Christopher Ingraham asks, "Is the money we're spending on health care keeping us alive?" It's this chart that gives him pause:

This is a dramatic chart, for sure. But I'm not sure it highlights the right issue. The US spends a lot more on health care than other countries, but that's not because we provide better or worse health care. We just pay more for the same stuff. We pay doctors more and we pay nurses more. We pay more for drugs, more for hospital stays, and more for tests. This is a consequence of a mostly private health care system that doesn't control costs very well, but it says nothing about the quality of care.

Instead, I would draw your attention to this chart:

The difference in life expectancy between the top and bottom is ten years for women and a stunning 15 years for men. Nor do you need to look at the very top to match European life expectancies. A merely average American has a life expectancy of 82 years, right in line with other advanced countries.

So here's the question: I assume that every country shows a decline in life expectancy as you get poorer. But do other countries show the astonishing decline we have in the US? I can't find an authoritative analysis of this, but I scanned through some reports from different countries and it looks to me like the income difference in most places is half to two-thirds of the US difference.

This is where I suspect our health care system goes awry: in quality of care to the poor. Compared to other advanced countries, it's terrible, and that shows up in the life expectancy numbers for the poor.

This is testable with the right statistics. In particular, I'd be interested in seeing the chart at the top not for overall life expectancy, but for life expectancy of those with median incomes. Does any such thing exist?

The American Medical Association has decided to speak up after all. They are not happy with the Republican health care plan:

While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.

....It is important that the amount of credits available to individuals be sufficient to enable one to afford quality coverage. We believe that credits should be inversely related to an individual’s income....We are concerned [] with the proposed rollback of the Medicaid expansion under the ACA....The AMA cannot support provisions that repeal the Prevention and Public Health Fund or that eliminate the ability of patients to receive their care from qualified providers of their choice.

....We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, CHIP, and other safety net programs are maintained and adequately funded. And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured.

Other than that, Mrs. Lincoln, how did you like the show?

In a separate commentary, under the headline "Physicians reject House ACA replacement bill," the AMA's president says this: "The ratings and analytics firm S&P Global Ratings has already estimated that as many as 10 million Americans could lose coverage if this bill becomes law....That just won’t do."

Among the big industry players, only the insurance companies continue to remain quiet about the Republican plan. However, with everyone else opposed to it, they might finally decide to speak up. They're the ones for whom RepubliCare is an existential threat, after all.

But while we're on the subject, has anyone noticed that there's one other player who doesn't support the Republican bill? So far, President Trump's sole comment about it has been this: "Our wonderful new Healthcare Bill is now out for review and negotiation." By Trump standards, that's practically a denunciation. Elsewhere in the administration, Tom Price apparently hasn't read the bill and Sean Spicer's big pitch was the fact that it has fewer words than Obamacare. This is a decidedly restrained approach. It appears that Trump doesn't want to be too closely identified with this dumpster fire of a bill. He may not be very smart, but he has an animal cunning that's probably warning him to keep his distance.

Engagement Labs is a company that tracks "what people are talking about." Brad Fay, one of their executives, tells us that during the presidential campaign people were talking very negatively about everyone. They were more negative about Donald Trump, but they were plenty negative about Hillary Clinton too. However, the gap between the candidates changed from time to time based on external events:

Most decisively, there was a sudden change in the net sentiment results that followed immediately after FBI Director James Comey released his Oct. 28 letter to Congress about a renewed investigation of Clinton emails. Immediately afterwards, there was a 17-point drop in net sentiment for Clinton, and an 11-point rise for Trump, enough for the two candidates to switch places in the rankings, with Clinton in more negative territory than Trump. At a time when opinion polling showed perhaps a 2-point decline in the margin for Clinton, this conversation data suggests a 28-point change in the word of mouth "standings." The change in word of mouth favorability metric was stunning, and much greater than the traditional opinion polling revealed.

Of course, a picture is worth a thousand words:

In late October, Clinton leads Trump by 24 points in the Engagement Labs survey. Two days after the Comey letter is released, Trump is ahead by 4 points. Trump kept that lead until Election Day.

Once again: Clinton did nothing particularly wrong in her campaign. She didn't ignore working-class whites. She wasn't too cautious on policy. She didn't overestimate the impact of educated voters. She wasn't complacent. What happened was simple: 12 days before the election, the FBI director released a letter saying he had found a brand-new trove of emails and implying that this might finally be the smoking gun about her private email server. That's it.

We'll never know for sure if James Comey did this because he's terminally stupid and didn't realize what impact it would have, or if he did it knowing full well what impact it would have. But he did it. And that's why Donald Trump is president.

Donald Trump on Monday:

I know, I know, it's just a Trump tweet. Who cares? Well, I was curious about how this went down, so I clicked on the press statement:

President Trump made a promise to bring back jobs to America. The spirit of optimism sweeping the country is already boosting job growth, and it is only the beginning.

....Darren W. Woods, chairman and chief executive officer of Exxon Mobil announced the company’s investment program during a keynote speech today to an oil and gas industry conference in Houston, Texas. “Investments of this scale require a pro-growth approach and a stable regulatory environment and we appreciate the President’s commitment to both,” said Woods.

The weasel wording immediately alerted me that this was BS, but just as I was about to fire up Google to check it out, I read further:

The company’s Growing the Gulf program consists of 11 major chemical, refining, lubricant and liquefied natural gas projects at proposed new and existing facilities along the Texas and Louisiana coasts. Investments began in 2013 and are expected to continue through at least 2022.

They're not even bothering to make us do any work anymore. They just admit straight up in the White House press release that this all started under President Obama four years ago. I guess they know they'll get called on it if they don't admit this, and they don't really care anyway. All they care about is that their fans see "45,000 jobs" and "construction & manufacturing." They'll believe anything Trump says, and 45,000 sounds like a pretty big number. Mission accomplished.

Just for the record, the country added 20,000 jobs per month in construction alone over the past six years. ExxonMobil is adding about 400 jobs per month. Here's the chart. Trump's starting point is 6.8 million.

Apparently the CBO plans to have an official score of RepubliCare next Monday. That gives Paul Ryan three days to ram it through committee and onto the floor before the world learns just how bad his bill is. Or, maybe five days if he's willing to work weekends. Do you think he can do it? I don't.

While we wait, however, let's take a look at some unofficial estimates. First, here is Edwin Park of CBPP on the Medicaid provisions of the bill:1

I should note that in practical terms, "shifts to states" means "cuts." But who cares, amirite? It's all just a bunch of poor people anyway. They may have to cut back on their iPhones and their T-bone steaks, but that's all.

On the other hand, the cuts would also affect people that Republicans care about. Here are David Cutler and friends over at Vox:

We estimate that the bill would increase costs for the average enrollee by $1,542, for the year, if the bill were in effect today. In 2020, the bill would increase costs for the average enrollee by $2,409.

....The impact of the Republican bill would be particularly severe for older individuals, ages 55 to 64. Their costs would increase by $5,269 if the bill went into effect today and by $6,971 in 2020. Individuals with income below 250 percent of the federal poverty line would see their costs increase by $2,945 today and by $4,061 in 2020.

....Over time, the value of the new tax credits under the Republican bill would erode significantly. That’s because they are indexed to grow with consumer inflation plus 1 percentage point, which is much slower than the rate medical costs are actually growing. Under the ACA, by contrast, tax credits grow in lockstep with premiums for “silver” plans, and costs are capped as a percentage of income.

Yikes! "Older individuals ages 55 to 64." That describes a lot of Republicans. We're certainly not going to ask them to give up their iPhones and T-bone steaks, are we? This is a real problem.

And one more thing. That business about "consumer inflation plus 1 percentage point" sounds really dry and tedious—and it is. But it's also really important. Here's a look at how CPI + 1 compares to medical inflation over the past few decades:

If this standard had been in place for the past three decades, subsidies would have eroded by more than a quarter. What used to be a subsidy of $1,000 would be a subsidy of $720—and you'd have to make up the difference out of your own pocket. It's sneaky and slow, but it makes a big difference over time.

1I note that CBPP's chartmakers have fallen prey to the PowerPoint disease of using apostrophes that point the wrong way. It's very sad. Pretty soon, though, this will be the new standard and we'll all just have to get used to it. Thanks, Bill Gates.

A few days ago I posted a tweet from Catherine Rampell about Donald Trump's proposal to slash the IRS budget, even though that would mean less enforcement and fewer audits, thus costing the government a lot of money. Today Rampell is back with raw data on this, which I've combined into one gloriously ugly chart. But there's a reason to make it so ugly. Can you figure it out?

You're too smart for me, aren't you? Or did my dotted line at 2011 give the game away? As you can see, IRS enforcement—and its audit rate—went up toward the end of the Bush administration and the beginning of the Obama administration. Then Republicans won a landslide victory in the 2010 midterms and took over Congress in 2011.

That was the high point of IRS efficiency. It's been straight downhill ever since. Enforcement is down, corporate audits are down, and audits of the rich are down. And why not? Corporations and the rich bought themselves a shiny new Congress in 2010, so why shouldn't they get their money's worth?

Let's round up some of the reaction to AHCA,1 the Republican health care bill. I think we know how liberals feel about it, so we'll start with real, dyed-in-the-wool conservatives:

A long-awaited plan to repeal the Affordable Care Act and remake the American health care system faced a revolt from the right on Tuesday....“This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction,” said Senator Mike Lee, Republican of Utah, who was joined by a constellation of conservative groups, including the Club for Growth, Heritage Action for America and Charles G. and David H. Koch’s Americans for Prosperity. “We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that.”

Oof. How about old people?

It's not age-rating in the bill, it's an age tax! They're not wrong about that, though. The bill really would be bad for us old folks. How about hospitals?

The American Hospital Association has already said no to House Republicans’ health care bill....[They] cite two major problems: First, the legislation has not been scored by the Congressional Budget Office — so there’s no official estimate for how many people will lose (or gain) health insurance as a result of the bill. Second, the bill cuts back on programs, particularly the Medicaid expansion and tax credits for health insurance, that make health care affordable and accessible to millions of people.

Insurance companies?

J. Mario Molina, chief executive of Molina Healthcare Inc., a major managed-Medicaid company that also offers ACA plans in nine states, said he believes that striking the coverage mandate penalties could help push individual-plan premiums up by 30% or more next year—and more in the future, when the reduced subsidies kick in. That shift, he estimated, could shrink enrollment in ACA plans by three-quarters or more, leaving a smaller, less-healthy group of enrollees. “You’re going to see big rate increases, and you’re going to see insurers exit markets...this is going to destabilize the marketplace,” he said.

The Congressional Budget Office?

Oh, right, they haven't scored it yet. By all appearances, Paul Ryan was literally hoping to jam the bill through so fast that it would pass the House and then get a cursory rubber stamp in the Senate before the CBO even had a chance to calculate a score. That was a fantasy, of course. We're all going to see the score, and it's going to be godawful.

It's genuinely not clear if there's a single group that supports this bill. The AMA hasn't chimed in yet, and neither has AHIP, the insurance company trade group. I doubt they think very highly of it, but they'll probably stay quiet for a while because they want to retain the possibility of working with Republicans to influence the bill. After all, it might pass. You never know.

1That's the American Health Care Act.

Apparently we now have an official excuse for why the Republican health care bill is so bad: It's just Phase 1. Phases 2 and 3 will be coming later and will include all sorts of wonderful things like selling across state lines and so forth.

In related news, Donald Trump has some land in Florida for your purchasing consideration.

You know, if there was a flaw with Obamacare that everyone agreed about, it was this: the insurance pool included too few young, healthy people to balance out everyone else. The problem is that lots of young people who are short of money figured they didn't really need insurance, so they just skipped it.

Obamacare attempted to fix this by (a) providing subsidies so insurance would cost less, and (b) assessing a penalty if you didn't buy insurance. Unfortunately, it wasn't enough. The subsidies were too small and the penalty was too light. Lots of young people still didn't want insurance, and either paid the penalty or else did nothing and hoped they'd get away with it.

The answer to this is obvious: increase the subsidies and the penalty until you get to the point where young people decide they might as well just get insurance. So what does the Republican health care bill do? It reduces both the subsidies and the penalty. As a result, the insurance pool will be even more unbalanced, and even more likely to fall into a death spiral.

This is all very obvious stuff. It's not an accident. It's just another piece of evidence that Republicans don't really want their plan to succeed.

In my post this morning about the Republican health care bill, I was going to make a snarky comment about its weakness being driven partly by the Republican desire to avoid anything like the "2,700 page" ACA, which they've been griping about for years. But I desisted. There's no need to get sarcastic when there are plenty of substantive criticisms to make. But then we get this:

These guys never give up. But just for the record, it takes a lot of pages to set up a healthcare system. It takes one sentence to repeal it. That's why the Republican bill is so short.

And as long as we're on the subject, Ezra Klein says this today:

The GOP health bill doesn’t know what problem it’s trying to solve

Ezra makes a bunch of good points, and his piece is worth reading. But I disagree with him. There's no way to say this without sounding hopelessly partisan, so I'll just say it: Republicans knew exactly what problem they were trying to solve. Their preference has always been to repeal Obamacare and do nothing in its place, but they don't have the votes to overcome a Democratic filibuster, so they can't do that. They also realize that the optics of baldly ripping away health coverage from 20 million people would be mildly troublesome.

So their goal was simple: do what they could to destroy Obamacare and take away as much health coverage as they could, without making it look like they weren't offering a replacement. The result is a plan that offers the trappings of health care—subsidies, pre-existing conditions, etc.—but which is all but useless to the people who actually need it. It's too stingy for poor people, and mostly unnecessary for middle-class folks who already get health insurance from their employers. It will cost very little because virtually nobody will use it.

The part they apparently didn't realize is that keeping the pre-existing conditions clause—which is both popular and impossible to repeal—while tearing down the rest of Obamacare is likely to destroy the individual insurance market. At least, I assume they didn't realize that, since this would be bad news even by Republican standards. I don't know what, if anything, they plan to do about that. Maybe nothing. Maybe they're just counting on their repeal bill failing in the Senate, so nothing bad will happen and they can get back to complaining about Obamacare.

The American Council on Science and Health has teamed up with Real Clear Science to rate science journalism. What scientific technique did they use to do this?

Our assessments were based off more than fifteen years of shared experience aggregating quality science content. We tried our best to disegard our own ideological biases to evaluate the sources based on our chosen criteria (more on that below), presenting evidence to back our claims. We placed all the selected sites onto a grid and moved them around over the course of a week's worth of discussions. After eight iterations, here are the results.

....Notable bottom feeders in science include The Huffington Post, Mother Jones, INFO WARS, and Food Babe. Read these sites only if you want to reinforce your comfortable cocoon of pseudoscientific hokum.

Goodness. They don't seem to think very highly of Mother Jones. Let's take a look at the infographic:

Jeez, we're not even as good as Fox News, which rates better than the New York Times on the quality of its reporting. Does this seem a wee bit unlikely to you? Well, the Real Clear empire is a conservative outfit, while ACSH was initially a Scaife-funded group which then branched out to oil companies and other industry groups. Under the circumstances, I suppose it's only natural that they'd think fairly well of Fox and fairly poorly of us. After all, ACSH has a long history of skepticism toward government regulation of food and chemicals, while we have a long history of skepticism toward the food and chemical industries that have worked tirelessly over the decades to manufacture doubt about any attempt to cut into their bottom lines. I guess we're natural enemies.

But I wonder what they think about lead and crime?