Obamacare Escapes the Maelstrom--On 3Quarksdaily.com

OBAMACARE ESCAPES THE MAELSTROM

by Michael Liss

That was quite close. But for a handful of votes, and some hubristic miscalculations, virtually all of the ACA would have gone down in a whirlpool of tax cuts and denials of coverage. 

And yet, the monster lives. The temptation is to fill volumes with the how and the why, all the inside baseball, who disliked whom. But, being the sort of person who is naturally attracted to dull, I am going to talk about AHCA and ACA without ever mentioning Donald Trump, Paul Ryan, and the Freedom Caucus. Spoiler alert—read further and you enter a sea of boiling wonkiness. 

Let's state what the last few weeks should have made obvious: For all the bloviating the overwhelming majority of Congressmen and Senators really don't know what they are doing when it comes to healthcare. They don't understand population health or public health issues or patient needs. They don't understand insurance. And they don't understand economics.  
No one should be surprised by this. Politicians rarely have granular knowledge in any field other than politics. Rather, governing is basically the mechanism through which the expertise of other, more informed people (in industry, academia, and inside government itself) is filtered through a political philosophy, debated, transmitted (or sold) to the public, and enacted.

Most of the time this process works—crudely, without attention to fine detail, without being perfectly engineered. Americans have been blessed with great assets. We can usually afford the inefficiencies that have ideology (or just garden variety spoils) triumphing over technocratic precision. Besides, there is always another election coming.

But healthcare is just too complex and nuanced and just plain important for bumper-sticker governance. We really do need deep knowledge and a multidisciplinary approach to have the slightest chance of drafting credible legislation. Whether we like ACA and want to improve it, or hate it and just want to blow it up, the least we can do is make an attempt at understanding its key components.

 See more at http://www.3quarksdaily.com/3quarksdaily/2017/04/obamacare-escapes-the-maelstrom.html

College Boys and Soldiers

My 40th college reunion is coming up. Yes, it's a jolt to the system to realize that I've gone from a skinny young nerd to a skinny vintage nerd in what seems roughly the amount of time it takes to play an Orioles-Yankees game. I'm making the calls and sending the emails to my far-flung (but "curated") group of friends, trying to decide whether Baltimore in Springtime is all that appealing...or should we just wait for 50?

It can get a little hot in April in Charm City. In fact, it can stay a little hot well into September. Along with hot, Baltimore has a well-deserved reputation for humid. It excels at humid. This, along with Chemistry, and, of all things, German, caused me briefly to wonder just what the heck I was doing when my guidance counselor suggested Johns Hopkins and I thought "Hopkins, wow, great idea, Cushing, Halsted, Osler, I'm going to be a doctor!"

Reality can be a cruel mistress. Yet there was something besides an absurd Heat-Index reading that was different about my first few days in college—there was also the sound of ROTC candidates training in the practice field behind my dorm. A reminder of Vietnam and a fate—perhaps my fate—rather narrowly escaped.

If you didn't live through it, it might be hard to grasp the turmoil, anger, and anxiety of the late 60s and early 70s. Turmoil, because no one knew when or how the war was going to end; anger, at politicians who seemed unable to find satisfactory answers; and anxiety—deep fear—that you, or a family member would somehow find himself in a place that few wanted to be for a cause in which many did not believe.

Richard Nixon had called for an all-volunteer army during the 1968 Campaign. Whether he actually believed in the concept or was merely using it as a tactic is hard to say. But he was also looking for a way to defuse the constant anti-war demonstrations. These, he thought, were led by middle and upper-middle class families who were concerned that once their boys completed their college deferments, they would be shipped off to die. Take away their risk, and they would no longer care, allowing him to pursue his strategic aims unencumbered by organized opposition.

See more at http://www.3quarksdaily.com/3quarksdaily/2017/03/college-boys-and-soldiers.html

Populists and Plutocrats Unite!

POPULISTS AND PLUTOCRATS UNITE!

I was in a 7-Eleven last Sunday morning for a restorative post-jog donut, when a big, late-middle-aged man with a MAGA hat and a matching red face came in. He grabbed a few tall-boys and a bag of ice, and made his way to the check-out line. To my reasonably educated eye (and nose) those particular tall-boys weren't going to be the first of the day.

In all the kaleidoscope of images from the first two weeks of Trump's reign, there is something about this man that I cannot get out of my head. To say he seemed out of place in my 83%-for-Hillary Congressional District would be an understatement—but there he was. Wow—a perfect specimen of a stereotypical Trump voter as if drawn in an editorial cartoon! Obviously, I wasn't actually going to interact with him, but this rara avis had somehow wandered into my cloistered neck of the woods and even allowed himself to helped by the Pakistani staff in the store. 

read more at http://www.3quarksdaily.com/3quarksdaily/2017/02/populists-and-plutocrats-unite.html#more