Monday, June 26, 2017

Missing the Bigger Picture

Saw some interesting observations about health insurance reform in the news this past weekend.  First off is James Davis:
James Davis, who runs communications for the Koch network, lamented that the conversation on health-care reform has focused too much on the number of people who have insurance — regardless of premiums or what kind of care those who have it will receive — and not enough on outcomes.
Hard to argue with looking at outcomes.  I spent my entire professional career evaluating the results of public programs and know that, in the end, public programs should produce the desired results.  I also know that identifying and measuring those results can be difficult, but health care has some definite outcomes for for society as a whole.  Mr. Davis is right to ask about results.  It would not take long for him to find that:
 The United States health care system is the most expensive in the world...[and]...underperforms relative to other countries on most dimensions of performance.
Mr. Davis did not say how he would define health outcomes but his statement suggests that he would encourage the Koch brothers to look for ways to promote improved performance at lower costs.  He may not need to do a great deal of research.

Perhaps a magic free market Koch brothers-approved system will change the trajectory of American heath outcomes but I doubt it.  So far, the most successful system the US has come with was the Republican-inspired Affordable Care Act and the Republicans HATED that.  It did reduce the number of uninsured but insurance does not guarantee actual health care.  On the other hand, the ACA did little to reduce costs.  It definitely needs work but I don't have much faith in the Koch's free market libertarian solutions. 

Also in the news is Pennsylvania Senator Patrick Toomey defending a change in the funding formula that will index Medicaid payments to the states to changes in the overall consumer price index rather the typically higher medical price index:
"The idea that there’s a sector of our economy that has to permanently have a higher inflation rate than the rest of our economy is ridiculous,” Toomey said Thursday. “I think that it’s absolutely essential to putting [Medicaid] on a sustainable path so that it will be there for future generations.”
Senator Toomey said the change was needed to “transition to a normal inflation rate” for a program in which he said costs were spiraling out of control.  Here, too, I can't argue with his underlying premise.  Program costs should not spiral out of control.  But he would simply refuse to address the causes of those spiraling costs.  Instead, he would fund Medicaid only to certain point regardless on the impact it will have on access to medical insurance (which may not guarantee health care but is a sine qua non for any hope of obtaining medical treatment).  When the funding runs out so will insurance coverage for many.

What neither of these men seem to wonder is why American health care costs are spiraling out of control even as the country spends far more per capita than any other nation.  This is a complex question that deserves considerable debate and discussion.  It is not a question that can be crammed into partisan legislation and voted on the quick-time.  Of course, in today's Congress, partisan legislation enacted in haste is exactly what we will get.


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Tuesday, June 20, 2017

Violence is Not Left or Right. It is Violence.

In the wake of the GOP ballpark shooting, politicians and pundits have been warning about the dangers of "left wing violence" and calling for restraint.  Which is fucking balderdash when you consider that in the past 10 years right-wing extremists have been responsible for about 74 percent of murders committed by domestic extremists in the United States

But more important than left- or right-wing violence is the fact of violence itself.  Violence is violence, an unfortunate human trait that is not always easy to predict or prevent.  What we can do, though, is look for the clues.  One clue is a  history of domestic abuse.  Maybe, just maybe, their previous violent behaviors could disqualify them from owning a weapon, especially weapons of mass destruction such as assault rifles and high-capacity automatic handguns.  That way, even when we miss all of the clues, the carnage is likely to be much less.

One of the enduring lessons of my military service is how easy it is to kill another human being.  Walking through the jungle in Vietnam with an M-16 in my hand it was disturbingly obvious that I could kill the guy in front of me just by pulling the trigger.  Any number of reasons, including the fact that such an act would be just plain wrong, kept me from acting on that thought.  You don't need any imagination to know what carnage an individual blinded by ideology, well-armed and acting with the element of surprise can inflict.  We have too many actual examples.

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Tuesday, June 13, 2017

Another Virginia Primary Election

Today's Virginia primary election brings back vivid memories.  In June 1969 I was 21 and newly eligible to vote in that year's gubernatorial primary.  And what an election it was.  An insurgent liberal state senator was a candidate for the Democratic nomination, challenging the ordained candidate of the Byrd Organization which had dominated state politics for the past four decades and was notable for its support for segregation and extreme fiscal conservatism.

But in 1969 Harry Byrd was four years dead and Virginia, along with the nation, was changing.  The incumbent governor, Mills Godwin, was an Organization stalwart who introduced Virginia's first state sales tax, and increased spending for highway construction,state mental health facilities and a newly-created community college system.  Enough to make old Harry spin in his grave.

The Organization and its traditional politics still held much sway in Virginia and the Lieutenant Governor, was its preferred candidate.  State Senator Henry Howell from Norfolk was a long-shot candidate backed by labor unions, civil rights groups and Virginians who wanted to build on and expand the previous four years.  Howell challenged the prevailing political attitudes in Virginia and decried the cozy relationship between state government, big business and utilitiy companies.  That was shocking enough for Virginia.  Even worse, Howell was loud and brash, running a campain to "Keep the Big Boys Honest" and pointing out that "Mrs. Moneybags" didn't pay sales tax on her hair-dos but even the poorest Virginians paid sales tax on food and medicine.  Virginia ladies and may have haughily dismissed him as "Howling Henry" but I and others loved him for just that reason.

So concerned was the Organization about a possible Howell victory that some of its leaders encouraged a the son of a former governor to run as a centerist "moderate" candidate.  His primary qualifications were a recognized name and service as ambassador to Australia.  It was enough, though.  He eaked out a narrow victory over Howell in a three-way race and a slightly higher margin in a run-off election.  In the end, though, Virginians were ready for a change and elected Linwood Holton, the first Republican to serve as Virginia governor since Reconstruction.  In many respects, Holton was the second most liberal candidate for governor after Howell.

The 1969 gubernatorial election and Henry Howell pretty much defined my politics for the rest of my life.  Howell never did become Virginia's governor but he was a public official with a genuine concern for the disposessed and excluded.  His skepticism of the established order has always resonated with me.  So this year, when the entire nation is watching Virginia and Democratic candidates are as liberal as ever ran for governor, I can look back and see where it all started.

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Monday, June 05, 2017

Looking Back

June 1st passed without my noting the 13th anniversary of Unsolicited Opinion.  I began posting to this site in the second year of the Iraq war and have kept at it ever since, although more sporadically in recent years.  These days I am more inclined to post my thoughts to Facebook since more people are likely to see them there than on this blogtopian backwater.  I like the interaction I get there as opposed to the occasional comment that came my way through this site.

But Facebook is not especially good for long-form pieces where I want to include source links and explore issues in any detail.  That kind of writing belongs here.  Which is another reason that more time passes between posts.  I am less likely to be writing long-form pieces lately.  One reason is that I am working on a memoir of my Vietnam experience which has absorbed much of my energy in the past couple of years.  Aside from the routine challenges of writing, the subject matter makes requires much energy that has left me with little inclination to write longer pieces.  Much easier these days to post a quick comment or link to a story on Facebook and be done.

Maybe, too, I am running out of energy to be outraged.  Back in 2004, the outrage was palpable and the ideas flowed easily.  These days I'm no less outraged but the energy is not as strong.  I often feel like I'm just rehashing the same pieces to an audience in the high (maybe) single digits.

Still writing has its value, if only for me.  I don't think I'll stop writing Unsolicited Opinion but the volume may continue to be low. 


Tuesday, May 02, 2017

Where I Agree with Republican Conservatives and Vladimir Putin

In thier biograpy of Vladimir Putin, Fiona Hill and Clifford Gaddy note that one of Putin's earliest objectives as Russia's president was to reduce Russia's national debt.  He viewed the debt in nationalistic terms and believed that Russia's indebtedness to western banks limited the nation's latitude in dealing with the west and forced it to capitulate to to the dissolution of the Soviet state in the early post-Comunist years.  Hill and Gaddy report that Russia's debt to has been reduced considerably under Putin.  I don't approve of the Putin's "New" Russia, with its oligarchs, corruption and political repression, but I reconize the value of limiting your exposure to outside forces that do not necessarily share your interests.  That makes sense to me.  A large and growing debt puts a nation, even the United States, at the mercies of the debt-holders. 

Also making sense to me are fiscal conservatives in America who question the wisdom of funding routine operations and programs with an ever-accumulating national debt.  I know governments, especially governments of rich, powerful nations like the United States, don't operate at the same level as my household or even a business but I don't see where an increasing level of debt is sustainable.  The US Government Accountability Office (GAO) doesn't think so either.  So when I hear Republicans talking about reducing the deficit, I can agree with the idea ensuring that the federal govenment is sustainable.

Where I disagree with the Republican fiscal conservatives is on the scope of government and how best to finance that government.  I support social welfare programs that protect the most vulnerable Americans and believe that the nation is wealthy enough to support those programs.  That's the socialist in me.  The socialist in me is more than willing to take from the rich and give to the poor and society at large. I'm not an economist but I do understand how markets work and how financial incentives drive innovation so I'm not talking about expropriation.

What I am talking about is asking those Americans who have profited handsomely during the past three decades of Reaganomics and neo-Regonomics to share a portion of their wealth with the rest of us.  Wealthy individuals and profitable corporations benefit greatly from organized government, often more than the mass of taxpayers.  It is reasonable for the nation ask a greater sacrifice from the wealthy and profitable corporations to support the nation as a whole.  I like to think Americans are smart enough to figure out how to make this work.  We are supposedly a practical nation.  At least, we used to be.

Non-economist that I am, I do not believe that America must pay off its entire national debt or even eliminate all deficit spending.  Debt can be used wisely for to build and aquire long-term assets like infrastructure that serves future generations as well as the present.  Deficit spending can be an effective tool for managing the economy.  I am by no means a deficit/debt hawk but it does seem like a good idea to keep the national debt at a manageaable level.  At this time in America

So while I agree with the Republican--and GAO--concerns about fiscal sustainability, I don't agree with their "trickle-down" tax cuts and consequent demands for program cuts.  Far better to tax the rich.  They can afford it and still continue to live well beyond the means available to the average American. 

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Friday, April 14, 2017

Deja Vu All Over Again

These days I can't help feeling like I am living in a 21st century re-enactment of the 20th.  The post-WW2 security structure that gave peace to a bloody continent during the Cold War is fracturing.  Nation states are erecting border walls and checkpoints to keep out "the Other" and asserting their uniquness and superiority over "lesser" beings from other countries.  Nations with large, well-armed militaries are growling and threatening each other.  It's kind of like Groundhog Day but the replay is August 1914.

But the situation is not simply a rerun of an earlier war.  This is the 21st century and, true to form, events are running toward the apocalyptic.  Nuclear weapopns aren't new but in Donald Trump's hands they haven't seemed so threatening since Ronald Reagan.  On the off chance that we don't obliterate ourselves in a nuclear holocaust, simply living on this planet will become a far more challenging proposition because of climate change.  Millions will become environmental refugees in a world that is already hostile to refugeesCompetition for critical resources will create more war and conflict.

And in the middle of all of this is the United States of America.  Hero-nation of the mid-20th century.  My home.  My country.  But looking objectively at the US in the current century, I don't see anything heroic.  The US has been at war or intervening in other nations throughout my seven decades on this planet, continuing a history that dates to the nation's founding.  We are the leading, arms merchant to the world.  Now we have Donald Trump brandishing America's massive nuclear arsenal to demonstrate his manhood.

Not content to just continue America's history of militarism, Trump and his minions are actively monkeywrenching the world's efforts to understand and deal with climate changeDenying the science, withdrawing America from active participation international agreements and eliminating  climate change research and mitigation programs while simultaneously promoting fossil fuels looks isn't outright aggression but coming from a major player, it can reasonably be seen as a threat.

Seen from that perspective, the United States looks uncomfortably like a danger to other nations, either from our militarism or climate change denial.  August 1914 set off a chain of events that lasted thirty years and brought incredible violence to the world.  If this is a replay, I don't feel especially confident about my country's role in the drama.

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Tuesday, March 28, 2017

A Battle Won. More to Come.

Donald Trump claims that the Democrats "own" healthcare now that the Republican has failed.  But like many of Donald's opinions, this is one is also wrong.  True that the Democrats are the architects of the system now in place but much of that system lies within his authority as president.  Obama handed him the keys on January 20.  His failure to craft a replacement means that he's in charge of administering the Affordable Care Act along with his minion, Health & Human Services Secretary Tom Price.

Donald Trump and the Republicans also claim that the Affordable Care Act will collapse of its own weight, that it's going into a death spiral, which like much information from Trump and the Republicans is not true. But Trump and his minions are positioned to monkeywrench the machinery.   We saw this when he canceled outreach efforts during the most recent enrollment period and his directive that IRS no longer enforce the individual mandate.  Plenty of opportunities exist for Trump to push the system into collapse.

If we let him.

The failure of Republican Repeal and Replace is a greater victory than I would have ever expected.  It came about because Paul Ryan offered a completely unacceptable alternative and people mobilized against it.  Now that we know the Affordable Care Act will continue in force for at least the forseeable future, we need to pay close attention to the administrative process to keep Trump's ideological minions from creating the death spiral they fervently wish upon the American people.

That goes for everything else, too.  Trump has seeded the federal government with ideologues who want to lead their agencies into the dustbin of history.  Scott Pruitt at EPA and Betsy DeVos at Education come to mind most readily but they are hardly alone.  They all will have plenty of opportunities for destructive mischief.  Legislative battles are dramatic but the administrative process carries great weight as well and is easily overlooked.  We can't afford not to pay attention.

Caveats aside, the defeat of  Repeal and Replace is worth celebrating.  For the moment, at least, one dreadful change is dead and the ideologues' plans are disrupted.  The trillion-dollar tax cut for the rich at the expense of health insurance for millions won't happen. 

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