I remember the Cuban missile crisis of 1962. I didn’t take the danger of nuclear war seriously at the time because I understood that neither President Kennedy nor Soviet Premier Nikita Khrushchev were crazy enough to start one. What I didn’t understand was how easily things could get out of control.
A contributor to the alternate history web log wrote an interesting speculation as to what might have happened if a few things had gone otherwise than as they did—a U-2 plane shot down over Cuba, a Soviet submarine commander who thought he was under attack firing his nuclear missile.
The writer is well-informed about U.S. and Soviet capabilities, positioning of armed forces and likely military strategies. He presents a convincing account of what a nuclear war would have been like and what the aftermath would have been.
Yes, the USA could have “won” a nuclear exchange. More of us Americans would have survived than those on the other side. I don’t think the Chinese would have escaped unscathed as the writer assumes. Daniel Ellsberg’s book tells us that the U.S. nuclear strategy, in the event of war, was to obliterate the USSR and China both.
All too many people make light of the risks of going to the brink of nuclear war. They say it hasn’t happened yet. Yes, but it only needs to happen once.
When I visit someone for the first time, I always sneak a look at the person’s bookshelf. It’s one way of getting to know them.
Frederick Douglass, the great African-American freedom fighter, had a library of thousands of books. A blogger named Julian Abagond listed some of the highlights. Particular favorites, according to Abagond, included The Colombia Orator, a textbook on public speaking with selections from great speeches, and the Bible, the works of Shakespeare, the poetry of Robert Burns and Charles Dickens’ Bleak House.
Douglass of course owned and read works by and about black people and their history, struggles and achievements, but his interests were wide-ranging and included history, politics, literature and science. The National Park Service has the complete list.
He had no formal schooling whatever. As a slave, he was not supposed to learn to read. He did it on the sly, by paying a white boy to teach him his ABCs. He went on from there to educate himself. He associated on equal terms with some of the leading intellectuals of his time.
Rod Dreher, a leading conservative Christian writer, wrote a moving article on the sacrifices required to be a good husband or wife, and a good parent. He drew on the Kenny Rogers country-and-western song, “Lucille”; the movie, “The Secret Life of Dentists”; and an article by Atlantic senior editor Honor Jones about why she divorced her loving husband and father of her children in order to live for herself.
It’s often said that science fiction is not so much a forecast of the future as a mirror of concerns about the times in which it is written. That is most certainly true of Cory Doctorow’s new book, RADICALIZED: Four tales of our present moment.
The title story is the most powerful and disturbing of the four. It is about an on-line community of men who’ve been denied, or whose loved-ones have been denied, insurance coverage for treatable cancer, and who, one by one, decide to take revenge.
The first engages in a suicide bombing at a Blue Cross / Blue Shield office to avenge the death of his six-year-old daughter. The second is a widower who kills a Senator who ran in a platform of health care for all, then voted against Medicare expansion.
The third is the elderly moderator of the forum, who has been subtly encouraging the bombings and killings. He wheels his wheelchair into the middle of a health insurance conference at a Sheraton before setting off a home-made bomb that blows away himself and a sizable percentage of the guests.
Their objective is not just revenge, but health care reform. They think that the power of fear may be enough to overcome the power of money.
Joe, the protagonist, joined the on-line forum when he was in despair about his wife not being able to get an “experimental” treatment that would cure her breast cancer. She turns out to be a lucky one who has a spontaneous remission, but he stays on the forum, arguing against suicide and violence on private lines
He realizes that he is guilty of a crime simply by being aware that crimes are being planned and not reporting it to the police. But he can’t bring himself to do this.
“Health care terrorism” spreads. There’s more security at HMO and insurance company offices than at airports. People who are denied insurance claims are put on terrorist watch lists. But bombings and killings continue. And Joe realizes it’s only a matter of time before Homeland Security catches up with him.
The conclusion is that a lot of people, including bystanders, have been killed, but Congress has enacted something called Americare. Joe’s wife, visiting him in prison, remarks, “Who says violence doesn’t solve anything?“
What would the U.S. unemployment rate be if all useless or harmful jobs were eliminated?
It would probably be equivalent to the Great Depression of the 1930s.
Barack Obama, in an interview in 2006, stated the problem:
“I don’t think in ideological terms. I never have. … Everybody who supports single-payer healthcare says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents 1 million, 2 million, 3 million jobs of people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”
David Graeber, in his new book, Bullshit Jobs: a Theory, quoted public opinion polls that found 37 percent of UK employees and 40 percent in the Netherlands thought their jobs made no meaningful contribution to the world.
Now maybe that is exaggerated. Maybe some of them think they make a contribution, but that it’s not “meaningful.”
Offsetting this, the inherent bias of people is to think we are accomplishing more than other people think we do or the objective facts indicate.
For example, public relations, advertising, lobbying, consulting and even speculation on financial and commodities markets have their uses. It is just that they play more of a role in the economy than they should.
I myself think the U.S. military and intelligence services are much greater than necessary to protect the homeland from attack. Of course, if the mission is to make the United States the world’s only superpower, no number could be great enough.
The question is: What would happen if all these people were thrown on the job market, all at once?
It would be a catastrophe, unless there were some sort of basic income guarantee (which Graeber advocates) or basic job guarantee.
Two Democrats—Senator Bernie Sanders [1] of Vermont and Rep. John Conyers of Michigan—have proposed bills to do something that President Donald Trump promised to do, but can’t and won’t do.
That is, they would repeal and replace Obamacare with something better.
I applaud what they’re doing, and I think Sanders deserves credit for making universal health care politically possible.
Tom Price
I don’t think Sanders or Conyers can get their bills through Congress at the present time, and I think President Trump would veto them if they did.
But under both the Sanders and Conyers bills, he would appoint the administrators of the new program, and, under the Sanders bill,
The Secretary is … directed to develop policies, procedures, guidelines, and requirements related to eligibility, enrollment, benefits, provider participation standards and qualifications, levels of funding, provider payment rates, medical necessity standards, planning for capital expenditures and health professional education, and regional planning mechanisms.
I’m pretty sure that neither Sanders nor Conyers intends to give Secretary Price the power to sabotage and discredit their plans. Their proposals are talking points to rally support for universal health care and encourage thinking about how to make their bills better.
Obamacare is a flawed system. It gives for-profit insurance companies a captive market. It fines people for not buying insurance that they can’t afford, or that does them no good because of the large co-pays.
It is more expensive than the obvious alternative, which is a single-payer system, otherwise known as Medicare for all.
But the Congressional Republicans reject the obvious alternative. What they’ve come up with is worse.
This chart is based on estimates by health researchers as to how many people die each year as a result of lack of health insurance, plus estimated by the Congressional Budget Office of how many people will be uninsured under the House Republicans’ American Health Care Act versus the Democrats’ Affordable Care Act.
It’s a cumulative chart. The estimated number of deaths are the same year by year.
The Republicans have a 52 to 48 majority, so they have the power to force through their plan. We the public don’t know what it is going to be, but, in order to be reconcilable with the House bill, it will include denying government health care benefits to millions of people in order to enable tax cuts for the very rich.
So the public loses a program that, despite its many flaws, has saved lives in return for the increased possibility of war with Russia.
Reports of a deal may be false or exaggerated and, if there is a deal, not all Democrats may be on board with it.
But it is an indisputable fact that the Democratic leadership in Congress is putting much more energy into investigation, so far fruitless, of Trump’s ties with Russia than into opposing the Republican political agenda.
I hadn’t realized that more Americans are enrolled in Medicaid, the health-insurance program for low-income Americans, than in Social Security, Medicare or any other federal benefits program.
And the increase in the number of Americans with health insurance under Obamacare—the Affordable Care Act—is due more to the expansion of Medicaid than to signups of people under the health insurance exchanges.
But Senate and House Republicans have reportedly agreed on a plan to dial back the Medicaid expansion.
Kevin Drum of Mother Jones reported that there are 68 million Medicaid enrollees, making it a bigger program than Social Security (61 million), Medicare (55 million), food stamps (44 million), unemployment insurance (6 million at the height of the recession), the earned income tax credit (26 million) and temporary aid to needy families (about 4 million).
Medicaid was created to provide health insurance for Americans earning poverty-level wages. Under Obamacare, eligibility was increased to Americans earning 138 percent of a poverty wage. This would be $16,394 for an adult, according to CNBC News.
The program is administered by state governments. President Obama’s plan pays states nearly all the costs added by the expanded plan, and then a progressively lesser amount sliding down to 90 percent. The Supreme Court ruled that state governments cannot be compelled to accept the expanded plan, and 19 state governments, all with Republican governors, opted out.
CNBC reporter Dan Mangan reported that Medicaid has added 15 million enrollees since Obamacare went into effect, a figure which includes some people who would have been eligible under the old rules. That’s nearly 4 million more than signed up for health insurance under the Obamacare exchanges.
I came across a 2015 study by The Commonwealth Fund that shows the Americans spend more on health care, use more medical technology and take more prescription drugs than citizens of most peer nations, but aren’t necessarily more healthy.
We’re not the worst in this respect, but we’re far from the best.
The charts above and below tell the story. I doubt things have changed much since 2013.
Americans pay more for medical care than citizens of other advanced nations, and get less in return. Our health outcomes are worse. So far as I can tell, enactment of the Affordable Care Act in 2010 hasn’t changed this.
Health care spending per person
United Kingdom, $4,003
France, $4,407
Canada, $4,607
Germany, $5,267
United States, $9,451
Percentage of population without medical insurance
United Kingdom, 0.0%
Canada, 0.0%
France, 0.1%
Germany, 0.2%
United States, 9.1%
What patients pay to see a doctor
United Kingdom, free
Canada, free
Germany, $5 – $11
France, $25, most of which is reimbursed later
United States, $30 to $200, depending on insurance
President Donald Trump, in his first day in office, issued an executive order to cripple the administration of the Affordable Care Act.
The order (1) forbids administrators to issue any new order or regulation that imposes new costs on states and (2) authorizes administrators to suspend any order or regulation that imposes undue costs on individuals or states.
The limitations are that the change has to be permitted by law and that there have to be advance note and public comment on the changes if the law requires it.
That may sound relatively harmless, but the ACA is so complicated that it is hard to make it work and easy to make it cease functioning—like removing a couple of bolts from a highly complex machine.
Here are some of the things reporters said could happen under Trump’s executive order:
Delay indefinitely enforcement of all the individual and state mandates to buy or provide health insurance.
Expand hardship exemptions under the individual requirement to buy health insurance so that they cover virtually everybody.
Extend the option of state governments to approve health insurance plans that don’t meet all the requirements of the ACA, including refusal to refuse insurance to people with pre-existing conditions.
Another thing the Trump administration could do is to stop defending a lawsuit by the House of Representatives challenging the legality of a program to reimburse insurers for providing subsidies for low-income patients. The program was authorized by law, but no money was ever specifically appropriated for it. The U.S. District Court agreed the program is illegal; the case is now on appeal to the U.S. Court of Appeals.
Update 1/19/2017. It seems that in fact the Congressional Republicans do have an alternative of sorts to Obamacare. A link has been added to this article.
The top video from Vox is about Kathy Oller, who lives in southeastern Kentucky and has a job signing people up for the Affordable Care Act. It tells why many people in her area think the cost of the ACA is too high, and why they voted for Donald Trump.
The bottom video is about an interview of President Barack Obama by Vox reporters on the topic of health care. Kathy Oller came along. Her question to President Obama and his answer begin at the 37th minute and take about eight minutes.
President Obama is right in saying Republican leaders are irresponsible in proposing to repeal the ACA without having a replacement plan in place, and in challenging them to come up with a better plan.
It’s apparent that the Republican leadership doesn’t have such a plan..
Speaker of the House Paul Ryan will try again to privatize Medicare.
President-elect Donald Trump said during the campaign that he will protect Medicare as it is.
Speaker Paul Ryan
But Ryan doesn’t seem to expect a fight with Trump. Why not? Does he have reason to believe that Trump didn’t mean what he said? Reporters need to press Trump to declare where he stands.
Grass-roots advocates should not stand by idly and assume the Democrats in Congress will defend Medicare. They should be letting their congressional representatives and Senators know that tampering with Medicare is unacceptable.
I give Ryan and the Tea Party Republicans credit. They never give up pushing for their goals. They take ideas that seem radical and make them mainstream.
And they strike when the iron is hot! They never hesitate to use whatever power they have to advance their agenda.
Liberals and progressives can learn from their example. Instead of just passively trying to preserve Medicare and also Obamacare as they are, they should be demanding a Medicare-for-all system to replace Obamacare.
A blogger named Charles Gaba has figured out that, under Obamacare, slightly over 294 million Americans now have health insurance, but 29 million are still without—about 9 percent of the population.
The striking thing to me is how much work he had to do to come up with a plausible estimate. I would have thought that the U.S. Department of Health and Human Services had that figure on a web site somewhere.
I would have thought that, in general, President Obama would do more to ensure careful management of his signature reform, given how complicated it is and given how determined his Republican political enemies are to make it fail.
Click on Charles Gaba’s Blog for a detailed breakdown of the figures and an explanation of how he arrived at them, and a larger, higher-resolution version of the chart.
At the start of 1993, the newly-elected President Bill Clinton appointed his wife, Hillary, as head of his Task Force on Health Care Reform.
Rep. Bernie Sanders of Vermont, the lone socialist in Congress, advocated a single-payer health insurance system—basically, Medicare for everyone, as in Canada.
Hillary Clinton in 1993
In February, Sanders requested a meeting with Hillary, “to bring in two Harvard Medical School physicians who have written on the Canadian system,” according to the records of the administration’s task force. Those physicians were Stephanie Woolhandler and David Himmelstein, leading advocates for single-payer health care.
They got their meeting at the White House that month, and the two doctors laid out the case for single-payer to the first lady.
“She said, ‘You make a convincing case, but is there any force on the face of the earth that could counter the hundreds of millions of the dollars the insurance industry would spend fighting that?’” recalled Himmelstein.
“And I said, “How about the president of the United States actually leading the American people?’ and she said, ‘Tell me something real.’ ”
Political reporter Ben Schreckinger said Sanders got the brush-off, the Clinton administration introduced a complicated plan limited to altering the existing health insurance system, the health insurance industry fought it anyhow, and the plan went down to defeat.
When the Affordable Care Act was enacted five years ago, I was aware of its flaws, but I thought it represented an advance over what we had before.
Obamacare did give access to health insurance to millions of Americans, including people with pre-existing conditions, who otherwise wouldn’t have been able to get it. The tradeoff was that it created a captive market for the health insurance companies to provide bad insurance.
My e-mail pen pal Bill Harvey sent me a link to an article by a Dr. John P. Geyman for the International Journal of Health Services which, in my opinion, sums up the problems with Obamacare very well.
Health care “reform” through the ACA was framed and hijacked by corporate stakeholders.
You can’t contain health care costs by permitting for-profit health care industries to pursue their business “ethic” in a deregulated marketplace.
You can’t reform the delivery system without reforming the financing system.
The private health insurance industry does not offer enough value to be bailed out by the government.
In order to achieve the most efficient health insurance coverage, we need the largest possible risk pool to spread risks and avoid adverse selection.
Dr. Geyman thinks the answer is a single-payer health system, financed by taxes which covers everyone. Such a system would be cheaper for most people than a private system because it simplifies administration and subtracts the need for profit.
One reason why such a system wasn’t considered in 2010, in addition to the entrenched power of pharmaceutical and health insurance lobbyists, was that many Americans were satisfied with their existing insurance and didn’t want to risk an unknown system.
Now private insurance has changed for the worse for most people. Unfortunately, it will be very natural for people to see the inadequacies of Obamacare as an argument against any government health insurance plan at all.
Many social welfare programs fail. The Obama administration has identified some that succeed. While this does not change my unfavorable opinion of the President’s policies overall, I think he is entitled to credit for having this research done.
Between 1974 and 1979, the small city of Dauphin, Manitoba, guaranteed all residents a basic income—employed or not, able to work or not. What was the ultimate outcome of this radical experiment? Nobody ever bothered to check and find out.
Georgia and Wisconsin are the latest American states to discover that a Third World economic strategy—low wages, low taxes, low services and low regulation—is not a successful formula for creating jobs and promoting economic growth.
Vermont Governor Peter Shumlin announced that he has given up on a plan to introduce a single-payer medical insurance plan—Medicare for everbody—by 2017.
The plan, known as Green Mountain Care, would have cost too much in payroll taxes and would not have generated big savings in medical and insurance costs, he said.
I don’t think the Affordable Care Act is satisfactory, and I would have liked to see Vermont prove that single-payer is a workable alternative by launching it successfully on the state level.
Maybe I’m wrong. Maybe single-payer, despite the success of Medicare-for-all in Canada, isn’t feasible in the USA. But I hate to think that Obamacare is the best we Americans can do.
Can a party philosophically defined by Fox News win millennial voters and the electorate of the future? Daniel McCarthy wrote that they can win only if there’s no-one well organized enough to complete with them.
The well-oiled machinery of movement conservatism remains in the hands of those who think the only trouble with George W. Bush is that he didn’t go far enough, McCarthy wrote.
Election of a Republican majority in the Senate means no possibility of agreement with Iran on nuclear weapons and fighting ISIS, no possibility of agreement with Russia on Ukraine and Middle East issues, and no possibility of action of climate change.
On the brighter side, Republicans, out of spite, will probably the Trans Pacific Partnership agreement, with its investor-state provisions to block environmental and financial regulation. The one thing the GOP and Obama administration will agree on is the so-called global war on terror.
China, which is excluded from the proposed Trans Pacific Partnership agreement, will launch a Free Trade Area of the Asia Pacific agreement as an alternative. All 21 members of the Asia Pacific Economic Cooperation group will be eligible to join.
Vladimir Putin is right to insist on the rule of law in international affairs for everyone, including the United States. The fact that the rule of law is not observed in Russia’s internal affairs is a separate question.
The Hospital’s Duty of Care by Greg Pond for MRSA Topic, a blog devoted to infectious disease. (Hat tip to Mike the Mad Biologist)
About 8,000 Canadians die every year of hospital-acquired infections. That’s because physicians and nurses are too under-staffed and over-worked to have time to wash their hands after every interaction with patients. I’m sure that U.S. hospitals are no better. This is a much more serious public health threat to North Americans, at this point, than Ebola.
I’ve long been of two minds about Obamacare. Sometimes I think it is a complete mess and sometimes I think that, despite its complexity and obvious flaws, it will be of net benefit to the American public.
There is one group of people who’ve made up their minds about it, and that is the Republicans who are determined to prevent implementation of the Affordable Care Act by any means necessary.
If they believed the law is as terrible as they say they do, the smart political strategy would be to allow the law to go into effect, allow the public to see how bad it is and then move to repeal or amend.
The only explanation is that they don’t dare let this happen because they think that, once Americans experience the new law in operation, they will embrace it and vote for Democrats forevermore in gratitude.
Rich people on average live longer than poor people, for many reasons. On average, they grow up in less toxic environments, they lead less stressful lives, they have more time to devote to exercise and they have better choices about diet.
Life expectancy overall is increasing, and 80-somethings such as movie director Clint Eastwood and Senator Dianne Feinstein as active and productive as people in previous generations who were 20 years younger.
But for certain segments of the population—white people who haven’t completed high school, for example—life expectancy is actually dropping.
Linda Marsa, writing in Aeron magazine, describes longevity research that may widen the life gap between rich and poor. Scientists are studying the genetic basis of aging with a view to using genetic material to slow down or actually reverse the process of aging. These treatments will be expensive, at least to begin with, and unavailable to those who can’t pay.
Science fiction writers have already explored the implications of this. Frederik Pohl, in his short story, “The Merchants of Venus” (1972) and novel Gateway (1977). described a society in which life could be prolonged almost indefinitely but only for those who can afford to pay. The protagonist of “The Merchants of Venus” has a bad liver, and is trying to make enough money to buy a transplant before it goes bad. Talk about living paycheck to paycheck!
The alternative to allocating scarce medical resources on the basis of money is to allocate them on the basis of merit. That is the situation in Bruce Sterling’s Holy Fire (1996).The 94-year-old protagonist is granted access to life extension technology on the basis of good health habits (she has little sympathy for her ex-husband, an addicted cigarette smoker) and her positive contribution to society, which consists of serving on boards and commissions having to do with health care policy.
She is allowed to participate in a clinical trial of a drug that supposedly will restore youth, but the drug affects her mind and she breaks with her cautious life. At the end, she loses her privileges and comes to terms with mortality.
I’m not attracted by either alternative, but I don’t have a better one. If something is scarce, then by definition it can’t be provided to everyone. And maybe over time the medical treatments available only to the rich, or to people with good connections to the medical research establishment, will become available to everyone.
Individual Americans are losing their right to sue large corporations by means of “terms of service” contracts that customers and employees are required to sign as a condition of doing business. By signing these contracts, individuals give up their right to take their complaints to a judge and jury and instead agree to abide by the decision of a corporate-friendly arbitrator.
Corporations have been complaining for years about the burden of litigation, and, back in the day, I fell for this. But even then, the courts were busier with lawsuits by corporations against each other than they were lawsuits by individuals or by class-action suits.
Owners and managers of corporations already have a privilege denied to ordinary citizens, which is limited liability for their debts and fines. We are getting far beyond the question of whether corporate entities have the same rights as individuals. By means of this 21st century version of the “yellow-dog contract,” they are becoming mini-governments.
When Bill Clinton ran for President in 1992, he ran as the advocate of working people against the corporate interests who didn’t play by the rules. What we got was Ronald Reagan with some of the sharp edges filed off. As Thomas Frank wrote in Salon today, the Clinton Presidency was an era of corporate mergers, financial deregulation, downsizing of government and NAFTA
That’s what we’re likely to get from a Hillary Clinton presidency, too. She voices the same populist rhetoric and has the same corporate allegiances.
How committed are we Americans to democracy? A Gallup poll indicates a “no confidence” vote in the institutions of democracy. The institution in which Americans have the most confidence (74%) is the military and the one in which we have the least confidence is Congress (7%). A majority lack confidence in the Presidency and the Supreme Court, but they have confidence in the police.
If I didn’t know better, I’d take that for a poll of Italians just prior to Mussolini’s march on Rome.
If the U.S. spending per person for medical care were the same as a typical industrial nation, our annual health care budget would be more than $1 trillion less. That’s the equivalent to the gross domestic product of Spain, out of which a nation of 47 million people feed, clothe, shelter, educate and amuse themselves, and, yes, also provide medical care.
Employers have brought a case before the U.S. Supreme Court claiming a religious conscientious objection to the provision of the Affordable Care Act requiring them to provide health insurance that covers contraception. What they’re claiming, as I see it, that religious freedom includes the right to refuse to do business with sinners.
The general rule is that there is no right of religious exemption from laws for the benefit of the general public that apply to everyone equally. Nevertheless, there is a tradition in the United States of bending over backwards to accommodate individuals with sincere religious beliefs, from allowing religious conscientious objection to military service to exempting Seventh Day Adventists from Sunday closing laws.
I think this is a good tradition, as it applies to individuals. I don’t think, for example, that the right of gay people to marry includes the right to do business with a florist or wedding photographer who thinks homosexuality is sinful.
Corporations are a different matter. Corporations are not human beings. They are soulless artificial constructs whose supposed personhood is a legal formality. How, then, can a corporation have religious scruples? Why do the managers of a corporation have any more right to impose their private views on their employees than do the managers of a state Department of Motor Vehicles?
The order (1) forbids administrators to issue any new order or regulation that imposes new costs on states and (2) authorizes administrators to suspend any order or regulation that imposes undue costs on individuals or states.
Phil Ebersole's Blog 