is comprehensive health coverage….it seems those who are elected and entrusted to address big issues are stuck in finding political short cuts that don’t solve the underlying problems, rather, they roil and exaccerbate it.

    More tomorrow. I have four minutes to make my comments and it took me longer to type this. I hope I can do justice to the gravity of the issue and those who are living in fear and concern. Laws need to be respected but why is it that all people are not held to the same standards of respect for the laws of our country?

    1. We recently had a meeting about this issue at my school. Undocumented children have rights to an education. Teachers are not permitted to ask about immigration status of their students or their families. I don’t know about administrators. Mostly I was told that students can not be apprehended at school.

      Here is something on the relevant law concerning undocumented students and education.
      https://www.americanimmigrationcouncil.org/research/plyler-v-doe-public-education-immigrant-students

      1. Right now schools and churches are off limits. For how long? And, if a child walks out the door of the school, what then? As I noted in my comments, the authorization is so broad as to give law enforcement and ICE agents (who are NOT police despite their use of this term to get many people to open doors to their homes…a legal challenge to that is in the works) the ability to act with the expectation that they are legally correct and the detainee ignorant or submissive in expressing their rights.

        Thanks for article. I’ve printed it out and it will accompany me tonight in case there are any questions in this regard. Unless I inspire some questions, I suspect the board will want me to stop speaking asap as this community is the hotbed of Tea Party activity. Let me just acknowledge that I will be speaking in a minority position – which is the story of my life. I’m used to doing so and totally unafraid to present a divergent pov. I recognize that I am not always right in my opinion, but I have always tried to stand up for what I believe and for fairness. This is one of those times.

      2. There are no protections from immigration authorities once a child leaves school. We were told that you may not know that a child comes from an undocumented family until they don’t show up for school one day.

        This stinks. Children who are US citizens can not petition for their parents to get citizenship until they turn 21. I don’t know what families in that situation do.

        http://immigration.lawyers.com/general-immigration/children-of-illegal-immigrants-fight-for-parents.html

      3. Those who haven’t read the detail in the new DHS guidelines, may not know that it authorizes the shift of ALL funds that are currently serving to counsel immigrants. The $ will be diverted to a program called “VOICE”. No details offered on accountability, dollar amount, etc. Another big fat blank check but this time for DHS ICE program….DHS is now the largest single agency in government. Think about that for a minute.

      1. Amen to that. I was amazed at the infrastructure of Pittsburgh when I moved here. The Obama stimulus caused a lot of repairs and rebuilding.(not political talk, just observation)

        We had a bridge that was falling apart and endangering people in traffic below. So we built a bridge under the real bridge to stop the falling bridge parts.

        It’s being replaced now.

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