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

What If?

Using crime and public safety as a political issue in an election year, New Mexico Governor Susana Martinez: “’I don’t believe that police officers should be under this constant threat of lawsuits that will often cause them to pause, if they’re following their training, there should be something that protects them.’

The bill would protect cops and citizens from the ‘massive payouts that taxpayers are giving crooks and thieves who are hurt or injured by police officers who are doing their job,’”

Today, the burden of proof is on the injured or the dead’s relatives to prove the police officer was negligent giving police officer’s one more level of immunity to lawsuit and convictions. Governor’s Martinez comment about police following their training, is a statement not recognizing the 2014 Department of Justice finding of a pattern and practice of excessive force being used by the Albuquerque police force against those who are a minor threat and the mentally ill. It is obvious they have not been doing so.

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Why Inequality Predicts Homicide Rates Better Than Any Other Variable

By Maia Szalavitz via Naked Capitalism and cross posted from Evonomics; originally co-published at the Guardian and Economic Hardship Reporting Project.

Why Inequality Predicts Homicide Rates Better Than Any Other Variable

– research suggests that inequality raises the stakes of fights for status among men.

The connection is so strong that, according to the World Bank, a simple measure of inequality predicts about half of the variance in murder rates between American states and between countries around the world. When inequality is high and strips large numbers of men of the usual markers of status – like a good job and the ability to support a family – matters of respect and disrespect loom disproportionately.

Inequality predicts homicide rates “better than any other variable”, says Martin Daly, professor emeritus of psychology and neuroscience at McMaster University in Ontario and author of Killing the Competition: Economic Inequality and Homicide.

This includes factors like rates of gun ownership (which also rise when inequality does) and cultural traits like placing more emphasis on “honor” (this, too, turns out to be linked with inequality). “About 60 [academic] papers show that a very common result of greater inequality is more violence, usually measured by homicide rates,” says Richard Wilkinson, author of The Spirit Level and co-founder of the Equality Trust.

According to the FBI, just over half of murders in which the precipitating circumstances were known were set off by what is called the “other argument” – not a robbery, a love triangle, drugs, domestic violence or money, but simply the sense that someone had been dissed.

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The Language of a Dictatorship

Worth a discussion at the least:

By Masha Gessen Gessen is the author of nine books, including “The Future Is History: How Totalitarianism Reclaimed Russia.

The New Yorker  23 December 17

Donald Trump has scored a legislative victory with staggering costs. The price of the tax bill has to be measured not only in the loss American society will face in the increase in inequality, in the impact on public health, and the growth of the deficit, but also in the damage to political culture inflicted by the spectacle of one powerful man after another telling lies of various sorts.

All along there has been Trump claiming that the bill was a “gift” to the middle class. That this assertion appears to have no basis in fact has not affected the President’s statements. The President’s Treasury Secretary, Steven Mnuchin, maintained that his department had run the numbers and had shown that the tax bill would pay for itself. It appears that he lied, not so much about the result of the Treasury’s study but about the existence of the study itself: the Times reported last month that the analysis had not been done.

This was a Trumpian lie, which is distinct from other kinds of political lying. It might be called a power lie: its purpose is not to convince the audience of something that isn’t true but to demonstrate the power of the speaker. Trump tweets blatant lies, repeatedly, to show that he can—and that by virtue of his bully pulpit, his words, however absurd, always have consequences. Mnuchin showed that he can do the same thing, and that he has more power than the opposition.

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December 14, 2012

Today is the fifth anniversary of the slaughter of the innocents at Sandy Hook Elementary School. 20 children between the ages of 6 and seven years old were shot dead as well as six adults who tried to protect them. All because this country’s politicians believes there is nothing which can be done to prevent this from happening and are in the pockets of the NRA.

Not a good day in the history of the United States. And still when these preventable tragedies happen, it is never a good time to discuss why they happened and what we can do to prevent them.

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A Race To Suppress Academic Freedom?

A Race To Suppress Academic Freedom?

The race is between the two nations competing for global dominance, the US and China.  This post is triggered by an unnamed editorial in today’s Washington Post (probably authored by Fred Hiatt) criticizing China for imposing ideological limits on Chinese universities.  Since the recent party congress, 40 universities have set up centers for studyiing Xi Jinping Thought.  14 universities have come under attack for being “ideologically weak.”  Joint operations between US and Chinese universities must appoint a party secretary as a vice chancellor.  There have also been restrictions on the internet and other matters.  Without doubt, putting restrictions on higher education will make it harder for China to move into a position of full global leadership.

Of course, the WaPo editorial did not notice trends in US academia that also may lead to suppression of research activity and threaten the current leading position of US higher ed in the world, although there have been reports and columns commenting on these trends.  Among them are the push for political correctness coming from students, but probably more important is the assault on higher ed coming from the Trump administration.  This is seen in the attack on tax breaks for students but also the push to distort funding for research on certain topics. While not directly on higher ed, probably the most damaging has been the attack on science in government agencies, especially the EPA, with such nonsense as banning scientists who have received funding from the agencies on their scientific advisory boards, even as those receiving funding from corporations at odds with goals of these agencies are allowed to be on those boards.

Really, it looks that the two most powerful nations on the planet are having a race to suppress academic freedom and suppress the free development of knowledge in this world at a time when we need more of that.

Barkley Rosser

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Freedom of Speech for Fascists? (An op-ed)

Freedom of Speech for Fascists?

I just finished reading the Chronicle of Higher Ed’s profile of Mark Bray, author of Antifa: The Anti-Fascist Handbook.  I don’t know how accurate it is as a portrayal of Bray and his ideas, but it seems like a sober, fair-minded overview of the debate over anti-fascist tactics and freedom of speech.

What the article doesn’t say, however, is that there are two very different bases for opposing public appearances by white supremacist and similar groups.  One is dangerously wrong, the other, which Bray presents, makes much more sense.

First the wrong approach, that groups should not be permitted to express themselves in public if they cause emotional distress to me or other people I care about.  You hear this one a lot: speech that I find demeaning is a form of violence, and there can’t be freedom for it.  There’s no difference between saying something horrible to me and punching me in the face.  No freedom for one, no freedom for the other.

This argument has its roots in a mindset that has become popular in much of the left, that the ultimate political goal is equal well-being for all, that well-being is essentially having a positive emotional state (or not being in a state of stress/despair/fear/etc.), and that actions should therefore be judged by the emotional response they engender, especially among marginalized groups.  It’s a deeply subjectivist conception of life and politics, one that puts feelings above “objective” conditions like economic status, access to social or institutional networks, risk of physical harm, or other measurable outcomes.  In fact, the primacy of subjective feelings is often asserted by denying the very possibility of “objective” anything.  (Objectivity is said to be a tool of knowledge/power to silence the oppressed.)

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Similar to “Alexander – Murray,” CMS Proposal Gives States Authority to Redefine ACA Minimum Benefits

I have been getting quite a few alerts on proposed changes happening behind the scenes with the ACA. I also found a couple of new places with some intelligent writers who have explained things in greater depth than what I knew. The CMS is proposing a rule allowing states greater authority in defining the ACA. This comes in addition to Trump’s EO. The new rule would give states greater flexibility in:

– Defining the ACA’s minimum essential benefits to increase affordability of coverage,

– a larger role in the certification of qualified health plans offered on the federal insurance exchange,

– and more leeway in setting medical loss ratios for individual-market plans.

If a state redefines the minimum benefits in the ACA, what we can expect to see is emerging trash plans or mini-plans, which were sold by McDonalds and other companies and are useless in many cases. Granting states a larger role in qualifying healthcare plans on the healthcare exchanges gets back to what I have pointed out before; states failed miserably in defining healthcare requirements and in providing healthcare to citizenry in many cases. Before the ACA, healthcare was the ER due to a lack of insured coverage. Patients were paying Chargemaster rates and often times paid little of the bill due to extremely high bills or low income.

Does the CMS proposal force states to adequately protect the vulnerable as called out in Section 1332 of the ACA? The same as the Senate Bill Alexander-Murray; without a change in Section 1332 of the ACA, underfunded states will have to provide similar coverage. Under Section 1332 States can:

“propose a change or eliminate almost all core ACA features, the individual and employer mandates, plan design including the Essential Health Benefits, and the subsidy basis and schedule. For a waiver to be allowed; however, the state must demonstrate that it will cover as many people, with coverage as affordable and comprehensive as the default structure and must not increase the deficit.”

In other words, the state can get a waiver to the ACA requirements as long as the state can show it covers the same numbers of people with just as affordable and comprehensive state coverage as the ACA while not increasing the deficit (to be redundant in stating such in all three cases). I do not see the CMS getting past this part of the ACA law and Alexander-Murray Republican-Democrat alliance proposes to change Section 1332 and the subsequent 2015 guidance.

In 2015, HHS had issued guidance on Section 1332 of the ACA stating a wavier:

Shall not disadvantage “vulnerable (low income, elderly, disabled), etc. residents.”

“Assessment of whether the proposal covers a comparable number of individuals also takes into account the effects across different groups of state residents, and, in particular, vulnerable residents, including low-income individuals, elderly individuals, and those with serious health issues or who have a greater risk of developing serious health issues. Reducing coverage for these types of vulnerable groups would cause a waiver application to fail this requirement, even if the waiver would provide coverage to a comparable number of residents overall.”

Shall not disadvantage residents by affordability.

(The CSR subsidies President Trump stopped with his Executive order will cause increased 2018 healthcare insurance premiums which will be picked up by premium subsidies for anyone who was eligible for a CSR subsidy. What makes it interesting is how the states apply this increase and their application of it could favorably impact all people who are on the healthcare exchanges [more on this later] ).

“Waivers are evaluated not only based on how they affect affordability on average, but also on how they affect the number of individuals with large health care spending burdens relative to their incomes. Increasing the number of state residents with large health care spending burdens would cause a waiver to fail the affordability requirement, even if the waiver would increase affordability for many other state residents. Assessment of whether the proposal meets the affordability requirement also takes into account the effects across different groups of state residents, and, in particular, vulnerable residents, including low-income individuals, elderly individuals, and those with serious health issues or who have a greater risk of developing serious health issues. Reducing affordability for these types of vulnerable groups would cause a waiver to fail this requirement, even if the waiver maintained affordability in the aggregate.”

The Alexander-Murray bill removes both guiding regulations and substitutes a much weaker one for affordability. Both the Alexander-Murray bill and the CMS proposals surrender control of providing healthcare to states with less federal funding and the same attitude of providing healthcare as experienced in the past. It leaves those who are uninsured or under insured vulnerable to state politics and includes the low-income individuals, elderly individuals, those with serious health issues, and those who have a greater risk of developing serious health issues now protected by the ACA.

While not Medicare-for-all, single payer, or something mimicking European healthcare; the ACA was still a huge step forward in comparison to what existed before it. It eliminated an attitude as expressed by Michigan State Senator Joseph Hune’s upon the passage of the Medicaid expansion; “I am sick to my stomach with the expansion of Medicaid.” An embarrassment of the same magnitude as Trump’s in his public comments and ignorance.

Alexander-Murray also calls for the HHS to issue guidance by providing examples of model state plans that meet the requirements for approval or what has been called cookie-cutter waivers. When asked by one blogger whether Alexander-Murray whether the amendment to Section 1332 effectively protects the vulnerable now protected in the ACA Timothy Jost had this to say:

“If administered by the Obama administration probably yes; if administered by the Trump administration, who knows? (sounds like a “no” to me) I think the intent of the provision is clear, that affordability not be decreased for vulnerable populations; but, the repeal of the guidance and of the procedural rule are to me, the most troubling parts of the bill.”

Given the attitude displayed by this administration now and in many state legislatures pre-ACA, it is hard to believe either would take an approach to protect the vulnerable over providing tax incentives to the 1% of the population making >$500,000 annually and their own re-election in 2018. It is pretty clear what the political priorities are today.

Both Michigan Senators Peters and Stabenow have come out in support of the Alexander-Murray bill repealing the 2015 HHS guidance including the detailed regulations governing waiver submission and assessment issued in 2012. An exception is being made for affordability if approved. I believe it is critical the ACA not be tampered with beyond taking it to the next level of healthcare which might be a form of European and a two tiered system. At this point in time with a lunatic as the president, I have no reason to support a legislature bent on cutting taxes for the 1% of the housholds making >$500,000 annually. That revenue to support such a tax cut will partially come from healthcare cuts.

I have emailed both Senators asking them to withdraw their support of the Alexander-Murray bill with no reply. It is time to go to pen and paper.

Does the Alexander-Murray bill adequately protect vulnerable groups?” Andrew Sprung, xpostfactoid blog

CMS to allow states to define essential health benefits” Harris Meyer , Shelby Livingston and Virgil Dickson; Modern Healthcare

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Cost Sharing Reductions and the Constitution

Republican Representatives who sued the Obama administration, Judge Rosemarry Collyer who decided they were right, Donald Trump and lawyers representing the Trump administration argue that the Department of Health and Human Services (HHS) can not compensate insurance companies for the expence of cost sharing reductions (CSRs) for people with income under 250% of the poverty line who purchase silver plans on ACA exchanges. The argument is that compensation for CSRs might be good policy, but the Constitution makes it clear that only Congress can choose such good policy.

I’m not an lawyer but I do not understand how anyone can make such an argument. Following Mark Joseph Stern, I quote from the ACA

(3) Methods for reducing cost-sharing
(A) In general
An issuer of a qualified health plan making reductions under this subsection shall notify the Secretary of such reductions and the Secretary shall make periodic and timely payments to the issuer equal to the value of the reductions.

(3) Payment
The Secretary shall pay to the issuer of a qualified health plan the amount necessary to reflect the increase in actuarial value of the plan required by reason of this subsection.

Tnat seems very clear to me. The whole case seems to rest on the fact that the ACA never says funds are appropriated for this purpose. My (non lawyer’s) understanding of precedent is that the Constitutional requirement that funds be disbursed only as appropriated by law by Congress has not been interpreted as requiring the approriate use of the appropriate “appropriated”.

Just to cut and paste a bit from Stern

When Congress passed the ACA, after all, it instructed HHS to make these payments. And in doing so, it effectively appropriated the necessary funds. As Georgetown University law professor David Super explained to my colleague Jordan Weissmann in 2015: “The Supreme Court has been very clear that you do not have to have a law that says ‘appropriations’ across the top. You just need a law directing that the money be spent.”

I don’t see an arguable case against paying the money.

Certainly, I don’t see how anyone can argue that the payments are not allowed and required without addressing the bits of the law which I cut and pasted.

It seems to me that to pretend they don’t exist is to lie by omission, and that lying to a judge is contempt of court, even if one isn’t under oath.

Lawyers help me. I sure wouldn’t want Trump administration lawyers to be disbarred.

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New Bill to Restore the ACA CSR

Senate Health Committee Chairman Lamar Alexander (R-TN) “Unless they are replaced with something else temporarily, there will be chaos in this country and millions of Americans will be hurt.”

Twelve Republicans and 12 Democrats signed on to the bill, which would continue ObamaCare’s insurer subsidies for two years and give states more flexibility to waive ObamaCare rules.

Senator Alexander is talking about the impact of Trump canceling the CSR which pays for deducible and co-pays directly to insurance companies for the insured between 138% and 250% FPL. And no, neither the CSR or the Risk Corridor Program bailouts for insurance companies. All of these are lies and misconceptions coming from the mouths of Republicans and the President.

Here is what will happen:

– Premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline.
– People with lower incomes who buy insurance on the exchanges get a tax credit (subsidy directly to the insurance company), so their costs remain stable as a share of their income. When premiums rise, those government subsidies rise as well.
– For people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits (subsidies offsetting premium increases to the insurance company).
– For those with incomes between 200 percent and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper. Some Gold plans may be cheaper than the Silver plans. 85 percent of people who bought Obamacare insurance got a tax credit.

Kaiser Family Foundation Vice president Larry Levitt: “The CBO analysis makes it clear. The ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face. Premiums would rise and the government would end up spending more in the end through tax credits that help people pay their premiums.”

The CBO report confirms earlier analyses, including this one by Kaiser and this one from the consulting firm Oliver Wyman suggested eliminating the cost-sharing payments could make policies cheaper for some individuals.

In the end, the elimination of the CSR may cause a cumulative deficit of $194 billion from 2017 through 2026, CBO and JCT estimate. While it may be chaotic in the beginning as people will not know what to do, premium subsidies paid directly to the insurance companies will pickup the difference, and the CBO assumes the chaotic conditions will level out over a period of 2-3 years.

Giving states more control over the ACA in areas such as the 10 essential benefits or cheaper than Bronze plans would spell the end for the ACA and we would be back to garbage healthcare polices.

If you are prone to do so, it would be helpful to write your sponsoring Senator and tell them you are opposed to this bill by Senator Alexander. The  Democratic co-sponsors include Sens. Jeanne Shaheen (D-NH), Joe Donnelly (D-IN), Amy Klobuchar (D-MN.), Heidi Heitkamp (D-ND), Al Franken (D-MN), Joe Manchin (D-WVA.), Tom Carper (D-DE.), Tammy Baldwin (D-WI.), Claire McCaskill (D-MS), and Maggie Hassan (D-NH).

There will be issues; but, the greater issue is with Republicans and states tampering with the ACA offerings.

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WA Senator Murray Thinks She has a Deal to Save the CSR

Sen. Lamar Alexander (R-TN), chairman of the Senate health committee, said he hopes to release a bill this week, in collaboration with Sen. Patty Murray (D-WA), the senior Democrat on the committee, to fund the cost-sharing reduction payments and give states more leeway on insurance rules.”

Not sure why Senator Murray feels the need to go down this avenue when the preceding Executive Order already wandered into greater flexibility for states, states rights, and who decides what. As has been explained by the CBO, Drum, other pundits, and myself; the loss in out-of-pocket subsidies will result in increased premiums which are “still” paid for by the ACA between 138% and 250% FPL. In some cases, Bronze plans can be had for free, Silver plans become cheaper, and Gold plans offering better care and lower deductibles attainable.

Senator Murray is giving away the store if what Senator Alexander says is true. “Alexander said Murray agreed to a deal giving states ‘meaningful’ flexibility on coverage rules. Asked what the stumbling blocks to the deal are, Alexander replied: ‘The definition of meaningful.'”

We have already seen what the word meaningful means with regard to the expansion of Medicaid in some states . . . it never happened. I am hoping Senator Murray has second thoughts and decides not to go farther with her thoughts on negotiating with the Republicans as she is off base and we will be better off by not altering what is law already and it is the ACA.

Premiums will go up in 2018 as no one is going to trust Trump regardless of any deal reached with the Republicans.

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