Nuancing universal health care, #Medicare4All and copays

This is taken from an update about my Robert "Beto" O'Rourke visit to Northeast Texas two weeks ago, with a paragraph that was originally in the middle of this update pushed to the top.

If you're citing "Medicare for all" as your national health insurance model, you need to note that the actual Medicare program requires you to have your wallet open if you're middle class. Bernie Sanders got backfire in 2016 for wanting to present a "Medicare for all" that was really something more like workman's compensation.

And, I think this is the problem. A lot of Americans are flinging around the phrase "Medicare for All" without asking what the actual Medicare program is. And, if that's what O'Rourke means by saying we can do better than it — if he's referring to what level of coverage Medicare actually has, well, he's right.

A recent Tweet led me to one other update that needs to be italicized.

If you're citing "Medicare for all" as your national health insurance model, you need to note that MediCAID covers many things Medicare does not. But, from Bernie Sanders on down, classism in the US means that we can't talk about "Medicaid for all" because that would invoke poor people.

Back to the heart of things. In my original post about Beto's visit to Northeast Texas, I noted that he was some degree of squish on single-payer national health care, but less than Wendy Davis in her gov run four years ago on other issues.

As for him being a squish of some sort on single-payer? Well, if it is truly universal, in that everybody in the country, no ifs, ands or buts, has coverage, that's the rock-bottom starting point. A lot of the other developed counties that have national health care have co-pays, after all, and some people bashing Beto-Bob on this may not be aware of that. No, it's not ideal, and it's not close to gov candidate Tom Wakely's idea of a Texas NHS. But, if it is universal coverage, that's the baseline.

Per Wiki, many of those other countries have what is called two-tier care. Part of that second tier, with Denmark France and Germany countries mentioned by name, is for private insurance to cover the cost of copays. And, yes, that's deliberately boldfaced. Many countries with national health care use a two-tier system like that. Government insurance covers all basic medical and surgical needs. You buy private care for elective and experimental surgery and other things.

People need to look at the details of how universal health care works in these other developed countries, and is funded, in general. If you're poor, copays, etc., are usually paid by the government, kind of like Medicaid. But, if you're middle-class, in most the developed world? No, you need to have your own wallet open. Not a lot, maybe. But you need to have your own wallet open.

As for the amount of copays? Brains says Norway's is just $219 per person. That said, Norway has the highest overall cost of health care per person outside the US, and that's with a sovereign wealth fund and oil money.

Germany has an insurer-based universal health care system. Payment for the insurance works similar to here. It has much smaller copays than here, but it does have some. More details here. And, the German system isn't perfect; read here.

In countries like it and Switzerland, then, you're paying part of your health care premiums directly, rather than through a tax-based system. If you're in a low-income job, let alone unemployed, the government helps with this. But, if you're middle class? You're paying.

I went into this in some detail when I called out the groupies of Actual Flatticus and his toady, ShirtLost DumbShit Zack Haller, for being sketch on the details themselves.

As for people bashing Beto-Bob for wanting national health care to be useable at for-profit hospitals? You folks are either ignorant or willfully obtuse if you think nonprofit hospitals are significantly different from for-profits, because they ain't.

Thirty seconds of Googling found me not one but two or now three Pro Publica pieces with in-depth coverage of major ethical wrongs of nonprofit hospitals. And I can certainly find more. And, it looks like I may feel the need to do that, and do a separate piece.

If you want a true British NHS, as I do, fine. But stop falsely claiming that, within the current hospital system, nonprofits hospitals are somehow enlightened versus for-profit ones. For that matter, per Wiki, a few extra quid and bob will get you extra service even in an NHS hospital.

The NFL of concussion likes and Kaepernick hating is a nonprofit, for doorknob's sake.

Besides that, you know who else runs nonprofit hospitals? The no-abortion, no birth control Catholic Church.

Another issue is that "no copays" people may not be talking about cost controls. I sure don't want a no-copays national health care that still costs more than twice as much to treat a person as other developed nations. I have said that MANY times.

I think, other than reimportation of meds from Canada, few Dems and not that many Greens have tackled this issue. I've said I want at least a partial National Health Service, similar to Britain's, as part of the cost control side.

No, Beto-Bob hasn't mentioned that. But, as far as I know, neither has Sema Hernandez. Tom Wakely, for governor, has, in spades.

So, is Sema Hernandez' stance overall better than Beto-Bob's? Yes. Is it perfect? No. (And, I'll fess up that not being from Houston, I've not met her.)

And, if Brains is going to throw skepticism elbows at me? I've already commented to you 12 months or so ago on a bunch of stuff related to Jill Stein's recount. And, if you're going to go by his actual first name, you can call him Robert? Or "Robert Francis," per earlier cracking wise by me that he's a "Kennedy brother by an El Paso father."

And, I'll later tackle the issue of possibly undervoting this race in the general election.

==

Oh, while I'm here — Beto adopted, or was given, the nickname pre-adulthood. And, I'm sure he's not the only Anglo named Robert in a Hispanic-heavy area to take, or be given, the nickname.

So, "some people" who want to play with this? Just as on the for-profit vs nonprofit hospitals, and on the universal service? I think we're in "gotcha" territory.

Also, Brains knows what I put in italics, specifically because he sold Medicare supplement insurance. If Medicare copays weren't that high, he wouldn't have been selling such things.

Jim Stiles, blowhard? Half blowhard? (updated)

The iconic Delicate Arch at Arches National Park. (Author photo)

Jim Stiles, proprietor of the Canyon Country Zephyr online newsmagazine, likes to portray himself as the intellectual heir to Cactus Ed Abbey. Maybe I should say "THE heir" to emphasize that. And, what led me to this blog post was seeing High Country News run a retrospective on the 50th anniversary of "Desert Solitare," Abbey's memoir, environmental manifesto and quasi-anarchist screed about his years of seasonal ranger service at Arches National Monument, today a national park. I checked the Zephyr, which I sometimes like as a tweaker of the more mainstream HCN, to see if Stiles had something similar up, and he didn't yet.

(Update, Feb. 9: Stiles doesn't have anything specific to the 50th in his new February-March issue, either.)

Among his heirship angles is attacking eco-tourism as wrecking Moab, Utah in particular and the American West in general.

I'm no defender of swapping the single-industry mining or logging nature of many Western towns for one of tourism. And, per that link just above, Stiles is half right, maybe more. But, to say that eco-tourism has caused the problem is itself bullshit. I told High Country News the same when it wrote a semi-puff piece about Moab's retiring mayor, Dave Sakrison. And I'll say the same now, on this updating, about Stiles reprinting a semi-puff piece about a former Grand County commissioner Bill Heddon.

Western small towns and counties, unless forbidden by state law, can ameliorate this issues with eco-tourism (or the stagnant wages of extractive economies on the decline) by:
1. Increasing the local minimum wage
2. Getting developers to build affordable housing, including through either the carrot of subsidies or the stick of requiring it as part of a larger development.

Stiles mentions neither of those. (Moab's mayor never mentioned trying to get the rest of the city council to sign off on such, either.)

That's not all. Other actions could include:
3. Funding for other things to broaden the local economy done via an increased hotel-motel tax, which would primarily tag high-end tourism.
4. Getting the nearest recreationally developed federal area to work better to promote local attractions and events.
5. Getting counties to adopt county zoning policies outside of city limits.

Stiles' ERMIGOD GREEN TOURISM reached shitstorm level over the creation of Bears Ears National Monument. With Trump's (will it stand?) downsizing of BENM, Stiles reiterates claims that national monument designation involved no additional protection, gave American Indian tribes in the area no additional empowerment, and other things.

He's half-right on the first; the protection would have been even better were it to have been moved to the custody of the National Park Service.

But, he's not all right, and that's because he's all wet on No. 2. Jonny Thompson covered that by noting specifically:

A monument manager would be overseen by a commission, made up of one representative from each of the five tribes, and one each from the U.S. Forest Service, BLM and National Park Service. The tribes, collectively, would have the loudest voice in decision-making.

That's more than just "advisory," Jim.

Yes, most of the tribal powers with Bears Ears are advisory, not statutory. But not all of them.

He then ventures into Anglocentric stances from the top, when he claims:

For the purposes of this story I refer to the area of Grand Gulch and Cedar Mesa as “Bears Ears.” But please note that in the forty-seven years I’ve known and wandered southeast Utah, literally NOBODY ever referred to the region as ‘The Bears Ears”  until two years ago. That title is a piece of product packaging and marketing by mainstream environmental organizations and the outdoor recreation industry and has never been a name that meant anything more than the two buttes that lie along the southern edge of Elk Ridge…JS

Gee, Jim, maybe you should expand your circles.

First, what do Navajos, or Ute, or Hopi, call "Cedar Mesa"? Or "Grand Gulch"? We know what the Navajos call "Bears Ears," and that is "Bears Ears."

Second, and related, what do they call the entire area? (Stiles can positively invoke southwestern American Indians in other cases, but it seems as selective, and as personally motivated, as some gang green groups he likes to attack.)

Third, other national parks and monuments are named after just one portion of the territory. Saguaro National Park, which surely was not called "Saguaroland" 100-plus years ago, has more than just saguaros. Really, Jim, this is dumb shit.

Fourth, related to Point No. 2 on my first bullet points? Why not empower tribal cops for patrolling? Since this is outside any reservation, I presume that they could, as appropriately deputized, arrest Anglos, which SCOTUS says they can't on their reservations. The "Jim Chees" comment aside, Stiles in that piece, and per this HCN submission of his last year, seems conflicted or schizo in general about the idea of antiquities protection actually being put in place.

More seriously, Stiles' alternative idea for Bears Ears isn't all bad. But, more seriously, 500 BLM cops aren't going to enforce ARPA any more than now. So, let the tribes put 500 more cops in there, paid by the feds. Even with that, or even more, because of that, we're going to have a Bundyville. You'll need to make it 1,000. More thoughts below the fold.

#Cardinals notes — Yadi Molina, Hall of Famer?

Yadier Molina

Long time St. Louis Cardinals catcher Yadier Molina has said that when his current contract expires after three more years, he retires.

So, even as his name has drawn a bit more Cooperstown speculation from top-tier baseball writers, I'll add my thoughts to that.

First, WAR. It's not a perfect stat, and for catchers, especially, leaves out some things like pitch framing skills.

Nonetheless, right now, that number, which is at 35.4 WAR, doesn't look great.

Let's add 6.6 more to round out his career to 42 WAR.

And, only three catchers with lower numbers than that are in Cooperstown. One is Roy Campanella, career shortened by a tragic car wreck at the tail end, and shortened at the front end by not being pure white. The others are undeserving Veterans Committee adds Rick Ferrell and Ray Schalk, and deadballer Roger Bresnahan, who had a decent career when playing full time, but with the exception of one season, stopped doing that after he turned 30. Next lowest are Ernie Lombardi at 45.9 and Buck Ewing at 47.7. Lombardi is a beneficiary of the ultra-live 1930s plus, like Farrell, a thinning of talent during World War II that let him play well into his 30s. Ewing is buried another full decade back in the dead ball era than Bresnahan and, in addition, played half his games at other positions.

So, right there, doesn't look good. To frame the other way? Ted Simmons, at 50.1, has the lowest WAR of any catcher who's stimulated serious discussion about Cooperstown and not already in. (Thurman Munson, at 45.9 and career ended early by fatal plane crash, should get more discussion, in my opinion. In fact, I can't believe he's not already there.)

So, barring a late resurgence, going by WAR, it's going to be tough for Yadi.

There's the total intangibles, like pitch framing, though. And other tangibles, like still being the top active catcher in caught stealing percentage, despite his reputation reducing the number of challenges. Also, he's second career-wise, behind just Pudge Rodriguez, for total zone runs for a catcher, and will come close to his record before retiring.

OTOH, other than his peak of 2012 and 2013, he's not had a single year above 3.5 WAR.

Throwing out the undeservings, and playing Campy and Munson forward, I think we can say, per Ted Simmons, that 50 WAR is the cutoff point for catchers.

And, that means that unless Yadi's boosters can sell a bigger picture, he's not in.

Personally, I'm still not sure. Kind of the Jim Edmonds of catchers, but with even more in the way of intangibles to judge. Personally, I'd say he falls right around 50-50.

TX Progressives talk #MLK50 and more

Belated thoughts from this corner of the Texas Progressives on Martin Luther King Jr. Day itself, while noting, per the hashtag, that this is the 50th anniversary of his assassination.

Here's this week's roundup:

Neil at All People Have Value blogged about the Houston Democratic Socialists of America-endorsed slate for 2018. APHV is part of NeilAquino.com.

PoliTex reminds Texans that we are first in the nation with our primary elections, and that the deadline to register to vote in them is two weeks from today.

Socratic Gadfly is still waiting for Lupe Valdez to take a political stance.  And in a sidebar, he had snarky pieces about Trump's alleged payoff to Stormy Daniels and what's new on Gorilla Channel viewing, both run with Ken Silverstein's Washington Babylon.

Michael Li outlines the Texas redistricting case SCOTUS has agreed to hear.

Therese Odell at Foolish Watcher reluctantly climbs down into the shithole.

Grits for Breakfast points out a problem with life-without-parole sentences.

Off the Kuff takes a shot at predicting which female candidates for Congress in Texas have the best chance at getting elected, and Lion Star has video of some of the CD-16 candidates (he seems to like Norma Chavez).

Even as larger communities like Houston have welcomed the New Year and largely turned the page on Hurricane Harvey, this is not the case for many other Texas cities and towns. As Texas Leftist shares, Harvey is very much a 2018 reality for coastal towns like Rockport.

Downwinders at Risk chronicles the holiday in the aftermath of the cancellation of the Arlington MLK Day parade (the one Greg Abbott was supposed to be the grand marshal of).

Jim Schutze at the Dallas Observer notices that life has gone on in Dallas even after tearing down the statue of Robert E. Lee.

Texas Standard's regular aggregation of state news includes the story at the Statesman that justices of both the Texas Supreme Court and the Texas Court of Criminal Appeals heard in a symposium from experts on how to better serve defendants with mental health issues.

Leah Binkovitz at the Urban Edge ponders the Houston region's transit future.

Sarah Martinez at the San Antonio Current documents the brief but impactful life of the #DentonTrumpster, and Leif Reigstad at Texas Monthly profiles some Texans, well known and lesser known, that we lost last year.

Ross Douthat, Tyler Cowen have lightweight religious dialogue

The piece is about six months old, but I only came across it recently, and it's a hoot, while also being a sad illustration of the Peter Principle, especially in Douthat's case, and a warning about false appeals to authority, if anybody thinks Cowen's thoughts on religion are worth crap just because he's a thought-provoking (though not necessarily insightful) economist.

Anyway, here it is — Ross Douthat and Tyler Cowen have a back and forth on religious belief that is laughable.

Among Cowen’s biggest hoots is deploring the lack of Bayesianism in most religious belief. I suppose he thinks Richard Carrier’s Bayesian book-cooking in the name of Jesus mythicism is spot on? Cowen also confirms that his libertarian bona fides are deep and thoroughgoing when he claims to be a Straussian on religious issues. Anyone who invokes Leo Strauss for THAT bears careful watching. (Note to Massimo Pigliucci: Cowen strongly blurbed Harry Frankfurt’s new book, which was the first reason I became highly skeptical of it.)

Straussianism plus Bayesianism brought to putative religious study.

First, miraculously-based religious events, per a Humean definition of miracles, don't have priors, you know what I mean, Vern? Yes, one can crack open "The Golden Bough" and point to something like a virgin birth in places around the world. Whether or not the Frazier-Campbell type approach to comparative religions in myth and ritual is true or not (less true than not, usually), or whether this reflects a quasi-Jungian mindset that Stith-Thompson and the encyclopedias of mythology reference, nonetheless, in the naturalistic, Humean world, such things have no priors, period.

That said, I'm on record multiple times in multiple places in thinking that Bayesian probabilities as used by Gnu Atheists like Carrier is a bucket of warm shit.

And, a Straussian? As in the big noble lie? Well, Paul said "I am all things to all men," and Og Mandino lauded him as the world's greatest salesman, so in that case, Cowen may have more in common with Douthat than he recognizes!

Douthat responds by ignoring that both Blaise Pascal and C.S. Lewis stacked the deck with their wagers on, respectively, the existence of god and the divinity of Jesus.

It's true! For an existentially-thinking secularist, this life, as the only one we have, IS "eternity," if you will. So, Pascal stacks the decks that way. Second, he ignores whether this is the Christian god or some other, though, as a semi-orthodox Catholic with touches of Jansenism, we know where he was placing his bet, and it wasn't on Allah or Yahweh. It may not even have been on the Protestants' version of the Trinity, for that matter.

Cowen then replies that he takes William James seriously. Wow. “Varieties” only shows how deep-seated are the human mental evolutions that have been “hijacked” by the development of religion. Nothing more.

Worse, this is from someone claiming just a few paragraphs earlier to be a religious Straussian? While William James was about many things, I don't think he was about the Straussian big lie. On the other hand, his insistence on interpreting religious experiences by pragmatic value could leave him open to being moshed up with such things.

Rusty then extends that to a “mystical ineffability means its true!” stance. He doesn't question how this might lend itself, or not, to a Straussian take.

Surprisingly, near the end, Douthat lays out his own Bayesian take, and only 45 percent of his total of 100 percent is for classical theism.

That’s called “Cafeteria Catholic,” Rusty, next time you lay that label on the likes of John Kerry or any pro-choice Catholic.

Douthat finishes by invoking Nicholas Taleb’s black swans and saying that, among religions, Christianity is the blackest of all. This is nothing more than a fancy new presentation of Tertullian’s “Credo quia absurdum.”