Here's something else to think about:
In modern times, rising death rates are extremely rare and typically
involve countries in upheaval, such as Russia immediately after the
collapse of the Soviet Union. In affluent countries, people generally
enjoy increasingly long lives, thanks to better cancer treatments, drugs
that lower cholesterol and the risk of heart attacks, fewer fatal car
accidents, and less violent crime.
But progress for middle-aged
white Americans is lagging in many places — and has stopped entirely in
smaller cities and towns and the vast open reaches of the country. The
things that reduce the risk of death are now being overwhelmed by things
that elevate it, including opioid abuse, heavy drinking, smoking and
other self-destructive behaviors.
This appeared yesterday in the Post. Although the article is a bit scattered, one bottom line is this: the health of rural america is declining, particularly among the under-class. It's probably not wholly surprising that it is occurring in areas that are predominantly religious, predominantly conservative in their political orientation, and predominantly Trump supporters. As Jeff Guo wrote:
a few weeks ago, following the Republican Iowa caucuses, I pointed out an eerie correlation in the voting data. It seems that Donald Trump performed the best in places where middle-aged whites are dying the fastest. That
wasn't a fluke. The relationship between white mortality and Trump
support is real, as the fresh results from Super Tuesday confirmed.
Part of the decline can be, I think, attributed to an "irony deficiency." Here's one way of thinking about it. Merle Haggard recently passed away, and I have to admit, I like his music, but his most familiar song, Okie from Muskogee, though dated, points to the deficiency. There is a self-image of being down-to-earth Americans, who "like livin' right, and bein' free," who still "wave old glory down at the court house." The prevailing myth is that rural life is more wholesome, and they pride themselves on the ethical superiority of down-home small-town folk, They still like to think of themselves as "living' right, and bein' free" despite tangible evidence to the contrary. The rising death rate is just one piece of evidence that suggests they are not "living right," but the prevailing myth allows them to go as if everything were fine.
Anecdotally, one of my "buddies" from the shop, fueled by the delusion that he was going to be the next Merle Haggard, told me he couldn't abide (his word) even Nashville. Although he isn't obese, he does smoke, and he does binge drink regularly to excess. He is unemployed, and unemployable because he wouldn't be able to pass a drug test. He has used meth, but gave that up after "it nearly killed" him, though I suspect the damage done helps him keep the weight off. He still "smokes marijuana," if not in Muskogee, then in Mountain Home. There is little about him that is wholesome, or healthy, but at least he's "bein' free." He supports Trump, and wants to make America great again, though I'm not altogether clear what his vision of greatness might be.
Here's another case of "irony deficiency." A consumer advocacy group, Wallet Hub, ranked states by most to least dependent on federal aid. One could point to the greater dependency of conservative rural states on federal assistance, among other things, for additional evidence that they are not self-reliant folks "living free" from assistance. Having said that, however, they WANT to live with greater freedom from federal dependency, and they have chosen health care as one place to make a stand. As Ben Hallman of the Huffington Post reports,
the most obvious evidence of this trend can be seen in the expansion of Medicaid, the health plan for the poor, under the Affordable Care Act. Of the 10 states with the biggest dependency gap as determined by Wallet Hub, seven -- Alabama, Mississippi, Louisiana, Maine, Montana, South Dakota and Tennessee -- have decided not to expand their Medicaid programs, even though the funding would come from federal coffers.
I wouldn't go so far as to say that there is a causal correlation between the increasing death rate among rural whites, but I would go so far as to say that the actions of their elected officials, every last one of them a "conservative," are doing absolutely nothing to help. On the contrary, they are doing everything they can to resist help. Perhaps they are, as my wife suggested, trying to thin the herd. If so, they're succeeding.
Monday, April 11, 2016
Sunday, April 10, 2016
The Underclass
I made the point the other day, in a rare response to a Post article, that the world has grown much to complex for simplistic solutions. This appeared yesterday:
Maybe everyone is overcomplicating America's economic challenges today. Maybe there are no deep mysteries behind the slow growth, the stagnation incomes and the widespread economic anxieties that have given rise to populist movements on the left and right. Maybe the problem is simple: too many workers.
This appeared in a blog post by Tankersly. I do think he's right, or rather Daniel Alpert of Third Way is right. The basic premise is this: economies are "demand" driven. Unemployment, but especially underemployment, dampens demand. Consequently, even though a good number of low wage or part time gigs are available, those that are available do not provide enough "demand" in the form of disposable wages to really jump start the economy. The answer: a public Rooseveltian infrastructure project, which would create the jobs, which would create the wages, which would create the demand, which in turn would encourage employers in the private sector to invest the money that they are currently sitting on, creating the virtuous cycle of more jobs, more demand, et cetera. The general structure of Alpert's argument is, I think, correct, but here's my take one step at a time. Whether a public infrastructure project could help solve a "global" problem is debatable, but then employment is always right here, right now, so I say nothing ventured nothing gained.
On several occasions, I have referred to a more or less permanent "underclass," in some ways not unlike the servant class of the mid-19th century, except today there is no compelling need for domestic servants. My thinking on this would take a full series of posts, but it goes like this: technology has changed, and will continue to change, the fundamental nature of work. As a hypothetical, if shipping and other costs drive manufacturing back to America, it won't be assembly line of the past. Robotics, CNC, and other technologies will be "employed" to help reduce personnel costs. There will be jobs, and they will be higher paying jobs, but they will be far fewer, and they will require an up-front investment in education.
I could go on about "education," but let me just say that "education," such as it is today, tends to reproduce the "parent," in level of attainment, in level of economic viability, and the like. This shouldn't be surprising, in part because more and more of that "up-front investment" is borne by the student and parent. At the secondary level, setting aside private schools, the quality of schooling depends heavily upon where one lives. Nothing has changed since Kozol's Savage Inequalities and if anything, with charter school movements and the like, it has grown worse. At the post secondary level, with state legislators cutting funding to public universities, tuition rates have sky-rocketed in compensation. The up front investment is either case is steep, and getting steeper. That "education" tends to reproduce the social class of the parent runs counter to the horatio alger myth that "getting an education" will lift one out of the "underclass" into the middle or upper classes. There are always enough exceptions to help fuel the myth, but for the vast majority, it nevertheless remains much more a myth than a reality.
Those beginning their education in the "underclass" are much less likely to complete their education. Even if they do complete, they are much much much less likely to complete it at anything resembling an "elite" institution, even the better state institutions, that would make a significant difference in their job search. Members of the "underclass" are more likely to emerge from an underfunded secondary system, start at the local community college, or fourth tier state university, and then drift out of higher education altogether. The educators at these institutions are often dedicated and idealistic, but ultimately calculous is calculous, and it often takes an understanding at the level of calculous to run that CNC machine. It's not that the underclass students are fundamentally incapable, though long socialization and poor preparation have rendered them so, and we are asking them to expend enormous intellectual energy and defer expectations in preparation for a job that isn't fun, doesn't fulfill "a dream," and is for the most part socially inconceivable to them. What is life like as a CNC operator? Who knows, but it doesn't sound fun. It's easier to imagine one's self as the next entertainment or sports star, a delusion fueled by reality TV, among other things.
Although good, high-wage jobs might exist, that they go un-filled simply means that employers are competing for those employees, which means they are in "short supply." There seems to be, however, no shortage of workers prepared for underemployment, part time, poorly paid work in the service industries that don't require an understanding at the level of calculous. Although employers will complain about turn-over, low work ethic, et cetera, the employer nevertheless has the competitive edge. The wages don't go up, despite the high turn over, because they don't have much trouble filling those jobs. There's always someone else who can, so to speak, flip the burger. Now add the millions upon millions of under-employed in china and india. For the most part the service industry is not exportable. Other industries, however, are exportable, as the donald will attest, and it's cheaper to make ties in indonesia than indiana, which means there are even fewer jobs that don't require an understanding at the level of calculous. Tariffs? Better trade deals? Both are dangerous and neither will help. As I said, even the manufacturer does return, it won't be the assembly line of your grandfather.
Bottom line, when you are making little better than minimum wage, you are living at or near poverty, and those living at or near poverty do not consume in ways that fuel the economy. I don't think we're on the edge of collapse, at least not yet, but I do think we're in for a long, ever-so-slow, decline. Basic argument is this: the so-called billionaire class is already sitting on boat loads of money. They are unwilling to invest it in the sorts of ventures that will create jobs because, well, there is insufficient demand. Unlike China, we will not be building cities that go uninhabited, or factories that sit idle, so the money sits in investments that produce "rent" in the economist's sense, or worse just sits, zen like, doing nothing in off-shore, tax-avoidance accounts. Conservatives who listen to the billionaire class do not support infrastructure projects that will create jobs that might help fuel the economy, because, well, where will the money come from? The answer to that question is the obvious one: out of the off shore accounts of the billionaire class. Over the long haul, it might help them, but not in the next quarter, and the next quarter, after all is said and done, is what we live for ...
Maybe everyone is overcomplicating America's economic challenges today. Maybe there are no deep mysteries behind the slow growth, the stagnation incomes and the widespread economic anxieties that have given rise to populist movements on the left and right. Maybe the problem is simple: too many workers.
This appeared in a blog post by Tankersly. I do think he's right, or rather Daniel Alpert of Third Way is right. The basic premise is this: economies are "demand" driven. Unemployment, but especially underemployment, dampens demand. Consequently, even though a good number of low wage or part time gigs are available, those that are available do not provide enough "demand" in the form of disposable wages to really jump start the economy. The answer: a public Rooseveltian infrastructure project, which would create the jobs, which would create the wages, which would create the demand, which in turn would encourage employers in the private sector to invest the money that they are currently sitting on, creating the virtuous cycle of more jobs, more demand, et cetera. The general structure of Alpert's argument is, I think, correct, but here's my take one step at a time. Whether a public infrastructure project could help solve a "global" problem is debatable, but then employment is always right here, right now, so I say nothing ventured nothing gained.
On several occasions, I have referred to a more or less permanent "underclass," in some ways not unlike the servant class of the mid-19th century, except today there is no compelling need for domestic servants. My thinking on this would take a full series of posts, but it goes like this: technology has changed, and will continue to change, the fundamental nature of work. As a hypothetical, if shipping and other costs drive manufacturing back to America, it won't be assembly line of the past. Robotics, CNC, and other technologies will be "employed" to help reduce personnel costs. There will be jobs, and they will be higher paying jobs, but they will be far fewer, and they will require an up-front investment in education.
I could go on about "education," but let me just say that "education," such as it is today, tends to reproduce the "parent," in level of attainment, in level of economic viability, and the like. This shouldn't be surprising, in part because more and more of that "up-front investment" is borne by the student and parent. At the secondary level, setting aside private schools, the quality of schooling depends heavily upon where one lives. Nothing has changed since Kozol's Savage Inequalities and if anything, with charter school movements and the like, it has grown worse. At the post secondary level, with state legislators cutting funding to public universities, tuition rates have sky-rocketed in compensation. The up front investment is either case is steep, and getting steeper. That "education" tends to reproduce the social class of the parent runs counter to the horatio alger myth that "getting an education" will lift one out of the "underclass" into the middle or upper classes. There are always enough exceptions to help fuel the myth, but for the vast majority, it nevertheless remains much more a myth than a reality.
Those beginning their education in the "underclass" are much less likely to complete their education. Even if they do complete, they are much much much less likely to complete it at anything resembling an "elite" institution, even the better state institutions, that would make a significant difference in their job search. Members of the "underclass" are more likely to emerge from an underfunded secondary system, start at the local community college, or fourth tier state university, and then drift out of higher education altogether. The educators at these institutions are often dedicated and idealistic, but ultimately calculous is calculous, and it often takes an understanding at the level of calculous to run that CNC machine. It's not that the underclass students are fundamentally incapable, though long socialization and poor preparation have rendered them so, and we are asking them to expend enormous intellectual energy and defer expectations in preparation for a job that isn't fun, doesn't fulfill "a dream," and is for the most part socially inconceivable to them. What is life like as a CNC operator? Who knows, but it doesn't sound fun. It's easier to imagine one's self as the next entertainment or sports star, a delusion fueled by reality TV, among other things.
Although good, high-wage jobs might exist, that they go un-filled simply means that employers are competing for those employees, which means they are in "short supply." There seems to be, however, no shortage of workers prepared for underemployment, part time, poorly paid work in the service industries that don't require an understanding at the level of calculous. Although employers will complain about turn-over, low work ethic, et cetera, the employer nevertheless has the competitive edge. The wages don't go up, despite the high turn over, because they don't have much trouble filling those jobs. There's always someone else who can, so to speak, flip the burger. Now add the millions upon millions of under-employed in china and india. For the most part the service industry is not exportable. Other industries, however, are exportable, as the donald will attest, and it's cheaper to make ties in indonesia than indiana, which means there are even fewer jobs that don't require an understanding at the level of calculous. Tariffs? Better trade deals? Both are dangerous and neither will help. As I said, even the manufacturer does return, it won't be the assembly line of your grandfather.
Bottom line, when you are making little better than minimum wage, you are living at or near poverty, and those living at or near poverty do not consume in ways that fuel the economy. I don't think we're on the edge of collapse, at least not yet, but I do think we're in for a long, ever-so-slow, decline. Basic argument is this: the so-called billionaire class is already sitting on boat loads of money. They are unwilling to invest it in the sorts of ventures that will create jobs because, well, there is insufficient demand. Unlike China, we will not be building cities that go uninhabited, or factories that sit idle, so the money sits in investments that produce "rent" in the economist's sense, or worse just sits, zen like, doing nothing in off-shore, tax-avoidance accounts. Conservatives who listen to the billionaire class do not support infrastructure projects that will create jobs that might help fuel the economy, because, well, where will the money come from? The answer to that question is the obvious one: out of the off shore accounts of the billionaire class. Over the long haul, it might help them, but not in the next quarter, and the next quarter, after all is said and done, is what we live for ...
Friday, April 8, 2016
Were it not for slavery
it's a shame the south wasn't successful in their secession. It's not a mystery that bigotry is self-reinforcing. I'm not sure which comes first, the bigotry or the religion, but it's not a mystery either that the bigotry of the south is reinforced and justified with religion, over and over again. I am not so naive to think that bigotry doesn't exist elsewhere. Of course it does, but those in the south seem determined, more than people elsewhere, to wave it from the state capital's flagpole along with the confederate flag. I don't believe that people are "entitled" to their ignorance, because the long list of ignominious belief has real consequence for real people, but then too I am not sure quite how we disabuse otherwise intelligent people of their fearful adherence to belief.
I'm not sure if I believe this, but I have this sneaking suspicion that the united states is, well, too big, too complex, to be governed effectively, so some partitioning might actually be appropriate. As the 20th century lapses into the 21st, there seem to be two contravening forces, one toward the globalization of "business," the other toward a balkanization. There are several things happening right now that tend to point in this direction, not least the current spat over the so-called "religious liberty" laws. On the one hand, I do have to admire big business for stepping up and refusing to look the other way. I imagine they could have remained neutral, and simply gone about their business, but they took a positive stand. Likewise, those state governments that have subsequently banned travel to states with discriminatory laws on the books are also taking a positive stand, although that points toward the balkanization -- it's as if New York State has excommunicated Mississippi. That some of these divides take place along traditional regional lines of tension makes it even more pertinent, and it's also pertinent that it's New York, long a "global" city, long home to the biggest of big business, that banned the travel.
It's not quite that neat, however. The real divide seems to be more urban and rural. It's probably not by accident that the governor of Mississippi signed his bill, governor of South Carolina vetoed his. In the former, as a test, name one city in Mississippi? The largest is Jackson, but it is home to only about 175K, which makes it smaller than most suburbs of Chicago. In the latter, Atlanta, not unlike New York, is a "global" city, home to some of biggest of the "global" corporations. It is not a difference without a distinction. At some level, global corporations must be tolerant of cultural, religious, and other differences. If they are truly global, then those markets will be, as they say, diverse, and it makes little sense to confine themselves to a "particular" world view. Although I am sure that there are all sorts of bigotries in the corridors of corporate america, GE cannot endorse a religiously justified hatred of homosexuality, any more than they can endorse the muslim over the christian versions of that hatred. The so-called southern strategy of the GOP, simultaneously courting big business and the evangelical fundamentalists, has perhaps seen its day. For the conservatives, one will need to choose ultimately whether one is a "globalist" and urban, or an "evangelical" and rural. In the end, I don't think one can remain both.
I say, "perhaps has seen its day," in part because marriages, even those made in hell, are difficult to dissolve. I'm pretty sure that the man in the 2000 dollar suit, finds it uncomfortable being at the same party with the toothless red-neck, railing about the niggers and the faggots, but I'm not sure he can yet show the red-neck to the door. That red-neck writes songs about his dog being a democrat, thinks of himself as a "republican," and the 2000 USD suit needs his vote if he is to remain free from taxes and free to exploit that self-same red-neck. Ted Cruz is a case in point, but I think the divide is visible even there. The brief spat about "New York values"shows the crack, though I think that was more a rhetoric of convenience, not conviction, and if push came to shove, as it might at a contested convention, I'm not sure which side Cruz would take. I suspect he'd follow the money, and I also suspect that many of his big business republicans have the same suspicion, and so can tolerate him over the loaded loose cannon of the donald, despite the donald's self-professed big business "cred." The real operatives of global corporations know that the "reality tv" mogul is no more "one of them" than his red-neck, biker-gang supporters. Still, better red than dead, as they say.
I'm not sure if I believe this, but I have this sneaking suspicion that the united states is, well, too big, too complex, to be governed effectively, so some partitioning might actually be appropriate. As the 20th century lapses into the 21st, there seem to be two contravening forces, one toward the globalization of "business," the other toward a balkanization. There are several things happening right now that tend to point in this direction, not least the current spat over the so-called "religious liberty" laws. On the one hand, I do have to admire big business for stepping up and refusing to look the other way. I imagine they could have remained neutral, and simply gone about their business, but they took a positive stand. Likewise, those state governments that have subsequently banned travel to states with discriminatory laws on the books are also taking a positive stand, although that points toward the balkanization -- it's as if New York State has excommunicated Mississippi. That some of these divides take place along traditional regional lines of tension makes it even more pertinent, and it's also pertinent that it's New York, long a "global" city, long home to the biggest of big business, that banned the travel.
It's not quite that neat, however. The real divide seems to be more urban and rural. It's probably not by accident that the governor of Mississippi signed his bill, governor of South Carolina vetoed his. In the former, as a test, name one city in Mississippi? The largest is Jackson, but it is home to only about 175K, which makes it smaller than most suburbs of Chicago. In the latter, Atlanta, not unlike New York, is a "global" city, home to some of biggest of the "global" corporations. It is not a difference without a distinction. At some level, global corporations must be tolerant of cultural, religious, and other differences. If they are truly global, then those markets will be, as they say, diverse, and it makes little sense to confine themselves to a "particular" world view. Although I am sure that there are all sorts of bigotries in the corridors of corporate america, GE cannot endorse a religiously justified hatred of homosexuality, any more than they can endorse the muslim over the christian versions of that hatred. The so-called southern strategy of the GOP, simultaneously courting big business and the evangelical fundamentalists, has perhaps seen its day. For the conservatives, one will need to choose ultimately whether one is a "globalist" and urban, or an "evangelical" and rural. In the end, I don't think one can remain both.
I say, "perhaps has seen its day," in part because marriages, even those made in hell, are difficult to dissolve. I'm pretty sure that the man in the 2000 dollar suit, finds it uncomfortable being at the same party with the toothless red-neck, railing about the niggers and the faggots, but I'm not sure he can yet show the red-neck to the door. That red-neck writes songs about his dog being a democrat, thinks of himself as a "republican," and the 2000 USD suit needs his vote if he is to remain free from taxes and free to exploit that self-same red-neck. Ted Cruz is a case in point, but I think the divide is visible even there. The brief spat about "New York values"shows the crack, though I think that was more a rhetoric of convenience, not conviction, and if push came to shove, as it might at a contested convention, I'm not sure which side Cruz would take. I suspect he'd follow the money, and I also suspect that many of his big business republicans have the same suspicion, and so can tolerate him over the loaded loose cannon of the donald, despite the donald's self-professed big business "cred." The real operatives of global corporations know that the "reality tv" mogul is no more "one of them" than his red-neck, biker-gang supporters. Still, better red than dead, as they say.
Thursday, April 7, 2016
The virtue most in demand
is tolerance, but it is the virtue in the shortest supply, making it very expensive indeed. A prominent atheist -- I can't remember who precisely -- was asked the hypothetical question, "well, suppose you are wrong. Suppose after you have died, you come face-to-face with God. What would you say?" He responded, "I'd ask, "who are you? Are you Zeus? Odin? Shiva ..." and from there he went through a list of gods. The one asking the question hadn't, of course, considered it from that angle. He assumed, of course, that he would come face-to-face with the one "true" god, the god of Abraham. Of course, even then, there is some dispute. Is the one true god worshipped by the jews, the christians, or the muslims? It seems, at the end of the day, that they are incompatible with one another. Indeed, it seems that the god of the catholic christians is incompatible with the god of the protestant christians, and it was a dispute worthy of years and years of trouble in Ireland, and that assuming you discount the whole tutorial history of protestantism in the British Isles.
Religion is either a pretext or a justification for the worst forms of intolerance. The new foray into intolerance -- the so-called religious liberty laws -- are of the worst sort. While it is a hopeful sign that many corporate sponsors have withdrawn from those states that have enacting them, it is a less than hopeful sign that they were enacted in the first place. The Human Rights Campaign, a lobbying group for the LGBT community, has written to the Governor of Mississippi concerning their own house bill 1523, saying:
Discrimination is wrong, and we believe it has no place in Mississippi or anywhere in our country. As companies that pride ourselves on being inclusive and welcoming to all, we strongly urge you to repeal this bill.
This letter was signed ostensibly by several corporate leaders, among them the CEOs of Levi, GE, Hyatt Hotels, and Pepsi. The latter is not be a concern, of course, because Coke reigns supreme in the south, and so it came to be and passed into law. HB 1523 is titled "Protecting Freedom of Conscience from Government Discrimination Act." Of course, such laws already exist, and in the US it is called the first Amendment, which prohibits government from "establishing a religion, or preventing the free exercise thereof." The second amendment, though, is written from the mutual obligations imposed by tolerance. I will tolerate your religion, if you tolerate my religion, and we will happily thrive side by side if not together. Of course, if one's religion demands a certain sort of "intolerance," at the moment directed at the gay and transgender community, then one cannot freely exercise one's religion if one cannot freely discriminate. It's a bit of a conundrum.
The Mississippi law only "protects" those whose "religious beliefs or moral convictions" are the "belief or conviction that" (a) "marriage is or should be recognized as the union of one man and one woman," (b) "sexual relations are properly reserved to such a marriage," and (c) "male (man) or female (woman) refer to an individual's immutable biological sex as objectively determined by anatomy and genetics at the time of birth." I think it endearing that they must point out that males and females are man and woman, and I think it worth pointing out that the anatomical sex at birth is not quite immutable, as Caitlyn Jenner has famously demonstrated. They are saying, of course, that it "should be" immutable, and the Jenner episode in the news cycle probably "creeps them out" just a bit insofar as he was an athlete, a man's man, in his day. Regardless, if one believes (a) through (c) with sincerity, then under the terms of the statute one is free to discriminate in a wide variety of circumstances outlined in the law. I won't detail them all, but the list is relatively extensive. You can find the text of the law and the full list of allowable circumstances at http://billstatus.ls.state.ms.us.
The law assumes a number of things, not least of which is that the "sincerely held religious beliefs or moral convictions" are christian and protestant. Fundamentalist muslims are no more tolerant of homosexuality than the fundamentalist christians, and I'm sure those who sincerely subscribe to islamic law or sharia would favor just such a law. They may want to take it one step further, but as I'm sure the evangelical community looks at HB 1523 as a "first step" in the implementation of sharia in the US ... whoops, my bad, I meant christian law ... in the sincere belief that it "expresses the highest and best goals of all societies," it being the will of allah ... whoops, my bad again, I meant simply the one true god. As I think about this, we may be missing a golden opportunity in Mississippi. We may bring the faithful of the christian and muslim faiths together in their common hatred of gays? Nothing draws a community together like a common hatred ...
Religion is either a pretext or a justification for the worst forms of intolerance. The new foray into intolerance -- the so-called religious liberty laws -- are of the worst sort. While it is a hopeful sign that many corporate sponsors have withdrawn from those states that have enacting them, it is a less than hopeful sign that they were enacted in the first place. The Human Rights Campaign, a lobbying group for the LGBT community, has written to the Governor of Mississippi concerning their own house bill 1523, saying:
We are disappointed to see the legislature and governor’s office pass discriminatory legislation. The
business community, by and large, has consistently communicated to lawmakers at every level that such
laws are bad for our employees and bad for business. This is not a direction in which states move when
they are seeking to provide successful, thriving hubs for business and economic development. We believe
that HB 1523 will make it far more challenging for businesses across the state to recruit and retain the
nation’s best and brightest workers and attract the most talented students from across the country. It will
also diminish the state’s draw as a destination for tourism, new businesses, and economic activity.
Discrimination is wrong, and we believe it has no place in Mississippi or anywhere in our country. As companies that pride ourselves on being inclusive and welcoming to all, we strongly urge you to repeal this bill.
This letter was signed ostensibly by several corporate leaders, among them the CEOs of Levi, GE, Hyatt Hotels, and Pepsi. The latter is not be a concern, of course, because Coke reigns supreme in the south, and so it came to be and passed into law. HB 1523 is titled "Protecting Freedom of Conscience from Government Discrimination Act." Of course, such laws already exist, and in the US it is called the first Amendment, which prohibits government from "establishing a religion, or preventing the free exercise thereof." The second amendment, though, is written from the mutual obligations imposed by tolerance. I will tolerate your religion, if you tolerate my religion, and we will happily thrive side by side if not together. Of course, if one's religion demands a certain sort of "intolerance," at the moment directed at the gay and transgender community, then one cannot freely exercise one's religion if one cannot freely discriminate. It's a bit of a conundrum.
The Mississippi law only "protects" those whose "religious beliefs or moral convictions" are the "belief or conviction that" (a) "marriage is or should be recognized as the union of one man and one woman," (b) "sexual relations are properly reserved to such a marriage," and (c) "male (man) or female (woman) refer to an individual's immutable biological sex as objectively determined by anatomy and genetics at the time of birth." I think it endearing that they must point out that males and females are man and woman, and I think it worth pointing out that the anatomical sex at birth is not quite immutable, as Caitlyn Jenner has famously demonstrated. They are saying, of course, that it "should be" immutable, and the Jenner episode in the news cycle probably "creeps them out" just a bit insofar as he was an athlete, a man's man, in his day. Regardless, if one believes (a) through (c) with sincerity, then under the terms of the statute one is free to discriminate in a wide variety of circumstances outlined in the law. I won't detail them all, but the list is relatively extensive. You can find the text of the law and the full list of allowable circumstances at http://billstatus.ls.state.ms.us.
The law assumes a number of things, not least of which is that the "sincerely held religious beliefs or moral convictions" are christian and protestant. Fundamentalist muslims are no more tolerant of homosexuality than the fundamentalist christians, and I'm sure those who sincerely subscribe to islamic law or sharia would favor just such a law. They may want to take it one step further, but as I'm sure the evangelical community looks at HB 1523 as a "first step" in the implementation of sharia in the US ... whoops, my bad, I meant christian law ... in the sincere belief that it "expresses the highest and best goals of all societies," it being the will of allah ... whoops, my bad again, I meant simply the one true god. As I think about this, we may be missing a golden opportunity in Mississippi. We may bring the faithful of the christian and muslim faiths together in their common hatred of gays? Nothing draws a community together like a common hatred ...
Tuesday, April 5, 2016
It's perhaps no secret
that American politics, of late, has become increasingly dysfunctional, increasingly divisive with entrenched positions on both the left and the right. The administration of Obama has been stymied at every turn, and there is a telling line in one of the Post's stories this morning that labeled the republican dominated congress hypocritical welfare queens -- taking government benefits while refusing to do their constitutionally mandated job. It is, for example, the president's job to appoint federal judges, the congressional job to either affirm or reject those appointments. We know what is happening with Obama's supreme court nominee. Let's face it. I'm sure he could have found a judge more staunchly progressive in his orientation, but he chose to nominate someone that even the republicans couldn't object to -- except, of course, they did -- and, yes, in doing so, like good union members, went on strike, refusing to do their (I keep saying) constitutionally mandated job.
At some level, of course, it's the fox news syllogism -- everything Obama does is wrong, he is attempting to appoint X, ipso facto presto the appointment of X is wrong. Nothing will move in this climate, and it goes from top to bottom. One of toss off lines in the article reads "republicans may be trying to make the federal government as dysfunctional as possible under President Obama," and there may be some truthiness in this. I wouldn't vote for Mike Simpson, my republican congressman, who basically blew me off, in part because I won't fit his stereotype of one "hurt" by Obamacare. I do fall into the category of one "hurt" by Obamacare, but my "hurt" results, not from the structure of the law, but from the state exchange's inability to do their job. Obamacare COULD work just fine, thank you very much, and I COULD have health insurance of a sort, thank you very much, but it ISN'T working because the state and federal legislators simply don't care that it isn't working, are actually I'm sure pleased that it isn't working, even though I strong suspect that it's not working because they are simply not fulfilling their obligations under the law.
Back in the day, our popular state governor, Butch Otter, hoped to push through the Idaho legislature what is referred to as "nullification." It is, on a point by point basis, the principle of "succession." If the Attorney General of the state feels that a law is "invasive," they may simply "succeed" from that law. Among many other things, the Attorney General is
to seek in juncture and any other appropriate relief as expeditiously as possible to preserve the rights and property of the residents of the state of Idaho, and to defend as necessary the state of Idaho, its officials, employees, and agents in the event that any law or regulation violating the public policy set forth in the Idaho health freedom act, chapter 90, title 39, Idaho Code, is enacted by any government, subdivision or agency thereof.
The "public policy" set forth is this:
It is hereby declared that the public policy of the state of Idaho, consistent with our constitutionally recognized and inalienable right of liberty, is that every person within the state of Idaho is and shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty.
OK, such a statement would be consistent for a libertarian governor. In principle, who could disagree with liberty? Well, here's what it REALLY means. The state of Idaho has set its people free from the any government sanctioned encroachments on their freedom to choose their means of providing health care for themselves. If the people are free, the governments only obligation is to do nothing, except resist the attempts on the part of the government to do anything. Part of this was reaction against the "insurance mandate" -- the provision of the law that made it obligatory that everyone MUST have insurance or face legal tax penalties. It's the notion that, by Gosh, if a person doesn't WANT to have insurance, they shouldn't be mandated by the federal government to GET insurance.
All of this is well and good, but here's the kicker. The person who doesn't get insurance affects me as the person who does get insurance. The arguments for this are familiar, but essentially it comes down to two things.
First, the provision that a person can't be denied insurance for pre-existing conditions. Health insurance companies really don't want to insure sick people who will make claims. They want to insure healthy people who don't make claims. Consequently, if there is no provision that prohibits denial for pre-existing conditions, health insurance companies will raise individual rates or drop those people who make claims. We're familiar with this from our automobile insurance. Insurance companies don't want to insure people who have lots of accidents. They want to insure people who have no accidents who don't make claims. If you have accidents, insurance companies raise individual rates or drop those people who make claims. There is, however, an ethical difference of reasonable responsibility. It is reasonable to hold people ethically responsible for their accidents, less reasonable to hold them responsible for their diseases -- not entirely, of course, because there are "lifestyle diseases" linking, for example, lung cancer and smoking, heart attacks and too much McDonalds, et cetera. For the most part, however, people can't be held responsible for their diseases., and we tend to feel that dropping the cancer patient because they are "too expensive" is egregious.
Second, if insurance companies can't drop people who make claims, then they need to mitigate their risk. If insurance companies must extend insurance to those who demand it, then only the sick would demand it. People would not pay the premiums if there were little perceived risk of making claims, so the more rational among us would hold off getting insurance until we "needed" it. Such behavior would, of course, quickly bankrupt the insurance companies. If people are "free to choose or decline any mode of securing health care services without penalty or threat of penalty," then, of course, the more rational of us would "decline health care services" and hold off on insurance premium payments until we "needed" it, particularly if we cannot be denied insurance. Such behavior would, of course, quickly bankrupt the insurance companies. If people are complete free to choose or decline services, then the insurance companies too must be free to give or decline services. It's only fair.
And so, in a world of perfect "liberty," either the insurance companies or the populace can behave egregiously. Some of this is hidden by employer based insurance, which mitigates the risk by equipping all employees across a wider employee pool to have insurance, but one has to ask how much "liberty" an employee has in choosing his "health care." Of course, in those states where unions have some sway, employees can bargain for health care, but Idaho is a "right to work" state which effectively also nullifies most attempts at collective bargaining. Outside of collective bargaining, health insurance is an employer's, not an employee's decision, and employers will choose plans that are in their own, not necessarily in their employees' interests.
Despite the high minded rhetoric of nullification, it was essentially just a ploy to remove any obligation on the part of government to do anything, which in turn simply retains the status quo. We should ask who benefits from the status quo, but I have railed on that enough. For those not covered by "employer based" insurance, either because we are self-employed or under-employed, in a world of perfect liberty and "market based solutions," if we are to have health insurance at all we must (1) not need it at all when we sign up, and (2) be willing to pay upwards of 10K per year for insurance with deductibles of over 5K. Such liberty, if we are to have health insurance at all, puts about 25% of the median income into the pockets of the insurance providers. Suffice it to say that, under the status quo, one didn't see the profit margins of the health insurance providers suffering, but we did see hundreds of thousand of people without insurance suffering. Obamacare helped, however marginally, to address that issue. It is a perfectly rational function of government to set such "compromises" on liberty into law, and that, of course, includes the federal government. The republican dominated supreme court even recognized this function of government.
There is, however, the other path to "nullification," which is, as was suggested above, do what you are required to do, but do it as half-heartedly, as poorly as possible, which seems to be the case in many republican dominated states like Idaho. Any libertarian approach to government, despite the high minded infusion of Ayn Rand philosophy, only supports the existing power structures within the status quo. If the government of the state is not obligated to do anything, except perhaps resist the obligation to do anything, then they are indeed welfare queens, drawing a government salary to do absolutely nothing.
At some level, of course, it's the fox news syllogism -- everything Obama does is wrong, he is attempting to appoint X, ipso facto presto the appointment of X is wrong. Nothing will move in this climate, and it goes from top to bottom. One of toss off lines in the article reads "republicans may be trying to make the federal government as dysfunctional as possible under President Obama," and there may be some truthiness in this. I wouldn't vote for Mike Simpson, my republican congressman, who basically blew me off, in part because I won't fit his stereotype of one "hurt" by Obamacare. I do fall into the category of one "hurt" by Obamacare, but my "hurt" results, not from the structure of the law, but from the state exchange's inability to do their job. Obamacare COULD work just fine, thank you very much, and I COULD have health insurance of a sort, thank you very much, but it ISN'T working because the state and federal legislators simply don't care that it isn't working, are actually I'm sure pleased that it isn't working, even though I strong suspect that it's not working because they are simply not fulfilling their obligations under the law.
Back in the day, our popular state governor, Butch Otter, hoped to push through the Idaho legislature what is referred to as "nullification." It is, on a point by point basis, the principle of "succession." If the Attorney General of the state feels that a law is "invasive," they may simply "succeed" from that law. Among many other things, the Attorney General is
to seek in juncture and any other appropriate relief as expeditiously as possible to preserve the rights and property of the residents of the state of Idaho, and to defend as necessary the state of Idaho, its officials, employees, and agents in the event that any law or regulation violating the public policy set forth in the Idaho health freedom act, chapter 90, title 39, Idaho Code, is enacted by any government, subdivision or agency thereof.
The "public policy" set forth is this:
It is hereby declared that the public policy of the state of Idaho, consistent with our constitutionally recognized and inalienable right of liberty, is that every person within the state of Idaho is and shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty.
OK, such a statement would be consistent for a libertarian governor. In principle, who could disagree with liberty? Well, here's what it REALLY means. The state of Idaho has set its people free from the any government sanctioned encroachments on their freedom to choose their means of providing health care for themselves. If the people are free, the governments only obligation is to do nothing, except resist the attempts on the part of the government to do anything. Part of this was reaction against the "insurance mandate" -- the provision of the law that made it obligatory that everyone MUST have insurance or face legal tax penalties. It's the notion that, by Gosh, if a person doesn't WANT to have insurance, they shouldn't be mandated by the federal government to GET insurance.
All of this is well and good, but here's the kicker. The person who doesn't get insurance affects me as the person who does get insurance. The arguments for this are familiar, but essentially it comes down to two things.
First, the provision that a person can't be denied insurance for pre-existing conditions. Health insurance companies really don't want to insure sick people who will make claims. They want to insure healthy people who don't make claims. Consequently, if there is no provision that prohibits denial for pre-existing conditions, health insurance companies will raise individual rates or drop those people who make claims. We're familiar with this from our automobile insurance. Insurance companies don't want to insure people who have lots of accidents. They want to insure people who have no accidents who don't make claims. If you have accidents, insurance companies raise individual rates or drop those people who make claims. There is, however, an ethical difference of reasonable responsibility. It is reasonable to hold people ethically responsible for their accidents, less reasonable to hold them responsible for their diseases -- not entirely, of course, because there are "lifestyle diseases" linking, for example, lung cancer and smoking, heart attacks and too much McDonalds, et cetera. For the most part, however, people can't be held responsible for their diseases., and we tend to feel that dropping the cancer patient because they are "too expensive" is egregious.
Second, if insurance companies can't drop people who make claims, then they need to mitigate their risk. If insurance companies must extend insurance to those who demand it, then only the sick would demand it. People would not pay the premiums if there were little perceived risk of making claims, so the more rational among us would hold off getting insurance until we "needed" it. Such behavior would, of course, quickly bankrupt the insurance companies. If people are "free to choose or decline any mode of securing health care services without penalty or threat of penalty," then, of course, the more rational of us would "decline health care services" and hold off on insurance premium payments until we "needed" it, particularly if we cannot be denied insurance. Such behavior would, of course, quickly bankrupt the insurance companies. If people are complete free to choose or decline services, then the insurance companies too must be free to give or decline services. It's only fair.
And so, in a world of perfect "liberty," either the insurance companies or the populace can behave egregiously. Some of this is hidden by employer based insurance, which mitigates the risk by equipping all employees across a wider employee pool to have insurance, but one has to ask how much "liberty" an employee has in choosing his "health care." Of course, in those states where unions have some sway, employees can bargain for health care, but Idaho is a "right to work" state which effectively also nullifies most attempts at collective bargaining. Outside of collective bargaining, health insurance is an employer's, not an employee's decision, and employers will choose plans that are in their own, not necessarily in their employees' interests.
Despite the high minded rhetoric of nullification, it was essentially just a ploy to remove any obligation on the part of government to do anything, which in turn simply retains the status quo. We should ask who benefits from the status quo, but I have railed on that enough. For those not covered by "employer based" insurance, either because we are self-employed or under-employed, in a world of perfect liberty and "market based solutions," if we are to have health insurance at all we must (1) not need it at all when we sign up, and (2) be willing to pay upwards of 10K per year for insurance with deductibles of over 5K. Such liberty, if we are to have health insurance at all, puts about 25% of the median income into the pockets of the insurance providers. Suffice it to say that, under the status quo, one didn't see the profit margins of the health insurance providers suffering, but we did see hundreds of thousand of people without insurance suffering. Obamacare helped, however marginally, to address that issue. It is a perfectly rational function of government to set such "compromises" on liberty into law, and that, of course, includes the federal government. The republican dominated supreme court even recognized this function of government.
There is, however, the other path to "nullification," which is, as was suggested above, do what you are required to do, but do it as half-heartedly, as poorly as possible, which seems to be the case in many republican dominated states like Idaho. Any libertarian approach to government, despite the high minded infusion of Ayn Rand philosophy, only supports the existing power structures within the status quo. If the government of the state is not obligated to do anything, except perhaps resist the obligation to do anything, then they are indeed welfare queens, drawing a government salary to do absolutely nothing.
Monday, April 4, 2016
Gridlock
My friend stopped by yesterday. He succeeded in getting his disability. Take this with a grain of salt, since I'm no doctor, but he's certainly no more disabled than my wife who suffers (at times quite literally suffers) from neck and back pain, the causes of which are visible even to a lay person looking at an x-ray, and the scars of three very expensive surgeries to prove it. He was disappointed that he wasn't awarded all the "back" disability pay, but nevertheless seemed quite pleased with himself, like someone who had won a battle of wits. He also gets his medical care from the VA, and takes some very heavy duty prescribed pain meds, which no doubt helped along his disability claim.
He is, of course, a republican, in part because he is a self-professed "evangelical," and evangelicals are, well, republican in this day and age. He would vehemently deny that he is a "practicing" socialist -- that is to say, he tacitly approves of "democratic socialist programs" because he is taking benefits from at least two such government run, tax-supported programs -- and, indeed, has said that "Clinton is a socialist" in much the same way that he would say "Clinton is shit," with the same expectoration of the sibilants, with the same expectation of self-evident evil. I don't want to make too much of my friend. He is not as smart as he thinks he is, and he completely lacks a sense of irony when it comes to self-knowledge, but he is typical.
The resentment I feel toward him stems, not from his receipt of a government benefit, but from the fact that he gets it, through persistence and subterfuge, and my wife doesn't. She has more severe disability, and spent longer in the military, and I do -- just can't help it -- resent the fact that she "qualifies" for neither disability nor VA benefits. Part of the issue results from the very notion of "needs" or "means" testing. On the former, of course, having some form of "needs" testing is inherent to "disability." I resent the fact that he was able, through a government sponsored program, to have his "need" tested and presumably affirmed, but we cannot afford to have the procedures necessary to demonstrate my wife's "need." The PET scan would cost about $5,000, and that assumes we can "shop around" and get the best price. The other day, she suggested a "divorce," not because she wants to end the reality of our 30 year marriage, but because, as a single woman, she would be "destitute" and qualify for medicaid.
As I said, the resentment I feel toward him stems, not from his receipt of a government benefit, and I am not qualified to judge whether he actually "deserves" the benefit or not, but the invidious comparison. I do believe -- and I say this without irony or shame -- that health care should be a "universal right" or entitlement. I am more than willing to pay my share of taxes to support it. As I've said, contrary to the republican claims that America is one of the highest taxed nations on earth, we are one of the lowest. I can only speak for myself when I say that I would be willing to pay more if I received comparable benefit in return. Unless, of course, there's some form of complete social collapse, comparable to the great depression and the second world war, we'll never get there from here. No matter how much I support Bernie Sanders, Katie was right when she asked him how he would get past a grid-locked republican congress to get anything like a "universal" system in place.
Beyond that, my resentment stems from our "gridlock" with the health care systems. We applied for health insurance, per state law, through Your Health Idaho, our mandated state exchange. We received confirmation of our application for insurance through Select Health, our private provider. The long and short of it is this: Your Health Idaho claims to have sent the necessary information to Select Health. Conversely, Select Health claims they did not received the "correct" information. Your Health Idaho, the state agency, will not contact Select Health to determine the correct information, saying "we have done everything we can." Conversely, Select Health cannot contact Your Health Idaho to "inform" them of the missing or incorrect documentation, ostensibly because the state agency will not speak with them, and so claims "we have done everything we can." In the meantime, of course, we are without insurance. We cannot even pay the full freight on the insurance. Select Health simply would not do so for reasons that were incomprehensible to me. In the meantime, we are without insurance.
I wrote to my congressman, Mike Simpson (R). Although I received a call almost immediately from his staffer, requesting that I fill out a privacy release, this is ultimately what I received from him:
March 28, 2016
Dear Dr. Picard:
Thank you for entrusting me to assist with your case. I am glad to have the opportunity to provide assistance to you.
I have contacted Your Health Idaho on your behalf. Although, I cannot guarantee a particular outcome, I have asked the agency to address your concerns in a fair and timely manner and to send a written response to my office. In order for the agency to give your case the proper attention it deserves; please allow at least thirty (30) working days to receive a response. If a response is not received in that timeframe, my staff will contact the agency for a status update on your case and will keep you informed on the matter.
In the meantime, if you have questions or additional information, please feel free to contact Linda Culver at (208) 734-7219 or send written correspondence to my Twin Falls office at 1341 Fillmore #202, Twin Falls, Idaho 83301.
Once, again thank you for bringing your concerns to my attention. I look forward to working with you to resolve this matter.
Sincerely,
Mike Simpson
Member of Congress
To be honest, I didn't expect much more, but "30 days" with no "guarantee [of a] particular outcome?" Let's be honest, he is a republican. He opposes "obamacare." His answer to health care reform goes something like this:
I strongly oppose Obamacare and have voted over 50 times in Congress to repeal it. I also strongly oppose Congress receiving a special exemption from Obamacare. That’s why I cosponsored the bill to repeal Nancy Pelosi’s special deal for Congress. I will continue to the fight to repeal Obamacare. We need real reform of our healthcare system, and Obamacare doesn’t do it. As Congress continues to look for ways to delay, defund, alter, and repeal provisions of this devastating law, we must not stop exploring ways to improve both the quality and cost-effectiveness of our health care system. Medical malpractice (tort) reform is an idea that most Americans support that would bring down health care costs for taxpayers and improve access to care. Our current system increases costs both directly, in the form of higher malpractice insurance premiums, and indirectly, in the form of defensive medicine—when medical services are prescribed primarily to avoid liability rather than for the benefit of the patient. Placing reasonable limits on health care litigation would help reign in these costs and protect quality of care.
I'm not sure how limiting the way in which common people, like thee and me, can sue for medical malpractice will make all the changes needed to our health care system. I'm can see that it might reduce the cost of medical malpractice insurance to providers, but unless the "tort reform" also carries provisions mandating that those "savings" be passed along to the consumer, I don't see how it benefits thee or me. I DO see how it might improve the profit margin for corporate providers.
Insofar as "defensive medicine" goes, I would agree that there are some medical procedures that are purely CYA, but let's look at it slightly differently -- as "thoroughness." Given the fear of litigation, doctors are as "thorough" as possible in their approach to patient complaints, perhaps to the point of over-zealousness in their "thoroughness." I don't see how "thoroughness," even "over-zealousness," itself is a bad thing. I DO see how tort reform benefits corporate medicine, reducing insurance costs while allowing them to act with greater impunity and cut back on care given less fear of litigation. I guess I'm not "most Americans" because I don't really support tort reform, and even view it with some suspicion because I don't see how it alone "protects quality of care." I DO, however, see how it might diminish quality of care. In the meantime, we are without health insurance.
Again though, its not substance, but tone. I would absolutely agree that "we need real reform of our healthcare system, and Obamacare doesn't do it." I believe we need a universal, single payer healthcare system. In the meantime, we are without insurance, not because Obamacare is a "devastating law." Indeed, if the state exchange worked the way it is supposed to work, we would indeed have "affordable" health insurance. I suspect, however, that Your Health Idaho has not been set up to succeed. In this staunchly republican state, I suspect, rather, that it has been set up to fail, and I suspect this, as one small piece of evidence, because wait times on hold approach an hour every time one calls, and the poor person on the other end of the line is not empowered to do anything except say "I understand how you feel" and "we've done everything we can." I suspect that Mike Simpson, along with the state legislature, absolutely want us to be "pissed off" at the government enough to agree that we should what? dismantle it? Finally, I suspect that Mike Simpson, along with the governor and state legislature of Idaho, would rather see the law fail, not because it provides no benefit to the people of this country -- it could and does elsewhere -- but because ... well, really? why is it so "devastating?" I have heard the assertion, but I have not seen the evidence. I would love to have an answer to that question.
He is, of course, a republican, in part because he is a self-professed "evangelical," and evangelicals are, well, republican in this day and age. He would vehemently deny that he is a "practicing" socialist -- that is to say, he tacitly approves of "democratic socialist programs" because he is taking benefits from at least two such government run, tax-supported programs -- and, indeed, has said that "Clinton is a socialist" in much the same way that he would say "Clinton is shit," with the same expectoration of the sibilants, with the same expectation of self-evident evil. I don't want to make too much of my friend. He is not as smart as he thinks he is, and he completely lacks a sense of irony when it comes to self-knowledge, but he is typical.
The resentment I feel toward him stems, not from his receipt of a government benefit, but from the fact that he gets it, through persistence and subterfuge, and my wife doesn't. She has more severe disability, and spent longer in the military, and I do -- just can't help it -- resent the fact that she "qualifies" for neither disability nor VA benefits. Part of the issue results from the very notion of "needs" or "means" testing. On the former, of course, having some form of "needs" testing is inherent to "disability." I resent the fact that he was able, through a government sponsored program, to have his "need" tested and presumably affirmed, but we cannot afford to have the procedures necessary to demonstrate my wife's "need." The PET scan would cost about $5,000, and that assumes we can "shop around" and get the best price. The other day, she suggested a "divorce," not because she wants to end the reality of our 30 year marriage, but because, as a single woman, she would be "destitute" and qualify for medicaid.
As I said, the resentment I feel toward him stems, not from his receipt of a government benefit, and I am not qualified to judge whether he actually "deserves" the benefit or not, but the invidious comparison. I do believe -- and I say this without irony or shame -- that health care should be a "universal right" or entitlement. I am more than willing to pay my share of taxes to support it. As I've said, contrary to the republican claims that America is one of the highest taxed nations on earth, we are one of the lowest. I can only speak for myself when I say that I would be willing to pay more if I received comparable benefit in return. Unless, of course, there's some form of complete social collapse, comparable to the great depression and the second world war, we'll never get there from here. No matter how much I support Bernie Sanders, Katie was right when she asked him how he would get past a grid-locked republican congress to get anything like a "universal" system in place.
Beyond that, my resentment stems from our "gridlock" with the health care systems. We applied for health insurance, per state law, through Your Health Idaho, our mandated state exchange. We received confirmation of our application for insurance through Select Health, our private provider. The long and short of it is this: Your Health Idaho claims to have sent the necessary information to Select Health. Conversely, Select Health claims they did not received the "correct" information. Your Health Idaho, the state agency, will not contact Select Health to determine the correct information, saying "we have done everything we can." Conversely, Select Health cannot contact Your Health Idaho to "inform" them of the missing or incorrect documentation, ostensibly because the state agency will not speak with them, and so claims "we have done everything we can." In the meantime, of course, we are without insurance. We cannot even pay the full freight on the insurance. Select Health simply would not do so for reasons that were incomprehensible to me. In the meantime, we are without insurance.
I wrote to my congressman, Mike Simpson (R). Although I received a call almost immediately from his staffer, requesting that I fill out a privacy release, this is ultimately what I received from him:
March 28, 2016
Dear Dr. Picard:
Thank you for entrusting me to assist with your case. I am glad to have the opportunity to provide assistance to you.
I have contacted Your Health Idaho on your behalf. Although, I cannot guarantee a particular outcome, I have asked the agency to address your concerns in a fair and timely manner and to send a written response to my office. In order for the agency to give your case the proper attention it deserves; please allow at least thirty (30) working days to receive a response. If a response is not received in that timeframe, my staff will contact the agency for a status update on your case and will keep you informed on the matter.
In the meantime, if you have questions or additional information, please feel free to contact Linda Culver at (208) 734-7219 or send written correspondence to my Twin Falls office at 1341 Fillmore #202, Twin Falls, Idaho 83301.
Once, again thank you for bringing your concerns to my attention. I look forward to working with you to resolve this matter.
Sincerely,
Mike Simpson
Member of Congress
To be honest, I didn't expect much more, but "30 days" with no "guarantee [of a] particular outcome?" Let's be honest, he is a republican. He opposes "obamacare." His answer to health care reform goes something like this:
I strongly oppose Obamacare and have voted over 50 times in Congress to repeal it. I also strongly oppose Congress receiving a special exemption from Obamacare. That’s why I cosponsored the bill to repeal Nancy Pelosi’s special deal for Congress. I will continue to the fight to repeal Obamacare. We need real reform of our healthcare system, and Obamacare doesn’t do it. As Congress continues to look for ways to delay, defund, alter, and repeal provisions of this devastating law, we must not stop exploring ways to improve both the quality and cost-effectiveness of our health care system. Medical malpractice (tort) reform is an idea that most Americans support that would bring down health care costs for taxpayers and improve access to care. Our current system increases costs both directly, in the form of higher malpractice insurance premiums, and indirectly, in the form of defensive medicine—when medical services are prescribed primarily to avoid liability rather than for the benefit of the patient. Placing reasonable limits on health care litigation would help reign in these costs and protect quality of care.
I'm not sure how limiting the way in which common people, like thee and me, can sue for medical malpractice will make all the changes needed to our health care system. I'm can see that it might reduce the cost of medical malpractice insurance to providers, but unless the "tort reform" also carries provisions mandating that those "savings" be passed along to the consumer, I don't see how it benefits thee or me. I DO see how it might improve the profit margin for corporate providers.
Insofar as "defensive medicine" goes, I would agree that there are some medical procedures that are purely CYA, but let's look at it slightly differently -- as "thoroughness." Given the fear of litigation, doctors are as "thorough" as possible in their approach to patient complaints, perhaps to the point of over-zealousness in their "thoroughness." I don't see how "thoroughness," even "over-zealousness," itself is a bad thing. I DO see how tort reform benefits corporate medicine, reducing insurance costs while allowing them to act with greater impunity and cut back on care given less fear of litigation. I guess I'm not "most Americans" because I don't really support tort reform, and even view it with some suspicion because I don't see how it alone "protects quality of care." I DO, however, see how it might diminish quality of care. In the meantime, we are without health insurance.
Again though, its not substance, but tone. I would absolutely agree that "we need real reform of our healthcare system, and Obamacare doesn't do it." I believe we need a universal, single payer healthcare system. In the meantime, we are without insurance, not because Obamacare is a "devastating law." Indeed, if the state exchange worked the way it is supposed to work, we would indeed have "affordable" health insurance. I suspect, however, that Your Health Idaho has not been set up to succeed. In this staunchly republican state, I suspect, rather, that it has been set up to fail, and I suspect this, as one small piece of evidence, because wait times on hold approach an hour every time one calls, and the poor person on the other end of the line is not empowered to do anything except say "I understand how you feel" and "we've done everything we can." I suspect that Mike Simpson, along with the state legislature, absolutely want us to be "pissed off" at the government enough to agree that we should what? dismantle it? Finally, I suspect that Mike Simpson, along with the governor and state legislature of Idaho, would rather see the law fail, not because it provides no benefit to the people of this country -- it could and does elsewhere -- but because ... well, really? why is it so "devastating?" I have heard the assertion, but I have not seen the evidence. I would love to have an answer to that question.
Sunday, April 3, 2016
I'm worried that we'll go into a depression
Or so I hear someone say the other day. I wondered where that came from, since most the economic indicators are getting better, not worse. Of course, the person who said it, wasn't looking at economic indicators, but tapping into his own sense of foreboding -- that something is rotten in the state of US. I admit I am not in the habit of watching fox news, but for those who are, this sense of foreboding doom is a staple. It's built partly on a clear enough logic. First premise, everything Obama does is wrong. Obama did such and such. Such and such is wrong. There has been enough said about the mental gymnastics that fox must perform on occasion to show that "such and such is wrong," but it seems it is never done without a sense of strident impending doom -- if this continues, God save us. When Micheal Gearson writes that "the worst stereotype of the GOP is coming to life in the form of Donald Trump," there is more than a little "truthiness" in it despite all the GOP back-peddling of late. If fox news is the voice of American conservatism, then the donald has tapped into that strident sense of impending doom, of outrage with the emphasis on rage, and offers himself, the great and the wonderful, as the savior.
Building on the fox news syllogism, under the Obama administration, the economic indicators have improved. Could it have happened faster? Of course. Could they be better? Of course. Nevertheless, most economic indicators have improved, and were anyone in the white house OTHER than Obama (well, not Hillary, and especially not Sanders) -- let me start over, if a republican were in the white house, you know that fox news and bill o'reiley would be singing hosannahs. But it's Obama, and everything that happens under his watch must, just must! be wrong, so the positive economic indicators must portend some lurking doom hidden in the shadows. One cannot look to the mainstream indicators to find it, so one must look to the fringe. Here's Jim Tankersly writing for the Post:
There is a theory on the fringes of economics and finance that the United States is riding another bubble, which is about to burst and plunge the economy into a deep recession. It is not a housing bubble, like the one that triggered the last recession, but a stock bubble, puffed up by years of monetary easing from the Federal Reserve. Few professional economic forecasters subscribe to that theory, but a few finance pundits do, and so, too, does Republican presidential front-runner Donald Trump.
There could be some kernel of "truthiness" in this. Markets have been propped up, and it may well be time to ease off on the quantitative easing, but the path chosen by the Obama administration has had some real success, particularly in the creation of jobs. Could there be more? Of course. Could they show more wage growth? Of course. Nevertheless, if we are to maintain the sense of foreboding, the strident sense of imminent collapse, there must be something deeply wrong, and of course! the quantitative easing that has assisted in the recovery itself must be wrong. The donald has picked up on the unease and so now is pushing an economic theory of impending doom.
I won't go into the specifics. I could do little more than repeat what Tankersly has written. It's not the specifics, however, that are important. It is the tone. We can do the math until we're blue in the face, but the math doesn't matter. It's the tone. So you get something like this:
I can fix it. I can fix it pretty quickly...I would do a tax cut. You have to do a tax cut. Because we’re the highest-taxed nation in the world.
Here I'm quoting the donald himself. This is assertion without fact. Here's a more progressive view from the Citizens for Tax Justice:
Building on the fox news syllogism, under the Obama administration, the economic indicators have improved. Could it have happened faster? Of course. Could they be better? Of course. Nevertheless, most economic indicators have improved, and were anyone in the white house OTHER than Obama (well, not Hillary, and especially not Sanders) -- let me start over, if a republican were in the white house, you know that fox news and bill o'reiley would be singing hosannahs. But it's Obama, and everything that happens under his watch must, just must! be wrong, so the positive economic indicators must portend some lurking doom hidden in the shadows. One cannot look to the mainstream indicators to find it, so one must look to the fringe. Here's Jim Tankersly writing for the Post:
There is a theory on the fringes of economics and finance that the United States is riding another bubble, which is about to burst and plunge the economy into a deep recession. It is not a housing bubble, like the one that triggered the last recession, but a stock bubble, puffed up by years of monetary easing from the Federal Reserve. Few professional economic forecasters subscribe to that theory, but a few finance pundits do, and so, too, does Republican presidential front-runner Donald Trump.
There could be some kernel of "truthiness" in this. Markets have been propped up, and it may well be time to ease off on the quantitative easing, but the path chosen by the Obama administration has had some real success, particularly in the creation of jobs. Could there be more? Of course. Could they show more wage growth? Of course. Nevertheless, if we are to maintain the sense of foreboding, the strident sense of imminent collapse, there must be something deeply wrong, and of course! the quantitative easing that has assisted in the recovery itself must be wrong. The donald has picked up on the unease and so now is pushing an economic theory of impending doom.
I won't go into the specifics. I could do little more than repeat what Tankersly has written. It's not the specifics, however, that are important. It is the tone. We can do the math until we're blue in the face, but the math doesn't matter. It's the tone. So you get something like this:
I can fix it. I can fix it pretty quickly...I would do a tax cut. You have to do a tax cut. Because we’re the highest-taxed nation in the world.
Here I'm quoting the donald himself. This is assertion without fact. Here's a more progressive view from the Citizens for Tax Justice:
Of all the OECD countries, which are essentially the countries the U.S. trades with and competes with, only Chile and Mexico collect less taxes as a percentage of their overall economy (as a percentage of gross domestic product, or GDP).
This sharply contradicts the widely held view among many members of Congress that taxes are already high enough in the U.S. and that any efforts to reduce the federal deficit should therefore take the form of cuts in government spending.
Only Chile (21.2) and Mexico (19.7) collected less taxes as a percentage of GDP than the US (24.0)? Denmark (47.7) is the highest. The tax numbers are from 2011. I'm not 100% sure of their accuracy, since they come from a lobbying group, and I'm sure the relative measure of tax per GDP can be disputed, but I am 100% sure that we are NOT, by any measure, "the highest-taxed nation in the world." If we entered into the dispute over the numbers, we would at least be arguing something that resembles fact, but to address tone with fact leaves one feeling insipid, powerless. Who the hell does love the IRS? Who the hell doesn't want a tax cut, if not for everyone, for themselves? Who the hell doesn't feel pushed around? Who the hell doesn't want to tell the IRS to go f--k themselves? One imagines an accountant auditor, confronting a biker-supporter of the donald, complete with leathers and chains, saying, "well, sir, I must insist, in point of fact, you are wrong. The US is one of the LEAST taxed nations as a percentage of GDP, among other things." Who is going to kick whose ass? And that's what this country needs? Someone who is willing to kick some ass?
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