If Sarah Palin got her wish and became the Secretary of Energy in a Trump administration, she’d be in charge of our nuclear weapons. And if she chose to use her appointment as she promises, to close down the Department of Energy, then she’d be the point-person for figuring out how to reorganize our government so that it can deal with our nuclear weapons in some new way.
That these things can be part of our national political discourse is proof the Gods are just mocking us and that the Sun will soon explode.
No. Just no. Does not bear thinking about. An asteroid strike would at least be faster.
time to re watch Armageddon. Obama will go into outer space and personally blow up the asteroid then return to a constitutional amendment that gives him 2 more terms. Yay!!!
In a just and sane universe, Sarah Palin would never ever be allowed to run for any type of office anywhere.
So…
Trump is just playing her the way the GOP plays the “social conservatives,” and Democratic politicians play “New Deal” and minority Democrats.
Did you see that interview? She is simply crazy. Can you imagine her as Sec of Energy? Cnn is discussing it now and says she made some good points. Lord. Please help.
“Energy is her baby.” So, she would quickly terminate that Department. (I’m guessing not before she earns federal employee retirement benefits.)
Wish Republicans and the MSM would recognize that this star became stillborn years ago and offers nothing but the most unserious blather to public policy.
Well, Congress would have to shut down the DoE, the Secretary couldn’t do it. That said, the whole concept of Sarah Palin in any position of responsibility is so preposterous it’s unimaginable that anybody would ever consider …
Oh wait.
Any of them might consider naming her head of the Faith Based Initiative office. She wouldn’t know that it’s not a cabinet position or any less important than the cabinet.
I heard someone on CNN actually thinking she is qualified. The gods are indeed mocking us now.
As sect of energy she would be responsible for all of our nuclear material for bombs, reactors, and all domestic use. She is not even qualified to hire someone to do that or provide oversight.
People who want to shut down the Education Department or the Energy Department mostly don’t want to shut down every function under them. And the Nuclear weapons and energy complex under the Department of Energy is a case in point. The Federal role in Education actually precedes the Constitution and is firmly embedded in law still in effect that was originally enacted under the Articles of Confederation. And there has been a Bureau of Education or an Office of Education (names changed over time) since the first expansion of the Executive Branch during and after the Civil War. That the Office of Education was folded into the new cabinet omnibus Department of Health, Education and Welfare (HEW) and then broken out into the Department of Education had more to do with how Presidents wanted to position themselves as anything to do with fundamental restructuring. Abolish either DOE (Energy or Education) and the important offices will just be transferred under some other Cabinet department. At best you get a bunch of Under Secretaries and Deputy Assistant Secretaries that become redundant.
But Pell Grants will not magically disappear if Education is abolished, nor will grants to colleges or to school districts with “disparate impacts” due to military bases. And nobody is going to shut down Los Alamos or the Livermore National Lab because Energy was shuttered. Those nuclear bombs are not going to design themselves. 99% of this is Small Government Theatre.
Well, maybe so when it comes to whole cabinet departments. But the current appropriations bill wending its way through congress zeroes out the Agency for Healthcare Research and Quality. They can certainly abolish some government functions and fully want to.
The ones whose absence is likely to see health care costs continue to go up.
There is no alternative to single payer. It is only a matter of recognition or continued poor health care.
I am really surprised at how resilient the ACA is given the very high deductibles, co pays and very narrow networks. I hope someday soon, people wake up to that.
It’s not even two years old. It took more than seven years for all that mortgage backed securitization crap to blow up.
Drawing an association between the ACA and the repeal of Glass-Steagall is….unusual. I have not found analysis from any credible economist making a prediction of the dire nature you infer here. The association appears to me to be quite outlandish, particularly given the current outcomes of the ACA’s policies.
Didn’t have Gramm-Leach-Bliley at all in mind when I mentioned the time frame for those securities to blow up. Not that that legislation was unrelated to the MBS industry, but it existed before then. What kicked it into overdrive was the insurance the industry was able to purchase that backed up the derivatives first from the mono-line bond insurers AMBAC (which didn’t survive) and MBIA (that barely survived) and later AIG. That’s the type of insurance that Wall Street had always been looking for since early in the 20th century when it had been somewhat outlawed in NY and all other reputable insurance companies refused to consider it because it is super high risk.
It’s also super high profits for the first three to five years before the losses begin to trickle in and those trickles quickly turn into a flood. While the health insurance component of the ACA is not yet mature, and I do expect those costs to rise, that’s not going to create a meltdown for the ACA in the next few years. The longer term problem is the continuing shift from low cost health care providers, include public health in favor of higher cost, for profit providers. Which the GOP is aggravating with its attacks on PP. So, as health care costs as a percentage of GDP continues to increase over the next couple of decades, do we just continue to “suck it up?” Is 25% of GDP okay? 30%? When we reach the point of having no option other than to say enough, we really won’t be able to fix it without a major capital investment with a price tag that will cause the public to gasp. Or drastically cutting providers reimbursements — if that were so easy, why has it failed prior attempts? Most likely we’ll resort to austerity — the public be damned.
“It’s also super high profits for the first three to five years….”
The super high profits you claim on the onset are capped as a percentage of private insurance policyholder payments by the Medical Loss Ratio policies in the ACA, which create nationwide regulations of MLR percentages.
“… before the losses begin to trickle in and those trickles quickly turn into a flood. While the health insurance component of the ACA is not yet mature, and I do expect those costs to rise,…”.
On what evidence for either of these claims? There is little to no evidence that there has been a large adverse selection problem for enrollees on the Exchanges; this was the major prediction made by ACA opponents which they claimed would cause the cost spiral you “expect.”
“The longer term problem is the continuing shift from low cost health care providers, include public health in favor of higher cost, for profit providers.“
This is one of the strongest parts of the original language of the ACA: it essentially required all States to expand Medicaid eligibility. In States like our California, more than twice as many citizens have gained insurance through our public Medicaid insurance than have gained insurance through our ACA-enabled private health insurance exchange.
It is mystifying that you imply that Obama and the Democrats must bear responsibility for Chief Justice Roberts’ evisceration of this portion of the Act, and must own the rejection of Medicaid expansion (and now PP defunding?) by the Stupid States. We’ve been round and round on that one. But this claim of yours is new, and interesting:
“So, as health care costs as a percentage of GDP continues to increase over the next couple of decades, do we just continue to “suck it up?” Is 25% of GDP okay? 30%?“
This, this is exactly wrong, even with all the various GOP monkeywrenchings of the implementations of the ACA through all three branches of State and/or Federal governments. The years of the ACA have seen U.S. health care costs as a percentage of GDP completely flatline; they are no longer going up:
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
2010- 17.1%
2011- 17.1%
2012- 17.0%
2013- 17.1%
This cost had risen from 13.8% in 2000, so there certainly was a rapidly escalating cost problem to be addressed; you were right to point that out. It is in the process of being addressed, helped in no small part by the ACA’s growth in millions and millions of Americans who have been added to Medicaid.
Let me end with this: I agree that it will be difficult to reduce the U.S.’s health care costs without making more major shifts of Americans onto public insurance plans. Two points on that:
I think this is a good piece of analysis. Its just not realistic to think that single payer is the only acceptable alternative for universal coverage. It ignores that there are hybrid private-public systems that function very well in other well-developed nations.
ACA is far from perfect but there is a path to improving it and making it more efficient that is likely more feasible than passing single payer.
I’m not opposed to Medicare for All. I was hoping Vermont would successfully transition to single payer but that didn’t work out and it would be a much larger task at the federal level.
Again — you’re looking at an insurance book of business that isn’t even two years old and concluding that its rock solid. With all the cost shifting practices in the US medical “system,” that component of the ACA won’t mature in less than seven years. So, arguments today are futile or merely guesswork.
Note that 20% (plus whatever else can be legally finagled) overhead and profit for the health insurers is 13-17% more than what is legally allowed for insurers or government managed reimbursements in countries with UHC.
And again, I stipulated that while the insurance component of the ACA is problematical, it’s not likely to lead to any sort of blow-up.
Expanded Medicaid should reduce individual patient costs. Particularly for pregnant women that are legal residents as they can now access prenatal care. It’s to be hoped that those lower costs will compensate for expanding the utilization rates. It’s also humane. However, greatly expanding PP and mid-wife centered birth clinics would significantly reduce aggregate costs — first by reducing the incident of unintended pregnancies and second the actual delivery costs which aren’t insignificant. With near half of all births paid for by Medicaid (including that for undocumented residents), one would think that this would get some attention other than private hospitals expanding their birth facilities because it’s profitable.
However, note that when a state like PA boasts that the ACA saved it half a billion dollars, it makes no statement as to how much those savings cost the federal government. The original federal/state partnership for Medicaid was structurally a sound idea for several reasons. There was an incentive for states to manage locally all the factors that contribute to the cost of medical care. A recognition that medical care in a high income/high cost of living states should cost more than comparable care in a low income state and high income state coffers should cover that that difference. States then have to go further and place responsibility for management/control at the county level. Unfortunately, as Medicaid is the smaller portion of government payments for medical care, state and county management/control is limited. Hence, Medicare has become the most costly health insurance program in the world. A similar cost for the same covered population in countries with high quality UHC would bankrupt their systems. And yet, for lower per capita costs for the Medicare population, the measure of health outcomes in the UHC countries is equal to or better than that of the US.
As long as we ignore the elephant in the doctor’s and hospital rooms, costs are not going to magically decline and structurally, there is no way to increase the access for at least 25% of the population and not see an increase in aggregate costs. But what would a cost and value conscious socialist that believes government can operate basic services like medical care like me know about such things?
The Medical Loss Ratio in the ACA prevents some private health insurers from spending more than 15% of private health insurance money away from health care services:
https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Rati
o.html
“MLR requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the review provisions imposing tighter limits on health insurance rate increases.”
Your claim that “Expanded Medicaid should reduce individual patient costs” seems to argue against your later claim that “there is no way to increase the access for at least 25% of the population and not see an increase in aggregate costs.” The only way I can draw the two together is if you’re making the point that government could spend more money on health care, and by doing so cause patients to spend less money.
There’s significant evidence to show that the first is truer than the second. Increased access to sub-acute health services can absolutely decrease aggregate costs if it means helping people avoid needless visits to Emergency Rooms and other costly acute care services. Since ER’s are the only health providers in most States which are legally required to treat people regardless of their insurance statue or ability to pay, they become the primary provider to the many people, usually those with Medicaid or the uninsured, who cannot find a doctor to treat them. This drives up aggregate health care costs; using ER’s as a substitute for general practitioners of specialists also drives up costs, because ER’s are not intended to serve people with chronic health care problems, and cannot automatically see to it that a referral for follow-up care will be honored by outside caregivers.
This logic questions your assumption: “However, note that when a state like PA boasts that the ACA saved it half a billion dollars, it makes no statement as to how much those savings cost the federal government.”
What evidence do you have that those savings cost the Federal government anything in the aggregate? Recall that the CBO scored the ACA as likely to reduce the Federal budget deficit.
It’s resilient because of the end to denials because of pre-existing conditions, ending recissions, and the reduction of rating to two pools. Even people who complain about it don’t want to lose those legal restrictions on insurers.
The narrow networks are ways for insurers to try to introduce a different way of slicing the pool for profit. Each network is priced differently.
One single pool ends that sort of risk arbitrage and makes comparative profits impossible, which forces pure premium competition that customers can actually understand. With a sufficiently large number of insurers, profits tend toward zero. Incentives for fraud increase. A government single-payer plan becomes less subject to fraud and more efficient.
It doesn’t happen as long as there are employers buying employees with golden handcuff health care subsidies. The Cadillac tax is a blunt instrument to eliminate that two-tier system. Unfortunately organized labor negotiated themselves into the top tier before the ACA passed.
The ACA’s Medical Loss Ratio policies helps prevent the wilder levels of profit-taking by insurers in the pre-ACA days. Here’s a good summary chock full of policy outcomes and the historical State Legislative records on the subject:
http://www.ncsl.org/research/health/health-insurance-medical-loss-ratios.aspx
People have gotten checks from their insurers who have exceeded the percentages. That shows that the percentages were set at a meaningful rate, and that the regulations are being enforced.
If we’re talking about reasons why more Americans are supporting the ACA’s policies, it seems to me important that under the Act, insurers have been forced to send rebate checks to millions and millions of Americans, and have been forced to place in the envelope with the check a letter which explains that they have sent the check to their policyholder because they violated this portion of the ACA.
I also care to respond to your claim that “organized labor negotiated themselves into the top tier before the ACA passed.” This story from August shows that this is far from universally true:
http://www.huffingtonpost.com/entry/cadillac-tax-democrats-unions_55d5e7c7e4b0ab468da00204
For Union memberships that have prioritized quality health care insurance in their negotiations, the “Cadillac Tax” is getting ready to bite them in the ass. It’ll make it very difficult to maintain many hard-won Labor contractual standards across the country.
Saved the lives of people I know. I suspect that may have something to do with it.
Matt Taibbi, Rolling Stone: The GOP is now official the party of white paranoia
Taibbi is telling Trumpistas that the GOP has had them in the veal pen since Reagan.
Taibbi gets it and puts it straight:
We’ll see who wins that.
Raise that 175,000 per Congressional District that Democrats must turn out to 185,000. 🙂
GOTV cannot succumb to gerrymander victimization or Presidential fixation. In this election, down-ticket is what overcomes Presidentially-fixated Trumpeteers.
I’m a long term fan of Taibbi’s political reporting, but for me, this piece fell a bit short on being astute.
Is there a more fundamental problem in American politics as currently practised? I don’t think we have fully wrapped our heads around what an opportunity cost this presents.
Not seeing that as unique. More prevalent and overt in some years, but when it takes a back seat, anti-women, hippie punching, commies or terrorists coming to get us moves up to the front seat.
An antidote to that horrible woman.
Moosalini really is a horrible person. Thanks for using that very accurate adjective, and for providing such a quality antidote.
Moosalini really is a horrible person. Thanks for using that very accurate adjective, and for providing such a quality antidote.