2017 Politics open thread, July 9-15

What political comments do you have this week?

This video shows world leaders preparing for their group photo.  I like seeing their facial expressions, especially Putin’s.  Do you think Merkel wears bright colors on purpose so she’ll stand out?

Emmanuel Macron jostles his way to the front of G20 photo to stand by Donald Trump

If you want to read commentary on the “fake news” about this video you can check out Ann Althouse’s blog.

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403 thoughts on “2017 Politics open thread, July 9-15

  1. Along the lines of the absurd media reaction to Trump’s speech in Poland, which Milo mentioned last week, is this WaPo profile on a right-wing talk radio host from the Illinois hometown of the Alexandria shooter. You may recall that the shooter was an enthusiastic Sanders supporter, not one of the deplorables who voted for Trump, but, hey, we spent money to send a reporter out to the boonies to find some connection, and here it is:

    “I can’t say for sure if this Hodgkinson guy listened to me, but he probably did,” Romanik said in a recent interview. “If people would be honest about what drove Hodgkinson to the point of violence, you’d probably see a lot of people right on the same page with him all over the country. But around here, for sure.” https://www.washingtonpost.com/news/post-nation/wp/2017/07/08/in-alexandria-shooters-home-town-rage-filled-radio-host-channels-middle-americas-inner-frustration/?tid=sm_tw&utm_term=.a7b4318ac5db

    When it was obvious that Clinton would win, the media and government leaders fretted that disappointed Trump supporters might resort to violence, including this Australian (!) professor who wondered whether they would “raise pitchforks and torches.”
    https://www.washingtonpost.com/news/monkey-cage/wp/2016/10/25/how-will-trump-supporters-react-if-he-loses/?utm_term=.3f04170a1f06
    When it turned out that the “progressives” were quite capable of raising pitchforks and torches of their own, well, it’s time to look for scapegoats. There is reason that the mainstream media gets lower approval ratings than does Congress.

  2. Scarletts point was sort of raised in this article:

    At a surface level, some issues do appear to unite current conservatives: disdain for anticonservative and anti-Republican bias in the mainstream media…Vin Weber, a former Republican Representative, summed it up this way: “We sort of know who we are against.” Mr. Weber believes that conservatives “need to refocus on why we have a G.O.P.”

    Sort of like Obamacare, they got a lot of mileage out of opposing it but now that they are in power they have to admit it was all a ruse and they really have no palatable alternative policies to offer.

  3. he’s sure Putin could be of assistance in Trump’s effort to prevent election hacking “since he’s doing the hacking.” – John McCain

    “It’s not the dumbest thing I’ve ever heard but it’s pretty close. – Lindsay Graham

    Partnering with Putin on a “Cyber Security Unit” is akin to partnering with Assad on a “Chemical Weapons Unit”

    John, Lindsay and Marco – obviously left wing mainstream media shills spreading fake news about Trump. What else could it be? I know I was assured the election hacking was just left wing fake news.

  4. We finally have a conviction for voter fraud in the presidential election:

    DES MOINES, Iowa — An Iowa woman charged with voting twice for Donald Trump last fall pleaded guilty to election misconduct and is scheduled to be sentenced next month.

    In exchange Terri Lynn Rote’s guilty plea to the felony charge, prosecutors agreed to drop a perjury charge, court records show. Judge Michael Huppert accepted her plea on June 27 and set sentencing for Aug. 15.

    Rote is a registered Republican and a Trump supporter. She was arrested on Oct. 21 after showing up at a Polk County election satellite office in Des Moines and tried to cast a second ballot for the November election. She told police that she believed Trump’s claims that the election was rigged and thought that her first ballot would be changed to a vote for Hillary Clinton. Trump easily beat Clinton in Iowa to carry the state’s six electoral votes in the Nov. 8 election.

    http://www.kcra.com/article/woman-charged-voting-twice-for-trump-pleads-guilty/10276367

  5. Rhett,
    Point taken, but then one of the reasons Clinton lost the election was her failure to convince voters that she stood for anything. “Stronger Together” and “I’m with Her” were evidently insufficiently compelling. Both parties have struggled in this regard.

  6. Clinton convinced 3 million more voters. I don’t think her message was the problem. The absurdity of the electoral college (yeah! states vote, not people!) was the problem

  7. Eh, you can’t lose 30 states and expect to be President. That’s not absurd–that’s the system working exactly as intended.

    Additionally, if we were to go to purely a popular vote, then everyone needs an equal say in how elections are carried out, so voter ID laws, for example, would be decided by Congress rather than state legislatures.

  8. Furthering the one from last week, I found this to be an interesting essay on the liberal freak-out over the fact that the U.S. President dared to praise Western values and Western civilization. And it’s worth noting that Ross Douthat is defending Trump against such hysteria:

    http://www.theamericanconservative.com/dreher/yes-they-really-do-despise-their-civilization/

    But it’s also important to know that many on the left offend and repudiate people who dislike Trump by reacting to him like rabid rats got loose in their shorts. Seriously, when I read the transcript of Trump’s speech yesterday, I thought it was pretty ordinary stuff. The American president saying Western civilization is good and worth defending? This is controversial? And as I’ve said a couple of times in this space, it’s eye-rolling to hear Donald Trump talk about the importance of strong families and strong values. Still, if you’re going to go to pieces every time a politician says something hypocritical, you’ll never be able to get out of bed in the morning.

    But then here comes respectable commenters on the left, like Bouie, Beinart, and Fallows, yammering about fascism, Leni Riefenstahl, and racist dog whistles, and you realize that whether he meant to or not, Trump’s speech was clarifying. I don’t think Donald Trump could write ten meaningful sentences explaining why the West matters, but that’s beside the point. The point is, when talking about the worth and the defense of Western civilization makes you into Hitler McGoebbelsface in the eyes of liberal commentators, then you suddenly see the situation in starker relief.

  9. Milo,

    So you think “the media” should focus itself like John, Lindsay and Marco on Trump’s ludicrous policy proposals? Or would that still rub you the wrong way?

  10. Rhett – You’re asking if I think that the media should report on any policy proposals that the President makes? Yes. Yes, I do.

    I’m not sure what your point is, or how that’s relevant to their reaction to the Warsaw speech.

  11. OK, 2.9 million voters. That is a lot of people who liked Hillary Clinton’s message. Perhaps that is why Trump is so unpopular now. People don’t like his message.

    As for number of states, it is true that in our silly antidemocratic system, it determines the winner. But states don’t listen to messages, states don’t have opinions about heathcare or free trade, and states don’t vote. People vote.

  12. ANd if Republicans have such an awesome message, why do they keep trying to cram that turd of a healthcare plan down our throats? No one wants it. Forget it. Do something people actually want.

  13. 2.86, actually. She knew the rules going in. A campaign fight for the popular vote would mean a very, very different campaign entirely, ginning up base turnout in TX and CA, for example. It’s a silly, sore loser thing to whine about after the fact. You may as well bitch and moan that your losing team gained more rushing yards.

    See last week’s discussion on healthcare. People don’t agree on what they want; they barely even know themselves what they want because nobody is honest about the tradeoffs and costs.

  14. why do they keep trying to cram that turd of a healthcare plan down our throats?

    The elite opposed the ACA because they fundamentally disagree that the government has a role to play. The rank and file voter opposed the ACA because they bought into the idea that the ACA was terrible and republicans had a much better plan. Now we’ve come to find out republicans have no plan and the ACA is about the best we can do given various reasons: the legacy of WWII price controls, irrational voter preferences, healthcare industry lobbying power, etc.

  15. I don’t understand why Donald Jr is admitting to this whole mess. Boy needs a better lawyer.

  16. You’re cool with the President’s son meeting with Russians to get info to help their campaign? Alrighty then.

  17. “Who cares if it come from the Russians?”

    You’re being sarcastic, but really, who cares? You think Hillary wouldn’t take an Access Hollywood video if it only came from Russians?

  18. Seriously, the only way this thing brings them down is if they lie and cover it up. If they just say, “Yup, we worked with the Russians.” It’s a story for one news cycle then it’s over. But if you lie the story just keeps on going.

  19. I still don’t understand the fuss about the Russia thing. The US meddles in foreign elections all the time. We also tap the phones of foreign leaders (Merkel) who are our allies. I don’t think we have a leg to stand on with these protests.

  20. Houston,

    The lying about it is the probelm They did it and they got caught. Just admit it and move on. I mean technically they committed a felony by conspiring to violate the Computer Fraud And Abuse. But, come on, petty rules like this only apply to Hillary.

  21. “Then why lie?”

    He didn’t. He said “yes, I met with this person. And she ultimately gave us nothing.”

  22. “Ahhh! An offshoot of the ever popular, “but the Clintons did it, too!””

    No, I’m not saying that. I’m saying it’s not a problem for anyone. Campaigns are always looking for dirt no matter where they can find it. Why is everyone so obsessed with Russia?

    And they didn’t “hack the election.” That would mean they actually changed or falsified vote tallies. Wikileaks hacked Podesta’s private email account. It’s up to the voters to decide if the contents are worth scrutiny.

    The election was last year. If this is the best that the Democrats can cluck about in the summer of 2017, they really haven’t learned a thing.

  23. Then, on Sunday, Trump capped his time at the G20 summit in Hamburg, Germany, with an announcement that he and Putin had agreed to create “an impenetrable Cyber Security unit so that election hacking, & many other negative things” will be prevented.

    But you’re claiming the election hacking didn’t happen. McCain and even Trump (if you read between the lines) seem to be saying it did.

  24. DJT Jr.

    Is that the only member of Trump’s campaign? That really doesn’t put the issue to bed. Does it?

  25. Wikileaks hacked Podesta’s email in an apparent attempt to expose unflattering information about Hillary Clinton and her campaign.

  26. “I guess we’ll wait to see what Mueller says. 15 more people hired!”

    Don’t hold your breath. It’s been a year, and nobody’s found anything.

  27. democratic and media firms have been looking for some smoking gun for a lot longer than that.

  28. your losing team gained more rushing yards…

    For someone who claims disinterest in sports, it’s nice to see a sport-related comment.

  29. Has there been a smoking gun? Have I missed it? Has anyone lied or covered anything up?

  30. Yes, DJT Jr lied. In March, he said no contacts. Then when this was found out, he said it was about adoption. Now he admits that it was his intent in going there was to get info regarding campaign/opposition.

  31. March was an oversight. And it was about adoption, and it was about opposition info.

    Democrats are going to be playing these games for 7.5 more years. They should focus on things that voters actually care about.

  32. And even if the meeting had been about adoption, that’s not ok. It implicates sanctions. Ask Flynn how well that is working out for him.

  33. Like I said, let’s wait for Mueller. Comey thought it a big enough deal to do what he did.

    And with that, I must sign off. The pool awaits me.

  34. I’ve been semi following this story, wondering what was behind it. Vox has an interesting theory – they think it could be a White House sanctioned leak, to get ahead of something damaging. Why? Because there were 3 leakers, all from inside the White House, suggesting coordination. Also, three at that level would be easier to idenify if Trump wanted to.
    Worth considering…
    https://www.vox.com/policy-and-politics/2017/7/10/15947100/donald-trump-jr-russia-leaks

  35. Ross Douthat had an interesting column a few weeks back about the politics of Harry Potter.

    “Prendergast also offered a harsh assessment of the trend: “If you have ever wondered why young people are often so childish in their politics, why they want to divide the world between tolerant progressives and wicked reactionaries, it helps to understand” that they think they’re living in a Potter novel.

    Admittedly, if you think that the world really is divided between tolerant progressives and wicked reactionaries, you won’t find this assessment all that damning.

    But I’m not sure that sort of Manichaean vision is actually the most important political teaching in the Potter novels. Because if you take the Potterverse seriously as an allegory for ours, the most noteworthy divide isn’t between the good multicultural wizards and the bad racist ones. It’s between all the wizards, good and bad, and everybody else — the Muggles.”

    He goes on to suggest parallels between Hogwarts and Harvard, ending with the observation regarding the inconvenient Muggles that the novels essentially disregard:

    “Because after all it was mostly Muggles, not some dark conspiracy by the Slytherin sort of conservatives, who put Donald Trump in power.

    It is Muggles who keep turning to parties of the far left and farther right, Muggles who drift into radicalism and set off bombs. Mass migration, rising nationalism, Islamic terrorism, rural despair — many disruptive forces in our era flow from global Muggledom’s refusal to just be a tame and subsidized surplus population, culled for its best and brightest, living only for the hope that occasionally a gifted son or daughter might be lifted up.

    In the Potterverse, the meritocracy of magic allows the chosen to withdraw, to disappear behind a curtain into their academic world, leaving Muggledom to its own devices.

    In our universe, though, the meritocracy of talent expects the chosen to actually go out and try to rule. On the evidence we have, they are not particularly good at it. And how to lead wisely in a society where most people did not go to Hogwarts is a lesson that J. K. Rowling’s lovely, lively, but ultimately childish novels do not teach.”

  36. Sorry, I never could make it through Harry Potter (way too smarmy for me) so I have no idea what you or Ross are even talking about!!

  37. Scarlett,

    The only flaw in your analysis is thinking the muggles have more faith in the received conservative ideology than they have with received progressive ideology. As we can see from the ACA repeal effort, the libertarian premise on which opposition to the ACA was founded has no appeal to the mass of muggle republican voters.

  38. wtf is a muggle anyway? Is that like what libertarians call “sheeple”?

    I am going to repeat this one more time: more people who actually got off their butts to vote voted for the Democrats. We can speculate all we want as to what people who stayed home were thinking, but more of the voters wanted Democrat policies. So claiming that Democrats are out of touch with the sheeples or muggles or whatever is just crock. And given the massive unpopularity of Trump and the turd-health-plan, I don’t think the Republicans are doing very well at convincing people that their message is great.

  39. And the reason that Trump is constantly rehashing the election is because he knows perfectly well that most living breathing human beings didn’t want him and want him even less now.

  40. I read that article and what first came to my mind is how the “Muggle Problem” has made it clear to Ross and his intellectual brethren, both those who develop and debate fine points of conservative political theory and those who espouse highly educated throwback Catholicism, that they too are essentially irrelevant to day to day Muggledom. Not only do the Muggles “rightly” thumb their nose at the morally bankrupt condescending liberal elites who offer the illusion of opportunity and rarely grant them entrance into their hallowed halls, they also refuse to follow the moral dictates and benevolent guidance of those who offer a more traditional and hierarchical world in which everyone finds satisfaction and dignity in his/her rightful place.

    Ross should not refer to the meritocracy of talent as “they” but as “we”, unless he is a closet monarchist.

  41. “more of the voters wanted Democrat policies.”

    I’m skeptical of this.

    My guess is that a significant %age of Hillary votes were against Trump, and a significant %age of Trump votes were against Hillary.

    For many voters, party policies were not why they voted how they did.

  42. Finn, that is speculation, just as making statements like “people don’t like the Democrats message” is speculation. The fact remains, more people pulled the lever for the Democrats. Whether that was out of wild enthusiasm for the Democrat message, or dislike for the Republican message, we don’t know. More people thought the Democrat alternative was the better choice. I am just getting really tired of everyone waving their hands about the unpopularity of the Democrats, when everything says that the Republicans are more unpopular.

  43. Mooshi, I don’t disagree. We’re both speculating on voters’ motivations for voting as they did.

  44. “Nancy Kimmel Viola, a 63-year-old social worker who lives about a mile away from Clinton’s campaign headquarters in Brooklyn, keeps a “Bernie 2016” sticker taped to the front door of her Carroll Gardens home, a vestige of her support for the unsuccessful bid of Sen. Bernie Sanders. While she plans to vote for Clinton, she confesses that her “heart’s not in it.”
    “I have to vote for her.” Viola said. “Having Trump in there is too scary.”
    In Denver, residents in the Democratic stronghold of Park Hill posted many yard signs over a local zoning issue, but few for the presidential race.
    “Most of us around here will vote Democratic, we always do, but we’re not overly enthusiastic for Clinton,” said resident Pablo Marron. “But we are united in our opposition to Trump. http://fortune.com/2016/09/26/hillary-clinton-support-democrats/

    Nancy Viola seems typical of many of those who voted for Clinton. Googling “hold nose vote Clinton” generates a ton of hits.
    Granted, so does “hold nose vote Trump.”

  45. Scarlett, anecdotal speculation. The one hard fact remains: more voters pulled the Democrat lever.

  46. MM,
    Here is the other hard fact. Clinton lost. It is the only hard fact that matters now.

  47. Hey RMS – go check out the latest from NYT. We can start a “but his emails!” thing now.

  48. “So claiming that Democrats are out of touch with the sheeples or muggles or whatever is just crock”

    Actually, recent polling shows a full two-thirds of the country believes the Democrats are out of touch, somewhat higher than the percentage who say the same of Republicans.

    But none of this means that Democrats are seen as echoing the concerns of the common man. In fact, the Democratic Party is viewed as more out of touch than either Trump or the party’s political opponents. Two-thirds of Americans think the Democrats are out of touch — including nearly half of Democrats themselves.

  49. “And the reason that Trump is constantly rehashing the election is because he knows perfectly well that most living breathing human beings didn’t want him and want him even less now.”

    1) Most living, breathing voters did not vote for Clinton, either.

    2) The President’s approval ratings are essentially unchanged from their level on the day that he wòn 306 electoral votes.

    3) At 40%, the President’s approval ratings are not remarkably lower than the level at which President Obama spent much of his eight years. Both men have already proven that some voters don’t need to approve of you to vote for you.

    4) The only person whose poll rating continues to decline to all-time lows is Hillary Clinton:

    http://www.suffolk.edu/documents/SUPRC/3_7_2017_tables.pdf

  50. Trump is our president. The continual discussion of Hillary, or Obama is irrelevant. But after the latest NYTimes article it’s clear that the Trump campaign knew and accepted that they were getting support from the Russian government. In my possibly naive view, that’s a huge deal. Russia’s interests are clearly adversarial to ours and to our NATO partners. And I absolutely believe that someone from another campaign would have rejected Russian help. Lots of people live ethical lives, or at a minimum are conscious that the same tactics can be used against them in the future. Didn’t Gore’s campaign contact the FBI when they received Bush campaign documents? I have been baffled and appalled that the Republican leadership seems to be fine with their leader welcoming Russia on to the team, but reading these comments there are clearly plenty of people who I do not suspect have taken illegal campaign donations from Russia who think this warrants nothing more than a “so what?” Can you elaborate more on why you think the acceptance of Russian influence, the concealment of that assistance, the lying when directly asked about it, and the potential that raises for future demands in repayment, is nothing we should be concerned about?

  51. Democrats are out of touch with the sheeples or muggles

    Oh I disagree, the democrats have increasingly become the party on the front of the class kids, the party of the meritocracy. As Milo has said before, we’re seeing a slow realigning of the parties. The new economic elite and the existing cultural elite along with the comfortable professionals in the democratic camp and those toward the bottom in the republican camp.

  52. One more question: does the answer change with a different country. I would surely be less disturbed if the country interfering were the U.K. If the country offering oppo research in exchange for sanctions relief were N Korea or Iran, is it still no big deal?

  53. “and those toward the bottom in the republican camp.”

    That’s a bit too far, even though you think you’re quoting me. Remember that Hillary won the households with income less than $30k by a wide margin.

    President Trump won every single other group. The working class (obviously), the middle class, and he won those with incomes over $200k. I agree that Democrats cultivate the front-of-the-class kids, and I think they’ve gotten more enthusiastic about that over the years.

    Becky – To answer your question, I’ll have to read more about it. Surely you can understand why someone would be wary (and weary) of yet another breathless expose from the NYT that turns out to be a bunch of nothing. I haven’t seen any evidence to suggest that a deal was ever made or considered for promises of future sanctions lifting or something like that.

  54. “But after the latest NYTimes article it’s clear that the Trump campaign knew and accepted that they were getting support from the Russian government.”

    The evidence that the NYT presents does not make that clear at all; more specifically, it does not add much of anything to what was previously known or suspected. The Trump campaign was not in control of Wikileaks or of Podesta’s email accounts. At this point in time, they barely had the support of their own party.

  55. The Trump campaign was not in control of Wikileaks or of Podesta’s email accounts.

    Doesn’t that still mean they were conspiring to violate the CFAA?

  56. Milo,

    That article doesn’t really say what they want the ACA replaced with. It’s like voters wanting to balance the budget by cutting foreign aid.

  57. even though you think you’re quoting me

    That’s why I said, “a slow realigning of the parties.” None of this happens overnight.

  58. “That article doesn’t really say what they want the ACA replaced with. It’s like voters wanting to balance the budget by cutting foreign aid.”

    Exactly!

    “That’s why I said, “a slow realigning of the parties.” None of this happens overnight.”

    True.

  59. Milo,

    I would ask you what I asked Scarlett : What should replace the ACA in your mind?

  60. “What should replace the ACA in your mind?”

    I have no idea, and I’m surprisingly dispassionate about it.

    I could make a pretty good argument for Medicare for all. But I think the base level should be mainly the bare-bones essentials, and then individuals can decide if they want to additionally obtain supplemental coverage for the more nice-to-haves. But, nobody should be worrying about going broke (or even handling complicated billing) for cancer treatments.

    I also think ACA could probably work a lot better if the penalty for non-compliance were significant and enforceable; as written, neither is true, so you enter the death spiral when the healthy decide to forego coverage.

    And I’d like to see some very rigorous death panels.

    None of this is politically palatable.

  61. Milo,

    The current talk is that if the bill fails in the Senate, McConnell will partner with the democrats on a bill to “stabalize” the insurance market. What I think that means is pour in enough money to make insurance such a good deal that we avoid the death spiral. Not the ideal solution but there are no ideal solution.

    Considering that components of the ACA are so popular with republican voters that with control of both congress and the White House, they can’t even agree on a replacement. What do you think was the source of all the opposition?

  62. I like Milo’s health care ideas. i would also tax employer sponsored healthcare.

  63. Rhett – I think a lot of the opposition stems from:
    – the individual mandate (to buy/be covered by health insurance) being perceived as government overreach
    – the cost to the government and resulting increased deficits due to the funding provided

    I agree with Milo “…Medicare for all. But I think the base level should be mainly the bare-bones essentials, and then individuals can decide if they want to additionally obtain supplemental coverage for the more nice-to-haves. But, nobody should be worrying about going broke (or even handling complicated billing) for cancer treatments.”

    Though I don’t know how/where to draw the line between “bare-bones/basic” and covering e.g. cancer or other chronic conditions. The elimination of annual/lifetime caps is one aspect of the ACA I think is good, as with the ‘pre-existing condition’ elimination.

    I know I’ve posted the comments a friend (at the time a CEO of a midwest Blue Cross) made when the ACA was being implemented “To make it work everyone has to be covered. No exceptions. Given that, all the insurance companies will support it, too.”

  64. “they can’t even agree on a replacement. What do you think was the source of all the opposition?”

    I’m not sure, but I think that the problem is that they started out with the idea that they wouldn’t even attempt to get any Democratic support whatsoever.* That means you need 50 of the 52 GOP senators to agree on a plan. While everyone was nominally onboard with “repeal and replace,” there’s quite a spectrum, from Collins to Cruz**, of what form the “replace” part should take.

    * Republicans, of course, share much of the blame for this, but that’s also just the tone now. When Democrats like Elizabeth Warren are attacked by their own base for doing something as innocuous and inconsequential as confirming Ben Carson to HUD, well, what do you expect? That’s what leads to a failed filibuster and the “nuclear option” down party lines to confirm Justice Gorsuch, someone who had been confirmed to his previous bench by many of the same senators 97-0. So if they’re forced to come up with something together, even if it’s not ideal, I think that’s a good thing.

    ** There’s a fascinating New Yorker article about the politics of the Texas State legislature. Obviously, I take everything from the New Yorker with a huge bucket of salt, especially in the political realm. On the other hand, we’re friends with people whose father/FIL is in that body, and they are definitely the most right-wing people I know. More to the point, the only real political challenge that this guy ever has is being “primaried” from even further on the right. The weeks of Facebook posts precede their election parties on Primary nights; the actual election is always an afterthought.

  65. “I would also tax employer sponsored healthcare”

    Houston – why? Because the e.g. $15,000/yr my employer pays on my behalf should be treated as income to me? I guess I can support that income being taxable, just like my salary, as long as I have a choice to receive it in cash and then buy my insurance via a well-functioning* market, so that I meet the “everybody needs to be covered” mandate.

    *something that would be in the eye of the beholder.

  66. I think the first idea is a non-starter politically.

    Of course the second idea will work. This has been argued by the Dems for a long time. However, if you recall, our Supreme Court isn’t going to accept that. So blame Roberts for that. Probably not going to get better under a more conservative court which is where we are obviously going.

    So, we’ll put more $ in to Obamacare as it is, maybe implement some of the 60+ modifications that the Dems have previously suggested and continue on our merry way.

    Unless McC can come through at the last minute. Exciting!

  67. “However, if you recall, our Supreme Court isn’t going to accept that. So blame Roberts for that.”

    Remind me of that again? Roberts said “No, Mr. President. Despite what you claim, this *IS* a tax, and that’s why it’s OK.”

    So why couldn’t the tax be higher?

  68. Milo – yes. “The payment is not so high that there is really no choice but to buy health insurance;” Chief Justice John Roberts wrote in the decision.

    The size of the payment was a factor. Not sure why, because we pay a lot in taxes and I don’t see him letting us skip those.

  69. ohhh. So Option 2 is off the table. Option 1 is not going to happen.

    I guess that’s why we’ll be propping up insurance companies.

  70. Just as well. Like I said, I’m going to need some sort of affordable coverage when I quit at 52 to do the Loop.

  71. Probably. Which is an ok solution. Not great. But I don’t know that there is a great solution out there

  72. And I won’t be anywhere near required minimum distribution age, so it might make sense to keep my taxable income between 52 and 65 really low. If I have no mortgage, and no second mortgage or loan on the boat, then I can probably keep income low enough to qualify for some generous subsidies.

  73. – the individual mandate (to buy/be covered by health insurance) being perceived as government overreach

    So basically what voters want is no mandate and no discrimination based on pre-existing conditions which is economically impossible?

  74. So basically what voters want is no mandate and no discrimination based on pre-existing conditions which is economically impossible?

  75. “Medicare for all” sounds like a good idea, but consider the disaster that has been unfolding at the VA. Then add in the travesty called the Indian Health Service.

    https://www.wsj.com/articles/people-are-dying-here-federal-hospitals-fail-native-americans-1499436974

    Then there’s Medicaid, the free program which, if you take the CBO estimates at face value, millions of people would DROP absent the mandate, and which research shows produces no better health outcomes than having no insurance at all.

  76. Scarlett,

    “Medicare for all” sounds like a good idea, but consider the disaster that has been unfolding at the VA.

    But obviously don’t consider how popular Medicare is because that would totally undermine your point.

    Can you expand on your preferred option whereby the government provides subsidies for the poor to buy private insurance? How much would it cost both the recipient and the total cost to the government? How will the costs be lower without the government’s near monopsony buying power? As you know the rates private insurers pay are much higher than what Medicaid pays.

  77. Scarlett,

    And just so I’m clear, your contention is that your plan to provide subsidies for the poor to buy insurance will result in better health outcomes than Medicaid?

  78. Rhett – yes. They want ins to cover what they need and want, but not to have to pay much for it. And only pay for it when it is precisely needed. And certainly not pay for my family or yours.

  79. Medicare and the VA are totally different animals and not analogous. The VA is a health care system. Medicare is a payment system. There would be plenty of room in the marketplace for Medicare for all + private supplemental insurance.

    There are a lot of health care services that Medicare doesn’t cover, and those health care services are still available to 65+ folks that have been willing to buy a Medigap policy, pay out of pocket, or who still have employer-provided insurance. It’s a good model. (Unlike the VA, which is a disaster on many levels.)

  80. Rhett, my point is that we should think twice before entrusting to the federal government an even greater role in the health care system than it currently has.

  81. Medicare and the VA are totally different animals and not analogous.

    Medicare for all is single payer like they have in France. The VA would be equivalent to the NHS which no one is really advocating.

  82. “research shows produces no better health outcomes than having no insurance at all.”

    The ultimate outcome is the same for all of us.

    http://www.theonion.com/article/world-death-rate-holding-steady-at-100-percent-1670

    World Health Organization officials expressed disappointment Monday at the group’s finding that, despite the enormous efforts of doctors, rescue workers and other medical professionals worldwide, the global death rate remains constant at 100 percent.

    Death, a metabolic affliction causing total shutdown of all life functions, has long been considered humanity’s number one health concern. Responsible for 100 percent of all recorded fatalities worldwide, the condition has no cure.

    “Everybody talks about death,” Sen. Pete Domenici (R-NM) said, “but nobody seems to actually be doing anything about it. I propose we stop molly-coddling death, not to mention the multi-billion-dollar hospital, mortuary, funeral and burial industries that reap huge profits from it.”

    Under Domenici’s new bill, all federal funds will be withheld from the medical industry until it “gets serious and starts cracking down on death.”

    Consumer rights advocate and staunch anti-death activist Ralph Nader agreed with Domenici.

    “Why should we continue to spend billions of dollars a year on a health care industry whose sole purpose is to prevent death, only to find, once again, that death awaits us all?” Nader said in an impassioned address to several suburban Californians. “That’s called a zero percent return on our investment, and that’s not fair. Its time the paying customer stood up to the HMOs and to the so-called ‘medical health professionals’ and said: ‘Enough is enough. I’m paying through the nose here, and I don’t want to die.'”

  83. Rhett, my point is that we should think twice before entrusting to the federal government an even greater role in the health care system than it currently has.

    What’s your alternative? You seem very cagey about providing any details.

  84. Two different friends with adopted children have posted this link on Facebook in past weeks. Situations like this (they are Christians with views of the limitations of government not far from mine) contribute to the distrust of government.

    Wait, so now you’re in favor of throwing unlimited government money at problems? Shouldn’t the adoptive parents just cry and accept their lot? Shouldn’t they have been smart enough and responsible enough to be extremely rich? After all, why should my tax dollars go to paying unlimited amounts to help the screwed-up kids?

  85. RMS, I’m offering background information for why some people who are working/middle class are ambivalent about relying on goods/services promised by government.

    Certainly my personal choice to remain childless if I was unable to have biological children was affected by the challenges my friends have with their adoptive children. My choice is selfish and statistically based.

  86. What’s your alternative? You seem very cagey about providing any details.

    Rich, smart, white people should get health care and live; everyone else should suffer and die.

  87. WCE,

    How is that an example of government overreach? It seems like limited government to me. Are you saying the government should pay for intensive mental health care even if the kids are still under the care of their parents?

  88. RMS,

    Rich, smart, white people should get health care and live; everyone else should suffer and die.

    To be fair, Scarlett proposed the government subsiding the purchase of private health insurance rather than relying on Medicaid. That’s certainly something to look into and it may be better, but it’s hard to imagine it being cheaper.

  89. My choice is selfish and statistically based.

    Statistically speaking, all those kids should have been euthanized, because the odds are good that they’re going to grow up to be drains on the system. So this “wah wah the government isn’t spending money on my preferred outcome” is crap. The government shouldn’t have promised any help at all, because the “help” is statistically pretty useless. “Therapy” and in-patient treatment doesn’t work on those kids, mostly. They should just be put down. Why can’t y’all be consistent?

  90. “I would also tax employer sponsored healthcare”

    Houston – why?

    I’ll answer….because employer sponsored healthcare is compensation and compensation is taxed.

  91. Rhett, if the concern is preventing people from going broke to pay for catastrophic health expenses, why not focus on catastrophic coverage for all, via withholding taxes, rather than trying to pay for first-dollar coverage for the Medicaid expansion cohort? Get the Feds out of the business of mandating a list of benefits that every policy must include.

  92. It is the catastrophic care that is expensive. The other stuff should just get thrown in. Doesn’t cost much and on an individual basis it can help.

  93. Scarlett,

    What do you consider catastrophic coverage for a family of 4 with an income of $22k?

    Get the Feds out of the business of mandating a list of benefits that every policy must include.

    You are assuming the existence of a vast untapped quantity of cognitive ability and executive function whereby someone at the 5th percentile can weed though hundreds of pages of fine print to determine what services that want and don’t want to pay for.

    The problem is when someone chooses not to buy drug treatment and they become addicted to narcotics after a car accident, voters don’t want the insurance companies to be able to discriminate when they buy treatment coverage the day before they go into treatment.

  94. Rhett, I don’t perceive their concerns as an example of government overreach, more that government makes promises that it can’t/won’t fund and sets up perverse incentives for its CPS/DHS-type employees. Social workers have an incentive not to disclose about children’s histories to facilitate long-term placement. That makes middle-of-the-road people like me even more reluctant to adopt.

    I’ve noted in the past that the mental health system (which would include care for children, adopted/foster or not) is an area that I believe should receive more government funding.

    RMS, to the extent I am willing to participate in the political discussion, it’s because I don’t hear the perspective of working class people accurately represented in many cases. Please stop assuming I hold a particular view. If you don’t know, ask, and if I’m available, I’ll respond. I don’t have strong opinions about whether health care is more important than social services, small public school classes, adequate natural disaster plans, the military and well-maintained transportation systems, but I understand all those compete for tax dollars. My point is not, “Nothing should be funded,” but “What shall we give up to fund X at a higher level?”

  95. I am not getting the point of WCE’s post about the adopted children. This is a well known problem that is not unique to adopted children. Liberals have been pointing this issue out for years. The problem is lack of funding for mental health services. Families with kids who have severe mental illness – schizophrenia, severe depression, severe forms of autism – sometimes end up doing this because they can’t pay for the custoidal care needed. This article dates way back to 2009 – this has been a problem for a long time, in many states. The answer is better coverage of treatment for mental illness – but do you think that will get included in those barebone plans?
    https://opinionator.blogs.nytimes.com/2009/02/19/is-there-no-place-on-earth/

  96. – but do you think that will get included in those barebone plans?

    Which goes to Scarlett’s point about mandated coverage. What does she propose to do with someone who develops schizophrenia at 22 but chose not to buy mental health coverage?

  97. “The problem of parents being forced to give up custody of their children to access mental health care is not new. It was first raised twenty-five years ago in Jane Knitzer’s (1978) groundbreaking study, Children Without Homes: An Examination of Public Responsibility to Children in Out of Home Care. Families are not able to access mental health treatment through their private health plans and are turned down by the public mental health system as well.”

    http://dsq-sds.org/article/view/622/799

  98. more that government makes promises that it can’t/won’t fund…Christians with views of the limitations of government not far from mine

    Aren’t they also the people who don’t want to properly fund mental health services? They are saying they don’t want to do it because the government won’t fund it properly but they are the ones who don’t want to fund it. The logic is entirely circular.

  99. And another case from 2016 – a teen with autism. This one speaks to me – I have a FB friend who has a teen son with autism this severe, and while she has not yet had to consider giving up custody, things are starting to get very bad. Her son (and the one in the article) are not adopted. When you have kids, you do not know how things can turn out, and care for a severely autistic or schizophrenic child can easily bankrupt you.
    https://www.disabilityscoop.com/2016/05/24/to-help-son-parents-custody/22350/

  100. Rhett, Christians are not a monolithic group. Like non-Christians, people with a particular problem wish there was government funding to solve it and people without a problem often believe more government funding isn’t needed, because they have groceries to buy and utility bills to pay. To me, being Christian is about having an eternal hope in salvation from Jesus Christ, not about any particular viewpoint about how to optimize trade-offs in a sinful world.

    I agree with your point about logic.

  101. Rhett,
    At some point, people have to be responsible for their own decisions, in health care and otherwise. Society has decided that, absent extreme circumstances, we don’t want to force mentally ill people into treatment. I happen to disagree with that approach but until we change those laws, that is the current reality. People often act against what others perceive to be in their best interest. Families with schizophrenic children go through hell. Not sure that mandating a mental health benefit will help the person who refuses treatment

  102. Not sure that mandating a mental health benefit will help the person who refuses treatment

    So you agree it will help those who are amendable to treatment?

    At some point, people have to be responsible for their own decisions,

    No, they really don’t. That’s why SS and Medicare aren’t optional.

  103. I agree that everything should be covered–mental health, disabilities, illnesses, etc. But how do we pay for it all. Medical costs are like a black hole of need. Also, home health providers are not paid enough–their hourly rate is really half of what it should be. Same with child care providers.

  104. WCE said “Not sure that mandating a mental health benefit will help the person who refuses treatment”

    the links I posted where about children, not adults refusing treatment.

  105. sorry ’bout that. You are right. But I was puzzled about the original post, since the problem is really not about adopted children, and not about mean government agencies. The problem is really lack of funding.

  106. Rhett, I think that mental health issues should be treated no differently than physical health. Where we seem to part company is with the extent to which people should be responsible for their own routine ordinary health care expenses and decisions.
    Sorry I know you asked other questions but I haven’t gotten to them yet.

  107. “Where we seem to part company is with the extent to which people should be responsible for their own routine ordinary health care expenses and decisions.”

    That is fine, but it isn’t an approach that will cut the cost of the health plans. The costs are all in the treatment for schizophrenia, not in screeing for it. Same thing for cancer – mammograms are cheap, but treatment for metastatic breast cancer is not. If you cover catastrophic costs to an extent that they do not bankrupt people, your plans will be expensive whether or not the screeing and vaccinations are included.

  108. Where we seem to part company is with the extent to which people should be responsible for their own routine ordinary health care expenses and decisions.

    How much should they be responsible for? A family of 4 making 22k? $2,200? A totebag family making $270k? $54k? I have no doubt that mandating totebaggers cover everything up to 20% of gross income would end up saving a lot of money*. The problem is it’s never going to happen as voters hate it so much.

  109. MM,

    Scareltt’s plan would work. If totebaggers had to pay the first $54k out of pocket that would apply a lot of informed pricing pressure on the healthcare market. But that’s not in the cards. What is in the cards is how much a family making $22k should have to pay. I don’t know that such a low number would result in any serious pricing pressure as the amount it so low.

  110. People with a severely mentally ill child routinely pay $54K a year in costs, even with insurance, and it doesn’t seem to exert much pricing pressure. Children with mental illness, especially autism, are very expensive because so much of the treatment falls outside what is covered by medical insurance. It is even expensive to have a child with mild mental health needs – because there are so few child psychiatrists or psychologists who take insurance, families are often forced to pay out of pocket and that adds up

  111. MM,

    You could be right. My understanding is that the cost of veterinary care is rising just as fast as human healthcare and veterinary insurance is relatively rare with the vast majority paid out of pocket.

  112. There are lots of severely mentally ill children, and the vast majority of them do not live in families where there is 54k in disposable income. So, it is a bit of hyperbole to say that it is a “routine” expense. I have to say, in my HMO practice which serves a lot of people in the 5%, I see most mental health care being delivered through the system. There are a handful of trendy “no insurance” counselors around here, and they have nicer waiting rooms and better access than the therapist I take a kid to. However, they are far outnumbered by the nonflashy folks who take 4 weeks to get an intake with when you are not in crisis.

    This is probably a small point in the greater argument, but I continually see NYC metro area held up as representative of the US. It’s not.

  113. Yeah, in my bare bones plan, there’s not going to be a lot of taxpayer funding for psychological treatment for things like ADHD. Some kids are going to be B- or C students, and that’s just the way of it. Parents can either accept that, or pay entirely out of pocket.

  114. “the vast majority of them do not live in families where there is 54k in disposable income.”
    “but I continually see NYC metro area held up as representative of the US. It’s not.”

    I agree wholeheartedly.

  115. Ada, my friends with the severely autistic son do not live in the NYC metro area. I also have a friend in Ohio who had to wait for months to get an appointment with a child psychiatrist who took their insurance. Lack of access to pediatric mental health services is a national problem, If you took a look at my links, you will see not a one is in the NYC metro area.

    And yes, most people can’t afford 54K. That is why they start considering trading over custody to the state.

  116. mammograms are cheap

    So, I have a question about this, and it’s an actual question. At one point I was reading a discussion about whether mammograms should be funded because they don’t actually reduce all-cause deaths. So someone suggested that they could be paid for out of pocket, and everyone started screaming “No, that just increases medical costs in the U.S.”, or something along those lines. And I absolutely don’t get it — if I pay for some procedure out of pocket, even if it’s a procedure that the Medical Gods have decided shouldn’t be performed that much anymore, why is that detrimental to everyone else?

  117. “Yeah, in my bare bones plan, there’s not going to be a lot of taxpayer funding for psychological treatment for things like ADHD. Some kids are going to be B- or C students, and that’s just the way of it. Parents can either accept that, or pay entirely out of pocket.”

    So if two or three of these kids who can’t afford medication are in class with your kids, they will distract from learning of the other 30-35 kids in the class. This means that those two or three kids will be C or D students, but your kids are now B students because the teacher can’t manage the outbreaks that happen (or the accommodations from an IEP) while still keeping the other kids at the pace that the class should be progressing. What I can never understand is how people can’t seem to understand that we are part of a society and that comes with a cost. I won’t get every penny out that I put in and I’m OK with that as long as I have a safe, stable community. Mental health treatment and medication helps that happen.

  118. According to this article published by the Association of American Medical Colleges
    ” Approximately 80% of children and adolescents who are in need of treatment do not receive mental health services. For families that do seek services, 50% terminate treatment prematurely due to lack of access, lack of transportation, child mental health professional shortages, and stigma related to mental health disorders. ”
    https://www.mededportal.org/icollaborative/resource/3930

  119. Rhett, when you consider that smokers pay hundreds of dollars for cigarettes without government subsidy, is it too much to ask them to spend at least as much on health care before someone else picks up the tab?

  120. If this was Clinton, if this was Hillary Clinton whose kid maybe colluded with foreign intelligence agencies to diddle the election in her favor, if this was Clinton’s scandal plagued and incompetence riddled administration six months in, if this was Clinton, Republicans would have already convened seventeen different investigations, held ten Congressional committees and four Senate reviews, brought up the Articles of Impeachment, spent $25 million in taxpayer money, and found at least one illegal blowjob.

    — Jim Wright

  121. Yeah, in my bare bones plan, there’s not going to be a lot of taxpayer funding for psychological treatment for things like ADHD.

    If a script for ritalin can put the kid on the path to being a taxpaying contributing member of society isn’t it well spent? I can certainly see applying some cost benefit analysis to this but to dismiss it out of hand seems a little penny wise pound foolish.

  122. is it too much to ask them to spend at least as much on health care before someone else picks up the tab?

    If they had the kind of executive function to prioritize things properly they wouldn’t be poor to begin with now would they?

  123. there are varying levels of severity, to be sure.

    Rocky – It’s another big blow up that ultimately amounts to nothing. “Dossier!!”

  124. Scarlett,

    Is our primary disagreement over the amount of surplus executive function and cognitive ability possessed by someone in the 5th percentile?

  125. When 20% of the population suffers from a mental health disorder, how do we prioritize? Cost-benefit analysis is critical.

    This discussion makes me sad for my high school friend-turned-psychiatrist who was murdered a couple years ago. She had a heart for disadvantaged people with psychiatric problems.

  126. “Although 1 in 5 children in the United States suffers from a diagnosable mental health disorder”

    How much money do you suppose is required to treat that to their standards? Like, if the average mental health care professional earns $125k annually, and one in five children in the United States should have, what, an hour a week with one?

  127. Milo – I feel as though you are not appreciating the $hitshow that this is. This is a very big deal. And he just tweeted it all. Amazing.

  128. Ada, I am sorry but your sneering tone about NYC really rubbed me the wrong way. I have friends in lots of areas of the country, and a certain percentage of them have kids with serious mental health issues, and I see how they struggle. In particular, because I am involved with the adoption community and the pediatric cancer community, I may know more families than usual with kids with mental health needs – both groups often suffer from trauma, PTSD and severe depression. Lack of access to competent mental health providers – not just psychologist and psychiatrists – but also hospitalization, support services, etc. is a huge problem for everyone.

    And it has been a problem for a long time. My brother suffered from severe depression and needed hospitalization as teen. Even back then, it was really hard to find services without going bankrupt. And no, this was not in the NYC metro area. I have a cousiin in the midwest who suffered from schizophrenia which appeared in late childhood. They never could find affordable custodial care for her and she ended up burning the house down.

  129. Milo, you still are not getting it. Some number, probably most, of those kids may need the stock 45 minutes a week with someone sympathetic. Some need time with someone more specialized than that. Kids who are suicidal, or who have crippling PTSD need someone who can handle their problem. And some kids need 10 hours a day of supportive services, and others may need 24/7 care, at least for a time. You seem to think that childhood mental health is about coaching a kid with a touch o’ ADHD or a little “sadness”.

  130. Like, if the average mental health care professional earns $125k annually

    According to the Bureau of Labor Statistics, the median annual salary for clinical, counseling and school psychologists was $67,880 in May of 2011.

  131. Kate – We’ll see. And I don’t mean that sarcastically; I could be wrong, and we’ll see if anything comes of it. There’s no evidence that anything was exchanged, or that any deal was made. (There’s not even the allegation that there was.)

    We’ve been here before. I honestly think people are tired of hearing about Russians. The people who are hysterically mad about it are a minority, they’re concentrated in a few non-contested geographic areas, and they’re not in overall political power.

    The Democrats have lost four out of four special elections having done nothing since November other than scream about Trump and Russians.

  132. Mooshi – I get it. Some need less, some need more. My question was what’s the average, and is there any way we could possibly afford that for 20% of all children in the U.S.? (And we haven’t even gotten to the adults.)

  133. My FB friend with the autistic son lives in FL. They moved there from NC because FL has better educational services. The kid is 14, same age as my middle kid – that is how we met. He sleeps one hour a night, wanders off from the house so they have to lock everything, attacks his mom and sister, and has recently started to threaten his father. He is completely nonverbal. They have insurance, but insurance does not come close to paying for the respite care, the therapists, and so on. The mom is about at the end of her rope right now and they are considering next steps to get the care needed.

  134. Milo, so we just let ’em burn the family house down, or knife their parent like that kid of the VA senator did?

  135. Milo,

    At $50/hr sending 14 million kids to an hour a week of therapy would cost $37 billion.

  136. Mooshi – Surely you don’t believe that 20% of all children are going to burn the house down or stab their parents?

  137. So if it’s just an hour a week on average, and just for someone who only bills $50 per hour (which seems pretty low), then that’s already about 6% of the current Medicare budget. And then we need to think about prescriptions…

  138. “Surely you don’t believe that 20% of all children are going to burn the house down or stab their parents?”
    Nah, but identifying the ones who might takes having access to good mental health services. And, it might be nice to head things off before it gets that bad…

    Seriously, the kids who are very violent or very disabled may be a small proportion, but they are very expensive to treat – and worse yet, the consequences of not treating are pretty dire. Ask the Sandy Hook parents or Gabrielle Gifford, or the people in that movie theater in Aurora. Our refusal to provide adequate mental health services leads to a lot of social disarray and costs us in other ways. Our jails are crammed with people with mental health issues. Addiction to opiods and meth is an epidemic. People with ADHD are overrepresented in the prison population. Maybe if you gave 45 minutes a week (45 is standard not one hour) to that kid with ADHD, you could end up keeping him out of jail.

  139. Milo, you may be right that nothing will “come of” the Russia scandal because Republicans in Congress are desperate to hold on to their power and Trump’s disciples will support him even if he shoots somebody in the middle of 5th Avenue. That does not mean that it was no big deal. Junior knew that a hostile foreign government was working to “help” his father get elected. He should have reported this to the FBI, like Al Gore did when he received Bush campaign materials. Instead, he chose to accept their assistance. I don’t know if that technically qualifies as treason, but I agree with Rocky: if either Clinton had done anything close to that Republicans would be calling for death by firing squad.

  140. I think this is out of the Republicans’ hands. Mueller is the one who will report on it. Unless Trump fires Mueller.

  141. ” if either Clinton had done anything close to that Republicans would be calling for death by firing squad.”

    What would Democrats be doing?

  142. Therapist without PhD is $90/hr. With a PhD, most don’t take insurance and charge $150/hr. Get lucky enough to find one who just really likes you and your kid and they may give you a discount. This only happened for us once.

  143. What would Democrats be doing?

    So what do you actually think absent partisanship? Hillary conspired to violate the Freedom of Information Act and the Trump campaign conspired to violate the Computer Fraud and Abuse Act.

  144. So HRC was saved in part because they didn’t think there was intent. Donny Jr just served it up on a silver platter.

  145. “conspired to violate the Computer Fraud and Abuse Act.”

    Ideally, DJT Jr. could have said “No, don’t hack Hillary!” But he didn’t.

    At the same time, there’s no evidence at this point that he made any deal, or even received anything.

  146. “Therapist without PhD is $90/hr. With a PhD, most don’t take insurance and charge $150/hr.”

    So that $37 billion becomes close to $100 billion, best case scenario.

    Or the government needs to look into cheaper options for therapists/therapy.

  147. “Or the government needs to look into cheaper options for therapists/therapy.”

    Like waiting until they commit a crime and then putting them in prison. Or letting them end up on drugs, and then trying to mop up the devastation wreaked on their communities, Or letting them end up homeless and then trying to fund services to get them treated and into housing. That is what we do now. It probably costs just as much, but since the spending is scattered, we don’t see it.

  148. “Or the government needs to look into cheaper options for therapists/therapy.”

    Or is there a way we could streamline their education? Do we get a lot of value out of medical school being a separate 4 year program after 4 years of college. Would it be better if it was a 5 year program that started at 18 like they do in France. Same with the credentials needed to be a therapist – are we doing things as efficiently as possible.

  149. I don’t want to wade into the moral/political issues around treatment and coverage. But since i am probably the only person on this blog actually on Medicare, I would like to share with you what it covers and costs. Recall that I live in a very well served medical area with little need to wait ridiculous amounts of time for appointments or elective surgery (unless you insist on the rock star doctor), and little difficulty in finding a primary doctor or medical specialist.

    I have a bare bones Medicare Advantage plan with basic drug coverage, which functions as an HMO with a primary doctor and a “circle of care” limitation on referrals. (This happens to be the cheapest option in one of the five top rated plans in the nation.) It is available to anyone in the geographic area with no additional premium above the amount of medicare premium. There are copays for most services beyond the yearly physical, shots and screening tests, high enough ($40 a visit) to discourage me who has plenty of ready cash from using all of the 12 authorized visits to the occupational (hand) or behavioral (intrusive thoughts) therapist when I didn’t perceive further benefit. If I wanted to pay 100 extra dollars a month the specialist copays would go way down, but it is not cost effective for my limited usage. There are caps that kick in very quickly to limit out of pocket to a few thousand a year. I pay my copays out of my previously established Health Savings Account, into which i was only able to contribute for 6 years.

    DH has the 40 extra dollar a month version of the same plan with an actual, not virtual, HMO and his week in hospital for Congestive Heart Failure cost about 1500, his copays are 20 dollars, his pills about $100 a month and he is a power user.

    Medicare does not cover hearing aids or eyeglasses. The Medicare Advantage plan does offer favorable rates for equipment from hearing aid providers and opticians, but I think you can do just as well at Costco. Non-drug based mental health services are covered theoretically, but the availability of therapists outside of clinic settings and the long waits mean that if your PCP isn’t able or willing to prescribe routine chemicals, you may be out of luck. I don’t think addiction services are covered. Of course reproductive services, including male ED treatments, are not covered.

    Very poor elderly people are on a hybrid Medicaid/Medicare program that limits their out of pocket. Most elderly people (heartland lower middle class and up) have basic coverage but do have some tradeoffs to consider, especially if they are in an area too remote for an HMO type plan and do not have a Health Savings Account to draw on.

    I personally think that the degree of personal financial responsibility baked into the baseline Medicare model (with the option to buy a higher degree of coverage for those who can afford it) is the way to go. I would add a robust Health Savings Account system (perhaps even partially funded by government for lower income folks), and eliminate the employer health insurance preference and convert of the hidden cost into regular taxable income (perhaps with an above AGI deduction or tax credit for the purchase of health care through the single payer system). The health insurance companies would have a reduced role in actual “insurance” outside of supplements, but I am sure they could find a way to make money out of the creation of virtual medical HMO type organizations and their services as payment processors and gatekeepers.

  150. At the same time, there’s no evidence at this point that he made any deal, or even received anything.

    If it is also innocent, why did they feel like they needed to lie at every step of the way? They denied meetings ever happened until confronted with the evidence. There’s video of Junior on talk shows absolutely outraged at the implication that there was ever any sort of discussion with Russia. Trump supporters would have absolutely believe them and dismiss the whole thing if they had just said then what they are saying today. The fact that they lied about all of it, repeatedly, makes me think there was nothing innocent or inconsequential about it. And I think everyone who is so dismissive of it would have been out raged had it been a democrat that had done the same thing. (And I saw Milo’s link to the Ukrainian attempt to provide info detrimental to Manafort, and think the Clinton campaign would have been wrong to pursue that. But since Trump is currently Pres, and has the ability to wreak all sorts of havoc right now, I think that is where the focus should be.)

  151. “Medicare does not cover hearing aids or eyeglasses”.
    Medical insurance in general does not cover hearing aids, for anyone. While you can do fine at Costco if you have the usual age related hearing loss, children often have more specialized needs. We have to get the programmable hearing aids because my son has severe sloping loss, which interferes with his ability to hear consonants, and thus distiguish words. Kids with this amount of hearing loss often have trouble learning to read, both because they are very speech delayed (my kid was about 2 years delayed through early elementary) and because they can’t distiguish sounds and thus can’t learn phonics. Also, the earmolds have to be redone yearly, and the hearing aids themselves replaced as the kid gets bigger. Lack of coverage is a perennial topic on my pediatric cancer mailing list. The things cost about $3000.

  152. Responding to MM links:

    In rural TN, people have to drive 20mile or 1 hour for care. They sometimes have to wait 5 weeks for an appointment. I don’t see this as a huge problem.

    In Rhode Island, there aren’t very many child psychiatrists. Is anyone in Rhode Island more than an hour from Brown University?

    Child Psychiatrists are sub-specialists. They won’t be available in Franklin Tennessee, and neither will pediatric rheumatologists. That doesn’t mean that there is no mental health care for kids.

    From your article:

    “Mental health disorders are on a spectrum,″ said Dr. Karyn J. Horowitz, director of outpatient services at Bradley Hospital, who provides consulting for PediPRN. “And for some of the more mild cases I think it’s OK for pediatricians to treat them.”

  153. “And I saw Milo’s link to the Ukrainian attempt to provide info detrimental to Manafort, and think the Clinton campaign would have been wrong to pursue that.”

    Wrong to pursue it? Wasn’t the DNC meeting regularly with them?

  154. I agree that we provide poor care to mentally ill people in America (not just children). However, access to psychiatrists is not the answer. Lamenting the months that people wait to see a psychiatrist doesn’t get us closer to the answer.

    We can have health care that is two of three things: affordable, excellent or easy to access. You can’t have all three. I’ll chose affordable and excellent, and make people wait for the sub-specialty services.

    I’m going to go “sneer” my house clean. It will probably lower my blood pressure a bit.

  155. But before I take my sneering elsewhere:

    “creation of virtual medical HMO type organizations”

    This is a curious idea. In my experience, HMOs can control costs by creating a certain culture of care. In California (I have heard), Kaiser refuses to treat endometriosis with surgery. Statistically, it doesn’t work – women have the same pain and problems whether or not they get surgery. However, you kind of have to have a team of Ob-gyns who buy into the practice and spend their time counseling patients about alternatives, and going to CME on non-operative treatment for that to work. It can’t be someone who does surgery for some patients, no surgery for others. I think an HMO needs to truly be a community of like minded physicians (and patients to some degree) to work – which is why so many failed in the 90s.

  156. “In rural TN, people have to drive 20mile or 1 hour for care. They sometimes have to wait 5 weeks for an appointment. I don’t see this as a huge problem.”

    So when your kid is voicing suicidal thoughts, a 5 week wait is OK? ‘Coz that happened to a friend of mine (not in TN, but in Ohio)

  157. Kate –

    “A former DNC staffer described the exchange as an “informal conversation,” saying “‘briefing’ makes it sound way too formal,” and adding, “We were not directing or driving her work on this.” Yet, the former DNC staffer and the operative familiar with the situation agreed that with the DNC’s encouragement, Chalupa asked embassy staff to try to arrange an interview in which Poroshenko might discuss Manafort’s ties to Yanukovych.

    While the embassy declined that request, officials there became “helpful” in Chalupa’s efforts, she said, explaining that she traded information and leads with them. “If I asked a question, they would provide guidance, or if there was someone I needed to follow up with.” But she stressed, “There were no documents given, nothing like that.”

    Chalupa said the embassy also worked directly with reporters researching Trump, Manafort and Russia to point them in the right directions.”

    I won’t cut and paste everything, but what this outlines involves far more organized and strategic coordination between Ukranian officials and a paid DNC consultant than anything that is remotely alleged about the Trump campaign.

    http://www.politico.com/story/2017/01/ukraine-sabotage-trump-backfire-233446

  158. Mooshi: What is your solution to the mental health crisis? More money? How much more? I’m curious because I agree that everyone should receive decent care. Ada is absolutely right that there are trade offs involved.

  159. And your attitude, that someone who lives in NYC doesn’t know anything, makes my blood pressure go up. It is sneering, just as much as making fun of people who live in Appalachia is sneering. Like I said, I have friends in many parts of the country who all relate significant issues with this particular part of the healthcare world. I think doctors tend to have their own POV, which often relates heavily to their area of practice, and families have their own POV which can be quite different.

  160. And if they find Chelsea’s smoking gun in meeting with the Ukrainian govt to influence our election, they should go after Chelsea. Or Hillary. Or anyone else.

  161. “I’m not getting the “both sides do it so who cares” argument. Both sides are wrong.”

    It certainly throws a wrench into the “OMG, can you imagine if Hillary or the Democrats had DARED to do something like this?”

    No need to speculate, apparently.

  162. There is zero evidence that Hillary did anything. We have Jr admitting he did this.

  163. Houston, my opinion is that we are already paying through the nose for people with mental health issues, but we just do it really stupidly and counterproductively. I have always heard the stats that a large proportion of prisoners have serious mental illness. Maybe if we paid upfront for mental health treatment when they are young, we could cut our vast and growing prison budget. Prisons suck up a huge part of state budgets. It is all about tradeoffs, you know.

  164. Of course it matters. If you can establish a link between Trump and Jr’s actions, that is a huge deal.

  165. or the people in that movie theater in Aurora

    That guy was actually seeing a psychiatrist. There’s very little evidence that psychiatric care actually helps people with severe problems. You can dope them into submission, and in many cases you should. But that’s about it.

  166. How much would it cost? Where would we get the funds? Milo has posted some scary expenses. How do European countries handle this?

  167. “If you can establish a link between Trump and Jr’s actions, that is a huge deal.”

    What do you mean establish a link? Like the burden of proof is that there has to be some evidence of a favor repaid?

  168. “I have always heard the stats that a large proportion of prisoners have serious mental illness.”

    I just heard some stats that a large proportion of children in general have mental health issues, so it would only be surprising if prisoners DIDN’T have mental health issues.

  169. That guy was actually seeing a psychiatrist. There’s very little evidence that psychiatric care actually helps people with severe problems.

    As Scarlett mentioned: we don’t want to force mentally ill people into treatment. I happen to disagree with that approach

    I agree with her that our current balance is less than ideal.

  170. And obviously not everyone needs a full fledged child psychiatrist. There are other models – group counseling, telephone counseling – that can be cost effective and helpful. And even kids with really serious problems may need some kind of service other than a psychiatrist.

    I teach medical informatics courses from time to time, and do research in the area. We are currently funded by a pharma for a project that may cut costs in a certain area. My co author just got back from a medical informatics conference overseas, where our work was getting some interest from healthcare companies. Despite the fact that that I live in the NYC metro area, I actually know a thing or two about how the healthcare system works – not as a doctor, but as someone who looks at how all the pieces intersect. Wny else do you think I like to get so wonky about healthcare insurance?

  171. I am sure Trump will deny knowledge of this. That is what their narrative is right now. So, the prosecution will need to prove Trump was in on all this.

  172. “So, the prosecution will need to prove Trump was in on all this.”

    Is that sufficient, to just know about it, or do they have to prove that he actually solicited information from illegal means?

    If they just say “We have information on Crooked Hillary,” and the Trumps say “Great! I love it!” I’m not sure that counts.

  173. I am not sure anyone is sure, Milo. It is all kind of crazy. But given the relationship with Trump and kids, it is hard to imagine Jr was acting on his own. They even met in Trump Tower while Trumpmwas there. Although their campaign was seemingly a mess, so who knows! But I continue to think we are watching something really big. And it might take a while to all come out.

  174. The Republican convention platform was changed to be less critical of the Russian invasion of Ukraine and more favorable to Russia right after this. I think there is certainly something to pursue in regard to a return of the favor. And if someone central to the Dem campaign was involved in something similar, they should face consequences for it. But Trump is our president, with the ability to return Russian buildings, readmit the expelled diplomats, damage the strength of NATO, and all sorts of other things. I think the immediate focus needs to be on whether the administration is indebted to Russia in any manner, including financially, and whether all of those with security clearances should actually possess those clearances. Again, the continual lying about every single thing is very suspect.

  175. I see what you’re both saying.

    The stock market, after dropping a little this morning with headlines relating the drop to DJT Jr.’s tweets, has returned to neutral, maybe slightly positive territory.

    It’s certainly not a great, or rational indicator, but it’s one reflection of how people feel about the current news that requires them to put their money behind their opinions.

  176. Milo why would the market drop if is looks like Trump’s on the way out? He’d be replaced by Pence who is not only business friendly but competent as well.

  177. Milo – I appreciate your willingness to engage and share your thinking. I feel so strongly in my own opinion (OMG!! Appalling! They are trying to destroy US!), but I really want to understand the other side. These are not the kinds of questions I can ask people IRL without risking offense, so thanks.

  178. Having any President leave before the end of a term is going to mess up the markets, even if the replacement is pro-business.

  179. I think it is entirely possible that Jr didn’t realize this is a no no. Manafort would certainly know, but the Trumps are used to kind of doing what they want without repercussions and aren’t well versed in this kind of stuff. Not that it changes the legal analysis at all. But I am not sure Jr was trying to hurt the US at all. Just HRC.

  180. OMG!! Appalling! They are trying to destroy US!

    They were trying to win. I can’t really fault them for that and I can’t really imagine either one saying no to the help if they knew they’d never get caught. My only issue is the same with Hillary it’s the incompetence that I take issue with.

  181. I mean we’re hiring these people to supervise the playing of three dimensional chess with Putin, Merkel, Xi Jinping, Kim Jong Un, etc. This level of idiocy is very disconcerting.

  182. Is that what Rhett’s referring to as incompetence? Like incompetence in not appreciating how email works with her private server, or incompetence in not realizing it could be a political issue, or incompetence in not just apologizing and taking responsibility when it first came out?

  183. What Hillary incompetence?

    If for convenience or to get around FOIA requests she had her staff set up an e-mail server at her house. She should have known better. Either don’t do it or do it in a way where you won’t be caught.

  184. Like incompetence in not appreciating how email works with her private server, or incompetence in not realizing it could be a political issue, or incompetence in not just apologizing and taking responsibility when it first came out?

    Exactly. Same for Trump. Meeting with the Russians, getting caught meeting with the Russians, trying to cover up meeting with the Russians.

  185. I totally agree on the incompetence, and I don’t necessarily think they are out to hurt the US (except maybe Bannon and his deconstruction of the administrative state), but I think they have little respect for democratic institutions, diplomacy, relations with our allies, and would willingly sacrifice any of those things if it meant earning a book personally or for their businesses.

  186. The WSJ finally just published their version of the story, and it’s interesting that the most popular comments are all very anti-Trump. Of course the comments are still streaming in, and the WSJ commenters have been oddly mixed on Trump all along.

  187. WSJ hates Trump. They were against him, and sided with more classic Republicans, during the election.

  188. “And I absolutely don’t get it — if I pay for some procedure out of pocket, even if it’s a procedure that the Medical Gods have decided shouldn’t be performed that much anymore, why is that detrimental to everyone else?”

    Perhaps the thought is that if you don’t get the mammogram, you don’t find your breast cancer early enough to warrant expensive treatment to keep you alive, the cost of which would be spread among others.

  189. “Children with mental illness, especially autism, are very expensive because so much of the treatment falls outside what is covered by medical insurance.”

    The care of such kids has much in common with the care of seniors who can no longer care for themselves. We’ve not really figured out how to take care of those seniors, so it’s no surprise that we haven’t figured out how to care for these kids either.

  190. “Medicare for all is single payer like they have in France.”

    I don’t know about France, but would expansion of our current Medicare model, which allows for purchasing of Medigap policies from various private insurers, be considered single payer?

  191. If single payer means we’re not allowed to purchase additional coverage beyond what the government provides, I’m absolutely opposed.

  192. “we’re not allowed to purchase additional coverage beyond what the government provides”

    I’ve never seen anyone suggest that; I couldn’t imagine how it would even be enforceable.

  193. “I could make a pretty good argument for Medicare for all.”

    I’ve pointed out before how, at least locally, Medicare (and Medicaid) patients have difficulty finding MDs willing to take them as patients because of low reimbursement rates, which many providers claim is below their costs.

    So I’m wondering what happens if everyone’s insurance reimbursement rate is too low to cover the providers’ costs. Something would have to give– maybe reimbursements go up, maybe some MDs go completely out of system (e.g., concierge medicine), maybe providers require all or most of their patients to have supplemental coverage?

  194. “maybe providers require all or most of their patients to have supplemental coverage?”

    That’s not legal now, though, is it?

  195. “I’ve never seen anyone suggest that; I couldn’t imagine how it would even be enforceable.”

    IOW, “single payer” is not really single payer?

  196. Rhett, from your prison link:

    “Even psychiatric patients who are actively being treated often get tangled up in the criminal justice system: in 2012, researchers reported that 12 percent of adult psychiatric patients receiving treatment in the San Diego county health system had been incarcerated; in 2013, 28 percent of Connecticut residents being treated for schizophrenia and bipolar disorder had been arrested or detained.”

    Not sure that simply tweaking the health insurance template to include more mental health coverage is going to solve the problem this article describes. Perhaps it was wishful thinking that persons suffering from serious mental illnesses could successfully be treated in community rather than institutional settings.

  197. “That’s not legal now, though, is it?”

    AFAIK, currently a lot of practices don’t take patients without coverage, or severely limit the number of such patients they take.

    I don’t see how it would be illegal to similarly only take patients with sufficient coverage to ensure reimbursements are not less than the cost of care.

  198. Perhaps it was wishful thinking that persons suffering from serious mental illnesses could successfully be treated in community rather than institutional settings.

    Is the key the force? My understanding is that if you get TB someone from the government will come to your house everyday and watch you take your pills. I’m sure such a system would work for sever mental health but we have an issue with forcefully medicating someone. Maybe if they agreed while of sound mind that would apply to them even when they aren’t of sound mind?

  199. Scarlett, I’ve read more than a few times about crimes committed by people being treated for mental illness who refused to take their meds, often victimizing random people.

  200. I don’t see how it would be illegal to similarly only take patients with sufficient coverage to ensure reimbursements are not less than the cost of care.

    If you want to take any government money it can apply. That’s how the EMTALA works. Any hospital that wants a dime of medicare or medicaid money has to treat every ED patient regardless of their ability to pay. If you want to go totally outside the system then you can do what you want. But if you want part of that government revenue stream you need to abide by their rules.

  201. “I’m sure such a system would work for sever mental health but we have an issue with forcefully medicating someone.”

    IMO, any such person who’s ever hurt someone else because of such a choice to not take meds should be incarcerated based on being an established threat to the public.

    It’s trickier for those who’ve not established themselves, through actions, as threats to the public.

  202. I’ve always been fascinated by how quickly we adopted the model for “lunatic asylums,” and how quickly we dissolved them.

  203. Physicians can discriminate based on any non-protected class. You can refuse to see smokers, but cannot refuse to see deaf patients. You can refuse to see certain insurance, or certain zip codes, but not refuse someone who doesn’t speak English. You can refuse to see people who have filed lawsuits.

    EDs (and by extension the docs who work there and the specialist who are contracted to take call) cannot refuse to see anyone on any grounds.That’s EMTALA. The ED can diagnose your Narcissistic Personality Disorder (well, not really) but cannot force anyone to see you in follow up.

  204. ” But if you want part of that government revenue stream you need to abide by their rules.”

    I don’t think that currently applies to Medicare and Medicaid. What I’ve heard is that practices will limit the number of Medicare/Medicaid patients they take, and consider that part of their charitable work for the community.

    If it were similarly made illegal for them to refuse Medicare/Medicaid patients because they’re getting government revenue, one logical response would be for those practices to not take any Medicare/Medicaid patients.

    For some practices with older MDs, another possible response would be to retire. I’ve read of MDs retiring rather than complying with mandates for electronic records. I’d guess that some private practice MDs might have closed their practices and moved to places like Kaiser to avoid complying with that mandate.

  205. We know several people who have adult children with schizophrenia, both of whom have, for long stretches of time, gone off their meds and cut off contact with their families. It is a nightmare, but one without an easy fix.

  206. “I’ve always been fascinated by how quickly we adopted the model for “lunatic asylums,” and how quickly we dissolved them.”

    Well, at a certain level, they were a logical, if imperfect, response to a real problem.

  207. Houston, I just finished The Year of Living Danishly by Helen Russell (published in 2015). Dane’s are taxed at 50 percent. That is how they pay for all the services that the government provides. They also seem to “trust” the government to do the right thing. Furthermore, most of them have used a government service or had a family member do so and understand how the programs work and how their money is used. They accept this as part of their national culture. The population is just under 6 million and 11 percent of that is immigrants. I think it is easier to share a culture if 89 percent of you have the same background,

    So Denmark has everything we complain about, free education, paid maternity and paternity leaves, free child care at six months, free healthcare, support if you lose your job or leave your partner (they have a high divorce rate). They seem to have modest homes and accept a number of “rules” on how to live. The price is that you pay 50 percent in taxes to have all that is needed. So we either accept that we all need to pay 50 percent in taxes or accept that all the services we “want” or think we are entitled to or to WCE’s point we need to be clear that certain programs cannot be funded.

  208. Kate, did you read the original article about Dream Hoarders that Brooks linked to? I’m not quite sure what to say about it.

  209. No. I will. My brain kind of shorted out with the Italian cold cuts/Mexican food thing.

  210. Used to Lurk,

    How much does the accounting matter? On paper taxes are lower and government is smaller in Singapore because everything is run through a complex system of mandatory savings. Germany runs its healthcare system through a series of highly regulated non-profit sickness funds. France runs the money trough the government. Is it materially different?

  211. Oh my. I don’t know any of the secret barre techniques. Does that mean I don’t live the rarified life that I thought I did? Or is David brooks crazy?

  212. From the book and each year they adjust the bottom level this is what she lists:

    Anyone who has an income less then 4,600 pounds or $7,800 pays no income tax. You pay 37 percent on earnings up to 50,000 pounds or $85,000 and then a 51.7 for anyone who makes above the last tier. In addition, everyone pays 8 percent social security tax. When you purchase goods, you pay a 25 percent VAT. Homeowners pay a property tax (she was renting so doesn’t list the percentage). Members of the Danish national church (most of the country) pay a separate levy. They also pay high taxes on cars, petrol and electricity to regulate consumption.

    It appears there is no way to hide earnings. It is based on what you make, own or consume. Since she was a writer, she did have to estimate her taxes and incidentally though she messed up the first year, you need to pay monthly so you don’t “skip” out and not pay – she received a hand delivered tax notice. If you’re employed by a corporation, the taxes are January to December. Everyone has a National ID card and that is how you are identified, do your banking, receive services etc.

  213. “Dream Hoarders” seems like a perfect fit for this group. Here is the link included in Brooks’ article https://www.brookings.edu/book/dream-hoarders/ and a quote from that link:

    “But Reeves defines the upper middle class as those whose incomes are in the top 20 percent of American society. Income isn’t the only way to measure a society, but in a market economy it is crucial because access to money generally determines who gets the best quality education, housing, health care, and other necessary goods and services.

    As Reeves shows, the growing separation between the upper middle class and everyone else can be seen in family structure, neighborhoods, attitudes, and lifestyle. Those at the top of the income ladder are becoming more effective at passing on their status to their children, reducing overall social mobility. The result is a fracturing of American society along class lines, not just an economic divide. Upper-middle-class children become upper-middle-class adults.”

    To begin with, the top 20% of income group is roughly $100K, which is comfortable but not UMC in many major metro areas. It’s the proverbial cop and nurse couple. You don’t need a college degree, let alone an elite degree, to get into this group.

    Second, wondering the extent to which “family structure” affects outcomes. Maybe you don’t need to know the secret code Brooks describes, but just need to finish high school, get married before having children, and stay married until your children are grown in order to keep your kids in the game.

    There is a silly interactive game in the brookings article, which asks you (among other things) to decide whether to make a donation to your alma mater to get your kid in. Never mind that, at our university at least, you need a donation of at least $1 million even to get your kid considered as a development admit, which puts you well into the top 1%, not the top 20%, of income.

  214. Those at the top of the income ladder are becoming more effective at passing on their status to their children, reducing overall social mobility.

    “Becoming more effective”. Cite? They were always effective at passing on their status.

  215. I suspect that it’s the characteristics that families with incomes over $100k tend to have and not the income itself that is the primary cause of the difference. Income redistribution won’t change the underlying family characteristics. We’ll understand more in another 3 decades.

  216. Oh man, RMS!

    No. Not family structure. Not money. Just knowing the diff between sopressata and capicola. Don’t be scared of the meats.

  217. “Those at the top of the income ladder are becoming more effective at passing on their status to their children, reducing overall social mobility.”

    Downward mobility is a good thing?

  218. need to know the secret code Brooks describes, but just need to finish high school, get married before having children, and stay married until your children are grown in order to keep your kids in the game.

    Remember J.D. Vance and Hillbilly Elergy in which he talked about growing up in a high conflict environment. Familial relarionships among the UMC are about calm and stability and deescalation (use your words). But if you’re poor and raised to believe that every slight requires escalating conflict, maintaining a stable relationship is much harder.

    I agree totally with your solution but you can’t dismiss how hard that solution is to implement for those who don’t live in a world that supports it.

  219. Finn, we can’t have mobility without the same percentage moving into the top quintile as moving out of it.

  220. Downward mobility is a good thing?

    Yes, we want the best engineers and doctors and researchers to rise to the top and those of more modest gifts to live comfortable lives in the middle. We don’t want a world in which there are so manny barriers for those not born at the top that well borne engineers of modest intellect rise to the top and those of far greater ability are artificially kept down.

  221. OK, so Reeves does define UMC as the top 20%, so for anyone to move up into it, someone has to move down out of it. Crabs in a bucket. Moving people up the economic ladder without them being any better off, just making those that had been above them worse off.

    That’s a great way to improve our country.

  222. That’s a great way to improve our country.

    It would be as the people with the most ability would be at the top not those that came from the best families. Overall productivity, wealth etc would be higher than it currently is and vastly higher than it would be if Brooks worst fears are realized.

  223. How does a person with mediocre abilities (including mediocre soft skills) stay in the UMC if his UMC parents cannot do more for him than SAT prep and travel soccer? If he’s truly in the lower quarter of the ability distribution, he will be lucky to finish at a directional college in five years and then will end up in a job that doesn’t even really require a college degree. He has just made room in the UMC for a striver like JD Vance.

    This is actually the UMC parent nightmare that drives the SAT prep and travel soccer. You can’t gild the path to the meritocratic elite on a $100K income, or even a $400K income. You need to have your own business empire in which to plant your kid of mediocre talents.

  224. Scarlett – I think that is an interesting puzzle – what would one actually do if one wanted to ensure a reasonable income for a compliant but not highly able child?

    If I thought one of my kids wouldn’t be able to make it into UMC due to ability, I suppose I would spend my energy and time on identifying and placing in an apprenticeship program – lineman school, electrician, plumber, general contractor. For a more stereotypically feminine job – RN, surg tech, Resp Therapist, postal worker. Not to say there aren’t terrifically smart people in these roles, but I think they are obtainable by the folks in the bottom quartile of ability, at least with some coaching. They are also fields that can yield 75k+ in income, which puts you into UMC (at least by my definition). Also – high end personal services – personal training, professional organizing come to mind – people often make >50/hr for these.

    Related, my cousin is interested in being a electrician (like his father and grandfather) but can’t pass the apprenticeship entry math exam. He graduated last year from an “alternative high school” The family did not over spend on SAT tutoring, or any other kind of tutoring, but they thought he had a brilliant career coming in sports and heavily invested time and money in that . Half a dozen surgeries later, he is not going to be a professional athlete of any kind. .

  225. ““Becoming more effective”. Cite? They were always effective at passing on their status.”

    The rich indeed have. But for the mere middle class/UMC, one thing that I would point out is the ignored side effect of the massive shift of this group into self-funded retirement plans. The media always focuses on how many people are ill-prepared for their retirement, having not saved enough. Few people pay attention to the many, many quiet middle class types who have amassed one or two million, or more. This is the money that is getting quietly passed down here and there to adult children in a way that didn’t happen when these parents were far more reliant on their pensions. I also think it’s a major contributor to the geographic nature of our political divide — those who get significant help from their parents are more likely to congregate into the high-COL, blue inner-ring suburbs that they otherwise could not practically afford. Of course, in so doing, they drive up the prices even further, effectively pulling up the bridge behind them. And they’re the ones who have never had any real exposure to working-class challenges or areas.

    Their counterparts of similar aptitudes, and even similar professions, but from working-class backgrounds and no parental support, are the ones who take a look at this:
    http://www.realtor.com/realestateandhomes-detail/29-N-Oakland-St_Arlington_VA_22203_M65288-56787

    and say “Oh hell no. I can’t afford that making $85k as a CPA. But I’ve heard Knoxville has been really up and coming:

    http://www.realtor.com/realestateandhomes-detail/8333-Bluestone-Ln_Knoxville_TN_37938_M82298-45535

    And they go to TN, along with their generally more conservative attitudes about self-reliance and so forth.

  226. Used to Lurk: The 50% tax model might be the way to go. I’m tired of worrying about healthcare!

  227. I think Dream Hoarders has a point. We all give our kids extra support, everything they need to be successful. They are all born on third base, vs kids in less supportive households.

  228. DH has donated to a boys/girls club in a small Texas town. This is a place for the kids to go when their parents won’t let them into the house. I was totally shocked that this was a thing, but it is.

  229. If he’s truly in the lower quarter of the ability distribution

    We’re taking more about the top quarter. With the right help hey can stay in the top 10% and someone with more ability but without all the prep is kept out.

  230. “But Reeves defines the upper middle class as those whose incomes are in the top 20 percent of American society.”

    This self-flagellation has gone too far. It seems reasonable to shit on the “UMC” ($100k? Really?) if you’re claiming that they constitute only the top fifth of the income distribution. But that’s ridiculous, because a far greater percentage of people than 20% spend their prime childrearing years in the top 20% (counter-intuitive though that may seem). Probably 40%. And easily more than 50% if you adjust for the value added of a SAHP.

    Mostly, this is all just a big criticism of people who are married before they have children and generally stay together or at least remain committed co-parents. And yes, having parents who do that is a big advantage. The conservatives have been saying that for 40 years. Now that you frame the same lesson as an attack on the UMC, the left is acknowledging reality.

  231. And they go to TN, along with their generally more conservative attitudes about self-reliance and so forth.

    Not to mention the worse job prospects driving other political concerns.

  232. Rhett – the unemployment rate for CPAs in Knoxville is rather low, I’d assume.

  233. Of course Dream Hoarders is correct. But so what? That is entirely rational behavior. Isn’t this why we need outside forces like government to redistribute income and wealth?

  234. This is the money that is getting quietly passed down here and there to adult children in a way that didn’t happen when these parents were far more reliant on their pensions.

    The timing doesn’t work unless you’re talking about the grandchildren. If you have your first kid at 30 they will be out of college when your’e 51. The IRA money won’t be available without penalty until you’re 59.5. If the parents are subsidizing the children, and many are, they are UMC and doing it out of current cash flow not MC doing it via their IRA.

  235. “they will be out of college when you’re 51.”

    I don’t think they’re buying these houses at 22, more like 30/35, which aligns well with your math.

    It’s not really about the specifics. The point is that changing from IBM pension system to IBM 401(k) matching, while allowing some to go recklessly underfunded, also gives others the opportunity to accumulate a lot more capital.

    I was also thinking of this in terms of Scarlett’s quote:
    “You need to have your own business empire in which to plant your kid of mediocre talents.”

    I’m not sure that you do. Certainly to hire him, but does it really matter if you have a $4M plumbing supply business, or $4M worth of VTSAX shares in terms of setting up your adult kids? In the first case, you may actually have to hire him and deal with all those associated issues; in the second, you can simply support him while he pursues his music or filmmaking passion.

  236. I also think that we forget that prior to the post WWII period how many high native ability diamonds in the rough there were with zero chance of entering the professional classes or even the white collar and pink collar middle class. In the immediate post war period opportunity expanded as the economy took off. For those who did not leave home and social class behind via education, there was also plenty of local paid work and local businesses to run. In the first 15 years it was most white men and their families, in the the 60s more opportunity for non white men, and in the 70s and beyond most new professional class slots were taken by women most of whom were already middle class. Add in the new wave of education-focused striving Asian immigrants starting in the mid 90s and there are plenty of reasons that the period of 1946 to maybe 1980 was an outlier in class mobility in this country.

  237. I read the article differently. My take was of course….all the policies that keep kids in mediocre/lousy schools are very effective at keeping those kids from competing with the kids from the UMC. My kids’ school is not an anomaly, it is business as usual for non totebaggy areas. There are lots of kids that will not be able to go to and do well at flagship university, let alone HSS university because they simply have not had access to adequate math, science, English or foreign language instruction. They have the cognitive ability and executive function, but they have not had adequate instruction.

    And, to develop and keep running a successful business requires a huge amount of energy, intelligence and executive function. The kid with mediocre talents is not likely to be able to keep such a concern going.

  238. you can simply support him while he pursues his music or filmmaking passion.

    I’m not sure film making is typical. Back in my day ™ the jobs with the most potential didn’t pay the most. An example today might be a startup that offers equity and rapid advancement potential vs. a higher paycheck stable job in a large company. With a financial backstop you can take more risk without worrying about ending up on the street.

  239. Everyone in Trump’s orbit is like a husband on Dateline who googled “undetectable poisons + wife” then bought a shovel with a credit card

    Chuckle…

  240. “does it really matter if you have a $4M plumbing supply business, or $4M worth of VTSAX shares in terms of setting up your adult kids?”

    Well, I was thinking of a higher-end business empire, in which the parents can afford to let Jr dabble in some money-losing but self-esteem-building corner, such as the family winery. Or send him to Las Vegas to learn the casino business.

  241. “If I thought one of my kids wouldn’t be able to make it into UMC due to ability, I suppose I would spend my energy and time on identifying and placing in an apprenticeship program – lineman school, electrician, plumber, general contractor.”

    And ironically, the typical UMC parents are not nearly as well-equipped to take this approach as the blue-collar workers who are already embedded in those trades.

    If I didn’t already have too many books in the queue, I’d like to read Dream Hoarders to see if the author confronts the inconvenient truth regarding family structure.

  242. inconvenient truth regarding family structure.

    Is anyone really arguing against the family structure idea? Or are they acknowledging how hard it is if, like J.D. Vance, it’s not something you grew up with?

  243. Is there anyone who doesn’t think a stable two-parent family with loving, involved parents is a huge advantage? I think what we often discuss is can/how we encourage this and what to do with those kids when we fail.

  244. Murphy Brown was dumb. She wasn’t an issue. Just like Sheryl Sandberg isn’t either.

  245. “Is there anyone who doesn’t think a stable two-parent family with loving, involved parents is a huge advantage?”

    Kate – This mundane quote would not have sparked a national controversy otherwise:

    “Bearing babies irresponsibly is simply wrong,” the vice president said. “Failing to support children one has fathered is wrong. We must be unequivocal about this. It doesn’t help matters when prime-time TV has Murphy Brown, a character who supposedly epitomizes today’s intelligent, highly paid professional woman, mocking the importance of fathers by bearing a child alone and calling it just another lifestyle choice.”

  246. a stable one parent family with a loving, involved parent is also a huge advantage

  247. Family size is an issue in addition to family structure. My summer babysitter’s family has 5 kids and her Dad is a dentist. She is considering becoming a dentist, too, and could probably join the family practice and work part-time while her kids are young. Baby sitter’s mom is nearby to help with childcare, though she may also be helping elderly parents. Not sure how many of the kids will join the family dental practice, but this is an example of how families can propagate status not purely by financial support.

    I think general contractors are typically top decile in IQ (including spatial). The contract we signed for our house remodel was well-written and our truss change conversation demonstrated better visualization skills than I have. (Contractor and Mr WCE mutually admire one another so far.) I was chatting with a tech the other day and observing how much he can do (remodel his kitchen, fix cars, fix woodburning stoves, installed code-compliant gas line for his kitchen remodel, reroof house, etc.) that isn’t part of traditional education but that requires aptitude to do without training. One person like him propagates/advises an extended family, in many cases.

  248. “a stable one parent family with a loving, involved parent is also a huge advantage”

    Yes, but in reality, that’s a lot less likely as children grow up becoming attached to, and then quickly separated from, the various romantic interests of their single parents.

  249. Right. The introducing kids to a series of romantic partners is part of the not stable bit.

  250. “I think general contractors are typically top decile in IQ”

    I would agree with this, at least re: the business owners. I remember walking around outside talking with the one who built our deck and screened porch, and he could do quick math calculations in his head just as easily as I could re: square footage of decking required, length of support posts for a certain grade, joist spacing and numbers required, roof angles…

  251. From the WaPo link Milo provided:

    “In later research, Ron Haskins and I learned that if individuals do just three things — finish high school, work full time and marry before they have children — their chances of being poor drop from 15 percent to 2 percent. Mitt Romney has cited this research on the campaign trail, but these issues transcend presidential politics. Stronger public support for single-parent families — such as subsidies or tax credits for child care, and the earned-income tax credit — is needed, but no government program is likely to reduce child poverty as much as bringing back marriage as the preferable way of raising children.

    The government has a limited role to play. It can support local programs and nonprofit organizations working to reduce early, unwed childbearing through teen-pregnancy prevention efforts, family planning, greater opportunities for disadvantaged youth or programs to encourage responsible relationships.

    But in the end, Dan Quayle was right. Unless the media, parents and other influential leaders celebrate marriage as the best environment for raising children, the new trend — bringing up baby alone — may be irreversible.”

    To answer the question Rhett and Kate posed, I think that the media and popular culture are so invested in the “families come in all shapes and sizes” meme that they can’t bring themselves to admit the truth that children raised by their mother and father have a huge advantage over those coming from the other “shapes and sizes” households.

  252. Scarlett,

    I think you may be missing the economics of it all. Many of these women don’t marry because if you’re a 10th percentile women your choices are typically limited to 10th percentile man and a 10th percentile man is far less likely to be able to earn an adequate living than in the past. As such, they are perceived as being just another mouth to feed. I think it’s wrong for you to totally dismiss the impact of skills based technological change and globalization on why these women aren’t getting and/or staying married.

  253. Rhett – If it were limited to the 10th percentile, you might have a point. We’re up to talking about the 40th percentile.

  254. Rhett,
    I’m not dismissing those realities. It’s also true that if your mother and grandmother were single moms and, in your world, two-parent families are outliers, you’re not going to have the same attitude towards marriage as a Totebagger would have. But my point is that these young people don’t even ASPIRE to marriage, and our popular culture enables their low aspirations by failing to encourage them, for example, to consider sexual activity as something best suited to the married state.

  255. We’re up to talking about the 40th percentile.

    OK – has their been any change in the earning potential of men in the 40th percentile over the past 30 years?

  256. sexual activity as something best suited to the married state.

    Or is it more realistic to encourage the responsible use of birth control until such time as one’s relationship and financial status is conducive to having children?

  257. “men in the 40th percentile over the past 30 years?”

    Military is definitely doing better over the past 30 years — they’ve never had it so good. Police, fire..same or better. Skilled trades (HVAC, welder, electrician, plumber) same or better.

  258. Skilled trades (HVAC, welder, electrician, plumber) same or better.

    Is that true? I don’t believe it is but if you have something that shows it to be true, I’ll take a gander.

  259. Rhett, half of all pregnancies are still unintended. That figure hasn’t really budged too much despite free birth control and

  260. Rhett – This isn’t sarcastic…do you have something to suggest that it’s not true?

    I think these guys are doing fine. They come to our house during the day and they end up exchanging tips with DW about their planned Disney World vacations with the kids. And we know those have gotten way more expensive.

    The DH of a friend of DW’s from college never graduated, but instead went to work for a national auto body repair chain. The woman is a SAHM (may go back to teaching at some point), they’ve got a little house in the suburbs, two kids in parochial school, a new RV…

  261. That figure hasn’t really budged too much despite free birth control and

    So maybe we should encourage it more like we did with smoking prevention or seatbelt use.

  262. do you have something to suggest that it’s not true?

    The influx of illegals doing that sort of work driving down wages?

  263. I don’t think too many illegals are doing the skilled trades. They might put up drywall, or do general labor around the site, but working as an actual electrician?

  264. Milo,

    Median electrician pay in 1983 was $22,048 or $55,172 adjusted for inflation. Median electrician pay in 2016 was $51,125.

  265. It’s hardly a reason to forego marriage and rear children alone. To the contrary, in fact.

  266. “The influx of illegals doing that sort of work driving down wages?”

    So Trump is right?

  267. It’s hardly a reason to forego marriage and rear children alone.

    It’s sort of like you being surprised that 25% of people can’t pass the join the military in any capacity. There are levels below that of HVAC technician.

  268. Milo,

    Would you at least agree that the less the other party is bringing to the table the less incentive to stay in the relationship? Note that nurse income went from $50k to $67k. For an electrician/nurse couple she needs him less economically and he’s bringing less to the table. At the margin that would influence people’s decisions would it not?

  269. yes, but we’re supposed to be talking about the 40%.

    Besides, I don’t think you have to be all that high in cognitive ability to do basic automotive body work.

    You’re obsessed with the idea that cognitive ability is the main sorting mechanism. At the same time, you’re quick to point out that it doesn’t take all that much of it to be a very high earner, and I agree. But the major sorting mechanism is simply the diligence to show up to work, on time, day after day, and maybe be willing to learn a couple of skills.

  270. Rhett,
    Instead of encouraging more young women to pump hormones into their body, perhaps we should be encouraging both men and women to consider, before engaging in sexual activity, whether they are prepared to parent a child with their partner. That would better reflect the reality.

  271. ” Note that nurse income went from $50k to $67k. For an electrician/nurse couple she needs him less economically and he’s bringing less to the table.”

    Yes, it’s certainly true that she’s less dependent on him, and I agree that that aspect encourages single parenthood, whether through divorce or never marrying in the first place.

    On the other hand, if they do get married and stick it out, then $117k combined household income, plus shared parenting and household labor, is a hell of a lot better than $67k. The only downside is that they now have to endure near-daily attacks by newspaper columnists and other navel gazers that *THEY* are the ones, smug as they are with their top 20% income and decent suburban schools, who are responsible for everything that’s wrong with America.

  272. Speaking of nurses who earn $67k (and who, in this case, happen to be in a program to become an NP), I wish I could tell you about someone in my family here who is married to that woman. It would be a huge blessing if he were earning that median electrician wage. He’s not, and I’m worried that it’s going to become a bigger issue for them than DW thinks it would.

    July, if you read this comment, just delete it, please.

  273. Scarlett – how would we do that? It didn’t really work for my circle of friends.

  274. On the other hand, if they do get married and stick it out, then $117k combined household income, plus shared parenting and household labor, is a hell of a lot better than $67k.

    Oh I agree. I don’t really understand those who don’t get or stay together. I think if we looked into it we would find that they object to the premium totebaggers put on financials/practical aspects of a relationship. But, I really have no insight.

    The only downside is that they now have to endure near-daily attacks by newspaper columnists and other navel gazers that *THEY* are the ones, smug as they are with their top 20% income and decent suburban schools, who are responsible for everything that’s wrong with America.

    You’re misreading it. They are trying to explain the issues the kids have moving up. None of us disagree those kids have a harder time of it.

  275. That 1/2 of all pregnancies are unintended figure includes married couples. I know many married couples who were surprised by a pregnancy, including one where the husband was demanding his wife have an abortion. I know more where it was unintended only by the husband, whose wishes were disregarded. I also know single women who got pregnant intentionally. So it’s not simply a matter of abstaining from sex prior to marriage. I love my DH and was fully prepared to raise children with him. I was not fully prepared to raise 10 children with him, so bring on the hormones. Obviously, I would was getting them even when I had to pay for them, but I’m in a position where it’s easy to get off work for appointments and to afford the cost. I’m interested to see the results of Oregon’s switch to OTC availability 5 years down the road.

  276. “I’m interested to see the results of Oregon’s switch to OTC availability 5 years down the road.”

    I’m a big fan of this, and look forward to the results, too.

  277. Once I was of the age where I wanted to become pregnant, I remember thinking back about the sex education I received and thinking, “Liars. It is a lot harder to get pregnant than what they told us.” They just tried to scare us in to abstinence. Which didn’t work.

  278. And healthy fertile women under the age of 30 or 35 can get pregnant fairly easily.

    By definition, in fact, if they’re fertile. It’s the ones who aren’t who have the trouble.

  279. Most women ARE fertile.

    “One study, published in Obstetrics & Gynecology in 2004 and headed by David Dunson (now of Duke University), examined the chances of pregnancy among 770 European women. It found that with sex at least twice a week, 82 percent of 35-to-39-year-old women conceive within a year, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their late 20s and early 30s was almost identical—news in and of itself.)”https://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/

  280. Unmarried parents in the Murphy Brown mold (older, financially secure, badly wanting children, but, for one reason or another, have not found the right partner) can give children a highly stable, privileged, upper middle class life. Such children have much better life chances than children born unintentionally to hapless young people in casual relationships. Indeed, they arguable have better chances than children born to unhappily married parents who later divorce (depending on the circumstances of the divorce and the parents’ conduct in connection with it).

  281. Unfortunately, the people who hear the message that it’s a perfectly fine idea to have kids without first being married are never briefed on the class/education/financial security qualifier.

  282. Unfortunately, the people who hear the message that it’s a perfectly fine idea to have kids without first being married are never briefed on the class/education/financial security qualifier.

    Hell, they don’t even know what sopressata is.

  283. Slightly defensively, I will claim that since Risley’s kids and my stepson turned out admirably, divorce (while not great, and always best avoided) is not fatal to kids as long as the dads remain very involved.

  284. It’s not really divorce that’s the issue. It’s the never having a dad involved at all, or not even trying to avoid divorce, or serial divorces, or just serial boyfriends in and out of the kids’ lives.

    Divorce is probably like preschool. If you’re conscientious enough to even worry about it, it doesn’t matter.

  285. “The contract we signed for our house remodel”

    Did you recently pull the trigger? If so, congrats and good luck!!

  286. “Stronger public support for single-parent families — such as subsidies or tax credits for child care, and the earned-income tax credit — is needed”

    OTOH, doesn’t this sort of government subsidization provide a financial disincentive to marriage?

  287. I really wish Science would come up with some sort of long-term, reversible birth control for men. I think that would cut down on unintended pregnancies a lot, since I suspect (admittedly with no evidence to back me up) that there are more women in uncommitted relationships who would be OK with having a child than there are men in uncommitted relationships who would be OK with having a child.

  288. “the ignored side effect of the massive shift of this group into self-funded retirement plans.”

    Which itself was a side effect of an interpretation of GAAP.

  289. “The government has a limited role to play. It can support local programs and nonprofit organizations working to reduce early, unwed childbearing through teen-pregnancy prevention efforts, family planning, greater opportunities for disadvantaged youth or programs to encourage responsible relationships.”

    It can also get out of the way of responsible decisions to not have kids.

  290. It doesn’t really matter, but I sincerely doubt the statistics on “unintended pregnancies” among married couples. It’s a good thing, actually, but I remember so many people making pregnancy announcements, and they’re so thrilled but they add “And we WEREN’T EVEN TRYING!!”

  291. Thanks, Finn. I think we are lucky to have a well-regarded contractor near our house agree to our project (which includes family room over garage) during the dry season in part because he wants to be near his new baby, due end of July. Remodeling contractors are pretty booked up here now and he could probably get a better dry season project if he wanted.

  292. “we can’t have mobility without the same percentage moving into the top quintile as moving out of it.”

    When Milo retires early and suppresses his investment income until he is eligible for Medicare, that will allow someone else to become UMC.

  293. “When Milo retires early and suppresses his investment income until he is eligible for Medicare, that will allow someone else to become UMC.”

    LOL! That’s technically true. But then when I reach the age of required minimum distributions, I’m going to knock that person right back down, so tell him not to get too accustomed to living high on the hog.

  294. Just musing… Let’s consider the possibility that Milo’s (and his DW’s) retirement accounts are all Roth IRAs and Roth 401ks, and his cash flow to cover his spending comes from a combination of Social Security and withdrawals from their Roth accounts, and his investments are generating minimal income (i.e., growth primarily through increase in value).

    The max Social Security income they could get is somewhere around $70k/year.

    Would that allow another family to take their place in the UMC even after he becomes eligible for Medicare?

  295. ” But then when I reach the age of required minimum distributions, I’m going to knock that person right back down”

    Or perhaps, someone else similarly decides to retire early just when you start taking RMDs.

    Or you could convert your IRAs and 401ks to Roths, putting you into the UMC while you do that, then back out once you’ve completed the conversions.

    Of course, this musing is all pointing out the folly of using income as the sole determinant of UMC.

  296. I suppose it would, but
    1) We didn’t take advantage of Roths when we coulda/shoulda, so most is in regular 401(k)s. I could do conversions, but it’s not such a great deal now, and I’ve always thought that it would make more sense to do that if/when DW is not working, which hasn’t happened. Or maybe I’ll spend my early retired years doing some conversions. It just depends on the situation, and health care policies, etc.
    2) By the time we’re eligible for Medicare, DW’s parents may no longer be with us, and with that inheritance, suppressing investment income to levels that would make us middle class would either be impossible or counterproductive.

  297. Milo — If you’re going to suppress your income enough to qualify for subsidized health insurance in your pre-Medicare years, how are you going to afford gas/maintenance/repairs on the boat when you’re touring around? And is Mrs. Milo on board (no pun intended) with the idea of 10-12 years of low-income boating, or is she going to need some convincing? :)

  298. NoB – I’d have to look at costs. On an efficient, single-diesel-engine trawler, doing the Loop slowly over a year you might only spend $6k or $8k on diesel. You can spend that on a week at Disney. With a new, or new’ish boat, there shouldn’t be much in the way of repairs. Some regular maintenance, like filter and water pump changes, but I can do that myself, or it’s not that much, anyway.

    We’ll have to see how DW is that point. She’s been getting a little more spendy lately :), esp. with the kids gone and work has been light for her. Too much time for going to the mall. What’s worse, our rich friends (the ortho surgeon and part-time NP) have a youngest child the same age as my youngest, i.e., both going to K in the Fall. Rich friend told DW that she wants to set up weekly lunch appointments with her on (I guess one of) her days off. Ugh. :)

    DW is just happy to finally have a friend, so I guess that’s worth it.

  299. “Of course, this musing is all pointing out the folly of using income as the sole determinant of UMC.”

    That’s one, but I think the greater folly is relying on relative comparisons to determine overall economic wellbeing. The old obsession with “inequality.”

  300. Interesting bedside reading:

    “According to our member submissions, a newly christened Gold Looper averaging under $2.50 per gallon completed the Loop for a diesel cost less than $30,000. That’s an enormous dollar amount, you say–what gives? Well, that’s the cost for a twin engine kraken-sized giant, near 700 in horsepower and 60 feet in length.

    But that high dollar amount proves the top end of Looping fuel costs under 30k. In the bygone days of $5 diesel gallons, you could reach 30k per Loop, but no longer.

    Today, your average Looper–on a comfortable, decently-equipped boat ranging from 25′ to 45′–will likely spend less than $10,000 on fuel, including on-board generator consumption. Many Gold Loopers in recent years spent approximately a dollar per mile on the 5,500 mile cruise.

    Recently submitted diesel numbers averaged from $1.72 to $3.87 per gallon, while totaling $3,700 to $10,500 per Loop. These submitted numbers were for a variety of single-engine boat makes, mostly tugs and trawlers, such as 40′ Pilgrim, 34′ Marine Trader, 36′ Grand Banks, 39′ Nordic Tug and 32′ Grand Banks, to name a few. Even a diesel, twin-engine, forty-two foot trawler averaging $3 per gallon Looped for under $11,000 total in fuel cost. “

  301. “It doesn’t really matter, but I sincerely doubt the statistics on “unintended pregnancies” among married couples.”

    That was my thought as well, but Guttmacher addresses that issue:

    “An unintended pregnancy is one that was either mistimed or unwanted (45% of all pregnancies). If a woman did not want to become pregnant at the time the pregnancy occurred, but did want to become pregnant at some point in the future, the pregnancy is considered mistimed (27% of pregnancies). If a woman did not want to become pregnant then or at any time in the future, the pregnancy is considered unwanted (18% of pregnancies).

    An intended pregnancy is one that was desired at the time it occurred or sooner. When calculating unintended pregnancy rates, women who were indifferent about becoming pregnant are counted with women who had intended pregnancies, so that the unintended pregnancy rate only includes pregnancies that are unambiguously unintended.”
    https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states

  302. RMS – divorces where the dad sticks around and contributes significant time and money aren’t all what I am thinking are not stable. It isn’t even within the same realm.

  303. “will likely spend less than $10,000 on fuel, including on-board generator consumption.”

    Does it make sense to add some PV to the boat to offset some of the diesel consumption?

    I suppose that depends in large part on how often you use the boat.

  304. “Or maybe I’ll spend my early retired years doing some conversions.”

    That’s sort of what I plan to do. I’ll do some conversions early in retirement, but I won’t spend my years just doing that.

  305. “Does it make sense to add some PV to the boat to offset some of the diesel consumption?”

    Some people have it to keep the batteries topped off. Especially sailboats. But a powerboat can easily charge the batteries when running, just like a car does. And batteries aren’t going to run A/C, so for that you’re either on shore power or the generator.

  306. Unintended pregnancies are going down! I attribute this to long acting contraception (IUDs among others).

    We were actively preventing pregnancy (just not effectively) when I got pregnant with my third. As WCE (I believe) said once, “this is what 2% failure times x years looks like.”

    I know two physicians who have had pregnancies post surgical sterilization. This is huge when you consider that there are really very few people whose gonads’ surgical status come up in every day conversation. I would guess there are 1-2 more professional acquaintances who have had similar events but terminated the pregnancy, so have not heard about it.

  307. WCE,
    Interesting that the Justice department staffer in charge of this issue is both herself a sexual assault survivor and an attorney who represented sexual assault victims.

  308. Oh, come on, you both know perfectly well that “popular” doesn’t mean “good”.

  309. Is the National Review also crying about the lack of tenured professors these days? Because this is what tenure is for.

  310. Did any you see Michelle Obama at the ESPYs last night. Eunice Kennedy Shriver received a video tribute (her kids got the posthumous trophy) for establishing the Special Olympics. The former FLOTUS was eloquent in narrating the tribute, well received by the crowd, and gorgeous. She wore an amazing dress.

  311. Good description of non-single payer healthcare in Netherlands

    In the Netherlands, insurance is considered a social service, and it’s much more heavily regulated than in the United States. People are required to buy insurance, just like under Obamacare, and so less than 1 percent of the population is uninsured. (The Senate bill would eliminate the individual mandate.) Premiums are funded in part through payroll taxes and in part through subsidies that much of the population receives, according to a 2009 paper by Washington and Lee University law professor Timothy Jost. The list of essential benefits is generous and also regulated by the government. Rather than allow insurers to pick only the healthiest customers to insure, the Dutch government redistributes the risk among insurers by making those with healthier risk pools pay into a pot of money that other, less fortunate insurers can draw from.

    Dutch people all pay a deductible of around $500, and unlike in the United States, providers there aren’t allowed to balance bill if insurance doesn’t fully cover their services. What’s more, primary-care doctors provide after-hours care, which helps explain why 77 percent of Dutch people say they “saw a doctor or nurse on the same or next day the last time they needed medical care.”

    from
    https://www.theatlantic.com/health/archive/2017/07/us-worst-health-care-commonwealth-2017-report/533634/

  312. I’m still unclear about what US politicians mean when they talk about single payer healthcare. Do they mean it will be illegal for anyone other than government to provide health insurance?

  313. In this country, Medicare is essentially a single payer system that allows supplemental insurance policies.

  314. The Netherlands has a first rate healthcare system. It isn’t truly single payer or fully private, rather it is a mix. I think they have a government run insurance system, sort of like Canada’s, for catastrophic coverage and then mandatory private insurance for other healthcare costs. The German system, also first rate, is based entirely on private non-profit insurance plans. Both countries heavily regulate the plans that are offered, as does Switzerland, a country that for some strange reason is sometimes held up by conservatives as an example.

    One of the mistakes liberals make is assuming that all other countries with good healthcare are using single payer systems. They aren’t – there are lots of models.
    One of the mistakes conservatives make is ignoring the commonalities in all those models, commonalities that make those disparate systems work: mandatory coverage, price controls, and heavy regulation of insurance plans.

    I listened to a great podcast today – a discussion between Ezra Klein and Avik Roy, who is a conservative health wonk. Ezra Klein’s site Vox is one of the few news outlets that pays serious attention to healtcare issues. If you want a deep digdown into healthcare policy, take a listen
    https://www.stitcher.com/podcast/vox/the-ezra-klein-show/e/50669199

  315. The German system, also first rate, is based entirely on private non-profit insurance plans.

    This is huge point – non-profit. I still think the best solution is having insurance companies that are cooperatives rather than corporations.

  316. Cooperatives are a not-uncommon model for rural utilities. We have some for electricity and water, as I recall.

  317. “even countries like Canada with true single payer systems do not prohibit supplemental insurance.”

    Thanks for the explanation.

    It still seems inaccurate and confusing to describe a system that has supplemental insurance that would result in payments from more than one payer to be described as single payer.

  318. Microsoft stopped supporting my Windows cell phone so I should probably replace it before I wind up SOL. I want an Android(?) phone that gets decent reception with a mediocre signal that I can talk on and hear/be heard fine. Battery life is a moderate priority. (Replaceable battery desired.) I send about 10 texts/month. I use no apps, because I’ve had a Windows phone for which no apps are available. I occasionally look things up on the web and use driving directions.

    I am cheap- refurbished would be fine- and there is a good chance I will lose this phone because I am scatterbrained.

    Any advice? Everything looks sort of the same. I had an iPhone once and didn’t care for it.

  319. Finn, I think the tight regulation is more important. Non-profits can be as corrupt as for-profits

  320. I love my Android phones. I tend to prefer a barebones Android without a heavy third party layer, so I use a Droid Turbo2, which has amazing battery life and good ability to find signals. My husband has a Samsung but I don’t like it as much – less battery life and too much Samsungy stuff on top. My oldest son also has a Droid Turbo, which he abuses as teens will, but it still works

  321. My iPhone died by being dropped into a toilet so some level of waterproofness might be good too.

  322. “I send about 10 texts/month.”

    Really? I sent more than that per day. Wow.

  323. My phone doesn’t work reliably in my building at work so I’m not in the habit of trying to use it. I’m an e-mail person.

  324. WCE, are you locked into a service plan?

    If you, I suggest that rather than look for a phone now, you first take a look at various plans and providers and find one appropriate for you, then look for a phone that works with that plan.

    So we know you send about 10 texts/month. How many do you receive? We also know you don’t use a lot of data. How much talk time do you use?

    Rather than limit yourself to phones with replaceable batteries, I suggest you consider getting a power bank, whether you get a phone with replaceable batteries or not, given your history of inconsistent charging. An extra cable to keep at work so you can charge your phone there would also help mitigate the impact of your inconsistent charging.

    DW and I have gotten several power banks for free at trade shows; I imagine you or Mr. WCE may already have some, or could get one that way.

  325. Oops, that should be: If not, I suggest that rather than look for a phone now . . .

  326. I receive ~30 texts/month. Mr WCE and I share a family plan and he’s not enthusiastic about shopping/considering another provider. Providers claim to provide service here but in reality, the service may be poor and I don’t have interest/bandwidth to figure that out- part of why I’ve been on here so much this weekend is that I have a feverish, teething toddler and have been holding her pretty much all weekend. Phone shopping is one of the few activities that fits with that obligation.

    I use less than 100 min/month of talk time on average but had issue with my 500 min/month plan several years ago when I had to spend hours on the phone with insurance for months, so I care moderately about talk time.

    I already keep a cable in my purse so I can charge my phone at work when I forget to charge it at home. I should probably either buy a powerbank or snag one of Mr WCE’s.

  327. WE, if you don’t remember to charge it regularmy, I’m not sure how you’ll remember to charge and take a spare battery. I’m not sure a power pack will help becuase you’ll need to rember to keep that charged and bring it with you. But i dont see why you have a problem as long as you have a charger in your purse and a car charger in the car. That should cover you everywhere.

    As for providers, check rootmetrics.com. They have independent ratings for all of the carriers pretty much everywhere.

  328. Thanks for the rootmetrics suggestion.

    The power pack would help because when I drive places where the cell signal is intermittent and have driving directions on, that drains the battery super-fast. But since I don’t often do that, I usually just print directions in advance rather than have the phone on.

  329. Use one that plugs into the outlet, not the usb port. It charges much faster.

  330. My Buick only has a cigarette lighter, not a USB port. I haven’t noticed what the minivan with the USB port does in terms of charging speed.

  331. Right, but Denver Dad means get an adapter for the cigarette lighter and plug the charging cable into that. Do that in both cars. Ignore the USB port in the newer car. The phone will charge much faster when the cable is plugged into the adapter in the lighter. I find this to be true too.

  332. Good to know about the cigarette lighter vs. the USB port. On rootmetrics, the places I spend time either have no information or mostly have 2G/3G data and/or slow rates, which is probably why I don’t use much data on my phone. :) Thanks for referring me there.

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