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society

The 115th’s First Week

The mommy and daddy legislators packed lunches in leather backpacks and carted the rugrats to the Capitol. There was crying and separation anxiety and some had to change their pants after wetting themselves. Ah, they grow up so fast.

The Ethics Reform Ironies

Although they quickly backtracked, the House tried to gut ethics reform. The debacle highlighted how hypocritical and tone-deaf the legislators truly are. They had the gall to complain about their treatment at the hands of independent oversight, while they continue to ignore the plight of indigent defendants in criminal courts and civil courts throughout the country. Moreover, the Republican members gladly hounded the executive-branch with oversight attacks without a second thought to issues like due process or press overreach.

Meanwhile, folks called about it, then Trump tweeted against it, and then it went away. But for all the folks dealing with a case against them that can’t afford proper representation, Trump is silent and the House is making no first-day efforts to ease their burdens.

Does Trump deserve credit for being outraged with everybody else? Sure. Good job. But he also said the office was unfair, suggesting it needs reform. Again, fine. But what about criminal justice reform, specifically ensuring all defendants have access to equal justice and due process? Even the media hasn’t connected those dots, much less Trump. I’ll be waiting for Trump’s tweet about that.

Go ahead, reform the guard dogs at the Capitol. But you damn well better fix the other guard dogs while you’re at it.

Repeal and Retire to Be a Lobbyist?

The efforts to repeal the Affordable Care Act are underway, with the Senate clearing their hurdles and committees gearing up to write reconciliation language that will gut the health insurance law. A replacement will likely be left for future members of congress, as it seems reasonable that the current crop will run to the refuge of lobbying jobs as soon as possible upon recognition that replacing the law (or even finishing a repeal) is a task they are not suited for.

Trump Uproots Ambassadors’ Families, but Not His Own

As has been widely covered, Trump’s wife and his youngest male heir will remain where they currently reside while Trump moves to the capital, but now we know he doesn’t offer the same courtesy to the families of ambassadors who may not be replaced for months. Hip-hip-hypocrisy! (Though the common misspelling, hypocracy, might actually fit in this case.)

Cutting Peoples’ Healthcare to Pay for the Wall

Republicans and the Trump administration are planning to re-fund a dusty plan from the Bush years to build hundreds of miles of barriers along the southern border. The money they are cutting from health care is basically going to be redirected to build the wall. They are robbing Peter of healthcare to pay for a wall to keep Pablo out.

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society

A Spooky Obamacare Post

It’s that time of year again. The blood, the guts, the candle-lit theramin music… the open enrollment period for Obamacare is nearly here.

Premiums are up, again, somewhat steeper. Insurers have cut back or dropped from some markets. The Republicans are painting this as the dire predictions come true. But you can contrast their alternative at abetterway.speaker.gov which should probably be called “a bettor’s way”—they are betting that you’ll take them at their word that they’ve cracked the code for making healthcare work for the country rather than the country working to afford healthcare.

Getting into the bog means facing down the swamp monsters of things like age-rating. Plainly, should older people be able to be charged 3× or 5× what younger are? In practical terms that’s likely a difference of at least $500/month or $6000/year…. Obamacare says 3×, while the GOP says five by default and let the states do whatever they want (Do I hear 50×? 100×?). Their argument is that limiting the gap raises premiums for young people.

But the whole argument is fucking stupid, on both sides. You simply cannot charge older people an arm and a leg to fix their arm and their leg. And charging young people a ton is equally batty. (Caveat: in both cases, means testing should be employed such that poor people pay little and wealthy people pay more.) In other words, the main issue is cost of healthcare, and neither the GOP’s plan nor Obamacare do enough to directly address the cost issue.

The GOP’s plan makes other major strategic errors, such as a one-time open enrollment, which damns the laggards to a future without what they term “continuous coverage protections” (the idea that a new, major health problem can’t skyrocket your premiums) and automatically higher premiums when they do sign up. They’re basically lining up a whole class of people to be taken for a ride by insurers here.


What do people want? Healthcare at an affordable price. What does Obamacare deliver? Healthcare that’s affordable to the rich and the subsidized, semi-affordable to the young, to those in some luckier states, and to those who have employer-based coverage. What does the GOP plan deliver? Basically the same, with some musical chairs on who’s getting fucked over. But basically the same.

Neither party is doing anything about the real monster in this film: cost. The lobbies (minions of the monster) for hospitals, doctors, drugs, et al. are too mighty for these extras to tackle. We’re awaiting the hero of the film to slay them, and then take the monster on for the grand finale. And we’ll still be waiting in 50 years, because our planet is fresh out of heroes.

How do you tackle costs?

  1. End fee for service. Current medical billing in the USA is based around the idea that every action taken in a hospital is profit for the hospital. Every pill, every bedpan, all of it is billable. And therefore, it all must be tracked for billing purposes (it ought be tracked for scientific reasons, but that’s a different story).
  2. Stop subsidizing the global pharmaceutical industry. The USA pays premium prices for drugs while the rest of the world pays far less. Effectively, the USA is subsidizing the rest of the world (or just giving massive profit to pharma for nothing). End that. We should pay our fair share, but not more (unless it’s formally negotiated in our treaties for other tangible benefits).
  3. Require providers and insurance companies to publish the cost to the consumer if they lived in other countries. Let people know how badly they’re getting screwed every time they go to the doctor or pay their premiums. (This might be doable in another way: by having foreigners create a searchable database of conditions/treatments that US consumers could look up and see the prices. But having it on the bill would work better.)
  4. End employer-based coverage (including in union contracts). Portability laws are a bandaid over a system that obfuscates value in employment, causes undue labor loyalty, invites corruption, and so on. Workers deserve to be paid in real money, and never in trade for economic decisions they ought to make for themselves (i.e., the decision itself has an economic value that is not represented in the value of the health care).
  5. Invest in automation and allowing non-MDs to provide more care. Both of these will probably do a lot in the future, but it will take time for them to kick in.
Categories
society

Healthcare.gov’s Identity Problem

Identity management poses the most important and most striking problem for the new healthcare exchange site. Identity management remains one of the great, unsolved issues of our times and uniquely displays the anti-capitalist postures of some of the biggest technology businesses that exist.

That something as basic to any and every service as identity remains a closely guarded commodity shows that many major companies do not wish to compete on an even playing field. They would rather draw straws amongst themselves for the userbase pie, based on lock-in and turf wars, than to actually free their own markets. But while that general malignance runs rampant throughout virtually every industry, why in gods’ names should it infect government projects?

Indeed, inevitably the government will create a single sign-on or other universal identity mechanism for its Internet services. But in the meantime we all suffer. Everyone includes the government, with all of the bad press the new website received post-shutdown. Finger-pointing from the contractors, calls for resignations, and general what-the-fuckery from most of the attempted users of the site.

But a rough guess would get you the answer that at least half of the problems with the site center on identity when you include:

  • The initial sign-up process (username, password, e-mail verification)
  • The identity verification process (document submission, phone verification integration)
  • Family member and employee identification process

The site, like any government services site, relies on identity for so much of what it does. Handing off to other databases for things like subsidy requirement verification and other eligibility requirements.

A whole swath of inefficiency in government, much less in this one site, vanishes if the government merely gets its identity house in order.

But instead the government pays a high premium to build a monstrosity. Of course, that same argument bears against the Affordable Care Act itself with equal keenness (that a simpler system like single-payer would have saved far more money and woe both in the short term and long term).

What else could have eased the creation of the site? Some say that management of such a large-scale project requires a so-called quarterback. Others say you want a catcher. Some say you really need a good goalie, or a head chef, or even a Benevolent Dictator for Life (BDFL).

Nah. New projects suffer the most pain from the code they use for the first time. Like a new idea, fresh in your mind, or a fresh stone broken off a larger stone. Still sharp, cuts your hand, not yet smoothed by time and trial. Full of mealy worms wriggling waiting to grow into full-fledged bugs.

A QB will screw up a new play the first time through just like the rest of us. The most-needed piece of kit in software? Reuse. Use something that already gets used a ton, that does not have bugs because it gets used all the time.

The site broke because too much of the code and the way the code got used had not been proven. The databases had not been proven for their loads.

Testing a new project does help you sand the code smooth, but building from smooth code to begin with sounds smarter.

Categories
unAmerican

A House of Reprehensibles

The so-called Republican members of the US House have moved forward with a plan to defund the Affordable Care Act (Obamacare). They have done this without even a feint toward repairing its faults before or now, nor with a whiff of trying to replace it.

The resolution, H.J.RES. 59 (Library of Congress: Thomas: H.J.RES. 59 of the 113th Congress), is meant to fund the government for the next year. But it’s a bit like the gun from The Fifth Element, the ZF-1 (YouTube: (excerpted from The Fifth Element) little red button of the bottom).

The nation has a healthcare problem, well documented, and obvious to anyone willing to look. The ACA, imperfect as it is, will improve the number of covered individuals. Will lower costs, if only marginally. It should be replaced with something better (indeed, it came with a five year period to implement and several prominent extensions have been granted to select interests, a jarring clue that it isn’t the right course). But it is simply irresponsible, it is reprehensible, to simply try to strike the funding for it.

The majority has failed in their duties, repeatedly. Their broken-record activity of trying to simply elide from the books this attempt to improve healthcare is simply obtuse. It’s bad politics. The supporters of the effort, bless their hearts, should be lining up behind an alternative at the very least. Should be fighting for something.

That’s what the tombstone for the GOP will read: “Here lies a bunch of bones from those who forgot how to fight for anything, who died fighting against everything.” And that day cannot come too soon: we need a real conservative party to fight for ideas alongside a vibrant liberal party fighting for theirs. And together they can shape the country for the better.

Like the Syrian escape hatch, the Republicans need to exercise a quick pivot before they cross too far across a red line. But, instead they have repeated empty rhetoric.

We have learned lessons from the ACA passage, the most prominent which should be not to promise the status quo in the face of a corrupt status quo. Many opponents of the law have latched onto the claim that people would keep their insurance, which in fact did shape the law’s construction for the worse.

Any law that takes a half-decade to implement is either too much or not enough. The ACA is definitely both. And extensions for protected interests only fuels the divisiveness amongst our countrymen. The ACA should have been a unifying act, removing barriers between different groups of healthcare customers.

And so on. But again, none of these nuances, absolutely not one single idea of improvement or replacement, has been forwarded by the House Republicans. Their desperation is telling. Their constituents have been bombarded by rhetoric against the ACA from extremist media sources, who themselves offer no alternative ideas. The leadership, unable to push for ideas in a space devoid of them, is left with the choice to rally against the law, holding a basket full of air.

The White House has offered a small window between shutdown and full funding, quoting:

The Administration is willing to support a short-term continuing resolution to allow critical
Government functions to operate without interruption […]

Read: “if you guys are this dumb, we can pass something at the zero hour to avert true disaster, and then clean up your mess later.” Indeed, we will be cleaning up the dysfunctional mess of our governments and businesses for the foreseeable future, even as they explore strange new disasters, to seek out new botches and new catastrophes, to boldly fuck up what no one has fucked up before.

Categories
unAmerican

Inertia: Chains You Can Believe In

President Obama recently said, in discussing the alleged leaking of marked-protected documents by Pfc. Bradley Manning:

People can have philosophical views about [these things].  But look, I can’t conduct diplomacy on an Open Source [basis].  That’s not how, you know, the world works.

He went on to discuss more directly the law with regard to such disclosures.  But I’m not writing today about the law or the allegations against Manning or his treatment while in detention.

This post is about the inertia that Barack Obama has chained himself to in the time since he took office.  It hasn’t been wholesale.  Progress has been made on some fronts.  But on major fronts, the status quo keeps on pulling us down.

The biggest areas are the following:

  1. Foreign policy
  2. Energy policy
  3. Fiscal policy
  4. Social Health policy

In these four key areas (though there are others that are less obvious, and all of these have overlap too) we haven’t seen the change that’s needed.  In these areas there are entrenched interests that preclude the change that’s needed.

Obama says, rightly, that diplomacy isn’t conducted in the light of day.  But he gets it wrong saying that he can’t change that.  He can’t change it by not changing it, but if he moves to change it, it will change.

All systems seek equilibrium, and by changing any aspect of any system you introduce further changes toward that equilibrium.  If you can’t swim, and you’re alone in deep water, you’ll drown.  But if you introduce a floatation device, like a life preserver, then the equilibrium shifts, and you won’t drown.

What should happen in this situation, if Obama does want change, is to speak up about that.  “I would like to have a higher burden of the health care system be carried by Registered Nurses, Nurse Practitioners, and the like, to lower costs and increase access, but the current system’s inertia makes that hard to enact.”  And then he would have those classes of workers (RNs and NPs) on his side to help push for the change.  He would have patients that want better care and better pricing saying, “Yes, I know a few nurses and they could handle more responsibility.”

Open Source Diplomacy would mean that everyone has the same information, and therefore, there’s no strategic advantage to lying or subterfuge.  It would mean that if a Middle East leader can’t stomach telling his people what he’s doing, he shouldn’t be doing it.  It would mean that we wouldn’t find ourselves in wars without a cause.  If the world can’t work that way, then I don’t see why the hell we’d bother at all.  But of course it can work that way.

It works that way all the time.  Just not in the circles that Presidents and Congresscritters run in.  Every day the software that powers the internet is developed in that way.  The stack that the likes of Obama and all of these other chained leaders are depending on to improve their productivity isn’t created in secret, behind closed doors.  Their own computers may be running the equivalent of a closed door, but the servers are overwhelmingly running software that anyone in the world can download, compile, and hack on.

People that go to school aren’t told, “you aren’t allowed to apply this knowledge without prior written permission,” and then forced to get their Algebra teacher to sign off when they need to do a calculation.  Learning in such an environment would be impossible.

Don’t get me wrong, there’s a right and wrong way to handle the open sourcing of diplomacy, and as I’ve indicated with the nursing example, there’s a good way to mitigate inertial effects when seeking change.  Things don’t need to change overnight.  But we do need change, not chains, and if Obama wants to be that leader, he needs to start standing up for the cause and be honest about it, not just spit another can’t in the face of the world.