Biden’s Opposition to Medicare for All: It’s All About the Billionaires, Baby

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[Editor’s Note – this is a guest post by a friend of ours here at the Emptywheel Blog, Bob Lord. Bob is a longtime tax and finance attorney with some very salient thoughts on why the centrist Democrats are pushing back so hard on Medicare For All. One other note, we here at Emptywheel have purposefully not engaged on behalf of any particular candidate in the primary process, but the issues in play are fair game.]

By Robert J. Lord

Joe Biden has lots of reasons why he opposes the Medicare for All plan favored by Bernie Sanders and Elizabeth Warren.

The cost runs too high, the former vice-president tells us. People will have to give up their private health insurance. People will lose the right to choose their health insurance provider.

The list goes on, but do these reasons reflect Biden’s actual worries? Surely, he’s seen the studies that show Medicare for All would drive costs down, not up, as removing health insurance company profits and administrative costs from American health care totally changes the system’s accounting dynamics. Yes, an expanded Medicare would require administrative expenses, but nowhere close to the expenses that our current system requires.

Biden also knows Americans would welcome the chance to swap their private health insurance for Medicare. Don’t believe me? Speak to someone between the ages of 60 and 64 who’s relatively healthy. Ten to one she has her fingers crossed hoping to make it to age 65 without a major health challenge, so she can qualify for Medicare and never have to confront the insufficiency of her wonderful private insurance plan.

And very few Americans, we must keep in mind, choose their health insurance provider. Most of us get insurance through our employers. Employers choose the least expensive plan for all employees collectively, without regard to the needs and desires of individuals.

Given that Joe Biden’s stated reasons for opposing Medicare for All don’t pass the smell test, what could be the real reason for his opposition?

Could Biden simply be beholden to the health insurance industry and Big Pharma? Perhaps, but I suspect that something larger — the overall wealth of our wealthy — may be at play. After all, it’s not like health insurers and pharmaceutical companies are going to have his back come general election time.

Consider the difference between how Joe Biden, on the one hand, and Bernie Sanders and Elizabeth Warren, on the other, view the billionaires and centimillionaires who make up America’s super rich. Sanders believes the greed of America’s billionaire class threatens the social fabric of our country and has proposed a significant increase in the federal estate tax on grand fortunes. Warren has proposed a 2 percent annual wealth tax on all fortunes in excess of $50 million.

Biden’s differences with Warren and Sanders go deep. He has assured his rich donors — at big-dollar fundraising events — that their lifestyles will not change if he’s elected. Biden, whose donor list includes at least 13 ten-digit fortunes, has made it clear that he doesn’t think billionaires bear any more responsibility for America’s woes than any of the rest of us.

Just this week, he voiced his opposition to policies that would make it harder to become a billionaire.

But why would billionaires and centimillionaires particularly care whether we have Medicare for All versus the Obamacare-with-a-public-option plan Biden favors?

To answer that question, consider the fundamental difference between Obamacare and Medicare for All: who pays. Under Obamacare, individuals pay for their health care, through the insurance premiums they pay and their out-of-pocket expenses for the charges their insurance policies don’t cover. The government subsidizes insurance for lower income Americans through Medicaid, but the bulk of health insurance costs are paid by individuals or their employers.

The public option, Biden’s proposed fix to Obamacare, won’t change any of this. Even if every American healthcare consumer chose the public option, putting the private health insurance industry out of business in the process, individuals still would be responsible for their own health care costs.

Medicare works differently. Under Medicare, the government insures healthcare costs directly. Individuals don’t pay premiums or co-pays. Instead, tax dollars fund the cost of the program.

All this means that the transition from Obamacare to Medicare for All would transfer the burden of health care costs from health care consumers, who share in costs based on how sick or healthy they happen to be, to taxpayers, who would share in costs based on their respective incomes and tax rates.

The great majority of Americans live their lives as both health care consumers and taxpayers. Under Medicare for All, they would see an elimination of both insurance premiums and out-of-pocket medical costs. They would also see a tax increase, but ordinary Americans would save substantially more in health care costs than they’d pay in increased taxes.

But those billionaires and centimillionaires on Joe Biden’s donor list? Their tax increases would dwarf any savings they see in personal healthcare expense. Some could see seven figure tax increases.

Viewed through the billionaire lens, Biden’s loud opposition to Medicare for All makes distinct political sense. He needs billionaires to fund his White House aspirations, which still drive him three decades out from his first presidential run in 1988. He’s not only convinced himself that his billionaire supporters pose no threat to our social fabric, he even seems to believe that any health care reform that puts the squeeze on billionaire fortunes does pose a threat.

All in all, a classic case of why ambition often blinds us. In a 2018 speech, just a sentence or two after saying the billionaires he’s courting aren’t a problem, Biden lamented that the income gap in America is yawning.

What Biden’s ambition won’t let him see: Billionaires don’t exist in isolation. We have approximately 700 billionaires today in the United States. We have a larger number of half-billionaires and a still larger deep-pocket cohort of centimillionaires. And so on. Which leaves our top 1 percent controlling close to half the country’s wealth and the country with an income gap that Biden openly recognizes is “yawning” and, obviously, a problem.

In other words, those billionaires Biden’s won’t let himself see as a worry really are inseparable from the yawning income gap that he knows is a problem.

Sanders and Warren, by comparison, are clear-eyed. They can see that when the gap is so yawning that treatable or preventable injuries and illnesses are killing Americans who can’t afford healthcare and bankrupting millions of others, the only answer is that society — through taxation — must assume the cost of healthcare. Other countries, like Canada, recognized this reality decades ago.

And when America’s billionaires, with Joe Biden as one of their many mouthpieces, stand in the way of that process because they don’t want their taxes to increase, their greed tears at the fabric of American society.

Joe Biden can’t see that. His two leading rivals sure do.

[Robert J. Lord, a tax lawyer and former Congressional candidate, is an associate fellow at the Institute for Policy Studies. Bob previously served as an adjunct faculty member at the Arizona State University School of Law. Bob’s work focuses on the relationship of tax law to inequality. He contributes to both the Inequality.org website and to OtherWords, the Institute’s national syndicated editorial service. Bob also is a staff member at Blog For Arizona, the leading political blog in Arizona.]

Three Things: Hey You, Mr./Ms./Mx. Pissed-Off

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[NB: Check the byline, thanks. /~Rayne]

I get it. You’re furious, en fuego, royally pissed off. You’ve traveled through shock and traversed anger, raging for days now since Attorney General Bill Barr issue that POS four-page letter chock full of holes big enough to drive a 40-foot dry van through again and again.

And now you’ve hit bottom, burned out and blue having reached another stage in the grieving process.

We all know this isn’t the end of it, no matter how much gaslighting and abuse the White House, its proxies, the right-wing horde, and asshats like David fucking Brooks spew. You know what you saw in the speaking indictments, plea agreements, and sentencing memos produced over the last two years.

We all know who ‘Individual 1’ is no matter how much he and his myriad minions and handlers would like us to forget his role as an unindicted co-conspirator who denied the public the right to know the truth about his past during the 2016 election.

At least one conspiracy to defraud the American public is right there spelled in black and white under our noses, and again in congressional records as part of Michael Cohen’s testimony before the House. Trump worked with Cohen to lie to the voting American public, violating campaign finance laws in doing so.

“If the people don’t have the facts, democracy doesn’t work,” as Judge Amy Berman Jackson told former Trump campaign manager Paul Manafort during his sentencing hearing, another liar Trump brought into his team, allowing Manafort to change the Republican’s platform on Ukraine without a wide and open discussion among conservatives about it.

Trust your eyes and ears. You’re right to be angry and disappointed. Take a deep cleansing breath in and center yourself, feel that righteous burn of indignation, then let out the poison.

And then take another deep breath, roll up your sleeves, grab your phone, and let’s kick some ass.

~ 3 ~
What: Barr didn’t confine himself to his four-page POS summary on Sunday. Oh no. He had to make it really fucking personal for a huge swath of Americans by refusing to allow the DOJ to defend the Affordable Care Act. From the ABA Journal:

The DOJ’s new stance would strike down additional provisions that allow children to have coverage on their parents’ policies until age 26 and that guarantee “essential health benefits” such as mental health, maternity and drug coverage. The stance also would eliminate an expansion of Medicaid and free preventive services for people on Medicare.

Quite literally Americans could die because of this move.

Needed:
— Call your representatives and tell them you support the current ACA legislation in the absence of a better, Medicare for All replacement.
— Ask your reps to do what’s necessary to ensure the DOJ fulfills its mission to enforce the laws of this country, which at this time includes ACA.

You can see Barr is now setting a precedent for a unilateral executive branch which can pick and choose the laws it will enforce in spite of precedent backing existing laws. This can’t go any further.

Congressional Switchboard: (202) 224-3121

~ 2 ~
What: Betsy ‘Multi-Yacht’ Devos decided disabled Americans do not merit an opportunity to achieve; she’s proposed ending funding for Special Olympics.

That shallow, stupid wretch has no real idea what Special Olympics means to the disabled, especially children and their parents. One of my family members has worked for more than a decade at a Special Olympics camp, spending weeks with children who otherwise wouldn’t be able to go to camp like abled children. The kids meet other kids like themselves, make new friends, learn new skills, hone their physical abilities, begin to see themselves as capable of so much more. And their parents get a much-needed respite from caring for children who may need around-the-clock monitoring.

But as the former director of the Office of Government Ethics says, the cruelty is the point. Devos is Cruella De Ville who will kill puppies for their coats given the chance. Pro-life, my foot; she cares not a whit what life is like for the disabled after birth.

She quite literally wants to axe Special Olympics and take the money to give to charter schools, which fail at around 25% rate. The money she will steal from the disabled will literally go down a rat hole and nobody except the charter school profiteers will benefit from this scam.

In fact the amount we spend as taxpayers providing additional support to Special Olympics could be offset easily if Trump spent four less weekends at his golf courses on our dime.

There are those who argue it’s really Trump who insisted on this cut and Devos is merely is grunt doing the scut work of hurting the disabled. Sure — but a person whose values are genuinely aligned with caring for fellow humans would have told Trump to stick this sidewise and quit their post instead.

The chances of this proposal passing the House are slim to none, especially after Devos was grilled by Rep. Mark Pocan (D-WI) on Tuesday, but it’s a line in the sand we should draw.

Needed: Call your members of Congress in both houses and let them know this kind of cruelty to disabled Americans is unacceptable and it will not fix the inherent problem of making schools into privatized profit centers with an unacceptably high rate of failure.

Congressional Switchboard: (202) 224-3121

~ 1 ~
What: Acting Interior Secretary David Bernhardt is appearing before the Senate Energy and Natural Resources Committee as Trump’s corrupt nominee for Interior Secretary.

If you have a moment or two, watch for the swamp monster — the one in the green mask sitting behind Bernhardt, not Bernhardt (because when you’ve seen one of the fleshy pink swamp monsters, you’ve seen many).

Needed: This guy is selling out our national resources. Call your senators and tell them hell no on this dirtbag, we don’t need another swamp monster helming the Interior Department.

Congressional Switchboard: (202) 224-3121

~ 0 ~
Don’t forget to check your phone’s battery charge. Get calling!

This is an open thread, by the way.

[Photo by Piron Guillaume via Unsplash]

Vertical Demand Curve: When Your Money or Your Life Isn’t a Choice

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[NB: Byline — check it. /~Rayne]

Hold this thought: depicted above is a gun.

Like nearly every freshman student, I took my Economics 101 along with Intro to Business, Accounting 101, Intro to Marketing my first year of B-school.

This is when the indoctrination begins, when these squeaky-new eager beavers departing their teens are slowly steeped in the toxins of American-style business.

I was an older than average student, though, having switched majors after working for a few years before I returned to school. I’d seen and done things before I returned to the classroom, squinting often at a blackboard in disbelief.

My first econ prof was fairly young himself; he was also an avowed libertarian. Everything he taught was colored with the perspective that government was a bad thing. My younger cohort went along without questioning this view.

And yet our prof had a difficult time saying government was bad when introducing us to  supply and demand curves.

More supply, price goes down. More demand, price goes up. The degree to which the market is sensitive to price or demand is reflected in elasticity. Basic.

But then we were presented with the vertical demand curve — when the buyer will pay anything for the available supply, when demand is perfectly inelastic.

This is the model for business in which the supplier demands your money or your life, a gun to one’s head, “Give me all your money or you’re dead,” a perfectly inelastic demand curve.

Libertarian prof called this extortion. The dutiful 18- and 19-year-olds in class nodded their heads, fighting a yawn. From the look of them none had experienced this caliber of threat.

Prof made a departure from “government is bad,” by insisting this is the point when government should regulate the market. He said it was illegal to base an exchange on forfeiting every claim to rights including one’s life; we prohibit extortion.

This is why health care should be regulated, he said. I was a little skeptical at the time; this was smack in the middle of the Reagan years and there wasn’t a lot of regulation on health care per se. If you got cancer there weren’t many options no matter how much money you had; doctors cut it out or tried to zap it with a limited range of therapies.

The risk then wasn’t the cost as much as the gamble of effectiveness. I lost a dear friend to the after-effects of available therapy; they survived a bone marrow transplant in the early 1980s but their immune system failed.

Decades later we have a sizable number of therapies for illnesses which are effective and keep people alive, but the number of people who suffer from some of these illnesses are so low that these drugs aren’t profitable. The Food and Drug Administration has helped in these cases — until now.

The “gun” in the image above is a money-or-your-life situation for patients with Lambert-Eaton Myasthenic Syndrome (LEMS), who may require permanent hospitalization or suffocate and die without this drug called Firdapse.

Thanks to the FDA calling Firdapse an “orphan drug,” the company which owns its intellectual property rights will now charge $375,000 a year for this medication.

One patient in Iowa said she’s willing to pay something for the medication but a year’s therapy is three times what her house is worth. She doesn’t know if her health care insurance will cover it.

This isn’t even your money or your life now — she doesn’t have the money.

She’s gotten the business end of the gun without any warning, after having benefited from the drug for years.

This is worse than extortion; it’s a death sentence for anyone who isn’t a billionaire. Yes, billionaire because someone worth a million can pay for a little more than two years of this drug and that’s it.

Why Catalyst, the company which owns Firdapse’s intellectual property, even bothered to buy this drug is beyond me. If the three million patients who currently rely on this drug can’t afford it, there’s no profit to be made, no recouping the cost expended to buy the rights to the drug.

With only a couple thousand billionaires in the world I find it hard to believe enough of them will develop LEMS and pay for Firdapse to make the acquisition worthwhile.

It’s not just an unethical business, creating a gun to hold and fire against the heads of LEMS patients.

It’s really stupid business to aim an economic gun at one’s self.

I wonder all these years later how many former B-school students struggle with the vertical demand curve lessons once they enter the real world.

And I wonder what the supply curve looks like when it comes to insulin, the price of which has jumped dramatically over the last few years so that it has become your-money-or-your-life proposition for many diabetics.

At what point is insulin no longer profitable — after 10, 25, or 50% of insulin-dependent patients die because they can’t afford it, is it no longer profitable to make insulin?

Treat this as an open thread.

[Photo by Piron Guillaume via Unsplash]

A Neoliberal Argument for Medicare for All

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[NB: Note the byline, as always. /~Rayne]

The old white billionaire dudes lipping off about “un-American” expectations of fairness and equity in income distribution jogged something loose in me.

I’m so damned angry about their willingness to complain their ability to buy yet another fucking yacht may be diminished because the average working American has the chutzpah to demand health care for everyone on top of a living wage.

What really cheeses me off is the utter stupidity of these so-called business geniuses.

WHY ARE THEY IN THE HEALTH CARE BUSINESS AT ALL??

Let’s pick on Mr. Luxury Beverage’s business. His core competency is preparing beverages to meet Americans’ tastes in an appealing environment.

Why has he spent any of his corporation’s human resource dollars on health care programs? His corporation’s expertise is NOT health care or insurance; they’re only providing health care because competition for stable, healthy employees is tight and turnover costs a butt-load of money.

I know you’ll love that technical term ‘butt-load’ but seriously, turnover in low-wage jobs in which employers have invested considerable training eats away at profit margins. It can take a year or two for low-level employees to reach maximum productivity — like pouring the optimum level of crema on a double espresso and know the entire menu by heart while operating at full-speed during rush hour.

What does it cost the Luxury Beverage business if workers leave inside that first year because they can get health care elsewhere?

Ditto for Mr. Business News Provider. His core competency is gathering, reporting, distributing timely news preferred by businesses ahead of the rest of the competition; time matters greatly if stock trades on this corporation’s work product. Why is his corporation in the health care business at all?

And yet both disparate businesses — beverage purveyor and news distributor — expect a comparable level of health among their workforce. They aren’t factoring into SWOT analyses the possibility a competitor’s workforce might be more healthy and fit.

If we look at other industries like the automotive industry or construction, healthy workers who can handle physical demands becomes mission critical. Only so much work can be automated or eased with technology and equipment.

And yet the cost of negotiating and providing health care for their employees can be the difference between profitability and business failure.

The challenge is greater when competing with companies overseas as automakers do.  Health care costs for the Big Three here add a significant percentage to the cost of goods sold — far more than $2 billion a year — while their foreign competitors pay less because the costs is absorbed across all of society instead of their businesses’ experience. The costs are based on a population which has had uniform access to health care throughout their lives.

So why are industries which aren’t delivering health care in the business of providing health care at all?

It’s in the best interest of the country and its industries to use economies of scale to acquire good health care at lower cost, provide it to the entire country, so that the country’s businesses can focus solely on their core competencies as well as the features which differentiate them positively from competing overseas products.

This is exactly what the neoliberal “strong but impartial state” is for in concert with “free enterprise, the system of competition,” to provide what the people know is needed to establish economic justice, insure domestic peace, provide for the common defense against health and employment insecurity, promote the general welfare of all citizens and workers, while securing an optimum opportunity for businesses to compete.

The U.S. is going to spend $3.5 trillion on health care this year under this current system. This is nearly two times what comparable countries spend on average. It’s inflating the cost of everything we make and sell. Imagine the profits corporations could make and keep if they didn’t have to spend valuable time and resources on health care benefits management.

But, but socialism! — this is the immediate refrain offered as push back against institutionalizing health care as a federal program to be provided to all.

Do you see either Mr. Luxury Beverages or Mr. Business News Provider complaining about the federal government’s role in assuring baseline education across the country through its K-12 public school system? I would argue this is the most American federal program we have now or have ever had since its inception with the Pilgrims.

But socialized K-12 education!

Imagine having to argue as a presidential candidate that we can’t have education for all though this program has already directly benefited every business and our common defense in some way.

Imagine American corporations, each independently in isolation, spending billions each year on human resources to research and negotiate education programs as an offering for employees and their families. Ridiculous, right? It’d suffocate so many young businesses on the verge of scaling up.

But these old white male billionaires don’t see any problem with publicly-funded education for all which helped make them what they are today.

I can’t believe I’ve had to argue a neoliberal case for publicly-funded health care for all because a guy who grew up in public housing thinks such health care is “un-American.”

 

Treat this as an open thread.

[Photo by Piron Guillaume via Unsplash]

Another Kind of Recovery: Post-Maria Puerto Rico and Health Care Critical Infrastructure

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I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.

Pay Now and Pay Later: What Losing CHIP means to America

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Let me tell you something you (most probably) secretly believe, secret even from yourself,  because you are an American: poor and sick children aren’t going to amount to anything. This is true whether you’re a Republican or a Democrat. The two sides will argue it’s for completely different reasons, but the conclusion is the same. We all know that poor and sick children aren’t going to live lives of note or interest.Nevertheless, we all want to be good people, and that’s why CHIP has bipartisan support. CHIP is the Children’s Health Insurance Program, originally SCHIP, a Clinton-era expansion of social security specifically for children who were too poor to get insurance, but not able to be covered by Medicaid.

CHIP’s Congressional authorization expired in September. The program is slowly running out of money, with just under nine million children potentially facing life without access to healthcare.

Americans talk a lot about the cost of healthcare. The cost of not providing healthcare to children in a world with failing environmental protections and failing schools is impossible to calculate. It is very high, it lasts lifetimes and generations.

I am taking breaks as I write this. My neck and shoulders are making typing hard, and I am coughing up a yellow sputum, very much the same as I have been coughing up since I was a child, and I will have to see the doctor soon about it. I am an active 44-year-old woman, lifelong non-smoker, with a healthy BMI who has been receiving healthcare in Europe for the last three years. But for my life before my 40s, I was mostly an uninsured low-income American, born and raised in Los Angeles.

I was an active child and an avid dancer. When I became a teen I slowed down a bit, there were times when I would cough and cough for weeks, sometimes coughing up little solid and foul smelling lumps of material from my lungs. I threw up involuntarily a lot when I exercised. I didn’t talk about it much, there didn’t seem to be any point.

I dealt with mental health issues, which were treated by the school district. That treatment was not only substandard, but deleterious, always pushing poor children to see themselves as the source of their troubles, even at times when the troubles were obviously medical in nature. Everything was always in our heads, everything, even throwing up involuntarily and migraine headaches were something I was doing to myself.

Los Angeles in the 1980s was a time of intensive personal responsibility and very poor air quality. It was the Reagan years, and we were all self-reliant cowboys. There was always a cadre of depression-era grandparents around, calling themselves the Greatest Generation, and telling us that no matter what happened we had it easy and our complaints were just whining. The drug war was at fever pitch, and the world was made up of Good Guys and Bad Guys, and you sure as shit did not want to be one of the Bad Guys. And the air that I grew up in was so bad you could live next to a mountain range and not know it for months.

CHIP was created in 1997. The Clintons were pushing the nation towards centrism, the air in LA was getting cleaned up, and I was 24 — far past the age where it could have helped me.

I was used to making due by then anyway. Poor kids aren’t allowed to be sick, it’s a moral failing, and I’d learned to compensate and sneak to get what I could. But still, even after some kind of insurance became available, it was never because we deserved it. As children we’re burdens on the struggling poor. As students and eventual adults, we’re no better. We’re making it up, we’re lazy, we’re difficult, we cost too much and are worth far, far too little. The political debate has never been about letting us find our potential, for we have none. The debate has been about whether it’s more moral to help us or let us die quietly.

Of the 9 million kids insured on CHIP 3 million are, like me, chronically ill. Not all of them would die without medical treatment, I’m sure they could move on, scarred, struggling to survive, out of childhood and any realistic chance of being cared for. I know how it feels to be one of those children. I try to be a generous and caring person and see all of humanity as my family, but there is a part of me that really doesn’t care what those children decide to do to the rest of you. You have it coming.

Being uninsured when you’re a chronically sick child isn’t just the lack of care. It’s the constant and unrelenting sense that you are not valued, not desired by your society. It is the rejection of your ability to live itself, the feeling that you can never be more than lice on the body politic. Any self-esteem you can grab back from the way society treats you comes with a hate so dark it makes ISIS look like a summer camp.

But the truth is these children mostly won’t do anything. They’ll wander desperately through life, looking for hope, going to the ER for rescue inhalers, and trying to score many kinds of drugs to dull the pain both physical and mental. Some will escape up the socio-economic ladder, but they’ll hide where they came from because you think we’re all worthless. That’s what I did for years. Statistically, we’ll die younger than you, probably uninsured, in a hospital. The commentary on our lives won’t be: What have we done? How did we fail these fellow humans so terribly? What have we lost in creativity and talent? Instead the political story of our lives will be: This causes healthcare costs to rise.

There are sick children all over the world. There is only one country that blames them for making healthcare costs rise because we won’t give them care as children.

CHIP passed in 1997. In 1998, I got my first employer healthcare. The diagnoses started rolling in. Migraines, Irritable Bowel Syndrome, Major Depressive disorder. GERD with Barrett’s Esophagus. It wasn’t caused by weight, but because my esophagus doesn’t close. It just doesn’t. Weird, huh!? That would have been handy to know sooner.

That diagnosis wasn’t a surprise, as least not after I understood the context. I tended to throw up if I bent over too far. I was a high school gymnast, and even back then the contents of my stomach would regularly come out of my nose on the uneven parallels. My coach would send me home sometimes, but no one ever suggested I see a doctor. It was in my head, I was doing it to myself somehow, being a burden on everyone.

After the ’98 round of medical diagnoses and treatment, I came back and yelled at my mother for never believing me. I cried, I apologized later. She’d been a child herself when I was born, and she was trusting authorities who were telling her I was broken, and so was she. She apologized too, we cried and screamed and stomped off and hugged and cried some more.

This is how we cope. To try to think about this not personally, to see it as part of politics and society and an economic plan is too big and too painful to contemplate. Even now, it makes my throat tighten and a wave of nausea pass through me. It is so evil.

The diagnoses kept coming in the new century, and I became ineligible for any kind of insurance that wasn’t employer-based. EDS Hypermobility type, Cervical Dystonia, PTSD. The last one I crowdfunded to pay for, the old-fashioned way. I passed the hat amongst my friends and raised the money to pay the PTSD therapist. It was a difficult and sometimes humiliating decision, but it was the right one. I emerged from my therapy not fixed, but healing. I had tools I hadn’t had before. I went back to work. My friends had passed up dinners and presents and special things to help me get that therapy, but it worked.

GoFundMe brags about raising $5 billion in crowdfunding for medical care in America. Of course there’s more than that over the years; families that sell their houses for each other, friends that skip vacations to give the people they love a chance at life. Leonard Pitts wrote rather viciously about a conservative man trying to raise money to retain his sense of sight. This man was politically unworthy, socially irresponsible, and medically suspect; he smoked and owned a house. How could he ask for help? This is America, and even the people who believe in universal healthcare balk at care for those they deem Unworthy. We don’t even know how to imagine a system that just cares for people because they are people.

It’s been two years, and I hope that man is not blind, and I hope his loved ones haven’t suffered too much. Between people who love each other, there is no better use of these little monetary tokens to express love than paying so they may live and live well.

From an economic perspective, it’s a disaster. Every meal and trip skipped to pay for medical expenses slows down the stimulus that money could provide. The medical payments funnel money into the upper echelons of society where is slows down, sits, and ossifies. It is a disaster in every way.

But Congress is full of good people who are the somebodies who think of the children, and so CHIP is bipartisan. But it’s so expensive, and it’s hard for Congress to find the ~$14b it will cost. When it comes to funding stupid planes perfect for types of wars that don’t exist anymore, Congress has no problem finding the budget to switch from the disastrously stupid F-22 fighter (>$70b) to the next stupendously expensive F-35 fighter (>$400b for R&D). The F-22 finally saw action in two countries several years after being discontinued: against ISIS in Syria, and the Taliban in Afghanistan, both military forces more known for fighting out of the back of pick-up trucks than dogfighting with jets. More money goes to the federal employee travel budget than goes to CHIP. (According to Hatch and Coburn) More money goes to the black budget devoted to spying on everything and everyone on the net than goes to CHIP, but most of Congress probably doesn’t know how much more, it’s a secret. Congress can even find billions to make stupid fucking pennies no one wants.

A sick kid doesn’t realize the money that could help them is going to something as stupid as fighter jets no one needs or black budgets that may be straight-up illegally spying. But they do know that they’re a burden, they know that the world doesn’t want them. It makes them sad and angry, and everyone around them scrambles to find billions of dollars in spare change to take care of the people they love because Congress is so bad at finding things.

When you don’t treat the minds and bodies of children, it isn’t just those children who are affected. Something as simple as getting check-ups, interceding on basic problems early, and making mental and sexual health resources easy to access can stop a lifetime of expensive and heart-rending problems that weigh down families and communities and echo through generations.

Programs like CHIP, or universal healthcare as provided in Europe, are not about handing things to the worthless poor. They are about the epidemiology of the whole of society. Treating your neighbor’s kid now is about not having to treat them later, and not living with the consequences of their illness in your environment or tax expenditures. It is choosing to not live in a society of desperation and constant quiet anger. Programs like CHIP, and the proposal for Medicare For All, are fundamentally selfish, just a long-sighted form of selfishness that Americans are kind of bad at.

Without a program like CHIP, we are in the position of hoping parents bring their children into the ER for routine needs, jacking up our healthcare costs to ever more ridiculous heights, because the alternative is somehow much, much, worse. Untreated children don’t just infect other children with their diseases, they drag down schools, divert the resources of their families, increase crime and even lower property values. They spend so much time struggle to find their own worth, they deny the world their talents. If you don’t want to treat poor sick children, you might be better off going all Sparta on us and throwing us off cliffs than just letting us struggle along in society.

By the way, Sparta was a terrible place to live, despite what you’ve seen in 300. It was miserable and authoritarian and full of legally-required slavery and child rape and never really developed or got better. The Persian Empire, and even Athens, were better societies on every count, including military. Sparta wasn’t good at infrastructure and tended to steal what they did have. Infrastructure is what makes society nice to live in, and worth the bother. This is a fact Americans used to get; we like our highways and dams and standing armies and power lines, but apparently the water’s edge is schools, pollution, healthcare and paying taxes. Those are, for some reason, not infrastructure.

I never accepted my worthlessness, I never stopped fighting. I also never shot anyone or became a drug addict. I did a lot of sketchy things to get medical care. I’ve taken a lot of other people’s leftover drugs, and coordinated with other people to pass around drugs and advice from medical professionals who may have never known where it was going, and probably didn’t want to. And I rebelled and rejected society, sometimes violently, so that I could do worthwhile things not in keeping with my station in life.

Now I live in a place that provides me care. I haven’t had to prove my economic worth, which is good because it’s likely I never will. But now, after my expenses, I still have a little money left over. And every Saturday morning after food shopping, I go get myself a good cappuccino in the city center, and sit for a while enjoying the light, watching people go by, and little children chase dogs and birds. I’m not in paradise, there are plenty of problems here, like everywhere. But none of them are sick children hiding the yellow sputum they cough up from their parents because no one can afford a fucking inhaler.

My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.

Some of my sources were:
https://www.kff.org (many articles, it’s a treasure trove of information)
8.9 million children enrolled, cost is around $14 billion. 35 million children are enrolled in CHIP or Medicaid or both.

https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-care-crisis-is-a-gold-mine-for-crowdfunding
https://www.vox.com/2017/12/3/16730496/orrin-hatch-chip-tax-bill

More information on children on Medicaid: https://www.medicaid.gov/chip/downloads/fy-2016-childrens-enrollment-report.pdf

Spaced In Time Trash Talk

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Welp, moving from KIller Trash Talk to the things that are this weekend takes a lot. Insanity abounds, and is all around. Your healthcare? Yes, that is getting screwed hard. JCPOA (the Iran anti-nuke deal) yes, that too. If it affects the world in at least semi-positive way, the current President is blowing it all up. The fact that a black man might have even touched on any subject seems to infuriate the dementia ridden sundowning asshole in the West Wing even more.

It is who and what we life forms are now. And it is sickness in every regard, domestically and internationally. Trash Talk was designed to be a refuge from such things. I just cannot anymore. So, if that is a problem, I am sorry. Hopefully we will not stand by, and will not back down, while assclowns like Donald Trump cravenly politicize even common sports entertainment to soothe the 30% base they so cherish.

Nope.

Puerto Rico is dying in their own streets. Northern California is burning. People are trying to ride out the fire in swimming pools as their houses burn around them. While the Trump Administration and GOP sit on their hands, when they are not actively trying to make the entire situation worse. The fuckers are flying on jets, flying flags and making coins in their own image.

But, hey, the NCAA is moving on. Not sure anybody thought anything different would happen in Chapel Hill. Begging the question as to what happens to Louisville, another legacy NCAA basketball program. The NCAA under the terminally lame leadership of Mark Emmert will never change.

In the pros, it is getting hard to figure who is the bigger asshole. Is it Goodell and the NFL, or is it the, at this point, ignorant scorched earth strategy of Jeff Kessler and the NFLPA? The NFLPA is making an ass of itself in trying the everything and the kitchen sink theory as to Zeke Elliot. The NFLPA had a sympathetic plaintiff, Brady, and a supremely tenuous case by the NFL based on simple physics and chemistry. But then the NFL won in the 2nd Circuit. Zeke Elliot is not an all American kid with multiple championships. He is an abusive punk from Ohio State that is lucky the NFL did not find an aggravating act from when he pulled down a woman’s blouse in public during a parade. If you think Elliot has the better case here, you don’t try cases in real courts.

The thing is, whether under federal or state law, and in this case collectively bargained law, the arbitration rules….and the rules ARE “relaxed”….and control. It is about the process, not the facts. I, and a lot of others, tried to argue in the face of this in both Brady and Peterson. Same in Bountygate prior to those two cases. Those arguments were all made in cases with far more appealing clients than a repetitive malefactor like Zeke Elliot. He will serve the suspension, it is only a question of whether he and Jeff Kessler are smart enough to do so soon, or make it later, when it will really hurt a likely playoff team. We shall see whether the NFLPA scorched earth insanity prevails over the inters of Homer Simpson, er Jerry Jones and the Cowboys.

The games go on. The Natinals really ought to still be around, but the Cubs put them to rest. The Yankees somehow overcame Cleveland. Hard to not think the Tribe was the better team, but they didn’t close the deal, and the Yankees did. That said, the conference championships look truly awesome. I think the Astros are not only a better team, but have some juice right now as opposed to the Yanks. Not betting a lot of real money on that, but I think so. The Dodgers are what the Yankees used to be. The best team that all the money in the world can buy. But Chris Hayes made a Trump for Cubs deal with the devil last year, and I hope it still holds, and the Cubs win. If we “have” to have Trump, let the Cubbies win again.

Syracuse obliterated Number 2 Clemson already. Man, that was ugly. So was the job an average Cal did on Pirate Mike Leach and Washington State. Utah at USC should be interesting. Washington at ASU here might be as well, but Chris Peterson is a light years better coach than ASU’s Todd Graham, so ASU likely to get blown out, even at home.

Back to the pros: Philly already topped the Panthers, thanks to a good game by Wentz and a horrible one by Newton. Won’t always be that way, Panthers are dangerous if they get in the playoffs. Skins host the Niners. Will Kirk Cousins be playing on the other team next year? The Pack at Vikings looked really interesting when it looked like Sam Bradford was returning. Less so now, but Case Keenum can produce and they are in Minneapolise with that damn horn they blow. I’ll take Rodgers and the Cheese, but may be a great game.

My game of the week is the Buccos at Cardinals right here in the Big Toaster. Debut of Anthony Peterson at RB for Phoenix. Carson Palmer has quietly played superb QB so far this year for the Cards….when he is not getting murdered from bad, nee atrocious, O-Line play. If Arizona’s constantly remade O-Line can gel and protect the old man, it will be a hell of a game. Not going to bet on that, but just saying. Rams at Jags might actually be interesting. Glad that matchup is, for once, not in London. Other game of the week is unquestionably Scribe’s Steelers at Arrowhead to see the Chefs. I don’t for one second think Big Ben has lost a step, even if he may finally be maturing. But I am not sure that other forces in that locker room are unified the way past Steeler teams are. This will be a HUGE game for Pittsburgh, and less so for KC. I’ll take the upset on this one.

Okay, that is that. Another week. Another dime. Another dollar. Thank you for being here, and send some love to Puerto Rico and Napa.

Three Things: So Many Questions, September Edition

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It’s been a little busy in my neck of the woods, trying to tackle a long accumulation of honey-dos. But questions piled up, needing answers, so much so that I had to take time out to put bits and pixels to digital paper. Let’s begin, shall we?

~ 3 ~
PUERTO RICO POST-MARIA

Where the hell is the USNS Comfort, dispatched in 2010 to help after Haiti’s earthquake, and why isn’t it docked in San Juan, Puerto Rico, right the fuck now?

Why did we send 24,000 military personnel to help Japan after the 2011 earthquake but can’t muster them for a U.S. territory with a former navy facility and an active facility at Fort Garrison in San Juan?

Is Trump deliberately ignoring Hillary Clinton’s plea to send the USNS Comfort to PR because — well, it’s Hillary? (Yeah. Check that link. Even Fox News noted Hillary’s request.)

Has Trump deliberately ignored Puerto Rico’s urgent plight out of personal pique over the bankruptcy and losses from a Trump-branded, Trump-managed golf course located in Rio Grande, PR? He was trying to prop it up on Twitter back in 2013.

Are Trump’s tweets complaining about Puerto Rico’s debt yet more projection, since the failed golf course was built with government-issued bonds?

Why did the Senate approve as FEMA director — who only left to tour the island FIVE GODDAMNED DAYS AFTER MARIA MADE LANDFALL — the man who was the Hurricane Program Manager for FEMA under the Bush administration during Hurricane Katrina?

This, from The New York Times:

The head of the Federal Emergency Management Agency, Brock Long, has received widespread praise for his handling of the federal response to Hurricane Harvey, the first major natural disaster faced by the Trump administration.

Somebody get me a concrete citation of a real accomplishment attached to some of this “widespread praise” for anything besides being “a calming presence in press briefings.” Has the bar slipped this low that calmly stringing together cogent sentences is worthy of accolades? Can the NYT stop fluffing Trump and his band of co-conspirators?

Because right now American citizens are suffering and likely dying as a result of this administration’s gross ineptitude and negligence, if not outright malignance.

Now Trump says he’s going to Puerto Rico next Tuesday. That’s TWO WEEKS after the storm. Can’t disrupt his golf game over last or the next weekend, don’t you know. What I particularly despise about Trump’s response to this crisis is that he makes this guy’s fly-by two days after Katrina look so much better.

Call your members of Congress and demand action. Yeah, that’s not a question. Suck it up; you’ve got electricity, communications, and access to clean water if you’re reading this. Millions of your fellow Americans in Puerto Rico don’t. Let’s fix this.

~ 2 ~
GRAHAM-CASSIDY-HELLER-JOHNSON NOT-A-HEALTH-CARE BILL

Have you called your senator and asked them to vote NO on the debacle Sen. Bill Cassidy can’t explain and over which Sen. Lindsey Graham is ruining any cred as a rational human being, while disabled health care activists recover from being hauled away by capitol police yesterday before the Senate Finance Committee’s hearing on the bill?

Have you documented and shared publicly your senators’ position on Graham-Cassidy, especially if they are up for re-election in 2018?

The number is (202) 224-3121 if you don’t have it memorized already.

Need a script to make it easier? Here you go.

As wretchedly bad as this obscene joke of a bill is, I can’t help wonder if GOP members of Congress and their staff are gaming this. Have they been working on something even worse than previous attempts at ACA repeal just to game the stock market and make a few bucks on the backs of worried citizens?

[graphic: Health Insurance stock chart, via Google Finance]

For grins you should look at Aetna’s chart for last Friday and note the jump it took when Sen. McCain expressed his reluctance to support Graham-Cassidy. Price jumped about the same time capitol police arrived to arrest protesters. Easy money, that, conveniently ahead of the market’s close.

~ 1 ~
IRAN ~AND~ PUERTO RICO

What question do these two disparate places prompt?

First, Trump tweeted about an Iranian missile launch as if it had ~just~ happened, within 24 hours of a reconstituted travel in which Iran is listed. But the missile launch ~didn’t~ just happen; it took place more than six months ago but was mentioned only this week in Iranian news.

Second, Trump took his fucking sweet time ensuring FEMA went to Puerto Rico; Hurricane Maria made landfall on September 20th, visible to anyone who watched weather networks, NOAA, and NASA reporting.

Is Trump ignoring any and all U.S. intelligence and government experts on matters foreign and domestic, relying instead on some other criteria for responding to events, including cable TV? Should we believe for a second he’s simply and accidentally flooding his source of information?

In the case of Iran’s missile program, it looks more like he deliberately used stale news to defend a new travel ban while making propagandistic false statements to the public. The Supreme Court canceled hearing the travel ban after the travel ban was rejiggered — does this suggest his manipulation of perception worked, not only on the public but on the Supreme Court?

~ 0 ~
One more time: call your Senators to ask NO on Graham-Cassidy and get their position on the record. Call your members of Congress to ask for urgent response and funding for aid to Puerto Rico. The number is (202) 224-3121. Put it on speed dial.

Viajar bien, mis amigos y amigas.

Financing Medicare For All

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If you only read mainstream media you’d think Bernie Sanders’ Medicare for All bill was terrifyingly expensive. An opinion piece behind the paywall in the Wall Street Journal cites a couple of studies with huge headline numbers like $2.5 trillion dollars in the first year, from the Urban Institute. Taxes will soar, government takeover of health care blah blah blah. It comes from centrist Democrats like Jonathan Chait and Ezra Klein who I saw in an appearance on Seth Meyer’s show. Here are two things to bear in mind in self-defense.

1. In 2015, we spent about $3.2 trillion on health care in the US. There is a cool graphic here showing where it was spent and who paid that amount. Maybe the cost of health care covering everyone for the kinds of things the Affordable Care Act requires would cost more than that. (The Sanders Plan covers other services as well as those under the ACA, but let’s ignore that because I can’t find numbers.) We calculate the additional amount we would need by adding the cost of all uninsured people and the cost of the care that people with insurance can’t afford because of deductibles and other co-pays, and subtracting the savings from the new plan. Any analysis that doesn’t start with this is bullshit.

It’s true that the Sanders plan would change who pays and how much, so someone would have to redo that cool graphic I mentioned. Some businesses would pay more, others less, and there would be a change in corporate taxation as deductible costs of insurance change. Some individuals would pay more and others less. But whatever those changes might be, the amount we need to raise isn’t frightening, and practically everyone will be better off.

It’s easy to see the savings from negotiating drug prices, lowering the reimbursement to doctors and hospitals, reducing excess profits from the health insurance companies, and reducing the costs of administration throughout the health care business.

It’s also easy to see that the additional costs are not that high. Approximately 9.1% of us were uninsured in 2015, so the cost might be as high as 10%, or $320 billion. That doesn’t seem too terrible when the savings are deducted. It will be easy to finance that if we want to. I have a long list of things to cut if anyone cares, starting with dismantling the carceral state.

2. We need to think clearly about taxation. We live in a fiat money system; the US is sovereign in its own currency and cannot go bankrupt. I’ve read Modern Monetary Theory by Randall Wray and many shorter pieces and I am convinced. I could make an interesting argument from MMT about this whole matter, but I won’t and I not going to focus on that. If single-payer a hard sale, convincing the devotees of Econ 101 (course title: My Neoliberalism) about MMT is hopeless. Actually with the excellent Stephanie Kelton as a teacher and leader I could well be wrong. Check out this on the Twitter, and follow her if you don’t already.

I agree with Warren Mosler, another MMT theorist, that taxes for revenue are obsolete. But that doesn’t mean that taxes are obsolete. Quite the contrary. Mosler quotes from a 1945 speech by Beardsley Ruml, chair of the New York Fed, to the American Bar Association. Ruml gives four grounds for taxation other than revenue:

1. As an instrument of fiscal policy to help stabilize the purchasing power of the dollar;

2. To express public policy in the distribution of wealth and of income, as in the case of the progressive income and estate taxes;

3. To express public policy in subsidizing or in penalizing various industries and economic groups;

4. To isolate and assess directly the costs of certain national benefits, such as highways and social security.

We can make a case for taxes and other measures to support Medicare for All relying solely on those four principles, without explicitly discussing MMT. If we do that, we lay a foundation for future tax issues, and for a sensible discussion of tax reform more broadly. I have a list of tax changes that will meet those standards. How about that NASCAR deduction for a starter. We raise a bit of money and get rid of a bit of corruption with one change.

This is a great teachable moment for MMT, just as the government shutdowns were with the heated arguments about the trillion dollar coin. I know Kelton and others will push on the MMT side. We need to win this, and we can’t afford to fight on two fronts. In particular, it isn’t helpful to attack people who don’t want to argue about MMT on the way to fixing our health care system. People like me.

Three Things: In the Debris Field After Health Care ‘Freedom’ Act

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I still don’t have enough caffeine in my system and it’s nearly noon here. An entire pot of java may do the trick. As I rouse and read the hot takes after the failure of H.R. 1628 last night, a few thoughts stick with me.

~ 3 ~

All the think pieces — most written by white men lauding John McCain’s maverick move by departing from the party line — are evidence ‘the show’ worked.
McCain called it that when asked before the vote last night which way he was going. “Watch the show,” he said.

Meanwhile, the two women senators who have been firm all along they couldn’t vote for a bill causing damage to their constituents receive far fewer plaudits from the same mostly-white-male pundit class. Murkowski had been threatened by the Interior Secretary at Trump’s request. I haven’t heard for certain, but I’ll bet Collins received threats as well, probably from Trump-supporting constituents.

McCain won’t get those kinds of threats. He made his point last night about the power he wields within GOP Senate caucus as the final A/B switch on legislation. But the GOP Senate already knew this.

What McCain did was give the GOP a face-saving way to vote for a piece of shit they didn’t want to pass, without the repercussions Collins and Murkowski (and at varying times, Heller and Capito) have faced for rejecting a POS bill.

This is why they waited until the last goddamned minute to draft a meager eight-pages, slapping in some egregious stuff to ensure Collins and Murkowski couldn’t vote, adding the 20% annual premium increase as a coup de grace.

Because McCain would do the maverick kabuki for them, slap on his mask and robes, make big gestures and kill the bill for them.

And it worked not only because all the white male pundit class got suckered by their usual privileged blindness, but the white male Tweeter-in-Chief bought it, hook, line, sinker. He blamed all the Democrats and three GOP senators. All the other senators are off the hook.

Bonus: McCain’s legacy is salvaged with the patriarchal punditry.

Great ‘show’, maverick.

~ 2 ~

Scaramucci is nothing more than a highly-animated automaton on a stage; nothing he says is real. Why? Because the real communications are being run out of house by Steve Bannon, and likely in violation of federal law.

What is it and to whom is Bannon really communicating for the White House?
This operation may be in violation of the Antideficiency Act, but is it also in violation of the Presidential Records Act? What about any other regulations regarding FOIA?

Don’t believe me about Scaramucci’s role? Take a look at your news feed and point to any announcement about his firing or resignation. You know damned well had a communications director acted like he has under any other previous administration he’d have been walked out the White House’s fence.

p.s. Some say Scaramucci’s lowering discourse. Come the fuck on. He talks the way all of Wall Street’s white males do. The misogynist crack about Sarah Huckabee Sanders’ appearance? Par for the course.

~ 1 ~

Recommended lunch hour read for you: a book review by Andrew Bacevich in London Review of Books on The General v. the President: MacArthur and Truman at the Brink of Nuclear War by H.W. Brands. Bacevich’s background here.

Putting this book on my shopping list after this review, given how much power Trump has given and is likely to give to the military, breaking with civilian control.

~ 0 ~

That’s it for now. I’m stewing on something else but it’ll be dedicated and not an open thread like this one. Hasta pasta.