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Trump: Failure of Health Care Bill Is All Democrats’ Fault

Mother Jones

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It’s laughable watching President Trump whine endlessly this afternoon about how his health care bill didn’t get any Democratic votes. Not one! The Democrats just wouldn’t work with him to craft a bill! Boy, that sure makes things tough.

Needless to say, neither Trump nor Paul Ryan ever tried to bring Democrats into this bill. It was purely a Republican plan from the start, and neither of them wanted any Democratic input. That’s just the opposite of Obamacare, where Democrats tried mightily to get Republican buy-in, and still ended up getting no Republican votes in the end. Not one!

Anyway, Trump’s plan now is to wait for Obamacare to implode and then Democrats will have to do a deal. I guess it hasn’t occurred to him that he could do a deal with Democrats right now if he were really serious about fixing health care. But no. Trump says he intends to move on to tax reform, because that’s something he actually cares about.

In the meantime, it’s very unclear what will happen to Obamacare. With so much uncertainty surrounding it, it’s hard to say how insurance companies will respond. They might give up and pull out. Or they might stick it out and wait. It’s pretty close to a profitable business now, so there’s probably no urgency one way or the other for most of them. And anyway, somewhere there’s an equilibrium. Having only one insurer in a particular county might be bad for residents of that county, but it’s great for the insurer: they can raise their prices with no worries. There are no competitors to steal their business, and the federal subsidies mean that customers on the exchanges won’t see much of a change even if prices go up. In places where they have these mini-monopolies, Obamacare should be a nice money spinner.

April will be a key month, as insurers begin to announce their plans for 2018. We’ll see what happens.

POSTSCRIPT: It was also amusing to hear Trump say that he learned a lot during this process about “arcane” procedures in the House and Senate. Like what? Filibusters? Having to persuade people to vote for your bill? The fact that the opposition party isn’t going to give you any votes for a bill that destroys one of their signature achievements? Reconciliation and the Byrd rule? I believe him when he says this was all new to him, which means he never had the slightest clue what was in this bill or how it was going to pass.

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Trump: Failure of Health Care Bill Is All Democrats’ Fault

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Obamacare Repeal Is Dead

Mother Jones

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Well, that’s it. Obamacare repeal has failed. The House will not vote on the Republican health care bill.

So what’s next? The first thing, of course, is for Trump to insist that he bears no blame for this. Possible candidates for being thrown under the bus include Paul Ryan, the Freedom Caucus, Democrats, Obama, and illegal immigration.

But what’s next after that? This is the depressing part. From a partisan perspective, I imagine the best bet is to sabotage Obamacare as much as possible and wait for it to fail. Then Trump can say that he was right all along (isn’t he always?) and now we really have to do something.

But there’s also the perspective of what’s best for the country. If Obamacare repeal can’t pass, the best bet is to work on making Obamacare better. This could be done fairly easily, since it’s mostly tweaks that are needed. There are even deals to be made here. Democrats would probably be willing to give Republicans some things they want (tort reform, expanded HSAs, etc.) in return for modest changes that would make Obamacare more stable (higher penalties, tweaks to the subsidies, funding the risk corridors, etc.).

But that’s a fantasy. There’s little chance of anyone in Congress these days working across the aisle to do what’s best for the country.

UPDATE: And the winner is…Democrats!

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Obamacare Repeal Is Dead

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The Crazy Theory About Smog That’s Gaining Ground in the White House

Mother Jones

This story was originally published by The New Republic and is reproduced here as part of the Climate Desk collaboration.

It was known as the Great Pea Soup. In 1952, a thick, greenish-yellow fog smothered London, halting traffic and daily life. At the time, when households burned cheap coal for heat, factories spewed unregulated smoke, and buses burned diesel fuel, Londoners were used to a certain degree of greasy haze. But the Great Smog or Big Smoke, as this 1952 pea-souper was also known, was unprecedented. Bitterly cold air “soaked up the pollution and held it like a blanket over the city” for four days straight, according to the Daily Mail. Twelve thousand people died.

Sixty-five years later, our scientific understanding of air pollution has advanced immeasurably. We now know—because of events like the Great Pea Soup, but also a groundbreaking 1993 Harvard University study of smog-ridden U.S. cities and countless research papers since then—that short-term and long-term exposure to air pollution can kill people, particularly those with pre-existing conditions. “The evidence is so large,” said C. Arden Pope, a professor at Brigham Young University world-renowned researcher of air pollution’s impacts on human health. “There are very few people conducting this research and publishing it in the peer-reviewed literature who don’t think fine particles pollution can lead to death.”

There are, indeed, very few people who believe air pollution—specifically “fine particulate” pollution, or PM2.5—doesn’t cause death. Those who do, however, are getting louder and gaining influence in conservative political circles and inside President Donald Trump’s administration. These air-pollution deniers have just one hope: the repeal of clean-air regulations that have long protected Americans’ health.

At last month’s Conservative Political Action Conference (CPAC), during a little-noticed panel on climate change and environmental regulation, air pollution denial was rampant and went unchallenged. Steve Milloy, formerly a paid flack for the tobacco and fossil fuel industries and member of Trump’s Environmental Protection Agency transition team, argued that excessive air pollution is not linked to premature death. “My particular interest is air pollution,” Milloy said, alleging that EPA’s scientists are inherently biased. “These people validate and rubber-stamp the EPA’s conclusion that air pollution kills people.” Milloy also said, baselessly, that EPA scientists are “paying for the science it wants,” and that Trump must change the research process at the agency.

It is extensively proven, and widely accepted, that air pollution can harm humans, which is why the government regulates it. PM2.5 refers to tiny particles that are 2.5 micrometers or less in diameter—small enough to penetrate deep into the circulatory system and potentially infiltrate the central nervous system. The particles range in composition, originating anywhere from cement dust to tobacco smoke to pollen. They are currently regulated under the Clean Air Act, a widely popular law passed in 1963 that has seen major amendments receiving unanimous or overwhelming support in the Senate. The CAA currently requires Congress to set what’s known as National Ambient Air Quality Standards for particulate matter.

Even Breitbart, the alt-right media organization with close ties to Trump, seems to accept that air pollution is bad for human health. It has published dozens of articles over the years—many from wire services, but some from its own contributors—that report, without opinion, about studies on the issue. “The chronic problem of pollution in China has been linked to hundreds of thousands of premature deaths,” Thomas D. Williams, Breitbart‘s Rome bureau chief, wrote in 2015. “The fine particles are believed to play a role in cardiovascular disease, lung problems, cancer, and emphysema.” Earlier this month, Breitbart senior editor-at-large Joel B. Pollack reported, “Air quality in some East Asian capitals is famously poor, with residents of Beijing taking extreme measures to avoid the health risks associated with heavy pollution.”

But Breitbart has also provided a platform for those leading the charge for air pollution denial. Last year, it published a column by Milloy titled, “How stupid is air pollution ‘science’?” And earlier this month, Breitbart columnist James Delingpole—who usually sticks to columns attacking climate science—joined the fray. In an article declaring that “The EPA’s Air Pollution Scare Is Just Another Fake News Myth,” Delingpole took issue with the most recent State of Global Air report, which found that air pollution contributed to 4.2 million deaths in 2015, because the study was partly funded by the EPA—while conveniently ignoring that it was also funded by 23 car companies and Exxon Mobil. Delingpole cited Milloy exclusively and extensively, linking to Milloy’s “fact sheet” on air pollution.

“Frankly, it’s full of stuff and nonsense,” said Janice Nolen, the assistant vice president of national policy at the American Lung Association, referring to Milloy’s fact sheet. “Particle pollution is one of the most researched topics in the scientific world, and has been reviewed extensively.”

There are pages of false claims in Milloy’s sheet, but a few are particularly egregious. He argues that two renowned air pollution studies that established the basic connection between PM2.5 and death—the aforementioned Harvard study and one by Pope, the BYU professor—have controversial methodologies that cannot be resolved because scientists refuse to make the raw data available. “For results to be considered to be scientifically credible, they must be capable of being independently replicated,” Milloy writes. This claim is the basis of a Republican-led bill currently being pushed through the House of Representatives.

There are several problems with this line of argument. The raw data Milloy seeks is private medical information on human subjects who were assured confidentiality when they participated in these studies. “There’s this issue if this data becomes public, will anyone be able to go and knock on these people’s doors?” said Marianthi-Anna Kioumourtzoglou, an environmental health professor at Columbia University. Long-term health data is also difficult to reproduce because the people who participated in the study have grown up; many likely have died. This is why, scientists say, many public health studies simply can’t be replicated. (The Harvard study, however, was successfully replicated in 2001 by the Health Effects Institute, which is funded by EPA, the motor vehicle industry, and the oil and gas industry. A similar reanalysis was published in 2005.)

Milloy and Delingpole also claim that “not one single” epidemiological or toxicological study has ever shown that particulate pollution directly caused a death, either in the short term or due to prolonged exposure. Kioumourtzoglou says this is a fundamental misunderstanding of how scientists classify cause of death. When people die, they are given an International Classification of Diseases (ICD) code to signify what happened, and there is no ICD code for pollution. “If you died of a heart attack, you get the ICD code for a heart attack,” she said. “If exposure to PM2.5 has caused a heart attack, on your death certificate, it would still say heart attack, not PM2.5.”

Pope, whose study was one of the first to establish the connection between short-term exposure to fine particulate matter and death, also said Milloy’s claim misunderstands the type of person who dies from exposure. A perfectly healthy person is not going to croak from a short jog through haze. But people who are already unhealthy—who have asthma, or cardiovascular or heart disease—should be worried. “We often refer to it as triggering,” Pope said. “Particulates will trigger these acute events, such as heart attack.”

This is not to say that the research on this subject is flawless. Kioumourtzoglou, unlike Milloy, has lead and published studies on problems with the scientific methods surrounding the impact of particulate matter pollution on human health. Scientists cannot strap pollution monitors onto humans and follow them around for years at a time, so sometimes they rely on models that predict air pollution concentrations at certain locations and times. “We have to rely on less than perfect measurements,” she said. “And these are known to induce error.”

The error, however, is exactly the opposite of what Milloy claims. Kioumourtzoglou’s research has found that current air pollution measuring methods tend to understate the effects of air pollution. “In reality,” she said, “the effects are even worse than documented.”

The good news is, Milloy and Delingpole remain outliers in a sea of evidence. As ThinkProgress pointed out last month, “The Centers for Disease Control, the World Health Organization (WHO), the National Institutes of Health, the American Lung Association, and the United Nations all link air pollution to increased risk of asthma, heart disease, and stroke. In 2013, the WHO even concluded that air pollution could be categorized as a human carcinogen.” Even Breitbart, as indicated above, has published uncritical articles about these organizations’ findings.

The bad news is, we already know that outliers can have disproportionate impact on policy. Just look at the debate surrounding climate change. Despite near-consensus in the scientific community, one third of Congress are climate change deniers, as are Trump and his new EPA administrator, Scott Pruitt. What’s more, they’re using their fact-free ideology to dismantle policies that slow climate change. Trump is expected to issue an executive order this week undoing the Clean Power Plan, which regulates carbon emissions from fossil fuel plants. He is also considering withdrawing from the Paris Climate Agreement, the landmark international accord to stop global warming.

Milloy and Delingpole surely would like air-pollution deniers to have a similar impact on national policy. Given Milloy’s closeness to Trump’s inner circle, and Breitbart‘s growing influence on the White House, and it doesn’t seem so far-fetched. But even if that doesn’t come to pass, these deniers have already succeeded in shaping—or rather, creating—a debate that no politician or scientist should rightly entertain. And that debate is now a public reality. Milloy’s “fact sheet,” for instance, is the first result in a Google search of “PM 2.5 science.” A legitimate scientific article is second.

Google screenshot

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The Crazy Theory About Smog That’s Gaining Ground in the White House

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There’s Only One Big Thing That Matters About the Upcoming Republican Health Care Plan

Mother Jones

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Politico has gotten its hands on a leaked copy of a Republican health care plan. It’s a discussion draft of a bill that’s a couple of weeks old, but it still provides a good idea of what Republicans are thinking these days. Here’s my summary of Sarah Kliff’s summary:

Good news: Compared to previous plans, it’s better on pre-existing conditions; more generous in its funding of high-risk pools; generally cheaper for young people; and includes bigger tax credits than earlier Republican plans.
Neutral news: Loosens the list of “essential” benefits for all plans. This is generally better for healthy people and worse for sick people.
Bad news: Eliminates Medicaid expansion; cuts Medicaid funding; is terrible for the poor; and is far more expensive for older workers.

There’s other stuff (all Obamacare taxes are repealed, for example, which is great news for the rich), but I submit to you that these are pesky details. There’s really only one big thing that matters: how much the program costs.

Obamacare spends roughly $100 billion per year on subsidies to make health coverage affordable for the poor, and even at that premiums are too high for many people and deductibles are too high for almost everyone. Handwaving aside, there’s no way to produce a plan that’s even remotely useful with any less funding than Obamacare. That’s just reality.

If the funding is sufficient, we can all have a good time arguing over continuous coverage penalties, age ratios, essential benefits, and all that. If the funding is insufficient, it’s all just whistling in the wind.

Rumor has it that an outline of this plan was already submitted to the Congressional Budget Office, and the score they returned was so horrific that it never saw the light of day. So when Republicans do finally release a bill and a CBO score, just turn immediately to the section that estimates the ten-year cost. If it’s substantially less than a trillion dollars, you can skip the rest.

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There’s Only One Big Thing That Matters About the Upcoming Republican Health Care Plan

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Trump Just Made Life Harder for Transgender Students

Mother Jones

On Wednesday, Donald Trump’s administration rescinded Obama era guidance directing schools to treat transgender students according to their gender identity.

While the most talked about part of Obama’s rules allowed students to use the bathroom that aligned best with their identity, the guidance also explained teachers should use students’ chosen name and pronoun and recommended steps to limit access to and amend transgender students’ school records. The move, which comes in a joint letter from the departments of justice and education, rescinds all such protections.

“This is the administration saying very clearly to anti-trans bullies…’These students are not worthy of protection….and we are not going to enforce the law,'” says Mara Keisling, the head of the National Center for Transgender Equality.

The letter claims rescinding the standing rules “does not leave students without protections from discrimination, bullying, or harassment,” and emphasizes that schools are responsible for ensuring all students “are able to learn and thrive in a safe environment.” But unlike Obama’s directive, which specified that a hostile environment could, for example, be established by failing to recognize students gender identity, the Trump administration’s letter gives no such guidance. That nod to bullying and harassment was reportedly added at the urging of Education Secretary Betsy DeVos, who, according to the New York Times, expressed discomfort at rescinding the guidance. When asked Wednesday about infighting between DeVos and Attorney General Sessions, who pushed strongly to rescind the guidance and who has long history of opposing LGBTQ rights, the administration maintained DeVos supports the move “100 percent.”

Without federal policies, transgender students’ rights will be inconsistent state to state and even between school districts and individual schools. In a statement released shortly after the letter, DeVos argued this “is an issue best solved at the state and local level…Schools, communities, and families can find—and in many cases have found—solutions that protect all students.”

“No child in America should have their rights subject to their zip code,” said Eliza Byard Executive Director of GLSEN, a nonprofit organization dedicated to making schools safe for LGBTQ students.

The Obama administration developed the guidance after the Education Department received questions from educators, administrators, parents, and students about how Title IX, a law which bans sex discrimination in educational programs and schools receiving federal assistance, protects transgender students. Bathroom access proved to be controversial, but it was seen as a key step towards compliance with the law by department officials.

“Students in kindergarten, elementary school classes are made to line up by boys and girls to go to the bathroom,” said Catherine Lhamon, a former assistant secretary for civil rights at the Department of Education who helped develop the guidance. “Transgender students had to face a choice everyday about which line to get in and answering questions from their peers about why they’re in one line versus another, and that causes harm and humiliation to a student to have to explain.”

Private bathrooms can also invite questions from other students, be far from classes, or require an adult to unlock them, which can make students late for class.

“There were physical consequences to students of having to go through extra barriers just to be able to relieve themselves at school,” she says. “There were psychological consequences to students from having to explain who they are inside everyday to other students rather than just being able to be who they are.”

The Trump administration’s decision to roll back the protections comes just weeks before the Supreme Court is set to hear its first transgender rights case. Virginia high schooler Gavin Grimm sued his school board after it adopted a policy barring him from the men’s bathroom. At the center of the case: the question of whether Title IX protections apply to transgender students.

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Trump Just Made Life Harder for Transgender Students

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