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Thread: 2017 American Political Scene

  1. #1381
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    ...and Switzerland does that by pretty much having the same private insurance model that Obamacare emulates.

  2. #1382
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    Quote Originally Posted by GVChamp View Post

    I am highlighting certain bold parts and don't see the disagreement. Why are we tossing around $30 billion a year to get people to move from 90 to 99, or 83 to 90? What's really the point when the government is actuarially broke? Especially when most old-age interventions are still expensive, especially when they involve any sort of in-patient care?

    Is that even the best use of scarce funds, assuming we want to spend $30 billion?
    There are a few different ways of answering this question.

    A: The $30 billion or so we spend a year on research feeds a $500 billion dollar industry that's turning rapidly into a trillion dollar industry. The products of basic biomedical research make the American people huge amounts of money, but the stage funded by the federal government is difficult for any individual company to do. Trying to make the companies pay for it will be very complicated and will have problematic consequences for free competition further up the researSo, you can think of it as infrastructure spending to support capitalism and commerce.

    B: Improving healthcare isn't just about improving how long you live, but how well you live. What's an extra 10 years of life worth? What's living healthier over 20, 30, 40, 50 years worth? How do we judge that as a society? How do you judge that for your familThis is a value question that people have to make for themselves, but if you look at the financial choices made by families with critically ill patients, look at their demands, and look at the general level of support for eg, cancer research in society, you have the answer. An overwhelming proportion of society support spending common resources to improve medical treatment.

    C: Going a bit further on the value of time, families of critically ill patients today are typically willing to spend a substantial portion if not all of their savings on medical treatment. They do this, today, for cancer treatments that extend life for 6 months. Given this is the case, does it not make sense to spend a small percentage of resources on improving the outcome purchased from that outlay?

    D: Disease doesn't stand still. The needs of society doesn't stand still. We constantly need to find new ways to fight infectious diseases that are actively evolving adaptations to our treatments. As our population age, we also need to find ways to make them more productive longer. This requires constant investment. In a $17 trillion dollar economy, how many fold over would our $30 billion investment in biomedical research pay for itself if it could keep our population healthy and working for 10 years longer?

    E: What's the point of anything? What's the point of life? If you are not spending money on improving the quality of life, what's a more worthwhile product? More stuff? Numbers on a spreadsheet?

    Now, of course there's a limit to all these arguments. We cannot spend ourselves broke and destroy the economic future of our society. However, the $30 billion we spend on the NIH is no where close to making us broke, cutting it will not make a substantive dent against the real fiscal monsters threatening our future, instead it will limit a significant sector of economic growth and actually make us poorer. It will slow down medical solutions that the vast majority of the country want present as a safety net for when they or their loved ones fall ill. All the arrows point in one direction:

    In a resource constrained environment, we should be spending significantly more on research, not less.

    Apparently not: other advanced nations spend less on R&D (and also less on all sorts of medical interventions and screening like MRIs or mammograms and a whole host of other things) and get comparable or superior results. With technology we currently have: anti-smoking efforts, anti-bacterial drug compliance, mold clean-up efforts, handing out inhalers for free...
    Other advanced nations are "advanced" partly because they can share in what we create. A number of the most dynamic ones actually spend much more, per capita, on research than we do, and they reap corresponding economic benefits: https://en.wikipedia.org/wiki/List_o...pment_spending

    They also get better health outcomes because they have different population mix, different mixture of socioeconomic conditions, and different social programs. For some countries, much of the spending that we account for in our health system they account separately for in their vast social welfare programs. Other countries have drastically clamped down on pay and other costs in their healthcare systems.

    I'm a tech skeptic and think we're stuck in the Great Stagnation: I'm inherently allergic to massive spending in Science (TM) because we think it's going to power through all of our problems. This isn't the Industrial Revolution anymore.
    The Great Stagnation is in someways real and in other ways an illusion of accounting.

    First

    The first Industrial Revolution took place over the course of about 60 years. Over that period how much did people's lives really change? If you took someone from 1800, and made them go back to 1790, what would they notice?

    Now try telling a millenial that they have to go back and live in 2007, or heck 2011. They would go into withdrawal. That tells us something right there.

    Similarly, compare the car I can buy today for $25K to the one I could buy in 2007. Compare the TV I'm looking at today with the one back then. Compare my laptop, my phone. The things I use are distinctively better, but they are not really worth more.

    What I'm getting at is that our society is changing in huge ways, but ones that economics isn't very good at measuring. That itself creates lots of problems in our society, which makes it feel like we are stagnating.


    Second

    What's the alternative to powering through with science and technology. Suggesting that we should look for other solutions suggests that there are other solutions. If we look at history though, the alternatives do not seem very pleasant at all. Many are outright terrible to contemplate, and all too real.

    Third

    Is the history of science and technology smooth? There are lull periods even in eras we recognize as revolutionary. There was a pause of about 50 years between the first and 2nd industrial revolutions. The Renaissance and the Enlightenment took place over the course of centuries. Even in the 20th century the decades of the 70s must have felt particularly stagnant to those who were experiencing its charms. Our society is actually changing faster. The reason why we don't think that's the case is that the past is vastly compressed in our perception relative to the present.

    Fourth

    Are there revolutions on the horizon? The answer is absolutely.

    The information revolution is on the cusp of breaking out into the physical world with the unleashing of AI and robotics. Ask yourself this: how much effort did it take and how many helpers did you need the last time you did some substantial repairs or remodeling on your house? Now, think about what you, by yourself, could have done, had you been able to control a robot like an extension of your hand, have it be able to move around your house, recognize the things that you are working with, be able to make it do what you want want it to do by simple commands, and be able to have heavy objects, carve, shape, paint things with far more precision and skill than you could?

    Now imagine if you could put the same type of robots out in the middle of the desert, in the arctic, under the ocean, into outer space. What would it mean for construction? For exploration? For natural resource use and geopolitics? What would it mean for Canada, Alaska, Russia, Indonesia, Saudi Arabia if you can do massive construction projects in the Arctic, in the middle of the Arabian desert, on the floor of the Pacific with 90% of your human workers sitting in comfy offices in Anchorage, Montreal, Moscow, Riyah, or Jakarta? What would it mean for the average American homeowner if any contractor with a $100K robot can build your house in a week and paint the Sistine Chapels on your ceiling?

    With the advances in computer vision, augmented reality, robotics, and power systems, those systems are coming surely as the tides.

    What about biomedicine? Today we are developing such good technologies for characterizing biology that we can pull protein, DNA, and RNA out of individual cells and analyze them en mass, we are seeing molecular interactions between individual proteins in those cells, we are seeing the atomic details of how those proteins work with electron microscopes that can look at uncrystallizable proteins. We have CRISPR-Cas which allows people now to easily modify cells with pretty much any group of genes they want. We have computer programs now that can not only predict the shape of proteins with good accuracy (something we thought impossible just a few years ago), but design ones of your own from scratch. This year Kite Pharma just reported genetically engineered cells that likely cured lymphoma for many of the patients they tested them on:

    http://seekingalpha.com/article/4054...history-making

    What's next? How far away are we from cures for other cancers? On helping quadraplegics walk again? On helping people recover from vision loss? On preventing limb loss in diabetes? How much money will that be worth? And is that any less meaningful, than being able to ride the train out of your village?

    Technological development has not stagnated. Instead it's continuing at an exponentially growing pace. The reason why it doesn't feel as revolutionary is that every advance is opening up even more space and directions for further growth. So whereas the minds of entire societies were fixed on particular directions of advance in the industrial age, today there are so many disparate directions that no one can fully perceive or understand the true magnitude of the progress, or how it will all fit together for the next leap.

    We are sort of like cavemen coming into the modern age, looking at all the cars around us and say: Ha, look at that, 10,000 years and they are still using the wheel. Yes, the wheel is the same shape. We haven't changed it from its basic concept. The cavemen thought we'd change the wheel because the wheel was all he knew. What technology development did instead was incorporate the wheel as a basic component of things that cavemen could never have imagined.

    That's a process that's constantly happening in science and technology. The things we know about, that we think have been revolutionary don't change. They just get incorporated into things that we can't yet imagine.

  3. #1383
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    GVChamp,

    I know you're allergic to Vox, but here (in bold) Ezra Klein lays out the very argument that you brought forth earlier, lol.

    WAB = you heard it here first!

    ====

    http://www.vox.com/policy-and-politi...hca-trump-iraq

    The health care bill could be Donald Trump’s Iraq War

    Sold on lies, poorly planned, deadly to thousands, and a catastrophe for its authors.

    Updated by Ezra Klein@ezraklein
    Mar 23, 2017, 8:00am EDT

    If it passes, the American Health Care Act will be Donald Trump and Paul Ryan's Iraq War. It's been sold with lies. It's been pushed forward with a shock-and-awe legislative strategy. And its architects are woefully unprepared for the chaos it would unleash upon passage.

    There is an honest argument that could have been made for the AHCA. Conservatives believe it is not the government’s responsibility to ensure the poor can afford decent health insurance. They argue that if taxpayers are pitching in for someone’s coverage, that coverage should be lean; a high-deductible plan that protects against catastrophic medical expenses is plenty for charity care. Under this view, the basic structure of Obamacare — which taxes the rich to purchase reasonably generous coverage for the poor — is ill-conceived and should be reversed.

    The core philosophical disagreement here is real and worth hashing out. Whereas liberals see access to health care as a right, conservatives see it as more akin to transportation — important, and perhaps worth subsidizing at low levels, but if someone can’t afford a car, it’s not the government’s responsibility to buy them one, much less buy them a nice one. This is the viewpoint the AHCA reflects.

    It is not the viewpoint elected Republicans are selling. Instead, their rhetoric fits the sort of plan that Sen. Bernie Sanders might offer. Donald Trump won the 2016 election promising to protect Medicaid from cuts and ensure coverage for all. After the election, he reiterated the vow, telling the Washington Post “we’re going to have insurance for everybody” with “much lower deductibles.”

    At about the same time, Senate Majority Leader Mitch McConnell went on Face the Nation to lament that under Obamacare, 25 million people remained uninsured, and many of those who did get coverage were in plans where the “deductibles are so high that it’s really not worth much to them.”

    Much as Americans were told the Iraq War was about removing the threat of Saddam Hussein’s weapons of mass destruction, they have been told that the GOP’s health care effort is about replacing Obamacare with “something terrific” — a plan that covers everyone with good health insurance that they can actually afford to use. In both cases, they were lied to.

    Just as there were no WMDs in Iraq, there is no health insurance Eden where everyone has better coverage at lower costs waiting on the other side of the AHCA — and there will be no hiding that fact if the law passes. The Congressional Budget Office estimates the bill would eventually push 24 million people into the ranks of the uninsured, and it would be particularly punishing to the old and the poor and the sick. The architecture of the bill pushes insurers to create plans with higher deductibles and less coverage and the shrunken tax credits push consumers towards crummier insurance. The experience most people affected by the AHCA will have is either giving up health insurance altogether or trading down into a cheaper plan with much higher out-of-pocket spending.

    This is not what Republicans promised — and it explains why they have rushed their bill through Congress so fast. Their legislation does not do what they say it does, and it does not do what voters want it to do, and so a normal, deliberative process that exposed those facts would be lethal.

    Shock and awe as a legislative strategy

    At a Monday rally, Trump laid out a capsule legislative history of the Affordable Care Act. “It’s important to realize how we got to Obamacare in the first place, back in 2009 and 2010, House and Senate Democrats forced through a 2,700-page health care bill that no one read and no one understood,” he said. “They ignored the public, they ignored the voters, and they jammed a massive failed health care takeover right through Congress.”

    A quick review of the Affordable Care Act’s history is in order. In the House, then-Speaker Nancy Pelosi introduced the Democrats’ health care plan on June 19, 2009. The bill wouldn’t pass the chamber until November. It wouldn’t pass the Senate until the end of December. And it wouldn’t pass into law until March of the following year. Over that period, the House and Senate would vote on literally thousands of amendments, and Senate Finance Chair Max Baucus would huddle with two Democrats and three Republicans for months in an effort to work out a bipartisan compromise.

    Republicans, by contrast, are attempting to pass their bill through the House less than 20 days after introducing it. They are trying to pass it through the Senate less than 30 days after introducing it. They are doing so without even a token effort to win over Democratic support; they are doing so even though the bill is already unpopular; and they are doing so despite loud, persistent warnings from stakeholders, experts, and even allied think tanks that the bill’s fundamental construction is flawed.

    I don’t recount this history merely to mount a charge of hypocrisy — though the hypocrisy on display here is genuinely breathtaking.

    Rather, while I didn’t buy the GOP’s argument that the process that led to Obamacare was a secretive, arrogant, undeliberative mess, I thought Republicans did. As Trump’s comments from this very week show, Republicans have spent years arguing, consistently, that Democrats made an awful mistake in 2009 — they moved too fast, ignored public opinion, steamrolled congressional opposition, and ended up with a bad law because of it.

    But Republicans have taken everything they said they didn’t like about the process behind Obamacare and supercharged it — it’s as if they’re using their critique of the ACA process as a playbook for retribution. They are moving faster than Democrats did, and they are doing so with less stakeholder support, with a smaller congressional majority, with less bipartisan input, with an unpopular bill backed by an unpopular president, with less information about what their bill would do, and while providing fewer opportunities for members of Congress to amend and improve the underlying ideas.

    At this point, the strategy has developed an air of farce. I am publishing this piece on the morning of Thursday, March 23rd, the day the House is supposed to vote on its legislation reshaping the American health care system — and no one even knows what the final bill will look like, as House leadership is in last-minute negotiations with the conservative Freedom Caucus.

    But the vote is still expected this evening, even though that will mean there’s no time for congressional or outside analysts to model the altered legislation. Republicans know not what they do, and more crazily, they like it that way — the absence of information has been seen, from the start, as a feature, not a bug.

    Republicans are lashing themselves to this insane process because they think it’s their only chance. Either they move fast or their effort perishes. “The Republican leadership has made a decision that time is of the essence here,” says Lanhee Chen, a Hoover Institute fellow who served as policy director to Mitt Romney. “Now, would it be great to have all the information we need in place while or before we have these discussions? In an ideal world, yes. But I also think that runs up against the reality that the deeper we go into this process, the harder it will be to achieve certain policy and political goals.”

    This is the cost of constructing a plan that people will like less as they understand it more: You have to make up in political momentum and legislative speed what you don’t have in popular support and defensible policy. But the problems Republicans are trying to obscure through congressional strategy actually need to be solved if the bill is going to work — and that, Republicans need to remember, is the real point of all this.

    The 2003 “shock and awe” campaign to topple Saddam Hussein reflected a misconception that the hard part of the Iraq War would be fighting through to Baghdad — but once we were there, and once Hussein was gone, it would all work out. It didn’t. The hard part was after Hussein fell, and the United States was responsible for the future of a country it didn’t understand and faced with chaos it hadn’t planned for.

    President George W. Bush famously called the invasion of Iraq a “catastrophic success” — it was a military victory that left America embroiled in a catastrophe. Of course the misery caused by the invasion of Iraq — hundreds of thousands dead, impoverished, brutalized, for no reason at all — is different both in degree and kind than the misery caused by the ACHA would be.

    But here, again, Republicans have misunderstood the challenge before them. This bill has always seemed like an answer to the question, “What can we pass that would count as repealing and replacing Obamacare?” But that’s not the right question. The right question is, “What can we pass that will actually make people’s lives better?” Given the truncated, fearful process Republicans have retreated behind, I’m not persuaded even they believe this bill is the answer.

    With a sufficient congressional majority, and sufficient arm twisting, Republicans can pass a bill. The problem is what happens once Obamacare is toppled and they need to rebuild the health care system they’ve destroyed, manage the fury of the voters they’ve betrayed, and explain away the insurance markets and rural health care systems they’ve wrecked.

    You break it, you buy it

    In the runup to the Iraq War, Secretary of State Colin Powell famously told President Bush, "You are going to be the proud owner of 25 million people. You will own all their hopes, aspirations, and problems. You'll own it all." Privately, he referred to this as the Pottery Barn rule: You break it, you own it. (For the record, it turns out Pottery Barn does not actually have this rule.)

    This is a problem that afflicted Democrats too. After passing Obamacare, they found themselves responsible for both the law’s problems and the broader, systemwide problems that had nothing to do with the law. If employers raised premiums — which they did before the Affordable Care Act, too — Obamacare got blamed. If local hospitals closed, Obamacare got blamed. And all this happened even as they pumped new money into the system, insuring tens of millions of people.

    If Republicans pass the American Health Care Act, they will be blamed, correctly, for tens of millions of people losing their health insurance and for untold others who have to trade down to plans with higher deductibles and more cost sharing — exactly what Trump promised wouldn’t happen.

    But they’ll also be blamed for the sundry chaos their plan creates: the local insurance markets that collapse because all the insurers pull out, the seniors who find their premiums quadrupling, the rural health systems that crack under the thinner subsidies, the low-income workers whose raises push them above Medicaid eligibility only to find their larger paychecks more than consumed by larger health bills.

    Some of these problems are not what Republicans intend — they’ll be the result of a poorly constructed bill the GOP hasn’t taken the time to consider and fix. But this is a choice they’re making in moving so fast: The schedule they’ve adopted doesn’t give them nearly enough time to understand what the American Health Care Act will break.

    To all this, Republicans have an answer: Just wait for phases two and three of health reform! In the GOP’s telling, everything that is not in this bill will be added in phase two, when Health and Human Service Secretary Tom Price reinterprets unspecified regulations to strengthen insurance markets, and in phase three, when Republicans attain a 60-vote Senate majority and pass all the changes they couldn’t fit through the filibuster-proof budget reconciliation process.

    The very absurdity of this plan shows the depths of the GOP’s self-delusion. This is the heath care version of Dick Cheney’s promise that American troops “will, in fact, be greeted as liberators.” When that didn’t happen, the inadequacy of America’s postwar planning was laid bare, and a catastrophe unfolded. Here, too, Republicans are building their health plan around a blindly optimistic post-passage scenario, and when it fails to come true, they will own a catastrophe.

    Republicans are creating a policy vacuum they may not be the ones to fill

    Here, I think, is a plausible vision for what might follow passage of the American Health Care Act. In 2018 — the AHCA’s first real year of operation — the ranks of the uninsured will rise by 14 million, as the Congressional Budget Office has predicted. Not all those people will be losing health insurance they already had, but most will. Millions more will find their tax credits insufficient to cover the plan they had, and liked, and will be left paying more out of pocket for insurance that covers less. The news will be thick with stories of counties where insurers jack up premiums to manage the market upheaval, and there will likely be some areas that find themselves with no insurers offering coverage at all.

    Those reports will be the easier ones for Republicans to ignore. Though it is uncomfortable to speak in these terms, people will die if they can no longer afford health insurance. A cautious estimate, based off the best available evidence, suggests coverage losses on the scale Republicans envision will lead to more than 24,000 deaths annually. This is a major difference from Obamacare, which also caused disruptions in the health insurance market, but did so while covering millions of people and saving lives. The AHCA, in taking coverage from millions, will generate wrenching stories of human suffering — stories that power ads and protests and campaigns all across the country.

    Next will come the midterm elections — and Democrats will ride the fury of their side, Trump’s unpopularity, and anger over health care to massive gains in the House. Then in 2020, the Medicaid expansion will freeze, and restoring both it and Obamacare’s broader coverage gains will be the animating issue for Democrats. The Republican zeal to repeal Obamacare will be matched by the Democratic zeal to restore and expand it — and Democrats, unlike Republicans, will actually have a plan that accords with their rhetoric.

    If a Democrat wins the presidential election — and whether it happens in 2020 or it happens later, the party will win power back eventually — Democrats won’t waste time mucking about with the lengthy, bipartisan process and centrist ideas that animated the Affordable Care Act. They will not scour the country for a health plan implemented by a Republican governor, as Obama did before finding Mitt Romney’s reforms in Massachusetts. They will have learned that no Republican aid is forthcoming, and that there is no point in attempting to find it. Republicans have, at this point, firmly discredited Democratic moderates and their promises of technocratic compromises.

    Instead, Democrats could, within a matter of weeks, pass a short, clear law restoring and expanding the Medicaid expansion, restoring and expanding Obamacare’s tax credits, allowing Americans to buy into Medicare as an option on the exchanges, and paying for the whole thing by levying hefty taxes on the rich. The bill would be easy to write and easier to explain.

    In this, Democrats would be passing exactly what Republicans have promised: lower-deductible care that everyone can access. This is the core advantage Democrats have in this fight: Their basic agenda of taxing the rich to offer generous health insurance to the poor is popular enough that they can sell their legislation based on what it actually does. To the extent that Obamacare is unpopular, it is unpopular because it strayed too far from that theory — it tried to hold down tax increases down by cutting Medicare, and tried to hold down total costs at the expense of keeping premiums and deductibles low for the middle class. Those were choices Democrats made to attract moderate Republicans and centrist Democrats in a process that required 60 votes to pass anything. They will not make those choices again.

    This is only one possible scenario, of course. You can come up with your own. The broader point is that toppling a regime without a stable or popular plan for the aftermath rarely goes well. If Republicans upend Obamacare, their replacement plan is unlikely to survive the aftermath — it’s simply too different from what voters want, too vulnerable to future change, too loathed by existing interest groups, and too shoddily constructed to build support on its own merits. Rather, their plan will create chaos in insurance markets, anger among voters, and radicalization among their opponents; the policy that eventually fills the vacuum they create will not be one they like.
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

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