Relevant and even prescient commentary on news, politics and the economy.

The US suicide rate has increased markedly over the past 8 years

The US suicide rate has increased dramatically (via Kevin Drum whose commentary is excellent as usual)

I have two thoughts about possible causes

One hand gun ownership. I know the rate of gun ownership has declined (always explained by the alleged decline in hunting). It is rare for people to kill themselves with rifles. I have a sense that handgun ownership has increased, but google didn’t send me to handgun specific data in5 minutes. Gallup & GSS give contradictory numbers. I will look at Gallup. Here there is a strong geographical pattern with increases in the East and MidWest. That can be compared to suicide rates by someone less lazy than me.

http://www.gallup.com/poll/150…

Suicide rates by sex shout out that it has a lot to do with guns. I think the evidence is mainly state level correlation http://www.hsph.harvard.edu/ne…

The other idea is recent wars and suicide. The rate of suicide among veterans is far about that of the general population. The increase in suicides in your graphs is roughly equal to total suicides by veterans. Suicide rates are highest for young men. Young veterans with recent service are most at risk. This can’t be the whole story (the numbers are change compared to total) but the correlation is in the time series.

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I’ve diagnosed the problem (with Clinton’s campaign; one of the problems, anyway): She keeps coming up with vapid soundbite lines that in the context of this primary contest are ridiculous. Like “It’s easy to diagnose the problem. You’ve got to be able to solve the problem.”

I’m getting really good at recognizing instantly the latest vapid or ridiculous soundbite that Clinton has settled on and will be repeating again and again.  So I detected her latest one the moment she introduced it at last Thursday’s debate:

It’s easy to diagnose the problem. You’ve got to be able to solve the problem.

Clinton was busy with private fundraisers on Friday and Saturday, I believe, but she confirmed the accuracy of my radar when on Sunday she told a block party in Washington Heights:

It’s easy to diagnose the problem. You’ve got to be able to solve the problem.

I’m not sure what problem she’s diagnosed that she has in mind.  It’s certainly not, for example, that many millions of Americans remain without healthcare insurance and that many, many millions more live in fear of actually needing major medical care because their deductibles are so high and that huge swaths of Americans find their standard of living significantly impaired because of the high and annually-increasing insurance premiums.

Unless, of course, she means that Bernie Sanders has diagnosed the problem.  And that he is proposing a way to solve the problem.

I mean … just sayin’.

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More to the Story on Killing the VHA

run75441: Ater I posted my article on the VA, it received a comment from

Suzanne Gordon

who writes on healthcare and has covered VA healthcare at her blog and also at American Prospect; Unfriendly Fire Fall 2015. Unfriendly Fire discusses the VHA coming under severe criticism from Libertarian ideologues and conservative right wing politicians even though the VHA offers far better care than what the commercial healthcare system offers. I would urge you Suzanne Gordon’s article on American Prospect.

I also checked out Suzanne Gordon’s blog and her latest post. She was discussing the 15 member Commission on Care put in place after the made up Phoenix scandal claiming 40 veterans died while waiting for an appointment (never happened in the manner described or happened at all). It appears a gang of seven members of the commission have taken it upon themselves to meet in private away from the other 8 members and drew up a proposal to eliminate the VHA by 2035 rather than strengthen it. Besides meeting secretly and outside of the public-eye together which may be a violation of the Federal Sunshine Act, the commission gang of seven met with Congressmen Jeff Miller and Paul Ryan.

Congressman Jeff Miller is the House Veterans’ Affairs Committee chairman and a staunch advocate of privatizing the Veterans Health Administration who has decided to interfere with the congressionally appointed Commission on Care not only by meeting privately with select members of the commission but also by writing a stern letter criticizing the one member of the Commission veterans can count on, Phillip Longman. First lets point out in reading Congressman Jeff Miller’s biography, it does not appear he is a military veteran of any type. Yet, he has claimed intimate knowledge of what veterans would and would not accept. For example, he believes veterans would agree with him the VA should be under funded and would reject an increase in US debt to fund the VHA so it could provide better services for veterans. Simple answer Congressman Miller, this veteran believes you should sponsor an increase in taxes on the upper income bracket you and the Republicans have favored over veterans.

I think most veterans (including myself) realized the last administration underfunded the VHA about the time an influx of Iraq and Afghanistan veterans were hitting the VHA’s doors and many aged Vietnam veterans needed more care also. Besides attending private meetings with a portion of Commission members, Congressman Jeff Miller has chosen to attack Phillip Longman, a supporter of all veterans being able to receive healthcare under the VHA besides funding the VHA properly. Again, it does not appear Congressman Jeff Miller is a veteran of any type. Yet while attacking Phillip Longman (who helped expose the truth) and calling the Washington Monthly article and Phillip Longman’s editorializing fabrications; Congressman Jeff Miller feels it is ok to meet privately with 7 members of the VHA Commission. Please take a moment and read Congressman Jeff Miller’s attack letter on Phillip Longman to the chairman of the VA Commission on Care Nancy Schlichting. There are flagrant and intentional inaccuracies in Congressman’s Millers letter which I will go through at a later time.

I dally here in anger and I want to move the readers on to Suzanne’s blog post “Secret Group Trying to Kill VHA” on the topic.

Suzanne Gordon

This has been a pretty amazing week in D.C. when it comes to healthcare. We just discovered about a secret cabal — made up of right wing ideologues and hospital executives with a huge financial stake in VHA privatization –within the VA Commission on Care. The group has been promoting a plan to totally privatize the VHA. I wrote about it on The American Prospect blog. Please read and be alarmed and act to protect the VHA.

Deliberations by the VA Commission on Care, the congressionally mandated group planning the future of the Veterans Health Administration, have, as The American Prospect has reported, become increasingly marred by controversy. When the 15-member commission met in Washington in mid-March, another furor erupted. A recently uncovered proposal to privatize the VHA set off a firestorm of protest within the veterans community.

Several members of the commission learned that seven of their colleagues had been secretly meeting to draft a proposal to totally eliminate the Veterans Health Administration by 2035 and turn its taxpayer-funded functions over to the private sector. Those commissioners dubbed the plan “The Strawman Document.”

The authors of the Strawman Document insist that the VHA is so “seriously broken” that “there is no efficient path to repair it.” Although the commission’s work is supposed to be data-driven and done by the all the commissioners together, the faction meeting independently of the full commission has ignored many of the studies that indicated that treatment at the VHA is often better and more cost-effective than the care available in the private sector.

It is not surprising that the Strawman group has chosen to ignore this research—its members have a vested interest in dismantling the VHA. The Strawman authors include Darin S. Selnick, a part-time employee of the Koch-funded group Concerned Veterans for America, as well as Stewart M. Hickey, a former leader of Amvets, a group that broke away from a coalition of large veterans service organizations because of its support for Concerned Veterans’ interest in dismantling the VHA.

The Strawman authors acknowledge that private-sector health-care systems do not provide integrated care, high-quality mental-health treatment, or many other specialized services that the VHA currently delivers. But if the VHA became an insurer—paying the bills instead of providing direct care—it could spend more money trying to “incentivize” providers to give better care in these areas.

Private hospitals would also get federal funding to run what are now VHA Centers of Excellence, which treat epilepsy, Parkinson’s disease, and other conditions veterans face.

Representatives of veterans service organizations (VSOs) believe the secret meetings of the Strawman group may violate the Sunshine and Federal Advisory Committee Acts, as well as the commission’s agreed-upon processes. The commission had set up working groups to consider key VHA issues. Unlike the secret Strawman meetings, the subcommittee members were well known by all members and the public. Meeting times were posted, and discussion minutes were recorded.

The Strawman faction engaged in another end run around their colleagues when they met with Republican Representative Jeff Miller, chair of the House Veterans’ Affairs Committee, and Speaker Paul Ryan. One representative of a major VSO, who asked not to be identified, observes: “If the authors requested the meeting with the House leadership, that constitutes lobbying. If they were invited by the House leadership, that constitutes more interference into the commission’s deliberations. Either way, this meeting, funded by the U.S. taxpayer, was totally inappropriate.”

“The plan does represent a complete deflection of responsibility to subject these men and women to an alternative ‘payer-only’ system of care that not only is ill-equipped to absorb the demand but is also, at best, minimally equipped in terms of expertise and the ability to coordinate such complex care over a veteran’s lifetime,” says Sherman Gillums Jr., acting executive director of Paralyzed Veterans of America.

Before the Strawman proposal became public, Disabled American Veterans (DAV) launched Setting the Record Straight—a social media campaign against proposals that would privatize some or all of the VHA. Garry Augustine, DAV’s Washington executive director told the Prospect, “Although we have voiced our views about VA health care for the future, it seems many on the commission are committed to [doing] away with the VA health-care system and turn veterans over to private health care, which we believe would result in uncoordinated and fragmented care for veterans.”

The commission would do far better to consider the views of VA Undersecretary of Health David Shulkin and commission member Phillip Longman. Shulkin has argued for strengthening the VHA and giving it a more active role in directing and coordinating any care veterans receive in the private-sector system. Longman believes that the VHA should serve all veterans—not just those with service-related conditions or those who are low-income veterans.
- See more at: Secret Group Trying to Kill VHA

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Bananas

I find this vox.com post by Natahnael Johnson even more interesting than their very high average. It is a paean to genentically modified bananas originally published at Grist.

The Grist (and Vox) headline people tease “These vitamin-fortified bananas might get you thinking differently about GMOs”. Johnson should be glad it didn’t get me thinking differently as I have been a raving GMO enthusiast for 35 years.

The claim is that bananas genetically engineered to produce (more) beta carotene will reduce vitamin A deficiency in Uganda. Johnson devotes much of the post to arguing that the bananas will end up in people’s stomachs unlike the golden rice which was a flash not yet in any pans.

I am, of course, convinced. I am especially interested that the post was put up at Grist.

I really don’t have much to add beyond the link.

I guess the only overlap with economics is that the bananas will be public domain, because the research is financed by the Gates foundation not a profit seeking corporation. This is actually necessary for the product to exist, because bananas can be reproduced from shoots, so there aren’t and can’t be profitable banana seed companies.

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“The Battle for VA Healthcare and Its Funding”

VA healthcare has its faults; but, it still is one of the more successful examples of publicly funded healthcare even while hampered by a lack of funding to provide more capacity in strategic places for new Iraq and Afghanistan veterans and aging Vietnam veterans like myself. Libertarian Pete Hegseth, a veteran of Afghanistan and Iraq and the CVA, both sponsored by the Koch Brothers, are hawking a dismantling of the VA hospitals in favor of higher cost and less result-oriented commercial healthcare and their own ideological interests. invisible hand

The history of the VA has always included struggles with ideological, political, and commercial (healthcare providers, pharma and hospital supply) interests. In the seventies, activists went as far as to stage scenes (Life Magazine picture depicting care for Vietnam veterans) to make the care look worst than what it was. For commercial interests, it is all about selling more services, healthcare procedures, and pharma as compared to the evidence based treatments received at the VA. For the Kochs, Libertarians, and Pete; it is all about a Randian ideology, an ideology which Ayn Rand could not live up to and forsook to accept Social Security and Medicare.

As you may remember the Koch Brothers are also buying their way on to college campuses such as Western Carolina University by funding Centers for Free Enterprise A Slippery Slope Indeed. The selling of Public Choice and Libertarian ideology under the guise of Economics courses is paramount and they staff these centers accordingly by selecting those who view it favorably. The centers are not a free range of salt water and fresh water economics or intellect as one might find at typical universities. The American Legion and other VSOs have shown similar support for the dismantling of VA Healthcare the same as the Western Carolina University administration showing support for the Free Enterprise Centers. The VSOs have bought into the Koch funded CVA push to do so in favor of commercial healthcare and giving veterans healthcare vouchers.

Together they have orchestrated an attack on the VA by claiming 40 veterans in Phoenix , AZ had died while waiting for their appointments. I did not pick the claim of 40; but, I believe it is time to debunk it and challenge subsequent claims based upon the lack of integrity and truth in the original claim. What was reported to the public by CNN and other news media sources as a failure of the VA to take care of the 40 veterans in critical need by keeping them waiting for care is not true. Yes, there is a longer wait for new patients and first time visits; but, it is not to the extent stated. The Koch Brothers, Pete, and their “web of affiliates have succeeded in manufacturing a ‘scandal’ at the VA as part of a larger campaign to delegitimize publicly provided health care” in favor of the commercial healthcare industry. The exaggeration fed scandal forced the dismissal of Shinseki besides creating another taxpayer-funded commission to investigate the alleged abuses by the VA. “The Best Care Anywhere; Why VA Health Care Would Work Better For Everyone” author Phillip Longman was appointed to this commission. He will need all of the support he can get from veterans who oppose this move by ideological and healthcare industry interests to dismantle VA healthcare.

Former Wall Street Journalist Alicia Mundy (author of Dispensing with the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle Over Fen-phen) gives a different story of what took place at the VA “The VA isn’t Broken Yet,” The Washington Monthly. Her article and two other articles report on the latest findings and paint a dismal picture of Koch Brothers and the healthcare industry attempts to dismantle the VA using innuendo and exaggerations.

While the allegations of deaths were not proven, the declared accusation of increased deaths resulting from wait times did raise concerns about how effectively the VA was with their care of Veterans. Of course, we all know how effective the overly funded commercial healthcare system is with the care of its patients. If you can afford it you will get every pill, procedure, and practice known to mankind regardless of effectiveness. This is not to say there are not good institutions or professionals; but to say commercial healthcare and wait times are both far better than the VA is simply not true. Indeed, it is the opposite. The overriding interest of those advocating the dismantling of the VA in favor of commercial healthcare is in securing it’s funding for commercial healthcare rather than improving the care for veterans.

One month into his presidency, President Obama appointed former General Eric Shinseki with no opposition in Congress to his appointment as the head the VA. Shinseki immediately set to work transforming a VA burdened by returning Iraq and Afghanistan veterans, a lack of needed capacity in places where needed (Phoenix and Tampa), and funding which did not keep up with the influx of new patients. The Bush administration had failed to close costly unneeded facilities (5 million square feet @ $53 million annually) and add capacity in other places (Phoenix and Tampa) as recommended by the CARES report besides increase the funding necessary to meet the onslaught of new vets. The CARES report listed what facilities needed to be improved and modernized, projected the future demands on VA services through 2022 in each geographic area the VA serves, compared them again to existing infrastructure, and made recommendations on how to meet the future needs of veterans. It was largely ignored as it too needed funding.

Instead of helping to care for all veterans, President Bush had also reversed the decision of former President Clinton to allow all veterans to use the VA and again installed the “proof of need” format for VA care. In other words if you were exposed to Agent Orange, drank bad water at LeJeune, were exposed to radiation from depleted Uranium artillery shells, or indigent; you again had to prove your ailment was military related or provide proof of being indigent. This can be difficult to do and it takes time. Again, presidential enforced bureaucracy ruled at the VA. It could again raise its ugly head with the wrong administration in place.

What about those news broadcasted wait times and other things Shinecki was accused of by Pete, the Koch Brothers, and the CVA? The VA under Shinseki reduced the number of homeless vets by ~25%, reduced the backlog of unprocessed veteran disability claims resulting from increased numbers of new and wounded Iraq and Afghanistan vets by 84 percent, and helped convince Congress to take in Vietnam veterans with chronic illnesses associated with exposure to Agent Orange making them automatically eligible for VA care.” As accused by the Koch Brothers, Pete, the CVA, and the silly news media, this was the man and the General who allowed veterans to wait for appointments and care only to die in the chow line of the VA while side stepping? But wait, there is more:

Under Shinseki, the VA built teams of healthcare providers whose responsibility was the care of its patients. Specific teams of PCPs, nurses, social workers, pharmacists, and health technicians were assigned to manage and coordinate the needs of each patient. This methodology overcomes the fragmentation of care, which can be seen in commercial healthcare today, and was described in Phillip Longman’s “The Best Care Anywhere.” I am taken care of by the VA Blue Team of healthcare providers.

Mental health professionals and substance abuse specialists were integrated into each team and this care excelled beyond that provided by commercial healthcare as it applied proven, evidence based therapy and methodology for mental illness. Insurance companies, Medicare, and Medicaid will not pay for this type of “body and mind” care by commercial healthcare. It is crucial to have it available for veterans as 25% of veterans suffer from chronic mental illness and 16% are addicted.

One study, “The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans” touched upon the differences in the success rate of VA care as compared to commercial healthcare.

” In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.”

Furthermore the study concludes the ‘findings demonstrate the significant advantages accruing from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.’”

Hey, but what about those overly long wait times broadcasted by the news media and pitched by Pete and the CVA which caused the deaths of so many veterans as stated by them? After all, the team methodology and evidence-based physical and mental care put in place by Shinseki does strain the VA capability to set prompt appointments for new veterans coming into the system for the first time. Then too the need for primary care doctors outstrips the supply of them by ~7500 in 2010 and the shortage is estimated to more than double by 2020. This shortage as well as the amount of team care given does place a strain on the VA capability to supply care to new vets. Unlike commercial healthcare, the VA put in place performance measurements which are available to the public. Commercial healthcare does not make its performance measures available beyond the advertisements seen on TV. “Across facilities, veterans waited an average of six and half days from their preferred date of care to their actually seeing a primary care doctor. In comparison, a private survey taken by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days.”

For the first half of fiscal year 2015 starting October 2014 through March 2015 using the most recent data available from the Assessment B (Health Care Capabilities) Page 190 wait time study, the average number of days “Veterans waited for new patient appointments was approximately six and a half days from the preferred date for primary care, six and a half days from the preferred date for specialty care, and three and a half days from the preferred date for mental health” care as taken from page 190 of the same report.

Indeed, Figure 4-14 shows >93% of all veterans completed their appointments within 30 days. Again to compare, the average wait time for new veteran patient appointments is six and 1/2 days from the preferred date while the average wait time for non-veterans using commercial healthcare as experienced in 15 markets for first time visits is 19.5 days from the preferred date or three times longer.

invisible hand

And those 40 deaths caused by too long of a wait time? As taken another report, Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System, revealed, six and not forty veterans had died experiencing ‘clinically significant delays’ while on waiting lists to see a VA doctor. In each of these six cases, the IG concluded “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” But for some reason those wishing to dismantle the VA can conclude such. Maybe they have a different source of information? They do not and this gets to the root of the issue. Why would someone make up such stories and the media report on them without adequate research when the end result would potentially cause so many veterans to lose their coverage and surrender to a must worse situation with commercial healthcare? News and especially catastrophic news sells and news today is lazy and lacks integrity. For everyone else concerned, it is the money involved or the VA funding.

My own experience with the VA has been good and that with major US hospitals and commercial doctors has shown similar if not greater wait times. God knows, I have been in enough hospitals since 2012 advocating on my own treatment. If you do not know, ask questions and do not be so ready to accept what is told to you because the person is a doctor. They do make mistakes like being given blood thinners when you have a blood disorder. As Alicia Mundy put it succinctly “while the VA has an assortment of serious problems, it continues to outperform the rest of the U.S. health sector on nearly every metric of quality—a fact that ought to raise fundamental questions about the wisdom of outsourcing VA care to private providers.”

I am not on board with this take over of VA Healthcare by commercial interests as supported by moneyed ideological and political influences. I would urge veterans to speak up as what you are going to get will not match what you have. Once your voucher is spent, game over.

References:

“THe VA Isn’t Broken Yet Alicia Mundy, Washington Monthly

Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System

” Assessment B (Health Care Capabilities)” Rand Study on Wait Times 2014/2015

” Comparison of Quality of Care in VA and Non-VA Settings: A Systematic Review”

“Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000–2010″

“Department of Veterans Affairs to Realign Its Capital Assets”

“Documents Show the VA Debacle Began Under George W. Bush”

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Millennials like socialism — until they get jobs. Or until a pollster tells them that it would mean tax increases but doesn’t tell them, for example, that the tax increases would replace healthcare insurance premiums and out-of-pocket medical expenses. And doesn’t tell them that “more government services” means something other than, say, trash collection twice a week instead of once a week.

Okay, so the title of a Washington Post op-ed piece today by research fellow and director of polling at the Cato Institute Emily Ekins is “Millennials like socialism — until they get jobs.”  She knows that this is do because a recent Reason-Rupe poll—that’s libertarian magazine Reason, and some polling organization they hired—found that:

When tax rates are not explicit, millennials say they’d prefer larger government offering more services (54 percent) to smaller government offering fewer services (43 percent). However when larger government offering more services is described as requiring high taxes, support flips and 57 percent of millennials opt for smaller government with fewer services and low taxes, while 41 percent prefer large government.

Ah, yes; the ole, reliable, generic smaller-government-with-fewer-services-vs.-larger-government-with-more-services polling gimmick. Because of course everyone absolutely definitely, completely understands what the generic “services” are.  Like, say, trash pickup twice a week rather than once a week?

The survey was, by this writer’s undoubtedly accurate account, prompted by a recent Gallup survey that, to quote Ekins, found that an astounding 69 percent of millennials say they’d be willing to vote for a ‘socialist’ candidate for president — among their parents’ generation, only a third would do so.”  Spilling the beans about the motive for the Reason survey, she continues, “Indeed, national polls and exit polls reveal about 70 to 80 percent of young Democrats are casting their ballots for presidential candidate Bernie Sanders, who calls himself a ‘democratic socialist’.”

Uh-oh.  And that was before Bloomberg released a poll yesterday showing Sanders’s support with a 1-point lead over Clinton nationally, with almost no undecideds: Sanders has 49% to Clinton’s 48%.

Ekins writes:

Millennials are the only age group in America in which a majority views socialism favorably. A national Reason-Rupe survey found that 53 percent of Americans under 30 have a favorable view of socialism compared with less than a third of those over 30. …

Yet millennials tend to reject the actual definition of socialism — government ownership of the means of production, or government running businesses. Only 32 percent of millennials favor “an economy managed by the government,” while, similar to older generations, 64 percent prefer a free-market economy. And as millennials age and begin to earn more, their socialistic ideals seem to slip away.

I dunno.  Ekins continues:

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The Key to Defeating Trump in the General Election Is in a Single Sentence of His in Last Night’s Debate: Angry Americans want big tax cuts for the wealthy

People come [to Trump campaign events] with tremendous passion and love for their country. … When they see what’s going on in this country, they have anger that’s unbelievable. They have anger. They love this country. They don’t like seeing bad trade deals. They don’t like seeing higher taxes. They don’t like seeing a loss of their jobs. … And I see it. There’s some anger. There’s also great love for the country. It’s a beautiful thing in many respects. But I certainly do not condone that at all.

– Donald Trump, during last night’s debate

Back last fall when Ben Carson was surging and according to the polls had overtaken Trump in Iowa, the Koch brothers’ main super PAC saw an opening to end the Trump phenomenon once and for all: It announced plans to buy, I think it was, $1 million in ad time on Iowa and New Hampshire airwaves.

Trump, up to that point, had been campaigning as sort of a fiscal progressive, suggesting (among other things) that he supports a more progressive tax code and maybe even universal healthcare insurance.  Uh-oh; he definitely had to be stopped by a Koch brothers’ super PAC ad campaign.

Unless, of course, he adopted Koch brothers fiscal-policy positions and continued his climate-change-is-a-hoax thing. The latter would be easy, of course, but the former required the hire of a mainstream-wingy Republican fiscal-policy consultant who could, and did, chose a mainstream-wingy Republican fiscal-policy candidate’s already published trickle-straight-down-to-the-sewer-system fiscal policy platform and just double the tax cuts for the wealthy.  Take that, Jeb!

It worked. At least to my knowledge, the ad buy never materialized. Carson collapsed in the wake of the Paris terrorist attacks, Trump’s campaign regained steam—and never looked back.  Until two weeks ago or so, anyway, when comments he made about not wanting people to die in the street for lack of access to medical care raised questions about whether he – he – he supports Obamacare and its Medicaid expansion.

Not to worry.  That mainstream-wingy Republican fiscal-policy consultant was still under contract with the Trump campaign and could quickly rattle off the points on the Movement Conservative list of heathcare-insurance-reform clichés for Trump to post on his campaign’s website as his healthcare-reform proposal.  There was increasing healthcare savings accounts.  There was allowing insurance companies to sell policies nationally.

And of course there was the end-Medicaid-by-giving-the-money-to-the-states-to-use-for-anything-they-wished-even-maybe-Medicaid-which-of-course-Republican-controlled-states-won’t-use-it-for proposal.

And you, Tea Partiers, were starting to worry that Trump doesn’t really want to kill Obamacare and Medicaid!  Fear no longer. It’s safe to vote for him.  Whew.

That was a relief, of course, for Establishment wingers, too.  But, dang.  It’s not enough.  Some of them are pretty worried that although that fiscal policy proposal is still there on his website, Trump never actually talks about it.  Instead he’s always just playing to the white blue-collar folks who’ve been financially devastated by the free-trade treaties.  And by other policies that have had the effect of favoring the well-off, to the detriment of, well, these Trump supporters.  And this guy Bernie Sanders keeps detailing the statistics about wealth and income distribution over the last thirty-five years.  He won’t shut up about it.

Big problem.  Especially since this week it became time for Trump to try to unite the Republican establishment behind him.  Not easy for someone who’s one positive contribution to the political climate is to expose Republican establishment financial-elite proxies as not really so in sync with the Republican blue-collar base after all.

The answer? Ah. Higher taxes! The perfect fiscal dog whistle to the Koch folks and their ilk.

So … the people who come to Trump rallies?  They have anger.  They love this country. They don’t like seeing bad trade deals.  And they don’t like seeing higher taxes on the wealthy.  Because, see, the angry people who come to Trump rallies and who don’t like seeing bad trade deals are wealthy.  Just ask them.

Interesting, isn’t it, that now that Trump has all but wrapped up the nomination and wants the party establishment’s support, his first olive branch is assuring them that he really does support massive tax cuts for the wealthy?

____

UPDATE: An exchange between reader Warren and me today in the Comments thread:

Warren

March 12, 2016 2:43 pm

I missed the part where Trump said “for the wealthy”.

Or are you saying that only the wealthy pay taxes, so it is implied?

 

Me

March 12, 2016 7:06 pm

You missed the part where Trump said “for the wealthy”, Warren? Guess you didn’t read Trump’s tax proposals or any of the articles summarizing them. You should.

The link is to an Oct. 2 blog post by Paul Krugman.  Trump had released his tax plan earlier that day.

Then:

Warren

March 12, 2016 8:53 pm

So is it “a single sentence in his in last night’s debate” or isn’t it?

Did he say “for the wealthy” in that sentence, or didn’t he?

 

Me

Beverly Mann

March 12, 2016 10:39 pm

I said the KEY to defeating Trump in the general election is in a single sentence of his in Thursday’s debate. In a debate performance in which he was saying he wanted to unite the party, he dog-whistled the Kochs, the other donors, and the rest of the Republican establishment that, as president, he would attend to their needs: big tax cuts for the wealthy.

Angry Americans don’t want big tax cuts for the wealthy. But the Republican donors and the rest of the Republican establishment do, and the only one they’re angry with right now is Trump. He announced to them on Thursday that he wants to change that.

The key to defeating him in the general election is to simply point that out. Trump’s tax plan says what it says. It’s just that the only ones who know what it says, other than Paul Krugman and a few other journalists and progressive economists, are the people it was targeted to: the Republican establishment, to keep them at bay.

He was reminding the Republican establishment of his tax plan.

Added 3/12 at 7:44 pm and 10:50 p.m.

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John Cornyn Adopts Trump-Like Fascism Techniques. Good Job, Donald! [Updated.]

Dan Crawford sent me links to these two articles about Senate Judiciary Committee enforcer John Cornyn’s threat on Tuesday that he and his compadres will destroy the reputation of anyone nominated by Obama for Scalia’s seat.  I responded to him after reading the articles:

You know, Dan, this is so palpably, stunningly offensive that Sanders and Clinton need to tell the public about it.  It’s really just jaw-dropping. It’s just … I don’t know; I can’t even think of a perfect adjective.  Scary, maybe?

Beverly

Sanders, especially, should mention this on the campaign trail as a way to illustrate the lengths that the people who want the federal courts—most prominently but by no means only, the Supreme Court—to continue to serve as a fully owned subsidiary of Koch Industries and the legal arm of the Republican Party, albeit with the full force of the United States government’s powers.

Cornyn is a former Texas state supreme court justice and Texas attorney general.  I’m betting that his professional history isn’t pretty, so he’s perfect to have his Fascism routine turned back on him. As in, turnabout is fair play.  Exposing his record as a state supreme court justice and a state attorney general to national examination may, given what some of the specifics are likely to be, ensure his seat as a Texas senator for as long as he wants it.  But it also may well help in making the remainder of his tenure as a senator, beginning next January, be as a member of the Senate minority.

And I don’t mean that I expect him to become a Democrat.

Thug-like threats and actions aren’t likely to appeal to a majority of voters.  As Trump’s general-election and favorability poll numbers indicate.

In other words: Citizens united against Citizens United!  And so very much more.  Hoist this politician by his own piñata.

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UPDATE: The New York Times today has an editorial on this, writing:

On Monday, John Cornyn, the senior Republican senator from Texas, warned President Obama that if he dares to name a successor to Justice Antonin Scalia of the Supreme Court, the nominee “will bear some resemblance to a piñata.”

Violent imagery has been commonplace in political statements for a long time, but even so, it is disgraceful for a senator to play the thug, threatening harm to someone simply for appearing before Congress to answer questions about professional accomplishments and constitutional philosophy

The editorial is titled “Republican Threats and the Supreme Court”.

Senator, may we not drop this? … Senator. You’ve done enough. Have you no sense of decency, sir? At long last, have you left no sense of decency?

Added 3/11 at 8:42 a.m

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Harry and Louise Now Support Sanders’ Medicare-for-All Plan. With Good Reason.

In the Comments thread today to my post yesterday titled “Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs,” reader Urban Legend wrote, as part of a several-paragraph comment:

While a single payer plan is superior in theory — and has been proven in practice — thought should be given to the extreme political danger of offering a program at this time that can and will be painted by Republicans as one that will destroy half a million jobs in many different states. There was more than spite in Joe Lieberman’s objection to the public option. Think Hartford, Connecticut, insurance capital of the country. We would see “Harry and Louise” in spades. (Look it up if you’re too young to remember, and see what happened to Congress in the following election in 1994.)

I responded:

Guys, I’ve pretty much given up on trying to convince Dem baby boomers and silent generationers that it’s no longer the ’80s and ’90s and that the Bernie-is-a-SOCIALIST thing would mean a George McGovern-like trouncing and a Repub sweep in congressional elections. Finally, that argument is no longer being made by the punditry; instead it’s now the reverse: Can Clinton beat Trump, given the public’s now-obvious anti-Koch-brothers-Republican-platform mood.

But I do want to respond to Amateur Socialist’s concerns about Harry and Louise, whom I remember quite well.

The reason for the success of the insurance industry’s anti-Hillarycare ad featuring the young couple Harry and Louise was that the essence of Hillarycare was that it would all-but-force people who had choose-any-doctors-and-hospitals-you-want insurance into HMOs or PPOs that limit the choice of doctors and hospitals to those in a network, sometimes a small network, especially back then, and that sometimes required a referral by a primary care doctor for access to a specialist.

Most people back then had employer-provided insurance that did not have those limitations.  Their insurance was like Medicare—usually like Medicare with a supplemental plan is now.  The problem back then was that there still were tens of millions of people who had no access to insurance, many of them because of preexisting medical conditions, and also that premiums had been skyrocketing. And suddenly many employers were no longer paying the entire premiums.

But of course now, very few employers provide insurance that does not involve healthcare networks.  And very few now pay the full premiums.  And most policies have much larger copayments and much larger deductibles.

These are the really big problems with the ACA’s marketplace plans, too.

And these are the problems that Sanders’ Medicare-for-all proposal would eliminate.  No provider networks, no large copayments, no large deductibles, and affordable premiums.

In other words, Harry and Louise would support the Sanders plan now.

Enough said on that, I would think.

The two paragraphs in Urban Legend’s comment that precede the one I quoted read:

I agree that the Thorpe alleged take-down of Sanders’ single payer proposal is ridiculous. As you say, you can’t expect a candidate to dot every i and cross every t in a broad campaign proposal. The experience of other countries indicates almost certainty that in the long run, everyone would come out ahead with a “Medicare for All” system.

And:

I disagree completely that Clinton has no proposals for healthcare. She has quite specific proposals, including tax credits up to $5000 to reduce co-pays and deductibles (which she says are excessive), efforts to reach 16 million people who are eligible for Medicaid (a single payer plan) but haven’t signed up, and revival of the public option, the primary purpose of which was to make a genuine non-profit, efficient insurance offering available and force insurance costs further downward through direct competition. Whether they are adequate or not is a matter of opinion, but it should not be said that she has no proposals. They are there for everyone with a finger and two seconds to see.

The first of those paragraphs refers to the main point of my post: the sheer silliness of Emory University healthcare economist Kenneth Thorpe’s most recent attempt at a takedown of the Sanders proposal. The second of the paragraphs—well, it’s meaning needs no background.

But it does raise this question: Why has there been no study by mainstream progressive economists about the costs of these proposals of Clintons’, and an explanation of why this would be better than a plan that would, among other things, significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles?

Paul Krugman, maybe?  Nah.

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Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs. [Typo in sentence referencing Max Ehrenfreund's Wonkblog post corrected 3/2 at 2:28 p.m.]

Paul Krugman has been incessantly complaining about some Sanders supporters who accuse him and other high-profile Sanders critics, especially academics, of conflict of interest. The Sanders supporters allege all manner of self-interested reasons for the Sanders animus, much of it (including Krugman’s) expressed with vitriol.

I’m not among the Sanders supporters who subscribe to the academics-who-want-a-position-in-the-Clinton-White-House general theory.  And making that charge against Krugman is ridiculous.  But there is one virulently anti-Sanders healthcare economist who I’m betting is motivated exactly by personal ambition: Emory University’s Kenneth Thorpe.*

Thorpe, a Clinton administration healthcare official, gets his Sanders’-single-payer-critique cred because he worked on the failed Vermont single-payer plan.  Just before it was about to begin being implemented last year, the governor, a supporter of the plan, agreed to kill it because it became clear that its costs would significantly exceed former projections.

Weirdly, the failure of the Vermont plan is used, by Thorpe and others, as evidence that single-payer could not be cost-effective nationally.  As if the tiny state of Vermont has the same contractual bargaining power, regulatory power, medical training funding power, and any other relevant power as the federal government has.

Thorpe recently made big news with a report that deconstructed the Sanders plan as little more than witchcraft in its cost savings and costs overall and in its costs to this or that entity—the federal government, the states, etc.  But in a January 29 response published at Huffington Post, two healthcare economists, David Himmelstein and Steffie Woolhandler—both with credentials at least as impressive as Thorpe’s—deconstructed the Thorpe deconstruction as, well, odd in light of certain facts.  Including several that Thorpe earlier had used.

Not to worry.  Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would.  (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.)  It is an issue that this week has become red hot now that Trump is the probable Republican nominee.  And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump.  According to the NYT, the Clinton campaign itself now shares our concern.

The Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized Thorpe’s headline grabber thusly:**

Sanders estimates a middle-class family of four would pay an annual premium of $466 under his plan, with no deductible or co-pays. Less affluent households would pay less than that, or nothing at all.

But for at least 72 percent of households enrolled in Medicaid — in which someone is working — the costs of Sanders’s plan would exceed the benefits, according to an analysis by Kenneth Thorpe, a public-health expert at Emory University.

That figure includes 5.7 million households, or 14.5 million people — among them, 4.2 million Hispanic recipients and 2.5 million black recipients. The requirements for eligibility for Medicaid vary widely by state, so that group includes some households living in poverty as well as some that are modestly better off.

How? Well:

“The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren’t going to receive really any financial benefits,” said Thorpe, a former Clinton administration health official.

Many lower-income people are already insured or eligible for insurance under Medicaid, at least in the states that expanded the program under President Obama’s health-care reform. Many Medicaid beneficiaries also work, and those workers’ wages would likely decline due to the additional 6.2 percent payroll tax the proposal would levy on their employers.

The lengthy blog post is titled “Study: Bernie Sanders’s health plan is actually kind of a train wreck for the poor.”

That, presumably, is because of course Sanders could not, or at least would not, tweak the plan to remove the payroll tax for people who qualify for Medicaid under current federal law.  Because although the ACA is a very complex and very lengthy statute that took a year of drafting and amending to finalize, Sanders surely has thought of every possible issue and when that one came up he simply said, “Too bad.”

Sort of like Hillary Clinton, who regularly professes plans to build on Obamacare and move toward universal coverage for all—$10,000 deductibles?  No prob.—but who never hints at what her building plans are, and, curiously, is never asked.  Not by the likes of Thorpe or Krugman.  And not by the likes of anyone else I know of.

But she’s definitely working on a plan for that move-toward-universal-coverage thing, and, as with the release of the transcripts of her highly-compensated speeches to large finance-industry and other big-corporate players, she’ll give us a hint about how she plans to do that the very minute after the Republican presidential candidates outline their plans to move toward universal healthcare coverage.

Or instead, she could refer us to Thorpe.  Since he will again be a healthcare official in the Clinton administration.

*This entire paragraph was inadvertently deleted before the post was published. So now it’s back.  And the post makes sense!

____

UPDATE:  Reader J.Goodwin and I just exchanged these comments in the Comments thread:

J.Goodwin

March 1, 2016 6:08 pm

Is there a reason we should anticipate that it would be significantly different than the Health Security Act?

I.e. larger federal subsidies and a stronger employer mandate than the ACA?

 

Me

March 1, 2016 6:54 pm

I think it wouldn’t be anything at all, J.Goodwin. I think it’s outrageous of her to keep saying generically that she wants to build on the ACA without saying what she wants to do, yet criticize Sanders for his plan.

And I think it’s outrageous of the Hillary shillary economists brigade–Thorpe, but Krugman too, and probably others–for not mentioning that she has said nothing at all about what she has in mind, yet keeps saying she has, well, something in mind.

Then again, I don’t know why Sanders hasn’t pointed out that she’s taking a page out of the Republican playbook: just keep saying you plan to do something about the uninsured; just don’t say what that is.

Added 3/1 at 6:59 p.m.

_____

**Sentence edited and separated from preceding paragraph, to make sense. 3/2 at 2:19 p.m.

Gotta tell ya, Microsoft updated its Office 365 last week, and since then I’ve had nothing but big problems trying to write anything using Word.  With this post, two main parts were just missing from the post by the time I pasted it into AB’s new-post function. There was the mysteriously deleted paragraph that I reinserted last night, and there was a sentence between this now-edited one and the preceding paragraph, and they were two separate paragraphs, as they are now.

This post is not the only thing that the Word update has made very hard for me to write.  I am not happy about this, and do not look forward to calling Microsoft and having them FIX THE SETTINGS SO THAT I CAN USE WORD AGAIN.

Okay. Rant done.  Now back to trashing pols and economists.

I’m very grateful to Yves Smith for reposting this post at Naked Capitalism this morning, and I’ve now posted the following comment to the repost there:

POST SHOULD READ:

“… Not to worry.  Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would.  (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.)  It is an issue that this week has become red hot now that Trump is the probable Republican nominee.  And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump.  According to the NYT, the Clinton campaign itself now shares our concern.

“The Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized Thorpe’s headline grabber thusly:”

I just corrected the original post at Angry Bear and added a note at the bottom raging about Microsoft’s update to Office 365 that has caused big, big problems for me in drafting anything in Word.  In this case it mysteriously deleted an entire paragraph, which I reinserted last night, and also a sentence that had prefaced the one mentioning Ehrenfreund’s blog post and making clear that his post was about Thorpe’s latest attempt to take down Sanders’ healthcare plan, not about the Clinton campaign’s concerns about the strength of Trump’s candidacy and problems with her own.

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