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Buh-bye, Bannon?

If Republicans take nothing else away from Roy Moore’s loss they should pay heed to the dangers of supporting a Bannon acolyte.

Even without the sex angle, Moore was a flawed candidate for  a national position, yet he was the one that Bannon chose to push to the front.

In the end, it may have been the accusations, whether true or not,  that Moore forced himself on teenagers that ultimately led to his defeat, but trying to portray him as a Trump loyalist just wasn’t credible.

Not that Alabama got any prize in Doug Jones, a man firmly under the control of the national left’s  kingmakers.

What they did get was proof that a candidate proposed by a man who often looks and sounds like the town drunk won’t play well in prime time.

The write-in vote may have been significant, but the people who stayed home elected Doug Jones.

Neither candidate managed to get 50% of the vote, so Mr. Jones represents about half of the voters.  That, in a state that has voted solidly Republican for decades is a BFD.

One voter who went with a write-in may have captured a feeling that the RNC and even President Trump did not recognize when he said,

“I didn’t vote against the President’s policies.  I voted to save him from Roy Moore.”

There’s obviously more to the story than the push to portray Moore as a lifelong sexual predator.

From the left’s push to register thousands of convicted felons to vote, to Jones’ obvious racial division component, to the efforts to tie Trump to the radical right Roy Moore’s of the world, the GOP  is under attack.

It’s time they wised up to that.

Why no one will win in Alabama.

It took a little while for Democrats to figure out how to use the sexual misconduct allegations and accusations against members of Congress to their advantage,  but they’ve got it all dialed in now.

That was evident when Nancy Pelosi’s first instinct was to defend John Conyers, followed swiftly by throwing him to the wolves.

Pelosi is usually right on top of the party line, so her seeming about face says more about party strategy than it does about her or even Conyers himself.

For the moment, try to ignore what Conyers was accused of doing. After all, everyone else did, as long as it was to their advantage to do so.

The MeToo movement is also separate from the political haymaking.  It is only right and proper that women stand up as a group and demand both respect and justice, provided that is the only result of the movement.

What is of political significance is how easily that can be weaponized.

Politically, this ranks right up there with racism as a cause célèbre, and the groundwork was already being laid with the “toxic masculinity” claims.

What we have now is a climate where if a man even notices that half the population is female, they are immediately accused of sexual misconduct.

There isn’t even a firm definition of  the term at this point.

Is calling a woman honey or dear or sugar or even a “girl” sexual harassment, or is it just perpetuating a stereotype?  What about women who refer to males as studs or boy toys?

Society may eventually sort all that out, possibly by “de-genderizing” both males and females.

For the present though, it makes a damn fine weapon.

The Alabama election will be a case in point.

If Roy Moore wins today, his win will be characterized as a furtherance of male-dominated sexual oppression. Those mean nasty redneck husbands and boyfriends must have threatened their biological opposites into voting for him.

Then we can read about that for the next year or so.

Unless he gets kicked out by his “peers” in Congress, in which case maybe the Alabama governor could appoint a Republican female conservative to replace him.

A win for Moore would also provide congressional members with a perfect opportunity to tie him even closer to Donald Trump. Birds of a feather and all that.

If he loses, it will validate yet another non-issue-related strategy as a useful political tool for Democrats. Without the sexual overtones, Doug Jones had little to nothing to offer politically in deep red Alabama.

Nope, no one wins today, least of all the American people.

Healthcare, factory-style?

With repeal and replace of the ACA sure to be a hot topic in 2018, it is time to consider just what it could be replaced with, and why.

They say sex sells, and nothing is sexy about the coming revolution in healthcare models, such as mergers and reimbursement. That means no screaming headlines.

The Aetna-CVS merger has made it to the evening news, but less nationally reported are the myriad of hospital mergers occurring in regional markets.

Until yesterday, when the Wall Street Journal highlighted what is touted to be the largest merger to date.

Is bigger always better?

Unsubstantiated claims of improved care and lowered costs aside, is creating a mega-care health factory a good idea?

No one denies that for all the money we spend on healthcare, we aren’t getting the best bang for the buck. That has created a number of macro-solutions, like mergers and changes to how services are reimbursed.

As reported upon in this must-read 5/27/16  LA Times article by Michael Hiltzik, hospitals are merging into ever-larger monolithic entities at an alarming rate.

The article reports that in 2015 alone “…112 hospital mergers were reported nationwide…” but the expected economies of scale have either not been forthcoming, or have not been passed on to consumers. Patients also report feeling more like specimens than human beings in these large healthcare conglomerates.

In part this is being attributed to the recent emphasis on pay-for-performance (P4P) payment models  being instituted by both insurers and the Federal government,  the popularity of which was a selling point for the ACAm or Obamacare.

That model is based upon the idea that payment should be scaled to outcomes of treatment, rather than just quantity of procedures performed.

P4P  has been heralded as a replacement for the fee-for-service payment system which many people feel is at the heart of our overly expensive healthcare industry.

In theory it’s a good idea, but like most theories, the validation is in the results. The results of these mergers and changes to payment models are so far proving more detrimental to the quality of care than beneficial.

Anecdotally, Medicare patients and doctors who treat them are noticing ever-shrinking payments, often coupled to adjustments tied to quality.

Providers say “quality” means curing the patient, or at least substantially improving their condition so that they use less healthcare.

Unrealistic goals may worsen outcomes.

For instance, one diabetic Medicare recipient has seen the share paid to her provider shrink by 50% over the last year.  At first the physician absorbed the shortages, but she recently received a letter stating that the office would now be billing for some of the shortages. Hardly a surprise since the physician is being paid $20.50 on a fairly reasonable $75.00 office visit fee, and other previously paid charges are not being reimbursed at all.

When she began to ask questions, it appears that the provider’s payments are being docked for “quality reporting deficiencies”. She has been unable to ascertain what reporting her provider is or is not doing.

It does appear on the surface that because her underlying condition has not improved, her physician is being penalized with lower reimbursements under the Physician Value Modifier Program and/or the Physician Quality Reporting System, both of which are explained in this CED report.

Given that she has had diabetes since childhood, it is unlikely that it is going to improve now.

However, because she has had good medical care, she has not suffered from some of the more drastic complications like gangrene or blindness. She cannot afford to pay the additional charges, and the provider can’t work for free,  so whether that will continue to be the case in the future is problematic.

It seems obvious that further studies of the efficacy of P4P needs to be conducted at some length.

According to the above-referenced report by the Committee for Economic Development such studies as have been done to date have not proven that simply restricting payment and requiring optimum outcomes in every circumstance is the answer.

No one disputes that for the average cost of over $8700 per person spent in the U.S. our world ranking is below that of other countries who say they spend less than half that figure to achieve the same or better results.

Medicare itself may be partially to blame for that. Medicare is divided into four “parts” or plans:

  1. Medicare Part A is inpatient hospital coverage, plus skilled nursing, hospice, and home health care. This is the only coverage included in basic Medicare.
  2. Medicare Part B is for doctor visits and preventive services like screening tests, at approximately $138/month, plus a small annual deductible. It is supposed to pay 80% of the charges.
  3. Medicare Part C is the part that covers Medicare Advantage plans which are managed care  (PPO or HMO providers) provided by private companies. The typical cost is from $55 to well over $200 per month.
  4. Medicare Part D is drug coverage, and can also be purchased as a stand-alone benefit in lieu of Part C. Costs range from about $25.00 a month and up, depending on the plan’s private company administrator and the drugs covered.

Critics of Medicare feel that some Part C benefits such as routine dental and vision care should be a basic plan benefit, since the former can adversely affect nutrition and the latter can prevent accidents as well as allowing patients to read prescription labels accurately. Also not routinely covered is hearing care.

Currently access to some of those services might be available to people qualifying for Medicaid, but that adds yet another complicated system to the patchwork quilt of healthcare access.

But how does that affect “regular” health insurance?

Insurers aren’t stupid. They see that providers, while they may use ordinary insurance to defray the cost of serving the Medicare and Medicaid population, can be forced into taking a lot less. Thus the rate of reimbursement for private insurance or ACA policies has been going down as well.

That works for providers because the remaining balance owed can be collected from the patients themselves.

Some of the so-called “cadillac” plans that used to be available paid as much as 90% of covered costs. They cost more, but they also provided a lot more. Now it is rare to see a plan that covers more than 80% of the costs, with some of the more affordable bronze ACA plans down as low as 70%.

We all have heard about the gargantuan deductibles that effectively stop patients from even going to the doctor. Previously it was possible to purchase quite reasonably priced plans with deductibles as low as $500-1000 per person or $3,000 to $5,000 for an entire family.

Many people felt that the protracted fight over repeal and replace earlier this year didn’t allow for the investigation of actual improvements.

Hopefully, that will not be the case now that the immediate need to produce “tangible legislative results” will be  assuaged by passage of the tax cuts bill, assuming that does come to pass.

However, that assumes some modicum of common sense on the part of Congress, and that’s always an iffy bet.

TGIF – December 8, 2017.

The failed Green movement.

No, not the environmental one.  The somewhat deranged move to impeach President Trump authored  by Texas Representative Al Green (D-TX).

After coercing the far left members of the House of Representatives into backing his two articles of impeachment, Green saw his efforts fail by a vote of 364-58, with four Dems abstaining by voting present.

That’s hardly a surprise, given that Green’s main complaint in his two Articles  of Impeachment  was that he doesn’t like the way the President talks.

Aside from simply being weird, the Congressman’s articles of impeachment  accused the President of (what else) racism and “being divisive” apparently considering those things to be “high misdemeanors.”

Rather interesting, given that his party’s nominee had been slinging around her racial and gender-based accusations throughout the campaign as well, and still does it to this day.

Most Democrats know that they need something a lot more solid than that to begin impeachment proceedings, apparently preferring to wait and see if they can extract some sort of cause from the Special Counsel’s investigation.

To be fair, this was not a vote to impeach, but simply a vote to advance a resolution to consider the articles.

OK, at least he got it out of his system. On the plus side, we now know beyond a shadow of a doubt which representatives are squirrelly enough to ignore the identity politics that originated with the Democrats, including the 44th President, before, during and after the election.

The other kind of harassment.

Although the media would lead one to believe that all men are created equally perverted, there is another kind of harassment that if the truth were to come out is probably both far more prevalent and more equally distributed between genders.

Although it doesn’t yet have a catchy media label, it too is simply the product of the misuse of power.

In its lowest form it shows up in battered women’s shelters, but in the workplace, it’s the boss you spend all your time trying not to provoke.

It’s the boss who sends a pen or a phone whizzing past your head when you fail to stroke their ego sufficiently, or who starts a whisper campaign or the ones who consistently blame his or her employees for their own failures.

Some people call this type of boss the grown up schoolyard bully, and they sure aren’t all men.

Most employees just call them jerks, but they are responsible for possibly ten times the harm and loss of productivity in the workplace that an actual sexual abuser causes.

They are the ones that create the aptly named hostile working environment.  Maybe someday they will get the attention they deserve too.

We pay for this?

Yesterday Christopher Wray, the newly appointed FBI director, spent a bit more than two hours cheerleading for the FBI rank-and-file and tap dancing around questions about the integrity of some Bureau investigators from members of the House Judiciary Committee.

Granted FBI Director Wray is pretty new on the job and it’s doubtful he’s anyone’s best work buddy yet, but this was, as so many of these televised dog-and-pony shows are, a total waste of time.

Unless you have (a) been following every word a witness has uttered and can spot inconsistencies on your own, or (b) the witness knows nothing about spin and/or doesn’t have an attorney you will only hear what each side wants you to hear.

It should be obvious to Congressional committees by now that they are a toothless tiger. They scare no one in the swamp. You can bet it doesn’t take the FBI itself eight months to get someone in and break them, but Congress can’t even enforce a FOIA request in a timely and effective manner.

Indeed, the public hearings one and only purpose seems to be to allow committee members to establish whatever creds they can with their voters back home.

If, and it’s a big if, anything is ever learned by these committees it’s going to be in the closed door sessions.

Enough, already. Put a cork in it and do something useful.

The #1 sanctuary city discussion we aren’t having.

It seems that the more people we import into the United States, the greater problems we have with social unrest.

Could it be that it’s not where they come from, or their religious ideologies, or the color of their skin, but simply that they are here?

To backtrack a moment, this discussion was the result of an seemingly unrelated news article.

The city of San Diego, CA  has a massive homeless problem, and according to this health-related ABC news wire story that problem exacerbated the recent outbreak of Hepatitis A, an incurable liver disease.

Why did that pique my interest?

Well, it’s not something I admit very often, but I am a native San Diegan, although I left decades ago.

I just couldn’t visually square the memories of the city I grew up in with the growing city-sanctioned and financed  tent cities for the homeless detailed in the story.

Of course the reason for them is the crazy-high cost of living, not just in San Diego, but in many population magnet cities.

Like the prices of anything else, the cost-of-living and particularly housing, is driven by supply and demand.

You might be asking, “hey, isn’t this more a matter of distribution instead of quantity?”

Yes and no.

Some places don’t attract a lot of people. It’s doubtful that many people who aren’t originally from Siberia are all that attracted to live in International Falls, MN or Mount Washington, NH, two of the coldest places in the U.S.

But it isn’t just climate that draws so many people to San Diego, Los Angeles, San Francisco, Portland  or Seattle.

It’s a social  and governmental mindset that encourages selective overpopulation.

The population of the United States in 1960 was 179,323,175 according to the U.S. Census Bureau.  In 2016 it was estimated to be 322,762,018, and that presupposes that everyone here illegally stood up to be counted. That’s a growth rate of approximately 172%.

In San Diego city specifically, the population has gone from 573,224 in 1960 to an estimated total of 1,406,600, up 245% over the same time period.

All those people have to live somewhere, and unless California starts mimicking China and building offshore islands the available land mass isn’t growing proportionately.

To the extent that sanctuary and open border policies contribute to the problem, immigration actually is as much a problem of quantity as it is of quality.

The hard truth is, neither a city nor a county nor a nation can absorb more people than its resources can provide for, no matter what the political climate of the moment.

The saying for years has been “As California goes, so goes the nation.”

Let’s hope not.

Truth, the foreign political language.

Jerusalem is the capital of Israel.  The Bible says so, historical and archeological records independent of theology say so, and every modern President at least since Bill Clinton has acknowledged that as a truth.

So why is everyone so astonished that President Trump would do so as well and then decide to move the U.S. embassy to that capital city? Every other capital city in the rest of the world has a U.S. embassy, so wouldn’t it be only logical to put one in Jerusalem too?

More to the point, why is everyone surprised that the President would make good on a campaign promise to do just that, especially in view of the last 11 months?

After all, it isn’t as though the Arab world has brokered any lasting peace agreements with Israel, possibly due to our political propensity for making promises we never had any intention of keeping.

Some critics are saying that this move runs counter to then-candidate Trump’s vow to put America first, accusing him now of meddling in world politics when that clearly could create problems for us.

Interestingly, many of those critics are the same ones who labeled him a white nationalist isolationist.

Whatever your views on Israel, one important fact about No. 45 is either overlooked or denigrated by his enemies

The man believes in keeping his word when at all possible.

That single quality, or rather his supporters belief in it, is why he is President instead of wondering what just happened.

Not everyone is going to agree with him.  That’s the nature of the human condition, and that’s OK.  He isn’t Caesar and he should hear and sometimes even heed the dissenting voices.

Perhaps he will find things he promised that need to be modified, or even discarded as he learns more and more about the realities of running a country.

Nevertheless, his promises were the truth as he saw it at the time.

For those who love to quote Scripture, take a look at John 8:32.  For the rest, the salient phrase most quoted is “You will know the truth and the truth shall set you free.”

That’s the trouble with truth.  It’s the most foreign and least taught and spoken language in the world today.

No wonder so many didn’t recognize it when they heard it.

More swamp creatures.

Don’t you just love the smell of swamp in the morning?.

Now we know what John Conyers is going to do…resign. Hopefully he won’t be the last to take the political equivalent of an Alford plea.

As for his endorsement of his son to take his place, well, this isn’t Saudi Arabia, and as proven by what’s-her-name, as well as Jeb Bush,  dynastic succession still isn’t embedded in our political DNA.

You also know now what some other Congress members do with their spare time. They don’t all play golf.

Maybe Al Franken, Blake Farenthold and Ruben Kihuen should follow Conyers’ example. Rep. Joe Barton is also mentioned in the same breath with them, but in his case, he was in a long term romantic liaison with the woman in question when he sexted her.

Then there is the matter of Roy Moore. That’s going to be another congressional conundrum, assuming he is elected.

First, he has categorically denied all the accusations, and even offered up “evidence” that one of his accusers might be at the very least, misremembering events.

Second, until he is elected, there not a heck of a lot Congress can do about him.  The voters of Alabama still have a right to vote for anyone they choose.

Frankly, the RNC and the President should have stayed out of that one. Former Judge Moore already has a lot of political baggage that has nothing to do with sexual misconduct, not the least of which is his close tie to Steve Bannon, himself a political lightning rod.

With Democrats dropping like flies, even Doug Jones winning might be the lesser of two evils in terms of public perception.

Then there is the FBI.  Well, not the whole agency, just certain members of it. Like two former directors and a senior special agent, for starters.

It’s kind of funny, really.  Way back during the campaign, several people warned Donald Trump against making enemies in the Department of Justice, and it’s crack investigative agency. In fact, Lindsay Graham is still doing that.

Then along came Peter Strzok, proving that if the s—t gets deep enough, it eventually starts to slop over everyone’s boot tops.

The Bureau has been suspect in the public eye ever since former director Comey gave that remarkable public statement in which he first charged and then exonerated what’s-her-name.

From the off-the-record conversations with various members of the Democrat candidate’s inner circle , to the Bureau’s agreement to destroy evidence, to the re-naming of gross misconduct, that whole episode has reeked from Day One.

Agent Strzok was reassigned to the FBI’s version of Siberia, i.e. the HR department, way back in the summer of this year, but that tasty little tidbit didn’t become public until after Thanksgiving.

Normally, that might be seen as an internal personnel matter.  Given his alleged involvement in assisting former Director Comey in whitewashing certain events pertinent to the election however, it has become considerably more than that.

If the Democrat’s candidate had been indicted for gross negligence pertaining to her official duties, it’s likely that President Trump may have actually won some of the states that backed her by just a few points.

That would have made Russiagate a non sequitur.

We likely would have saved several million dollars already wasted on trying to make it a reason to invalidate the election at best and an excuse to overthrow a duly elected President at worst.

All of this is fascinating, as well as deeply frustrating to watch and follow, but in all honesty it isn’t that surprising.

The details may be just coming to light, but the smell is what got Donald Trump elected.

As it turned out, America apparently has a pretty good nose.