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

Social Justice: Debt, Solidarity or Care?

by Peter Dorman (originally published at Econospeak)

Social Justice: Debt, Solidarity or Care?

Mozi: scholar and activist
 

How do we think about the obligation of social justice?  The dominant American political culture is based on individualist values: you have a right to do whatever you want, and the main problem is how to prevent you and other rights-bearing individuals from getting in each other’s way.  Without extra considerations, social justice in such a universe is a matter of taste and inclination, which is to say charity.  You offer help to others when you feel like it.

But there is an important extra consideration, debt: our freedom in an individualist world is constrained by obligations to repay the debts we have incurred.  This may result from a purely financial transaction like a mortgage or a student loan, but we also recognize what might be called social or moral debts, where one person has benefitted at the expense of someone else and therefore owes compensation in return.  This might not be recognized in a court of law, but it makes an ethical claim that can cause people to feel a sense of obligation.

The you-owe-it-to-them argument is used on behalf of coffee-growers, for instance.  Those on the sipping end of the industry, when they hear stories about how hard these growers work and how little they get for it, rightfully feel obligated to go out of their way to make amends.  They buy fair-traded beans and patronize cafes that share, or seem to share, these same values.  If you benefit by drinking, you are indebted.

Ta-Nehisi Coates, who I discussed in an earlier post, strongly pushes this framing of racial justice in America.  White people benefitted from centuries of un- and underpaid black labor, and from racial domination in general, and in this way they have accrued an immense debt.  Justice will not be achieved until the debt is acknowledged and paid back.

In fact, the “white privilege” language used to analyze racial inequality implicitly draws on this same notion of debt obligation.  Inequalities are assumed to all take the form of zero-sum relationships, where some (whites) have more because others (blacks) have less.  Thus the difference in outcomes can be understood as a debt that the better-off owe to the worse-off.  It’s politically effective insofar as it appeals to this deep theme in our culture, justice as the retiring of debts.

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Trump’s Inadequate Response to Hurricane Maria and the Posse Comitatus Act

by ProGrowthLiberal  (originally published at Econospeak)

Trump’s Inadequate Response to Hurricane Maria and the Posse Comitatus Act

Credit to Matthew Yglesias for his discussion of the incompetence of Donald Trump as well as the excuses for it from his defenders including:

Officials have also cited the Posse Comitatus Act as a complicating factor that helps explain why Trump was so much slower to dispatch assistance to Puerto Rico than the Obama administration was to send help to Haiti after it was devastated by an earthquake in 2010.

Except this 1878 Congressional Act does not bar the President from calling in the military as Michael Spak and Donald Spak note:

Before 1878, it was common for the United States Army to enforce civilian laws. In frontier territories, the army was often the only source of law enforcement, supplemented by occasional U.S. Marshals. Over time, marshals and county sheriffs regularly called upon the army to assist in enforcing the laws… By the time of the 1876 presidential election, Southern states were reconstituted. Many Southerners opposed both Grant, the outgoing Republican president, and Rutherford B. Hayes, the Republican presidential candidate. Federal troops actively assisted U.S. Marshals in patrolling and monitoring polling places in the South, claiming to be enforcing the federal election laws and preventing former Confederate officers from voting (as was the law at that time). Following bitter election contests in four Southern states, Hayes won the presidency by one electoral vote. Many felt that the federal troops, which supported Hayes and the Reconstructionist Republican candidates for Congress, intimidated Southerners who would have voted for Samuel Tilden, the Democratic candidate. The resulting Democratic Congress was at odds with the Republican President Hayes. In response to what was seen as undue influence over the 1876 election, Congress outlawed the practice of posse comitatus by enacting the Posse Comitatus Act (PCA) (as 20 Stat. 152) as a rider to the Army Appropriation Act for 1880. The act stated: “Whoever, except in cases and under circumstances expressly authorized by the Constitution or Act of Congress, willfully uses any part of the Army or the Air Force as a posse comitatus or otherwise to execute the laws shall be fined under this title or imprisoned not more than two years, or both.” Congressional debates indicate that the PCA was intended to stop army troops from answering the call of a marshal to perform direct law enforcement duties and aid in execution of the law. Further legislative history indicates that the more immediate objective was to put an end to the use of federal troops to police elections in ex-Confederate states where civil power had been reestablished.

In other words, this PCA is an outdated piece of legislation. But there’s more:

Others suggest the act is obsolete and should be repealed because numerous legislative exemptions have eroded the underlying policy and left the PCA a hollow shell. Others insist that although there are many exceptions, the act is essential to bar misuse of the military by civilian authorities and to prevent a military dictatorship from assuming control of the nation through use of the armed forces. Still others argue that the act means only that federal military forces may not be commandeered by civilian authorities for use in active and direct law enforcement as a posse comitatus. If local authorities need military personnel for specialized operations enforcing state laws, it is argued, they may call on the state governor for the assistance of the state National Guard.

There are many exceptions and no one would think giving aid in a time of need endangers either military dictatorship or the misuse of the military by civilian authorities. This pathetic excuse from Team Trump is just another example of how he turns everything into a culture war.

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Oxfam America President Abby Maxman Questions Slow Aid Response to Puerto Rico

Oxfam is a global organization working to end poverty. Its goal is to help people build better futures for themselves, hold those responsible accountable for the failures of people in power and/or government, and work in disaster areas. Their mission as stated is: “ To create lasting solutions to poverty, hunger, and social injustice.”

Earlier in the week Oxfam acknowledged the ongoing tragedy in Puerto Rico. Oxfam President Abby Maxman said:

“Oxfam has monitored the response in Puerto Rico closely, and we are outraged at the slow and inadequate response the US Government has mounted in Puerto Rico. Clean water, food, fuel, electricity, and health care are in desperately short supply and quickly dwindling, and we are hearing excuses and criticism from the administration instead of a cohesive and compassionate response. The US has more than enough resources to mobilize an emergency response; but, it has failed to do so in a swift and robust manner. Oxfam rarely responds to humanitarian emergencies in the US and other wealthy countries; but as the situation in Puerto Rico worsens and the federal government’s response continues to falter, Oxfam has decided to step in to lend our expertise in dealing with some of the world’s most catastrophic disasters.”

And still what Trump thinks about during a visit to the island is the debt owed Wall Street. “They owe a lot of money to your friends on Wall Street and we’re going to have to wipe that out. You’re going to say goodbye to that, I don’t know if it’s Goldman Sachs but whoever it is you can wave goodbye to that”. Trump was and is holding Puerto Rico hostage to getting aid on behalf of Wall Street.

Abby Maxman continues:

“Oxfam will join forces with Puerto Rican leaders to appeal to Congress and other federal agencies in Washington to dedicate resources to the response and remove barriers that are keeping aid out, and to commit to long-term support to help Puerto Rico build back better. We’ll also engage policy makers about the roles inequality and climate change are playing.

In addition, Oxfam has sent a team to San Juan to assess a targeted and effective response. We are currently determining how best this response could benefit from our expertise, such as meeting the needs of rural communities who face increasing risks of disease like cholera without clean water, providing shelter and meeting other immediate needs.”

Where are our Congresspersons and Senators? The population of Puerto Rico are US Citizens. I would urge people to write your representatives and senators pushing them to pressure the President to move quicker and forget the banking and financial sector Main Street bailed out. If this were a white population, no one would stand for this type of treatment.

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Jon Chait and Alex Pareene

Lifted from Robert’s Stochastic Thoughts:

Jon Chait and Alex Pareene

I have a Jon Chait problem. I generally agree with him on most issues. I find him very provocative. I am very sure that no one cares about my opinion about Chait’s latest post. That includes me. I don’t want to waste time thinking about the exactly how far I agree with him. But here I am.

I also have a vaguely favorable view of Alex Pareene, but don’t read him much. I was very entertained by his mild mannered amused Phillipic on Chait “You Are Jonathan Chait’s Enemy”.

There is one marginally interesting sub-topic. It appears that Pareene and Chait can’t both be right, but I am confident they are.

Pareene wrote “I say “you” because his conception of the left almost certainly includes you. … He means basically anyone to the left of Bill Clinton in 1996. ” Chait wrote ” (I allegedly oppose “basically anyone to the left of Bill Clinton in 1996,” which is odd, because I was to the left of Bill Clinton in 1996, and still am.)”

I see no contradiction. I think Chait was to the left of Clinton in 1996 and also that he considers anyone who goes out of her way to note that she is to the left of Clinton’s positions as of 1996 to be a dangerous lefty. So the “basically” is a vague hint at “who is to the left of Bill Clinton in 1996 and says so even when not accused of being as far right as Bill Clinton in 1996”.

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How I Came To No Longer Be A Kaldorian Economist

How I Came To No Longer Be A Kaldorian Economist

Yes, for a period of time, according to some sources, I was a member of the “Kaldorian” school of Post Keynesian  economic thought, although I had not previously thought of myself as such, indeed, had been unaware that there even was such a school of economic thought.  But now, according to such sources, I am no longer a member of such a school.  Indeed, it is not clear that there even is such a school, if there ever was.  This is a tale of the ongoing tangle of schools of Post Keynesian economics, as well as how Wikipedia operates, and more broadly the history of economic thought.

I note that while it lasted, this matter was taken at least somewhat seriously.  So, a few years ago I was at a conference and walked into a plenary address that was being given by Tyler Cowen of George Mason.  There was a pretty large crowd, but Tyler interrupted his talk when I came in to note, “I see that Barkley Rosser has entered the room, so I had better be careful what I say about Nicholas Kaldor.”  Indeed, ironically, he was just about to say something about Kaldor, and I must say that I had no serious disagreement with his remarks, although maybe he cleaned up his act, given my presence as the representative of “the Kaldorian School,” if not the late Lord Kaldor’s personal representative.  That was then, but this is now, and I am nothing, nothing, I tell you!

Anyway, as I said, I had not been aware of such a school, much less that I was supposedly a part of it, but then in 2014, my friend Marc Lavoie published his excellent Post-Keynesian Economics: New Foundations.  In it he provided set of supposed schools of Post Keynesian economic thought.  I note that there has long been a history of arguing and battling and generally warring among various strands of Post Keynesian thought, with some expelling others, although not necessarily totally.  Joan Robinson coined the term back in the 1950s, and for a while Paul Samuelson was using the term for an eclectic bunch of Keynesian economists of the early 1960s.  But the term became narrower as the 1960s moved on and journals were started, and battle lines were drawn.  Going into the 1980s, and focused on Post-Keynesian summer schools being held in Trieste, Italy, there was a sharp split between Sraffian neo-Ricardians based in Italy, led by the late Pierangelo Garegnani, and American Post Keynesians who focused on uncertainty and the role of money led by Paul Davidson.  In between them was a more British and Australian based group, some of whom were thought to be followers of Michal Kalecki, and probably Joan Robinson, some of whom made efforts to overcome the sharp split between these other two.  The most important leader of that group was probably Geoff Harcourt, he of the “different horses for different courses,” how open-minded of him.  Anyway, those summer schools fell apart, with each of the more sharply opposed groups not attending the seminars of the other, and after this the Americans all but expelling the Italian Sraffian-neo-Ricardians from Post Keynesianism, even if they were still counted by others.

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Worse Than The Usual Hypocrisy: Trump, Puerto Rico, And The Jones Act

Worse Than The Usual Hypocrisy: Trump, Puerto Rico, And The Jones Act

The Jones Act was passed 97 years ago to protect US shipping within the US from foreign-made ships.  I doubt I ever would have supported such an act, but at least back then there were plenty of US-made ships to fulfill the demand. Despite the Jones Act, the US shipping industry has collapsed in the last century so that the number of such ships is far below demand in normal circumstances, so that intra-US shipping costs are far higher than those outside the US.  Puerto Rico was covered by he Jones Act and remains so.

After Hurricanes Harvey and Irma the Jones Act was temporarily suspended for Texas, Louisiana, and Florida on orders of President Trump, going through the Department of Homeland Security.  The Jones Act is not being suspended for Puerto Rico in the wake of Hurrican Maria, although damage to PR seems to be far greater than what happened on the mainland during Harvey and Irma (with those areas also accessible to supplies and aid by ground transportation, not relying nearly as much on ocean shipping).  The supposed reason is that PR’s ports are damaged, which is certainly the case, but even if suspending the Jones Act will only slightly speed up deliveries, it will certainly reduce the costs of supplies, allowing cheaper natural gas from Pennsylvania in place of more expensive oil from Venezuela, for example.

Which brings us to the worse then usual hypocrisy on the part of our president.  While he has been all worked up over football players kneeling and moved to get aid to Texas and Florida as rapidly as possible while expressing lots of sympathetic sentiments for the victims in those states, his initial reaction to Hurricane Maria, after several days delay, was to talk about how bad their infrastructure was before the hurricane and how they have a massive debt situation.  Of course, if he were really concerned about helping them, he could suspend their debt, but at a minimum, given that he is aware that they are poor and debt ridden, on top of having 80% of their crops destroyed and all their power out among other problems, he is insisting that they pay top dollar on supplies brought in by water, where almost all supplies will come.  His refusal to suspend the Jones Act for Puerto Rico after having done so for mainland US territories is far worse than the usual hypocrisy from any president, even this far more hypocritical than pretty much all others one.

Barkley Rosser

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Healthcare Insurance History

Last 21 Days ACA Healthcare History

On September 7th and shortly after Pelosi and Schumer decided to be nonpartisan and help Republicans who still had an ounce of decency to pass hurricane Harvey aid and set a new National Debt Limit, I wrote about the inherent dangers of being so magnanimous. Lets face it, during the Obama 8 years, Republicans made it a vow even before he took office to oppose everything coming from the other side of the aisle even refusing to participate in committee meetings. The ACA passed by Democrat votes only.

The danger with being nonpartisan with Republicans and passing good things which are beneficial to the constituency is you allow Republicans afterwards to concentrate on issues which will not favor the constituency or Democrats. Passing hurricane aid and a new debt limit did allow Republicans to get back to the more partisan effort of defunding the ACA and more money for the already rich through tax reform. The two are interlinked. The repeal passes funding for tax reform.

Angry Bear wrote on September 7 about the danger inherent in helping Repubs, wrote again on September 13 about Republicans being confident on defunding the ACA and its impact, again on September 15 about trusting Trump and Republicans with a hand-shake-deal, and last week on September 21 when Kimmel called Cassidy out as a liar and Krugman, other columnists, and blogs finally woke up to the impending danger of the Graham – Cassidy Bill.

Angry Bear called it early in the month on Republican treachery to defund the ACA. The vote will be this week before the 30th. I do not trust McCain. Hopefully, I am wrong on McCain.

Older Healthcare Insurance History

I thought this comment by a blogger was interesting to read as we wait for the Senate to take up the Graham – Cassidy Healthcare Insurance Bill which will defund the ACA if passed this week. I wander the blogosphere and I run into some interesting people from time to time. This particular commenter had a wealth of knowledge on healthcare insurance going back a ways. I have captured the commenter’s words to present them to Angry Bear. Hope you enjoy them.

“When, early in our adventures in managed care, I was marketing for clients like Sisters of Providence, who were attempting to set up their own managed care, non-profit PPO (which ultimately they did not see to completion), in the late 1980s, health care insurance was still non profit.

At that time ‘commercial insurers’ did not refer to health insurers at all. Commercial insurers provided for-profit RISK insurance — which health ‘insurance’ isn’t (and can’t be without defeating its original purpose; to help more people afford care while helping providers maintain expensive facilities and services). Health insurance was created as an additional way, beyond taxes and charity, to socialize increasing health care costs — to assure the healthy, self-interestedly, that the resources to meet their inevitable health care needs would be there when needed. And to ensure hospitals would have a revenue stream to help them maintain the increasingly sophisticated and varied resources to meet the modern care needs of their communities.

Although the first actual, modern health insurance program is credited to a hospital in Texas in the 1920 which contracted with school district employees to provide services to for a monthly premium (it was non-profit); proto-insurance schemes based on the same principle — asking healthy EMPLOYED people to contribute a modest monthly amount to cover care if and when they were injured or ill — were used long before. The Sisters of Providence, for instance, established the first hospitals in my part of the world, the Pacific Northwest, in the middle of the 19th century, offered loggers care for their not-infrequent injuries for a payment of $1 a month (this I understand having cut down trees while gaffing up them). The connection between health insurance and employment did not, as many people believe, just arise as a government idea with favorable WWII tax policies. It arose from a much older recognition of the reality that injury and illness compromise patients’ ability to work, earn and pay — and the recognition the employed, especially those in the more commonly dangerous occupations, had both the income with which to make regular payments and an incentive to make arrangements to provide for themselves, as eventual patients, with care when needed despite the economic vulnerability illness caused — while providing providers with resources that helped maintain facilities and services and workforce to provide that care.

Until the advent of ‘managed care,’ which deregulated the health insurance market in ways giving insurers a greater ability to limit who was covered and what was covered — to their own benefit (but not necessarily to the benefit of our social need for broadly available health care, or increasingly, premium payers’ needs either). In fact, commercial insurers avoided the health insurance market like the plague.

It was understood by everyone that there was no way to make a profit in it While still meeting policy holders actual needs.

Health insurance was created solely as a way to socialize costs for health care consumers.

It did and does not and can not work like a car, flood, or even life insurance where insurers work out, and profit from, fairly reliable actuarial probabilities about what percentage of policy holders are likely to ever make a claim, the likely length of time the average policy holder will be paying premiums before making a claim, and from those probabilities charge — and deny coverage — accordingly. People, the overwhelming majority of policy holders, will depend on health care coverage again and again and again — for services large and small — with more and more needs, and more serious needs, accumulating over time.

Inviting commercial insurers into the market as we did in the late 70s and 1980s, with managed care, was a big mistake.

But many countries, Germany, Switzerland, France, provide excellent, cost-effective universal systems that are not single payer — they rely in different ways on a networks of non-profit and public insurance. Although some countries allow for-profit insurers who provide some limited extra coverage, they are very limited.

I don’t think we should throw their examples out while looking for the best way for the US to provide universal coverage.

Especially considering how many Americans do receive coverage through insurance at work, and are happy with that coverage, and our long history with that method of socialization.”

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A thought for Sunday: the most important issue in the 2016 election was…

A thought for Sunday: the most important issue in the 2016 election was . . .

This is a post I’ve been meaning to write for several months. For a while after the election last year, there was a debate about whether the “economic anxiety” in the (white) working class was the most important factor vs. was it simply a matter of racism. The consensus has nearly settled on the narrative that racism was decisive, to the point where “economic anxiety” has become a taunt, and some who embrace identity politics actively disparage progressive economic issues.

I’m here to show you data that – in part – disputes that consensus. What was the most important issue in the 2016 presidential election?  The below data on that issue all comes from the Voter Study Group, from its survey published several months ago: “Insights from the 2016 Voter survey.”

In the below graphs, the potency of various issues are examined in terms of how well they lined up on a liberal/conservative or favorable/unfavorable axis, but for simplicity’s sake it is pretty clear that they correlate with a vote for Clinton (left) or Trump (right).  The more vertical the line, the more decisive the factor, whereas a horizontal line means that the factor made essentially no difference in whether a vote was for one candidate or the other.  the 2016 results are in red, vs. the 2012 results in gray. What I’ve done is to delete the names of the nine factors they tested, so you won’t be swayed by any pre-existing opinion you might have had about the factor.  Here they are:
I’ll give away one finding right away.  The most decisive factor, shown at the right of the lowermost column, is party affiliation. D’s voted for Clinton. R’s voted for Trump.
But after that, it’s pretty clear that the close runner-up for most decisive factor in how people voted is the issue at the left of the middle column, which was …
the economy!
That’s right. The single most decisive factor in the 2016 vote was how people felt about the economy.

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Ta-Nehisi Coates and the Limited Art of Interpretation

by Peter Dorman (originally published at Econospeak)

Ta-Nehisi Coates and the Limited Art of Interpretation

Among the least persuasive writers on contemporary politics, for me, is Ta-Nehisi Coates.  Mind you, I often agree with him, but only because I agreed with him before reading him.  If I go into a piece of his with a different perspective, nothing he says has an effect on me.

Now, if I were intellectually stubborn, the sort of person who rarely changes his mind, that would be a statement about me, not Coates.  In fact, I’m always changing my mind.  Nearly every day my views are shifting, sometimes only slightly, sometimes a lot.  When I go back and read what I wrote several years ago, my first instinct is to grab an editor’s pen.  Maybe I’m too susceptible to persuasion.

But not by Coates.  The thing is, he seldom makes arguments in the sense I understand that term.  There isn’t extended reasoning through assumptions and implications or careful sifting through evidence to see which hypotheses are supported or disconfirmed.  No, he offers an articulate, finely honed expression of his worldview, and that’s it.  He is obviously a man of vast talents, but he uses them the same way much less refined thinkers simply bloviate.

But that raises the question, why is he so influential?  Why does he reach so many people?  What’s his secret?

No doubt there are multiple aspects to this, but here’s one that just dawned on me.  Those who respond to Coates are not looking for argumentation—they’re looking for interpretation.

The demand for someone like Coates reflects the broad influence that what might be called interpretivism has had on American political culture.  This current emerged a few decades ago from literature, cultural studies and related academic home ports.  Its method was an application of the interpretive act of criticism.  A critic “reads”, which is to say interprets, a work of art or some other cultural product, and readers gravitate toward critics whose interpretations provide a sense of heightened awareness or insight into the object of criticism.  There’s nothing wrong with this.  I read criticism all the time to deepen my engagement with music, art, film and fiction.

But criticism jumped channel and entered the political realm.  Now events like elections, wars, ecological crises and economic disruptions are interpreted according to the same standards developed for portraits and poetry.  And maybe there is good in that too, except that theories about why social, economic or political events occur are subject to analytical support or disconfirmation in a way that works of art are not.  How should we hear The Rite of Spring in the twenty-first century?  Colonial or pre-postcolonial?  Racist or deracializing?  These are meaningful questions, and thoughtful criticism can help us explore them more deeply, but neither evidence nor reasoning can resolve them.  If you want to know why the US election last year turned out the way it did, however, reasoning and evidence are the way to go.

Coates is an interpreter.  His latest piece in the Atlantic, The First White President, reads the election the way a film critic would read a film.  There are references to factual events, like quotes taken from the campaign trail, but they serve the same function that references to camera angles serve for a critic interpreting the latest from Darren Aronofsky.  In the end, Coates wants to convey his sense of what the election means, that it is a reflection of the deep racism that was, is and will continue to be the core truth of America.  If anything was different, it was that eight years of a black president ratcheted up the racism and allowed a sociopathic white extremist to prevail.  Post-election concern for the well-being of the white working class by white pundits is itself a further reflection of this truth, a turning away from the ugly reality of bigotry. This is a reading of the election as a cultural artifact.

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“We Made Certain they knew that”


I was always very candid with my patients. They want to know that you are working for them, not someone else. We made certain they knew that.” Tom Price, MD – Secretary of HHS

Republicans, the Trump administration, led by Graham and Cassidy are moving forward to defund and cripple the ACA bringing millions of people back to when states decided who could have a smidgen of healthcare and who could not. This comment by Dr. and Secretary of Health Tom Price in 2016 is priceless and is the opposite of what he said then. Both he and his fellow Republicans are deliberately misleading constituents and his patients about their intentions with the ACA. Tom Price is more concerned with the politics of the ACA rather than his constituents well being. Recently, commentator/comedian Jimmy Kimmel brought this to the forefront in his monologue about Senator Cassidy who was a guest on Jimmy’s show and made comments about the most recent Republican Healthcare bill.

The same as other recent healthcare bills by Republican, the Graham – Cassidy bill will return healthcare back to pre-2008 when states could deny able-bodied people healthcare, had limited funding, could allow denial of insurance based upon pre-existing conditions, eliminate premium subsidies, not subsidize out of pocket expenses, cap healthcare, etc. These are all the things Senators Graham and Cassidy claim will still be covered in their state block grant bill for healthcare. Except, there is no mandate by Washington forcing states to have the same as what is offered today. It is all a state rights gambit with some states being generous and many not being so generous.

Kimmel: “I don’t know what happened to Bill Cassidy, but when he was on this publicity tour, he listed his demands for a health-care bill very clearly. These were his words. He said he wants coverage for all, no discrimination based on preexisting conditions, lower premiums for middle-class families and no lifetime caps. Guess what? The new bill does none of those things.”

Cassidy “just lied right to my face” according to Kimmel.

Graham: “He didn’t give (Cassidy) the courtesy of hearing his side of the story. He went on national TV and called this man — who has worked for the underprivileged and health care all of his life — a liar, (Graham referring to Cassidy), who practiced medicine before he entered politics. And I think that’s inappropriate.

I don’t like the idea of calling this good man a liar without ever talking to him first. That really says more about Mr. Kimmel then it does Dr. Cassidy,'”

The Cassidy-Graham bill would do away with Obamacare’s Medicaid expansion, subsidies for private insurance, eliminate the requirement that Americans have insurance under the Affordable Care Act, and reduce payments to insurers for out-of-pocket costs. In their place, it would offer states a block grant they could use to spend on health care as they saw fit. The block grant would be 17% less than what total federal spending would be in 2026 meaning states would struggle to cover the same number of people.

There is nothing to talk about with Mr. Cassidy or even Mr. Graham both of who are indignant at being called out by Kimmel.

There will be resources in your state; but, those resources may not be of the same value as under the ACA. The Graham – Cassidy plan will favor states which did not expand Medicaid or have not had higher premium/csr subsidies. It is obvious what Graham and Cassidy are doing. Punish states which expanded Medicaid and reward states which did not expand Medicaid. California would lose $27 billion in funding, New York would lose $18 billion in funding while Texas would be rewarded with $8 billion in funding.

In a letter to both Senators Graham and Schumer, this is what the America’s Health Insurance Plans (Modern Healthcare, September 20, 2017, Matthew Weinstock), the industry’s “main lobby group” had to say on the Graham-Cassidy legislation. The Graham – Cassidy healthcare plan fails to meet five crucial tests:

• stabilizing the insurance market;
• ensuring Medicaid reforms meet beneficiaries’ needs;
• guaranteed access to coverage for all Americans, including those with pre-existing conditions;
• time for the industry to prepare for any changes to existing law;
• and getting rid of health insurance and excise taxes.

The last item called out by the America Health Insurance Plans is the Cadillac tax, which was meant to tax excessive executive healthcare plans and also force “consumers to have more skin in the game” with higher co-pays and deductibles. People would then decide if they really needed to go to the doctor or not avoiding cosmetic or unneeded doctor visits. The attempt on the later is misguided as the commercial healthcare industry has a much larger impact on rising healthcare costs than consumer doctor visits. The emphasis needs to be on controlling the commercial healthcare industry and how healthcare serves are delivered to patients with better outcomes. Most of the burden of controlling healthcare costs has been shifted to the consumer through this tax by Congress and for-profit healthcare insurance companies.

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