Saturday, May 13, 2017

We are not in a failed state...yet. May it never be so.

I am seeing a lot of posts from friends and articles written for the left that are essentially declaring us a failed state and that our democracy is over.  Donald Trump is a Tyrant and we can't rescue the system, seems to be the gist of these posts and articles.  
While I understand the despair from whence this comes and I DO NOT want us to fail to realize the seriousness of the danger we are in, because we are in the balance and close to falling into authoritarianism, we haven't lost yet.  We are not yet in a failed state.  

Donald Trump has all of the characteristics of a tyrant and is causing constitutional crises (plural).  But we have not yet lost and that is important because if we believe that we have, prematurely, it hands him the victory.  

It took a while for Nixon to get ousted and, although it looks and is really bad (worse than Nixon) things are moving in that direction. It was always political pressure that did it. The reigning party must be more afraid of the voters than anything else. Of course, we have terrible gerrymandering and this is all desperately dangerous...I am in NO WAY trying to get us to think we are safer than we are, but we also need to avoid freezing in despair and proclaiming it to be over....or being too fast to throw our system overboard - although we clearly see places where it has to be strengthened.

Trump has the lowest approval ratings of any President at this point in time.  We have a couple of gerrymandering cases that could dramatically change things in 2018.  We have some of the biggest enemies in Congress and in government who are weakened.  The courts are upholding the constitution.

Yes…there are really horrible things happening and McConnell has done more to undermine our democracy than virtually anyone in our history.  But just because he and his cronies have blocked a special prosecutor and independent commission right now, doesn’t mean that this is over.  First of all…did people really think he was just going to turn around and do it?  If so, you had different expectations than me.  I expect us to have to put pressure on EVERY DAY for six months at minimum to get it.  If we do it and do it right, we will destroy McConnell in the process…which is a worthy goal because he has shown himself to be quite willing to re-write the rules for his own success regardless of their impact on generations to come.  He is unworthy of office.  We need to make this as much about him as about Trump.  I am going on the assumption that he may be implicated.  

McConnell and Sessions need to be as strongly targeted as Trump.  There is reason to believe that they may be implicated.  We know Sessions lied under oath about Russia.  He is supposed to recuse himself and has not.

So, when do we give up?  When do we proclaim that our democracy is over and it is no longer worth trying to fight for the system?  (And I believe it is important for us to fight for our system both to prove to ourselves it can work and to prove to the world…we are the oldest democratic system standing…we owe it to the world to try with everything we have to make it survive.  And all of you radicals who want socialism or some such?  The dangers from a GOVERNMENTAL perspective are the same, so we have to survive to prove it is possible).

These are the four things I am looking for:
  1. 1. Trump suspends the government for some sort of emergency (a Reichstag fire) and is not immediately deposed.
  2. 2.  The 2018 elections fail to meet the standard for fair and free elections (and with voter suppression…we are more dangerously close there than most of our citizens realize).
  3. 3.  The courts block Trump and he refuses to abide by their ruling, using the executive branch power to ignore them.  If he is not virtually immediately removed…we are a failed state.
  4. 4.   He orders our military to act against our citizens and is obeyed.
If these things happen, we are in a failed state.  The fifth, which is a little slippery in terms of when to call it, is the suppression of the press.
We edge closer and closer to it the more Trump flouts rule of law (over and over again) and is not checked by Congress.  If the GOP does not check him and then the Dems do not regain control after 2018, we will have to re-evaluate from there.
But, again, I would expect us to have to scream CONSISTENTLY about the need for a special prosecutor and to start implicating McConnell and Sessions for six months or so to get action.  Part of our problem is that these four months have felt like a decade and people are tiring out and giving up.  That is what they are expecting.  We have to remain focused.  

And then, when we win, we’ve got to very seriously revisit our form of government and see how to strengthen the protections.  Unfortunately, in any system, a huge amount of it is always upheld by societal norms.  Society is always a compact.  It just always is.  And our system is grossly imperfect and there are things we can do to tweak it.  But the biggest problem is that any democratic form of government is prone to what we are currently facing because people can be ignorant, hateful, tribal, and downright stupid.  That’s a human condition problem.  There are other forms of government that would theoretically be better, (the old meaning of aristocracy means rule by the best…which is not supposed to be hereditary, oligarchy just claims that you are ruling according to who has the most wealth which is usually hereditary, but can let new wealth in) but they tend to degenerate rapidly into rule by hereditary lineage.  The dangers of socialism as a form of government are essentially the same as a democracy.  
Until we all manage to achieve enlightenment…some form of democracy is probably best for us.  

My conclusions.  
  1. We are in real, serious danger…do not forget that and resist with everything you have got.
  2. We are not yet in a failed state, so don’t give up in despair and it is not yet time to chuck the system.  That hands the victory to the enemies of Democracy – which includes Trump, it includes the oligarch funders of the GOP, and it includes the oligarchs in Russia.  Don’t do it.
  3. We need to scream EVERY DAY for the next six months at minimum for a special prosecutor and special independent bi-partisan commission to investigate whether there was collusion with the Trump campaign and Russia and whether there IS a cover-up or continued collusion.  Don’t let the narrative wander (the media will let it wander if they don’t think it will sell).
  4. McConnell and Sessions are working to block a reasonable investigation – we very publicly ask the questions about whether they are implicated.
  5. Work very hard beginning now on 2018.  And this is about the survival of our democracy.  We must elect people who will be willing to stand up to the executive branch, if necessary…even against their own party.  Frankly, if this was a Democrat doing the same, we need to be willing to be as vigilant and outraged.  It is unlikely to be since Democrats tend to work for the system and the GOP has been trying to undermine it since the oligarchs have gotten control of their party…but our loyalty should be to the system, not the party.
  6. Anything that starts to slide on any of the four pathways to a failed state…we have got to be immediately up in arms. 
  7. We have to fight with everything we’ve got against suppression of the free press.

There are a lot of issues.  Tons of them…overwhelming us and overwhelming the narrative so that we don’t stay focused.  But the Russia issue, we need to get to the bottom of it.  At this point, if we don't want to lose our form of government entirely and end up in civil war, we focus on protecting the Constitution...just like every government employee, including every member of the military, has sworn to do.  May the oath breakers be held to account.

Monday, May 8, 2017

Some thoughts on healthcare

I am rethinking how I am going to talk about healthcare with people.  I think that it is important that we fight what is, essentially, a repeal of the ACA, but recognize that the ACA is a woefully imperfect bill.  I think we need to force the discourse to move in a different direction and be careful about how we do it.

One thing that is dangerous is debating pieces of Trumpcare - although we can point some of it out.  I'd really rather have us just start talking very differently about our entire healthcare system.  Take the debate where we want it to go rather than being on the defensive.  

To me, the real question--and it is a moral question--is, should profit-making motives have anything to do with healthcare?  Do we really want a system of healthcare that is designed to generate profit for corporations?

The reason that we have governments is that there are times in which "the market" is the wrong instrument for social organization.  There are many reasons why this might be the case.  Sometimes they are social "goods" that are just never going to make a profit, but that we recognize as contributing to society in important ways, so want to support them.  Sometimes it is because if the services were run like a business, it would be dangerous for society - imagine if the military was not a government entity, but was loyal to companies and shareholders - we would be back in the days of warring petite fiefdoms.  I believe that healthcare is one of these instances in which the market is just the absolute wrong instrument for healthcare.  The goal of healthcare is to prevent illness, heal the sick and the injured, ease the suffering of the dying, and to help the members of the society thrive.  As such, there needs to be enough money in the system to fairly compensate all those who work in healthcare, to ensure that facilities are top notch, and to encourage continued research and development into new treatments, but they should not be about profit.  And I'm going to point out that I know A LOT of people who work in the medical professions, and not a one of them got into healthcare with profit as their main motive.  They got into healthcare because they wanted to serve humanity as healers....because they care about people.

The ACA was an attempt to move the needle, but it was a compromise, and not a very good one.  What we really need is to get medical care free of the insurance companies by moving to single payer - to Medicare for all.  This would cut way down on the administrative burden.  A huge amount of the business that doctor's offices have to deal with is trying to get claims paid.  Medicare for all would dramatically simplify that.  With all the population in the pool - it would balance out the younger and healthier balancing the older and sicker.  Rather than returning to the horror-show of pre-existing conditions exclusions, Medicare for all would eliminate the terrible risks to people who have employer paid insurance if they lose or change jobs.  The government could negotiate for actually reasonable drug prices.  We could kill the UCR tables where every bill I ever get from a doctor says things like "Hospital services, amount charged $39,541.60, Allowed amount $4,466.50, Amount paid, $4,466.50."  (This was from my surgery).  So, what this says to me is that my surgery costs around $4500, but in order to get that amount, they jacked up the price by almost $35,000 and if I didn't have insurance...I'd be paying almost $40,000 for the surgery I just had...which means I wouldn't be having that surgery because I don't have $40,000.  I mean, who does?  What reality are we living in?  I guess I'd just continue to go through life with sinus troubles and not being able to breathe.  I suspect that if we had single payer, they could negotiate what they are going to pay and there would be no more of this crazy math.  And before anyone says, "But wait! SOCIALIZED MEDICINE!!!"  That is a red-herring.  Nobody says in hysterical tones, "SOCIALIZED STOPLIGHTS!!!"  There are things that it makes more sense if they are run through the government rather than the market.  Medical care is one of them.

So now, I want to wind the clock back to before the ACA and talk about what I DO NOT want to go back to...and what I believe Trumpcare could re-create.

Obviously, there were a lot of uninsured people who would go to emergency rooms for everything because they didn't have care and you can't get turned away from an emergency room.  We will have a lot of people who will lose their insurance.  But, at the moment, I'm going to speak from the position of someone who works as a manager in an organization that has employer-provided healthcare because I want to point out several ways that tying employment to healthcare makes NO SENSE.

Without laws making it illegal to exclude pre-existing conditions, depending on how large and aggressive your company is in negotiations, you may or may not have a plan that has pre-existing conditions exclusions.  Now, this doesn't necessarily keep you from getting "care," it just means that the plan is not going to cover conditions that you had prior to being covered by that plan.  So, let's say you are in the job and you have something that you are concerned might be serious or chronic.  If you knew that no matter what you would be covered, you would go get the diagnostic tests as soon as you were worried about it...possibly catching a situation early, when it is easier to treat.  But instead, you think..."well...I may want to change jobs in a couple of years and if it is something chronic, then if I switched insurers, they might not cover me and I think in the long-run, I'm not likely to be at this job in ten years.  Maybe I should just wait and see if it goes away."

This kind of thinking is really common.  It keeps people from getting checked out when things can often be dealt with more safely and cheaply and then they finally end up in the doctor's office when it is really bad and much more expensive to treat.  This is one of the reasons why our healthcare costs were so ungodly high.

Another scenario goes like this.  You know you have a chronic condition that needs to be managed and that if you left your job, would be uncovered.  Maybe you need a drug that costs $200 a month for the rest of your life, a liver test that costs $1500 annually, and if anything ever went wrong with it, it could be quite expensive.  You hate your job and you feel trapped, but you don't dare leave.  On the other hand, you are a good twenty years from retirement.  Every day, you get up, feeling trapped and resentful.  You carry that into the workplace where you are angry, ready to take offense, frustrated in general and are a morale dark hole.  You are totally toxic in your workplace, but are not going anywhere.  You do your job well enough to not get fired, but negatively affect everyone around you.  Another variant is that instead of being angry, you are a hyper-anxious mess about the possibility of getting fired and losing your coverage...which is also a seriously negative hit on productivity and morale.  These were really common and are devastatingly bad to an organization.

Maybe you have an entrepreneurial spirit and would really like to try starting your own business.  Or you are an artist and can support yourself, living frugally, on your art and a part-time job.  Except you can't, because you can't get health insurance that would actually cover anything at a price you can afford.  So, instead, you never strike out and, instead, stay at a full-time job that does not allow you to take a chance on your innovation.  Is this good for our country?  I don't think so.

Finally, you have employer-related insurance for your children.  You have a teen that is showing some signs of a potentially chronic condition.  They are going to be off your coverage you wait on seeking a diagnosis and medical care in the hope that they can make it until they get a job that they will then be tied to?  Do you get them the care and then hope that they will be able to get into a job that is both large enough and has been able to negotiate strongly enough that they don't have pre-existing conditions exclusions...but what if they don't?  What do you do?  If it's a mental illness, you only have until they are eighteen where you can force them to get help, but then you set them up to be potentially without care the rest of their lives.  Yay.  This totally sucks and there is no good conclusion without pre-existing conditions being illegal.

We need, we absolutely need, the requirement that companies must cover pre-existing conditions and that those with pre-existing conditions should not be isolated into their own "high risk" pool.  What will happen if they are isolated is that they will be given an "opportunity" to buy health insurance that will be so cost prohibitive that no one who is not wealthy will be able to afford it.  That isn't "access" to health care.  That is a "bare opportunity."

Again, I think we need to step back and ask ourselves why we have for-profit health insurance companies.  Unlike, say, fire insurance - health problems happen to all of us.  It is part of the human condition.  There isn't anyone who is not going to get sick, get hurt, get old, and eventually die.  So, it isn't like the statistical odds of various forms of accident or fire insurance where you are paying a bit into the kitty on the off-chance that you are the one who will need it...but you may never.  You WILL need healthcare.  You will probably need health care at some point this year.  You SHOULD probably at least get screenings for something so that you can stay healthy.  Insurance is not the way to deal with this.

The clear solution is Medicare for All.