hudebnik: (Default)
I spent the last two days at an academic conference upstate, which is (relatively) Trump Country. And I found myself talking to a security guard who was no big fan of either Hillary or Donald, and didn't say whom he had voted for, but told the following first-person story.

"I work mostly as an EMT; the security guard thing is on the side. And since Obamacare, it's been impossible to get paid. After we go on a call, we bill the patient's insurance company, and they just refuse to pay, because under Obamacare, they don't have to. Before Obamacare, they paid just like that <snap>."

Now, I have a hard time believing insurance companies ever "paid just like that <snap>", at least in recent decades. And I confess to knowing nothing about how EMT and paramedic services are now, or have ever been, funded. But for those of you who do know something about it, does the above make any sense? What aspect of Obamacare could have caused (perhaps indirectly) the above phenomenon?
hudebnik: (Default)
Mixed messages from Trump and Ryan. Some indication that Trump never really cared about health care except "repeal Obamacare" as a campaign slogan, and he would be delighted to never hear the words for the rest of his Presidency; also some indication of an interest in "working with Democrats". It's clear that the Republicans don't have enough of a unified vision to pass any health care bill on their own, so any change from here on will need to be bipartisan. What if he/they actually meant it? What improvements could be made that would get a significant number of both Democratic and Republican votes?

I wouldn't shed many tears if health insurance were divorced from employment, and most Americans got their health insurance through an individual market rather than through group deals worked by their employers. (This would make cases such as Hobby Lobby moot: if your employer doesn't pay for your health insurance, your employer doesn't get to choose what your health insurance covers based on their religious views.) This could be accomplished by gradually decreasing the amount of employee health-insurance expenses that an employer can tax-deduct, making it gradually less attractive for them to offer health insurance. The effect would be to move a lot more employed, reasonably-healthy people into individual markets (including, unless changed, the state Obamacare exchanges) and make those markets more stable and sustainable. And it would arguably be a "pro-free-market" move that would attract ideological Republicans.

One of the problems with Obamacare as it stands right now is that in some states most insurers have pulled out of the market. A public option would guarantee that there IS competition in every state, which should bring down premiums... but it's competition by a gummint entity (even though it's not taxpayer-funded), so Republicans won't go for it. Never mind.

Perhaps the biggest possibly-bipartisan improvement would be clarity and fairness in health care pricing. At present, most of the financial benefit of having health insurance isn't the amount of your health care costs the insurance company *pays*, but the amount that the insurance company *negotiates away in a puff of smoke*. Providers have to give deep discounts to big insurers, or they'll be out-of-network and will never get any customers from that insurer.

So here's how we change that. Require health-care providers to publish price lists of their services, and limit the ratio (gradually decreasing over a number of years) between the maximum and the minimum they charge different customers. (Might want to allow large discounts based on personal income, but not based on insurance.) This would make illegal a lot of insurance-company "negotiations" with providers, and mean that uninsured and insured people paid more-nearly the same prices for things. Health care providers would compete with one another on price and quality, rather than merely on which ones are in-network for your insurance company. The whole idea of in-network and out-of-network providers would become less important; consumers would have more choice of doctors, and maximum prices would come down as minimum prices rose. I suspect most doctors would love this, but insurance companies would hate it, so there would need to be some other sweetener to prevent the latter from blocking it. Perhaps the first idea above would please the insurance companies enough to balance this. And it's a free-market reform, so it should get a fair number of Republican votes (although not those who see ANY government regulation as evil, even government regulation to open the markets).
hudebnik: (Default)
Of course, the simplest way to have a large, reasonably healthy pool of people paying for health insurance is to have EVERYBODY paying for health insurance -- universal enrollment. But socialism, totalitarianism, Hitler, dark days of the war, Kenya, end of civilization as we know it. So never mind that.

People do cost/benefit calculations. For any given person, under any given life circumstances, there's a cost C of buying insurance, and a benefit (financial, psychological, etc.) B from having health insurance. It makes sense for you to buy health insurance if B > C.

What are the units of B and C? They're really about personal choices, so they have to be measured in what economists call "utility": one scenario has more utility than another if you would choose the former over the latter. It's tempting to measure them in dollars, but in fact any given number of dollars has more utility (it matters more in decision-making) to a poor person than to a rich person, so anything measured concretely in dollars will have utility that's a decreasing function of income.

Furthermore, poor people tend to be liquidity-constrained: even if they know something would be a good long-term investment, they're less likely to make that investment if it means being unable to pay the rent or buy food this month. In other words, they necessarily discount the future more heavily than rich people do; while everybody values a predictable dollar now or soon over a hypothetical future dollar, this effect is more pronounced for poor people. C is typically stated in concrete, predictable dollars/year, while B is partly hypothetical dollars and partly psychological; for both of these reasons, C is effectively a decreasing function of income. (At the very-rich level, B decreases with income too: if you could just write a check for a course of chemotherapy, you don't need health insurance. Let's leave the very-rich -- perhaps the top 1% of the income distribution -- out of this analysis.)

B is also an increasing function of health risk: the older and/or sicker you are, the more valuable health insurance is to you.

In the U.S., it's always been possible to buy insurance at different levels, ranging from cheap, bare-bones plans (B and C both small) to expensive, comprehensive plans (B and C both large). In other words, B and C are increasing functions of coverage; one assumes a given customer will choose a coverage level (possibly zero) to maximize B relative to C. If even the cheapest plan available costs more than it's worth to you, you'll choose no coverage at all.

So, to sum this up: regardless of the legal environment, B will be an increasing function of age, coverage, and sickness, while C is increasing in coverage and decreasing in income. Which means in general, health insurance makes more sense for old, sick, and rich people.

Laws about health care are intended to tweak the shapes of these curves. For example, a system of pure universal coverage removes the "no coverage at all" option, and indeed removes the notion of coverage level entirely, as everybody gets the same coverage (which is more valuable to you the older and sicker you are). In a pure laissez-faire system, C tends to be not only increasing in coverage and decreasing in income but increasing in age and sickness, essentially infinite for people with pre-existing conditions whom nobody wants to insure at all. Medicare was put in place to limit how high C can go at the high-age end, so old people (or moderately-old with long-term health problems) were more likely to have health insurance; their higher actuarial costs were shared by taxpayers so the insurance market didn't buckle under their weight. Medicaid was put in place to limit how high C (measured in utility) can go at the low-income end, so really-poor people were more likely to have health insurance.

Obamacare made several changes to this. It expanded Medicaid to apply to somewhat higher income levels as well as the poorest, making moderately-poor people more likely to have health insurance. It provided subsidies for people just above that level, making middle-income people more likely to have health insurance. It required insurers to cover already-sick people, at a cost not enormously higher than the cost for healthy people, getting rid of that vertical asymptote. And it removed the most "bare-bones" plans from the system entirely -- if your coverage doesn't meet certain minimum standards, your coverage is zero -- so below a certain level of coverage, B is zero, while C is the nonzero penalty P for being uninsured. The penalty is still less than the cost of buying insurance, so some liquidity-constrained people will still "choose" to be uninsured, but again the effect should be to make poor people more likely to have health insurance.

In particular, if you currently have health insurance and are contemplating dropping it, you know that you'll lose all your benefits B, but will save only C - P on costs, which makes you less likely to drop it. If you're currently uninsured and are contemplating entering the market, the reverse applies: you'll get benefits B, at a cost of only C - P. The larger P is, the more likely people are to stay insured, or become insured if they're not. Which is why one of the Republicans' first tactics in pushing Obamacare off a cliff was to reduce P.

Ryan/Trumpcare takes a different approach. There's no penalty for being uninsured, but there's a penalty of 30% of your first year's premiums for rejoining the market after being uninsured. So if you currently have health insurance and are contemplating dropping it, you know that you'll lose all your benefits B, while saving C immediately; if you rejoin the market later, you'll pay 0.3C for one year, but that's farther in the future so liquidity-constrained people will discount it more. In other words, poor people are more likely to drop out of the insurance market if they're in it, unless they're old enough or sick enough that B is still greater than C. If you're currently uninsured and are contemplating entering the market, you know that you'll gain B, while paying 1.3C immediately and C in the long run. The longer you go uncovered, the more money you save before paying that one-time 0.3C for a year to re-enter the market. In other words, those who re-enter the insurance market after a lapse will be those old enough and sick enough right now that B > 1.3C, and sufficiently liquid that they can handle the one-time penalty. So at both ends of a lapse, Ryan/Trumpcare encourages younger, healthier, and poorer people to go uncovered, leaving an older, sicker, richer pool of people in the system and inevitably higher average premiums. Pushing Obamacare off a cliff wasn't enough; they're pushing their own system off the cliff even harder.

At the same time, Ryan/Trumpcare decreases government cost-sharing and subsidies, making poor people less likely to participate in the system unless they're really sick. It makes those subsidies age-based rather than income-based; this brings a small advantage in reduced paperwork, but tends to encourage younger people to go uninsured unless they're really sick. At the same time, it increases what insurers can charge old people, thus encouraging old people to go uninsured unless they're really sick. (If you're sufficiently old, you can discount the one-time penalty to re-enter the market because you'll probably die before paying it.) And it largely dismantles the minimum standards of Obamacare -- the "bronze", "silver", "gold", and "platinum" levels -- effective 2019, thus encouraging people to buy cheaper coverage than is currently possible without a penalty, until and unless they get really sick. All in all, it gives us an insurance system for middle-aged people (probably near their earning peaks), fairly-rich people, and really sick people of all ages -- a recipe for skyrocketing premiums.
hudebnik: (rant)
He ran against politics and politicians. What's wrong with politicians? As anybody who's read a U.S. newspaper in the past 150 years knows, they promise the stars, and as soon as they're in office, they break all their campaign promises.

So he's not going to be like that: he's going to keep his campaign promises if it kills him us.

Problem is, most of his campaign promises weren't carefully thought out; they were just whatever got the most applause at rallies. Who knew he was going to win the election? Still, he's going to keep them, or find somebody else to blame when he can't.

He promised he would build a big, beautiful border wall, and make the Mexicans pay for it. There's been a delay in getting the Mexicans to pay for it, but at least he can keep the "build a wall" promise, and get around to making the Mexicans pay for it later. We'll spend at least 20 billion U.S. taxpayer dollars on a wall that won't keep anybody out, or make America safer, but it will demonstrate that Donald Trump keeps his promises. About the "making the Mexicans pay for it" part... he would totally do that if there weren't a bunch of politically-motivated international-law do-gooders who won't let him use his superb bullying negotiating skills.

He promised he would block all Moslems from entering the country "until our people can figure out what the hell is going on." He's tried twice so far, and he would totally do that if there weren't a bunch of politically-motivated Constitutional-do-gooder judges refusing to carry out his orders. For some reason the namby-pamby liberals have a problem with recognizing Moslems as the enemy. Weren't all of the 9/11 hijackers Moslem? Come on, people, use some common sense!

He promised he would institute "extreme vetting" for refugees. He didn't know exactly what was wrong with the existing system, but there would be time to figure that out later; at any rate, his was going to be much tougher and more extreme. He's tried twice so far, and again there are a bunch of politically-motivated Constitutional-do-gooder judges refusing to carry out his orders. And who knew he couldn't fire them for insubordination?

He promised he would scrap most of our existing deals with other countries and make much better ones. So far he's scrapped a couple of existing deals with other countries, and indicated his intention not to abide by others. About the "making much better ones" part, he would totally do that if there weren't a bunch of international-law do-gooders who want America to fail and won't let him use his superb bullying negotiating skills.

He promised he would repeal Obamacare and replace it with something much better and much cheaper. So far he's supporting the sort of wibbly-wobbly repealy-wheely stuff that Congress has come up with; he would totally come up with a much-better-and-much-cheaper replacement if there weren't a bunch of politically-motivated obstructionist Democrats in Congress who won't do what he says. And for some reason he can't fire them for insubordination either. And who knew health insurance was so complicated?

He promised he would "drain the swamp" of corrupt Washington insiders and bureaucrats. So far he's appointed non-Washington-insider people (indeed, people with no government experience at all) to run most of the government. As for getting rid of the rest of the Washington-insider bureaucrats, who knew the President can't just fire anybody he wishes? I mean, he's the President, isn't he?

He promised he would lock Hillary up. Who knew you can't do that without finding evidence that she committed a crime? What's the point of being the most powerful person on Earth if you can't lock people up?

He promised he would create lots of good American jobs in steel, coal, and heavy manufacturing. So far he's made a couple of phone calls, and several corporate CEO's have said they're going to create gazillions of U.S. jobs as a result. (OK, they actually announced those jobs before he was elected, and the last few times they said something similar, it fizzled.) But if the steel and coal companies don't have the gumption to hire hundreds of thousands of red-blooded American men the way they did fifty years ago, that's their problem; he can't do it himself.

He promised he would avoid conflicts of interest between his job as President and his job as boss of the Trump Organization. Of course, he could perfectly well run both at once, because he's a very smart guy, but just to keep people happy, he'll keep them separate. From his years running a corporation, he knows you're not supposed to trade on inside information, so he's removed himself from day-to-day operations of the Trump Organization to make sure he's not making company decisions based on secret President information. Problem solved; what other kind of "conflict of interest" could there possibly be?

He promised he would make America great again. How do you know a country is great? Because it wins all its wars. How do you win all your wars? By having a really big, powerful military. He's not quite sure what's wrong with the existing military, or what kinds of things the military needs to do, but his is going to be bigger and more powerful.
hudebnik: (Default)
The CBO says it'll put 14 million people into "uninsured" status almost immediately (i.e. 2018), and "24 million over the course of ten years." I'm not sure how to read that latter statement, but let's assume conservatively that the average number of people uninsured because of this bill in any given year is halfway in between those numbers, 19 million.

The bill also saves the Federal government $337 billion over ten years. That's $1774 per year per uninsured person. So the obvious question is, how much more will those 19 million people's health care cost as a result of their uninsuredness? This is tricky. One would like to know how much a typical person's health care costs in a year, how much a typical person spends on premiums and deductibles under ACA, how much a typical person gets in subsidies under ACA... but are these 19 million people at all "typical"?

One could argue (and I imagine Paul Ryan will) that most of these are young and healthy people who will choose not to carry health insurance because they feel they don't need it. But if you look at how the bill will affect various kinds of people, the ones most adversely affected are poor and/or old and/or sick, so one would expect a substantial number of the uninsured to be poor and/or old and/or sick people who feel they can no longer afford health insurance. Others will indeed be "young invincibles" who, in many cases, wouldn't have cost much in health care anyway. I'm going to assume, lacking evidence one way or the other, that the 19 million new uninsured are neither healthier nor sicker than the general population. I'm confident that they are poorer than the general population.

According to the NY Times, the majority of the newly-uninsured people -- 14 million of 24 million -- will become uninsured because of cuts and restrictions to Medicaid. Another 7 million will become uninsured because their employers no longer offer health insurance. (Far more people than this are expected to lose employer-sponsored insurance, but the CBO assumes reasonably that most of them will be able to buy insurance on the individual market; the 7 million are the ones who can't or won't.) The remaining 3 million, I assume, are currently on the individual market but will no longer buy insurance because either they don't think they need it or they can no longer afford it. I haven't read the CBO report itself yet.

Deductibles


As for deductibles, the right-wing Daily Signal and Freedom Partners say "an average medical deductible in 2016 for gold plans is $1,247, for silver plans $3,064 (up from $2,556), and $5,765 for bronze plans (up from $5,328)". The Freedom Partners numbers are quoted, mostly accurately, from a Kaiser study (Kaiser is fairly reputable), but I think they don't consider the "cost-sharing reductions" for people with incomes between 100-250% of the poverty level, which effectively turn a Silver plan into a Gold or Platinum plan with a much lower deductible; the Kaiser study discusses these cost-sharing reductions but doesn't quantify their impact. (I don't know where they got the $1,247 figure for gold plans; the Kaiser report doesn't give a specific number for gold or platinum plans.)

The left-wing Mother Jones says "The [enrollment-weighted median] deductible decreased from $900 to $850 in 2016.... it looks like nearly two-thirds of all enrollees had deductibles under $1,000. Only about a fifth had the horror-story $6,000+ deductibles that we hear so much about." These figures are quoted accurately from a Centers for Medicare and Medicaid Services study which says

"In 2016, among all consumers purchasing HealthCare.gov Marketplace coverage, the median individual deductible is $850. This is lower than the $900 median deductible for 2015....
These facts may seem surprising given anecdotes about Marketplace policies with very high cost sharing. However, those reports, which often focus on the highest-deductible plans in a market, ignore two important factors.

Financial assistance. The figures in this analysis account for the fact that about 60 percent of 2016 HealthCare.gov Marketplace consumers qualify for financial assistance that reduces their deductibles, out-of-pocket maximums, and other cost-sharing obligations....

Consumer choice. Rather than choosing bronze plans, which generally offer the lowest premiums, Marketplace consumers are overwhelmingly choosing silver plans, which generally have higher premiums, but lower cost sharing....

The net result of these factors is that about a third of HealthCare.gov Marketplace enrollees have deductibles less than or equal to $250, and over half have deductibles below $1000 in 2016."


This is going to take more work than I want to put into it right now :-)
hudebnik: (teacher-mode)
Conservative Republicans on Capitol Hill, Breitbart, the Kochs, etc. are outraged by Ryancare because it doesn't completely repeal Obamacare and it provides Federal subsidies (albeit age-based rather than income-based) to help people pay for health insurance.

What would they prefer? What's the ideologically-pure, conservative answer?

No Federal mandates about what needs to be in a health insurance plan, about who needs to buy health insurance, about who needs to offer health insurance, about who needs to be offered health insurance. Health insurance is strictly a matter between consumers and insurance companies, in a free and competitive market. (With some State regulation -- for some mysterious reason, many conservatives are willing to accept regulation at the State level that they wouldn't accept at the Federal or local level.)

Are insurance companies required to insure anybody who comes along? Certainly not at the Federal level; some states might enact such a requirement, but many won't, which means people with pre-existing, expensive medical conditions in red states simply won't be able to get insurance. They have several choices: (a) get all their care from emergency rooms without paying for it; (b) get lots of money from friends and family to pay for health care; (c) go bankrupt paying for health care; (d) die without health care. Competition won't solve this, because insurers don't want the business of people with pre-existing, expensive medical conditions; if anything, they'll compete for who can lock those people out the fastest.

So, young and healthy people can buy cheap, high-deductible insurance, or no insurance at all. Rich people can self-insure with HSA's, buying cheap, high-deductible insurance or no insurance at all. Old and sick people can buy no insurance at all. Since anybody who actually wants health insurance is unable to get it, the result is dismantling the health insurance industry.

What if conservatives compromised on the popular "pre-existing conditions" clause, but not the rest? Without an individual mandate and without government subsidies, young, healthy, and/or poor people won't buy insurance, leaving only old, sick people in the pool, so their premiums will go through the roof, so they won't be able to buy insurance either, again dismantling the health insurance industry.

Which is ironic, because "dismantling the health insurance industry" is also the result of the ideologically-pure liberal solutions (either single-payer or socialized medicine). The difference is that in the liberal solutions, everybody gets preventive care, rich and poor get the same health care, and nobody dies for inability to pay, while in the conservative solutions, poor people don't get preventive care and end up either in inefficient, expensive emergency rooms, or dying for inability to afford health care. Oh, and taxes are higher under the liberal solutions, but total spending on health care is higher under the conservative solutions.
hudebnik: (teacher-mode)
Paul Ryan actually said this yesterday (link with video):


The fatal conceit of Obamacare is that we’re just gonna make everybody buy our health insurance at the Federal government level. Young and healthy people are gonna pay for older, sicker people. So the young, healthy person is gonna be made to buy health care, and they’re gonna pay for the person, you know, who gets breast cancer in her forties, or gets heart disease in his fifties.

So take a look at this chart. The red slice here are what I would call “people with pre-existing conditions” — people who have real health care problems. The blue is the rest of the people in the individual market — that’s the market where people don’t get health insurance with their jobs, or they buy it themselves. The whole idea of Obamacare is the people in the blue side pay for the people in the red side. The people who are healthy pay for the people who are sick. It’s not working and that’s why it’s in a death spiral.

Here’s how we propose to tackle this problem. We want to have a system where we encourage states, with Federal funding, to set up risk pools and reinsurance mechanisms. For example, in Wisconsin, we had a great risk pool that actually worked, so that people with real high health costs and diseases, and pre-existing conditions, could still get affordable health care. Well, Obamacare repealed that. They had a great risk pool reinsurance system in Utah, a good one in Washington State… all those are gone under Obamacare.

Here’s how they work, and here’s how our system would work. We would directly support the people with pre-existing conditions. [Red slice removed from pie graph] Let me give you a sense of this. 1% of the people in these insurance markets drive 23% of the costs. 1% of the people in the individual insurance market drive 23% of the costs. So a reinsurance program is to cover more than just the 1%, to cover the people who have high health care costs. So by having state innovation funds to go to the states to set up these reinsurance programs, we would directly subsidize the people who have pre-existing conditions. Direct support for the people with pre-existing conditions so that everybody else has cheaper health insurance.

What you do when you do this is, the individual market, the people who don’t have pre-existing conditions, they have much more stable prices.


Oh. My. Gawd. As lots of people on Twitter have pointed out, "the people who are healthy pay for the people who are sick" is literally the definition of health insurance. More generally, "the people who are lucky pay for the people who are unlucky" is the definition of insurance -- fire, flood, burglary, health, life, etc. We've been discussing Obamacare and alternatives for eight years now, and the Republican Party's anointed policy wonk doesn't pretends not to know how insurance works.

Anyway, let's consider his alternative. We'll take the high-risk people out of the pool, leaving the low-risk majority of people buying their own cheaper health insurance -- and that's probably true. So what do we do with the rest? The Federal government gives the states money to set up "high-risk pools" and "reinsurance programs" that subsidize insurance companies to get them to cover those high-risk people without astronomical premiums. In other words, the money to cover the high-risk people, which was coming from low-risk people in the market, will now come from... Federal taxpayers! The leader of the anti-Federal-government, anti-tax Republicans in the House of Representatives is proposing that instead of paying for something through the free market, we pay for it with Federal taxes.

Mind you, nobody expects Ryan to raise Federal taxes to pay for this added expense -- indeed, the bill in the House cuts Federal taxes. Which leaves several alternatives:

(a) the Federal budget deficit goes through the roof (which is OK when Republicans do it), or

(b) high-risk people will get much less health care, die, and decrease the surplus population, or

(c) total costs will magically drop sharply because the money goes from Federal government to State governments to insurance companies to providers, rather than from Federal government to individuals to insurance companies to providers, or

(d) the Federal government will provide less money than it does now, and State governments will be expected to make up the difference by substantially raising their own taxes. Which California, New York, and Massachusetts might be willing and able to do, while high-risk people in Kansas and Utah (and pretty much any state that voted for Trump) are back to option (b).

I'm betting on (a) and (d).
hudebnik: (Default)
164.0 lbs
breakfast: grapefruit, yogurt, cereal, dried cranberries, strawberries
lunch: Thai
dinner: pasta, vodka sauce w/Italian [goat] sausage
bedtime: chocolate-avocado milkshake
hudebnik: (rant)
1) The world is divided into winners and losers. It's more fun to be a winner. In order for you to be a winner, somebody else has to be a loser. The more other people are losers, the more of a winner you are.

2) The appearance of being a winner or loser is self-fulfilling: calling yourself a winner and acting like a winner makes you a winner, and calling other people losers makes them losers.

3) Winners have the power to make what they say go. Whatever a winner says is (in practice) right.

4) Winner and loser status are not guaranteed to last: today's winner can be tomorrow's loser, and vice versa.

5) As a corollary, truth, morality, and justice are transient conditions: what's true or right today may be false or wrong tomorrow, when somebody different is on top.

6) Some people object loudly to that notion. This can be for two reasons: either they're making a hypocritical show of "objecting on principle" because they lost and you won, or they're so naive they don't understand how the real world works.

7) Since "rules" and "principles" are just whatever the guy currently on top says, they obviously don't apply to the guy on top. In choosing people to help you, it would be silly to choose them by their past adherence to somebody else's rules, because you can change those rules anyway; if you're on top, the most important criterion is their personal loyalty to you.


Some of this isn't specific to Donald Trump, but applies more broadly to Republicans (and neoconservative Democrats) in general: the notion that "it's a tough, dog-eat-dog world out there, and it calls for a tough man, not hobbled by rules and principles that nobody really believes in anyway."

See the recent Times op-ed, In Praise of Hypocrisy.
hudebnik: (rant)
Let's take the "pro-lifers" at their word and assume they (or a significant fraction of them) honestly believe that full human life begins at the moment an egg is fertilized. What happens if we insert that axiom into the rest of an ethical and legal system?


[Note: for purposes of this thought exercise, "woman" is defined in terms not of birth certificate or appearance or self-identification, but of the physical ability to get pregnant.]

A fetus, embryo, blastula, zygote, or fertilized egg is a full human being with the same rights as one who's already been born. Any intentional termination of the pregnancy, even days or hours after conception, is therefore murder. No "exceptions for rape or incest", because we wouldn't consider a child fair game for murder just because of its parentage or the circumstances of its conception. Likewise, no exceptions for crippling or life-threatening genetic defects, unless we as a society would be willing to actively kill a born child for having those defects. Even an "exception to save the life of the mother" is dubious: it amounts to choosing which of two human beings to kill. Terminating a pregnancy to save the life of the mother would be permissible only if the alternative was both mother and child dying; in that circumstance you're choosing to kill one person rather than two. In all these cases, it seems clear that both the mother and any medical personnel involved would be criminally liable.

What about unintentional termination or harm? It could be argued that conduct (e.g. strenuous exercise) that accidentally leads to the termination of a pregnancy is manslaughter or negligent homicide -- which typically get a lighter sentence but are still felonies. Conduct that leads, or could reasonably be expected to lead, to harm to the fetus, such as drinking alcohol while pregnant, is reckless endangerment of a minor, and could again be punished under the criminal code. Even allowing a spontaneous miscarriage without taking heroic measures to prevent it could be considered criminal medical malpractice -- negligently allowing a human to die who could have been saved.

Once you're pregnant, you no longer have full jurisdiction over your own body, because you share it with another human being who has the same rights as you, but no decision-making power. Indeed, if there's a realistic chance you might be pregnant, you should probably (to stay on the safe side) assume you are. In short, if you're a sexually active female of reproductive age, you have less autonomy than a sexually active male of the same age. Unfair, yes, but that's just the way the world is -- like menstruation.

A woman who has sex is giving up part of her autonomy for at least a few months until she's sure she isn't pregnant, and possibly for years to come. A man who has sex is not giving up anything unless it turns out she is pregnant and he's the father. So having sex is a much bigger decision for a woman than for a man. A woman who has sex "lightly" is therefore irresponsible and morally suspect, while a man who has sex "lightly" is normal.

If you're female and want to retain independence and autonomy, you need to avoid sex, at least any form of sex that could lead to pregnancy. Males, of course, don't face this dilemma -- indeed, they can express independence and autonomy through sex. Again, it's unfair, but it's just the way God made us: women have to choose between (hetero) sex and autonomy, while men get both at once. If you've chosen (or been forced) to live on the "sex" side of the divide rather than the "autonomy" side, your every action henceforth has to be assessed from your perspective as a growth medium.

If a woman is going to willingly risk her autonomy in order to have sex, she'd better get something in return, like financial security, so it is appropriate to consider most (hetero-)sexually active women as prostitutes, although the "respectable" ones get to call it "an advantageous marriage".

Which implies that in the natural order of things, there are two kinds of women: autonomous but (heterosexually) celibate ones, and sexually active ones financially supported by their male sex partner(s). Men can be autonomous, sexual, and financially independent, in any combination they wish, because these are orthogonal questions for them. If they don't want to take on the long-term financial responsibility for a wife and children (or if they get bored with their long-term partner), they can get their sex a la carte from short-term prostitutes and mistresses instead. Again: unfair, but that's just the way things are.

For women on the "sex" track, their main saleable assets (to be exchanged for financial security) are sex and physical attractiveness; a man's main saleable asset (to be exchanged for reliable access to sex) is his money-making ability. So it is entirely appropriate for women to be extremely concerned with physical appearance, and to spend whatever money (or eyelash-batting) they have on clothes, makeup, cosmetic surgery, etc, while it is entirely appropriate for men to concentrate their energy on their careers. Men earn money, men give it to women in exchange for sex, and women spend it on their appearance so they can keep getting paid for sex. That's the natural order of things; objecting to this model makes as much sense as objecting to the law of gravity.

And it's understandable that employers would be reluctant to hire women, or to promote women, or to pay them as much as a man: this particular woman might be on the "autonomy" track now, but both she and her employer know that she has another option, and could switch to the "sex" track at any time. Since she doesn't really depend on her job, you can expect her to take it less seriously than a man would, and her employer will accordingly take her less seriously.



In short, we can live in a society in which women have roughly the same rights and freedoms as men, or we can live in a society in which zygotes have roughly the same rights and freedoms as born children. We cannot have both.

Our new President and Vice President, in their different ways, have both made clear that they prefer the latter. The President has had three wives, whom he married at the fertile ages of 28, 30, and 35 respectively, and (I think) cheated publicly and repeatedly on all three of them, because he is just that oversexed. Their role was to be beautiful and fashionable and sexy and spend the money he made, as a sort of scoreboard to show off his supreme manliness (including, but not limited to, earning capacity). He's made abundantly clear that he values women primarily for physical attractiveness; the worst cut-down he can think of for a woman is to insult her appearance. Grown women are unimportant except as sex objects. Meanwhile, the Vice President has taken every opportunity in his career to assert the importance of unborn children from the moment of conception on, and to keep women in their rightful places as sex partners, housekeepers, and child-rearers. In short, zygotes are more important and have more rights than grown women.

Most of the conclusions I've drawn above aren't really about abortion: they're really about the equation of sex with pregnancy. Anything that breaks the "God-given" connection between sex and pregnancy -- whether abortion, contraception, or even homosexuality -- is a threat to an equally "God-given" social model built on the assumption that women can't have sex without risking their autonomy for months or years to come, and men can.
hudebnik: (Default)
President Obama took years after entering the White House to publish a paper in a refereed academic journal.

President Trump seems to be on his way after only two weeks, with an illuminating example of the Alternative Facts approach to mathematical proof.
hudebnik: (Default)
Somehow I got onto whitehouse.gov's e-mail list, and my first e-mail from the Trump administration asks me to sign a petition supporting Justice Gorsuch's nomination to the Supreme Court.

The e-mail includes this bit: "Judge Neil Gorsuch follows the same principled approach espoused by Justice Scalia. He carefully applies the statuary text and he follows the Constitution’s original meaning."

Seriously -- "statuary text"? I've heard of people viewing the law as an edifice, or as graven in stone, or as fixed and unmoving, but not literally as a statue.
hudebnik: (teacher-mode)
"clinamen", in this Politico piece.

Apparently it means an event that "just happens" for no particular reason. The term was originally used in connection with the classical Greek "atomic theory", which (in a curious prefiguring of Brownian motion) postulated that the atoms from which everything is made are constantly swirling unpredictably. So, for example, if by chance most of the atoms in a container are momentarily on the left side, thus exerting measurable pressure in that direction, the resulting pressure is a clinamen.

The author uses the term to suggest that in a complex system such as a U.S. Presidential campaign, actions have such unpredictable consequences that hidden conspiracies are unlikely to have much net effect distinguishable from background noise.
hudebnik: (rant)
So there were thousands of protesters for a Iannopoulos speech, all peaceful until about 150 masked protesters, dressed all in black, showed up and started setting things on fire, throwing Molotov cocktails, etc. The resulting TV images were exactly what Iannopoulos and his former boss at Breitbart wanted: intolerant, violent Leftists at the birthplace of the "Free Speech movement", suppressing free speech and turning an American city into the kind of war zone the President described in his inauguration speech. The President responded with a tweet threatening to cut off Berkeley's Federal funding, which coincidentally was what Iannopoulos's planned speech called for.

No arrests were made, despite lots of extra security called in for the event, so we have no idea who any of the masked, violent protesters actually were. A Trump supporter was pepper-sprayed on camera, and nobody was arrested.

I don't like to push wacky, paranoid conspiracy theories, but doesn't this look a little suspicious to you?

Mind you, I don't have any evidence that the guys in black were right-wing agents provocateurs, but neither is there any evidence that they were left-wing protesters. So we can't validly draw any conclusions about the behavior of either right-wingers or left-wingers, only that somebody behaved violently and didn't want to be identified.
hudebnik: (rant)
I asked myself the other day "What does ISIS want?" The answer is right in their name: they want to be recognized as the Islamic state, as the legitimate representatives of Islam on Earth. They're not the first to have this ambition: al-Qaeda and Saddam Hussein before them had the same desire (although Saddam was hardly a religious ideologue himself, he still saw himself as the representative of Islam to the secular world). They dream of restoring the Caliphate of a thousand years ago. They hunger more than anything for legitimacy, recognition, and glory. As with al-Qaeda and Saddam, their path to this goal is to convince the world's Moslems that the United States (first among other enemies) hates them and wants to destroy them, and the only thing standing in its way is ISIS.

What does Donald Trump want? He dreams of restoring the America of sixty years ago. He hungers more than anything for legitimacy, recognition, and glory. And his path to this goal is to convince the American people that Islam (first among other enemies) hates them and wants to destroy them, and the only thing standing in its way is Donald Trump.

Both ISIS and Trump have nothing to lose, and everything to gain, from encouraging the belief that the U.S. and Islam are inevitably at war with one another. Which side "wins" any given battle is almost irrelevant, as long as ISIS and Trump get to be the leaders of their respective sides. As long as one can "make Islam great again" while the other "makes America great again", Trump and ISIS are natural allies in a conspiracy against their respective constituencies.

Interestingly enough, what most distinguishes ISIS from previous Islamic-terrorist groups is its skill at making money, whether through taxes and fees, protection rackets, drug and oil exports, or antiquities smuggling. A fitting bedfellow for our first billionaire President.

ETA: article in The Intercept that reaches a similar conclusion, pointing out the long history of U.S.-Islam relations.

Politics

Feb. 3rd, 2017 07:30 am
hudebnik: (rant)
For anybody who hasn't already read David Frum's recent Atlantic article, go do that.

My summary: Donald Trump is taking us not towards an ideological dictatorship in the style of Franco, Mussolini, Hitler, Stalin, or Castro, but rather towards a kleptocracy in the style of Orbán, Chávez, Zuma, Suharto, Marcos, Milošević, Duvalier, Putin, .... There is certainly ideology among his allies -- Bannon, Pence, Ryan -- but as long as Trump himself is at the helm, they will get their ideology enacted only in exchange for their help in furthering Trump's profits and glory. The biggest loser in all this is not oppressed minorities but America's idealistic beliefs in the existence of sincere public service and non-partisan criticism. Once the American people have accepted that "they all do it", that the only reason to vote for one leader or party over another is which one has promised you a patronage job, and that the only reason to believe one news source over another is which one supports your party, it'll be extremely difficult to ever restore the faith that democracy can work.
hudebnik: (rant)
There are rumors and leaks of an upcoming Trump (presumably really Pence and/or Bannon) executive order about religious freedom, which he defines as the right to discriminate against gays, transgendered people, and anything else that offends your religious sensibilities, without fear of government penalties such as losing your tax-exempt status. It explicitly applies to non-tax-exempt organizations too, such as "closely-held private companies" such as Hobby Lobby.

There's an intuitively appealing argument that any economic transaction is supposed to be by mutual consent: I shouldn't have to hire you, buy something from you, sell something to you, etc. unless I actually want the transaction to happen.

But what's the difference between refusing to serve gays and refusing to serve blacks or Jews? The executive order is specifically about religious views, but there are certainly people whose sincerely held religious views are anti-Semitic, and if religious views are recognized as a legitimate loophole, there will shortly be people claiming that their sincerely held religious views forbid serving blacks.

The executive order avoids this slippery slope by going in an even worse direction. It doesn't say all religious views are a legitimate basis for discrimination: only specific ones, such as that marriage is inherently between one man and one woman, or that sex belongs only inside such a marriage, or that gender is an innate and immutable characteristic determined at birth. In other words, we're going to privilege the religious views regarding sex of a certain segment of socially-conservative Christians over the religious views of anyone else.

So if this order goes into effect, it will (and should) be challenged on establishment-and-free-exercise-clause grounds by people who say their sincerely held religious views forbid serving Jews, blacks, heterosexuals, or Republicans. The only way to preserve the order while beating back these challenges is for the courts to say "That's not a legitimate, sincerely held religious view," a question which the courts have generally considered beyond their competence for the past 240 years.

Or, I guess, they could just repeal the establishment and free-exercise clauses of the First Amendment....
hudebnik: (rant)
In any security system, the central policy question is how to balance false positives against false negatives. Any chucklehead can come up with a system with no false negatives: don't let anybody in. And any chucklehead can come up with a system with no false positives: let everybody in. The tricky stuff is in between. So in a sense, Trump's order simply weights the danger of false positives less, and the danger of false negatives more, than the previous system, as everybody would expect of a Republican, "law-and-order" administration.

But if you were really trying to "make America safe from terrorism," you would start by examining the existing vetting procedure and any bad guys known to have slipped through it, and adjust it accordingly, while maintaining whatever balance you've chosen against the danger of false positives.

I don't think that's Trump's goal. If he really is the infantile, ignorant narcissist most people think he is, the goal of this order is to "keep his campaign promise": he said on the campaign trail (as usual, with no evidence) that the current vetting system is inadequate, and that he would impose "extreme" vetting, much stricter and stronger and manlier and más macho than the current system. I suspect he has very little idea what the current system is, but his is going to be more. Without actually analyzing the current system, the only policy guaranteed to be more is the "first chucklehead's" system -- don't let anybody in -- so that's what he's ordered temporarily. The way the order was issued, with little or no consultation with the departments and secretaries who would need to implement it, makes this very plausible.

On the other hand, if he (or, more likely, Steve "Wormtongue" Bannon) is sufficiently Machiavellian, the goal may be to instigate Moslem terrorists to attack the U.S. in order to justify a state of emergency giving him dictatorial powers.

The latter is of course a wacky paranoid conspiracy theory, and I honestly think it's less likely than the former. But the two scenarios are not mutually exclusive.
hudebnik: (rant)
There's been a lot of discussion of the list of seven countries (Iraq, Syria, Iran, Sudan, Libya, Somalia and Yemen) covered by President Trump's order on immigration and refugees of last Friday, noting in particular that, although citing the 9/11 attacks as partial justification, it doesn't include the home countries of any of the 9/11 hijackers, and that it doesn't include any terrorism-wracked countries with known Trump Organization investments such as Turkey, not to mention non-Moslem-majority countries like France, Belgium, and the U.K. whose Moslem citizens have committed major terrorist acts.

The text of the order doesn't actually name any specific country except Syria, but rather refers to "countries referred to in section 217(a)(12) of the INA, 8 U.S.C. 1187(a)(12)". This is a section of law (existing at least since 2015) dealing with the "Visa Waiver Program" under which short-term (under 90 days) visitors from certain countries can enter the U.S. without meeting the usual visa requirements. In particular, section 12 says the visa waiver is not available to people who are "nationals" of, or have visited since March 1, 2011, a certain list of countries. The only countries named in the law are Iraq and Syria, but the Secretaries of State and Homeland Security are empowered to add other countries to the list on grounds that

  • "the government of [the country] has repeatedly provided support of acts of international terrorism;"

  • "the presence of an alien in the country or area increases the likelihood that the alien is a credible threat to the national security of the United States;"

  • "a foreign terrorist organization has a significant presence in the country or area;"

  • "the country or area is a safe haven for terrorists."


I can only assume that, as of Friday, the list of countries thus designated really was the seven we've been hearing about.

Anyway, my point is that Donald Trump didn't pick the list of countries; it already existed, having been created by Congress in 2015 or earlier, and fleshed out by the Secretaries of State and Homeland Security, probably under the Obama administration (since Trump's Secretary of State hasn't been confirmed yet, and his Secretary of Homeland Security has been in office only a week).

I'm inclined to suspect that he decided to use this existing list in part because it already existed, and people from these countries were already subject to heightened scrutiny for short-term visits to the United States; he didn't have to do the work of deciding which countries to put on the list.

The fact that he chose an existing list rather than just naming a couple of countries he'd seen on the TV news may actually be a good sign that he is, ever so slightly, tempering his shoot-from-the-hip instincts in favor of decisions made by people who know what they're talking about.

That said, one has to wonder why the existing list doesn't include Turkey, Afghanistan, Saudi Arabia, U.A.E., Egypt, Lebanon, or Pakistan: the criteria of section 12 seem to apply to those countries. That part isn't Trump's fault.

And one has to wonder about several things that are Trump's fault:

  • whether this action is an attempt to solve a real problem, i.e. whether there's reason to believe the existing refugee vetting procedure is inadequate;

  • whether criteria originally developed to apply to short-term visitors should also apply to refugees, applicants for long-term residency, and even people who already have long-term residency and have been living here for years;

  • whether criteria originally used to revoke a special privilege, so people meeting the criteria had to go through the usual visa process, should also be used as a ban, so those people can't go through the usual visa process;

  • whether suspending all refugee applications from all countries in the world is compatible with American ideals;

  • whether there's any evidence that refugees from Syria pose a special risk warranting indefinite suspension;

  • whether restrictions on Moslem-majority countries that explicitly favor non-Moslems from those countries will serve as a propaganda coup and recruiting tool for ISIS far outweighing any direct security improvement.

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