Health Care

It Happened Last Night

It was dramatic.  Even for 1 a.m. But….

…it appears that any chance of repealing (and replacing?) the Affordable Care Act died last night as Lisa Murkowski and Susan Collins were joined by John McCain in opposing the Senate’s “skinny repeal” bill.

Here’s how it went down.

Yesterday afternoon, the Senate voted against a straight repeal of the Affordable Care Act. It was a floor vote Mitch McConnell had promised after the failure of a joint repeal-and-replace bill last week, when defections from both the conservative and the moderate wings of the GOP caucus killed it before it reached a vote.

With both repeal-and-replace and the full repeal bills dead in the water, it was time for Plan C (or D or E or X at this point): “Skinny Repeal.”

“Skinny Repeal” was a frankly terrible bill that would get rid of some of the more problematic aspects of Obamacare, but come nowhere close to a full repeal. The idea was that taking away the individual mandate and the employer mandate, but leaving everything else for the time being, would have been enough to make sure the conservatives and the moderates were all on board.

But, it did not happen. The CBO almost immediately announced 16 million more people would go uninsured (because they would not be forced to buy insurance, but semantics and all that) and insurance companies complained skinny repeal would be disastrous for the market.

As a result, Lisa Murkowski, Susan Collins, and John McCain voted against the skinny repeal deal. The final vote was 49-51. Mike Pence had been in attendance in order to break the tie, but McCain’s defection from the caucus threw the bill onto the path of defeat that not even Pence could save it from.

After the vote, McConnell’s statement was simple: “It’s time to move on.”

The GOP has now been given the signal to go ahead and skip on to the next big project: tax reform – a subject I am sure will be much easier to tackle for a body that couldn’t even pass something it had campaigned on for the last 7 years.

The failure of every GOP health care reform initiative is significant because it shows a real weakness within the party in power, and it shows Donald Trump’s weakness as a leader of his party. Both of these weaknesses could potentially play against the GOP in 2018, a year that is (as of now) expected to be particularly harsh on House GOP members.

What’s next for health care reform is anyone’s guess at this point. McConnell has seemingly conceded that it won’t happen, but there are a good many conservative lawmakers who still want to keep that promise. We just don’t know where or when the time to keep that promise will come up again.

This may the only time that an article at Redstate speaks well for my thoughts.

The only thing I would add is… this should be a lesson to Republican politicians and voters about being the anti-everything party. There will come a time when you have to a solution, rather than complain. And if you don’t have a better alternative, you look like an ass.

BIG Vote Today On Something That Nobody Knows What It Is

In a few hours, Senate Republicans will vote whether to start debate on a plan to overhaul American health care, without knowing exactly what is in that plan or, by extension, how it will change the lives of millions of Americans.

There are few, if any, comparable examples of a bill with such wide-reaching consequences, being voted on so abruptly, with so many critical questions left unanswered less than 24 hours before it is taken up.

Senate leaders are bent on holding a vote. But after the plan was drafted in secret, it now needs substantial revisions under the Senate budget rules. And yet the White House and GOP leadership insist on forcing members to vote on Tuesday.

It is an unprecedentedly opaque process to try to pass legislation that overhauls an industry worth more than $3 trillion, which would undercut a law that has extended health coverage to more than 20 million middle-class and low-income Americans in the past seven years.

The fate of Obamacare, arguably the most significant domestic policy passed in a generation, hangs in the balance. Medicaid, a pillar of the American safety net since Lyndon B. Johnson’s Great Society, could be fundamentally changed by the Senate bill, with federal spending capped permanently for a program that covers more than 70 million of the most vulnerable people in the country.

But as the vote approaches, there is no final text, no Congressional Budget Office score. Senate Republicans at least acknowledge the absurdity, if you ask them — this, coming from a party that spent seven years eviscerating Democrats for passing Obamacare in the quote-unquote dead of night.

So what are Republicans throwing together at the last minute?

“Skinny repeal”.

No seriously. That’s what it’s being called.

The Senate is expected to bring to the floor a “skinny repeal” bill that would repeal Obamacare’s requirement to purchase insurance — and violate the health care promises that Republican leaders, including Trump, have spent more than seven years making.  It is just taking away the mandate for individuals to buy insurance. It would also repeal the ACA’s mandate that employers with 50 or more employees provide coverage, according to lobbyists and Senate aides, as well as eliminate the law’s tax on medical device manufacturers.

What will happen with skinny repeal? It would make premiums go up, not down (as some Republicans say). Insurance competition would decline as insurers worried about healthy Americans fleeing the individual market. Rather than all Americans gaining coverage, millions would lose the plans they currently rely on. This cartoon explains why.

When the Congressional Budget Office analyzed a bill similar to skinny repeal, which also rolled back this provision, it estimated that 15 million Americans would lose coverage. The agency estimated that “repealing the individual mandate would also result in higher health insurance premiums” for those who purchase their own coverage — by approximately 20 percent.

There is disagreement over whether or not Obamacare is in a “death spiral”, but this does not stop it. It might even CREATE a death spiral if not speed up an existing one.

John McCain is flying in from his brain cancer rehab, which one would HOPE would mean this thing doesn’t pass. And it might not. The first hurdle is the motion to put it on the table.

The Washington Post says Republicans are close to moving forward:

Senate Republican leaders appeared close to securing the support they needed Tuesday to begin debate on their plan to rewrite the Affordable Care Act, according to lawmakers and aides, though the proposal they would consider could change dramatically once senators begin voting.

Republican leaders now see a scaled-down version of the bill as perhaps their best chance of winning final passage on some kind of measure to overhaul Obamacare. If senators passed this stripped-down version — which some Republicans refer to as “skinny repeal” — they would set up a House-Senate conference to resolve the differences between the two proposals, buying Republicans more time.

The new strategy will allow Republicans to sustain their years-long effort to unwind the 2010 health-care law, though they have yet settle on a replacement for it. But it is also is a tacit acknowledgment that more sweeping efforts to revise or even simply repeal the law cannot succeed, even as Republicans control both Congress and the White House.

They’ll probably pass the motion to begin debate — and hail it as a great victory.

UPDATE:

Capito, Heller and Rand are the new yes votes. Watch: Murkowski, Lee.

Odd though.  The motion to proceed will pass and then what will they debate? A bill that is merely a concept at this point?

UPDATE #2:

Protests

Three GOP no votes stop the bill. Collins and Murkowski are “no”

It all comes down to Johnson, who is seen as being on the fence. (McCain is on his way in from the airport and expected to vote yes)

McCain votes “aye” after receiving a round of applause as he enters.

Johnson votes “aye” right after. It’s a done deal. Vote will be 50-50 and Pence will cast deciding “yes”

Dems are all voting “no”

Pence breaks the tie.

McCain with a scar on his head speaks about why he voted to allow debate on whether to take healthcare away from millions. Although he seems to be chastising partisan politics.  Announcing his retirement?

 

Now McCain railing against screaming AM radio pundits and urging cooperation.  Some applause, but not much.

He’s doing some preening about how GOP and Dems won’t work together, and he’s right, but the fault really lies with the Freedom Coalition in HIS party, and he needs to say so, without the “both sides”-ism.

McCain did say he won’t vote for a blind repeal of the ACA, even though he voted for the debate. Thank goodness.

EPILOGUE:

Trumpcare Declared Dead But GOP Not Finished Screwing America

So this happened:

Republican senator from Kansas and his Republican colleague from Utah said “no” to the GOP plan to replace Obamacare. This comes even before the CBO had scored it, but it would have resulted in tens of millions losing healthcare and higher premiums. That doesn’t include all those who would get crappy healthcare that is useless when they actually have a catastrophic illness.

The Senate vote was supposed to be this week and it was right on the edge. Only one more Republican Senator (besides the two nay-sayers already) needed to step up and say “no” and the thing was dead. Senate Majority Leader McConnell put off voting until August while Senator McCain had some pretty nasty eye/brain surgery which apparently accounted for his odd behavior recently at the Comey hearing.

It was thought that key swing-votes were Rob Portman of Ohio, Lisa Murkowski of Alaska, Jeff Flake of Arizona, or maybe Cory Gardner of Colorado.

But Lee and Moran stepped up and killed this. They joined Maine Sen. Susan Collins and Kentucky Sen. Rand Paul in opposition, denying GOP leaders the support to even bring the bill to the floor and upending Republicans’ seven-year goal of repealing Obamacare.

But apparently McConnell had a backup plan: he announced that the chamber would vote to take up a House bill from 2015 that repeals the Affordable Care Act and then provides for a two-year delay while the Senate develops a plan to replace it.

“[I]n the coming days,” McConnell said in a statement Monday night, “the Senate will vote to take up the House bill with the first amendment being what a majority of the Senate has already supported in 2015 and that was vetoed by then-President Barack Obama: A repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”

This is a terrible idea. Repealing Obamacare without implementing a replacement would have even more devastating consequences than Trumpcare. It would result in 18 million people losing their coverage the first full year after the bill’s enactment. That number would rise to 32 million by 2026, according to the nonpartisan Congressional Budget Office, which scored the repeal and delay plan when it was proposed in 2015.

Repeal and delay would also significantly increase premiums, the CBO said. In the first year following enactment of the law, premiums purchased through the marketplaces or directly from insurers would increase 20 to 25 percent relative to projections under the current law.

In the year following the elimination of the Medicaid expansion and subsidies provided by the ACA, that increase would reach about 50 percent, with premiums doubling by 2026.

The widespread confusion that repeal and delay would create would be detrimental even as the current law stays in place during the proposed two years the Senate would have to develop a replacement.

Insurers use projections to set prices, and knowing the industry is going to dramatically change but not knowing how is expected to cause insurers to pull out of the ACA marketplaces. This means higher premiums and, ultimately, a death spiral that would result in Americans losing their health insurance.

But the two defectors from last night are for repeal (right now), and so is this guy:

Trump clearly doesn’t care what the bill is.  He just wants to declare a “win”.  But this repeal-and-replace-later is a non-starter. I don’t think anybody thinks Congress will come up with a better idea in two years.  Plus, repeal will be hard since part so it require a 60-senator vote.

So the watch word on the left is: “Yay for us, but remain vigilant”.

UPDATE:  Yeah, it might be dead before this morning is out.

Healthcare Update

Yesterday was a strange news day and not just because of the Trump’s tweets about Morning Joe.  I want to cover much of it, and it is going to take a couple of posts.

First, healthcare.

The Senate Health Care bill looks dead.  McConnell wanted to get the Senate bill, BCRA, passed before the July 4 extended break.  He wanted it passed without hearings, without debate, without amendments. The CBO score on the bill was horrible, and McConnell could not bridge the gap between the Freedom Caucus (Rand Paul) who thought the Senate version didn’t go far enough, and the moderate Republicans (Susan Collins) who rightly saw the bill as barbaric.  A last ditch effort yesterday led to nothing, and the Senate adjourned.

That didn’t stop Trump from tweeting about health care this morning.

Why this tweet is extraordinary: It’s literally the opposite of what then president-elect Trump told Paul Ryan after he won the election and shortly before Congress went into session. Part of the reason why the House GOP leadership didn’t run with a clean repeal vote, as they’d done many times under President Obama, was because Trump had made it clear to Ryan he wouldn’t sign the bill.

Behind Trump’s tweet: He’s frustrated, like every other Republican involved in the jammed-up health care negotiations. HHS Secretary Tom Price met with senior officials at the White House yesterday, and a source familiar with the meeting said the mood was far more negative than the day before.

Looks like the break is coming and GOP lawmakers are going to get an earful in town meetings at home

How’s “Energy Week” Going?

The White House said this was “Energy Week”, but it just seems to be more bad-news-on-healthcare week.

The Ashford Zone’s correspondent*, Amy Da Luz is in Raleigh outside Senator Burr’s office at an anti-BCRA rally.  It is a pretty decent turnout.

* She doesn’t know she’s our correspondent.

By the way, I wrote something large on Facebook which I will share here:

Senate Health Care Bill Off Fast Track

It looks like BHCA (the Better Health Care Act, which isn’t) is not going to be voted on before the July 4 break, as Senator McConnell had hoped. I don’t see how he thought he could put such a terrible bill through committee, without hearings, without almost no debate, without amendments, and get a vote passed.  The horrible CBO score did him in.  Chaos broke loose.

Here’s a nice summary of the the bill:

Trump has invited Senators from both parties over to the White House to discuss health care. I would love to be a fly on that wall.  To discuss the issue, you have to understand the issue.

Breaking: The Senate Health Care Bill Gets Scored

The House Bill said 23 million would lose insurance under the House GOP plan to replace Obamacare.

Now the Senate version has been scored and it is…. just as bad.

The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

Silver lining?

The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

Good news unless you are uninsured and get sick.  The deficits mostly come from GOP bill cuts, i.e., the spending cut on Medicaid by 26% by 2026

To be honest, I really thought it would be somewhere around 15 million after 10 years.  Nope, it’s 22 million.  A disaster for the GOP.  And most of that — well, 15 million — would happen right away.  That would have a huge impact on the 2018 elections if this gets passed.

All Hail ACHA 2.0

Well, after weeks of secrecy, the Senate version of Obamacare “Repeal and Rewhatever” (PDF) is here. Remember, the House version of the ACHA would result in 23 million people becoming uninsured, and even Trump called it “mean”.  Is the Senate version any better?  Not much:

Here is how the Senate bill works:

  • The Senate bill begins to phase out the Medicaid expansion in 2021 — and cuts the rest of the budget’s program too. The Senate bill would end the Affordable Care Act’s expansion of Medicaid to millions of low-income Americans. This program has provided coverage to more Americans than the private marketplaces
  • It would also cut the rest of the public insurance program. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment.
  • The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance.
  • The Senate bill repeals the individual mandate — and replaces it with nothing. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. This could cause significant disruption in the individual market because it takes away a key incentive healthy people have to buy coverage, meaning only sick people may sign up.  This drives up premiums, deductibles, and co-pays.
  • The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.
  • The Senate bill defunds Planned Parenthood for one year. This would mean Medicaid patients could no longer seek treatment at Planned Parenthood clinics. Experts expect this would result in low-income Americans getting less medical care and having more unintended pregnancies, as access to contraceptives would decline.
  • All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.

Shorter story: the rich get tax breaks, the poor and sick get screwed. It’s a reverse Robin Hood bill.

Let’s recall what Sen. Mitch McConnell said about the Affordable Care Act in January:

MCCONNELL: Well, what you need to understand is that there are 25 million Americans who aren’t covered now. If the idea behind Obamacare was to get everyone covered, that’s one of the many failures. In addition to premiums going up, copayments going up, deductibles going up. And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it’s really not worth much to them. So it is chaotic. The status quo is simply unacceptable.

McConnell was right in every criticism he made of the ACA. Then he turned around and wrote a bill that made every single problem he identified worse.

Republicans have a mere 52-48 advantage in the Senate, so if there are two “no” Republicans, the bill could pass with VP Pence breaking the tie.  But 3 “no” Republicans would kill it (assuming, as I do, that every Dem is a “no”).  Senator Rand Paul (R) has already said “no” because it doesn’t go far enough in repealing Obamacare, but that might be posturing.

I wonder if Trump will endorse it.  After all, this is going to be thrown in his face:

Initial reaction is not good, and there are already some bad optics, like Capital Police dragging away protesters who are wheelchair-bound:

Senate Republicans Getting Hit From All Over

This screenshot from Memeorandum gives a sense of the bind that Senate Republicans are in over their very long and VERY SECRET internal negotiating (by 13 white men) over their healthcare bill.

House Republicans insist that their terrible mean bill (which knocks 23 million off of healthcare) doesn’t get altered too much, and Democrats — well, they just want to see the bill.  This is all revving up each day, as Senate Republicans cannot seem to decide how to fix healthcare.

I was worried this might go under the radar, but I think not. Especially if it goes into August.

The Trumpcare Fight

It was thought that Trumpcare, having passed the House, would die when it got to the grown-ups in the Senate.

Nope.  They’re trying to pass it.  Or something.

I can’t criticize the Senate version of Trumpcare.  Because nobody knows what it is.

We only know a few things. All reports say there will be no hearings on the text of the bill. There will be no amendments. Republicans are hoping to rush through an up-or-down vote on their version of the American Health Care Act passed by the House before the July 4th recess to avoid facing angry crowds who will build pressure for wavering members to vote no.

The best way to make those crowds angry? Give them something specific to be angry about. Look at the reaction to the House bill, which threatens protections for people with pre-existing conditions, would gut Medicaid and would – according to the nonpartisan Congressional Budget Office – strip 23 million people of their health insurance.

Of course people were furious. The bill is an exercise in man’s inhumanity to man. The AHCA isn’t really a health care bill at all; it’s a huge tax cut for the wealthiest Americans funded by taking health insurance away from the people who need it most. It’s designed to do as much damage as possible while still garnering the votes it needed to pass.

And pass it did in the House of Representatives, by the skin of its teeth, with both President Trump and Speaker Ryan and his whipping team going full stiff peaks on the Republican caucus. But even though the reconciliation process means the bill needs only 50 votes instead of the usual filibuster-busting 60, the House bill as passed didn’t have a chance in the Senate.

So a team of Republicans (and only Republicans) is cooking up a cauldron of tweaks and adjustments known only to them. The rest of us – the ones whose lives are going to be changed, damaged by whatever bubbling potion they concoct – don’t get to find out what’s inside. We don’t rate.

Ah, but what about those pesky reporters, always digging for the truth?  Well, this might be a clue:

So now they can hide.

New levels of low.

UPDATE:

To These Guys Everything Is A Partisan Conspiracy Against Their Perfect Great Idea

To these guys everything is a partisan, somebody else to blame conspiracy against their perfect, great idea:

It’s become the knee-jerk reaction for Republicans, in light of an ugly Congressional Budget Office analysis of their Obamacare repeal bill, to point the finger at the non-partisan research agency instead.

Office of Management and Budget Director Mick Mulvaney took it a step further this week, by questioning the abilities of Holly Harvey, the head of its health analysis division, to be non-partisan.

“At some point, you’ve got to ask yourself, has the day of the CBO come and gone?” Mulvaney told the Washington Examiner Wednesday. “How much power do we give to the CBO under the 1974 Budget Act? We’re hearing now that the person in charge of the Affordable Health Care Act methodology is an alum of the Hillarycare program in the 1990s who was brought in by Democrats to score the ACA.”

Prior to coming on to the CBO in 2009, Harvey served in the Clinton administration’s Health and Human Services Department, according to the Examiner.

The CBO director, Keith Hall, who signed off on the CBO score of the GOP health bill, was the chief economist for the  Council of Economic Advisers in the George W. Bush White House and was handpicked by then House Budget Committee Chair Tom Price (who is now Trump’s HHS secretary) to lead the CBO.

Mulvaney, in the Examiner interview, said that the CBO’s assumptions about Medicaid cuts were “just absurd,” while suggesting a bias in favor of Affordable Care Act’s individual mandate, which the GOP bill would eliminate.

“If the same person is doing the score of undoing Obamacare who did the scoring of Obamacare in the first place, my guess is that there is probably some sort of bias in favor of a government mandate,” he said.

The CBO has found that that the Republican health bill, the American Health Care Act, would lead to 23 million people losing coverage, cut $664 billion in taxes (mostly for high-earners and the industry), while saving the government $119 billion. It also found the legislation would lower premiums considerably in some places, but with the trade-off of making health coverage more expensive for older consumers and those with pre-existing conditions.

it’s problematic when one side of the debate simply argues, “Well, the other side is biased and therefore you can’t trust them.”  That’s not a fact-based argument.  And it certainly doesn’t raise counterfactuals.

One has to wonder why someone, whether it is an economist with the CBO or a climate scientist, would stake every bit of their learning and status in order to achieve a political result.  Most academics aren’t like that — in fact, it’s hard to find one willing to toss aside their expertise for the sake of reaching a pre-desired outcome.  Who does that?

Maybe conservatives do.  Maybe that’s why they think everyone else is biased and partisan — because that’s how they are.

Abomination

The Plum Line, this morning:

I won’t mince words. The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can’t recall what it might have been. And every member of the House who voted for it must be held accountable.

There’s certainly a process critique one can make about this bill. We might focus on the fact that Republicans are rushing to pass it without having held a single hearing on it, without a score from the Congressional Budget Office that would tell us exactly what the effects would be, and before nearly anyone has had a chance to even look at the bill’s actual text — all this despite the fact that they are remaking one-sixth of the American economy and affecting all of our lives (and despite their long and ridiculous claims that the Affordable Care Act was “rammed through” Congress, when in fact it was debated for an entire year and was the subject of dozens of hearings and endless public discussion). We might talk about how every major stakeholder group — the American Medical Association, the American Hospital Association, the AARP, the American Cancer Society Cancer Action Network, the American Heart Association, and on and on — all oppose the bill.

All that matters. But the real problem is what’s in the bill itself. Here are some of the things it does:

  • Takes health insurance away from at least 24 million Americans; that was the number the CBO estimated for a previous version of the bill, and the number for this one is probably higher.
  • Revokes the Affordable Care Act’s expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.
  • Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.
  • Slashes Medicaid overall by $880 billion over 10 years.
  • Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager tax credits pegged not to people’s income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.
  • Allows insurers to charge dramatically higher premiums to older patients.
  • Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.
  • Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.
  • Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
  • Produces higher deductibles for patients.
  • Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.
  • Shunts those with preexisting conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can’t cover the population they’re meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.
  • Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you’ll have to document every condition or ailment you’ve ever had.

It is no exaggeration to say that if it were to become law, this bill would kill significant numbers of Americans.

Crucial Vote on Healthcare Today

The ACHA, once thought dead, got revived yesterday.  The big change? 8 billion for states that choose to create high risk pools for people with pre-existing conditions.  Of course, the fact that this 8 billion boondoggle (which goes to insurance companies) exists only highlights the lie that “no changes are being made with respect to pre-existing conditions”.  And 8 billion, by the way, is nowhere near enough.

Here’s a table of key differences:

Terrible.

Chaitspeaks:

The heart of the bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class. They have added a series of hazily defined changes: waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits, and a pitifully small amount of money to finance high-risk pools for sick patients.

The implications of these changes are vast. The Brookings Institution notes that if a single state eliminated the cap on lifetime benefits for a single employee, then employers in every state could actually follow suit, thus bringing back a horrid feature of the pre-Obamacare system, in which people who get hit with expensive treatment suddenly discover that their insurer will no longer pay for their care. This would affect not only those getting insurance through Medicaid or the state exchanges, but also through their job.

The ambiguity of the details is the strategy. Republican leaders have been “assuring centrists that the Senate would make changes to allay their concerns and insisting that few states would actually use the waivers allowing higher premiums for pre-existing conditions,” reports The Wall Street Journal. Sean Spicer says it would be “literally impossible … to do an analysis of any level of factual basis.” Representative Fred Upton told reporters that if the Congressional Budget Office says the bill is underfunded he will push for more money — after it passes his chamber.

They are rushing through a chamber of Congress a bill reorganizing one-fifth of the economy, without even cursory attempts to gauge its impact. Its budgetary impact is as yet unknown. The same is true of its social impact, though the broad strokes are clear enough: Millions of Americans will lose access to medical care, and tens of thousands of them will die, and Congress is eager to hasten these results without knowing them more precisely. Their haste and secrecy are a way of distancing the House Republicans from the immorality of their actions.

There’s simply no way that this can be considered “better”.  The White House argument is that it is necessary to keep Obamacare from imploding.

It would be nice to have CBO scoring on this, but that is not going to happen.  That is very telling.

Two things not mentioned above:

(1)  Congress and its staff are exempt from these changes.  Some GOP congresscritters have suggested that the issue of their exemption be taken up in a separate piece of legislation, but I’m not holding my breath.  (Why not do it now?)

(2)  People like me who get insurance through their employer are not necessarily protected.  If your employer is a multi-state employer, it can pick the state which has the crappiest (cheapest) benefits and provide that to ALL employers.

The vote is scheduled for 1:00 pm today.  I will update as the day goes on.

23 “No” Republicans will kill the bill in the House.  Right now, it doesn’t seem like we are there.

UPDATE 11:40am –

Going the wrong direction (wonder why CNN dropped off the list)

UPDATE 1:14pm –

Voting should start in a half hour or so…

Not sure why WaPo went down…

UPDATE 2:00pm –

They are voting to exempt themselves from Obamacare or whatever else comes up.  Democrats AND Republicans.

….and it passes with zero Nays.

UPDATE 2:13pm –  Voting started on Health Care passage.  Five minutes.

And The House PASSED H.R. 1628 – American Health Care Act 217 to 213

Singing “Na na na na hey hey hey goodbye” — Is it Democrats or Republicans?

I wouldn’t want to be a House Republican in a district Clinton won.  Here they are:

TrumpCare 3.0 (4.0?) Is Dead Pretty Much

The Hill reports:

House Republicans have an updated bill to repeal and replace ObamaCare, and The Hill has a new whip list.

The updated bill includes an amendment that would allow states to opt out of key ObamaCare rules, including on minimum coverage requirements and allowing insurers to charge more based on individuals’ health.

Those changes are designed to win over conservatives, and the new legislation has been backed by the House Freedom Caucus and outside groups including the Club for Growth and FreedomWorks.

The question is whether GOP centrists can back it.

A mix of centrists and conservatives objected to the earlier ObamaCare bill, forcing GOP leaders to call off a planned vote.

No Democrats are expected to vote for the measure, meaning Republicans can only afford 22 defections.

And they kept an updated list of “No’s”, which just hit the 22 mark.

NO (22)

Rep. Mark Amodei (Nev.) — Amodei told ABC on Thursday he is still a no.

Rep. Andy Biggs (Ariz.) — “The MacArthur amendment is an effort to make the AHCA better, but it does not meet my constituents’ threshold for repeal,” the Freedom Caucus member said. Biggs was a no on the first bill.

Rep. Mike Coffman (Colo.) — Coffman told Politico he is currently a no.

Rep. Barbara Comstock (Va.) — The centrist Republican told The Hill she is still a no. Comstock is one of Democrats’ top targets in 2018.

Rep. Ryan Costello (Pa.) — Costello told reporters Thursday he was a no.

Rep. Jeff Denham (Calif.) — Denham told The Hill he was a no on Wednesday.

Rep. Charlie Dent (Pa.) — The co-chairman of the centrist Tuesday Group is still a no.

Rep. Dan Donovan (N.Y.) — The freshman lawmaker told The Hill on Wednesday he still plans to vote no.

Rep. Brian Fitzpatrick (Pa.) — A centrist, Fitzpatrick is still a no.

Rep. Jaime Herrera Beutler (Wash.) — Herrera Beutler, a member of the Tuesday Group, is a no, CNN reported.

Rep. Walter Jones (N.C.) — Jones, who has bucked GOP leaders on a number of occasions, is still a no.

Rep. John Katko (N.Y.) — Katko is still a no. “To me, it doesn’t move the needle enough,” he told Syracuse.com. Democratic presidential nominee Hillary Clinton won Katko’s district in November.

Rep. Leonard Lance (N.J.) — Lance is still a no.

Rep. Frank LoBiondo (N.J.) — LoBiondo is still voting no despite potential changes.

Rep. Billy Long (Mo.) — Long told The Hill he is a no on the revised bill.

Rep. Thomas Massie (Ky.) — Massie, a conservative who is not in the Freedom Caucus, said he is still a no.

Rep. Patrick Meehan (Pa.) — Meehan said the revised bill would raise premiums for those with pre-existing conditions and older Americans.

Rep. Ileana Ros-Lehtinen (Fla.) — The centrist Republican from south Florida said she is still a no even with the amendment. Clinton won Ros-Lehtinen’s district by nearly 20 points in 2016, but the longtime GOP lawmaker said she will not seek reelection in 2018.

Rep. Chris Smith (N.J.) — Smith told ABC he is still a no. The New Jersey lawmaker is meeting with leaders Thursday.

Rep. Michael Turner (Ohio) — Turner on Thursday told CNN he is still a no.

Rep. Daniel Webster (Fla.) — Webster is still a no. The Florida lawmaker wants changes that provide more Medicaid funding for nursing homes.

Rep. David Young (Iowa) — Young told reporters he is still a no. A Paul Ryan-aligned super PAC pulled their support for him after his decision not to back the initial bill in March.

It should be noted that NBC’s whip count shows 20 Republicans firmly against the bill. Another dozen are undecided.

The New ACHA Is Even Worse

I could talk about how terrible the revised Republican repeal of Obamacare plan is, but the best evidence is that the Republicans themselves decided to exempt Members of Congress from living under it. In other words, THEY (and their families) get to keep Obamacare, while their proposed new law takes it away from everyone else.

Here, read this.

How Is AHCA Doing?

Depending on which news organization you look at, if the Republicans lose 22 or 23 votes, the AHCA is dead in the House. The voting is taking place today, and the bill is changing with little giftees for certain districts.  Here is a wrap-up of where we are so far on the vote count, but pay close attention to the times below.  This is a VERY fluid thing.

And this just got tweeted:

I went to bed thinking they would make deals and get the votes.  But they failed to satisfy the Freedom Caucus last night, and I’ve seen a few confirmed no’s this morning.

On the other hand, there’s still more hours ahead. The Freedom Caucus is meeting with the President at 11:30 am today.

Ohhhhh…. if I had to guess, I would say it won’t pass the House.

UPDATE: Earlier today, the Freedom Caucus left the White House unmoved to change their NO vote.  And just now… this:

Speed Read: The House Obamacare Replacement Bill

From Axios:

The House Republican Obamacare replacement package is finally out, and the two main health care committees — Ways and Means, and Energy and Commerce — are scheduled to start working on the bills on Wednesday. Here’s your speed read on what’s in them — summaries are available here and here:

In:

  • Pre-existing condition coverage
  • Continuous coverage — 30 percent penalty if people don’t keep themselves insured
  • Special fund to help states set up “high-risk” pools, fix their insurance markets, or help low-income patients
  • Enrollment in expanded Medicaid will be frozen
  • Current enrollees can stay until 2020, and keep getting extra federal funds, until they leave the program on their own
  • Medicaid will change to “per capita caps” (funding limits for each person) in fiscal year 2020
  • A new, refundable tax credit will be available in 2020 to help people buy health insurance
  • Covers five age groups — starts at $2,000 for people in their 20s, increases to $4,000 for people in their 60s
  • It’s not means tested, but phased out for upper-income people (starting at $75,000 for individuals, $150,000 for families)
  • Insurers can charge older customers five times as much as young adults

Out:

  • All Obamacare taxes
  • All Obamacare subsidies, including its premium tax credit
  • Individual, employer mandate penalties
  • “Cadillac tax” (until 2025)
  • No longer will limit the tax break for employer-sponsored health coverage
  • No payments to insurers for cost-sharing reductions
  • Selling insurance across state lines (can’t be done in the “reconciliation” bill)
  • Medical malpractice reform (can’t be done in the “reconciliation” bill)

There’s also a little sugar in there for insurance company CEOs. Under Obamacare, insurance companies could not deduct an employee’s pay that exceeded $500,000 per year.  This limited incentives to give excessive salaries to CEOs and officers.  That limitation is gone now.

Look, if this is complicated for you (and no shame in that — it’s hard stuff) consider this: the House did not send this to the Congressional Budget Office for “scoring”. In other words, we would normally get an estimate as to (1) how much this will cost or save (will it add to the deficit?); (2) how many people will get lose coverage; and (3) how much insurance costs will go up (or down) as a result for the average consumer.  The House did not get the bill “scored” because — let’s face it — they didn’t think the numbers would look good.

AND they are trying to get this passed without debate.

My prediction? Even if they succeed in passing the bill, it is DOA in the Senate.

Draft Republican Plan Leaked

Politico has obtained a draft bill from House Republicans for Obamacare repeal. The draft closely follows proposals put forward by House Speaker Paul Ryan and the proposal Tom Price introduced last year. He’s now popular vote loser Donald Trump’s Secretary of Health and Human Services. It defunds Planned Parenthood completely. For everybody. No matter what they visit PP for. But more than that, it scraps Medicaid expansion and by allowing insurance companies to charge older people much more for insurance.

The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

Capped payments is basically the same idea as a block grant. The state would get a set amount of money—less than currently under Obamacare’s Medicaid expansion—depending on the current Medicaid population size. If for some reason the Medicaid-eligible population increased in a state, it would have to do that thing Republicans falsely screamed bloody murder about with Obamacare: ration care. It would have to decide whether to keep covering children, or the disabled, or the elderly in long-term care. Which means, fewer people covered.

The draft bill is two weeks old, so maybe there have been changes, but if this is the end result, GOPCare will suck.  And they will get an earful.

NOW They Are Asking What Would Happen If Obamacare Is Repealed

Winning is easy; governing is hard.

It is easy to get people – especially Republicans — to hate Obamacare.  For one thing, it has the name of the 44th President attached to it.  That alone gets many people to dislike it.

On top of that, it DOES have many problems.  Rates this past year jumped bigly, and many plans now have high deductibles.  (To be fair, the health-care premium increased 31% from 2006-2011, pre-Obamacare, and only 20% with Obamacare over the 5 year period of 2011-2016 — but some states have been hit hard.)

Also, in many counties now, there is only one choice of healthcare plan.

But the Affordable Care Act (see, it’s not Obamacare now!) is not the “total disaster” that Trump says it is. About 16.6 million people now have health insurance — people who wouldn’t have it otherwise.  Denial of insurance because of pre-existing conditions is a thing of the past.

The ACA also allows states to expand Medicaid eligibility, with the federal government paying most of the cost for new beneficiaries.

Finally, the ACA also prohibits insurers from charging different premiums to individuals based on their health. Everyone is in one big insurance pool, sharing in the average cost. Tax credits to help people buy private insurance.

The problems hit because more sick people enrolled than insurers expected when they initially set their premiums in 2014. That’s a big reason why premiums are rising more quickly for 2017 — with benchmarks increasing 22% on average nationally and 8% in California. Some insurers have exited the market, and Obamacare consumers face fewer choices. But the hope is that these higher premiums represent a one-time market correction rather than a sign of worsening trends to come.

But Republicans want to repeal.  They think it is what the people want.  Even some of the people think it is what they want.  It’s the most unpopular popular law.

The problem is, what happens when the GOP tries to change the ACA?

That, of course, depends on HOW they do it, and what they replace it with.  All indications are that they want to keep the popular parts of the ACA (the ban on pre-existing conditions, and the part where you can be on your parents’ plan if under age 26), but remove other parts (the individual mandate which penalizes people who don’t buy health insurance).

And how will they do this? It looks like they may use a budget maneuver known as a reconciliation bill, and through this, repeal parts of the ACA. The advantage of such a bill is that it cannot be filibustered in the Senate, meaning it can be passed with 51 votes instead of 60. The disadvantage is that it can be used only to make changes that have a direct effect on federal spending or taxes. So, for example, a reconciliation bill cannot repeal the ACA’s insurance market regulations, including protections for people with pre-existing conditions. But it can repeal the law’s premium subsidies and the individual mandate.

Unfortunately, this is going to wreak havoc and produce a death spiral in the individual health insurance market. With guaranteed insurance for people with pre-existing conditions but no subsidies or individual mandate, premiums could skyrocket. Or, more likely, insurers simply would exit the market. Why risk losses when the whole law is getting repealed anyway? The upshot would be canceled coverage with no other options for people buying in the ACA’s marketplaces (like healthcare.gov or Covered California), as well as those buying directly from insurers, where the same rules apply.

So what Republicans MUST do is hold off on the reconciliation bill until they have a replacement in mind for the ACA.  That presents a political problem though, because repealing Obamacare was designated a first priority.

In short, here’s the dilemma for Republicans: YOU HAVE TO HAVE THE INDIVIDUAL MANDATE IF YOU WANT TO KEEP THE BAN ON PRE-EXISTING CONDITIONS.  Period.  It’s that simple.  If you don’t, then premiums will go through the roof, since people will drop their insurance and insurance companies won’t have the money to cover all the people with pre-existing conditions.

The only other alternative?  Single payer.  But the GOP won’t touch that.

So the GOP is in a bit of a bind.  Maybe that’s why this happened:

In a Tuesday letter to congressional leaders, the American Medical Association (AMA) came out against plans floated by Republicans to quickly repeal Obamacare but delay fully replacing the law.

The AMA told congressional leaders that they must reveal their plans to replace the Affordable Care Act before repealing the legislation.

“[W]e believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,” James L. Madara, the CEO of the AMA wrote in the letter.

The GOP, no doubt, wants to dismantle Obamacare but doesn’t want to get the blame.  The ball is definitely in their court.  They’re like the dog that caught the bus by the bumper — not sure what to do.

But it ain’t looking good for the dog.

SCOTUS Strikes Down Oppressive Abortion Restrictions

This morning, the Supreme Court struck down parts of a restrictive Texas law that could have reduced the number of abortion clinics in the state to about 10 from what was once a high of roughly 40.

The 5-to-3 decision was the court’s most sweeping statement on abortion rights since Planned Parenthood v. Casey in 1992. It applied a skeptical and exacting version of that decision’s “undue burden” standard to find that the restrictions in Texas went too far.

The decision on Monday means that similar restrictions in other states are most likely also unconstitutional, and it imperils many other kinds of restrictions on abortion.

Justice Stephen G. Breyer wrote the majority opinion, joined by Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. Chief Justice John G. Roberts Jr. and Justices Clarence Thomas and Samuel A. Alito Jr. dissented.

The decision concerned two parts of a Texas law that imposed strict requirements on abortion providers. It was passed by the Republican-dominated Texas Legislature and signed into law in July 2013 by Rick Perry, the governor at the time.

One part of the law requires all clinics in the state to meet the standards for ambulatory surgical centers, including regulations concerning buildings, equipment and staffing. The other requires doctors performing abortions to have admitting privileges at a nearby hospital.

“We conclude,” Justice Breyer wrote, “that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes. Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the federal Constitution.”

I’m not surprised by the outcome, nor am I surprised by swing justice Kennedy joining the “liberals” on the court.  Frankly, the Texas restrictions were NOT intended to support women’s health.  If you saw who proposed those restrictions (longtime Texas anti-abortion legislators) and listened to their rhetoric, “health of women” was a sham rationale.  Their real objective was to make abortion clinics so regulated that they could not afford to make the required changes, and eventually close down.  In fact, to date, twenty abortion clinics have closed down under those regulations.

So, yes, a victory, and it would have been a victory even if Scalia was alive and on the court.  But it does underscore the importance of the election and who gets to pick the next justices.

Two Million Pregnant Women At Risk For Zika Virus

So far, the GOP-controlled House has offered a mere $622 million in Zika funding — far less than what will be needed to meaningfully combat the virus. It’s unclear when Congress may reach an agreement on this issue before its long summer recess. And according to an analysis by the Center For American Progress, this delay could be putting about 2 million pregnant American women at risk.

Using data from the Centers for Disease Control and Prevention (CDC), here’s the think tank’s prediction for the number of pregnant women who might be affected by Zika this summer and fall, broken down by state:

Zika-webtable-620x804

We’ve known for months that Zika, which has been ravaging our neighbors to the south, was headed for the United States as warmer weather approached. In fact, it’s already here — there are currently 472 confirmed cases of Zika in the continental US, though so far they are all travel-related. Including U.S. territories such as Puerto Rico, which is already being overwhelmed by the virus, so far 279 pregnant women have tested positive for the virus.

These new numbers, however, show just how great the risk is if the United States hits mosquito season unprepared. Preparation takes funding — which is necessary for basic research on the virus, to help develop a vaccine, and take preventative measures like providing mosquito nets and education campaigns about how to avoid getting bitten. Yet despite the clear and present danger, conservatives on Capitol Hill have dragged their feet, haggling over the finances.

Josh Earnest, White House Press Secretary, said, “The House of Representatives is three months late and more than a billion short of doing what’s necessary to protect the American people.”

This is typical of a Republican-led Congress.  They fail to do enough until it is too late, and then things get really expensive.

Disease Of The Week

It’s called dementia with Lewy’s Bodies, and Robin Williams.  So says his widow, citing the cause of his suicide.  It wasn’t depression that caused the suicide, so much as the dementia with Lewy’s Bodies which caused the depressions which caused the suicide.

I have to be honest here: Is attribution to a physical illness merely a way to make a mental illness more palatable?  Given the stigma against mental illness (which includes depression), you have to wonder if the family is trying to revive some honor to Mr. Williams.

Uninsured State By State

From tomorrow’s New York Times, this remarkable map shows the percent uninsured in each state under Obamacare.  The states which elected to expand Medicare coverage are outlined in bold, and you can see the difference.  Compare, say, Arkansas in 2015 to its southern neighbors which did not expand Medicare coverage.

ocarestatesbig

First Human Trials On An HIV Vaccine Start Today

Researchers may be one step closer to creating an HIV vaccine.

This month, the Institute for Human Virology at the University of Maryland School of Medicine in Baltimore launched the first phase of clinical trials for a new treatment. The immunogen, known as the Full-Length Single Chain (FLSR), could potentially induce protective antibody responses to HIV-1 strains, going where previous trial vaccines have fallen short.

And it only took three decades and millions of deaths.

Tales Of The One Percenters

Honestly.  What is it going to take for the people and/or the government to throw these rich bastards in jail?  No, not for being rich, but for, you know, breaking laws and regulations that effect the lives of actual people…. when?!?

Case Study Number One:

Volkswagen chief executive Martin Winterkorn resigned Wednesday as a growing scandal over falsified emissions tests rocked the world’s biggest carmaker.

“I am doing this in the interests of the company even though I am not aware of any wrongdoing on my part,” Winterkorn said after an emergency meeting with Volkswagen directors.

Winterkorn, 68, was Volkswagen (VLKAY) CEO for eight years. The German company, which also owns the Audi and Porsche brands, had just achieved his long-standing goal of overtaking Toyota (TM) to become the biggest automaker three years ahead of target.

But his position had looked increasingly precarious since the scandal broke Friday, when U.S. regulators said the company had deliberately programmed some 500,000 diesel-powered vehicles to emit lower levels of harmful gases in official tests than on the roads.

The crisis escalated Tuesday when Volkswagen revealed it had found significant emissions discrepancies in 11 million diesel vehicles worldwide.

Winterkorn, an engineer and former head of Audi, said he was stunned by the scale of the misconduct, and was accepting responsibility to clear the way for a “fresh start” for the company.

Stunned, my ass.  You don’t intentionally program an entire line of cars to “cheat” emissions tests without the CEO knowing about it.  So this guy straps on a golden parachute, and leaves Volkswagon.  But people die when these things are avoided:

Volkswagen has admitted that 11 million of its cars worldwide were designed to cheat emissions testing, in an escalating scandal that has loaded pressure on the wider motor industry.

Campaigners have long claimed engine emissions figures under laboratory tests are far exceeded in real-life conditions, and experts have said thousands of premature deaths could be averted by ensuring cars meet their legal limits.

Emphasis mine.

Case Study Number Two:

Hedge fund manager Martin Shkreli is 32 years old but he’s acting half that age on Twitter today after news broke that his company, Turing Pharmaceuticals, had raised the price of the life-saving drug Daraprim from $13.50 to $750 per pill.

That’s not a typo — $13.50 to $750.00 per pill.

Daraprim is used to treat toxoplasmosis, a condition caused by a parasite that exists in nearly a quarter of the U.S. population over age 12, but which can prove deadly for the unborn children of pregnant women and for immunocompromised individuals like AIDS patients. These vulnerable populations will now have to pay over 5,000 percent more for their treatment.

Due to the sudden price hike, Shkreli, whose company only acquired Daraprim last month, has already dethroned the dentist who killed Cecil the Lion as the most-hated man in America.

***

Shkreli did a news show circuit as well, beginning with Bloomberg, where he attempted to argue that Daraprim had been underpriced before Turing swept in.

“The price per course of treatment to save your life was only $1,000 and we know these days, [with] modern pharmaceuticals, cancer drugs can cost $100,000 or more, rare-disease drugs can cost half a million dollars,” Shkreli said, as if it should be shocking that cheap, life-saving medicine could cost less than a laptop.

When confronted by the reporter with the low cost of producing Daraprim—about $1 per pill by her estimate—Shkreli claimed that the price hike was necessary for Turing Pharmaceuticals to increase revenue, and that some of the profits would be funneled into research and development costs for a Daraprim alternative. But as Emory University infectious disease professor Dr. Wendy Armstrong told RawStory, “I certainly don’t think this is one of those diseases where we have been clamoring for better therapies.”

Why do one percenters get away with this?  Because they can:

But as reprehensible as Shkreli’s actions might appear, what is even more harrowing is that they are not illegal. With his social media swagger, Shkreli makes an easy target for a problem that extends far beyond the confines of his ego: the rampant overpricing of life-saving medicine. As USA Today reported, many new cancer drugs cost over $100,000 per year—a fact that Shkreli, ironically, sees as justification for raising the cost of Daraprim. And technically, there’s no way to stop him.

As a spokesperson for the Food and Drug Administration told The Daily Beast’s Ben Collins on Twitter in response to Shkreli’s actions, their power in this situation is, well, nonexistent.

An FAQ page on the FDA’s website asks, “What can the FDA do about the cost of drugs?” and the answer is, essentially, nothing: “We understand that drug prices have a direct impact on the ability of people to cope with their illnesses as well as meet other expenses. However, FDA has no legal authority to investigate or control the prices charged for marketed drugs.”

Martin_Shkreli__3449094bThis is true, but states have laws against gouging.  An industrious state Attorney General could make a name for himself on this.

In any event, Shkreli’s media blitz cast him in an even worse light — he came off as slimy and greasy as a used car salesman.  Just .look at his picture.  The latest news today is that Shkreli has agreed to reduce the price, although he will not say by how much.

He’s not the first person to corner the market on a drug and hike the price.  But he’s one of the most frequent offenders.  Fortunately, Bernie Sanders and Hillary Clinton have weighed in, and this could become a political hot potato.  Any chance for reform?  We’ll see.

 

Planned Parenthood, the Abortion Debate, and 2016 Elections

There is very little to recommend being over the age of 50, but one of the nice things is that it gives perspective and wisdom — the kind of experience that can’t be taught, but can only come from having lived several decades.

There is one thing I have learned – abortion rights are not going away.

notdifficultThat wasn’t always a certainty.  Roe v Wade was seriously challenged in the 1980s and 1990s, not only in the political arena, but also in the courts.  But that nadir of the conservative anti-abortion movement came in 1992, with the case of Casey vs. Planned Parenthood.  The Supreme Court was, like today, leaning conservative.  You had Scalia, you had Thomas, you had Alito, you had Rehnquist for crying out loud.  And they were handed, on a silver platter, a case in which Roe v Wade could have been overturned, or at least seriously curtailed.  The result was 5-4, with the conservatives losing.  The Casey case actually strengthened abortion rights.

Having lost in the legal arena, the anti-choice forces spent the next two decades challenging abortion in the political arena.  They have had some success there.  There was the Hyde Amendment, a legislative provision barring the use of certain federal funds to pay for abortion unless the pregnancy arises from incest, rape, or to save the life of the mother.  That was signed into law by Bill Clinton in 1993.  At the state and local levels, a hodgepodge of laws have restricted access to abortion through laws requiring waiting periods, mandatory ultrasounds, and over-regulation of abortion clinics (like requiring wide hallways).  But abortion itself remains legal.

The recent attempt to defund Planned Parenthood is probably the strongest national push against abortion since the Hyde Amendment.  It is quite obviously punitive in nature — since the Hyde Amendment already restricts federal funds to go to Planned Parenthood for abortions, the current legislative push seeks to defund Planned Parenthood of federal funds for everything else they do (cancer screening, etc.).  And why?  Because they sell “baby parts”, which of course is a crass and not-altogether-honest way of saying that Planned Parenthood provides fetal tissue to medical research facilities in the hopes of curing disease.  Conservatives want to kill Planned Parenthood (the largest abortion provider) even if it means killing women’s health.

Of course, this dovetails nicely into the “war on women” meme.  And Hillary Clinton is right to pound Republicans on this.  This issue was a gift to her — she was sagging in the polls and Bernie Sanders has been making a serious play for the nomination (coming within 8 points of Hillary in New Hampshire).  Now she can talk about women’s health, and the Republican efforts to kill it.

I am perplexed as to why Republicans want this debate.  They seems to care more about two-celled zygotes than million-celled actual women.  After they lost the 2012 Presidential elections, they performed an autopsy of their failures, which included statements like this:

When it comes to social issues, the Party must in fact and deed be inclusive and welcoming.

If we are not, we will limit our ability to attract young people and others, including many women, who agree with us on some but not all issues…

The RNC must improve its efforts to include female voters and promote women to leadership ranks within the committee. Additionally, when developing our Party’s message, women need to be part of this process to represent some of the unique concerns that female voters may have. There is growing unrest within the community of Republican women frustrated by the Party’s negative image among women, and the women who participated in our listening sessions contributed many constructive ideas of ways to improve our brand with women throughout the country and grow the ranks of influential female voices in the Republican Party.

But rather than do that, they seem to be doubling down on losing the women vote — going so far as to threaten a government shutdown.  At first I thought the talk of government shutdown was an empty threat, but maybe I am wrong.  Stan Collender at Forbes puts the odds of a government shutdown at 60% (up from his previous prediction of 40% ). Here’s his wonderfully descriptive way of saying what happened.

But the biggest change from last week in the odds of a government shutdown is because of the emergence of the one big thing that has been missing so far from the appropriations debate: a highly emotional, politically toxic and take-no-prisoners issue.

Even the front-runner in that contest right now – Donald Trump – declared his support for a government shutdown over Planned Parenthood. Any candidate who had doubts about whether or not a government shutdown would be good for their campaign will now have to weigh in with that in mind.  Also, we’ve already seen one example of a candidate making a mess of that when, in commenting about Planned Parenthood funding, Jeb Bush said yesterday that he was “not sure we need half a billion dollars for women’s health issues.” His campaign pretty immediately tried to walk that one back. Overall it’s very likely that, in order to win the GOP primary, these candidates will all wind up taking positions that their own autopsy suggested were one of the causes of their defeat in 2012.

The craziness of the high rhetoric of this 2016 election campaign is causing Republicans to shoot themselves in the face.  It is interesting to watch.

This Says It All

Obama Derangement Syndrome:

Atlanta resident Ted Souris, 62, describes himself as an “arch-conservative” who initially opposed the health law. He said he had mixed feelings about the ruling. He receives what he calls “a pretty hefty subsidy” to buy insurance — he gets $460 and pays $115 a month for insurance.

“I’m so against Obama, and I hate that he has any kind of victory,” Souris said, “but it’s nice that I don’t have to worry” about affording health coverage.

He said that he doesn’t like getting what he calls “a government handout” but that the law — and the subsidy — allowed him to retire early and still have coverage. “I am glad I have the Affordable Care Act, and I appreciate that I got the subsidy.”

These people just hate.  Hate Obama.  Even when Obama does things that are good for them.

I’m not saying it is racism, but whatever it is, it is a very strange pathology.

Obamacare Subsidies Upheld By SCOTUS

I’m actually not that surprised at the outcome.  The surprising thing was that the Supreme Court ever took this case in the first place.

But the US Supreme Court upheld the challenge to Obamacare.  The opinion is here.

In layman’s terms, the issue surrounded some (arguably) vague language in the Affordable Care Act relating to the federal government providing financial assistance to people who get Obamacare through their state exchange.  If you interpret the language one way, the federal government cannot provide financial assistance.  If you interpret it the way Congress intended it, then the federal government can provide financial assistance.  Without the federal government assistance, however, health insurance will become far too expensive for millions of people who buy it through their state exchange, and so they won’t buy it.  (In North Carolina, it would increase healthcare costs by over $300 per month).   In effect, it would end Obamacare.

So the question was actually quite simple…. did Congress intend to write a healthcare law that wouldn’t work?

Chief Justice Roberts wrote the opinion and the short answer to that question is….

CIWhRoVWsAAeoT0

Chief Justice Roberts did note that the ACA was a badly written piece of legislation.  (There are, he notes, three separate Section 1563s).

Scalia’s dissent is pure Scalia.  It refers to “interpretive jiggery-pokery” and calls the majority opinion “pure applesauce”.

CIWnz8RWoAARbz5

Elsewhere, he writes: “Impossible possibility, thy name is an opinion on the Affordable Care Act!”

He writes that the court “rewrites the law to make tax credits available everywhere… We should start calling this law SCOTUScare.” (that’s the first time “SCOTUS” has ever been used in a SCOTUS opinion).

He says: “Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”

And similarly: “[T]he cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

Talk about projection.  Scalia is the one with the obvious agenda and “favorites”.  That last comment is a pretty harsh attack on his colleagues, including the Chief Justice.

We should remember that Scalia didn’t give a rat’s ass about the clear language OR the legislative intent of the Voting Rights Act when he and his conservative colleagues gutted it, deciding unilaterally that it didn’t apply to today’s world, now that there isn’t racism any longer.

Roberts, by the way, took Scalia’s own dissent from the last major Obamacare case, and used it against Scalia.  It was buried in a footnote and amounted to a small dart lobbed Scalia’s way.  To defend making the subsidies available to consumers everywhere, Roberts cited a line the dissent to the 2012 decision in favor of Obamacare, in which Scalia said, “Without the federal subsidies . . . the exchanges would not operate as Congress intended and may not operate at all.”

Roberts used the line to argue that it “is implausible that Congress meant the Act to operate” in a manner to limit the subsidies only to those states with state-operated exchanges, as the challengers in King v. Burwell argued.

Other reax below the fold

Will America’s Uninsured Rate Go To Single Digits?

No major survey has ever found that the uninsured rate in America has hit single digits.  Ever.

But a new survey from the Urban Institute’s Health Reform Monitoring Survey, a quarterly survey of non-elderly Americans, says that 10.0% of nonelderly adults were uninsured.  That’s down from 17.8% in September 2013, before the Affordable Care Act’s insurance exchanges first launched.

And in fact, that data is only as recent as March 2015, so we are probably in the single digits now.

Let’s hope SCOTUS doesn’t screw things up now.

I Feel Bad For The Guy, But….

There are many angles about the story I am about to convey.

One might say it is a story about a guy out on his luck.  Another might say it is a story about the crappy healthcare system we have.  Or maybe it is about how Republicans talk about personal responsibility but then complain when they don’t get government handouts when they want it.  For me though, this is a story about a guy so entrenched in his Obama hatred that he screwed himself over (and yet he still blames Obama).  Anyway, you be the judge. From the Charlotte Observer:

Lang, a 49-year-old resident of Fort Mill, S.C., has bleeding in his eyes and a partially detached retina caused by diabetes.

“He will lose his eyesight if he doesn’t get care. He will go blind,” said Dr. Malcolm Edwards, the Lancaster, S.C., ophthalmologist who examined Lang.

Lang is a self-employed handyman who works with banks and the federal government on maintaining foreclosed properties. He has done well enough that his wife, Mary, hasn’t had to work. They live in a 3,300-square-foot home in the Legacy Park subdivision valued at more than $300,000.

But he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills.

That worked while he and his wife were relatively healthy. But after 10 days of an unrelenting headache, Lang went to the emergency room on Feb. 25. He says he was told he’d suffered several mini-strokes. He ran up $9,000 in bills and exhausted his savings. Meanwhile, his vision worsened and he can’t work, he says.

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Obama and Congressional Democrats for passing a complex and flawed bill.

Since Lang now has no income, he should be eligible for the ACA’s expanded Medicaid coverage, for which the federal government picks up tab. But Lang lives in Fort Mill, South Carolina. And South Carolina refused to accept Medicaid expansion. So he’s out of luck on that front too.

He now has a gofundme page to help raise some money for his medical expenses.

Okay.

That’s the story.  Now, he and his wife have decided to lay blame at ACA’s feet, so let’s play the blame game:

Let’s go through this point by point:

(1) Lang broke the law by refusing to get health insurance coverage because he prided himself on being able to pay his bills out of pocket.  ACA’s fault?  Verdict: No.

(2) He lost the health lottery and got sick.  That’s when he realized he actually had too little savings to cover even relatively small health care bills.  ACA’s fault?  Verdict: No

(3) By now open enrollment has closed. But he figured he’d be able to buy in if he got in a jam or wait till he got sick to buy coverage. Luckily the ACA’s Medicaid expansion covers him regardless. But the state of South Carolina refused to accept Medicaid expansion even though the federal government would pay for it. ACA’s fault?  Verdict: No (The US Supreme Court ruled that it could not be made compulsory on states to accept the Medicaid expansion, i.e., states had to opt in.  Most states did choose to opt in but the Republican legislature and governor of South Carolina said “no”.).

When all is said and done, Lang is left in precisely the situation that would exist if the ACA (aka Obamacare) had never been passed. So he blames… Obama?  It takes quite a lot of chutzpah to blame the Affordable Care Act for not covering him when he disdains government programs and never carried health insurance in the first place. If he thinks he should be covered now then he’s really asking for single payer, which he would probably call “socialist”.  Lang’s case shows the exceptional power of myths reinforced by Fox News-like partisanship and ideology.

Lead Paint And Inner City Violence

I’m just going to point to this comprehensive and insightful Washington Post article which talks about Freddie Gray (whose death while in Baltimore police hands sparked the recent riots there) and lead paint.  Like many inner city kids, Gray lived in sub-standard housing with peeling lead paint, and in his case, it specifically was blamed for ADHD and other problems.

It wasn’t long after that he was given the first of many blood tests, court records show. The test came in May of 1990, when the family was living in a home on Fulton Avenue in West Baltimore. Even at such a young age, his blood contained more than 10 micrograms of lead per deciliter of blood — double the level at which the Center for Disease Control urges additional testing. Three months later, his blood had nearly 30 micrograms. In June 1991, when Gray was 22 months old, his blood carried 37 micrograms.

“Jesus,” Dan Levy, an assistant professor of pediatrics at Johns Hopkins University who has studied the effects of lead poisoning on youths, gasped when told of Gray’s levels. “The fact that Mr. Gray had these high levels of lead in all likelihood affected his ability to think and to self-regulate and profoundly affected his cognitive ability to process information.”

Levy added, “And the real tragedy of lead is that the damage it does is irreparable.”

This isn’t unusual, and any discussion of violence in the inner cities needs to consider this as a factor.

NAMI On the Germanwings Air Crash

Reprinted in full:

NAMI shares the grief of the rest of the world over the crash of Germanwings Flight 9525.  We extend our condolences to the families of those who lost their lives in this senseless tragedy.

As often happens in tragedies, information emerges first through an immediate frenzy of reporting in news media and then through more careful analysis. It is always best not to speculate on causes, but to wait until all facts are confirmed and assessed.

In this case, as news cycles have progressed, we’ve been told that the co-pilot who crashed the plane had some history of depression. Most recently, a German prosecutor has reported that he had “received psychotherapy for an extended period of time, during which suicidal tendencies had been noted,” while the airline has reported in 2009 he had disclosed to them a previous episode of severe depression. Treatment apparently occurred before he received his pilot’s license.

He also apparently was being seen for one or more other medical issues. How relevant those factors actually are remains to be seen.

We know that by crashing the plane, the co-pilot killed himself, along with 149 other people.

We know that most suicides involve mental illness.

In the United States, approximately 40,000 people die from suicide each year.  Obviously, we are falling far too short in suicide prevention.

Typically, suicide involves a struggle between a person and his or her own psychological problem. Murder-suicides are very rare. Murder-suicides conducted by commercial airline pilots are even rarer—extremely rare—although that of course is no consolation to the victims of Flight 9525, their families and friends.

People living with mental illness are rarely violent. Usually, mental illness is only one factor, among several, if not many, that set the stage for violent tragedies.

In the case of Flight 9252’s co-pilot, the fact is that we don’t know his full history yet. We may never know every relevant fact. His precise history of depression, whatever it may have been, may ultimately be seen as unimportant compared to other issues in his life.

Please keep that point in mind as the global conversation now turns to whether anyone who experiences mental illness should be allowed to serve in certain occupations or professions. Mental illness is treatable. People do recover.

Senseless tragedies must not be allowed to resurrect or perpetuate stigmatizing stereotypes that associate anyone with a history of mental illness with a propensity to violence. It will be an additional tragedy if the crash of Flight 9525 leads to “witch hunts” in which people who have sought help for mental illness become unfairly discriminated against.

Sixteen million American adults—almost 7 percent of the population—had at least one major depressive episode in the past year.  When depressive symptoms occur, people need to see a doctor for a comprehensive examination. Underlying medical issues that can mimic a depressive episode, side effects from medications or any other medical causes must first be ruled out, before a treatment plan is chosen.

As a society, we need to create a cultural environment in which people are encouraged to seek help when they need it—regardless of whether it is a mental illness or any other illness.  No one should have to hide out of fear of negative consequences or reprisals such as loss of employment or social ridicule.

We want a society that affirms the worth of every individual—the same kind of affirmation that causes us to mourn the loss of so many precious lives on Flight 9525.

Today Is World Bipolar Day

wbdAccording to the World Health Organization (WHO), there are 450 million people globally with mental illness; of that number, 5 percent are labeled bipolar, which is three times all cases of diabetes and 10 times all the cases of cancer. Bipolar is the sixth leading cause of disability, according to WHO.

“Bipolar Disorder is a mental illness that represents a significant challenge to patients, health care workers, family members and our communities,” according to a press release from World Bipolar Day organizers. “While growing acceptance of bipolar disorder as a medical condition, like diabetes and heart disease, has taken hold in some parts of the world, unfortunately the stigma associated with the illness is a barrier to care and continues to impede early diagnosis and effective treatment.”

So how do we break down barriers and dispel myths and mistruths? Enter World Bipolar Day.

March 30 is the birthday of Vincent Van Gogh, the famous painter who cut off his own ear and was posthumously diagnosed with probable bipolar disorder, also known as manic depression. Dr. Pichet Udomratn, a member of the Asian Network of Bipolar Disorder (ANBD) who worked with with International Bipolar Foundation (IBPF) and International Society for Bipolar Disorders (ISBD) to create World Bipolar Day, thought March 30 would be a fitting day to bring the world information about a highly stigmatized and feared mental illness.

For more information on World Bipolar Day and how you can get involved, visit the cause’s Facebook page or follow the event on Twitter @WorldBipolarDay.

Don’t Blame Depression

This is in Forbes, so I don’t have to write it:

You saw a depressed person today. Probably dozens or hundreds of them.

They drive cars. They perform surgery.

They fly planes — and safely land them.

Of course, that’s been frequently forgotten since last week’s devastating Germanwings tragedy.

Many pundits quickly blamed the horrific plane crash on depression, noting that co-pilot Andreas Lubitz — who took control of the Germanwings airliner and steadily, deliberately flew it and his 149 fellow passengers into the Alps — was reportedly treated for depression and possessed a supply of antidepressants.

The argument came from know-nothing pundits like Piers Morgan. “Depressed pilots on medication for mental illness should not be flying passenger planes,” he declared. If they’re not pulled from the skies, he added, “it could be any one of us next.”

The supposed link was blared across European newspaper headlines, too.

Even the experts weren’t sure.

“Should a depressed pilot be allowed to fly?” wrote Dr. John Grohol, the founder & CEO of Psych Central.

“I’m not sure someone who has a lot of responsibility should be going into work on days where they’re dealing with this kind of emotional upset or sadness.”

On one count, Grohol’s right: there do need to be some basic protections. (That’s a key reason why the FAA has been incredibly restrictive when letting pilots return from treatment for depression, as Forbes writer David Kroll notes.)

And there is a possible link between depression and violence, at least in some cases.

For example, a recent Oxford University study reviewed 50,000 Swedish citizens diagnosed with depression, concluding that people who were diagnosed with depression tended to commit more violent crimes too.

“Our findings suggest that the odds of violent crime are elevated two to three fold after adjustment for familial, socioeconomic, and individual factors,” the researchers wrote in TheLancet Psychiatry in February.

But blaming a person’s depression for his evil acts is ridiculous.

For instance, the Oxford researchers noted that when accounting for other factors — like a previous history of violence, substance abuse, or psychosis — the elevated rate of violence among depressed was notably smaller. And it’s possible that “depression” was over-diagnosed in these people, too.

Mental health experts further stress: Depressed people may be suicidal, but almost never homicidal. The suicide rate in the United States is roughly double that of the homicide rate.

That’s why one of the most important public health efforts of the past few decades has been the effort to de-stigmatize depression — especially because it’s so widespread. Depression strikes up to 20% of Americans across their lifetimes, the Anxiety Disorders Association of America has found.

For the moment, depression is seen as a debilitating, but not disabling condition. “Depression made me do it” isn’t an acceptable excuse for doing a poor job at work, and can’t get you out of a legal bind.

And it doesn’t explain what happened in the case of Germanwings, as Lubitz horribly plunged a plane of screaming passengers into the Alps, acting with chilling evil.

If you believe the tale told by an alleged ex-girlfriend, the plane crash was chillingly planned for months; Lubitz supposedly wanted the world to know his name.

“I don’t know what that is,” psychiatrist Anne Skomorowsky wrote at Slate, “but it’s not depression.”

Ask one of the 10 million-plus Americans who are seriously depressed at any given time. The bravest among them will admit: Depression is devastating. It makes you self-loathing, and lays you low.

But it doesn’t make you a murderer.

See also: “Would We Be ‘Blaming’ Cancer for the Deaths of Those People Who Perished in the Alps?” at HuffPo

I would add that we shouldn’t blame bipolar disorder either.  That is being bandied about as the culprit because he was prescribed strong SSRIs and anti-psychotic medicine.

Don’t get me wrong… I think it is clear that he suffered from some mental illness.  He may have had bipolar disorder or depression, but these would only explain the suicide, not the 149 homicides.  Some have suggested narcissistic personality disorder, which is characterized by (among other things) indifference toward others and grandiosity (Lubitz reportedly said he wanted to “change the system”).  Perhaps that is true.

But the danger here is linking his illness to the tragedy.  I know people who have struggle with depression.  I know people who have been diagnosed bipolar.  And people who have NPD/borderline.  None of them are likely to become homicidal.  This tragic event, like some school shootings, could become a good teaching moment for mental illness — to explain both the frequency and severity and the wide range of problems it causes (homicide being extremely rare)  But instead, the media focus will merely add to the already-existing stigma of mental illness, causing fewer people to seek treatment, or deny their illness altogether.  And that would add to the tragedy.

Stigmatization Of Mental Illness Begins

It’s an explanation, not an excuse.

By the way, it bears mentioning that if there were no stigmatization of mental illness, the copilot would not have felt the need to hide his condition, and could have gotten the help he needed, thus saving 150 lives. But you can bet the media won’t take that angle.

The Cheap Wine You’ve Been Drinking May Contain Too Much Arsenic

That’s the allegation in a lawsuit (read the complaint here — PDF) filed in California this week.  The origins of the lawsuit draw back to Kevin Hicks, a former wine distributor who started BeverageGrades, a Denver-based lab that analyzes wine. The lab tested 1,300 bottles of California wine, and found that about a quarter of them had higher levels of arsenic than the maximum limit that the Environmental Protection Agency allows in water.

Now, it is important to keep in mind that this is a lawsuit, and it is entirely possible that this is essentially a nuisance lawsuit — one contrived by ambulance-chasing lawyers in order to get a quick shakedown of the wine companies involved, hoping that the companies would rather see this go away quickly than have to put up with years of bad publicity (even if they are vindicated in the end).  So take that into account. But in the meantime, below the fold is a list of wines that are included in the lawsuit. (Note: Any wines without a specific year listed mean that the grapes don’t come from a single year.)

Taking Anti-Vaxxing To The Next Level

It’s one thing to say that measles vaccinations are harmful (they’re not), but it is entirely different to say that measles don’t exist at all.  Yet, one German pseudoscientist did, going so far as to put his money on it.  He lost:

This is something I thought would probably never happen – a science denier, in this case German virologist Stefan Lanka, was ordered by a court to pay 100,000 Euros to German doctor David Barden for meeting his challenge to prove that the measles virus exists.

Lanka is clearly, in my opinion, a crank, which is a specific flavor of pseudoscientist who makes sophisticated arguments to support a hilariously wrong conclusion. There is some major malfunction in their scientific reasoning. Typically, in my experience, they have an oversized ego and think they know better than the rest of the scientific community. For some reason an extreme narrative gets stuck in their brain, and they spend their career marshaling evidence and arguments to support a nonsensical idea. I find cranks endlessly fascinating because I think they are extreme cases that reveal major weaknesses in the operation of the human brain.

One favorite tactic of cranks and deniers is to issue an open challenge to prove what they deny exists. I think this strategy is inspired by the Randi Million Dollar Challenge, which is a legitimate challenge for anyone to prove a paranormal phenomenon. Randi has a specific process spelled out, with concrete criteria for success.

Hoax challenges are pure publicity stunts – they sound grandiose but typically are framed in such a way that the one issuing the challenge can wiggle out of ever having to pay. They are rigged from the beginning, mainly by not spelling out what kind of evidence would meet the challenge.

I guess Lanka got a little sloppy. He issued a 100,000 Euro challenge to anyone who could prove the measles virus exists. That’s right – the measles virus. Lanka is an HIV denier from back in the 1990s (and still denying HIV). HIV denial is the claim that AIDS does not exist as a discrete medical illness, or at least is not caused by a specific virus, and in fact the human immunodeficiency virus does not really exist.

***

That a court has now demanded that Lanka pay Barden the reward for meeting his challenge is an interesting twist. Barden pulled together published scientific evidence that together proves beyond a reasonable scientific doubt that measles is real. Lanka, of course, denied the evidence. That is what he does. You will never meet his burden of evidence to prove the thing that he denies, which is what makes such challenges from deniers a hoax.

However, Barden went to the courts to settle their dispute. The court, unlike Lanka, has apparently applied a reasonable standard for scientific proof and determined that Barden did indeed meet the burden of proof to demonstrate that measles is real. Lanka, of course, will appeal, and there is always the possibility that he will wiggle out of the judgment on legal grounds (rather than the merits of the case).

Study: Selfish Anti-Vaxxing Parents Facilitated Measles Outbreak

L.A. Times:

Although epidemiologists have not yet identified the person who brought measles to Disneyland, a new analysis shows that the highly contagious disease has spread to seven states and two other countries thanks to parents who declined to vaccinate their children.

Using some simple math, a team of infectious disease experts calculated that the vaccination rate among people who were exposed to the measles during the outbreak was no higher than 86%, and it might have been as low as 50%.

In order to establish herd immunity, between 96% and 99% of the population must be vaccinated, experts say.

“Even the highest estimated vaccination rates from our model fall well below this threshold,” the researchers reported Monday in the journal JAMA Pediatrics.

… In other words, the only way to explain how the measles spread from a single person at Disneyland to 145 people in the U.S. and about a dozen others in Canada and Mexico is that a substantial number of parents have not had their children fully immunized with the measles, mumps and rubella vaccine.

“Clearly, MMR vaccination rates in many of the communities that have been affected by this outbreak fall well below the necessary threshold to sustain herd immunity, thus placing the greater population at risk as well,” the researchers concluded.

Fortunately, there are bills in the California legislature (and hopefully in other states as well) to make it harder for parents to “opt-out” their kids.

Why My Plans To Retire In Costa Rica Are Looking Better

Because of this:

Exactly five years ago this week, as the Congressional debate over the Affordable Care Act was coming to its eventual conclusion, Rush Limbaugh made a bold statement about his future as a resident of the United State of America.

Speaking to a caller who expressed concerns about the impact of Obamacare on the U.S. healthcare system, Limbaugh said, “If this passes and it’s five years from now and all that stuff gets implemented, I am leaving the country. I’ll go to Costa Rica.”

He’s still here in the U.S.  Maybe he was just saying stuff.

Whew!

Do We Have A Contender For Michelle Bachman’s Replacement?

MichelleFioreNevada Republican assemblywoman Michelle Fiore made a bit of name for herself when she was quoted in the New York Times saying that “hot little girls” on campus need guns to protect themselves against rapists.  She did not say what ugly large girls should carry.  This was all in connection with a bill she sponsored that would allow firearms onto college campuses (because what could possibly go wrong with that?)

Now she is telling her constituents that cancer is a fungus that can be flushed out with salt water and baking soda.

Yes, she really said that.

Gonna keep an eye on this one…..

P.S.  The more you know….

The Vaccination Debate Makes For An Interesting Political Wedge Issue

Of the potential 2016 presidential candidates on the GOP side, we have Christie and Rand Paul cuddling up with the anti-vaxxers (spouting “freedom” in their answers when asked about whether parents should vax)

And then we have one of the most conservative Christian candidates out there, Dr. Ben Carson, who seems to be the voice of reason on this issue:

“Although I strongly believe in individual rights and the rights of parents to raise their children as they see fit, I also recognize that public health and public safety are extremely important in our society,” Carson said in a statement to BuzzFeed News.

Carson said diseases of the past should not be allowed to return because of people avoiding vaccines on religious or philosophical grounds.

“Certain communicable diseases have been largely eradicated by immunization policies in this country and we should not allow those diseases to return by foregoing safe immunization programs, for philosophical, religious, or other reasons when we have the means to eradicate them,” Carson said in the statement.

Well, duh.

[UPDATE 2/4/15 — Looks like I gave Carson too much credit.  He stands by his statement, but he blames “undocumented people” for outbreaks (despite the fact that countries in Central and Southern America are better about vaccinations than we are.]

This isn’t a battle the Republicans want to have. This shouldn’t be one of those issues where you have to reflexively oppose whatever Obama or Clinton says, and the potential Republican candidates do this at their peril. The GOP is already thought of as the anti-science party. If Republican leaders are questioning the efficacy of vaccines, they’re going to double down on that label, alienating many of the moderates they need in 2016.

By the way, there is some interesting data on who supports/opposes vaccinations.  According to a YouGov survey, support for mandatory vaccinations for “childhood diseases like measles, mumps, whooping cough” is inversely correlated with age. Under-30s actually oppose it by a 42/43 margin, while those 30-44 support it 50/37; 45-64-year-olds support it 64/26, and seniors support it 73/21.

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I think the reason for this is quite simple: younger people are…. well, not stupid…. but ignorant.  They simply grew up in a time when these diseases had been eradicated for the most part.  They are going from their own blind lack of experience and firsthand knowledge.  They think of things like pro-choice and freedom, and apply it to this situation, without really knowing the history or facts.

The Problem With Libertarianism

Libertarianism (Latin: liber, “free”) is a political philosophy that upholds liberty as its principal objective. Libertarians seek to maximize autonomy and freedom of choice, emphasizing political freedom, voluntary association and the primacy of individual judgement.

For months, nay, years, I have been wanting to write about the shortfalls of libertarianism.  It’s been difficult because who in America, other than outright fascists, would argue with liberty and freedom of choice?

But finally FINALLY we have an illustrative example come to the fore.  And I’ve been blogging about it recently (a lot) and now I can make a simple tie-in without expending too many words.

Let’s go to the money quote from libertarian extraordinaire and 2012 Presidential candidate, Ron Paul:

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On Monday, Rand Paul, the son, hedged a little:

Paul was asked to weigh in on vaccines, after New Jersey Gov. Chris Christie (R), a likely rival for the GOP nomination in 2016, said Monday morning that there should be “some measure of choice” for parents leery of vaccinating their children.  “I’m not anti-vaccine at all, but most of them ought to be voluntary,” Paul, an ophthalmologist, said Monday on the “Laura Ingraham Show,” in a segment circulated by the Democratic National Committee along with criticism of Paul’s views.

UPDATE:  Later that day, Rand Paul was asked a follow-up, and said this with respect to vaccines:

I think they’re a good thing but I think the parent should have some input. The state doesn’t own your children; parents own the children and it is an issue of freedom.

Huh. So parents own their children (that’s libertarian?!?) and not only have the “freedom” to expose their property to deadly illnesses, they have the freedom to expose your kids to deadly illnesses.

The thing is — and I certainly can see why the anti-vaxxers hate this — IT TAKES A VILLAGE to get rid of some of these diseases.  All or most children had to be vaccinated before measles made its disappearance and the beginning of this century.  The same can be said for many more diseases.

The same holds true for other areas of human endeavor — the economy for example.  Libertarians think the self-interest and the invisible hand of Adam Smith will take care of everything.  Nope:

Neighborhoods, communities, villages, cities, societies — depending on the situation — can succeed and improve the quality of life where “individual freedom” cannot.  Does that mean socialism and communism is the way to go?  Of course not.  But libertarianism — the polar opposite of socialism and communism — is just as ineffectual for most things.

There is a balance between individual rights and the common good. This should be obvious, but hardcore libertarians seem to believe that the mere assertion of a right is sufficient to end a public argument. It is not, when the exercise of that right has unacceptable public consequences, or when the sum of likely choices is dangerous to a community.

Turning to the issue at hand, vaccines provide protection through two means.  The first is direct protection.  I get a shot for something and the probability of me getting that particular disease declines dramatically as my immune system now knows how to fight that type of invader.  The second is indirect protection via herd immunity.   If I get a shot, I go from being a possible vector and transmitter of a disease to another unvaccinated person to a very low probability of passing the disease along.  Herd immunity only works when the vast majority of the population already is immune to a disease as the probabilities of a current carrier bumping into a receptive individual is fairly low if the general population is overwhelmingly vaccinated.

So the point of vaccinations is to protect not merely ourselves, but the community. To not vaccinate is to threaten the array of trillions of antibodies and T cells that decades of vaccination have built up in our bodies/  We drape a web of germ-fighting agents not just in ourselves, but around our most vulnerable neighbors. To not vaccinate is to affirm an overweening individuality. It’s a form of selfishness.

community_immunity.0

The best results come when everybody does what is best for themselves and for the group.  Adam Smith was wrong.  So are Ron and Rand Paul.  And the anti-vaxxers.

World’s Worst Doctor

There’s always one.  No matter what hair-brained position you take, you can always find an “expert” to add alleged credibility.

This time the “expert” is Jack Wolfson.  He’s being embraced by the loons because he’s a doctor AND an anti-vaxxer.  Here’s the thing to keep in mind — he’s a cardiologist.  That means he knows as much about vaccines as a proctologist knows about muscle degeneration.  Weigh his medical views against literally tens of thousands of academics and doctors who actually study and practice in this field.

Anyway, here’s a little of his drivel:

“Measles isn’t a big deal”, he said, though the CDC definitely disagrees. “This quote-unquote ‘outbreak’ has infected 70 people who are quote-unquote ‘infected,’ ” he said. “This is a country of 300 million people, and no one has died, and no one is sick as far as I know. We are all worried, and we are all getting crazy, and what we’re talking about is really just a fever and a rash.”

Uh, Mr. quote-unquote doctor?  It IS an outbreak. There have been over 80 102 people identified as of two days ago.  And what’s more, as the same article notes, that in YOUR state (Arizona), as many as 1,000 people, including 200 children, have potentially been exposed to the disease, and seven are infected.

No, it isn’t that black plague, but there was a point in history when there were only 80 people infected with the black plague.  That wasn’t a big deal at the time either.

What’s interesting/scary about the guy is that he doesn’t deny that vaccines prevent measles, mumps, rubella, chicken pox, etc.  He just thinks children have the “right” to contract these potentially life-threatening illnesses.  He says:

“I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years…. That’s the best way to protect.”

Except it is not.  It is just another fad diet, one that nutritionists reject.  In fact, in 2012, a panel of experts reviewed 36 different diets for their weight loss and health (nutrition) value.  Guess what came in last?  The paleo diet, mostly because it was unsafe.

But morons will be morons.  Even with a DR in front of their name.

*******

Also, this:

Video of Kristiana Coignard’s Summary Execution

As I posted a few days ago, police in Longview, Texas, tragically shot and killed a 17-year-old girl last week.  Her name was Kristiana Coignard.

In the newly released video, it’s clear that her shooting death was completely and totally avoidable.

After speaking with officers and roaming around the lobby of the police station for ten minutes, Kristiana, who was struggling with mental illness, was subdued by an officer in the lobby until two additional officers entered.

After Kristiana clumsily charges at the original officer, he shoots and kills her instantly.  We’ve been told she was “brandishing” a knife.  I don’t see it, but (for now) we’ll take the officers word on that.

Even then, a lot of questions come to mind: Why did he not handcuff her earlier in the minutes he had her subdued? Why did he not search her for weapons earlier? Why did he not Taser her with a stun gun? Why did he not use pepper spray? Why did he not simply grab her and subdue her again? Why did he not throw a chair at her, run from her, ANYTHING?

This cannot and should not be the best practice for police officers.  Firing your weapon should be the LAST RESORT.  I’m pretty sure it used to be. If this is all our officers are trained to do, it’s insufficient.

What Is Grubergate And Why You Shouldn’t Care

Republicans think they’ve just happened upon a major moment in the never-ending political debate over Obamacare: Newly discovered video of White House consultant Jonathan Gruber’s controversial comments about the passage of the law.

In the video, from 2013, Gruber suggests the details of the law were obscured in order to assure its passage. He says the bill relied on the “stupidity of the American voter” and a “lack of transparency.” Pretty damning stuff.

Republicans, naturally, think they just might have this goose cooked now, with the Post’s Robert Costa quoting Rep. Jim Jordan (R-Ohio) calling Gruber’s comments a potential (for lack of a better term) game-changer — one that could finally help turn public sentiment against Obamacare for good and assist the GOP’s efforts to dismantle it.

“We may want to have hearings on this,” Jordan told Costa. “We shouldn’t be surprised they were misleading us.”

But while it’s clear this is hardly Obamacare’s proudest moment, the idea that Gruber’s comments will suddenly swing public sentiment against Obamacare is wishful thinking.  That’s because any damage Gruber did — ultimately — was to himself, and nobody knew who he was before last week.

What did Gruber actually do?  In The West Wing terms, it is the classic Washington scandal — get into trouble for telling the truth.  In a city where it is a cliche not to show how the sausage is made, Gruber was exposing something sordid yet completely commonplace about how Congress makes policy of all types: Legislators frequently game policy to fit the sometimes arbitrary conventions by which the Congressional Budget Office evaluates laws and the public debates them.

Indeed, when Gruber discusses the ignorance of American voters in the video clips, no political scientist who knows even smidgen about American public opinion would have raised an eyebrow. This isn’t because political scientists look down on voters; it’s because they have surveyed voters repeatedly and discovered that rational ignorance is this is just the way it is.

But stating that most voters are uninformed about most things is one of those rude utterances that one just does not say in polite political company. People can say it behind closed doors, or at academic settings, but never on camera.

Gruber, unknowingly, said it on camera. That’s his sin. And I suspect it’s a sin that countless social scientists have committed at myriad conferences over the years.

But Obama didn’t say it, and it doesn’t change what Obamacare is, or how we, as a country, are benefiting from it.

Nor will it lead to Obamacare’s downfall, despite the zeal of many conservative pundits who think this is THE “smoking gun”.  That’s because Gruber’s comments, while damning, aren’t exactly the most fertile political territory. While “stupidity of the American voter” is a pretty strong soundbite, Gruber’s connection to the law takes some explaining. And most people — apart from those who already decided the efficacy of the law years ago — are really keen on the latest Obamacare debate a week after the 2014 election.

Changing public opinion on something like this, five years hence, takes a lot — especially when the support and opposition have been baked in for so long at pretty constant levels.

If anything can change that, it is far more likely to be something that has a personal impact on lots of Americans — like large premium increases or canceled plans. And if Obamacare is dismantled, it will be because the GOP has Congressional majorities and a president who wants to do it.  That means no earlier than 2017.

Suicide – Brave Or Cowardly?

A person from my past had issues.  She was diagnosed with Bipolar I, which they don't diagnose unless you have psychotic episodes, which she claimed to have had.  I never witnessed any (I don't think); in fact, what I witnessed mostly was the depressive side of her bipolarity, which included a suicide attempt or two.

In that depressive state, we would often talk about her situation (sometimes, it seemed like that was all we talked about), and she would occasionally talk matter-of-factly about killing herself, listing the people who would be "better off" if she wasn't alive (including her daughter).  Her rationale made no sense, but… that's the nature of the being bipolar: the perceptions of a bipolar person are usually wrong, even when (especially when) they feel so so right to the bipolar person.  When you are bipolar, you can't trust how you feel.  Which must be very difficult.

One of arguments she liked to make was that committing suicide was a very brave thing to do.  I didn't take a contrary position, although I know what she was responding to — that old chestnut you often hear that people who commit suicide are "cowardly".  They are afraid to face their difficulties, the myth goes, so they do the "cowardly" thing by ending it all.  My ex's point was just the opposite: it takes chutzpah, gonads, bravery to end it all.

i am reminded of those conversations now that question had been raised again in the public conscience, in light of the recent and tragic Robin Williams suicide.  Was Robin Williams cowardly for "checking out"?  

My answer is the same as always.  Of course he wasn't cowardly.  But I wouldn't agree to call him brave.  Not everything that happens falls on that scale.  He was sick.  His depression had control over him.  He couldn't help it.  So the answer is "neither" and the debate itself is silly.

The same goes for the question of whether suicide is "selfish".  Yes, of course suicide is selfish, but not in the perjorative sense that we usually mean when we say "selfish". After all, depression is selfish — is there ever a time when a person is more self-indulgent and self-involved than when he or she is depressed?  So of COURSE a person attempting suicide is selfish — he/she is in pain.  Just as much pain as if shot with a bullet.  

But all you can say is that they were "selfish", then you are missing the larger point.  What MADE them selfish?  It's NOT a character flaw, but more likely (and certainly in the case of Robin Williams), a mental illness known as depression or bipolar disorder or something along those lines.  The selfishness is incidental to the illness.  Calling them selfish, even if it happens to be true, only serves to malign and stigmatize those with a mental disorder.  It's turning a sickness into a callous act of blaming the victim.

Why do that?

The Cost Of Obamacare Repeal

The GOP wants to run on repealing Obamacare in the upcoming elections?  How will that play at the state level?  A new Department of Health and Human Services report documents the impact federal subsidies under Obamacare are having on the insurance costs of people receiving them, and the Plum Line gives the bottom line:

But if subsidies were repealed, people would not lose coverage, instead seeing premiums jump from loss of the tax credit.

– In North Carolina, 357,584 people are paying an average monthly premium of $81 — and repeal would result in an average monthly loss of subsidies/cost increase of $300.

– In Michigan, 272,539 people are paying an average monthly premium of $97 — and repeal would result in an average monthly loss of subsidies/cost increase of $246.

– In New Hampshire, 40,262 people are paying an average monthly premium of $100 — and repeal would result in an average monthly loss of subsidies/cost increase of $290.

– In Louisiana, 101,778 people are paying an average monthly premium of $83 — and repeal would result in an average monthly loss of subsides/cost increase of $314.

– In Iowa, 29,163 people are paying an average monthly premium of $108 — and repeal would result in an average monthly loss of subsidies/cost increase of $243.

– In Alaska, 12,890 people are paying an average monthly premium of $94 — and repeal would result in an average monthly loss of subsidies/cost increase of $413.

– In Georgia, 316,543 people are paying an average monthly premium of $54 — and repeal would result in an average monthly loss of subsidies/cost increase in premiums of $287.

Let that be known.

UPDATE: Apparently, the courts are doing it for the GOP.  This morning, the D.C. Circuit court (the most conservative of the circuit courts) ruled in a case called Halbig v. Burwell.  Here is the D.C. Circuit Halbig ruling:

A federal appeals court dealt a huge blow to Obamacare on Tuesday, banning 
the federal exchange from providing subsidies to residents of the 36 states it serves.

A divided three-judge panel on the D.C. Circuit Court of Appeals ruled that the text of the Affordable Care Act restricts the provision of premium tax credits to state-run exchanges. The two Republican appointees on the panel ruled against Obamacare while the one Democratic appointee ruled for the law.

"We conclude that appellants have the better of the argument: a federal Exchange is not an 'Exchange established by the State,' and section 36B does not authorize the IRS to provide tax credits for insurance purchased on federal Exchanges," Judge Thomas B. Griffith wrote for the court in Halbig v. Burwell.

His ruling was joined in a concurring opinion by George H. W. Bush-appointed Judge A. Raymond Randolph, who said it would be a "distortion" to let the federal exchange provide subsidies. "Only further legislation could accomplish the expansion the government seeks," he wrote.

Carter-appointed Judge Harry T. Edwards voted to uphold the subsidies.

"This case is about Appellants’ not-so-veiled attempt to gut the Patient Protection and Affordable Care Act," Edwards wrote in his dissenting opinion.

The ruling is very troubling for the Obama administration because the subsidies are critical to the success of Obamacare. The law encourages states to build their own exchange, but if they don't the federal government operates one on their behalf. The subsidies, or premium tax credits, exist to help Americans between 133 percent and 400 percent of the poverty line buy insurance. That imperils the practicality of the individual mandate to get covered and the market regulations to protect sick people.

UPDATE #2:  Fourth Circuit to the rescue.  A few hours after this morning's D.C. Circuit case, the also-conservative Fourth Circuit comes out with an opinion in King v. Burwell, which goes in the other direction and upholds the subsidies in Obamacare.  The opinion is here.

Money quote:

No case stands for the proposition that literal readings should take place in a vacuum, acontextually, and untethered from other parts of the operative text; indeed, the case law indicates the opposite. National Association of Home Builders v. Defenders of Wildlife, 551 U.S. 644, 666 (2007). So does common sense: If I ask for pizza from Pizza Hut for lunch but clarify that I would be fine with a pizza from Domino’s, and I then specify that Iwant ham and pepperoni on my pizza from Pizza Hut, my friend who returns from Domino’s with a ham and pepperoni pizza has still complied with a literal construction of my lunch order. That is this case: Congress specified that Exchanges should be established and run by the states, but the contingency provision permits federal officials to act in place of the state when it fails to establish an Exchange. The premium tax credit calculation subprovision later specifies certain conditions regarding state-run Exchanges, but that does not mean that a literal reading of that provision somehow precludes its applicability to substitute federally-run Exchanges or erases the contingency provision out of the statute.

UPDATE #3:  I didn't realize this before, but the DC Circuit opinion was en banc.  It was not the full circuit.  Therefore, the 4th Circuit "wins" out for now.  The Obama administration is appealing the DC Circuit opinion to the full DC Circuit.

Ripple Effect

Among the dead in the Malaysian Air shootdown — about 100 people from the World Health Organization going to an AIDS conference.  According to the Associated Press, the exact number of individuals who were killed on their way to the conference is unconfirmed. However, Australian officials have noted that “there is no doubt it’s a substantial number” that includes “medical scientists, doctors, people who’ve been to the forefront of dealing with AIDS across the world.”

Go On Offense

Just a week ago, things looked bleak for Democrats and Obama for 2014. But then thePaul Ryan Vanity Project collided with 7 million new signups under the Affordable Care Act, and now the Democrats have the makings of a winning ticket for this year:

Go on offense.

One of Karl Rove’s basic tenets of politics was to attack from your area of weakness. In the same vein, Congressional Democrats and Barack Obama need to treat the next seven months as a sprint, an all-out attack campaign against their GOP opponents, day in and day out to push the GOP on defense for having no solutions except to throw millions off their health insurancehurt the vulnerable, and protect corporations and the wealthy. Democrats and the White House should aggressively push the ACA, attack the Ryan budget, and tar the GOP as whores for the Koch Brothers, end of story. Hammer the message every day without apology.

And watch these poll numbers go even higher. Go for broke and double down, instead of crawling into a hole.

The Hobby Lobby Case

Justice Anthony Kennedy, on whose vote the Hobby Lobby SCOTUS case rests, seems very concerned about the government forcing corporations to cover abortion:

WASHINGTON, DC — Justice Anthony Kennedy thinks gay people are fabulous. All three of the Supreme Court’s most important gay rights decisions were written by Justice Kennedy. So advocates for birth control had a simple task today: convince Kennedy that allowing religious employers to exempt themselves from a federal law expanding birth control access would lead to all kinds of horrible consequences in future cases — including potentially allowing religious business owners to discriminate against gay people.

Kennedy, however, also hates abortion. Although Kennedy cast the key vote in Planned Parenthood v. Casey upholding what he called the “essential holding of Roe v. Wade,” he’s left no doubt that he cast that vote very grudgingly. Casey significantly rolled back the constitutional right to choose an abortion. And Kennedy hasn’t cast a single pro-choice vote in an abortion case in the last 22 years.

So Hobby Lobby and Conestoga Wood, the two companies claiming that they should be exempt from the birth control rules had an ace in their pocket as well. Their path to victory involved convincing Kennedy that their cases are really about abortion — and it looks like Kennedy convinced himself of that point on his own.

It was clear from the get go that the Court’s liberals understood that their best course involved highlighting the dangerous consequences of a victory for Hobby Lobby. Paul Clement, the de facto Solicitor General of the Republican Party who argued the case on Hobby Lobby’s behalf, barely uttered his first sentence before Justice Sonia Sotomayor cut him off to ask what other medical procedures religious employers could refuse to cover in their employee health plans. Justice Elena Kagan quickly joined the party. If Hobby Lobby can deny birth control coverage, Kagan asked, what about employers who object to vaccinations? Or blood transfusions?

When Clement tried to deflect this list, Kagan came armed with an even bigger what. What of religious employers who object to gender equality, or the minimum wage, or family medical leave, or child labor laws? If the Supreme Court agrees with Hobby Lobby’s brief, which argues that laws burdening a corporation’s purported religious faith must survive the “most demanding test known to constitutional law,” then there would be few laws corporations could not exempt themselves from following.

Clement’s argument time then took a number of detours, with the Court’s three women dominating the questioning. Justice Kagan pointed out that religious liberty cases have never applied the same strict constitutional rule applied in race cases. Justice Ruth Bader Ginsburg wondered how the federal religious liberty law at issue in this case — the Religious Freedom Restoration Act (RFRA) — could have passed almost unanimously if it lead to the deeply controversial results advocated by Clement. Justice Sotomayor wondered how it is possible for a corporation to exercise religion.

The justices also spent a good amount of time discussing whether Hobby Lobby faces any real burden at all, since they could always simply stop offering health benefits and pay a tax — a position first articulated in a blog post written by Professor Marty Lederman.

At the end of Clement’s first turn at the podium, Kennedy asked the question that will probably give most hope to Team Birth Control. What about the rights of employees who may be hurt by their employer’s decision not to follow the law? For the moment, it appeared that Kennedy was worried about the parade of horribles that could follow a decision for Hobby Lobby.

Indeed, not long after Solicitor General Don Verrilli took the podium to argue the government’s case, it appeared that he may ultimately emerge victorious. Clement spent much of his argument on his heels. The three women on the bench appeared quite confident in their questioning. Kennedy was silent for much of Verilli’s argument.

But then he made a statement that will likely doom the government’s case. “Your reasoning would permit” Congress to force corporations to pay for abortions, Kennedy told Verrilli. This was not the Anthony Kennedy that worried about conservatives imposing their anti-gay “animus” on others, this was the Anthony Kennedy that views abortion as a grave moral wrong. Shortly after Kennedy made this statement, Justice Kagan’s face dropped. It appeared that she’d just figured out that she would be joining a dissenting opinion.

It’s worth noting that Kennedy expressed a different concern than one offered shortly thereafter by Chief Justice John Roberts. Hobby Lobby objects to four forms of contraception on the mistaken ground that these contraceptive methods are actually forms of abortion — a brief filed by numerous medical organizations explains that they are not. Roberts, however, suggested that someone’s mere belief that something is an abortion is enough to trigger an religious exemption to federal law.

This is insane.

Suppose I had the "mere belief" — religiously held — that black people evolved from mud and white people were descendents of Adam and Eve, and had a rightful place in heaven and on Earth?  And in my place of employment?

Of course, you don't have to go that far.  No Muslim or Jewish employer gets to demand that their employees not get coverage for, say, illnesses resulting from eating pork. No Hindu employer gets to restrict health coverage for people who eat beef or were born to the wrong caste.  Why do Christians get a pass?

We have actually addressed this issue before, in 1990, in Employment Division, Oregon Department of Human Resources vs. Smith.  In that case,  Smith and Black were fired by a private drug rehabilitation organization because they ingested peyote, a hallucinogenic drug, for sacramental purposes at a ceremony of their Native American Church. Their applications for unemployment compensation were denied by the State of Oregon under a state law disqualifying employees discharged for work-related "misconduct."

That case involved the same question: what happens when one's religious belief runs up against a generally-applicable law?

And the answer was: Tough.  Here's what Scalia — yes, Scalia — wrote:

We have never held that an individual's religious beliefs excuse him from compliance with an otherwise valid law prohibiting conduct that the State is free to regulate. On the contrary, the record of more than a century of our free exercise jurisprudence contradicts that proposition. As described succinctly by Justice Frankfurter in Minersville School Dist. Bd. of Ed. v. Gobitis, 310 U.S. 586, 594 -595 (1940): "Conscientious scruples have not, in the course of the long struggle for religious toleration, relieved the individual from obedience to a general law not aimed at the promotion or restriction of religious beliefs. The mere possession of religious convictions which contradict the relevant concerns of a political society does not relieve the citizen from the discharge of political responsibilities (footnote omitted)." We first had occasion to assert that principle in Reynolds v. United States, 98 U.S. 145(1879), where we rejected the claim that criminal laws against polygamy could not be constitutionally applied to those whose religion commanded the practice. "Laws," we said, "are made for the government of actions, and while they cannot interfere with mere religious belief and opinions, they may with practices. . . . Can a man excuse his practices to the contrary because of his religious belief? To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself." Id., at 166-167.

Emphasis mine.

There simply is no reason why abortion is entitled to some special category of religious exemption, where peyote and polygamy were not.

But it looks like this is where the Supreme Court is headed, and as Scalia notes, it will be throwing aside centuries of jurisprudence in doing so (Scalia is likely to be one of the justices contraditing himself).

Very sad.  And a very dangerous precedent.

 

Be Wary Of Obamacare “Losers” You See On TV

From HealthInsurance.org:

For months, health reform’s opponents have been feasting on tales of Obamacare’s innocent victims – Americans who lost their insurance because it doesn’t comply with the ACA’s regulations, and now have to shell out more than they can afford – or go without coverage.

Trouble is, many of those stories just aren’t true.

Yesterday I posted about a Fort Worth Star Telegram article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson, new insurance would cost her over $1,000 a month.

That claim stopped me in my tracks. Under the ACA, no 26-year-old could be charged $1,000 monthly – even if she has MS.

Obamacare prohibits insurers from charging more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

At that point, I knew that something was wrong.

When I checked the exchange – plugging in Johnson’s county and her age – I soon found a Blue Choice Gold PPO plan priced at $332 monthly (just $7 more than she had been paying for the plan that was cancelled). Co-pays to see a primary care doctor would run just $10 ($50 to visit a specialist) and she would not have to pay down the $1,500 deductible before the insurance kicked in.

My radar went up. Recently, I have been reading more and more reports regarding “fake Obamacare victims.”

Now I couldn’t help but wonder: Who are these folks in the Star-Telegram story? The paper profiled four people who supposedly had been hurt by Obamacare. When I Googled their names, I soon discovered that three (including Johnson) were Tea Party members.

The paper describes them as among Obamacare’s “losers,” but the truth is that they didn’t want to be winners. Two hadn’t even attempted to check prices in the exchanges.

Meanwhile, it appeared that no one at the Star-Telegram even attempted to run a background check on the sources, or fact check their stories. I couldn’t help but wonder: “Why?”

The answer will surprise you.

You should read the whole story.  Meanwhile, the Johnson lady makes the rounds…

 

Prediction

There are many many many things wrong with our healthcare system, including things that drive up costs.  None of this is the fault of Obamacare.  But you can be sure that these problems will come to light, and it will be blamed on Obamacare, even if those problems have been around for decades.

Dumbest Comparison Ever

On Mandela:

“He was fighting against some great injustice, and I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives — and Obamacare is front and center in that."

Folks, if you try to compare affordable health care to apartheid, you've already lost

Rand Paul And Doughnuts

Rand is all up in arms over the jack-booted doughnut snatchers:

Sen. Rand Paul warned Americans that the federal government is targeting doughnuts, the latest example of the oppressive nanny state in America.

"They're coming after your doughnuts!" the Kentucky Republican said, referring to the Food and Drug Administration decision to ban trans fats.

Paul added that if the FDA was banning trans fats, the employees of the agency should be forced to get healthy themselves.

"I say we should line every one of them up. I want to see how skinny or how fat the FDA agents are that are making the rules on this," Paul said…

"Because if we're going to have a nanny state and everybody's got to eat the right thing, and you can't eat a doughnut, maybe we just ought to enforce it on the government workers first," he said.

Apparently he thinks you can't make doughnuts without trans fats. I think that's going to come as a surprise to Krispy Kreme. Or anyone who's ever eaten real doughnuts made with real ingredients.

He's all upset about the nanny state in this piece, but keep in mind who he sees as the truly aggrieved party: the major food industry manufacturers who want to keep poisoning people with cheap, chemical ingredients that are killing them.

Sarah Palin’s Word Salad

Sarah Palin is on a media tour to promote her silly book about a nonexistent "War on Christmas," and appeared on the Today show with a tasty new right wing word salad, achieving (not for the first time) total incoherence:

The plan is to allow those things that had been proposed over many years to reform a health-care system in America that certainly does need more help so that there's more competition, there's less tort reform threat, there's less, um, trajectory of the cost increases, and those plans have been proposed over and over again. And what thwarts those plans, it's the far left, it's President Obama and his supporters who will not allow the Republicans to usher in free market, patient-centered, doctor patient relationship links to reform health care.

[…]

Uh, you know, when you stand in the middle of the road you're gonna get hit on both sides of the road. We need to take a stand especially on this Obamacare, and support those who are just fulfilling their campaign promises, SO many politicians ran for reelection and for election saying they will do anything in their power to defund the status [sic] socialized medicine program called Obamacare. Ted Cruz, Mike Lee, some of these guys actually were fulfilling their campaign promises and they asked for debate. That's why they stood up, they took the stand, fought for us, to debate the issue of Obamacare.

Wha?

Republican Alternatives To Obamacare

As the White House struggles with the rollout of Obamacare’s online health insurance marketplace, pressure has mounted within the Republican Party to begin offering conservative alternatives that address the nation’s health care crisis.

Here are some of the plans the GOP is considering:

  • Repeating the phrase “you can keep your current doctor” over and over until something happens
  • Loosening regulations to allow Americans to ship ill and injured family members to cheaper doctors overseas
  • Whatever the opposite of tyranny is
  • Allowing sick Americans to choose how they exhaust their life savings on a single medical bill, even if it’s out of plan
  • A true market-based solution—perhaps a convenient website—where uninsured people would pay for their own health insurance from private providers
  • $2,500 cash incentive to the first person who cures cancer
  • A health care law that won’t allow the disgrace of another Benghazi
  • Unsettling language and several ominous-looking graphs labeled “Obamacare” followed by a breezy smile and soothing, unspecific words

Yeah, that's from The Onion.  But it's not that far from reality.