Trump doesn’t understand stuff

I’m not sure if President Trump is stupid, ignorant, lazy, or some combination of the three. Here are two examples:

  • his accusation that Trump tower was wiretapped by President Obama:

President Trump refused to back down Friday after his White House aired an unverified claim that Britain’s spy agency secretly monitored him during last year’s campaign at the behest of President Obama.

and his evidence:

“We said nothing,” Trump told a German reporter who asked about the matter at a joint White House news conference with Chancellor Angela Merkel. “All we did was quote a certain very talented legal mind who was the one responsible for saying that on television. I didn’t make an opinion on it.”

“You shouldn’t be talking to me. You should be talking to Fox,” Trump added.

Fox News later added that they had no evidence, but the point is that Trump is getting his information from a TV station. Almost all reporters get their information from government sources, so Trump is saying that he is getting his information second-hand since he could directly ask the intelligence agencies which is where the reporters would have obtained their information. Does he not know this?

  • Donald Trump has said that the US should try to cut approval time for new drugs:

Trump’s direct aim at the NIH comes after his address to a joint session of Congress last month when he spoke to the importance of medical research. Trump told the story of Megan Crowley, a 20-year-old Notre Dame student who was born with Pompe disease, a rare illness. Crowley’s father helped develop a drug that saved her life, and in telling her story, Trump criticized the slow approval process at the Food and Drug Administration.

“If we slash the restraints, not just at the FDA but across our government, then we will be blessed with far more miracles just like Megan,” he said. “In fact, our children will grow up in a nation of miracles.”

That introduction comes from the fact that his administration wants to cut grants to the NIH by 18%.  I suppose in a perverse way it would decrease approval time for new drugs since fewer new drugs would be developed with the cuts to the NIH, but does Trump not know that the NIH funds studies to develop new drugs?

Wellness programs don’t really work … except for employers

I’m a little slow on this but it seems companies really want to get genetic information on employees:

A little-noticed bill moving through Congress would allow companies to require employees to undergo genetic testing or risk paying a penalty of thousands of dollars, and would let employers see that genetic and other health information.

Employers got virtually everything they wanted for their workplace wellness programs during the Obama administration. The ACA allowed them to charge employees 30 percent, and possibly 50 percent, more for health insurance if they declined to participate in the “voluntary” programs, which typically include cholesterol and other screenings; health questionnaires that ask about personal habits, including plans to get pregnant; and sometimes weight loss and smoking cessation classes. And in rules that Obama’s Equal Employment Opportunity Commission issued last year, a workplace wellness program counts as “voluntary” even if workers have to pay thousands of dollars more in premiums and deductibles if they don’t participate.

That doesn’t sound very good but at least it helps the health of employees:

Rigorous studies by researchers not tied to the $8 billion wellness industry have shown that the programs improve employee health little if at all. An industry group recently concluded that they save so little on medical costs that, on average, the programs lose money. But employers continue to embrace them, partly as a way to shift more health care costs to workers, including by penalizing them financially.

and from here:

The so-called “Safeway Amendment” was added to the ACA. Now, if you fail, or refuse to take part in, your employer’s “voluntary” wellness test, it can increase your premium by 30 percent — or, if you’re a smoker who refuses to quit, by 50 percent.

There is no evidence that this new rule produced a significant drop in America’s health-care costs. And that isn’t terribly surprising — since Burd’s column was composed almost entirely of lies.

“[A] review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years, the Washington Postreported in January 2010. “Those costs did drop in 2006 — by 12.5 percent. That was when the company overhauled its benefits … the decline did not have anything to do with tying employees’ premiums to test results. That element of Safeway’s benefits plan was not implemented until 2009.”

In other words, Safeway reduced costs for a single year by raising its employees’ deductibles. It didn’t save money by encouraging its workers to lead healthier lives — it saved money by making its workers pay a larger portion of their health-care costs.

Gee, it doesn’t help the employees but does help the employers. What a shock. And it gets better:

The privacy concerns also arise from how workplace wellness programs work. Employers, especially large ones, generally hire outside companies to run them. These companies are largely unregulated, and they are allowed to see genetic test results with employee names.

They sometimes sell the health information they collect from employees. As a result, employees get unexpected pitches for everything from weight-loss programs to running shoes, thanks to countless strangers poring over their health and genetic information.

So, to summarize, Obama and Congress were convinced to put a provision into the ACA that did basically shifted costs from the employer to the employee for little or no health benefits and now the GOP wants to expand that provision. You have to love it.

Here’s the Trump/Republican agenda

Today we get an idea of what Trump and Republicans want to do:

The revised order is narrower and specifies that a 90-day ban on people from the six countries does not apply to those who already have valid visas or people with U.S. green cards.

According to the fact sheet, the Department of Homeland Security will conduct a country-by-country review of the information the six targeted nations provide to the U.S. for visa and immigration decisions. Those countries will then have 50 days to comply with U.S. government requests to update or improve that information.

Additionally, Trump’s order suspends the entire U.S. refugee program for 120 days, though refugees already formally scheduled for travel by the State Department will be allowed entry. When the suspension is lifted, the number of refugees allowed into the U.S. will be capped at 50,000 for fiscal year 2017.

This will probably cut the number of visitors to the US, cut the number of students who want to go to college in the US, and cut the number of people who want to work in the US. This will cost millions of jobs and redirect some of the best and brightest to Europe and Canada.

House Republicans on Monday released their long-awaited plan for unraveling former President Barack Obama’s health care law, a package that would scale back the government’s role in health care and likely leave more Americans uninsured.

House committees planned to begin voting on the 123-page legislation Wednesday, launching what could be the year’s defining battle in Congress.

GOP success is by no means a slam dunk. In perhaps their riskiest political gamble, the plan is expected to cover fewer than the 20 million people insured under Obama’s overhaul, including many residents of states carried by President Donald Trump in November’s election.

The proposal would continue the expansion of Medicaid to additional low-earning Americans until 2020. After that, states adding Medicaid recipients would no longer receive the additional federal funds Obama’s law has provided.

More significantly, Republicans would overhaul the federal-state Medicaid program, changing its open-ended federal financing to a limit based on enrollment and costs in each state.

The changes also might crash the individual market to make it impossible for tens of millions of Americans to get health insurance. That would be a plus for Republicans.

However, it was the next phrase Carson uttered that landed him in hot water.

“There were other immigrants who came here in the bottom of slave ships, worked even longer, even harder for less,” Carson said. “But they too had a dream that one day, their sons, daughters, grandsons, granddaughters. . . might pursue prosperity and happiness in this land. And do you know of all the nations in the world, this one, the United States of America, is the only one big enough and great enough to allow all those people to realize their dream.”

Ok, that seems a little unfair. Well:

The original nine plaintiffs claim that detainees are forced to work without pay and that those who refuse to do so are threatened with solitary confinement.

Specifically, the lawsuit claims, six detainees are selected at random every day and forced to clean the facility’s housing units. The lawsuit claims the practice violates the federal Trafficking Victims Protection Act, which prohibits modern-day slavery.

‘‘Forced labor is a particular violation of the statute that we’ve alleged,’’ Free said. ‘‘Whether you’re calling it forced labor or slavery, the practical reality for the plaintiffs is much the same. You’re being compelled to work against your will under the threat of force or use of force.’’

This has been going on for a while so it’s not just the new administration, except that President Obama tried to cut back on private prisons for this type of reason and the Trump administration wants to expand them:

Notably, the stocks of the two biggest private prison operators, Geo Group and CoreCivic (formerly known as Corrections Corporation of America), have surged since Trump’s election. The companies donated a total of $500,000 to Trump’s inaugural festivities, USA Today reported.

Since Trump took office, his administration has reversed the Obama administration’s policy to end the country’s reliance on private prisons.

And if a little slavery slips in, well all for the better. Just ask Ben Carson–immigration and slavery are basically the same thing.

3=3.49

Via here, we get this:

Insurers would have more leeway to vary prices by age, so that premiums for the oldest customers could be 3.49 times as large as those for younger customers. Today, premiums for the old can be only three times as high as premiums for the young, which is what the Affordable Care Act stipulates. According to sources privy to HHS discussions with insurers, officials would argue that since 3.49 “rounds down” to three, the change would still comply with the statute.

At some level, this is politically stupid since it explicitly raises the rates of older people while reducing it for the young–the opposite of the voting pattern for Trump. For me, the problem is the math–at most 3 times as large means at most 3 times as large, even 3.01 is out, never mind 3.1 or 3.49.

This will be similar to the “Pi Bill” from Indiana which indirectly says that pi is 3.2 (the bill tried to prove a method of squaring the circle, which is impossible, by making it a law).

This is the type of thing which shows why there needs to be a March for Science (it will be on April 22 with satellite marches all over the country).

Trumpcare=No Care

Via Kevin Drum, we see how well Donald Trump and Republicans have prepared for the elimination of Obamacare:

Congressional Republicans, despite pledging to quickly repeal the Affordable Care Act, are struggling with what parts of the law to roll back and how to lock up the votes they will need, particularly in the Senate, to push their ambitious plans.

Thirty-one states, including many with Republican governors, have expanded Medicaid through Obamacare and could lose billions of dollars if the law is cut back.

In Washington, Republicans are also struggling to figure out what to do with Obamacare insurance marketplaces that Republicans worked for years to dismantle. In a reversal, GOP leaders now are trying to figure out how to prevent their collapse, which would jeopardize coverage for millions more Americans.

Insurance experts, including leading industry officials, have repeatedly warned Republicans over the past several months that repealing the health law without a replacement risks destabilizing insurance markets and will push many insurers to simply stop selling health plans.

So, not only will the repeal likely lead to tens of millions of people losing their health insurance it might actually wreck the entire individual health insurance market. Things would be even worse than before the ACA was passed:

But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12% of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the startup years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

And now comes the reality of the “repeal and replace” initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules.

Some in Congress seem to think that passing the “repeal” part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense.

How does the Trump administration plan to deal with this?

The budget legislation gives congressional committees until Jan. 27 — a blink of an eye for lawmakers — to write legislation repealing major parts of the health care law. Likely targets include the law’s tax penalties for people who don’t obtain insurance, its requirement that many companies cover workers and tax increases on higher-earning individuals and many health care firms.

Aware they have no chance of quickly agreeing on replacement legislation, Republicans plan to delay when their repeal would actually take effect. A range of 18 months to three years — perhaps longer — has been under discussion.

Trump has provided few specifics about how he would revamp the nation’s $3 trillion-a-year health care system. Steps he and congressional Republicans have mentioned include greater reliance on tax credits to help people afford coverage.

Republicans don’t want to abruptly end health care coverage for millions of voters who live in GOP-represented districts and states, or cause chaos in health care markets and prompt insurance companies to stop selling policies. So they are considering including provisions in their repeal bill to protect consumers and insurers during the transition period.

Sen. John Thune, R-S.D., a member of the GOP Senate leadership, said that could include money to temporarily continue helping people afford to buy coverage and language letting the Department of Health and Human Services help stabilize insurance markets.

A few things:

  • Republicans have been talking about repealing the ACA since it was passed and they have no plan to replace it yet? Obviously they have never really planned a real replacement.
  • Given the above discussion, it’s very possible that the repeal of the ACA will crash the individual insurance market so it won’t matter if there are subsidies since there will be no companies willing to participate in the market. Why would a company participate in a market they know will be gone in a few years and which depends on Congress supporting them to break even–knowing that Congress reneged the last time such a promise was made?
  • Given all the complexities, they are going to write the repeal legislation very quickly. I’m sure they will be very well written and carefully vetted.

Donald Trump, being Donald Trump, is trying to get out the lie that any failure will be the fault of Democrats:

massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight – be careful!

Sorry Donald, this will all be on you and the Republicans. You will be responsible for tens of millions of Americans losing health insurance.

Thank you Donald Henderson

The Boston Globe has a partial list of people who died in 20016. It’s a long list, they start with Muhammad Ali and Elie Wiesel, then run through a long list of high-profile names all the way through Jim Delligatti (the man who invented the Bic Mac). They even include a few scientists. They do not include Donald Henderson (although he is in the addendum in the paper):

Dr. Donald A. Henderson, a leader of one of mankind’s greatest public health triumphs, the eradication of smallpox, died on Friday in Towson, Md. He was 87.

Starting in 1966, Dr. Henderson, known as D. A., led the World Health Organization’s war on the smallpox virus. He achieved success astonishingly quickly. The last known case was found in a hospital cook in Somalia in 1977.

Now I can understand not starting with him but in some ways he was one of the most consequential men in history:

It carried off many European monarchs and buried the lines of succession to thrones from England to China. Because it killed 80 percent of the American Indians who caught it, it was a major factor in the European conquest of the New World.

Three American presidents survived it: George Washington, Andrew Jackson and Abraham Lincoln. In the 20th century, before it was extinguished, it was blamed for at least 300 million deaths.

Smallpox had already been eradicated in much of the West but it was still killing 2 million people per year when the campaign started. Dr. Henderson was far from the only person working on the battle, but I would still expect a person who is responsible for saving up to 2 million people per year to get a higher profile than the man who invented the Big Mac.

Trump will screw Trump states

Kevin Drum put this up:

Once Obamacare’s subsidies are repealed, it’s likely that 3 million people with expensive pre-existing conditions will be instantly tossed out of the health care system, unable to get insurance and unable to afford proper care.

He’s using the numbers from here. If you look at the chart in Kevin Drum’s post you notice that the states with the highest percent of people with pre-existing conditions voted for Trump. In fact, there are 23 states that are at or above the US average of 27% with pre-existing conditions–of these 4 voted for Clinton including Maine which split electoral votes (3 for Clinton, 1 for Trump). And all 11 with 30% or higher voted strongly for Trump (Clinton got less than 40% of the vote in all those states).

Hey, here’s a scatterplot (DC is the one in the upper left):

pre-exist

Donald Trump has said he wants to keep the ban on people being denied health insurance if the have pre-existing conditions but the health insurance companies will go bankrupt unless they’re allowed to charge them much more and/or force almost everyone to have insurance. Since the mandate to have insurance is not one of the things Trump wants to keep, health insurance will become unaffordable to a good chunk of these people which is why Kevin Drum says that 3 million of these people will be instantly tossed out of the health care system.

Trump voters really know how to stick it to themselves.

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