Mills Healthcare Plan

Mills Healthcare Plan

"If you want to look at the success of a program over time, you need to look at a bunch of things that are not discussed by Mills. What is the health status of people coming into the plan, which relates to a number of facts - their average age, the gender breakdown, their health history and their lifestyles? What the outcomes of the program in terms health improvement, the break out of costs between the company and whether people continue to work their in good health?

If you employ younger employees to begin with, and make an effort to eliminate older employees who have more health issues and hold down your corporate costs, you keep your costs down and your employee's can more easily handle the occasional health issue. Whether intentional, if you punish those who get sick financially to save corporate funds and financially reward those who through no effort of their own are healthier, you fail to understand the purpose of health insurance, to make sure employees with real persistent problems get the care they need.

Encouraging healthy lifestyles is of course a good idea, but you need to be careful how you do it. Some of us get a bad draw genetically. I person knew for 25 years before I got it, that a genetic condition would some day mean I would need a kidney transplant. Nothing I could do would alter that fact - and that treatment was 1) extremely expensive and 2) somewhat toxic, as after effects are the norm. Early death was the only way to avoid the need. Only the very rich could fund this treatment out of their personal funds and all of us face the cost of a chronic illness that will be tremendously expensive, if not soon rather than later.

People don't think of these things, but benefit managers do. When I had the surgery, obviously any smart employer knew my continuing costs would be high. For self funded companies, there is a big temptation to get rid of those with these problems. In fact, it was necessary for Congress to ban genetic discrimination in hiring and firing. This didn't pass without strong Republican opposition. I suspect that if Mills had he been in a position to vote of this law, he would have opposed it, as genetic discrimnation would allow him to cut corporate spending.

So ultimately, for a program like company health insurance, one needs to look at what motivates a company to offer things like wellness programs. If they call on employees doing things that they have some control over, produce better health status and don't discriminate against older, sicker employees, OK. However, if they are designed mostly to lower corporate benefit costs, increasing employee risk of neglecting their care need or experiencing medical bankruptcies, it is not OK. It is never right to weed out those who are less health due to their genetics and the aging process.

It is not clear where this company comes out. However, if worker interests are not served well, then any person who designed such a program should not be rewarded by being allowed to impose their wrong-headed notions on the country. If Mills has designed program that is more beneficial than not, then he should back up his claims with supporting data." Joel S.

"My company just implemented one of these plans and did a terrible job of explaining it.  However after studying how it worked I think they are a step in the correct direction. (maybe)

You are correct that as long as the company is paying a large part of the employee's healthcare cost, there is an incentive to employ young healthy people. I was talking with a friend and found that their company's premiums are much lower because their workforce has many young single men in it, whereas my company's employee pool is very diverse.

So exactly how much more should the young single men with excellent lifestyle habits at my firm have to pay each month to subsidize the premium of older peers who make poor lifestyle choices?

How do you think we can encourage the older person to change their life long habits to become healthier?

With obesity and overweight sky rocketing in the USA, we need to do something about it if we truly want to reduce healthcare costs. I think programs like that set up by Mill's is a good start.

By the way, the program I am part of allows employees to get their Doctor to sign a medical waiver if the employee truly has a condition that prevents them from attaining the normal and is under the direct care of a doctor for that issue." G2A

Healthcare: Make Em Pay

In the name of keeping the Titles and Comments somewhat aligned, and since I know everyone cares and has opinions about healthcare.  I have copied these from our Union discussion.

And if you have a thought, don't be shy about commenting.  It really doesn't hurt a bit, and you may help us learn something or consider something differently.

"You are correct when you say that at some point The Law mandated that healthcare providers, in the form of emergency rooms, were required to give away their services for free to anybody that asked. But that is pure socialism and slavery by another name, and it is wrong. Of course we do not want people dying by the side of the road just because they lack the means to pay for simple catastrophic insurance or because they could afford expensive medical insurance but chose to forgo it. The problem is that government consistently drives up the cost of health insurance through mandates of various kinds (and because somebody has to pay for all that free medical care being given away). If government would butt out of the health insurance business, a lot more people could afford it. Then all you have to do is to modify the current emergency care law to minimize the immense amount of freeloading now going on. Simply allow the hospital to bill people who use the service but do not have insurance. It's called personal responsibility and we need to give it a try.
The problem, as it has always been, is not that someone will choose "who lives and who dies" by virtue of the medical care they can or cannot receive but rather WHO DECIDES. It should not be some faceless bureaucrat in Washington DC. It should be somebody standing at the emergency room door – on both sides – both taking responsibility for their personal actions. That is what Republicans want. How is that wrong?"  Anon

If you use the "Search This Blog" function off to the right, and enter Healthcare. You will see that this is a favorite topic of mine, and we have had many discussions on it. Since it involves money, ethics, religion, personal choice, etc. I don't think many people here see that as wrong, though I see it as impractical.

Holding the patient who neglected to get health insurance and is broke responsible is easy if society is willing to do it. Let them die. Unfortunately then the ambulance chasers will show up and try to make the hospital responsible for turning them away unless the law allows it.

Holding the ER Doctor responsible is pointless, they don't control the budget and the hospital can't fund all of the Doctor's choices. Talking about responsibility without authority... Or maybe we should have the triage nurse make the choice.

Now if you are a supporter of getting Gov't out of healthcare, how do you feel about physician assisted suicide? And pro-choice/pro-life? Just curious..." G2A

"Why health care costs are out of control in America is a complex and little understood problem. Because of the polarized and political nature of the issue, there just isn't an independent understanding of this issue. For one thing, it's not obvious to me that whatever mandates we have in the United States are any more onerous than those in countries where health care costs are much lower. I do believe the inefficient and unaccountable way we redistribute the costs of "free" health care is a factor, but hey that's just my unsupported opinion. Other countries don't have "free" health care, it's paid for in ways that are understood and accountable, which I believes results in a controlling of costs."  Hiram

"Or, you could simply treat them and send them a bill. Make them FINANCIALLY responsible and, if they can't pay, you give them easy payments or write off the debt from the hospital's taxes, just like everybody else does with bad debt. This cuts off the freeloaders of both kinds, because they will find (if government would allow it) either that basic non-emergency care is cheaper WITH the insurance, or that serious emergency care is VERY expensive without it.


As for health care costs, we know that getting the government out of health care, in four simple ways, would cut our costs in HALF while improving quality of care."   J. Ewing

"Since most of these hospitals are not big profit centers, especially in the neighborhoods where the poor live. I assume this bad debt would put them in the red pretty quick. Would you advise tax credits to help them stay afloat? (ie write offs don't work without profits)


And how would this be different than today? Other than a bunch of broke folks would get a lot of collection calls. I guess the upside is it would create jobs in the collections and bankruptcy industries.

I don't doubt that it would keep people from getting unnecessary treatment, however I don't see that as a big cost driver. Most folks I know do what the Doctor says, and don't sit around wondering when they can spend more time in the Doctor's office.   (Imagine: "Doctor, Please can I have another colonscopy. Pretty please.")
Maybe if we had the Doctor pay for any tests that don't yield useful information. That would cut back on the running of tests. Though the consequences may not be desirable."  G2A

Facts, Opinions and Values: Health Care Edition

Guest Post by Laurie:

Health care policy is an area that is as divisive and polarized as anything between liberals and conservatives. I recently offended regular commenter J. Ewing, by asserting conservative leaders and the voters who elect them lack compassion for the uninsured. I also commented that opposites sides tend to operate from completely different sets of facts and suggested that he would dismiss whatever facts I presented out of hand. So my goal / experiment is to see if there is any common ground to be found on the facts related to the American health care system. I am also curious what facts people use to support their opinions about the benefits or drawbacks of the ACA act. Lastly, I'd really like to understand the values of conservative Christians who seem to advocate for health care policies that make absolutely no sense to my value system, but I am not too hopeful on this last one.

So to start off the discussion I would like to posit what I consider fact. The U.S. spends the Most On Health Care, Yet Gets Least. The linked study rates the US low on access, efficiency (cost), equity, life expectancy, infant mortality and even quality. I was going to argue that the USA has high quality care for the majority, but according to this study we are 6 out of 7 here as well. For further discussion the linked article ends with the following opinion, "About the only good news for America,.... is that the new health law could put the U.S. on a path towards improvement," which sounds about right to me. As the ACA act will not be fully implemented for a few more years, comments on it will necessarily stay in the realm of opinion. I suspect opposite sides will rely on very different sources of expert opinion of its likely impact.

Thoughts?
Contradictory information?
Explanation of why affordable access to a full range of health care services in a country as rich as ours should not be considered a basic human right?

MP Mediation Frustration: Again

MP Obamacare and Gridlock


I know I owe Sean some wise words regarding healthcare policy, and my subconscious is still chewing on it...  But right now I am going to vent about inconsistency...


So Paul is going on and on about how great Single Payer would be. (ie high quality, low cost, excellent availability, even more R&D, etc) And how the Healthcare Experts are incompetent and should be as smart as he is.....


And I can not even post this simple response:


Here are 4 near monopolistic government run entities that should serve as a warning of why Single Payer will not deliver as promised:

• US Military: Good Quality, but Incredibly Expensive
• US Veteran Services: Good Cost but significant quality and availability concerns
• US Public Education System: Expensive, Good Availability, but 100's of thousands of children are left behind every year and likely to propagate generational poverty.
• US Welfare System: Good Availability, A Bit Expensive, but Is Making almost no progress on decreasing the number of Financially Dependent Americans. 

Ironically, Paul and I were having a similar discussion on MP Exceptionalism.

"The primary objective of single payer is universal and unrestricted availability for everyone; cost containment is just a natural feature of single payer. Quality also improves because resources and priorities are directed and driven by best practices rather than ability to pay or marketing. Colonoscopies in the US aren't "better" than colonoscopies in Germany despite being twice as expensive for example.

You're higher insurance premiums for instance don't buy better quality health care, they just buy more coverage for health care. In fact even expensive health insurance in the US can actually trap you in a mediocre provider system depending on the network you're restricted to. We used to call the old Group Health "Group Death" when I worked in a hospital for instance. At any rate it's much much much easier for a nation to focus on best practices in health care once you move all this other garbage out of the way. It's a basic principle of engineering: KISS- Keep It Simple Stupid.

The US ranks at the bottom of every health care metric (i.e. cost, availability, quality, etc.) among our group of peers and one basic reason for that is our system is ridiculously and needlessly complex compared to our peers. Medicare for all would be the simplest, best, and easiest way to bring our system up to par." Paul

"The goals for the Public School System is to ensure unrestricted availability for everyone; cost containment is just a natural feature of single payer. Quality also improves because resources and priorities are directed and driven by best practices rather than ability to pay or marketing.

And yet a large portion of our young adults can not pass a basic academic test... And continue the cycle of generational poverty... Even though we have one of the most expensive education systems in the world....

I'll say it again single payer has some upsides and a lot of downsides.
Single vs Multi payer

I always wonder who is going to encourage companies to spend on R&D if not us?" G2A

"There are many causal factors that have nothing to do with the Healthcare systems that one needs to take into account.

Checkout this regarding single parent household differences between here and the OECD countries.  Internation Single Parent Families  Or obesity. World map obesity" G2A

Well, maybe someday I will figure out what they use as moderation rules.

Why Mandatory Health Insurance is Good

VOX The success of Medicaid expansion, explained in 5 charts

The above may fit in well with the discussion we were having at Obamacare vs TrumpCare  In summary, I believe that every citizen in the USA should be required to:

• buy good full coverage insurance
• if they can not afford it, it should be subsidized or free

My logic is pretty simple...  When something serious happens people go BROKE, then us tax payers and/or consumers end up paying the bills + collection / bankruptcy expenses... (ie bankruptcies, uncollectible debts, etc)  The "patients" poor choice costs us MONEY...

We force car drivers to carry liability insurance for the exact same reason. We want to make sure that the driver has the money to pay their bills in case something BAD happens. We do not want some one else to pay for their buying a bargain policy or driving without insurance.  Therefore society through the government demands that people buy insurance of some minimally acceptable amount / type.

And yet for some reason Conservatives like Jerry have no problem with letting people save money today by going along without health insurance. Which of course is like letting people drive with NO LIABILITY INSURANCE.  I mean we know that some percentage of these people will  get cancer. heart disease, or some very expensive illness...  And unfortunately we tax payers / consumers will end up paying their bills since we are not allowed to let them die as a consequence for their being CHEAP and TAKING A BAD RISK...

Therefore, mandating appropriate healthcare insurance is to protect all of us from irresponsible people transferring their expenses to us. (ie bankruptcies, uncollectible debts, etc)

Below are a couple of comments from Jerry and Sean regarding my belief.

"...let people decide if they need liability insurance on their car." Not what I said at all. Liability insurance is mandated because it affects others (though many cannot afford it and don't have it, which is why I need "uninsured motorist" coverage), but if I want comprehensive I can CHOOSE to have it and pay for it. Health insurance is ALL for your benefit, so none should be mandatory by YOUR analogy.

And you are still not grasping the difference between health care and health insurance. Those who are under-insured, deliberately or by virtue of it being unaffordable [under the "Affordable Care Act" :-( ] still get health care through the emergency room, or charity, or by running up bills they can or cannot pay. Yes, we "all" (some of us far more than others) "pay" for that care, in some fashion. But YOUR solution would have us all pay for INSURANCE against those events, whether needed or not, whether wanted or not, or usable or not, or whether the cost of care could be covered by any of a number of other mechanisms. And that drives UP costs for everybody, meaning FEWER people can afford coverage. It's just backwards.

Just look at what happened after Obamacare mandated that everybody have "acceptable" insurance. Emergency room visits for basic care went UP. People lost the plans they liked. Doctors left the profession rather than accept the mandates and poor reimbursements. Like all liberal utopias, Obamacare was long on good intentions and short of sensible policy. Trumpcare, regardless of what it may be, must be better." Jerry

"Here in the real world, the number of licensed doctors in the U.S. increased by 100,000 between 2010 and 2016. A Census of Actively Licensed Physicians in the United States, 2016" Sean

The Morality of Healthcare Financing

MP US Exceptionalism continues to drive excellent discussion.

"Maybe, Just Maybe: The power of the presidency has been so downsized by an ineffective congress that realistically, change just might suggest a tyrant could soon be in control? 

Let's say if all candidates or at least the major two, pass by the concept of a free society, then all credibility; hope for a functioning democracy is a dream ending...who knows?
Sleeping at the gate: The 'people' are left out...and rather than ever being the recipients of positive change like universal health care etc..and if major parties are content with or zeroing into those false gods like money and power and greed, downsizing the people who seem at times to be in a catatonic state of denial? Better wake up Joe B and Joanna too eh?" Beryl 

"Left Out? "The 'people' are left out...and rather than ever being the recipients of positive change"  Now you do realize that a large portion of US citizens consider that changing to Single Payer would be a negative change...   Gallup Healthcare Poll Results

My point is that people's voices are being heard, but their voice opposes your view of "positive". Maybe because they will be paying more and getting less. 

I work with people from many countries, there are definitely pros and cons to single payer plans. That is why most countries have Private Options on top of the public system. Personally I am against single payer for several reasons:

• Patient does not bear the costs. Little incentive to live healthy.
• Rationing and long waits for some services.
• Price controls do not work well, something is going to slip.
• other

So I am happy that my voice is being heard." G2A

"Rationing of health care under single-payer systems isn't caused by the fact that they are single-payer. They're caused by other policy decisions -- specifically, the desire to limit health care spending. Need proof? There's a single payer system very near to us that doesn't ration care in the way that, say Canada or Britain do -- it's called Medicare and it serves every American over the age of 65. 

We should also acknowledge that our current multiple-payer system also rations care -- by the ability to pay. Every system will ration care to some extent, what we need to decide is on what basis we choose to ration." Sean

"People in America who go to school, learn, work hard, make good choices, work hard, etc get the best medical care in the world when they need it. The disabled and old get the best medical care in the world when they need it. 

Those who do not fit into either category struggle and are handled on a case by case basis. Makes sense to me." G2A

"Really? Ask a doctor if she decides who gets the best care based on their moral worthiness. 

If a disabled or old person did not go to school, learn, work hard, make good choices, work hard, etc does he or she still get the best medical care in the world when they need it?" RB

"Moral Worthiness: I am not sure this is a moral issue, I think this is more of a capitalism and person financial management issue. Thankfully the USA's systems reward the smartest hardest working saving /investing people very well. This is one reason why we are such an exceptional country. 

And yes the best hospitals / Doctors would like to get paid. Thankfully we do live in a society that believes in charity and caring for the old, disabled, so they get good care." G2A

"Pay to play health care is inherently immoral: The idea that people who fail to meet someone or another's moral standard (such as a work ethic) are rightly doomed to suffer injury illness and death is morally bankrupt. 

The idea that financial incentives are (or should be) the primary driver of individual health care, safety, or lifestyle decisions is simply daft. People don't exercise or eat healthy diet because it saves them money, on the contrary many people pay an incredible amount of money to exercise and eat healthy food. 

Nor do people seek to avoid injury for financial reasons... pain avoidance and fear of death are basic biological mechanisms. 

Furthermore we've seen time and time again now financial priorities distort health care and safety decisions frequently producing increased injury and illness. We never had millions of uninsured Americans because they were all lazy an "unproductive" members of society. 

I hate to say but the idea that people who fail to meet some standard of work ethic deserve their fate of death and suffering looks a lot like "final solution" logic." Paul

"Immoral: No system is perfect, however I think ours is best. Pretty much everyone gets some care, but the most responsible citizens get the best care.

The Liberal view that citizens have a right to food, housing and healthcare just because they are standing on American soil is also flawed and doomed to cause disaster. And I would say that it is also immoral because it allows "free loaders" to live as parasites on the efforts of others. (ie drain on society) And if you doubt that there are a significant number of freeloaders within our society, just take part in a group activity, look at our crime statistics, look at the academic failure within our schools, our large welfare roles, etc.

I am actually living proof that money can be a good incentive to living healthier. My company implemented a two tier premium system and I will be paying an extra $180/month for family coverage if I do not lower my sugars and triglycerides. Therefore I am changing my diet somewhat. Now I wish more programs would do this, I mean why should my co-workers need to pay more for my bad choices?

Why should our society have to pay the huge healthcare costs in part created because of sky rocketing obesity, etc?

G2A Healthcare Cost Drivers 

ObamaCare vs TrumpCare

Jerry referenced the opinion piece by Alex M. Azar II is U.S. secretary of health and human services that was posted on WAPO.  There is some truth to it and yet it is also worth serious review and analysis.   Obamacare forgot about you. But Trump didn’t.  I copied it here for your convenience.

For all the discussion of Obamacare since its passage, it is too rarely known that the law effectively split the United States’ individual insurance market in two .

One group of Americans — about 8 million enrollees in 2017 — now pay, on average, less than a quarter of the cost of their health insurance, receiving ever-growing taxpayer subsidies to insulate them from Obamacare’s high premiums. But there is a second group of Americans who have faced the full premium increases driven by the law’s broken regulations. Roughly 5 million Americans, as of 2017, have chosen to pay those premiums without any subsidies, while 28 million other Americans remain uninsured, many priced out of coverage entirely.

The law’s skyrocketing subsidies have kept subsidized insurance enrollment fairly steady — although more than 50 percent below what was once expected. But Americans who make too much to receive subsidies have begun to opt out of the insurance market en masse. An independent analysis found that the entire unsubsidized individual insurance market shrank by more than 40 percent from the first quarter of 2016 to the first quarter of 2018. In other words, Obamacare has forced unsubsidized Americans to choose between unaffordable insurance and no insurance at all.

This is unacceptable. It is one reason the Trump administration recently expanded an affordable insurance option the previous administration had all but discarded, providing new choices for these forgotten men and women.

Americans will once again be able to buy what is known as short-term, limited-duration insurance for up to a year, assuming their state allows it. These plans are free from most Obamacare regulations, allowing them to cost between 50 and 80 percent less.

President Trump said on June 19 that association health plans will "rescue Americans from Obamacare."

Insurers will also be able to sell renewable plans, allowing consumers to stay on their affordable coverage for up to 36 months. Consumers can also buy separate renewability protection, which will allow them to lock in low rates in their renewable plans even if they get sick.

Unsurprisingly, experts believe there will be healthy demand for these affordable options. Up to 2 million Americans, and possibly more, are expected to enroll within the next few years.

Such plans were offered for terms of up to 12 months for decades until, in an effort to push Americans into Obamacare, the previous administration restricted the plans to 90 days and prohibited insurers from renewing them beyond that time period. This eliminated them as an option except for the shortest transitions between other sources of coverage.

But these short-term plans can be a good option for many Americans priced out of Obamacare’s regulations — especially small-business owners, independent contractors in today’s “gig economy” and younger Americans transitioning between school and employment.

The Trump administration has gone to significant lengths to ensure customers know that these plans are not subject to the same regulations as Obamacare plans and that they are not the right choice for everyone. In fact, we require more robust warnings about the limits of these plans than President Barack Obama’s administration did.

Some have raised concerns about the possibility that short-term plans will pull healthy consumers out of the Obamacare exchanges, driving up premiums. But estimates from the Centers for Medicare & Medicaid Services actuary suggest any such premium increases would be minimal and would not affect subsidized consumers. This is, in part, because those without subsidies who were previously enrolled in Obamacare plans have already left those plans in droves because of premium hikes under the law. For these consumers, short-term plans can offer an affordable option. Our decision to allow renewability and separate premium protections could also allow consumers to hold on to their short-term coverage if they get sick, rather than going to the exchanges, which improves the exchange risk pools.

Fundamentally, this administration believes in more options, not fewer, for consumers. Expanding short-term insurance is just part of President Trump’s larger agenda to improve health-care choice and competition for Americans.

The president signed legislation that will end the individual mandate penalty starting in 2019. Repealing the mandate and expanding short-term plans mean that millions of middle-class Americans who couldn’t afford health insurance will now be able to do so. The Labor Department has also made it easier for small businesses and self-employed Americans to band together to purchase more affordable insurance through association health plans. And last year, the Trump administration took rapid, decisive action to help stabilize the Obamacare markets and end ways to game the system. We have also worked closely with states to develop solutions that can bring down premiums and expand choices.

Starting about two months from now, thanks to this president, insurers and states will have more freedom to offer consumers more options. Obamacare remains broken at its core, but this administration isn’t shutting out the law’s forgotten Americans. Instead, we’re finally giving them affordable choices.

Here is what Kiplinger Finance had to say about the "bargain plans". And here is a Politico piece describing Trump Admin spin.

Natural Consequnces

MP Exceptionalism keeps giving.

"You are absolutely correct that there are many rewards to be gained by going to school, learning, working, staying married, saving, investing, etc. One of which is I can easily afford the higher premiums they are going to charge me for making bad choices. This is one of the strengths of America.

I guess I see taking money from one citizen to pay for the poor choices of another is also immoral. Trade offs..." G2A

"Further punishing those whose lot in life enables a meager existence fraught with the constant peril of physical and financial collapse. All in order to save oneself a pittance on the tax bill, and to impose some vague idea of "moral justice" on those percieved as "lessers". Thanks, but I think I'll take Mr. Udstrand's version of morality 10 times out of 10." Matt

"I guess I see taking money from one citizen to pay for the poor choices of another is also immoral. Trade offs..."

This is where ideology become incoherent as well as immoral. This is how a citizen of a liberal democracy is converted into a "victim" of oppressive government simply because citizens pay taxes. The horror. Yeah I don't like paying for other people's bad choices either... how do I get my money back for the Iraq war and all these stadiums?

You do realize that your insurance premiums don't actually pay for your health care and that your premium dollars aren't earmarked for your health care and your health care alone right? One way or another we all pay for each others health care whether your in a private or public system." Paul 

"As we have discussed before.

I have 3 children, two are savers and one is a spender. When the spender can not afford to go out with her friends and I refuse to give her additional money to do so, am I punishing her?

When my other 2 kids go out and the spender is stuck at home with Mom and me, am I rewarding them unfairly?

If I gave the Spender more money, what message would that send to the Savers / Spender?

What behavior would that promote?

All Americans are given the opportunity to attend free public schooling, what they do with that societal investment in them is up to them and their Parents. There are natural consequences if one squanders that incredible opportunity. No punishment or judgment required." G2A

"You correct. Insurance is a pool of money to spread the risk. This is a very personal cost / benefit, unlike stadiums and wars.

If people want to be covered from the pool. Please have them pay their premiums." G2A 

Do More Equal Societies Work Better for Everyone?

A guest post by Laurie (previously known Nokomis). By the way, I am happy to extend this courtesy if you have thoughts that you would like to get feedback on.

____________________________________
While reading my spring issue of American Educator today, I came across this interesting article, Greater Equality the Hidden Key to Better Health and Higher Scores. In it the authors provide a graph showing the relationship between social/physical health and level of income inequality for about 20 developed countries. Not surprising to me was that the USA ranked highest in income inequality and worst in a composite score of social/ physical health measures (i.e. life expectancy, mental illness, drug abuse, education, obesity, homicides, imprisonment rates, teenage births, social mobility.)

The point of this article written for teachers was that decreasing levels of inequality would increase educational achievement for students of all income levels. This is illustrated in a graph showing literacy levels for adults of differing education levels in countries with different levels of inequality. In short, it shows that Paul Wellstone spoke the truth in his well-known quote "we all do better when we all do better."

For an interesting look at more graphs and discussion of the evidence that more equal societies work better for everyone, check out The Equality Trust website. Here, when I clicked to learn more about education and equality, I was pleased (and not surprised) to see that Minnesota ranked among the states with lower levels of inequality and this corresponded with our low high school drop out rate. Of course this idea about the negative effects of inequality seems very logical and even obvious to a strong liberal such as myself.

I am curious what others with a different worldview / political ideology think of the idea /evidence. Questions:

• Do More Equal Societies Work Better for Everyone?


• While the greatest gains go to those at lower income levels, would the wealthy benefit, as well, from greater income equality (as authors argue)?


• Would decreasing the inequality in the USA through a progressive tax code save $ on things such as prisons, health care, drug treatment, welfare (fewer teen mothers) etc?


• In a wealthy country such as the USA, will more economic growth lead to a happier, healthier, or more successful population (especially if the gains keep going to the few at the top)?

Thoughts?

ACA Revisited... Again...

You know how I like to keep our posts and comments somewhat aligned. :-)
And Molly, you have some reading to do to catch up with our 10+ years of arguing this...
See the links below...

Sean, My guess is that she thinks the "activist judges" should have ruled against it... SCOTUS now rules against ACA, Not supported it. G2A 

Molly, Now I need to find a reason to post about ACA to see what you disliked about it and if you have a better solution. :-)  G2A 

All, It was a very complicated ruling. In the end the court claimed that forcing people to buy something was a tax and Obama had told the public that is was not a tax. He told the public if you like your doctor you can keep your doctor and said that it would save people money all untrue.Molly 

Molly, I lost my highly desirable plan also. No love here for the Unaffordable Care Act. Jerry 

John, I thought the original point of the ACA was to to get insurance for the uninsured. I would have rather had a tax to all to pay for those folks to have insurance rather than completely change our healthcare system.  Molly 

All, The real problem with the ACA is that it didn't change our healthcare system enough. Sean 

Sean, Nonsense. The ACA was supposed to solve all health care problems, for everybody, for all time. Maybe the actual legislation did not match the promises made for it?  Jerry 

Sean, what did you want the ACA to do that it didn’t?  Molly 

All, "X was supposed to solve all problems" is a classic straw man argument. There is no health care policy that will solve all problems. Making that the goal of policy is a de facto decision to have no health care policy at all.  ==Hiram  

All, I did not suggest that the ACA /could/ solve all problems. I merely suggest that is what was promised and not delivered. And how did we get off on this old topic? Jerry

 G2A ACA Search
G2A Health Search
G2A Healthcare Cost Control
G2A Sean Healthcare Improvement Plan

Lock Up the Elderly and Infirm?

I have been spending time in Jerry's world.  Please join us and help me understand his thinking?

"There you go again, simply ASSUMING that the shutdown "slowed the transmission." And by the way, I value human life in its entirety-- the freedom to move about, worship, speak, socialize, WORK, and to take reasonable precautions with ones own health and the health of others. 

In New York, Cuomo ORDERED nursing homes to take in active COVID patients! And he let the subways continue to run. A shutdown that should have been well-targeted and lasted 2-3 weeks might have been effective, but what was actually done was not, so 1/3 of all US deaths attributed to CV are in New York. 

Time for you to admit that these statewide tyrannical edicts have done more harm than good over huge swaths of the country. I'm simply not buying that "if it saves one life" nonsense. People die. Governors are not gods." Jerry

Jerry  So based on this. "And by the way, I value human life in its entirety-- the freedom to move about, worship, speak, socialize, WORK, and to take reasonable precautions with ones own health and the health of others." 

You are willing to have other people literally die so you can do as you wish? 

And of course lock downs work, as Vietnam proved very well.  We just did not lock down early enough or hard enough... Remember that Trump was denying the need in the end of February, just before it became real to him and he supported the lock downs.

What do you think the states should have done differently that could have saved more lives? Please be specific. (G2A / John)

States could have locked down just long-term-care facilities, perhaps even quarantining employees in place. They could have /suggested/ stay-at-home, masks, social distancing where possible. NYC could have sanitized the subways frequently. They could have NOT criticized Trump for shutting down travel with China and Europe, and NOT shut down medical facilities unnecessarily, and not picked winners and losers in other businesses. They could have had emergency supplies available or at least on order. 

And what makes you think that states "saved more lives" with these drastic measures? Might the opposite be true? Jerry

So here is Jerry's list as I understand:

1. States could have locked down just long-term-care facilities, perhaps even quarantining employees in place. 
2. They could have /suggested/ stay-at-home, masks, social distancing where possible. 
3. NYC could have sanitized the subways frequently. 
4. They could have NOT criticized Trump for shutting down travel with China and Europe.
5. They could have NOT shut down medical facilities unnecessarily.
6. They could have not picked winners and losers in other businesses. 
7. They could have had emergency supplies available or at least on order.
8. May we have saved lives today and caused people to have shorter lives?

And my new response to Jerry...

1. Do you think any of those low dollar workers would be willing to stay away from their life, families, etc for many months?  I mean this proposal does nothing to make the virus go away. And please remember that a LOT of the dead are not in the long term care centers.  
2. They did "suggest"... In most states no one was being arrested or charged.  Since I work for an essential business I really have not noticed a change and no one has ever asked me why I was out of the house.
3. Apparently they started sanitizing the subway system on March 3rd. And with the stay home orders ridership decreased by 90%.  They likely could not shut public transportation down since the essential workers needed it. 
4. Trump's travel restrictions were somewhat useless because he did not follow through. And he did not limit travel from Europe until mid-March.  And by then it was too late, the barn door had been open too long.
5. I do not think any essential medical facilities or procedures have been shutdown?  What are you thinking of?
6. How would you have changed the critical industries and personnel definitions?  Are you thinking they should have left the gathering places open?
7. They apparently did have medical supplies on order for a normal year, and they increased their orders ASAP.  However demand exceed supply and the national stockpile was not adequate and or fully stocked.  
8. We are having a hard enough time determining how many are dying from what today, (ie covid, depression, scared to go to the hospital, etc)  And you want to try to guess the long term impacts of shut downs?  "Sorry Granny... We chose that you should die instead of stress these other folks out?"

So in summary it seems that your proposal to save lives was that we should have quarantined all the elderly, infirm and their care givers for 6+ months?  And /suggested/ stay-at-home, masks, social distancing where possible.  And let any businesses stay open that wanted to.  Does that seem an accurate summary?  Do you think this would have worked and saved more lives?

Link to an Interesting Detailed Timeline

The Health Insurance Question?

Well J left an interesting comment recently at an old post.  I thought it deserved some further clarification, and that more discussion may be warranted.  G2A Village of Deficits and Surplus

"Well, I've already lost my health insurance because Obamacare is coming. Millions of others have lost their insurance or had their hours cut back to avoid Obamacare. Insurance premiums have risen drastically, and more doctors are refusing to take Medicaid or Medicare patients, because of the Obamacare requirements. "Fully implemented" isn't a necessary condition for saying that there has been too much damage caused already."  J. Ewing

J,What did you mean by  "I've already lost my health insurance because Obamacare is coming."  Ready to share?

G2A Principles

I have my Trying For Balance graphic to the right. Here are the affirmations and related values that go with it. I often fail to meet these high standards that I set for myself ~4 years ago, however they do act as a solid anchor that keeps me from going too far adrift. They help me stay self aware, and are incredibly valuable when strong emotions surface or I am faced with difficult life choices. Finally , I hope they show up in my writing....

I owe the general concepts to TeachingValues.com and their discussion of Principles that appear across almost all formal religions and forms of sirituality. It seems if we get past all the human documentation, tradition, ceremony and interpretation issues, the core Principles are pretty unviersal. I have to wonder if God is laughing or crying over all the conflict that humans create in God's name.

My Principles have been stable for the last couple years, however I am always up for improvement ideas. Thoughts?

Integrity
I align my thoughts, words and actions with truth and have the courage to act with sincerity and honesty. This strengthens me and my relationships. (ie, impartial, objective, open/full disclosure, honor confidences, meet professional and personal responsibilities, loyalty, authenticity, trustworthy, due diligence, no conflict of interest)

Perseverance
I work and strive towards self-improvement, because wholeness is not realized in a moment. I need the confidence to endure all situations in order to reach my goals. (ie diligence, initiative)

Self Discipline
I restrain my lower desires through determination. And through obedience to my higher self, I develop inner control and greater confidence. (ie health, behaviors)

Devotion
I maintain a feeling of calmness and concentrate on higher thoughts. By focusing on higher thoughts and actions, I am better able to connect with the divine. I also take the time to go within my heart, where I find my true self and creative energy.

Surrender
I accept my present situation as a necessary part of a grander plan. This new freedom allows me to surrender my wants and desires and welcome whatever comes into my life. With this new awareness comes contentment and peace. (ie compliance, patience)

Moderation
I choose moderation in all aspects, because it brings balance into my life and helps maintain my inner peace and true reality. The alternatives would be burn-out, stress and illness, which would hinder my productivity and creativity. (ie abstinence, temperance, emotional/spiritual/mental health)

Faith
I maintain my trust and hope even though I live in the midst of uncertainty, because God pervades all things. Faith is my willingness to take the next step without fear or looking back, and yet have the patience to trust God and not try to force the results myself.

Gratitude
I am grateful and appreciative for what life has given me. I think magnanimously and act generously because abundance is the universal reality, therefore what I give to life returns to me. (ie family & friends, home location, financial security, great job, personal successes, health, hobbies, experiences, prestige, recognition, pleasure, joy)

Humility
I maintain an attitude of unpretentiousness and modesty, and realize that God in his own way and time will reward me with whatever I need. As long as I rid myself of pride and maintain an attitude of gentleness toward all life. (ie questioning, humble)

Synchronicity
I am alert to highly significant events that cannot be explained, because I then have an opportunity to go beyond the daily occurrences in my life. I am also receptive and have the courage to act on my inner promptings, thereby supporting my transformation into a higher self. (personal freedom/power, independence, creativity, experiences, spontaneity)

Forgiveness
I choose a new understanding of my situation, because forgiveness is a conscious act that frees me from the damaging image of myself as a victim and dissolves the poison of resentment. This frees me to extend mercy and compassion to myself and to those who have wronged me, which reconnects me back to my real self.

Attraction
I work to be discerning and self-aware, so I can distinguish between beneficial and destructive things that I attract into my life. I need courage to take the next step toward wholeness by eliminating the negative desires that attract chaos into my life. If I do not curb my destructive desires, life becomes increasingly difficult. (ie personal development, wisdom, expertness, self renewal, vision, values)

Purity
I choose to see the beauty of the simple things in life and perfection all around me, instead of complexity and distortion. Therefore I retain the innocence and joy of life that uplifts me and reconnects me to my true inner self. (ie chastity, live now, notice)

Cause & Effect
I am accountable for my every thought, word and deed, and recognize the wisdom of restraint and being aware of the intentions of my actions. For every action there is an equal reaction. (ie karma, awareness, consequences)

Love
I use positive inner dialogue to bolster my self-esteem and self-respect. This frees me to nurture all individuals by being the caring, compassionate, thoughtful and kind person I truly am. (ie empathetic listening, understanding, concern, affection, protect, friends, family, affirm, support)

Respect
I strive to treat all whom I meet with courtesy, tolerance and cooperation, because everyone is part of the divine family and deserves my respect. No matter their religion, sex, culture, age or status. (ie justice, fairness, win/win, trust, open minded, honor autonomy of others, acceptance)

Service
I came into this life with a special plan or purpose to help elevate humanity. I am responsible for successfully executing the plan and infusing my service with the creativity of my special God-given talents. (ie benevolence, leadership, community/society/environmental responsibility, interdependence, mentoring, contributing)

Harmony
I choose to be optimistic, cooperative and enthusiastic, rather than a victim of my negative emotions, so I remain in control of myself and maintain inner happiness. The alternative would be to choose negative feelings, which would make my life infinitely more stressful and complex. (ie praise, affirm, appreciate, congratulate, collaborate, motivate, cheer, empower, positive)

Jerry: Reduce Healthcare Costs, Maintain Quality

From G2A Who Demands Compliance Jerry said

"Healthcare requires money. Well said, but it makes the glaringly erroneous assumption that the only way to deliver health care is exactly the way it is done today. As I've said before, four changes would reduce our total costs by about 50% without affecting quality. So should we NOT do those things, just because we might be able to lower taxes for somebody? I'm not understanding the reasoning, here. It looks like an attempt to keep a political argument alive, regardless of what the "right thing to do" might be. " Jerry

I asked him to provide them and here are the answers.

"Actually, they aren't mine; they come from a Mayo study many years ago. They are:

1. Eliminate first dollar coverage. Every use of the system costs /something/ (a copay, IOW). 
2. Eliminate fee-for-service. This is the big one. Rather than doing what is the quickest and best treatment, doctors are led to do what pays the best or, more likely, to add on something unnecessary just to cover their costs.
3. Eliminate third-party payers. Forget single-payer. Everybody pays their own fees or buys insurance on their own. If they get a stipend or a tax credit to do so, that's their own affair. 
4. Eliminate defensive medicine. The malpractice system is out of control and drives up costs, not directly, but indirectly.

To that we should add, now, deregulation of the health insurance industry. If I want, I should be able to buy a "catastrophic only" policy, or open an HSA or "prepaid care account," without government telling me I can't. 

  

"We just have a whole lot of well paid people in the system." G2A

 

"And yet that marketplace is badly distorted by government regulation. Medicare tells doctors they can only get, say, $250 for an appendectomy (I have no idea, but) the doctor doesn't make a penny unless he charges at least $500. So he makes it up somewhere else or refuses to do it. If the doctor could charge, say $550, he might get "rich," but do we really want to hire the low-cost bidder for something like that?  

And by law, all insurance companies in Minnesota are "non-profit." Why would anybody get into that business?

 

In fact, the whole idea seems illogical to me. If we had a free (or mostly free) market in health care, prices would be set by the millions of individual choices and implicit contracts made between providers and patients-- sellers and buyers. The best and/or scarcest goods and services would make those providers "rich" and everybody else would enter the market at the point where they saw a beneficial exchange, or exit the business for lack of business. Absolutely nothing wrong with that. " Jerry

1200 Studies: Fact or Conspiracy Theory

A distant cousin who is a chiropractor and health / wellness coach has published a document that challenges the safety and effectiveness of vaccinations. WellnessDoc 1200 Studies  Initially I think he is just promoting conspiracy theories, however I will take some time to read some of his work.  I mean how could so many other highly reputable health organizations be wrong?

For more data from the main stream medical doctors.
Immunization Alliance
CDC Child immunization schedule
CDC Why metals are in vaccines?
McGill Should we worry about metal in vaccines?
Mayo Clinic Tough Questions about Childhood Vaccines
Children's Hospitals Immunization site
APA Paper

Here are some of my response on his FB page so far.

The challenge with people doing research, be it pharmaceutical companies or yourself is that both have a belief that biases their research. (confirmation bias) I fear that you are a "natural medicines" fan who is seeking to support your beliefs rather than to help keep families across America safe and healthy. And scaring young mothers and fathers certainly is concerning.

What are the folks who did this study missing?
Are they in the pocket of a pharmaceutical company?

"Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States. The study authors found evidence that some vaccines are associated with serious adverse events; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide." from one of the above sites :-)

And here are my interesting ethical questions:

• If people fail to vaccinate their child(ren) for fear of a rare event. 
• And other children suffer or die because of that choice. 
• Did those parent(s) do the ethical thing?

Healthcare Cost Control 1

Ok, we seem to agree that health care is a big expense in the United States. Beyond that we have not gotten very far. Therefore I will post a few questions and comments during the next week or so. First:

• Why are so many Americans OBESE and/or out of shape?
• Why do people still drink excessive amounts of alcohol and/or smoke?
• Why do people continue to participate in "risky" behaviors?
• What can be done about it?
• Should these actions be taken?

After decades of being told that a good diet and regular exercise are key to being healthy and happy, we don't seem to listen or change our behaviors. Some folks want to tax our twinkies, raise our insurance rates, sue fast food restaurants, nudge the farmers/food companies to grow/make healthier foods, etc. Of course the conservative folks see these changes as a violation of their rights and civil liberties. And no one wants "their" favorite junk food to become limited, expensive or unavailable.

By the way, I have linked a BMI calculator below. Remember, if your BMI is over 25 and/or you get winded climbing a few flights of stairs. You are or will be likely contributing to our healthcare cost problem. Using a treadmill, reducing portions sizes and/or cutting back on your processed sugars would be a very good thing for America. Being an Engineer, my simple math formula is:

Weight chg = Calories in - Calories out

And of course we all know that smoking, excessive drinking and being stupid increase America's health care bill. However, this does not seem to stop too many people.

Now if you are angry with me for unintentionally acusing you of being a burden on the American society and all your neighbors. Remember:

• My BMI is ~26
• I do minimal exercise and my diet is poor
• I ride motorcycles, snowmobiles, jet skis, down hill ski, etc
• And I love my beer and wine (rarely to excess. now a days...)
  
  Okay... Your turn...

BMI Site
OECD Health Site

Trump Accomplishments

White House: Trump Accomplishments

I was sent the above link, so I broke them into what I see as the main categories. Since this is a list generated by Trump, I am not sure what is real and what is fiction. So over the next day or two I hope to add some fact check links.  Here is a good starting point with good references.

Thoughts?

Economy: Lowered Taxes, Increased Government Spending, Generated Record "Boom Deficits" and Increased National Debt to Record Highs"

• Secured $6 billion in NEW funding to fight the opioid epidemic.
• Secured record $700 billion in military funding; $716 billion next year.
• Signed the biggest package of tax cuts and reforms in history. After tax cuts, over $300 billion poured back in to the U.S. in the first quarter alone.
• As a result of our tax bill, small businesses will have the lowest top marginal tax rate in more than 80 years.
• Almost 4 million jobs created since election.
• More Americans are now employed than ever recorded before in our history.
• We have created more than 400,000 manufacturing jobs since my election.
• Manufacturing jobs growing at the fastest rate in more than THREE DECADES.
• Economic growth last quarter hit 4.2 percent.
• New unemployment claims recently hit a 49-year low.
• Median household income has hit highest level ever recorded.
• African-American unemployment has recently achieved the lowest rate ever recorded.
• Hispanic-American unemployment is at the lowest rate ever recorded.
• Asian-American unemployment recently achieved the lowest rate ever recorded.
• Women’s unemployment recently reached the lowest rate in 65 years.
• Youth unemployment has recently hit the lowest rate in nearly half a century.
• Lowest unemployment rate ever recorded for Americans without a high school diploma.
• Under my Administration, veterans’ unemployment recently reached its lowest rate in nearly 20 years.
• Almost 3.9 million Americans have been lifted off food stamps since the election.
• The Pledge to America’s Workers has resulted in employers committing to train more than 4 million Americans. We are committed to VOCATIONAL education.
• 95 percent of U.S. manufacturers are optimistic about the future—the highest ever.
• Retail sales surged last month, up another 6 percent over last year.
• Increased our coal exports by 60 percent; U.S. oil production recently reached all-time high.
• United States is a net natural gas exporter for the first time since 1957.
• Net exports are on track to increase by $59 billion this year.

Judicial Appointments: This is appreciated by religious right voters.  Not so appreciated by Libertarian leaning voters like myself.

• Confirmed more circuit court judges than any other new administration.
• Confirmed Supreme Court Justice Neil Gorsuch and nominated Judge Brett Kavanaugh.

Regulations: Good for businesses. Uncertain the impact on our water, air, etc.

• Opened ANWR and approved Keystone XL and Dakota Access Pipelines.
• Record number of regulations eliminated.
• Enacted regulatory relief for community banks and credit unions.
• Cancelled the illegal, anti-coal, so-called Clean Power Plan.

Healthcare Changes: Appreciated by those who do not want to be pressured to carry high quality health insurance. Not sure if Trump is overstating his contribution to the others?

• Obamacare individual mandate penalty GONE.
• My Administration is providing more affordable healthcare options for Americans through association health plans and short-term duration plans.
• Last month, the FDA approved more affordable generic drugs than ever before in history. And thanks to our efforts, many drug companies are freezing or reversing planned price increases.
• We reformed the Medicare program to stop hospitals from overcharging low-income seniors on their drugs—saving seniors hundreds of millions of dollars this year alone.
• Signed Right-To-Try legislation.
• We have reduced high-dose opioid prescriptions by 16 percent during my first year in office.
• Signed VA Choice Act and VA Accountability Act, expanded VA telehealth services, walk-in-clinics, and same-day urgent primary and mental health care.

Protectionist: People who are scared of refugees will appreciate. Though we have researched this many times. The crime rate among illegals / immigrants is less or equal to that of US Citizens. And most of the drugs come in through other ports of entry.

• Protecting Americans from terrorists with the Travel Ban, upheld by Supreme Court.
• Issued Executive Order to keep open Guantanamo Bay.
• Improved vetting and screening for refugees, and switched focus to overseas resettlement.
• We have begun BUILDING THE WALL. Republicans want STRONG BORDERS and NO CRIME. Democrats want OPEN BORDERS which equals MASSIVE CRIME.

Trade: Some benefit... But very expensive for US businesses and Consumers. We pay the tariffs and experience the loss of foreign sales. (ie exports)

• Concluded a historic U.S.-Mexico Trade Deal to replace NAFTA. And negotiations with Canada are underway as we speak.
• Reached a breakthrough agreement with the E.U. to increase U.S. exports.
• NATO allies are spending $69 billion more on defense since 2016.
• Imposed tariffs on foreign steel and aluminum to protect our national security.
• Imposed tariffs on China in response to China’s forced technology transfer, intellectual property theft, and their chronically abusive trade practices.

Withdrew: Good or Bad?  Only time will tell.

• Withdrew the United States from the job-killing Paris Climate Accord.
• Withdrew from the horrible, one-sided Iran Deal.

Miscellaneous: Who Cares?

• Helped win U.S. bid for the 2028 Summer Olympics in Los Angeles.
• Helped win U.S.-Mexico-Canada’s united bid for 2026 World Cup.
• Process has begun to make the Space Force the 6th branch of the Armed Forces.
• Moved U.S. Embassy to Jerusalem.

Fun Keeps You Healthy

Sometimes I get very lazy... And these are so cute... Thanks to those that sent them in and who ever created them...

Let me get this straight. We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't, written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, to be signed by a president who also smokes, with funding administered by a treasury chief who didn't pay his taxes, to be overseen by a surgeon general who is obese, and financed by a country that's broke.

What the heck could possibly go wrong?

----------------------------------------------------------------

I do not like this Uncle Sam,
I do not like his health care scam.
I do not like these dirty crooks,
or how they lie and cook the books.
I do not like when Congress steals,
I do not like their secret deals.
I do not like this speaker Nan,
I do not like this 'YES, WE CAN'.
I do not like this spending spree---
I'm smart, I know that nothing's free.
I do not like your smug replies,
when I complain about your lies.
I do not like this kind of hope.
I do not like it.
Nope, nope, nope!

Go green... recycle Congress in 2010!

------------------------------------------

One serious question: What was the rationale behind Congress opting out of the National Health Plan ??? If it is good for us... Isn't it good for them ???

American Healthcare: 1% Spend 20%

The MinnPost article linked below pointed to the AHRQ Brief linked below.  Then I threw in some additional links. 

"In 2010, the top 1 percent ranked by their health care expenses accounted for 21.4 percent of total health care expenditures with an annual mean expenditure of $87,570. Overall, the top 50 percent of the population ranked by their expenditures accounted for 97.2 percent of overall health care expenditures while the lower 50 percent accounted for only 2.8 percent of the total." From the AHRQ Brief

Maybe that 80/20 rule applies to this also...  Thoughts?

AHRQ Expenditure Brief
MinnPost Costliest1% of Patients Spend 21%
EOI US Healthcare Costs
Common Wealth Explaining High American Costs
G2A American Healthcare Drivers

Trump or Warren?

NYT Trump or Warren   Laurie shared this excellent piece by David Brooks.  It will be interesting to see Trump can still win if a lot of Law and Order Republicans put our values ahead of the party line.

 I'll steal it for your convenience...

"This is a memo for the politically homeless. It’s a memo to those of us who could never support Donald Trump but think the Bernie-Squad-Warren Democratic Party is sprinting too far left. It’s a memo built around the following question: If the general election campaign turns out to be Trump vs. Warren, what the heck are we supposed to do?

The first thing we could do, of course, is pray for a miracle. Maybe the Democrats will nominate one of the five B’s or the K: Biden, Buttigieg, Booker, Bennet, Bullock or Klobuchar.

These candidates are pluralists, not purists. They make many voters who disagree with them feel heard and respected. They practice the craft of politics, building majority coalitions to get things done.

If the party nominated one of those six, you really could see the Democrats gather progressives and moderates into an enduring majority coalition as the Republicans recede into old, white, rural obsolescence. You could see movement on a range of issues where large majorities are already stacked on one side: guns, climate change, reducing income inequality, expanding health coverage.

But right now, Elizabeth Warren has the momentum, and so those of us who feel politically homeless may face a stark choice.

For many, supporting Warren is too high a price to pay, even for ousting Trump. “There is no universe where I will ever vote for Donald Trump, and there is no universe where I could ever vote for Elizabeth Warren,” Jennifer Horn, a former chairwoman of the New Hampshire G.O.P., told The Washington Examiner. And you can see why so many people have that reaction.

First, there are Warren’s policies. On trade, she’s a protectionist. Her 10-year, $34 trillion health care plan isn’t paid for. Her student debt cancellation plan is a handout to the upper middle class. Her campaign seems to not acknowledge the inevitable trade-off between economic growth and high spending, high taxes and high regulation.

Second, she’s one of the few Democrats who could actually lose. As Yascha Mounk notes in The Atlantic, Democrats won in 2018 because they won back a lot of nonpartisan suburban office park workers who found moderates they could vote for. When you remind independents of Democratic support for abolishing private health insurance and decriminalizing unauthorized border crossing — two key Warren policies — they become six percentage points less likely to vote for the Democrats. Trump will tell voters: You may despise me, but she’ll destroy the economy.

Third, a Warren presidency would be deeply polarizing and probably unsuccessful. Warren’s policy ideas would make any progressive-moderate coalition impossible. She’d try to govern with her 40 percent partisan base, just as Trump has, which is no way to pass big legislation.

Fourth, there is a wave of insular intolerance coursing through parts of the American left. If given executive power, some progressives may use it to cancel any culture or faith other than their own.

And yet, if it comes to Trump vs. Warren in a general election, the only plausible choice is to support Warren. Over the past month Donald Trump has given us fresh reminders of the unique and exceptional ways he corrupts American life. You’re either part of removing that corruption or you are not. When your nation’s political system is in danger, staying home and not voting is not a responsible option.

Politics is downstream from morality and culture. Warren represents a policy wrong turn, in my view, but policies can be argued about and reversed. Trump represents a much more important and fundamental threat — to the norms, values, standards and soul of this country. "

Last week, Trump all but greenlighted the ethnic cleansing of Kurds without an ounce of remorse. He normalizes dishonesty and valorizes cruelty. His letter to President Recep Tayyip Erdogan reminds us yet again that we have a president whose professional competence is at kindergarten level. Once a nation has lost its heart, mind and soul, it is very hard to get these things back.

Furthermore, Trump is an unprecedented threat to democratic institutions. Over the past few years, I’ve thought the progressive fears of incipient American fascism were vastly overblown. But, especially over the past month, Trump has worked overtime to validate those fears and to raise the horrifying specter of what he’ll be like if he is given a second term and is vindicated, unhinged and unwell.

In their book “How Democracies Die,” Steven Levitsky and Daniel Ziblatt argue that authoritarians undermine democracy in several ways. They reject the democratic rules of the game, the unwritten norms we rely upon to make the political system work. They deny the legitimacy of their political opponents, using extreme language to deny them standing as co-citizens. They tolerate or even encourage violence, threatening to take legal action against critics in rival parties.

Trump has been guilty of all three sins, and given a second term he will feel free to stomp where up until now he has merely trod.

This election is about whether we can hold together as a functioning nation, across our economic, racial, geographic and ideological divides. In such circumstances, a bad option is better than a suicidal one."