Thursday, December 05, 2019
"Yes, transitioning to a more equitable system might eliminate some jobs. But the status quo is morally untenable.
Life expectancy continues to rise in other wealthy countries, but not in the United States, researchers just reported. Some of the blame for that can be attributed to our dysfunctional health care system.
Life expectancy continues to rise in other wealthy countries, but not in the United States, researchers just reported. Some of the blame for that can be attributed to our dysfunctional health care system.Christopher Capozziello for The New York Times
Won’t you spare a thought for America’s medical debt collectors? And while you’re at it, will you say a prayer for the nation’s health care billing managers? Let’s also consider the kindly, economically productive citizens in swing states whose job it is to jail pregnant women and the parents of cancer patients for failing to pay their radiology bills. Put yourself in the entrepreneurial shoes of the friendly hospital administrator who has found a lucrative new revenue stream: filing thousands of lawsuits to garnish sick people’s wages.
And who can forget the lawyers? And the lobbyists! Oh, aren’t they all having a ball in America’s health care thunderdome. Like the two lobbyists who were just caught drafting newspaper editorials for Democratic state representatives in Montana and Ohio, decrying their party’s push toward a “government-controlled” health care industry. It’s clear why these lobbyists might prefer the converse status quo: a government controlled by the health care industry. If we moved to a single-payer system, how would lobbyists put food on the table, and who would write lawmakers’ op-ed essays?
Welcome to the bizarre new argument against “Medicare for all”: It’s going to cost us jobs. Lots of jobs. Good, middle-class, white-collar jobs in America’s heartland, where Democrats need to win big to defeat Donald Trump.
The argument is specious and morally suspect. Last week, health researchers reported that American life expectancy is declining for the first time in half a century, and some of the leading causes have to do with the ruinous health care system. Even if it is the case that reforming American health care might eliminate some jobs, it would seem to be a good trade for the likely benefit: More people might gain access to affordable health care and get to keep living.
But I worry that the jobs argument might sway moderate politicians, centrist pundits and much of the establishment, because it plays on one of the major fault lines of health reform: that in fixing the system so that more people benefit, those who now enjoy a privileged slice of American health care might end up worse off than they are today.
As a matter of ethics and equality, this should be O.K.; sticking with a system that is the source of so much death, debt and financial ruin just because you like your doctor or your insurance company or your medical-billing job is not really a defensible position.
On the other hand, in America, “I’ve got mine and I don’t want to lose it” is always pretty good politics.
The jobs argument goes like this: There’s a lot of fat in the American health care industry, and any effort to transform it into a simpler system in which everyone is covered would necessarily eliminate layers of bureaucracy and likely reduce overhead costs. Every year Americans collectively pay about $500 billion in administrative costs for health care — that is, for things like billing and insurance overhead, not for actual medical care.
These costs are significantly higher than in most other wealthy countries. One study on health care data from 1999 showed that each American paid about $1,059 per year just in overhead costs for health care; in Canada, the per capita cost was $307. Those figures are likely much higher today.
Wouldn’t lowering overhead costs be an obviously positive outcome?
Ah, but there’s the rub: All this overspending creates a lot of employment — and moving toward a more efficient and equitable health care system will inevitably mean getting rid of many administrative jobs. One study suggests that about 1.8 million jobs would be rendered unnecessary if America adopted a public health care financing system.
So what if some of these jobs involve debt collection, claims denial, aggressive legal action or are otherwise punitive, cruel or simply morally indefensible in a society that can clearly afford to provide high-quality health care to everyone? Jobs are jobs, folks, as Joe Biden might say.
Indeed, that’s exactly what Biden’s presidential campaign is saying about the Medicare for all plans that Senators Elizabeth Warren and Bernie Sanders are proposing: They “will not only cost 160 million Americans their private health coverage and force tax increases on the middle class, but it would also kill almost two million jobs,” a Biden campaign official warned recently.
Note the word “kill” in the statement. That word might better describe not what could happen to jobs under Medicare for all but what the health care industry is doing to many Americans today.
Last week, the medical journal JAMA published a comprehensive study examining the cause of a remarkably grim statistic about our national well-being. From 1959 to 2010, life expectancy in the United States and in other wealthy countries around the world climbed. Then, in 2014, American life expectancy began to fall, while it continued to rise elsewhere.
What caused the American decline? Researchers identified a number of potential factors, including tobacco use, obesity and psychological stress, but two of the leading causes can be pinned directly on the peculiarities and dysfunctions of American health care.
The first is the opioid epidemic, whose rise can be traced to the release, in 1996, of the prescription pain drug OxyContin. In the public narrative, much of the blame for the epidemic has been cast on the Sackler family, whose firm, Purdue Pharma, created OxyContin and pushed for its widespread use. But research has shown that the Sacklers exploited aberrant incentives in American health care.
Purdue courted doctors, patient groups and insurers to convince the medical establishment that OxyContin was a novel type of opioid that was less addictive and less prone to abuse. The company had little scientific evidence to make that claim, but much of the health care industry bought into it, and OxyContin prescriptions soared. The rush to prescribe opioids was fueled by business incentives created by the health care industry — for Purdue, for many doctors and for insurance companies, treating widespread conditions like back pain with pills rather than physical therapy was simply better for the bottom line.
Opioid addiction isn’t the only factor contributing to rising American mortality rates. The problem is more pervasive, having to do with an overall lack of quality health care. The JAMA report points out that death rates have climbed most for middle-age adults, who — unlike retirees and many children — are not usually covered by government-run health care services and thus have less access to affordable health care.
The researchers write that “countries with higher life expectancy outperform the United States in providing universal access to health care” and in “removing costs as a barrier to care.” In America, by contrast, cost is a key barrier. A study published last year in The American Journal of Medicine found that of the nearly 10 million Americans given diagnoses of cancer between 2000 and 2012, 42 percent were forced to drain all of their assets in order to pay for care.
The politics of Medicare for all are perilous. Understandably so: If you’re one of the millions of Americans who loves your doctor and your insurance company, or who works in the health care field, I can see why you would be fearful of wholesale change.
But it’s wise to remember that it’s not just your own health and happiness that counts. The health care industry is failing much of the country. Many of your fellow citizens are literally dying early because of its failures. “I got mine!” is not a good enough argument to maintain the dismal status quo."
Opinion | The American Health Care Industry Is Killing People - The New York Times
"It is worth exploring the election system in this country and who benefits from it.
Kamala Harris entered the presidential race with a bang.
She announced her candidacy on Martin Luther King Day and not only raised $1.5 million in its first 24 hours, according to Politico, but also “in the first 12 hours made $110,000 in revenue from its online merchandise store that sells T-shirts, hats and tote bags — breaking the single-day, single-candidate record for sales by the vendor, Bumperactive.”
Her campaign material used similar colors and typography as did Shirley Chisholm, the first black woman elected to Congress and the first to see a major party nomination for the presidency.
Soon after her announcement, FiveThirtyEight published a story under the headline, “How Kamala Harris Could Win The 2020 Democratic Nomination,” with a linked analysis by the site’s Nate Silver, who built a model of each contender’s “ability to build a coalition among key constituencies within the party” and wrote that “the coalition-building model has made me more skeptical about the chances for Bernie Sanders, Joe Biden and Amy Klobuchar, for instance, but more bullish about Kamala Harris, Beto O’Rourke and Cory Booker.”
About a week after her announcement, Harris held her kickoff rally outside the Oakland City Hall, and 20,000 people showed up and packed the plaza.
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Harris’s campaign was ablaze with potential and possibility.
Now, less than a year later, Harris has suspended her campaign. And, the inevitable autopsy articles are flying, attempting to diagnose what went wrong, or what her campaign did wrong.
But, it seems to me that the questions here are bigger than missteps, real or perceived. Every campaign has missteps. It is hard to look at this field of candidates and not remember a cascading list of missteps. And many of them have things in their past for which they have apologized. But one question is why missteps are fatal to some campaigns and not others.
It is fair to ask what role racism and sexism played in her campaign’s demise. These are two “isms” that are permanent, obvious and unavoidable in American society.
It is fair to ask how those features impacted media coverage, or the lack of coverage.
It is fair to ask about the Democratic debate rules and how they prioritize donations in addition to polls, thereby advantaging the opinions of people who can afford to give over those who can’t.
It is fair to ask about the Democrats’ schedule of caucuses and primaries that begin with two states — Iowa and New Hampshire — that are overwhelmingly white, so that candidates who poll best there get the benefit of momentum even before a ballot is cast and also before the contests move to states with more minorities.
It is fair to ask why, as of now, only white candidates have qualified for the next debate, even though the field began as one of the most diverse.
All of this must be explored and discussed and learned from.
But there is something else that we learn — or relearn — from Harris’s run: the enduring practicality of black voters. They, in general, reward familiarity, fealty and feasibility.
Joe Biden just fits that bill for the plurality of black voters. When it comes to picking a nominee, black people don’t adhere to racial tribalism, broadly speaking. They want their votes to matter; they want to pick a winner.
It is possible for these black voters to be exceedingly proud of the presence of candidates like Harris and Booker while simultaneously supporting another candidate as their first choice.
It is possible to feel a profound sadness that Harris would have to leave the race before Iowa and simultaneously believe that other candidates were likely to win the early contests.
This practicality has repeatedly been on display in presidential politics. In 2008, Hillary Clinton held a 24-point lead among black Democrats over Barack Obama before Iowa, but after Obama won the state he held a 28-point lead over Clinton among black voters. He had proven his viability. Harris will never get that chance.
If Harris had Biden’s level of support in the polls among black voters she would still be in the race. But, they chose a different course, in part because the system increasingly appears stacked against her, making her candidacy look more and more like a long shot.
But also, white people made a different choice. Everyone seems to have settled, for whatever reason, on the notion that a white person has the best chance of beating Trump, that a racial minority is too risky this time around.
But, that is a horrible place to be: courting the voters who abide racism rather than trying to excite the voters who despise racism.
There is absolutely no reason Harris should be out this race so early.
You can blame her exit on her past and her execution of her campaign, sure, but if you do so without examining the system the Democrats have built and the way that even black people feel that it’s stacked against the black candidates, you are not being honest."
Opinion | What Kamala Harris’s Campaign Teaches Us - The New York Times
"WASHINGTON — When times turn tough, presidents can hop on Air Force One to escape the country for a while and stride purposefully across the world stage. But the world stage was not so friendly this week for President Trump, who landed back in Washington on Wednesday night to confront a grim couple of weeks ahead.
Mocked by peers behind his back at a NATO meeting in London, Mr. Trump abruptly canceled a news conference and bolted early, only to fly home to a capital in the throes of judging whether he is fit for office. After hobnobbing with the queen, the president now faces the daunting likelihood that by Christmas he will become the third president impeached for high crimes and misdemeanors.
The NATO meeting had seemed like an opportunity to demonstrate his global leadership like Presidents Richard M. Nixon and Bill Clinton sought to do with overseas trips during their own impeachment struggles. Scheduled long ago, the meeting allowed Mr. Trump and his allies to assail his domestic foes as “unpatriotic” for proceeding with an impeachment hearing while the commander in chief was overseas and gave him a chance to boast of his success in pressing the allies to invest more in defense.
But the visit was soured by a contentious meeting with President Emmanuel Macron of France and a hot-mic video that captured other world leaders making fun of Mr. Trump. In response, a sullen president said one of the leaders caught talking on the video, Prime Minister Justin Trudeau of Canada, was “two-faced,” and then slipped out of town without the scheduled wrap-up session with reporters, seemingly intent on not further spoiling the image of a successful visit.
[Politicians have a long history of being caught saying impolitic things. Let’s roll the tape.]
“The Fake News Media is doing everything possible to belittle my VERY successful trip to London for NATO,” he wrote on Twitter as Air Force One streaked across the Atlantic. “I got along great with the NATO leaders,” he added, claiming credit for persuading them to increase their military spending, although wildly inflating the actual numbers. “No increase for U.S., only deep respect!”
Quarreling with foreign leaders, of course, never troubled Mr. Trump before and in some ways has domestic political appeal with a Republican base that cheers on his defiance.
“The president has never been much bothered by shaking up international conventions, so tussling with foreign leaders, by those standards, isn’t a bad thing from his perspective,” said Antonia Ferrier, a former aide to Senator Mitch McConnell, Republican of Kentucky and the majority leader. “For many Americans, having their president stand up to foreign leaders is a sign of strength.”
Sam Nunberg, a former political adviser to Mr. Trump, said the optics of the London visit would appeal to different elements of his base. “He held contentious press conferences with world leaders who are disdained in conservative circles while also getting the all important 10 Downing Street visit and greeting with the queen at Buckingham Palace, which always plays well with mid and high income voters,” he said.
Still, Mr. Trump seemed bothered by the conversation between the other leaders. Mr. Trudeau seemed to deride Mr. Trump for going off schedule to answer questions from reporters on Tuesday. “He was late because he takes a 40-minute news conference at the top,” the prime minister told Mr. Macron, Prime Minister Mark Rutte of the Netherlands, Prime Minister Boris Johnson of Britain and Princess Anne.
“You just watch his team’s jaws drop to the floor,” Mr. Trudeau said at another point in the video, expressing astonishment at Mr. Trump’s behavior. The other leaders are seen smiling in seeming sympathy or adding their own unheard comments to the discussion.
The overheard conversation came after Mr. Trump and Mr. Macron had engaged in a somewhat testy public session earlier in the day. “Let’s be serious,” Mr. Macron chided the president at one point during a discussion of Islamic State fighters.
At a separate session with reporters, Mr. Trump had complained that Mr. Macron’s recent comments bemoaning American disengagement with NATO had been “very, very nasty.”
The joking may have touched a nerve with Mr. Trump, who has long resented elites he felt did not show him proper respect or welcome him into their circles, whether it was Manhattan business titans or Washington political veterans. He visibly seethed in 2011 when President Barack Obama ridiculed him from stage during a black-tie Washington dinner.
“Trump doesn’t just want to be in the club, he wants to be the unquestioned leader and center of attention,” said Gwenda Blair, a Trump biographer. “It had to be both humiliating and infuriating that the other heads of state who were mocking him were untouchable by tweet or insulting nickname, but no doubt he was already calculating the next round of tariffs he would send their way.”
Foreign trips were a relief for Mr. Nixon and Mr. Clinton at similar points in their presidencies. As Watergate bore down in the summer of 1974, Mr. Nixon traveled to the Middle East and then the Soviet Union, reinforcing his peacemaking initiatives. Mr. Clinton similarly headed to Russia and Northern Ireland just after a grand jury appearance in 1998 and then later in the fall to the Middle East.
But in both cases, any relief was short-lived. Mr. Nixon ended up resigning weeks after getting home, and Mr. Clinton was impeached by the House only days after his return. The complaints about impeachment interfering with foreign policy rang loud then as well; Mr. Clinton was in the midst of bombing Iraq for defying international weapons inspectors even as the House took its vote.
There is no escape for Mr. Trump either, not in foreign cities, not in the Oval Office and not on the television he stares at upstairs in the White House for hours each day. His presidency is tethered to impeachment, his legislative agenda mostly on hold, his foreign policy overshadowed, his re-election on the line. He takes refuge in the boisterous and jampacked campaign rallies he holds and in the morning and evening lineups on Fox News.
While in London, Mr. Trump defiantly declared he would not watch the opening of the House Judiciary Committee’s impeachment hearings because he would be too busy conducting affairs of state, even as he lashed out at Democrats as “deranged,” “sick,” “nuts,” “crazy” and, in one case, a “maniac.” But while his blue-and-white jet headed back to Washington, he (or aides operating his account in his name) nonetheless blitzed out a couple dozen tweets recirculating posts from Republican allies castigating the hearing as it progressed.
At the White House in his absence, the atmosphere was somewhat surreal. The televisions around the building were tuned to the various news networks, especially Fox News, as they broadcast the hearing, but the volume was usually muted and aides sought to go about their business.
The White House refused to participate in the hearing, arguing that the process has been rigged by partisan Democrats, but it did send a couple of aides to sit in the hearing room and monitor the proceedings.
The assumption there, as elsewhere, was that the hearing changed no minds and the course of the next few weeks is already set — the House will probably vote by the end of the year to impeach along party lines, and the Senate will then hold a trial in which the president will not be convicted, setting him up to litigate the case during his re-election campaign.
“While I wouldn’t say impeachment is a good thing for the president, it is a highly divisive and partisan issue breaking down on party lines,” Ms. Ferrier said. “It has not changed people’s minds on the president. His approval ratings are remarkably consistent, in particular with Republican voters, and he clearly relishes a fight.”
But some who have been through this before said it was hard to put it aside. Dennis Ross, a foreign policy specialist who accompanied Mr. Clinton on his trip to the Middle East days before he was impeached, said that an impeachment vote remains part of a president’s legacy, even if it does not lead to his removal.
“Even though he may feel that he will be acquitted in the Senate because Republicans will not break ranks, and however much he tries to turn this to his advantage at a later point, the truth is no matter how you slice, it you can’t run away from the fact you were one of the few presidents who was impeached,” Mr. Ross said. “He obviously likes to be singled out, but not like this.”
Mocked Abroad and Assailed at Home, Trump Returns to Face Impeachment - The New York Times
Wednesday, December 04, 2019
Chris Matthews on world leaders laughing at Trump: He’s a joke now. He has been a joke since he built that tacky, tasteless building at 725 5th Ave, New York, NY 10022. My friends and I laughed at it when it opened. It just did not fit. We knew Trump's parents never exposed him to art or architecture.
What if Democrats Have Already Won Back Enough White Working-Class Voters to Win in 2020? Since the 1980s, Democratic candidates have proven that they can win elections while losing whites without a college degree by a significant margin.
‘In September, Cook Political Reports elections guru David Wasserman argued that Democrats would be foolish not to court non-college-educated white voters in 2020. That group may make up 45 percent of the electorate nationwide, he wrote, but it represents a majority of the electorate in key battleground states—Wisconsin, New Hampshire, Michigan, Minnesota, and Pennsylvania—and casts almost half of the ballots in North Carolina.
That set off another round of debate about whether and how the Democrats should “win back” the non-college-educated whites who played a crucial role in delivering the Rust Belt, and ultimately the Electoral College, to Donald Trump in 2016.
Some analysts argue that progressives who urge Democrats to focus on turning out their core base—people of color, unmarried women, and younger voters—are too cavalier about the consequences of continuing to lose less-educated whites. Those progressives in turn worry that the pundits and moderate Dems who obsess over working-class whites rarely define what appealing to those voters would look like in practice. Does it mean shifting the party closer to the center and putting less emphasis on issues that matter to the base, like discriminatory policing, reproductive health care, and LGBTQ rights?
But these debates miss quite a bit of evidence, direct and indirect, that Democrats have already “won back” enough white working-class voters to compete next year. Since the 1980s, Democratic candidates have proven that they can win elections while losing whites without a college degree by a significant margin. Obama won 36 percent of their votes in 2012. Bill Clinton averaged 41 percent in his two victories. And in 2020, the candidate will likely need to win a smaller share of white people without a degree, because that group has long been declining as a share of both the electorate and the broader population. According to Gallup, their share of the population has declined by three percentage points since 2014. And a study released by the Center for American Progress in October projects that next year their share of the electorate will be 2.3 points lower than it was in 2016.
The reality is that the Democratic candidate is unlikely to do as poorly with this group as Hillary Clinton did. In 2016, despite winning the national popular vote by a significant margin, she won just 28 percent of these voters, according to Pew, and that wasn’t enough to deliver Michigan, Wisconsin, and Pennsylvania. According to a data set that combines survey and voter registration data with election results, Clinton lost non-college-educated whites by a 28-point margin in 2016, significantly worse than Obama’s 10-point deficit in 2008 or his 21-point gap in 2012.
A similar analysis looking back further found that Al Gore lost working-class whites by 17 points in 2000, and they went for George W. Bush over John Kerry by 23 points in 2004. Clinton also fared significantly worse among this group in 2016 than Democrats did overall when Republicans crushed them in midterm waves in 2010 (by 23 points) and 2014 (by seventeen points).
There are three reasons to believe that Clinton’s performance with non-college-educated whites in 2016 was an outlier, and that Democrats’ support among this group has already reverted to its longer-term trend line—one of gradual decline that has been offset by demographic shifts in the electorate.’