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Trump and Russia, What We Know is Disturbing



Beyond wild allegations, what’s clearly true about Trump and Russia is disturbing

With reports that the Russian government may have dirt that they are using to blackmail Donald Trump setting the political world ablaze, it’s worth being clear about two things.   One is that the content of these reports is unverified and, likely, unverifiable.   What’s more, to the extent that any of it could be verified, it’s inconceivable that the Intelligence Community would publicly reveal the kind of human or signals intelligence sources that could verify it.   So as far as the public knows, we are never really going to know.

The other is that the Russian blackmail theory is composed of two sub-elements, both of which are clearly true based on publicly available information.   One is that Donald Trump has a curious and wrongheaded affection for the present government of Russia and its foreign policy.   The other is that Donald Trump has engaged in scandalous conduct, the public revelation of which would cause a rational person to reduce their opinion of him.

Allegations now floating around range from the salacious (Russia has Trump sex tapes made at the Ritz-Carlton in Moscow) to the serious (using intermediaries, Trump and Russia agreed to an explicit quid pro quo in which Russia would give him electoral help and in exchange he would shift US foreign policy).   None of this is proven, and much of it is unprovable (if the FSB has a secret sex tape, how are we going to find it?) but the truth is that these kind of allegations, though difficult to resist, simply shouldn’t matter much compared to what’s in the public record.


First, on Russia: 




    Trump’s strange ideas about Russia date back to at least 1987, when Trump called for a US-Soviet alliance against France and Pakistan.

    During the 2016 campaign, Trump publicly called into question America’s commitment to defending NATO allies from Russian attack.


    Trump praised Russia’s intervention in the Syrian Civil War.


    Trump has also pointedly declined to criticize Putin on any front, whether it’s about killing journalists or invading Ukraine.


    Trump’s former campaign manager, Paul Manafort, made a lot of money working for Putin’s proxy party in Ukraine.
    Concurrently, the Russian government’s state-owned English-language media operations, RT and Sputnik, were fairly open in their advocacy for Trump and against Hillary Clinton during the campaign.
    Trump, at the same time, has been very open about his desire to implement a more pro-Russian foreign policy — up to and including his decision to bypass conventionally qualified candidates and instead tap the CEO of an oil company with extensive business dealings in Russia as Secretary State.

We may never know why, exactly, Trump thinks Russia’s brutal war in Syria was good or why it would be wrong to condemn Putin for killing journalists. But Trump’s Russia policy is both a bit bizarre and also quite clear. Maybe the Russians are bribing him into it. Maybe he just has bad ideas. Maybe they are blackmailing him.

I have no idea. But if you’re wondering whether there is dirt on Trump out there, then the answer is clearly yes.




 Trump was recorded telling a casual acquaintance that he routinely sexually assaults women and escapes culpability because “when you’re a star they let you do it.”

    Trump paid $21 million in damages to students at his fake university who alleged he’d defrauded them.


    Trump’s foundation broke a wide range of rules about how it is legal to raise funds for charity and how it is legal to manage charitable funds.   Some tax experts say the material is in place to open a criminal tax fraud investigation.


    Trump’s Atlantic City comeback was fueled by bilking shareholders.

Last but by no means least, it’s quite obvious that there is at least one thing — and perhaps several things — lurking in Trump’s tax returns that would be highly damaging to his political standing.   He has taken a fair amount of political heat for quite some time now to defy tradition and keep these documents secret.   I have no idea what he’s hiding or whether the Russians somehow secretly know what it is, but he’s pretty clearly hiding something.

A special congressional select committee investigation — or maybe some kind of independent prosecutor — seems clearly appropriate given the level of questions still hanging around the specific issue of Russian hacking and communication with Trump’s staff during the campaign.   But in broad terms, you don’t need to resort to any cloak and dagger theories or secret classified information to know what you need to know:  Trump has a weirdly sunny view of Putin, an alarming lack of attachment to America’s treaty obligations, and some serious skeletons in his closet.   Most people didn’t vote for that, but the dictates of the Electoral College elevated him to the presidency anyway.

The question now is whether congressional Republicans will uphold their constitutional obligations to check him.   I hope we learn more about the stories roiling the internet this week, but the publicly available facts are pretty clear.






Trump Will Remove Sanctions on Russia As Soon As He Can



If there was ever any doubt about who owns the President Elect, this should clear things up:

President-elect Donald Trump says he would be open to removing sanctions against Russia if Moscow is “really helping us.” In an interview with the Wall Street Journal that came out late Friday, Trump said he would leave the sanctions in place “at least for a period of time,” though he did not elaborate or provide a more specific time frame. The sanctions, imposed by the Obama administration in late December amid allegations that Moscow meddled in the presidential election, have been widely seen as a test for Trump as he takes office.

Our elite institutions are not serving the interests of the American people, are they? Decent people are not doing the decent thing. Far too many are putting party above all else. None of the things that should be happening are and we're left to wonder, what's it going to take? At what point do we acknowledge as a nation that we've been had? Somewhere, I hope someone is doing the right thing and investigating what's gone on. I suspect that everyone who could do something about this is just sitting on their hands, hoping it all goes away.

Faith in the rule of law has never been more shaken. Not during the Bush years, not at any time before that. We've seen insanity normalized and the whole country would trade what we have now for Bush and Cheney in a heartbeat. What does that tell you?








 The "madman theory" of Nuclear war has existed for decades. Now, Trump is playing the madman.


 Is Donald Trump a madman?   Or, at least, would he like foreign leaders to think he might be just a little unstable?   Such questions are being batted around in papers like the Boston Globe and the Washington Post in response to the president-elect’s foreign policy moves:  his provocations toward China, his attacks on NATO and the UN, his warm overtures toward Rodrigo Duterte and Vladimir Putin.

Across the pundit-sphere, analysts are asking, is he crazy, or crazy like a fox?

In no context is the question more pertinent than Trump’s position on nuclear weapons.   His comments both as candidate and president-elect show a more cavalier attitude toward their proliferation and use than any president in the past 30 years.   “You want to be unpredictable,”  Trump said last January on Face the Nation when asked about nuclear weapons.   More recently, he tweeted that it was time for the US to start stockpiling nukes again.   The comments prompted instant parallels to Richard Nixon’s “madman theory” of foreign relations:  the idea that the president couldn’t be controlled — including where America’s nuclear arsenal was concerned — so foreign leaders should do everything in their power to appease him.

The madman question is so important here because madness has been a mainstay of nuclear culture since the atomic age flashed into being in the Jornada del Muerto desert in 1945.   The bomb, carefully engineered by some of the 20th century’s most brilliant scientists, able to raze cities and civilizations, has always spanned rationality and irrationality, logic and madness.



The brightest minds created the most destructive force, and then leaders spent years working out rationales for its world-ending use.   It was a madness begot by logic.   But that madness doesn’t always present in the same way, which is why the history of nuclear madness has to precede our understanding of the Trump-as-madman debate.

High culture and pop culture alike have wrestled with the insanity of nuclear weapons

The first nuclear detonation in 1945 split history itself:  the time before the bomb and the time after. Scientists had harnessed the atom, the same energy that fueled the stars — a new Big Bang.   Hermann Hagedorn captured the sense of dislocation ushered in by the atomic age in his 1946 poem,  “The Bomb That Fell on America.” 


The bomb, he wrote:  did not dissolve their bodies,
    But it dissolved something vitally important to the greatest of them, and the  least.
    What it dissolved were their links with the past and with the future.
    It made the earth, that seemed so solid, Main Street, that seemed so well- paved, a kind of vast jelly, quivering and dividing underfoot.



Science fiction became a repository for those anxieties.   The Japanese grappled with the aftermath of the bombings of Hiroshima and Nagasaki through films like 1954’s Godzilla, featuring a prehistoric monster revived and remade by a nuclear blast.   That same year, American filmmakers released the horror film Them!, which saw giant irradiated ants making their way from nuclear test sites in the deserts of New Mexico to Los Angeles.   Tellingly, the easily described monsters — they’re just big ants — are referred to in the film as an “unknown terror” and “nameless horror.”   This was not just an ant movie.

The trailer for Them! gave away the game:  “Cities, nations, civilization itself:  threatened with annihilation, because in one moment of history-making violence, nature — mad, rampant — wrought its most awesome creation.”   Nuclear weapons were not presented as scientific marvels but instruments of “history-making violence,” quickly elided with nature itself, as though humans had not, with precisely drawn equations and charts and blueprints, engineered and unleashed that violence.

That celluloid terror was a product of changing geopolitics.   For a moment — just a moment — the US had a nuclear monopoly.   During that brief period, the terror of nuclear science, with its unprecedented destructive power and its potential for fueling more and more powerful weapons, seemed controllable, knowable.   But four years after Hiroshima and Nagasaki, the Soviets tested their own nuclear bomb, and the race was on for more powerful bombs, for better strike capability, for the ability to annihilate the other side before it could return fire.   By the mid-1950s, the arms race had reached its illogically logical endpoint:  If one side struck, everyone would be wiped out.   Mutual assured destruction. MAD.



The acronym stuck, perhaps because of the horrific absurdity of it all.   The logical conclusion, the position to which the world had been brought by the combined education and expertise of scientists and strategists, was the verge of obliteration.

No giant irradiated ant could compete with that. 
As time passed, Mutually Assured Destruction came to seem — MAD

In the early 1960s, the world wobbled on that edge during the Cuban Missile Crisis.   John Kennedy, the young, optimistic president surrounding himself with the “best and the brightest,” had toyed with nuclear war, engaging in brinksmanship right until the moment Khrushchev blinked.   Never had the world come closer to war between two nuclear powers.   One false move, one miscalculation, and the story would have ended there.

Maybe it was the exhaustion of the arms race, or the terror of the missile crisis, or the apocalyptic consequences of MAD, but by 1964 the idea of ever using nuclear weapons was considered insane.   If the outcome truly was mutual assured destruction, then it would take an act of self-destructive madness to press the button.   That was the conceit behind Dr. Strangelove, the film that offered characters like Strangelove, the German-émigré nuclear “mad scientist,” and Jack D. Ripper, the insane general with a killer’s name, as models of madness.

Ripper, convinced that the Soviets were brainwashing Americans through fluoridation, sent ordinance-laden planes toward the Soviet Union.   But in order for the spittle-flecked lunacy of Ripper to have world-ending consequences, another madness had to precede it: the game-theory logic of brinksmanship, stockpiling, and second-strike strategies.

These arguments were not contained to film.   Dr. Strangelove was quickly reinterpreted as an allegory for the Goldwater campaign, especially after Goldwater advocated the use of low-yield nuclear bombs in Vietnam.   Goldwater’s suggestion that the US should use nuclear weapons, even on a small scale, fed into his image as an unstable extremist, a madman in the Strangelovian mold.   It was those public doubts that led Fact magazine to ask psychiatrists to evaluate Goldwater’s mental health.   And it was also why the popular rejoinder to Goldwater’s slogan, “In your heart you know he’s right” was “In your guts you know he’s nuts.”

This belief — that advocating the use of nuclear weapons was insane — likewise shaped Richard Nixon’s early foreign policy moves.   Upon entering office, Nixon used a make-’em-think-you’ll-do-it tactic with the Soviets and Vietnamese in an attempt to bring Hanoi to the bargaining table.   (This effort followed his efforts during the 1968 campaign to scotch the Johnson administration’s attempt at peace talks, the subject of some recent archival revelations.)



The tactic became known as “the madman theory”, a term Nixon coined and shared with his aide H.R. Haldeman in the summer of 1968.   The basic concept had been brought into the White House by Henry Kissinger, who wrote about the “strategy of ambiguity” in his 1957 book Nuclear Weapons and Foreign Policy, although the idea seems to have come from a 1959 lecture by Daniel Ellsworth called “The Political Uses of Madness.” 
Nixon explicitly embraced the “madman theory”

Nixon put the madman theory to the test early in his first year.   In October 1969 the US went on nuclear alert, loading up 18 B-52 bombers with nuclear warheads and aiming them right at the Soviet Union’s eastern border.   As historian Jeremi Suri explained in his account of the incident, Nixon’s goal was not to attack the Soviets but to convince everyone Nixon was out of control, and just crazy enough to start a nuclear war in pursuit of ending the war in Vietnam.

Despite resistance from the joint chiefs and Secretary of Defense Melvin Laird, for three days the planes looped between the West Coast and the edges of Soviet airspace, skirting the border in ways that might gain notice but would not make the Soviets think they were under attack.   (There is no evidence the Soviets had any significant reaction to the provocations.)

“I want the North Vietnamese to believe that I've reached the point that I might do anything to stop the war,” Nixon told his aide H.R. Haldeman.   “We'll just slip the word to them that, ‘for God's sake, you know Nixon is obsessed about communism.   We can't restrain him when he is angry — and he has his hand on the nuclear button’ — and Ho Chi Minh himself will be in Paris in two days begging for peace."

The Soviet ambassador, Anatoly Dobrynin, walked away from a meeting with Nixon and Kissinger convinced that Nixon was unhinged.   But the feint didn’t work.   Hanoi did not rush to cut a deal.   The war raged on for another four years.   Nixon’s foreign policy victories came instead from more rational strategies of détente and triangulation, resulting in open relations with Communist China and SALT I, the first arms-limitations agreement between the US and the Soviet Union.

Arms-control talks were the norm until Ronald Reagan took office and reintroduced a note of instability into US nuclear policy.   In the 1980 race he had campaigned against SALT II, which he called “fatally flawed,” and pushed for a new arms build-up, along with a missile defense initiative.   In office, his hawkish rhetoric, combined with Soviet Premier Yuri Andropov’s fear of a secret attack and increasingly realistic American war games in Europe, brought the world once again to the brink of nuclear war.   A recently declassified 1990 intelligence report concluded:  “In 1983, we may have inadvertently placed our relations with the Soviet Union on a hair trigger.”   The trigger nearly went off in November of that year.



When Reagan learned that the Soviets believed he was capable of starting a nuclear war, he was stunned.   During the 1983 war scare, he said:  “I feel the Soviets are so defense minded, so paranoid about being attacked that without being in any way soft on them, we ought to tell them no one here has any intention of doing anything like that.”   His rhetoric soon softened, and Reagan, like Nixon before him, switched from the madness of brinksmanship to the rationality of arms-control, starting first with a ban on intermediate-range missiles and culminating in the Strategic Arms Limitation Treaty.

The Cold War ended.   The Soviet Union broke apart and the challenge became keeping nuclear weapons secure in the hands of the new Russian state, and away from actual madmen whose geopolitical calculations did not conform to the great-state deterrence model of the Cold War.   Neither MAD nor the madman theory had a place in a post-cold War world, where nuclear policy was instead defined by controlling and destroying weapons and managing their spread. 
Trump embraces a Nixonian approach in the post-Cold-War era.

This has not been an easy feat.   World leaders understand that nations with nuclear weapons are treated differently than those without, and so there is a rational reason for pursuing nuclear technology.   At the same time, the use of nuclear weapons against an enemy would make a nation-state into a global pariah.   It would be insane.

Enter Donald Trump.   The president-in-waiting is schooled in none of these particulars, claiming to believe only in strength and the desire to use it.   His loose talk about nukes has re-raised the long-dormant question:  Is he crazy enough to actually press the button?

Here, the history of nuclear madness may be as much a trap as a guide.   Because the questions now shouldn’t be about Trump’s madness but his impulsivity and ignorance.   Whatever one thinks of Nixon and Kissinger’s madman theory, it was a calculation.   Kissinger was steeped in game theory and Nixon had a deep knowledge of international affairs.   Reagan was a foreign policy autodidact with experienced ideological advisors.   Their administrations could tell a hawk from a handsaw.   (Admittedly, some of these comforting thoughts were only fully evident in hindsight.)

Trump doesn’t share his predecessors’ considered strategic thinking and mastery of geopolitics, but that doesn’t make him a madman.   The madness is in the weapons themselves, powerful enough to obliterate entire countries, entire peoples, and in the logics that grew up around them to govern their disuse.   The only hope is that, as with Nixon and Reagan before him, Trump’s time in office makes clear how badly things can go in an atomic age, and how important it is to continue the push to contain, if not eliminate, the madness in our midst.









What Happens If Trump Repeals Obamacare?


 
President-elect Donald Trump has pledged to repeal the Affordable Care Act when elected, calling it a "total disaster."   With Republicans -- who have vowed for six years to overturn President Barack Obama's health care law -- set to control both the Senate and the House of Representatives in addition to the presidency, a dismantling of Obamacare is more likely than ever.   Here's what repealing the law would mean for you.

Republicans do not hold 60 seats in the Senate, so a full repeal is unlikely, according to the New York Times.   But according to Price waterhouse Coopers, Trump and Congress could make "targeted changes" to the law, including defunding "the consumer exchange subsidies in a budgetary maneuver known as reconciliation."

These are the targeted changes:  In January, the GOP passed a bill (that Obama vetoed) that eliminated the subsidies that help many Obamacare recipients afford their health coverage as well as Medicaid expansion that gave coverage to more than 6 million low- and moderate-income Americans.   The bill also eliminated the employer mandate; the individual mandate, which requires everyone to have health insurance or pay a tax penalty; and restricts funding to organizations like Planned Parenthood.


What Women Should Know About Health Care Under Trump



 According to Amy Lotven, a reporter and editor for Inside Health Policy/Inside Health Reform, it is possible that the elimination of subsidies could cause millions of people to lose their insurance overnight.   A clause in the agreement between insurers and the government allows insurers to bow out of policies if subsidies end.

However, given that Vice President-elect Mike Pence said there would be a transition period—which the GOP plan put at two years—that is not necessarily likely.   Additionally, "the clause also says 'subject to state law,' so [it is] unclear how that would pan out on the ground level," Lotven writes in an email.

The Times reports that the reconciliation noted above would not impact some of the most popular provisions of Obamacare, including allowing people under the age of 26 to stay on their parents' health insurance and the requirement that health insurers cannot refuse coverage to those with pre-existing conditions.


During the two year transition period stipulated by the GOP bill, Trump and the GOP would theoretically implement whatever new policy they come up with.   "Practically, you can’t turn everything off immediately,"  Chris Condeluci, a healthcare expert who worked with Senate Republicans, told Vox's Sarah Kliff.   "The GOP doesn’t want to get beat up over kicking 20 million people off of insurance."

The issue is that there may not be a replacement plan ready if it is repealed right away by the Trump Administration, as Republican law makers are already promising.


Obamacare Really Isn’t the Job Killer Trump Says It Is






Trump and the GOP can absolutely repeal Obamacare — and 22 million people would lose health insurance

The Republican Party, for the first time ever, has a very real shot at repealing Obamacare — and leaving tens of millions of Americans without health insurance coverage.

Donald Trump has won the White House. Republicans retained control of the Senate, and they’re expected to keep the House, too.   One party rule means that President Obama’s health care law is in real jeopardy.

“They have a death blow to the Obamacare health coverage expansion,”  says John McDonough, a Harvard University professor who worked in the Senate on the passage of the Affordable Care Act.

Republicans began to lay serious groundwork against Obamacare last winter.   In January, both the Senate and the House passed a reconciliation bill that took apart Obamacare’s expansion of Medicaid and private, subsidized health insurance.

The bill didn’t matter much at the time — Obama repealed it when it arrived at his desk — but it showed that Republicans could use the reconciliation process to take apart key Obamacare pillars, requiring a simple majority rather than the 60 votes needed to overcome a filibuster.

Trump has promised that repealing Obamacare would be his first act in office.   All he needs to do is pull this ready-made Republican plan off the shelf.


Republicans have already mapped out how to repeal Obamacare with a simple majority in the Senate.

Most Senate bills need 60 votes to overcome a filibuster.    But Senate rules also allow bills to pass with a simple majority if they only relate to spending, a process known as reconciliation.   Reconciliation bills need to be approved by a parliamentarian, who certifies that the content does indeed have budgetary impact.

Last winter, Republicans drafted a bill that would fit the parameters of the reconciliation process.   HR 3762 was introduced into the House on October 16, 2015, by Rep. Tom Price (R-GA).   The bill would repeal Obamacare’s tax credits for low- and middle-income Americans to purchase insurance at the end of 2017.   It would end the Affordable Care Act’s Medicaid expansion at the same time, essentially creating a two-year transition period in which Republicans would presumably consider Obamacare replacement plans.

“Practically, you can’t turn everything off immediately,”  says Chris Condeluci, who worked as tax and benefits counsel for the Senate Finance Committee's Republicans during the Affordable Care Act debate.   “The GOP doesn’t want to get beat up over kicking 20 million people off of insurance.”

HR 3762 would also repeal Obamacare’s mandate.   It would end many of Obamacare’s major taxes that helped pay for the health law’s insurance expansion.

This includes taxes on health insurers, hospitals, and medical device manufacturers and a Medicare payroll tax of 0.9 percent that the law levied on Americans who earn more than $200,000 (or $250,000 for a married couple).

The Congressional Budget Office estimates that 22 million people would lose insurance under this plan after the two-year transition policy ended.   These would mostly be people who have coverage through Medicaid and the insurance marketplaces.

The repeal plan would reduce the deficit by between $281 billion and $193 billion, depending on how CBO measures the economic effects of the legislation.

House Republicans passed HR 3762 on October 23, 2015, and the Senate followed on December 3, 2015.   President Obama vetoed the bill when it came to his desk, and the bill was covered as yet another failed Republican attempt to repeal Obamacare.

But as McDonough recounts, it was arguably much more.

“People laughed about why would Republicans pass another repeal vote that Obama would veto,” he says.   “I wasn’t laughing.   It took significant unity to get this through Congress.” 
Republicans have a strong Obamacare repeal plan.  They don’t have a strong Obamacare replace plan.

HR 3762 does thorough work demolishing Obamacare’s insurance expansion.   But it also leaves millions without health insurance unless Republicans also pass a replacement plan.

Right now that replacement plan isn’t really fleshed out.   Condeluci, who worked in the Senate during the Obamacare debate, expects that Republicans would use the two-year transition window to come up with a replacement — but that they’d pass this initial reconciliation bill before that.

“I don’t think the two [repeal and replace] would come in tandem,”  Condeluci says.   “Replace needs to be litigated to a greater degree than it has before.”

House Republicans did publish a document outlining their Obamacare replacement plan this summer, called “A Better Way.”   It envisions many health policy proposals that have become common in conservative plans, like block-granting Medicaid and allowing insurance sales across state lines.

But as Condeluci points out, that paper  “isn’t in legislative form, and the Senate hasn’t weighed in.”

Trump does have a health policy proposal, but it is still a relatively sparse, bullet-pointed list on his website.   “I would envision Trump looking to Congress to drive the replace process, just as the Obama administration did with the Affordable Care Act,” Condeluci says.


Republicans have promised dozens of times to repeal Obamacare.   Will they actually follow through?

Repealing Obamacare would undeniably lead to millions of Americans losing insurance coverage — many who had gained coverage for the first time as the law ended preexisting conditions and expanded Medicaid to cover more low-income Americans.

And Trump has repeatedly promised throughout his campaign that he is committed to covering everybody.

"I am going to take care of everybody,"  he told 60 Minutes in an interview last fall.   "I don’t care if it costs me votes or not.   Everybody’s going to be taken care of much better than they’re taken care of now."

Trump’s health care website promises that he will “not allow people to die on the sidewalks and the streets of our country" for lack of access to health insurance.

At the same time, Trump, like the majority of Republicans, has repeatedly called to repeal Obamacare.

"If we don't repeal and replace Obamacare, we will destroy American health care forever,”  Trump said at his Pennsylvania rally last week.

He called the law a “catastrophe” and lamented how deductibles could go “up to $15,000.”   Meanwhile, he promised to deliver “quality, reliable, affordable health care.”

It is a moment of reckoning for Trump and other Republicans — whether they will follow through on the calls for Obamacare repeal that they have made consistently for six years, or whether they will back off at the prospect of causing millions to lose insurance coverage.

“The fly in the ointment is that some of the Republicans supported the reconciliation repeal thinking it would never happen,” says McDonough.    “Will they actually vote to take away insurance from 20 million Americans? That’s the unknown right now.”






Better Off Before Obamacare?

Before the law, which Trump has said he would repeal, health insurance was cheaper for a few, but outright unattainable for many.



Throughout his campaign, President-Elect Donald Trump repeatedly vowed to repeal and replace Obamacare, which he called “a disaster.”

That was music to his supporters’ ears.   Repealing Obamacare is Republican voters’ biggest priority for the Trump administration, according to a recent Politico/Morning Consult poll.   People who are unhappy with the Affordable Care Act overwhelmingly voted for Trump, and now 74 percent of Republicans want it gone.

The frustration with the health law is understandable;  many people are struggling to afford medical care even if they have insurance.   The problem is, it’s not clear Americans would have been better off had Obamacare never been passed.

First, some people might be confused about what, exactly, they’re angry at.   When we talk about “Obamacare,” we’re talking primarily about the 12.7 million people who are buying individual insurance coverage through state marketplaces or Healthcare.gov.   Roughly 60 million people voted for Trump last week, so they can’t all be on Obamacare exchange plans.   More than half of all non-elderly Americans still get insurance through work, and premiums on employer-based plans are actually growing more slowly than average.   (About a third of Americans are either on Medicare or Medicaid, and the rest are uninsured. Only about 4 percent are on the exchanges.)

Before Obamacare, insurance premiums on the individual market were rising by about 10 percent a year.   But, it’s important to note, the cost of any given person’s health plan purchased this way depended on how sick they were.   Insurance companies could charge people more if they had cancer, for example, or deny them coverage entirely.   Insurers were partly able to keep costs down just by keeping sick people off their plans. Under Obamacare, insurers can’t do that anymore.

In 2014, right after most of the Affordable Care Act sprang into action, a middle-of-the-road plan—the “second-lowest cost silver-level” plan—was between 10 and 21 percent cheaper than a similar plan was before the ACA in 2013.   So concluded an analysis published in Health Affairs in July by the economists Loren Adler and Paul Ginsburg, two health-care experts at the Brookings Institution.

Since then, the price of individual-market plans has climbed higher.   Health-care prices go up all the time, no matter what.   We all wish they didn’t;  they do anyway.   But in the years since the ACA was implemented, individual-market premiums haven’t been rising as fast as they were before, according to Jonathan Gruber, an economist at the Massachusetts Institute of Technology.

They went up by “35 to 40 percent in the three years before ACA,”  Gruber told me.   “If you look at the three years since ACA, it’s still below that, including this year.”

The “including this year” part is important.   News of soaring Obamacare premiums—they went up 22 percent this year—was everywhere right before the election.   But according to Adler and Ginsburg’s projections, premiums are still lower this year than they would have been without the ACA, given how premiums were rising before the law.   “People are getting more for less under the ACA,” they wrote.

Not everyone agrees with this analysis.   Some conservative health wonks, such as the Hudson Institute’s Jeffrey Anderson, have disputed Ginsburg and Adler’s paper, arguing premiums are higher now than they would have been without Obamacare and pointing to yet another Brookings study supposedly proving that point.   (Adler responded that the two studies use different sets of data.   “Both studies are well done and valuable, just all of our analyses have their inevitable shortcomings,” he said.)

Either way, it’s clear that Obamacare is too expensive for some people, especially if they’re not qualified for the subsidies for low- and middle-income people who purchase insurance on the exchanges.   People are now spending larger shares of their income on health care than before Obamacare, but that’s not because of the law—it’s because health-care costs are growing faster than incomes.

The vast majority of Obamacare enrollees—some 85 percent—receive federal subsidies that bring down the cost of their premiums.   But those who don’t might indeed be facing unaffordable premiums.   Hillary Clinton’s health-care proposal would have made those subsidies more generous.   When Trump’s proposal was initially released, it wasn’t clear if it would involve subsidies.   But his campaign later told me that “those now receiving ‘premium support’ would be given subsidies or other forms of support to purchase health insurance in the private market through Health Savings Accounts.”   Still, it’s not clear whether Trump’s subsidies would be more widespread or more generous than what’s currently on offer.

In an email, Ginsburg points out that, without subsidies, most Obamacare enrollees’ premiums are in fact higher than they would have been, “but that is more than evened out, on net, by the lower premiums that sicker people now face.”

Okay, so if you are one of the less than two million Americans who are not insured by an employer or the government, and are too wealthy for the subsidies, and are extremely healthy, you might be paying more for health insurance under Obamacare.   (That is, unless and until you one day get sick.)

However, even Anderson concedes the higher premiums are the result of some of the consumer protections baked into Obamacare.  As he wrote:

    The Congressional Budget Office offers some useful language to help explain why:  “Many of the [Patient Protection and Affordable Care Act] regulations tend to increase average premiums, particularly in the nongroup market.   For example, when they sell those policies, insurers must now accept all applicants during specified open-enrollment periods, may not vary people's premiums on the basis of their health, may vary premiums by age only to a limited extent, and may not restrict coverage of enrollees' preexisting health conditions.   Insurers must also cover specified categories of health-care services, and they generally must pay at least 60 percent of the costs of those covered services, on average.”

Indeed, Obamacare did a lot besides make everyone buy insurance, such as:

    Free birth control
    No charging women more for insurance
    No risk of having your insurance plan cancelled because you got sick
    Young adults can stay on their parents’ plan until they’re 26
    No risk of paying more, or being denied insurance, because of a pre-existing condition.

Trump has now said he wants to keep these last two elements of the law, which are very popular.   (Here’s a good Steven Pearlstein piece explaining why this will be tough to do while still repealing Obamacare.)

In fact, maybe we’re arguing about the wrong things.   While much of the debate over the merits of Obamacare has focused on whether individual-market premiums are higher or lower than they would have been, perhaps the biggest difference the law has made is allowing people to buy insurance who wouldn't have been able to otherwise.

As Charles Gaba, a blogger who tracks health-care numbers, described on his website, ACASignups.net:

    For instance, let's take someone with cancer... Without the ACA, they'd be utterly screwed and would very likely go bankrupt trying to pay the full price for treatment, or die without it, or the first followed by the second.   To them, it isn't a question of "I was paying $X, now I'm paying 25% more than $X"; it's a question of “before, I would've died; now I hopefully won't.”

Before 2014, the individual market for insurance was often nasty, brutish, and short, as John McDonough, a Harvard public-health professor who helped write the Affordable Care Act, reminded me via email.   Sick people and old people paid through the nose for coverage, if they could get it at all, and, he added, about 130 million people faced lifetime or annual limits on their health coverage.   Many insurance plans didn’t cover basic services, like mental-health care, which is now mandatory.

“So comparing an individual policy in 2008 versus today is like comparing a pineapple to an iPad,” McDonough wrote.   “Two very different products.”

Now that Republicans have a good chance of repealing Obamacare, we’re about to see just what kind of pineapple we get.









Donald Trump Meets, and Assails, the Press


 
In his first formal press conference since July, the president-elect blamed Russia for hacks, offered a plan to resolve conflicts of interest, and scolded the media for its reporting on him.

In his first press conference since July 2016, President-elect Donald Trump took only a few questions but made news on several fronts, saying he accepted the conclusion that Russia conducted hacks on top Democrats, bashing the press, and refusing once again to release his tax returns.   Trump also refused to answer questions about whether any of his aides had been in contact with Russian officials, though he later said they had not as he departed the press conference.

During the press conference, Trump announced a plan he said would answer concerns about conflicts of interest between the government and his business interests, yielding the stage to an attorney to explain the arrangement.

The president-elect was in combative mode, scolding reporters and the intelligence community and dodging several questions.   He was asked early on about a pair of stories that emerged Tuesday night—one, from CNN, saying that he had been briefed on a memo that said Russia agents claimed to have compromising information on him, and a second, from BuzzFeed, that posted a dubious dossier of allegations.

He blasted the publication of that dossier, and thanked news organizations that had not run it.   “I read what was released, and I think it was a disgrace,”  Trump said.   He would not comment on whether he had been briefed on the material, saying briefings were classified, but he said the allegations contained in the memo and dossier were untrue.

But Trump said for the first time that he believed the Kremlin had conducted the hacks against the Democratic National Committee and others, but he downplayed that particular action as just one of many.   “As far as hacking I think it was Russia, but I think we also get hacked by other countries and other people,” he said.   (He later added, in response to a separate question, that it “could’ve been others also.”)   Trump offered an ambiguous read on the publication of private material, on the one hand blasting the leak of the dossier to the press—an action that he pinned, without proof and probably incorrectly, on the intelligence community—while at the same time suggesting that the hacking of the DNC was bad but somewhat mitigated because of the information it revealed.

The president-elect refused to answer questions about whether any of his aides had been in contact with Russian officials, as some reports have stated.   In an extremely tense exchange, he dismissed dogged questioning from CNN’s Jim Acosta, saying, “You are fake news.”   As he left the press conference, however, he answered another reporter who reprised the question, saying, “No.”

Trump insisted, despite copious reporting to the contrary as well as his own son’s statements, that he did not and never had business dealings in Russia.   When a reporter asked him whether he would release his taxes to prove that, he once again demurred, claiming they are under audit.   (He has not proved that claim, and the IRS says there’s nothing to prevent him from releasing taxes that are under audit.)   Yet he also seemed to suggest that having won the election, he no longer had any incentive to release the returns.   “The only ones that care about my tax returns are the reporters,” he said.   “I mean, I won! I became president!”   (A recent Pew poll found that 60 percent of Americans would like Trump to make the documents public.)

The details of Trump’s plan to solve his conflicts of interest remain to be explored and parsed, though he made several peculiar comments during the press conference.   He asserted, dubiously, that he has very little debt.   He claimed to have been offered a $2 billion deal in Dubai over the weekend, but he said he’d turned it down—even though, he said, he had no obligation to do so.   “I could actually run my business and run the government at the same time,” Trump said.   He added, “I have a no-conflict situation because I’m president.”   That’s an outrageous statement.   While not all conflicts-of-interest laws apply to the president, the lack of legal constraints does not mean conflicts of interest cannot exist.   Moreover, Trump is still subject to the Constitution’s Emoluments Clause, among other rules.

Before taking questions, Trump boasted about companies opening new factories in the U.S., or canceling planned offshoring.   Although he claimed credit, most of those decisions were made prior to his election.   “I will be the greatest jobs producer that God ever created, and I mean that,” he said.

And Trump promised to continue to throw his weight around.   He thanked states that had voted for him on Election Day and seemed to suggest that those states would be rewarded.   He attacked pharmaceutical companies for charging high prices, and said the federal government should bargain with them.   Current federal law bars such negotiation for Medicare.   While Democrats have long lobbied for greater bargaining power, pushing this argument could put the president-elect into conflict with Republicans in Congress, who have opposed bargaining.

Yet as much as the event was a chance for the press to address Trump, it was also a forum for Trump to address—and dress down—the press.   The first speaker was incoming White House Press Secretary Sean Spicer, who called the publication of the dossier “frankly shameful and disgraceful.”   Next up was Mike Pence, who scolded reporters that “with freedom comes responsibility.”   When Trump himself arrived at the lectern, he, too, attacked reporters.

“It’s very familiar territory, news conferences, because we used to give them on a nearly daily basis,” Trump said.   “We stopped having them because we were getting a lot inaccurate news.”

He also thanked news organizations that had not published the dossier.   “I have great respect for the news, and great respect for freedom of the press and all of that,” Trump insisted.







The Atlantic Ocean and an Actual Debate in Climate Science

Scientists have recently begun to re-examine a scary question:  Will a crucial ocean current shut down?

Americans who are concerned about climate change have long found themselves in an unenviable position:  They have to debate about the existence of a debate.

For about two decades, the vast majority of climate scientists have agreed that human industrial activity is forcing the planet to warm.   For about as long, some doubters have argued that this consensus is nonexistent or premature—and that, despite repeated studies identifying it, media attempts to report on the consensus constitute so much liberal bias.

These fights will likely be recapitulated this month.   Scott Pruitt, the attorney general of Oklahoma and President-elect Donald Trump’s nominee to lead the EPA, has invested a lot of time in fighting the Obama administration’s climate and environmental regulations.   He has not, however, said very much on the record about climate change.

One of his only quotes on the matter appeared in a National Review editorial last year.   “Scientists continue to disagree about the degree and extent of global warming and its connection to the actions of mankind,” he wrote, in an article co-authored with Alabama attorney general Luther Strange.

The problem is:  Not all of this sentence is true.   While scientists continue to explore the consequences of climate change, there is essentially no d


This post first appeared on ACVDN, please read the originial post: here

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Trump and Russia, What We Know is Disturbing

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