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How the Republican Healthcare Mess Makes Sense

Edit: As of Friday afternoon, Sens. McCain (hard no) and Collins (somewhere shy of hard no) have announced opposition, stalling the measure. Let’s hope it stays that way, and that both parties can work on a real plan to improve the healthcare system.

The blade is not yet to the throat, nor the gun to the temple, but by next Friday (or maybe Saturday) America may be in the middle of its biggest hostage crisis of the modern age. The Republicans, in a greedlust for victory on healthcare, are sneaking up behind the country, ready to strike.

The bill, a stinker in a long line of stinkers, will be not a millstone around the GOP’s neck, but a tombstone at its feet, if it ever activates. But that’s not what it’s meant to be at all. This timebomb is DACA 2.0: meant to bend Democrats to the Republicans’ will. Under the president’s DACA order, the hostages are the dreamers. Under Graham-Cassidy, the hostages are the millions who will lose coverage obtained under the ACA.

The notion that the American people are subject to political violence is hardly new or surprising, but it is a heartless and despicable fact. The Republicans want massive wealthcare, but they also want to undo all the things in the ACA they cannot touch under reconciliation rules. This is not serious legislation at all, by any measure. It has not benefited from study or debate, or even from a full CBO score. Governors oppose it, all the medical associations and nonpartisan nonprofits say no.

The only thing that’s left is a hostage play. For the low, low price of 50 votes, the Senate Republicans can shove this mess back to the House, where if the Republicans there can decide to wax their mustaches, they will hold the threat of death over enough Americans that the Democrats will have to cave in. That will, they believe, let them pass a 60-vote bill in the Senate, which will be less insane than Graham-Cassidy, will let them do a victory lap for repealing Obamacare, and will still let them shove a bunch of money in the rich peoples’ pockets.

This sort of abuse is irredeemable. There are millions of people who are stressed and anxious, as hostages to the GOP. This is nothing short of protection racketeering by a major political party on behalf of the wealthy. This is organized crime.

And sadly, that’s the only way this mess of a bill makes sense. All civic-minded Republicans should reject any attempt to hold their countrymen as hostages for legislative ends. A vote for Graham-Cassidy is a vote for tyranny.

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Medicare for All Cometh

Senator Bernie Sanders of Vermont has introduced his much-touted Medicare-for-All bill with a good slate of cosponsors joining the effort. And it sets the opposition out to pick at the draft with calls of calamity.

There are those opposed on principle, but the most common criticism seems to have to do with cost, which is interesting in itself. Basically, if you aren’t opposed to the idea that everybody be covered, and be covered through a Medicare-style system, then all you have left is to say that we need to work out the details (or maintain, farcically, that no iteration can work).

Arguing that a Medicare system isn’t workable, period, doesn’t fly. Medicare itself is strong evidence that it is workable. Other countries have their own systems, too. Universal healthcare is entirely achievable.

Cost is the main target now. How to fund it, and are the benefits correct?

The benefits are possibly too generous, but not by a lot. They would be adjusted down in any serious negotiation to pass this bill. That would lower the costs, at least a little. But serious costs, the bulk, would remain.

To pay for this bill, or one like it, will require new revenues. Primarily, there will be new taxes imposed on some combination of employment and income. The tax increases will be offset by the reduction or elimination of individual and corporate costs for healthcare. There is a reasonable expectation that the tax burden will be less than the current burden of paying for healthcare, as there is widespread agreement that healthcare costs are artificially high.

People don’t want to pay taxes. That’s mostly a function of an anti-American narrative built by the right wing. ‘Taxation is theft,’ and other such nonsense. Taxation is debt. It is owed, not taken. Norquist doesn’t say to the restaurateur after his meal, ‘I want you to sign this pledge saying you’ll never adjust the cost of your food.’

More importantly, within the range of contemplatable taxes (i.e., up to the actual revenue needed to fund government), tax isn’t a problem. It’s a distortion in the minds of the wealthy that has led to such fear of taxes, even to the point where they are happy to overspend on a necessity like healthcare to avoid a lesser tax. That sort of distortion begs correction.

Given the inability of the Republican party to offer an alternative proposal that could even pretend to be universal, Medicare for All or some other system will happen. Taxes will be raised to pay for it. If the Republicans don’t like that, their only possible move is to formulate a state-level plan that ensures universal coverage. They will have to fight like hell, and with haste, to get it enacted in all 50 states before the Democrats have a chance to set up a national healthcare system. They will need to solve portability between states, too.

But they have run the clock out on not moving the nation to universal coverage.

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Hurricane Thoughts, 9 September 2017

Superfund and Climate Change

Apologies to federal officials that have had their brains altered so as not to be able to read the words “climate change.” The political correctness on the right has gone too far.

Now, with Hurricane Harvey’s impact on the Texas coast and in Houston, we have renewed insight to the vulnerability of toxic sites being impacted by natural disasters. We surely need to have the EPA prioritize cleanup of coastal sites, of which there are many given the economic gravity of the coastline in deciding where to live and work. As seas rise and as storm surges and tidal flooding become more common, we will see more disturbances of cleanup sites.

Self-Driving Evacuations

As self-driving cars are soon to become reality, and as the electric fleet model will likely dominate the space soon thereafter, there is a need to understand how evacuations and pricing and (battery) charging events will interact. That is, if the normal demand of a city is one car per six people, during an evacuation scenario it will need to become one per three, or whatever the ramp-up is.

In all likelihood, phased evacuations will be needed, with limited ranges and limited charge capacity on the grid. Ground-zero evacuees will be shuttled up to zone-one, and one-to-two, etc. Meanwhile, a flow of excess vehicles from surrounding states will be flowing in to continue moving individuals away from the disaster.

All of this needs to happen as orderly as possible, and it needs to be lotterial, so all in risk areas have equal chance if the number of seats is too low to accommodate demand. In the near-term, pop-up traffic lights could be deployed as drones with some of the existing vehicle-vision technologies to places without existing lights.

The delivery-first commerce model will require other adjustments for the delivery of water and other preparedness items prior to a storm for those not being evacuated.

Social Rescue Communications

One of the stories that kept appearing during and after Harvey was the use of various social platforms to report and organize rescue needs. There needs to be more integration of social sites, or some better way for rescuers and dispatchers to cover the whole spread of such sites, to ensure that signals aren’t getting lost because of fragmentation in that space. Nobody should be left unrescued simply because they didn’t use the right social media platform.

The key issue there is likely portability across platforms. The ability to easily take a post from one site and relay it to the dispatcher or rescuer on another service with full information and return-contact ability needs to happen. Included in that would also be some requirement that sites not block unregistered or off-platform access (while maybe not requiring they specifically accommodate it). If you don’t have a smartphone, but have a laptop, and there’s important information on a smartphone-only service, that could be a real bummer. Sites need to recognize those situations.

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Flood Insurance Shouldn’t Be Political

There are a number of government-sponsored enterprises, government-chartered corporations, and government-owned corporations, such as Fannie Mae, the Corporation for Public Broadcasting, and the Tennessee Valley Authority.

The flood insurance program should be arranged as either a government-sponsored enterprise or a government-chartered corporation. The updating of maps and the adjustment of premiums should not be subject to political whims, as there is a proven record of moral hazard in failing to adjust the risk ratings to what exists in the real world.

States should have a role in funding the program that covers their state, with a choice between property taxes, real estate sales tax, a rake on mortgage payments, or other mechanisms.

Under the current regime, the program gives a false sense of security. Many at-risk properties without coverage, many more that aren’t paying according to their real risks. Without truthful premium costs, the market gets a distorted risk signal, knowing the federal government will pay for municipalities’ and states’ messes. Sound familiar?

The political environment makes risk adjustment difficult. Nobody wants to pay more, but they want flood protection. If the program is private, the owners want to ensure they are keeping liabilities in check, so they will keep premiums rising with risks. Specifically, if the lenders are on the hook for underinsured properties that are damaged, they will demand proper insurance.

Similar moves should be made for other issues that should be outside of political tampering, such as the gas tax and vehicle efficiency standards, drug price negotiations for public healthcare programs, and other similar budgetary matters. If these various measures require a waiver process, that’s fine, but generally firms and individuals should pay what’s required for the efficient operation of the system as designed.

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Please Leave Enough Time to Override a Veto

The debt ceiling and the continuing resolution votes coming up should be passed with at least 11 days to spare. In the past, these votes have been done at the last minute, but Congress should leave nothing to chance here.

Under the Constitution, the president could sit on a bill for at least 11 days (ten, but they excepted Sundays) before issuing a veto (any longer and it automatically becomes law). While the president would probably sign either bill at the last minute, if McConnell and Ryan give him the chance, he might just screw it up.

The debt ceiling is the bigger deal here, though both matter. But in both cases, what should have been handled well before hand has been put off to the last minute. In both cases, there are efforts to try to leverage political gains out of what should be the most basic, no-nonsense acts of government.

But, worse, we have a president who appears unstable enough to stick a pinky on the corner of his mouth and fire guns at the feet of the legislature, telling them to dance and build his wall and whatever other villain cliches might be on hand at the time.

If the legislature puts the debt bill on the president’s desk in time, and he fails to sign it, causing any default, he would be impeached and likely removed for it. But the damage would be done. The fiscal reputation of the country would be harmed in a way that is not easily repaired.

It’s an easy call to make. Pass the bill early. If President Trump doesn’t sign it, override his veto. It’s the least the government can do for its people.

The continuing resolution to fund the government and keep it open is a similar story, though thankfully the only people directly harmed by a shutdown would be millions of workers and not the very fabric of the international financial order. So, no big deal, right? Just get the bill done. No gimmicks. Clean bill, with a plan to override any veto.

There is about a month left to get both done. If you want to do tax reform, then get these out of the way quickly.