Not exactly news . . .

The Commonwealth Fund has done the latest in its series of surveys of 11 countries (western Europe, Canada and the U.S.) and, well, you already know:

• Adults in the U.S. are more likely than those in the 10 other countries to go without needed health care because of costs. One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs. This percentage is down from the 2013 survey (37%). [But it's about to go back up!] As few as 7 percent of respondents in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these affordability problems.
• U.S. adults were also the most likely to report material hardship. Fifteen percent said they worried about having enough money for nutritious food and 16 percent struggled to afford their rent or mortgage.
• Half of U.S. adults struggled to get health care on the weekends and evenings without going to an emergency department. Between 40 percent and 64 percent of adults in the other countries reported the same. The Netherlands had the lowest rate on this measure, 25 percent.
• Adults in the U.S. (19%) and France (24%) were the most likely to say that their medical records or test results had not been available at the time of an appointment or that duplicate tests had been ordered in the past two years. These problems were reported less commonly in the other countries.
• Fourteen percent of chronically ill U.S. adults said they did not get the support they needed from health care providers to manage their conditions. This was twice the rate in Australia, Germany, the Netherlands, New Zealand, and Switzerland.

So the Republicans take over and vow to make all this worse -- much, much worse. My question is simple: what is the constituency for this? Why do we so passionately want to hurt ourselves?

We'll be in for a lot of this . . .

Sam Stein and Matt Fuller for the Puffington Host report on the 21st Century Cures Act, which appears likely to pass. Believe it or not, it does some things Democrats want to do, including providing some additional funding for NIH and money to the states to combat opioid addiction.

But of course, there's a high price to be paid. It also makes it easier to get medical treatments approved without demonstrating that they are safe and effective. Senator Warren has denounced this as a corrupt bargain. The Democrats in congress will be offered more of these corrupt bargains in the coming years, such as the phony infrastructure plan that really consists of giving away public goods to capitalists. The Republicans haven't been afraid to obstruct everything for the past 8 years -- how will the Democrats behave now?

Stay tuned.

Speaking of scams . . .

While the new president and his minions are busy selling out the country for personal enrichment, the pharmaceutical companies will not be left behind.

This is a slightly complicated scam, so you might want to read the essay in NEJM by Dafny, et al. For those with short attention spans, I will try to explain. There are lots of medications available to treat most conditions. The FDA has to approve them if they are safe and effective, but they don't have to be superior to existing treatments. Comparative effectiveness research doesn't always get done, but sometimes we know that a less expensive drug works as well as a more expensive one, at least for most people. Also, of course, once marketing exclusivity expires there are often cheaper generic alternatives to brand name drugs.

So, insurance companies put drugs in different "tiers" with consumers facing higher co-pays for medications the insurers want to steer people away from, because they are more expensive or less effective, or both. This helps them make money, sure, but it also helps keep premiums down for all of us. So what do the drug companies do when they want to keep selling their more expensive brand name drugs?

They pretend to be doing you a favor by giving out coupons that cover the co-pay. But they aren't doing you any favor, they're screwing you. Let's say a drug costs the insurance company eight times as much and they give you a coupon for a 20% copay? You use the brand name drug instead of the generic, which might have a much smaller copay but with the coupon the brand name drug is free. But the cost to your insurance company is much higher. The drug company gets their ill-gotten gains and ultimately, it comes out of your wallet anyway in the form of higher premiums.

I wouldn't count on your friends in congress to do anything about this.

The New Normal

Simon Maloy thinks Trump's corruption will sink the Republican party. To which I say, poppycock.

According to the New York Times and the rest of the corporate media, Hillary Clinton was the corrupt candidate. Can you imagine if Clinton had just settled a fraud lawsuit for $25 million, or the Clinton Foundation had admitted to self-dealing? My imagination can't even encompass what the news coverage would be like.

But they are doing their best to ignore Trump's blatant and proven corruption -- one brief story on each revelation, and we move on. What makes Maloy think that's going to change?

Theories of History

There are several approaches to understanding and writing about history. There is the Great Man (rarely Woman) school, which consists largely of biography. There are grand theories that explain history as a process shaped by large forces in which the choices of individuals have little weight, from Marxism to the inevitability of neoliberal dominance of the planet. The latter didn't exactly have a name but lots of people believed in it.

Then there are those who say, sure, there are grand forces -- technological change, climate, resource depletion, demographics -- but against that background, a lot of shit  just happens. Call this the "for want of a nail" theory of history. Well, it's true.

No-one can enumerate the links in the causal chain that led to our present disaster, but we can spot a few that are both necessary and basically stochastic. Hillary Clinton actually won the election by quite a substantial majority, but thanks to the historical anachronism of the electoral college, it doesn't count. There is no argument that I can see that makes this the right result. A few thousand votes in a key state tips the whole thing. In past elections that has been consequential but in this election it puts the country on a path completely opposite to what would otherwise have been.

Another necessary link was the Comey letter. There is plenty of evidence that it flipped the election, and probably the Senate. This of course would not have happened in the corporate media hadn't been obsessed with the completely bogus non-issue of Hillary Clinton's e-mails to begin with. But they were, and Comey  knew it.

Comey could not have played his dirty trick, however, if he didn't have Anthony Weiner's computer. Ergo, if the ridiculous and ridiculously named Anthony Weiner did not have an incorrigible habit of tweeting his junk, Hillary Clinton would be preparing to assume the presidency and appoint a young liberal justice to the Supreme Court.

In other words, this whole thing doesn't mean shit. It's a horrible accident. Jessica Williams (a Daily Show regular with John Stewart for those who aren't with it) said, "The first rule of politics is, Don't Tweet Your Junk," which presumably Weiner would have learned when it cost him his congressional seat. He did not, causing him to lose his chance to be mayor of New York and prompting Williams to say, "The second rule of politics is, Don't Tweet Your Junk."

Apparently we need a third rule. "Don't Tweet Your Junk."

Resistance

So, Paul Ryan says his first priority in 2017 is to phase out Medicare. He'll give people vouchers that will cover part of the cost of private insurance instead, but obviously the whole point is that they won't be sufficient. Medicare is much more cost-efficient than private insurance, because it doesn't have to pay for marketing, multi-million dollar executive salaries, or profits. And insurance companies have all kinds of ways of avoiding the most costly customers and screwing people out of benefits. Read the linked post if you want more details, but . . .

What is most strange about this is that it has almost no constituency, apart from a few extremist ideologues and plutocrats who don't want to pay taxes. Retired people and people who will retire depend on the program (as do people with disabilities). Doctors and hospitals get most of their revenue from it. The only way Republicans can advance their agenda is to lie to people, which is what Ryan is doing.

It seems to me that now that Republicans have total control over the federal government, and it actually comes time for them to do everything they have promised to do, it's suddenly going to get difficult. The first thing George W. Bush said after he was reelected was that he wanted to privatize Social Security. Funny thing about that, it didn't happen.

We need to resist everything, everywhere, with maximum energy. There is still plenty of life in the American republic and the progressive vision. We will win in the end.

How worried should we be?

I commend to your attention this essay by Ezra Klein. Before I try to very briefly summarize his argument (but do read this, although it's long form) I want to pull this:

He is a man who routinely praises dictators. Of Vladimir Putin, Trump said, "He's running his country, and at least he's a leader, unlike what we have in this country." Of Kim Jong Un, Trump said, "You've got to give him credit. He goes in, he takes over, and he's the boss. It's incredible." Of Saddam Hussein, Trump said, "He killed terrorists. He did that so good. They didn't read them the rights."

It’s not just that Trump admires authoritarians; it’s that the thing he admires about them is their authoritarianism — their ability to dispense with niceties like a free press, due process, and political opposition.

Trump has promised — in public, and repeatedly — to bring this hammer to American governance. He stood in a nationally televised debate and vowed to jail his opponent if elected. He has proposed strengthening libel laws to make it easier to cow the press and antitrust laws to punish Jeff Bezos and Amazon for the Washington Post’s coverage of his candidacy. In a recent speech at Gettysburg meant to preview his first 100 days in office, Trump said he would sue all of the women who accused him of sexual assault. 

During rallies, Trump has exhorted his followers to assault protestors, and has promised to pay their legal fees if their thuggery leads to arrest. He has warned that the only way he could lose the election would be if it is rigged, and has suggested he may refuse to concede.

And all this ignores his more basic flaws. He is cruel, lazy, and reckless. He knows nothing of policy and has not bothered to find anything out. He is easily baited, reliant on sycophants, and prone to conspiracy theories. He is a bigot who slimed an American-born judge for his Mexican heritage and a misogynist who boasted that his celebrity gave him license to commit sexual assault. He has cast doubt on America’s commitment to the NATO alliance and offhandedly encouraged Saudi Arabia and Japan to build nuclear weapons. His business is rife with conflicts of interest, and his campaign has been amateurish and poorly managed.

 Klein wrote this before the election, when he expected Trump to narrowly lose. (Actually, he did lose the popular vote, and it wasn't particularly close. But the problem of the electoral college is for another day. He got plenty of votes.)

Klein's basic claim is that the gatekeepers who once had control of the nominating process -- party elites, mostly, but corporate media as well -- have completely lost influence. But while the parties are institutionally weak, the public is more partisan than ever. The result is that once Trump got the nomination, Republican voters stuck with him despite whatever doubts some of them may have had. And party elites could not afford to abandon him lest their voters retaliate against them.

We can forget about checks and balances because soon, far right extremists will control all three branches of the federal government. They will do whatever they want, and believe me, New York Times editorials won't slow them down.

Gross Domestic Problem

Back when I was a 22 year old Nader's Raider I heard Hazel Henderson speak at one of our conferences and she was already saying what Edoardo Campanella apparently thinks is a radical new idea, which is that Gross Domestic Product is not a valid measure of well-being, and not even a valid measure of economic activity.

Hazel was not the only person to figure this out 40 years ago and plenty of people have kept hammering on the fairly obvious truth of it since, but it's just pissing into the wind. The corporate media and political leaders continue to treat GDP growth as the measure of a "healthy" economy.

The reasons why this is wrong are so many and so gross that nobody should be arguing about it, but apparently we have to do it anyway. Here are a few:

GDP does not account for externalities. You know, air pollution, stuff like that.

It treats resource extraction as production, even though the resource is gone.

It treats harms as goods. For example, a hurricane that destroys houses becomes economic growth because the cost of rebuilding them is counted as a positive while their destruction is ignored. Same with automobile crashes, disease (which leads to health care spending), basically anything that goes wrong and has to be fixed.

As a corollary, saving money is bad. Preventing disease, avoiding disasters, improving public safety - these are all negative for GDP.

It doesn't properly account for the value of technological advances. As the same goods and services get cheaper, we still have the value, or even greater value, but the contribution to GDP goes down.

It takes no account of inequality. If one person gets all the loot and the rest starve, it doesn't matter.

It takes no account of any activity that doesn't involve exchange of money -- from household work to volunteering. Take care of your elderly parent yourself, zero contribution. Hire somebody to do it, GDP. 

More money flowing around does not translate into human happiness. No account of community, friendship, the value of common space, free concerts on the green, mutual respect, you name it.

Do we really need to keep having this pointless discussion?

The grotesque corporate media

Jesse Berney and Matthew Yglesias have posted very similar essays, which means they are channeling a collective consciousness, not that one is stealing from the other. As Berney puts it:

You start with the assumption that Hillary Clinton is corrupt. After all, there have been whispers and accusations and investigations and allegations and scandals with ominous names like WHITEWATER and BENGHAZI for years. Even if you can't describe exactly what she's done wrong, there must be something to all these stories, right?

Or, in the words of Yglesias:

The latest Hillary Clinton email revelations arose out of an unrelated investigation into Anthony Weiner’s sexting. The best way to understand this odd hopscotch is through the Prime Directive of Clinton investigations: We know the Clintons are guilty; the only question is what are they guilty of and when will we find the evidence?

Berney:

When I fired up the New York Times app on my phone Saturday morning, I had to scroll through four full screens before I got to a headline that wasn't about FBI Director James Comey's letter to Congress that the bureau had discovered emails on Anthony Weiner's computer that possibly maybe perhaps might be related to its earlier investigation of Clinton’s private email server. With zero information about what is in those emails, zero information about any connection to Clinton, zero new allegations of wrongdoing, the Times and much of the media treated this story with the kind of wall-to-wall coverage usually reserved for the first moon landing.

Yglesias:

There are several rules that govern media coverage of the Clintons, but this year the Prime Directive has dominated them all. Network news has devoted more minutes of coverage to Clinton’s emails than to all policy issues combined, even as email investigations have not uncovered any wrongdoing. It’s inexplicable news judgment, unless you simply assume there’s a crime out there.

On their editorial and opinion pages, the corporate media from the New York Times to CNN all say that Trump is unqualified to be president and that his candidacy presents an unprecedented risk to the republic. But in their news pages all they ever talk about is phony Clinton scandals, while Donald Trump's innumerable very real scandals are completely ignored, even when they are reported by credible single sources such as  David Corn, David Farenthold and Kurt Eichenwald -- as are issues of public policy.

I am very puzzled by this.

Also, too, what Digby says.

All of this raises a question The Washington Post’s Paul Waldman raised two months ago: How is it possible that Clinton’s email brouhaha has marked her as thoroughly corrupt and dishonest, while Trump’s monumentally nefarious past, present and future are overlooked? Waldman’s assumption is probably the correct one: The narratives were set early in the campaign cycle, with Trump being the bigoted, crazy one and Clinton being the corrupt one. That’s just how the media frames the contest. They got it wrong. Yes, Trump is the crazy, bigoted one. He’s also a misogynist and worse. But he’s also the corrupt one, perhaps even more than most of us who had already understood that ever imagined.