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Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

I get why the liberal wing of the Democratic Party is obsessed with enacting Medicare-for-All as the vehicle to universal coverage. I do. There’s no question that if we got it right, it would be both far more equitable and cost-effective than the present chaotic patchwork of a “system” that we’re currently lumbered with. I was raised in England and I know what a blessing the National Health Service has been, warts and all, in providing first class health care to everyone and without driving any of anybody into bankruptcy.

I also understand only too well the frustration of forever being told that it simply can’t be done, that the odds are stacked against it. How do we know unless we try, right?

Nevertheless, reality must intrude. First, as we have already seen with the few states that have tried to add a public option to their ACA markets that the health care industry will wage total war on any suggestion of even a modest expansion of of a public health care option. And when I say the health industry, we’re talking the insurance companies, the hospital industry, the pharmaceutical industry and much of the medical profession, particularly specialists, surgeons and the hospitals each of whom gain the most from the present lack of price controls on any but Medicare patients, and who will fight tooth and nail to keep it that way. Added to the health industry’s implacable opposition will be the Republican Party and the entire right-wing universe complete with relentless fear mongering and lies. And they will have a powerful issue that lends itself to demagoguery. Socialized medicine! Egads!! The fact that they’ve called the ACA, modest insurance reform at best, the same thing will of course be lost in the din.

Second, a total reform of the entire US health care system, one that dwarfs the enactment of the ACA, will require the support of most Americans, 180 million of whom currently have employer-provided health insurance which most of them believe is just fine, thank you very much. And Democrats would be asking them to give that up and see their taxes increase to boot – a hard sell even though insurance premiums will go away. All of this on the promise that expanding Medicare to include everybody, entirely rationale but something we’ve never tried before, would be better. And then there’s the seniors who are currently well satisfied with their Medicare and will be scared into believing (by you know who – see above) that somehow they will lose much of what they have if their health care is folded into a national scheme for the whole population.

In short it will not merely be an uphill struggle to enact Medicare-for-all but the policy equivalent of free climbing Half Dome in Yosemite National Park and to believe otherwise is delusional.

But there are other ways to universal coverage. In fact there are many models among developed countries that have achieved and did so with a system that incorporates private insurance albeit heavily regulated. Switzerland is one, for example. Check this link to the non-partisan Commonwealth Fund for a thumbnail sketch of the Swiss system and that of other developed nations from whose systems we can draw lessons .

Which brings us to the Affordable Care Act. Like all compromises on huge and complex pieces of legislation, the ACA is manifestly imperfect and in need of substntial improvement, for example by vastly reducing out-of-pocket expenses and greatly expanding the income cut off to receive premium subsidies. Yet the law has significantly increased the number of people with health insurance whilst proving unexpectedly resilient in surviving GOP efforts to repeal it and the Trump administration’s attempts to weaken it. If Democrats win the White House and Congress in 2020, they have an opportunity to undo all the damage of the Trump era and to make the ACA a far bigger success in providing affordable health coverage to a vulnerable population.

As well, Democrats have other costly priorities to address such as climate change and relieving our kids of the huge debt burden of college loans, to name but two. A full throated battle for a single payer health system will suck all the political oxygen out of the air and leave us with little energy to seriously tackle those issues. And that would be a tragedy.

President Trump Insults Mayor Khan on Day One of London Visit

President Trump Insults Mayor Khan on Day One of London Visit

From the official Twitter account of U.S. President Donald J. Trump:

There so many things wrong with this. Where to begin? The feud with London Mayor Sadiq Khan started in 2016 when Khan, a Muslim, criticized Trump’s Muslim Ban. And Khan wrote a piece for The Guardian just two days prior to Trump’s current London visit that compared him to fascists.

Well that didn’t sit well with our volatile president, so he responded by saying Khan is “nasty” to the visiting POTUS but immediately insults Khan with his own nasty rebuttal. Trump says Khan should focus on crime in London while he sits in a plane pounding out a series of petulant tweets in which he calls Khan a “stone cold loser” and insults him further with a comment about his height by comparing him to the “terrible” but tall NYC Mayor Bill de Blasio. Then he closes with how he looks forward to being “a great friend to the UK”. So presidential!

It’s no wonder that hundreds of thousands of Londoners greeted their “great friend” with protests, like this message mowed on a lawn that could be seen from Air Force One as it descended for landing:

And the now famous Trump Baby Blimp with with its pugnacious face and weaponized cell phone in hand.

Robert Mueller’s Road Map for Impeachment of Trump

Robert Mueller’s Road Map for Impeachment of Trump

I hope all of you took the time to watch Mueller read his statement about the findings of the special investigation and what he could and could not do according to law. The law matters to him – a lot. Not so much to the person at the center of the investigation.

I was working so I could not watch it, but I did read accounts of the reading on a few different news websites.

David Frum’s column gets to the heart of the Muller report and distills it in just a few short paragraphs:

Obstruction of justice, though, need not be clandestine to count as a crime. What matters is intent—and that must be judged by Congress, not a special counsel subordinate to the Department of Justice and bound by its rule that a president cannot be indicted.

The full report is rich with details. But that’s the essence. A foreign power interfered in the U.S. election to help the Trump campaign. The Trump campaign welcomed the help and repeatedly lied about it. The lying successfully obscured some questions the investigation sought to answer; in the end, it found insufficient evidence to charge a broader conspiracy. President Trump, in public and in private, worked to stop the investigation.

Those are the facts. What are the remedies? Mueller underscored at his press statement: He did not exonerate the president. Under the Department of Justice rules he was subject to, he lacked the power to act.

Meanwhile, the Trump administration refuses to take steps to secure the next presidential election against the interference that swayed the last.

I have two questions:

Congress – Will you carry out your duty to oversee the Executive Branch or will you let the president get away with obvious crimes for which only your branch of government can hold him accountable?

Trump – will you do anything about interference in American elections by hostile foreign governments, or will you shrug it off hoping you can benefit from the interference again in 2020?

It’s Alive!

It’s Alive!

Were it not for Robert Mueller reading a summary of his report last Wednesday, this blog would most likely be dead. As you can tell, all of us content providers haven’t been writing anything for quite a while. And, our domain master forgot to renew the domain name. Had I not tried to go to this site on Wednesday, I would not have seen the notice that that the domain name was for sale. I asked Cory about it and said that at least it ought to be worth something – even if it is bastardized English for the Japanese “harakiri“. Well I guess there is some grace period, because Tony was able to get it up and running again. He said it would have been gone for good within three days.

Providence. Thank you Mr. Mueller

So I guess I’ll try and put some stuff up once and a while. Like now.

Russian entanglements, fear at heart of militarized Trump administration

Russian entanglements, fear at heart of militarized Trump administration

Donald Trump’s flirtations with Russian president Vladimir Putin likely started out as a give and take, leaving Trump to trust that someone as corrupt as Putin could be bullied into silence using a threat of exposing his corruption, a narcissists code of honor, or an unscrupulous attack on his reputation.

In our world, Trump is the guy who disregards all of his social obligations to focus on the privilege our social contract has afforded him, and then that guy wins a democratic election despite how obvious it is that he’s a sociopath with no goal other than enriching himself at any cost. He’s the worst of us.

But in Trump’s world, Putin is that guy. Trump found himself played by his own game and by then, Putin had everything he needed to put Trump in a bad, bad place. He tried repeatedly to lose the election. He gave it a lot of effort. He knew that he’d be Putin’s puppet forever if he managed to ascend to the most powerful office of Putin’s most powerful enemy. Losing to Hillary Clinton would give him a less dramatic undoing.

But now that he’s in, and he’s identified the long-term threat, he needs to circle the wagons and regroup. Militarizing the Executive branch must be signaling to Putin that Trump is finally understanding what’s actually happening here.

Will Colin Kaepernick Stand for the Canadian National Anthem

Will Colin Kaepernick Stand for the Canadian National Anthem

San Francisco’s backup quarterback Colin Kaepernick (#7) is coming to Seattle on Seattle’s annual Canada Day game. The Canadian national anthem, “Oh Canada” will be played before “The Star Spangled Banner”. Kaepernick started the national-anthem protests against police killings of unarmed black people across the country. What will he do during the Canadian national anthem? Stand? Sit? Kneel?

kaepernick-anthem-kneel

Since the Canadian anthem will precede the US anthem, I think he will be standing for that (Canada doesn’t have a racist-cop problem do they?) and take a knee before “The Star Spangled Banner”. He has probably thought this through to the media reaction: He stood up for Canada but not the US?!!!!!! What horrible ungrateful, military-hating man! Who does he think he is? Why doesn’t he just move to Canada?!!!!!! And all the racists  will say: “Move to Canada N***R!”, or worse, “MOVE BACK TO AFRICA WHERE YOU CAME FROM N****R!!!!” Who knows? It certainly would keep people talking, and that is the whole point of protest.

You will have to watch the pre-game festivities at 1:00 p.m. on Fox tomorrow to find out what he does and how the media reacts.

 

Dear Diary,

Dear Diary,

I sat down with my iPad last night and was bored out of my skull because there was nothing engaging on Facebook and I was at least three days caught up on all of my newsfeeds, so I started up Paper by 53. Previously I had looked at it and played with it. But then I dismissed it completely when I discovered the useful brushes and tools were in-app purchases.

Until last night. Bored and grumpy, I opened it up just to draw something. It presented me with a blank sketchpad with around 10 pages and I started experimenting. Well, to make a long story short, this morning I posted this to YouTube. I don’t even know where all of this came from. A very limited set of tools, fingers for brushes, and a complete lack of familiarity with the UI of this app and my imagination went somewhere completely unfamiliar to me.

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Rules for Walking in the 21st Century

Rules for Walking in the 21st Century

This new century needs new rules for walking mostly because of cellphones. Some people are so engrossed by what’s happening on the tiny screen in their hands, they have no idea what’s going on around them or how many other people are out walking at the same time they are. So here’s a list of rules: Some of them haven’t changed since a hundred years ago when cars took over roads, and people had to learn rules for walking on sidewalks or sides of roads; the new ones are pretty cellphone-centric.

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Technological solutions to common problems

Technological solutions to common problems

A guy on the bus the other day was openly criticizing those around him for abandoning the world around them in favor of the pale imitation our handheld devices offer up.

A friendly woman next to him unwisely* offered up a different perspective. “It’s interesting to think about whether this is any different from reading a book or newspaper on your commute. Some might be studying or reading the news. I wonder if we have always tended to isolate ourselves in these situations, and the difference now is that anyone who is unfamiliar with one method or the other makes assumptions about what’s going on on the other side of that barrier.”

Early 20th Century commuters immersed in printed newspapers
All this technology is making us antisocial

For a second I thought she was bravely bridging a gap with this old guy who had an armful of old, used (out of print looking) vinyl records and sheet music he’d obviously just acquired. But no. The old guy flew into a rage about how the internet is a “breeding ground for witches and slutty feminists who have no respect for our Christian culture!” He angrily sputtered on about the muslims, the gays, and abortion culture tearing the fabric of society apart until he disembarked at 15th and Pine.

It was sad because this old guy was dressed in dapper digs from the 40s, on the 10, and looked like a Capitol Hill native. He looked like a fascinating old guy and I would bet he has a trove of stories that would enrich all of us to hear, even if it is tinged with bigotry. I mean, Cap Hill has has a much more varied past than you might know just living here now.