Friday, December 9, 2016

Taking a break

Friends -- I'll be taking a few day's break from ShrinkRap and invite you to check back next Wednesday, December 14th.


Thursday, December 8, 2016

Hospitals would be imperiled by "repeal and delay"

Republicans' plan to repeal the Affordable Care Act and give themselves three years to come up with something to replace it -- the so-called "Repeal and Delay" plan -- simply will not work.     First, their idea of "replacement" comes nowhere near providing equivalent service.

Second, they don't seem to have grasped the fact that the ACA is a balance of many parts.   If you remove some of them, the whole thing collapses.   That's the only way the Obama administration could come up with a plan that would work, even as well as this one has done.

Specifically, here's one good example that makes repeal and delay not work.    A bargain was struck with hospitals over how to get reimbursed for at least some of the services provided for people who can't pay.   As explained by Jeffry Young of Huffington Post:

"Hospitals traded billions of dollars in Medicare and Medicaid payment cuts for expanded health coverage under the Affordable Care Act, reasoning it would be good for hospital finances to have fewer uninsured patients who don’t pay for their care.   [But now] Congressional Republicans are leaning toward a plan that would repeal the law early next year, but delay enacting a new system for up to three years.

"That won’t work, according to two influential hospital lobbying groups. . . .  [Hospital groups] are demanding that legislation repealing the law and creating an alternative pass simultaneously, or that Congress and the incoming Trump administration restore the funding cuts from the law. . . . 

Repealing the ACA while leaving its Medicare and Medicaid cuts in place will have huge implications for hospitals and the patients they serve.  Losses of [that] magnitude . . .  cannot be sustained and will adversely impact patients' access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals sustain and grow, and result in massive job losses.”

*     *    *     *     *
We've already seen that happen in states that did not take advantage of the Medicaid expansion available under the ACA.     Before the ACA, there was another law that provided some federal funds directly to hospitals to offset their charity work.   As part of the ACA bargain, those funds were eliminated, to be offset by the expansion of Medicaid, which would pay for their care.

But politics ensued.  Some states (all but one with Republican governments, including Georgia) sued to block the incentive built into the ACA for states to agree to the Medicaid expansion  SCOTUS agreed with them and overturned that portion of ACA.   As a result, the other funding had been cut;   now states wouldn't get the increase Medicaid coverage either, if they didn't expand Medicaid.

What happened?   Some rural hospitals couldn't sustain themselves and had to close;  others reduced their services to Emergency Rooms only.   Others are just managing to hang on.   In my home town of Sandersville, they passed a local tax increase to keep the hospital alive.   Otherwise, it would not have been able to survive.

It's a basic difference in how conservatives and progressives see the role of government.  Conservatives see it as government forcing something on them they don't want;   progressives see government as a much needed safety net being taken away, leaving a lot of people to suffer, and die.

Why don't we just go back to privatizing police protection and fire departments as well?   When there's major storm damage, conservatives are all too happy to have FEMA come in and pay to rebuild their homes and businesses.  Is health care less vital than these other services?


Wednesday, December 7, 2016

SCOTUS wrestles to disentangle race and partisan politics in redistricting and voting

Here's something important that I didn't know about redistricting the congressional map.   I had blithely assumed that neither race nor political party voting could be a factor in drawing district boundary lines for Congress.  After all, isn't the idea that every vote should carry the same weight and that gerrymandering is wrong, for whatever  purpose?

Well, no.   It turns out that the Supreme Court has never exactly settled that question.  SCOTUS has found that gerrymandering violates equal representation only when it is done on the basis of race.   It seems that doing it to favor Republicans -- or Democrats -- is pretty much OK.

Or, put another way, if you can convince the courts that you're just being political, you can get away with packing the district racially.   Actually that was exactly what the justices were struggling with in Monday's hearings of two cases where the two factors seem to be entangled.  As described by the New York Times' Adam Liptak:

"The two cases, from Virginia and North Carolina, were the court’s latest attempts to solve a constitutional puzzle:   how to disentangle the roles of race and partisanship when black voters overwhelmingly favor Democrats. The difference matters because the Supreme Court has said that only racial gerrymandering is constitutionally suspect."

Justice Elena Kagan summarized the dilemma:  “'If it’s politics, it’s fine.  If it’s race, it’s not.”   The problem is that race and politics correlate.”   And therefore attorney Paul Clement, representing both states, pointed out that it is very easy to ascribe racial motive when it was in fact "permissible partisan behavior."'   And I would add:   vice versa.  It is very easy to call it political when it's really racial.

The reality of voting patterns today makes it obvious that the simplest way to increase the Democratic votes in a district (legal) is to redraw the lines so that more African-American residential areas are included (which would be illegal).   And vice versa.

Liptak pointed out that it's even more complex than considering motivation.   In the Virginia case, the suit was brought by voters who claimed that lines drawn after the 2010 census had actually decreased their number of voters.  Apparently, the previous district lines had given them more than 55%.   This then violated the Voting Rights Act, "which forbade the diminishment of minority voters' ability to elect candidates of their choice."

The North Carolina case also involved conflicting rulings based on what criteria are used for judging whether race was the main factor.   Justice Breyer saw the difficulty as rooted in historical wrongs making it close to insoluble.   As he tried to explain:  “There were many states that had many black citizens and had no black representation. . . .  And the problem is, how does the law permit the creation of that, and at the same time, prevent the kind of packing that might appear in other cases, which is gerrymandering?  No one, I think, has a good answer to that question.  There is just slightly better, slightly worse.”

Here we have another example of a basic question in constitutional law begging to be resolved;   and a political power grab by Republicans means the Supreme Court is not operating at full strength.    What happens if they end up in a 4 to 4 tie?    Well, we know the legal answer.   The lower court decision will stand -- until another case comes along when the court has been reconstituted.   Decisions of 4 to 4 are not considered precedent-setting.

What I don't understand -- and don't like -- is why it is permissible to stack the deck for any reason based on which party is in power at the time?    District voting lines should be drawn by an impartial, independent board -- as a few states have chosen to do.    That should be the standard method mandated by federal law, in my opinion.


Tuesday, December 6, 2016

Two bits of good news (maybe 3) among the bad

1.  North Carolina Governor Pat McCrory, who soared to national infamy over the state's Republican government imposing the regressive anti-LGBTQ HB 2, has finally conceded defeat in his bid for re-election.   For almost a month, he kept insisting on a statewide recount, not only because of the close vote, but because of his allegations of widespread voter fraud.

The charges of voter fraud were based on an active campaign by Republicans to challenge the eligibility of thousands of voters, forcing them to vote provisional ballots based on minor variations in details of how a name or an address was listed.   That is a tactic used by Republicans seeking to suppress the vote of those who tend to vote for Democrats.  As those challenges were checked and mostly cleared, the lead of McCrory's opponent was only increasing.   Republican-controlled county election boards dismissed McCrory's protests and decided that a state-wide recount was not warranted.   McCrory then conceded, and the State's Attorney General, Democrat Roy Cooper, was thus elected governor.

2.  The U.S. Army Corps of Engineers, the Department of the Army, and the Obama administration have made the decision to deny approval of the final easement needed to continue construction of the Dakota Access Pipeline.   The pipeline would have crossed under Lake Oahe in North Dakota, posing a risk of leaks into the lake and all the areas it supplies with water.   Instead, the Corps will conduct an Environmental Impact Statement to explore alternate routes.

The construction has been the focus of growing demonstrations and protest occupations by Native Americans, environmentalists, and social justice activists.   One section of the pipeline is seen as a threat to ancestral, sacred Native American sites at the nearby Standing Rock Sioux reservation.   The final decisive factor seems to have been the group of military veteran activists who arrived at the site as self-proclaimed protectors of the other protesters.

3.  A third, possibly good thing;  but it's too early to tell the outcome.   Former Vice President and Nobel Peace Prize winner Al Gore had a meeting with President-elect Donald Trump yesterday to "talk about climate issues."   The transition team had billed it as a meeting with Ivanka Trump;  but, after meeting with her for a while, the bulk of Gore's time was actually spent with Mr. Trump himself.    Gore described it as “very productive” and a “sincere search for areas of common ground.”   He added that "I found it an extremely interesting conversation, and to be continued, and I’m just going to leave it at that.”

I find myself becoming cautiously, semi-optimistic about the number of serious experts in various fields who, after meeting with Mr. Trump, seem to react with the hint of surprise and hope that I find in Gore's comments -- that hope being the impression that Trump will be taking their issue seriously and looking for expert help in problem solving.   On the other hand, he can destroy that hope with his next appointment, or his next political statement, or any night he fires up his twitter account and lets it fly.


Monday, December 5, 2016

Truth vs Neutrality in reporting the news

The admirable CNN chief international correspondent, Christiane Amanpour, was given an award from the Committee to Protect Journalists at an event sponsored by the International Press Freedom Awards.   They cited her "extraordinary and sustained achievement in the cause of press freedom."

In her acceptance speech, Amanpour voiced her concerns that the press must "recommit to robust, fact-based reporting" in what is coming to be known as "the Age of Trump."   She made an appeal to speak up for Truth and not the trend to seek a false neutrality.

She also did not shy away from candor about Donald Trump's rhetoric that literally incited violence toward reporters:  "I never thought in a million years that I'd be standing up here, after all the times I've participated in this ceremony, appealing, really, for the freedom and safety of American journalists at home."

But that is the actual situation the media face with the incoming Trump presidency, with his turning his angry crowds and instructing them to vent their anger at reporters at rallies.  And now, as president-elect, he began by refusing to have a press pool following all his activities, as is the custom.    Amanpour said she had hoped that Trump would moderate his hostility toward the press after the election.   But so far, that is not the case.

She presented this chilling pattern seen in other countries:  "First the media is accused of inciting, then sympathizing, then associating. And then suddenly they find themselves accused of being full-fledged terrorists and subversives. And then they end up in handcuffs, in cages, in kangaroo courts, in prisons, and then who knows what.

Amanpour then emphasized the need for the media to stand firm in defense of facts and not fall into the trap of false equivalencies."   We cannot continue the old paradigm, "like it was over global warming, where the evidence is given equal play with the tiny minority of deniers."

She also referred to the recent political campaign, calling it "the most incredible development ever, which is the tsunami of fake news, aka lies."

    "I feel that we face an existential crisis, a threat to the very relevance and usefulness of our profession. Now, more than ever, we need to recommit to real reporting across a real nation, a real world in which journalism and democracy are in mortal peril. Including by foreign powers like Russia who pay to churn out and place these false news articles, these lies, in many of our press. They hack into democratic systems."

In concluding her address, Amanpour declared that "We must fight against the normalization of what is unacceptable, treating neo-Nazis and racists and anti-Semites as if they were just another place-setting on the table of ideologies. They are not."

[reporting by "News Corpse" on Daily Kos]

Sunday, December 4, 2016

Why health care should not be a for-profit business

Martin Shkreli made headlines last year when he bought out the pharmaceutical company that makes the anti-parasite drug Daraprim -- and overnight raised the price from $13.50 per dose to $750.00.

Following a public reaction that made Shkreli a pariah on social media and in news headlines, he agreed to cut the price of the drug for hospitals and needy patients by 50%, which Shkreli claimed would make it more affordable ($375 a pill) and also allow the company to still make "a very small" profit;   but private patients and insurance companies were still charged the $750.

Now some high school students in Australia have made the drug in their chemistry lab for the equivalent of $2 per dose.   Shkreli at first went on a twitter war, pointing out that the students didn't have to pay for the lab space or the equipment or the know-how of their teachers;  of all the other costs of actually producing and packaging correct, reliable doses.  That did play to his favor much better, so he finally switched to praising the ingenuity of the young people.

The point is that the corporate world runs on profit and greed.   The health of our nation is too important to relegate it to that realm.   Does the fire department check out your bank account before they come to put out your house fire?   Do the police ask for a credit card when you call them?

One reason medicines cost us so much is that the Bush administration, in setting up the Rx drug insurance program, put in a clause (demanded by their donor drug companies) that forbid the government to negotiate lower prices for the huge amounts it pays for through various government programs.

Sooner or later, we will join other advanced nations in adopting universal, single-payer health plans, paid for through taxes.    So many more people will be covered;   so much money will be saved through elimination of administrative costs and advertising.   Medicare is the most successful, most favorably reviewed government social program we have.    Why not just expand it to cover everyone?  But, with this election, it looks like we may have to go backwards for a while here before we figure it out.