Dylan Scott/STATNews:
What Trump’s HHS secretary pick believes about medicine
[Tom] Price has made his name in Washington for his vicious opposition to Obamacare — and implementing whatever congressional Republicans pass to repeal and replace the law would be a big part of his job.
But his work will touch many other parts of health care and medical science. HHS helps shape how doctors care for their patients, how prescriptions drugs are approved, and what medical research the federal governments funds….
A recurring theme in Price’s musings on health care is putting patients back in charge. In Price’s view, even popular federal health care programs like Medicare have been detrimental to medicine because they limit choices for doctors and patients, through restrictive reimbursement rates and federal rules on what treatments and procedures are covered by the program. He has said since the election that the new GOP-controlled government should overhaul Medicare, presumably in support of House Speaker Paul Ryan’s proposal to push the program toward a voucher system.
Price’s own solution to these problems include price transparency and health savings accounts. Some economists argue that HSAs would give consumers more “skin in the game” by making them more directly responsible for paying for their health care, which would drive down costs.
His Obamacare replacement plan would also allow states to create an official database disclosing quality ratings for physicians, hospitals, and other health care providers as well as the prices they charge.
This goes way beyond destroying Ocare. More of that, though, too.
WaPo:
A single chart everybody needs to look at before Trump’s big fight over bringing back American jobs
The above is how D’s can win in red states.
Or blue states.
Greg Sargent/WaPo:
Obamacare is probably toast. And a lot of poor, white Trump voters will get hurt by it.
The core philosophical difference here is that conservatives want far less in government spending and regulations designed to cover poor and sick people, protect consumers and enforce a minimum standard for coverage. As a result, they are willing to tolerate far lower standards in those areas, though some also want conservative reforms to strive to make very cheap bare-bones catastrophic coverage widely available. Liberals think we should spend and regulate to the degree necessary to move toward universal care and see expanded and improved coverage as part of a broader effort to progress toward a higher societally guaranteed minimum standard of living. Conservatives won the election, and apparently, we are now going to do it their way. Elections have consequences…
I have obtained new numbers from the Gallup-Healthways Well-Being Index that suggest that a lot of poor and working-class whites — who voted for Trump in disproportionate numbers — have benefited from Obamacare, meaning they likely stand to lose out from its repeal (and even its replacement with something that covers far fewer people). Gallup-Healthways numbers from earlier this fall showed that overall, the national uninsured rate has plummeted to a new low of 10 percent, a drop of over six percentage points since the law went into effect — which alone is a major achievement.
But that drop, it turns out, is even more pronounced among poor whites. Gallup-Healthways tells me that among whites without a college degree who have household incomes of under $36,000, the uninsured rate has dropped from 25 percent in 2013 to 15 percent now — a drop of 10 percentage points. It’s often noted that the law has disproportionately expanded coverage among African Americans and Latinos. That is correct, but it has also disproportionately expanded coverage among poor white people.
Jonathan Cohn/HuffPost:
The “Empowering Patients First Act,” as it is known, would gut Obamacare’s regulation of insurance plans, reduce the total financial assistance going to people buying private coverage and rescind entirely the law’s expansion of Medicaid for the poorest Americans.
Insurers could resume some of the practices that Obamacare now prohibits ― like selling bare-bones plans and, in some cases, denying coverage to people with pre-existing conditions. Price’s proposal would offer people tax credits, but there’d be no guarantee the credits could actually pay for comprehensive coverage.
The result, according to one analysis, would be less government spending and regulation ― as well as lower taxes on the rich. Many younger and healthier people would get access to cheaper insurance, particularly if they were comfortable with plans that had minimal coverage or gaps in benefits.
But a scheme like Price’s would also mean fewer people covered and, almost certainly, less financial protection for people with the worst medical conditions.
Did you hear the AMA endorsed Tom Price? No surprise. Igor Volsky wrote this 5 years ago:
Seventy-seven percent of physicians “say the American Medical Association does not represent their views, according to a new volunteer-based online survey by the physician staffing firm Jackson & Coker. Just 11 percent said AMA’s stance and actions reflects their beliefs.” The doctors also rated AMA as ineffective in lobbying for their priorities, including tort reform (72 percent called AMA ineffective), physician practice autonomy (69 percent), physician reimbursement (68 percent), protections from insurance company abuses (75 percent), and “intrusive government regulations” (78 percent).
The AMA took a big hit after it failed to secure a deal to stave off reimbursement cuts (changing the so-called SGR formula) as part of the Affordable Care Act and that did nothing to stop the slow bleed of doctors turning their backs on the organization. While it theoretically represents all physicians, the AMA’s paying membership comprises somewhere between 15 to 18 percent of doctors. Consequently, member dues accounted for a relatively small percentage of AMA revenue. The rest of its funds come from things like billing codes, CMS payment negotiations, and other non-membership-related operations.
They are a lobbying group. They want access to those in power, those who set fees. They are not in it for the patient. That’s why I am not a member.
Chemi Shalev’s piece in Haaretz is behind a paywall, but he speaks for me:
It wasn’t the erroneous polls or media complacency or New York elitism or a disconnect from white voters in Wisconsin. Contrary to the spate of retroactive mea culpas, all of these factors were well documented and repeatedly considered in the days leading up to the November 8 ballot. Rather, it was a basic belief, which turned out to be an illusion, that America, my America, would never prefer a foul-mouthed misogynist buffoon who thrived on people’s worst fears over a flawed candidate who was nonetheless measured and experienced like Hillary Clinton, who would be the first female president to boot. I suffered from cognitive dissonance, discounting warnings that this time around, my belief in America and in the wisdom of its ways may have been misplaced.
Dara Lind/Vox:
Republicans allowed voter paranoia to flourish. They got a president-elect who embraces it.
Trump’s “illegal voting” lie is based in Infowars fantasy, but the consequences are real.
Trump’s walking on ground they’ve prepared for him, but he’s severing the last connection of policy to reality — giving him the full power of the United States government without any apparent fealty to facts.
When Republicans have talked about the risk of voter fraud but avoided outright conspiratorial lies about it happening, they retained some link between policy and reality. Their attempts at voting restrictions often didn’t turn up the fraud they warned was possible, but nor did they punish real people for invented crimes.
Donald Trump’s tendency to ignore the carefully manicured distinctions other Republicans have made, between encouraging paranoia and embodying it, leaves no quarter for reality in policymaking. It gives his government free rein to pursue phantoms — and makes it all the more likely real people will be hurt.
Public Radio International:
White Americans are the biggest terror threat in the United States, according to a study by the New America Foundation. The Washington-based research organization did a review of “terror” attacks on US soil since Sept. 11, 2001 and found that most of them were carried out by radical anti-government groups or white supremacists.
Almost twice as many people have died in attacks by right-wing groups in America than have died in attacks by Muslim extremists. Of the 26 attacks since 9/11 that the group defined as terror, 19 were carried out by non-Muslims. Yet there are no white Americans languishing inside the prison camp at Guantanamo Bay. And there are no drones dropping bombs on gatherings of military-age males in the country's lawless border regions.
Attacks by right-wing groups get comparatively little coverage in the news media. Most people will struggle to remember the shooting at a Sikh temple in Wisconsin that killed six people in 2012. A man who associated with neo-Nazi groups carried out that shooting. There was also the married couple in Las Vegas who walked into a pizza shop and murdered two police officers. They left a swastika on one of the bodies before killing a third person in a Wal-Mart parking lot. Such attacks are not limited to one part of the country. In 2011, two white supremacists went on a shooting spree in the Pacific Northwest, killing four people.
Jamelle Bouie/Slate:
Keep Hope Alive
Demoralized Democrats have a road map for success in Trump’s America. It was written by Jesse Jackson.
At a rally in 1984, some of those farmers arrived wearing paper bags over their heads, to obscure their faces. It wasn’t until later that Jackson learned they were trying to hide their identities from farm bureau officials. “I looked out there, all these guys in hoods. Sort of a little moment there,” Jackson recalled a few years later in a conversation with farmer and supporter Roger Allison, as recounted by Frady. “But our people have always had more in common than other folks supposed—right, doc? We’ve both felt locked out. Exploited and discarded. People saying about the family farmer exactly what they say about unemployed urban blacks, ‘Something’s wrong with them. If they worked hard like me, wouldn’t be in all that trouble.’ Fact, more you get into this thing, more you realize that black comes in many shades. We’ve found out we kin.”
I really should have left this for Mark Sumner, but it’s true. Jonathan Chait/NYMag points out that David Brooks and other so-called centrists on the Republican side who could not accept either Obama or asymmetric extremism destroyed their own credibility and took the country down:
The effect of all this commentary was not to empower the moderate ideas Brooks favored, but to disempower them. Brooks was emblematic of the way the entire bipartisan centrist industry conducted itself throughout the Obama years. It was neither possible for Obama to co-opt the center, nor for Republicans to abandon it, because official centrists would simply relocate themselves to the midpoint of wherever the parties happened to stand. The well-documented reality that the parties were undergoing asymmetric polarization was one they refused to accept, because their jobs was to be bipartisan, and it is difficult to get a man to understand something if his salary depends upon not understanding it.
The centrists could have played a role in braking the growing extremism of the Republican party. It would have meant telling the country that there was now one moderate, governing party and one extremist faction, and parking themselves with the moderate party until such time as the dynamic changed. They could not do it. If there’s not much of a center left to stop Trump from trampling democratic norms, it is because the centrists abdicated their responsibility and destroyed themselves.
What’s in bold is the failure. And they are still failing.