Saturday, September 9, 2017

President Chemo

I must applaud President Trump for his deal with the Democrats on Harvey aid and the three-month delay of the fiscal cliffs before us.  The most interesting thing about the deal is that Republicans fell in line behind it.  Why didn't McConnell and Ryan say "Sorry, Don, but we're not going to bring that bill to the floor"?  My guess - they don't want to say that.  My guess - they do want to return to regular order.  My guess - they don't want an approval rating of 19% or whatever it is.  All they needed was political cover, and the President, nominally of their own party, has given it to them  This is how the fever breaks in American politics.  If it breaks.

The Republican party has destroyed itself, and race remains at the heart of the problem.  When Lyndon Johnson and the Democrats signed the Civil Rights Act in 1964, the GOP became the party of the unreconstructed South.  The votes were there, and, having no scruples, Richard Nixon and his pals went for them.  A voting (but not philosophical) coalition arose among white voters, even those who hated what the Yankee business interests the party actually stood for.  From Nixon onward, the GOP has been on the wrong side of domestic history, bailed out in the 1980's by being on the right side of world history.   Now, the party is on the wrong side of everything, all because it has put "winning" over deserving to win.

No doubt, the Democrats lowered the bar, and they get no praise for becoming the party of the disenfranchised and no one else.  The Democrats abandoned Big Labor and its members in favor of victims of "oppression."  Oppression is a bad thing, but a party devoted to its remediation is a makeweight, a group whose support one seeks - like the Greens, or the Libertarians - not one of two "major" parties.  Yet here we were, with one party representing racists and plutocrats and the other representing victims and moralists, and nobody representing Joe Sixpack, except to the extent he was also a racist or a moralist.

Without big strategies, the parties descended into color war - winning and losing as institutions and not as ideologies.  The Red side - our right wing, ironically - won via Operation Red Map.  Now, our local and Congressional elections can be won by the biggest wack job on the right, because the winner of the Republican Primary doesn't need swing voters. That sends Tea Party morons to Congress and makes Congress dysfunctional.  Which gives the very same voters who elected the Tea Party morons the idea that "Congress" is broken, but not because their bozos are breaking it.

And so the stage is set.  Everyone hates Congress, but no one blames his or her representative.  Someone has to come along and tell the idiots who elected the Tea Party that they have elected morons without telling them that they are idiots for doing so.  Trump pitched his candidacy perfectly for that purpose - racist enough to get the white vote but also anti-establishment enough to peel off the unorganized mass of opponents, several of whom are more competent and deserving of high office, but none of whom would have had the balls to do what Trump didn't need any balls to do last week.

Trump is chemotherapy for the cancer of intransigence that afflicted the Congress.  He is going to make Congress work by freeing non-Tea-Party Republicans to compromise without being primaried.  The toxic side effects include denigration of just about everything that makes America great - free speech, checks and balances, the truth - but that's how sick we have become.  Trouble is, the side effects won't be felt for years, so we may get eight years of what we only needed for one week: someone who says it's ok to compromise.  Because, make no mistake, by going along with the Trump/Schumer plan, the GOP is compromising, and the voters are going to like the result.  Especially if the next step is elimination of the GOP's annual hostage-taking when it comes time to raise the debt ceiling.  (Sad to see Ben Sasse lament the loss of his party's ability to threaten to kill our credit rating in order to get its way.  And he calls himself a patriot.  Yikes.)

So, score one for President Chemo.  Perhaps Congress will figure out that he will sign anything he can take credit for, and praise everyone who participates in getting it for him, including "compromising" Republicans.  That shifts the game away from satsifying the GOP base to satisfying the electorate.  At least, it would, if Operation Red Map had not been so successful.  It remains to be seen whether the GOP majorities in gerrymandered districts are ok with compromise once "their" President has blessed it.  One hopes so, but only time will tell.







Monday, July 31, 2017

Healthcare is not a right, but...

Remember the last episode of Seinfeld?  The gang is imprisoned forever with each other for failing to rescue a stranger.  For them, at least, Hell will be other people.  I didn't like that last episode, not because I didn't think the characters deserved each other as eternal punishment, but because the premise - that one can be punished for not helping others - is bad law.  Indeed, the greatest difference between here and the hereafter is that here we are not punished for being selfish jerks. I have since forgiven the dramatic license, but in the moment, the lawyer in me got the better of me.

Being rescued is not a right, because it is impossible to prove that one knew that one could have effected a rescue without paying some unreasonable price.  Where does one draw the line on who should rescue whom from what?  The idea is unworkable, and common law, at least, has rejected it.  You cannot have a right to be rescued if no one has a duty to rescue you.

And yet, certain politicians - I hesitate to call them "liberals" anymore, as such labels are losing their focus - claim that healthcare is a "right."  But healthcare is a rescue, and the law says you have no right to be rescued, because no one has the duty to rescue you.  People can volunteer to rescue you, and the society as a whole can agree, in a binding way, to "rescue" you by giving you the funds to buy healthcare from someone who will voluntarily sell it to you.  But those decisions do not arise from the idea that healthcare is a right, but rather from a political consensus that having others pay for one's own care should be a right.  Pols like Pelosi and Sanders argue that we should make healthcare a right because it is a right.  Huh?

I don't believe in economic rights.  In the grand scheme of things, everything is a luxury that some people cannot afford.  How many people are denied the luxury of a roof over their heads and three square meals a day?  We call these things necessities in common parlance to distinguish them from things we can more easily do without, but in the great algebraic continuum of desiderata, there are no necessities, only priorities.  Thus, by calling healthcare a luxury, I am not saying that only wealthy individuals should have health care.  I am saying that only wealthy people can have it.

I say "wealthy people" because a society can declare that all of its people are, by virtue of their membership in the society at any given time, wealthy enough to have healthcare.  All of the industrialized West, except the US of A, has determined that their polities are wealthy enough for all of their members to have healthcare regardless of their individual ability to pay.  One could say that, in such places, healthcare is a "right."  But that's a post hoc legal term, not an a priori bit of natural law from which one can reason - or argue- to a legislative conclusion.

How, then, do we get there?  There's been a lot of talk recently about a guaranteed basic income (GBI).  Lifetime healthcare has an actuarial cost that is more or less equal for all people.  If we assume that healthcare is a valuable commodity, then lifetime healthcare is a guaranteed basic income, delivered in a gift card rather than cash.  I'll bet there's a pretty strong overlap between those who favor universal healthcare and those who support the GBI.  But is the GBI a right?  If not, how can a targeted, actuarially determinable GBI be a right?  Because that's all universal healthcare is.

I like the GBI.  I think the time has come to make "survival" a right.  We should provide a roof and three squares a day to any American who wants them.  And healthcare. We are that wealthy.  We can afford that luxury.  But we can start with healthcare.

Friday, July 28, 2017

Lyin's of the Senate

Without a scorecard, one cannot be sure who is voting for what in the Senate.  But one thing seems to be clear: votes are not politically wasted.  No one votes against a stupid idea his stupid constituents want unless it may actually become law.  Then, as few senators as possible are given the task of "standing on principle," "showing political courage," "putting country over party," or whatever cliche will work to kill the stupid idea before it makes the senators look dumb in retrospect for passing it.

My best guess is that all of these acts of "courage" are carefully orchestrated.  Take last week's "battle" over whether to bring the various doomed Obamacare repeal bills to the floor.  After the vote was taken to proceed to a floor vote, Senator McCain gave a wonderful speech about how the Senate should return to regular order, with committees and hearings and inter-party negotiations and compromises.  It was a stirring speech, delivered after the thing to be stirred was already fully baked.  The horse had left the barn, and McCain was not gonna let him escape some more.

Why was this speech not given before the vote to do the opposite?  The answer is simple: leadership wanted to give members the ability to vote to repeal Obamacare one last time.  They could not get that opportunity if the motion to proceed was defeated, and it would not be seemly at all for them to vote to proceed after the heroic McCain had struggled from his deathbed to exhort them to legislate like, well, legislators.  So, McCain voted for the motion to proceed and then pretended to urge his brethren and sistren to do exactly the opposite of the thing they had just done.  A profile in courage?  Not hardly.

But wait, there's more.  Once the bill got to the floor, something had to be done to keep it from becoming law, because it was terrible and unpopular, without requiring too many senators to vote against repealing Obamacare.  Collins and Murkowski were already committed - it's not clear why, but let's call them brave and move on - but who would be the third necessary vote to bell this particular cat?  Who can exhibit such remarkable independence?  Who can be a maverick and put country first?  In other words, who had the least to lose?  Maybe some old guy with a short life expectancy and maybe a score to settle with our Feckless Leader?  Who might that be?

Reports are that McCain spent a fair amount of time openly chatting with Chuck Schumer on the night of the Obamacare repeal vote.  These are not dances one does as if no one were watching.  This dance was done in plain sight to suggest that McCain got something for his bravery, that his appeal to regular order won't end up making him look like a sap.  One can only hope that he did get something, that regular order does return to the Senate, and that they produce a popular bill that even the morons in the House won't be stupid enough to reject.  I'm not a fan of Schumer - he's a walking platitude, elevated by seniority to a position where a statesman might be useful - but he's not a terrible person.  We Americans may be approaching our Churchill moment, when we do the right thing after trying everything else.

Monday, July 17, 2017

The Rand Paul Compromise

I wish I knew St. Paul's view on healthcare.  Maybe he thought it was a right.  If so, Rand Paul would certainly be the right guy to propose the solution to the healthcare mess that he has come up with.

Being a complete hypocrite, Sen. Paul does not care whether Obamacare disappears.  He just wants to be able to say he voted to repeal it and did not vote to replace it.  It makes no difference to him what the replacement says or does, so long as he can "keep his promise" to vote for the repeal.  After that, if Republican moderates and Democrats want to destroy the country, at least his pecker tracks won't be on the bills.  He'll be the author of the procedure that made the new law possible, but he'll have voted against it, and that's all he has to do to fool enough of the people enough of the time in Kentucky.

I really like this solution.  By allowing Republicans to vote for what Sen. Paul calls "clean repeal," he gives each of them the ability to go home and shout from the rooftops the wholly irrelevant fact that he or she successfully voted to repeal Obamacare.  That's the promise Republican have been making for eight years, and it's the promise they can claim - substance aside, of course - to have kept.  After that, a compromise bill can be created.

On substance, Dr. Paul doesn't understand the issues.  He has latched onto an important insurance notion - adverse selection - but he has not shown any useful grasp of it.  Adverse selection is the tendency of people with the greatest risk to buy the most insurance.  In other words, the people voluntarily buying health insurance are, in general, sicker than those choosing not to buy it.

Adverse selection is a problem for insurers today because, under Obamacare, people can buy insurance from any carrier with no exclusion for pre-existing conditions.  The mandate that forces people to buy when they are healthy does not help insurers, because the insurer acquiring a sick person does not get the money that that person may have paid under the mandate when healthy.  If the person paid the penalty for declining coverage, or was covered by Medicaid or a parent's group plan, the new insurer must rely on a subsidy (or higher premiums on everyone it covers) to defray the cost of pre-existing conditions.

Senator Paul doesn't like these subsidies because the "health insurance industry" is making $15B annually, and he doesn't see why an industry that is making so much money should get a government bail-out.  This is really a stunningly stupid claim.  The insurance companies are making that much money only because they are not forced to participate in the individual Obamacare market.  They have withdrawn from that market so that they can remain profitable.  If the subsidies under Obamacare were increased to the level necessary to attract private insurers, those insurers would make some more money - they are entitled to profit on every class of business - but no more than is usual under our capitalist system.  That's not a "bail-out," as Sen. Paul likes to call it.  It's just how a free private market works.

What Paul does not seem to see is that he is exposing the thread on which the fans of single-payer are dying to pull: administrative costs.  If the insurance companies are making so much money, maybe it's because they charge more than a public payer - Medicare, say - would charge for covering the same ailments in the same way.   (That is, of course, the case.)  He is laying the groundwork for single payer by attacking the insurance industry.  Is that any way for a guy named Rand to think?

But wait!  There's more!  Sen. Paul's solution to the problem of insurers leaving the individual market is to get rid of that market by letting people form non-employer groups.  There are group policies available in other areas of insurance - life insurance through AARP, say - that are based on affinity of some sort, so why not health insurance?  The answer: all of these other insurance programs do have some underwriting requirements; they are actuarially sound and benefit primarily from the economies of scale.  Health insurance policies without pre-existing exclusions are not actuarially sound (see adverse selection, supra) and, therefore, cannot work that way.

Sen. Paul also argues that these pick-up groups would be viable just like employer groups.  If the large-employer market is profitable without subsidies, he, er, reasons, why wouldn't group plans of random citizens be healthy?  Well, one of the first thing one learns in the group insurance business is that group insurance isn't insurance.  Group insurance is "experience- rated." The employer basically pays the cost of all claims, plus an administrative fee.  The insurance policy simply smooths out the peaks and valleys, but premiums are adjusted to match claims over time.  An employer-based plan is an employee benefit, part of the compensation of the employees, with the added benefit of a healthier workforce for the sponsoring employer.  A random group of people with no interested third-party to pick up the rising costs simply would not be viable.

The employer's backstop for employee plans, and the entanglement of membership in the plan with having a job, make the employer market a wholly different place from the random group market.  Indeed, if these sorts of plans were viable, is there any doubt that insurance companies would have lobbied to make them legal?  If they made any damn sense, they would exist already. Because they don't make sense, they don't exist.  Sadly, the same cannot be said for Rand Paul.


Tuesday, June 13, 2017

What Privilege?

Part of the art of the dodge is in being willfully inarticulate.  Or in willfully not trying very hard to speak as clearly as one thinks.  I won't try to quote A.G. Sessions on the privilege that seems to have the Democrats on the Intelligence Committee so flummoxed.  If he had stated his position clearly, they might have figured out how to deal with the problem.  But, being a skilled obfuscator, the A.G. relied on "policy" - never a legal basis for anything - and forced the poor Dems to ask for a copy.  Yikes.

Here's what A.G. Sessions would have said if he felt obliged to speak clearly:  
All confidential communications between the President and anyone else in the Executive Branch are privileged.  Only the President can waive that privilege.  He does not need to "assert" it; it applies until it doesn't, and the Attorney General has no power to pretend that it doesn't.  Where, however, the President has publicly revealed a communication that would otherwise be covered by the privilege, the action implies that the President does not consider that communication privileged, and so someone privy to that communication can discuss it publicly.  
So, when the President says publicly "I asked Rod Rosenstein and Jeff Sessions for their views on Jim Comey," the communication ceases to be privileged, and the A.G. can properly, i.e., without breaking privilege, tell the Senate that the President "asked him" for his advice on Comey.  That testimony would not, pace, Senator King, amount to "selective" use of the privilege in question, however one frames it.

But Sessions did not expressly rely on Executive Privilege, because the President has not asserted it, as if that were necessary to its application.  Instead, Sessions relied on a policy of the Justice Department, which appears very much to walk like executive privilege and quack like executive privilege.  That's because it is executive privilege.  Otherwise, it would be nothing more than a wish that Congress could rightly ignore.  

This confusion serves Trump very well.  Not one Senator asked Sessions "Could the President authorize you to answer these questions?"  The answer is clearly "yes."  Leading to the follow-up "Will you ask the President to allow you to answer these questions?"  Stonewall that, Mr. Sessions. As things stand, the President can say he didn't "assert" Executive Privilege even has he hides behind it.  All because the Attorney General could get away with invoking the privilege on the President's behalf by reference to a bright, shiny object - the DOJ's policy (of tacitly treating Executive Privilege as asserted until waived) - that the Senators are now all trying to get a copy of.  

Where does that leave Mr. Comey's disclosure of things the President said to him?  The President is free to say that Comey is lying about his conversations with the President and, at the same time, claim Executive Privilege as to what he and Comey talked about.  Comey himself made this clear when he described a newspaper story as false but declined to say in what regard, because that would reveal things that should not be made public.  What is less clear is whether the President can order Comey, now a private citizen, not to disclose his recollections of conversations that arguably have a bearing on his personal status.  Privilege means "You don't have to tell Congress"; that's not the same as "Don't tell Congress."  Or is it?  I'm going to leave that hot potato for another day.

Thursday, June 8, 2017

No Comment

A lot of noise is being made these days about what Jim Comey did and did not say publicly.  Almost all of that noise is logically fallacious.  Comey tried to explain the matter using what he called the "slippery slope" analogy, but no one was listening.  He should have been more forceful.

The answer to the question "Why couldn't he simply say that Trump was not under investigation?" is simply this: "What would he have said if Trump were under investigation?"

If a reporter asks the FBI whether X is under investigation, there is only one suitable answer:  "No comment." Every other answer is wrong, because any other answer means that there are at least two possible answers: "No Comment" and [the other answer].  And, if that other possible answer is "No," "No Comment" must imply "yes"; otherwise, the "No" answer would have no reason to exist.

Already, we are seeing the fall-out of the possibility of "No" being an answer.  Comey testified
(i) that when he last spoke to President Trump, he told Trump that the FBI was not investigating him, and 
(ii) that his statement to Trump was true.  
Items (i) and (ii) are entirely separate things.  Item (i) is an action Comey swears he took in private.  Item (ii) is a public statement about an investigation that Comey swears is true.  It would be practically impossible for Comey to deny item (ii) without raising the possibility that he was lying to Trump, but that's why he should not have added item (ii).  Indeed, if asked whether what he told Trump was true, he should have answered "I can't comment publicly on whether an investigation was ongoing."  That sounds bizarre, and it would likely be treated as bizarre by the bozos who make hay out of things that sound bizarre.  But Comey could logically have said this:
"I can testify publicly to what was said by President Trump and me and to what I have done in connection with the matter.  Neither of those things requires me to make a public statement as to the truth of what I told President Trump, and, because there can be only one such statement - "No comment" - I am making that statement.  You should not infer anything from my statement, as it is the only one I am able to make, and so it carries no information with it, as if I did not hear it being asked.
Information theorists will see the heart of the matter quickly.  Information is anything that reduces the degrees of freedom in a system.  That's a high-sounding, generalized way of saying that if there are two possibilities (yes and no), and a statement about those possibilities causes there to be one possibility ("YES!!"), then that statement carries information.  If the statement does not reduce the number of possibilities ("No comment"), it carries no information, and nothing can be inferred from it.  For that description of things to be valid, however, it is essential that "No Comment" be the only possible answer.  Otherwise, there are more than one possible answers, so giving either one of them reduces the degrees of freedom in the system of answers and carries information.  Thus, there must be only one possible answer to the question if that answer is to deliver no information.

Comey's slippery slope argument says that if the FBI says it is not investigating X, it must also say that it is not investigating anyone else about whom it is asked, unless, of course, it is investigating that person.  So, if the answer isn't "no," it will be read as "yes," even if it is spelled "No comment," and there goes the FBI's ability to investigate someone without publicly saying so.

This is a big deal.  It explains everything about why officials don't say things publicly even when it is clear that they know the answer and may even be clear to everyone what the answer is.  Any deviation from "No comment" makes any subsequent "No comment" more meaningful than it needs to be.

Thus, Comey testified that, in connection with the matter of Secy. Clinton's emails, he was permitted to say, to Congress and in press briefings - it's not clear why - that the FBI had opened a "matter," but not an "investigation."  That bothered Comey, who said "We're the Federal Bureau of Investigation," so it makes no sense for us to open anything but and investigation.  But A.G. Lynch's justification for ordering him to call it a matter was that the FBI does not comment on whether it has opened an investigation.  But, by creating an alternative statement to "No comment," A.G. Lynch had made "matter" mean something other than "No comment," and the only reasonable thing it could be made to mean, when opened by the Federal Bureau of Investigation, was, duh, an investigation.  Again, Comey should have been directed not to say anything about the matter, other than "No comment." And now it looks like the A.G. was trying to provide cover for Mrs. Clinton, when, perhaps, she was trying, unsuccessfully, to adhere to a policy without understanding its most important instrument: "No comment."

Sunday, May 28, 2017

Plus ça change

"We, the German Führer and Chancellor, and the British Prime Minister, have had a further meeting today and are agreed in recognizing that the question of Anglo-German relations is of the first importance for our two countries and for Europe. We regard the agreement signed last night and the Anglo-German Naval Agreement as symbolic of the desire of our two peoples never to go to war with one another again. We are resolved that the method of consultation shall be the method adopted to deal with any other questions that may concern our two countries, and we are determined to continue our efforts to remove possible sources of difference, and thus to contribute to assure the peace of Europe."  Neville Chamberlain after Munich.

"This call for driving out terrorism is a message I took to a historic gathering of Arab and Muslim leaders across the region, hosted by Saudi Arabia.  There, I spent much time with King Salman, a wise man who wants to see things get much better rapidly.  The leaders of the Middle East have agreed at this unprecedented meeting to stop funding the radical ideology that leads to this horrible terrorism all over the globe."  Donald Trump after Riyadh.

Friday, May 26, 2017

The Rough Beast is a Piss-Ant

Above all else, Donald Trump  will be remembered for his smallness.  Not the hands nonsense, but the petty, petulant, puerility of his time on the world stage. Send not to know for whom the baby monitor tolls.  We have elected a puling nonentity and sent him out to represent us at the big-boy table.  Shame on us.  Shame on the Republican Party for having so little to offer.  But mostly, shame on us as a nation.

Vladimir Putin is popular in Russia.  People say it's because he suppresses information about his flaws, but I don't believe that's so.  I think he is popular because a classy leader is a luxury that the Russians have not been able to afford, ever.  Gorbachev might have been such a leader, but the fact that he has been supplanted by a fascist thug says something about the kleptocratic soil in which Russia grows its leaders.

Trump is living proof that the US can no longer afford the luxury of a quality President.  The GOP gerrymandered the Congress into a feckless mess with an approval rating of 19%, every missing 81 points of which are the other guys' fault.  They aren't to be pitied - they thought they were putting party over country - but there is a delicious irony to their having hoist themselves on their own petard.  When swing voters don't matter, cooler heads have no reason to prevail.  Instead, morons get elected, Congress becomes a swamp, sixteen Tweedle-dees run for the Presidency, and an abomination slouches toward Washington to be born.

Read some Gibbon.  Read Shakespeare's "Julius Caesar."  And then read Yeats:

Turning and turning in the widening gyre
The party cannot hear the ward leader;
Things fall apart; the centre cannot hold;
The Tea Party is loosed upon the world,
The heartless tide is loosed, and everywhere
The ceremony of compromise is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

Or something like that.  I'm quoting from memory.

Watching President Trump lecture the NATO chiefs on their obligations to the US was really, really painful.  The US has every right to pressure its allies into paying their "fair share" toward the defense of their own soil, but the idea of hectoring them in public should make any American's skin crawl.  With so much going on in the world, so many points to make in a public speech, our guy wants to know who ordered the lobster.  And yet, an astounding and sobering number of self-styled "Americans" actually think this bozo is a better leader than Hillary Clinton.  Or John Kasich or JEB Bush.

Like Willie Loman, when this many voters talk, attention must be paid.  We must take another look at Germany in the late 1920's and see why Hitler's, er, quirks, were overlooked.  If stupid people are empowered to vote, they don't suddenly become smart.  Rather, they just vote for stupid things - solutions that sound good fast, because no one else is offering any solutions at all.  So, no, Mr. Eliot, the way the world ends is not with a bang or a whimper.  It's with a snivel.

Tuesday, May 16, 2017

Or, in the alternative, I had every right to...

To paraphrase Voltaire, if the high-five did not exist, the Russians would have to invent it.

The famous (among lawyers) example of arguing "in the alternative" goes like this:
My dog doesn't bite. Or, in the alternative, my dog was tied up that night. Or, in the alternative, you were not bitten. Or, in the alternative, my dog was provoked.  Or, in the alternative, I don't have a dog. 

That's pretty much how the Trump administration addresses the Orange Peril's blunders.  Why was Comey fired? Because he was unfair to Hillary. Or, in the alternative, because this thing about Trump and Russia is a Hillary-sponsored hoax.  Did Trump leak classified information to the Russians last night?  Well, the formerly respected H.R. McMaster says he was in the room where it happened, and it didn't happen.  Or, tweets the leader of the free world, in the alternative, I had every right to do it.

The Russians have won the Powerball, and they've taken their winnings as an annuity payable over the political life of Donald Trump.  One can only pray that it is short, and that it ends non-violently.  I'll stop typing now, as this is probably already old news...

Sunday, May 7, 2017

It's Only Money (Healthcare Edition)

Is there anything seriously wrong with either Obamacare or the GOP House bill that money couldn't cure?  What are the gripes about Obamacare?  It forces you to buy insurance you don't want.  Would a sufficient subsidy not cure that?  Insurance companies can't make money, so they withdraw from state exchanges.  Would a sufficient subsidy not cure that?

And the GOP bill that lets states set up high-risk pools for people who are very sick.  The Dems' only objection is that such funds have historically been underfunded.  Would a sufficient subsidy not cure that?

Topology fans - yes, there are topology fans - there must be - are fond of pointing to the torus - a solid object with a hole in it.  Like a bagel, or a teacup.  To the topologist, these are the same thing.  (How different is a meatball pizza from a cheeseburger, really?)  Well, any healthcare system that covers the poor and covers sick people after they get sick - when else would they be covered? - is going to be like any other at heart.  The risk has already been socialized, and the only question is whether there will be enough money delivered to providers to get them to deliver enough care.  Everything else is a detail.

Socialized benefits are paid for by taxes, broadly understood as an economic hit imposed to cover the cost of mutual benefits bought by the collective.  Buying insurance you don't want is a tax (just ask Justice Roberts), and inflation is a tax.  Price controls act as a tax.  Export tariffs on drugs sold at a higher price here than abroad impose a tax.  And, of course, explicit taxation is a tax.  But it's all the same to us topologists.  Everyone is getting healthcare, and, as a consequence, we are taxing whomever should be taxed, and in whatever way, as our politics determines.

I have my preferences regarding tax policy, but that's for another day.  For now, it's sufficient to note that any politically acceptable U.S. healthcare system post-Obama will require a lot of public money to pay for people who cannot afford the care they need.  Any legislative scheme that does not come up with that money will fail.  The murderers in Congress killed Obamacare by underfunding it.  The House Bill grossly underfunds the state pools without creating large enough subsidies to entice private companies.  Governors are in a bind: their constituents won't be able to buy coverage from insurers who are not there or afford coverage from pools that are underfunded.

No, the House Bill is not law, nor will it be.  But no new law will work unless it adequately subsidizes the cost of care.  Of course, that gives the government a big stake in cost control - e.g., the aforementioned export tariff on drugs sold to public health systems abroad - but that is a detail to be worked out.  The important thing is that no system that is underfunded can work.  Unfortunately, our pols don't much care whether a plan works; they just care who will get credit if it does, or - what may be a more valuable prize - blame if it doesn't.


Saturday, April 8, 2017

Who Knew? (Sarin edition)

Not long ago, President Trump "discovered" to his amazement that healthcare is complicated.  "No one knew," he tells us, how complicated it was.  Because our President lives in an impenetrable shell of ignorance, we should not be surprised that he is shocked to learn that nerve gas is bad for babies.  But we should not mistake "his" response to Assad's recent gas attacks for something approaching sentience.  Rather, this attack was the smart move of the smart acorns that our blind pig in chief reluctantly put in charge of the NSC.

The Tomahawk attack had one goal: to cause Assad to stop using chemical weapons and, having no use for them, to stop producing them or storing them lest his stockpiles fall into his enemies' hands.  Our object is not to save Syrian babies.  We don't have a way to do that.  Conventional bombs are lethal, too, and we can't stop them.  We are not trying to change the outcome of the Syrian civil war.  We are not even trying to "punish" Assad the man.  We are instead trying only to make the production of nerve gas a bad idea.  If none is made, none can be sold to or stolen by people we cannot persuade not to use it.  That alone is reason to make the use of sarin unprofitable for Assad.

The strategic decision to make Assad regret using chemical weapons is worthy of a national discussion.  Instead, our foolish media obsess over the morality of its use, the legality of our intervention, slippery slopes, palace intrigues, and everything else that has nothing to do with this act.  The Pentagon has tried to make clear that this attack was intended to discourage the use of the weapons, not to change our policy on Syria per se.   Of course, that's not what the President himself said in his mawkish blather about babies, but who cares what he says?

I am a big fan of Miller's law, a bit of communication theory that tells us to interpret statements in whatever reasonable way will make them true.  That won't turn "Obama tapped my phones" into "my associate's conversations were picked up by legal surveillance of foreigners," but it does facilitate an understanding of what people acting in good faith are trying to communicate.  The spirit behind Miller's law extends to analyses of public policy.  We should interpret each action in whatever reasonable way will make it the right thing to do, completely ignoring as irrelevant any defenses of the action that don't hold water.  Just because an actor offers a bad reason for doing something does not mean that the thing was the wrong thing to do.

In the case of the attack on Syria, discouraging proliferation of sarin is the good reason for doing it.
Viewing the attack in that light, I come out in favor of the raid and give the Administration credit for conducting it.  That the White House chooses instead to go off on a moralizing tangent is beside the point.  According to news accounts, the Pentagon (not the White House) has put forward a reasonable defense and strategic context for the action.  That's where our attention should be focused, and if our President's brain weren't such a muddle, we could in fact focus it there.

Update, 4/14/17.  Sean Spicer got in trouble for saying that not even Hitler used gas on his own people.  On the same day, Sec. Mattis was saying that not even Hitler used gas on the battlefield.  The people on the left who get outraged for a living went nuts over Spicer's version, but no one made a peep about Mattis's statement.  Spicer, of course, is an inarticulate spokesman, a quintessential first hire for Trump.  Loyalty, first, then, when that doesn't work, settle for competence.  But finding a good spokesperson will be hard for Trump, because a press secretary can't speak any more clearly than his principal thinks.  Better to have a liar like Conway, who doesn't care whether she's making sense, or a dimwit like Spicer, who doesn't know whether he's making sense.

But I digress.  The real difference between Spicer's gaffe and Mattis's statement is not that the Defenese Secretary speaks more clearly than the Press Secretary.  The difference is captured in this article.  Mattis attacked the weapon, whereas Spicer, like his boss, attacked the user.  Mattis compared Syrian war-fighting and German war-fighting.  Spicer compared Assad's war crimes and Hitler's war crimes.  On his Sunday show "Reliable Sources," Brian Stelter made the interesting point that Trump's talk about the pictures out of Syria reflects the fact that we don't see the pictures of the damage done by conventional weapons.  As Stelter put it, Trump only saw the gas victims because their bodies were intact.  The pictures of conventional bombing victims are so horrific that news media won't show them.  Those attacks didn't move Trump, but the gas bombs did.  As our wordsmith in chief might say, sad.

Anyway, Spicer got in trouble for making a moral argument about someone not being worse than Hitler.  That's a no-no, because the survival of the Jewish people may hinge on no one ever being publicly judged worse than Hitler, even though any number of tyrants and psychopaths in power could give the guy a run for his money.  But it all starts with the idea that Trump was moved by the immorality of the gas-bombing and not by our national interest in having gas-based weapons go away.  Mattis didn't say anything about the relative evil of people, just about the threat to humanity posed by the unique power of the weapon itself as a force multiplier.

Spicer is a constant reminder of Trump's inadequacy as a President.  If the President had anything to say worth hearing, he'd be forced to find someone capable of saying it.  So far, however, nothing useful has been lost in translation.  If the guy steps in it from time to time, the Left's outrage machine can huff and puff if it likes, but there's really no substance there, and we ought not to be distracted by it.



Tuesday, March 14, 2017

There Can Be Only One (Healthcare edition)

The nation appears to have reached a consensus that healthcare should be affordable and portable.  Our pols are now left with the impossible task of putting this square peg into the circular hole called "insurance."

Insurance is not a label; it's a concept.  Insurance covers risks that have not matured.  But we want to provide coverage for risks of illnesses that have already been contracted when the insurance policy is issued.  Unfortunately, the existence of the condition removes the risk that it will arise later, leaving only the risk that treatment will cost an unknown amount.  That risk can be insured, but the risk that the illness will occur cannot, because that insurable event has already happened.

Yet, we have decided we want to cover the costs of illnesses that have already been contracted when the insurance is taken out.  How do we do that?

One solution - the one used in Obamacare - is to require everyone to buy "insurance," all paying the same price (perhaps age-adjusted), whether they are sick or healthy.  All we have to do is add up the total expected costs of treating all illnesses, divide by the number of people paying insurance premiums, and provide assistance to those who can't afford that amount.  Problem solved.

Except for one thing.  The logic behind this solution demands that all of the premiums collected be available to pay all the claims presented.  But that cannot happen with multiple insurers in the same market.  The better a company is at servicing claims, the more likely it is to attract those who need claims serviced. Meanwhile, a company with poor service would make more money, as its premium payers leave when they get sick.  The companies would, in effect, be competing for the right to go broke.  Companies don't do that, and, mirabile dictu, many Obamacare insurance markets are finding only one player in the game.  How else could it be?  Nothing else works.

Portability is basic stuff to insurance people. A carrier can take on a matured risk if (i) it is paid the estimated cost associated with that risk, or (ii) it is reimbursed for paying actual claims associated with that risk, or (iii) some combination of both.  In the property/casualty business, so-called "loss portfolio transfers" are a common practice.  Claims incurred under one carrier's policy are transferred to another carrier in exchange for a lump sum or other negotiated payment.

A more pertinent model involves reinsurance.  Many primary insurance carriers have reinsurance agreements in place that survive a loss portfolio transfer.  Thus, when the transfer occurs, the amount the original carrier will have to pay to the acquiring carrier may be fully known and fairly small, because the real cost of the loss is borne by the reinsurer.

An Obamacare fix could adopt this reinsurance model.  Each insurance company could take the risk that a healthy insured will get sick while under its coverage, collecting a premium for that eventuality. When an insured gets sick, the company would be required to buy "reinsurance" with respect to that illness by paying an actuarially determined amount into a common Already Sick Pool (ASP),  Then, if an insured changes insurance companies, the company acquiring the risk could tap the ASP for payment.

To assure adequate financing for the reinsurance pool, some combination of three things must occur: (i) healthy people must buy insurance, or (ii) healthy people must pay a tax in lieu of the portion of the premiums they would have paid in excess of the actuarial cost of insuring them, or (iii) coverage by insurance would be automatic and free, with a tax imposed to pay for it on some basis that people find fair.  (See "Medicare.")

Note, though, that a single ASP is central to any of these approaches.  It is not a "detail to be worked out in conference."  It is essential to portability, which is essential to covering pre-existing conditions.  Unless the insurer on the risk when the illness is contracted, or someone else, pays for the cost of that illness, there cannot be portability between competing insurers. Since that is not happening now, competing insurers are withdrawing from the market, and they won't come back no matter how easy it is to enter the market, because the market itself cannot support competition without a single-payer already-sick pool.

The ramifications of a single ASP are enormous.  Insurance companies are essentially investment banks that make their money lending out their insurance reserves. Underwriting activities are just a way of collecting money to lend.  Insurers can even compete on the extent to which their investment results reduce the premiums they need to collect. So, unless an insurance company gets some money to manage, it's not really doing what its shareholders set it up to do.  It becomes a buying service for insureds rather than an investment bank for its owners.  Those are different businesses.

Who, then would manage the ASP?  In what would it be invested?  One can imagine a mechanism whereby each carrier gets to manage a chunk of the pool based on its contributions to the pool.  That might be cumbersome.  The obvious alternative would be transferring the ASP money to the Medicare Trust fund, where it would fund the national debt.  That's not a terrible idea in economic terms, as it would lower interest rates for everyone, thereby benefiting savers and borrowers. But it would deprive the capital markets of the money they now get in the form of health insurance company reserves, so that's pretty much a wash.

And, if there's going to be one pool, it might make sense to put it in a place where administering medical claims is already being done.  That means putting everyone in Medicare.  In short, if we want to insure pre-existing conditions, the only viable solution is a single payer, and the best choice for single payer is Medicare.

The rabbit is already in the hat. All that remains is for some political magician to extract it. Unfortunately, the rabbit looks like a poisonous snake. Maybe "ASP" isn't so good a name for it...

Sunday, February 12, 2017

About Judge Gorsuch

When it comes to Constitutional law, I'm an originalist.  That's with a small "o," like the small "r" in the republican that I also am.  I won't bore you with the difference between my kind of originalist and the kind the Right wants on the Court.  I'm just saying that I take the words in the document seriously.

So, when the Constitution says, in Article II, Section 2, that the President "shall nominate, and by and with the Advice and Consent of the Senate, shall appoint ... Judges of the supreme Court...", I believe that an originalist must regard as a dereliction of Constitutional duty the failure of any Senator to perform with respect to any nominee for "judge of the supreme Court" the actions that the founders intended be performed with respect to such a nominee.  And it is, therefore, the obligation of any such originalist, should he be offered the chance, to decline to take a seat for which a prior President made a nomination that the Senate has refused, with clearly partisan political motives, to consider.

Judge Gorsuch said in his remarks on being nominated that any judge who likes every decision he has to make is not a good judge.  Well, here's his chance to put his money where his mouth is.  If he takes the Constitution as seriously as those supporting his nomination say, without irony, that they want him to take it, he should decline the nomination until the Senate has dealt with the nomination of Merrick Garland.

I wonder what would have happened if President Obama had sued the Senate, claiming that its stonewalling his nomination of Judge Garland violated the Constitution.  Ignoring the procedural hurdles, how would Justice Scalia would have voted on that one?  How would Justice Gorsuch? Happily, President Obama did not bring that case, and I don't hear any suggestion that such a case is in the offing.  As a result, Judge Gorsuch may legitimately be asked about his reading of the Senate's responsibilities under Article II, Section 2, without the questioner having to worry that the issue might arise before the Court.

I would urge the Democrats on the Judiciary Committee to press Judge Gorsuch for his views, as an originalist, on the Constitutionality of the Senate's treatment of Judge Garland's nomination.  And then, whatever he says, I would urge the Democrats on the Senate to vote "nay" on Judge Gorsuch on the grounds that his very standing for the office is inconsistent with his claimed devotion to the Constitution and with the oath to uphold it that he will take as he usurps Justice Garland's seat.