If Only

Nobody dies because they don’t have access to health care.

Rep. Raul Labrador (R-Idaho)

This week’s featured posts are “Climate of Propaganda” and “Much Ado About Religious Liberty“.

This week everybody was talking about the French election

The centrist globalist, Emmanuel Macron, won a decisive victory over neo-fascist Marine Le Pen. Following up the Dutch election in March, where a similar neo-fascist did much worse than expected, I wonder if Josh Marshall is right: “Perhaps Trump victory saved Europe.” I don’t think other countries look at our right-wing populist leader and say, “We should have one of those here.”

As they did in the U.S., Russian intelligence operatives favored the right-wing candidate by various means, including promoting fake news stories and hacking the Macron campaign’s computers.

and ObamaCare repeal

To my great surprise, House Republicans passed a bill, 217-213, with all Democrats voting no. It looks like a very bad bill, which is probably why they passed it before the Congressional Budget Office had a chance to analyze it. That analysis will probably come out next week, and then we’ll know just how many millions of people have to lose their insurance so that the rich can get another tax cut.

Trump and the House Republicans staged a celebration in the Rose Garden, as if something major had already been achieved just by moving the bill on to the Senate. (Did you ever see so many aging white guys in suits? If you study the photo really hard, you can find a woman on the lower right. I haven’t spotted any non-whites.)

What mainly seems to have been accomplished, though, is shifting the blame in case of failure: Conservative House Republicans can go back to their districts and say “We fulfilled our promise to repeal ObamaCare. It’s not our fault the Senate killed it.” Republicans from moderate districts, though, are left holding the bag: They’re responsible for the bill they voted for, whether it becomes law or not.

That’s why The Cook Political Report immediately shifted its projection on 20 congressional races, judging that conditions in all of them have gotten more favorable for Democrats.

Republicans’ 217-213 passage of the American Health Care Act on Thursday guarantees Democrats will have at least one major on-the-record vote to exploit in the next elections. Although it’s the first of potentially many explosive votes, House Republicans’ willingness to spend political capital on a proposal that garnered the support of just 17 percent of the public in a March Quinnipiac poll is consistent with past scenarios that have generated a midterm wave.

… Of the 23 Republicans sitting in districts won by Hillary Clinton in 2016, 14 voted for the repeal and replace measure. … [S]everal of the 20 Republicans who voted against AHCA could end up being blamed anyway, much as 17 of the 30 Democrats who took a pass on the ACA and then ran for reelection ended up losing in 2010. For others, tough votes could make the prospect of retirement more appealing.

Emphasizing the point a little: The bill passed the House because Republican “moderates” caved to the Freedom Caucus, as they so often do. The number who caved were exactly as many as were needed to pass the bill, plus one. More might have surrendered their principles had their votes been necessary.

Remember this whenever you’re tempted to vote for your local Republican candidates because (individually) they sound like reasonable people. Maybe they are, but that doesn’t mean they have the courage to stand up to their party’s majority, which is not at all reasonable.

Indications are that Senate Republicans will want to do something different. I wouldn’t be surprised if they also passed something that repealed ObamaCare, even if it is very different from what the House passed. And that’s when things start to get real: Can the House and Senate compromise on a bill that they can both pass?

I remain skeptical. From a certain point of view, having two irreconcilable bills is the best possible solution: Nothing actually changes, so no victims will haunt Republican candidates in 2018. And each house can say that it did its job, while the other one was unreasonable.

Here are 50 organizations opposing TrumpCare: AARP, AMA, the Catholic Health Association of the United States, and 47 others.

and Trump’s empty “religious liberty” executive order

I covered this in one of the featured posts.

but it’s worth considering whether ObamaCare saves lives

The quote at the top of the page raises an interesting issue. Do Americans die for lack of health insurance, or did they prior to ObamaCare?

Anecdotally, the answer is clearly Yes. It’s not hard at all to find accounts by people who believe their dead loved ones could have been saved by better insurance, or people saying “ObamaCare saved my life.

In a common-sense discussion, the answer is also clearly Yes. Republicans will tell you about emergency rooms, and how nobody who needs emergency help is turned away. And that’s true, as far as it goes. But life-saving health care is more than just emergency care. Where you’d expect to see universal health insurance save lives is by identifying common chronic problems like high blood pressure, ones that don’t have the kind of obvious symptoms that would motivate you to go to an ER. If you’re getting regular check-ups, your doctor spots that stuff early and gets it under control. Years later, you don’t have a stroke.

Statistically, the question is trickier. A lot of pre-ObamaCare statistics indicated that Americans suffered from a lack of health care. MinnPost wrote in 2012:

The United States has a higher rate of “amenable deaths” — deaths that could have been avoided if individuals had received timely and effective medical care — than France, Germany or the U.K, according to a new study published online Wednesday in the journal Health Affairs.

The study also found that most of the Americans who are dying as a result of this higher rate are under the age of 65. In other words, people who are not eligible for Medicare. In France, Germany, and the U.K., affordable, universal health-care coverage is available to everybody, regardless of age.

More recently, a study looked at the effect of RomneyCare in Massachusetts and concluded that covering 830 more people results in one less death each year. These kinds of stats are responsible for most of the articles about the tens of thousands of people who will die from TrumpCare.

However, RomneyCare expanded private insurance coverage, and most of ObamaCare’s effect comes from expanding Medicaid, so that they’re not precisely comparable. And an experiment in Oregon on expanding Medicaid didn’t show a major effect. It concluded:

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

Possibly a longer-term experiment would show a life-saving effect, but that’s more guesswork than science.

So: Pre-ObamaCare America had lots and lots of unnecessary deaths, so the people who say it was “the best healthcare system in the world” are full of it. It’s not scientifically provable that ObamaCare is fixing that problem, but repealing it and throwing millions of people out of the health insurance system won’t fix it either.

In short, there’s room to criticize ObamaCare. But doing so still leaves you with a question: How do we get American health care up to the level of, say, France?

and you may also be interested in

The Russia investigation is still perking along. James Comey testified again, and Sally Yates testifies today. (Comey’s explanation of why it was appropriate to discuss the Clinton investigation right before the election but not the Trump investigation still doesn’t satisfy me. Nate Silver concludes that his decision probably swayed the election.)

At times it may look like nothing is happening, but we gray-haired folks recall that Watergate was like this too. The mills grind slowly. The Watergate break-in happened in July of 1972, and Nixon resigned in August of 1974.

The Wikipedia people are getting into daily journalism. It will be based on subscriptions rather than ads.

Josh Marshall wasn’t intending to talk about WikiTribune, but his comments are relevant: Because the costs of digital publishing are so low, there will always be a glut of online news outlets chasing a finite pool of ad dollars. The golden age of American journalism worked because one or two newspapers in each major city monopolized the local ad market. That model isn’t coming back.

Another model that doesn’t work any more: the regional shopping mall. I’m trying to guess when the next recession will start and why, because we’re getting close to the normal life span of an economic expansion (6-8 years, usually). A collapse of retail jobs could be the spark.

New Orleans is still arguing about whether to remove some of its Confederate statues. I don’t mind so much the ones in parks, but to me all the Confederate soldiers outside of city halls and court houses look like white sentinels warning blacks not to come here for justice or to register to vote. Also, I’d like to see statues of the Southerners whose Civil War experiences seem much more heroic to me: slaves who escaped to join the Union Army, and came back to free their fellow slaves. Where are their monuments?

The Atlantic points out an unsurprising coincidence:

A timeline of the genesis of the Confederate sites shows two notable spikes. One comes around the turn of the 20th century, just after Plessy v. Ferguson, and just as many Southern states were establishing repressive race laws. The second runs from the mid-1950s to the mid-1960s—the peak of the civil-rights movement. In other words, the erection of Confederate monuments has been a way to perform cultural resistance to black equality.

and let’s close with an amusing image

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  • Camilla Cracchiolo  On May 8, 2017 at 11:19 am

    ERs don’t provide chemo or other cancer treatment. If you are bleeding out because your leukemia keeps you from making platelets they’ll give you a transfusion, stabilize you and send you home. Doesn’t do a thing for the actual cancer.

  • Jeff Rosenberg  On May 8, 2017 at 12:16 pm

    In light of Trump’s comments, you might want to compare USA health care to Australia.

    • MAHA  On May 8, 2017 at 9:49 pm

      ALL of the developed countries EXCEPT the USA have universal health care.

      Deborah McP

  • MAHA  On May 8, 2017 at 10:08 pm

    I am still trying to figure out the different kinds of health insurance there are in the USA. So, medicare is universal health care for seniors (65+). Is Medicaid something like that for people under 65 who are below a certain income level?

    Doug wrote:
    “In short, there’s room to criticize ObamaCare. But doing so still leaves you with a question: How do we get American health care up to the level of, say, France?”

    You have to be willing to pay higher taxes, but from what I have read, it doesn’t sound like you are saving much on the insurance options you presently have – unless you don’t get any medical insurance… but even for a young, healthy person that is pretty risky.

    Deborah McP

    • weeklysift  On May 8, 2017 at 10:16 pm

      Yeah, that’s pretty much what Medicare and Medicaid are. About half the medical spending in the US is some form of government health care.

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