President Trump has been promising a health care plan for months now. But when will we have it? Let's roll the tape:

January 15: "It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon."

February 5: "I would like to say by the end of the year at least the rudiments but we should have something within the year and the following year."

February 16: "We're doing Obamacare, we're in the final stages. So, we will be submitting sometime in early March, mid-March."

February 27: "We have come up with a solution that's really, really, I think, very good."

So we've gone from immediately to 2018 to mid-March to all done. Today, however, Politico reports that in reality, Trump has no plan at all: "His team has signaled to House Speaker Paul Ryan that they will embrace his health care bill next week, and aides hoped to get a marked-up bill ready."

Since the House bill is apparently what we're going to get, it's worth repeating something I wrote a few months ago. After describing both Obamacare and Ryancare in broad strokes, I noted that their foundations were basically the same:

If you haven't yet noticed what this all means, let me spell it out. The key parts of Obamacare and Ryan's plan are the same. They both (a) rely on private insurance, (b) require insurance companies to cover people with preexisting conditions, (c) encourage people to buy insurance continuously by penalizing them if they don't, (d) provide billions of dollars in federal subsidies to make insurance affordable for low-income households, and (e) rely on Medicaid for the very poorest.

As liberals have been pointing out forever, any kind of health care plan has to have three parts:

  • Protection for pre-existing conditions at a reasonable price, so everyone has access to insurance.
  • Some kind of incentive for everyone to buy insurance, so insurance companies have plenty of healthy people to balance out the sick people.
  • Subsidies so that poor people can afford coverage.

Sure enough, Ryancare has all those things, just like Obamacare. There are differences in the details, but those don't matter very much. What does matter is the difference in cost. Obamacare provides subsidies of about $100 billion per year, while Ryancare provides...something much less. We don't know exactly how much less yet, but certainly less than half of Obamacare, maybe as little as a quarter. This is what makes Ryancare useless, not its overall structure, which is fairly workable. The working poor and the working class can only barely afford insurance even with Obamacare's subsidies. They won't come close with Ryancare's.

But the rich will get a big tax cut, and the middle class will get a nice break on their health insurance. In short order, however, interstate deregulation will almost certainly lead to individual insurance becoming all but useless, and the individual insurance market will probably collapse fairly soon after that. Alternatively, it might collapse even before Ryancare goes into effect, as insurers bail out on Obamacare (why bother with it if it's just going away soon?) and conclude that they can't make money on Ryancare either.

See? It's not so complicated after all. I imagine this is what Paul Ryan has wanted all along.

I was reading something yesterday about President Trump's desire to speed up FDA approvals for new drugs, so I decided to check: how long does FDA approval take these days? Here are the numbers over the past decade:

I've used a 3-year rolling average to smooth out the spikes, but the trend is pretty obvious. In the past ten years, the time to approve new drugs has been cut in half and the approval rate has tripled. Note that this is only for "standard" drugs, not "priority" drugs, so it's not contaminated by special treatment given for certain lifesaving compounds.

I'm sympathetic to arguments that our narrow escape from the thalidomide disaster of the early 60s traumatized FDA scientists, and they overreacted by making approvals too hard. The problem is that the lesson of thalidomide approval in Europe isn't that approvals were done too quickly, it's that approvals shouldn't be based on handwaving from pharmaceutical companies. As long as the testing regimen is rigorous enough, there's no reason that approvals shouldn't be done in a timely way.

That said, how much faster does Trump want approvals to go? A recent study suggests that the average FDA approval time is now considerably faster than Europe's, and that "the vast majority" of new drugs were first approved for use in the United States:

If anything, the FDA may have become too aggressive. They've made some far-reaching reforms in only a decade. Ten years from now, the chart to look at will be a comparison of drug catastrophes before and after this change.1

1I don't mean this in a snarky way. There's no cosmic "right answer" for how fast new drugs should be approved. It's all a matter of how much risk we're willing to take vs. how long we're willing to delay potentially effective therapies. A decade from now, we'll need to look back and see just how much extra risk, if any, the FDA has introduced into the system.

It's Saturday. I figured I'd sleep in and eat breakfast before I checked in on the news. After all, how much can happen on a Saturday morn—

Oh FFS. Fine. Let's hear the evidence:

Then, just to show how serious this is, an hour later Trump tweets about Arnold Schwarzenegger's "pathetic" ratings on Celebrity Apprentice. Then it's off to the golf course.

So what's going on? Did Obama really tapp Trump Tower during the sacred election process? I hope so! If he did, it would mean a judge had found probable cause that Trump had committed a crime of some kind.

Alternatively, it could mean that the FBI or the NSA was listening to a foreign phone call and Trump was on the other end. That would be great too.

Or, of course, Trump might be full of shit. Sadly, this is the most likely possibility. But you never know. Maybe there's some real dirt here and Trump is trying to get ahead of it. When it leaks, he'll try to convince everyone that the real issue is all the illegal leaks. Or the Nixonian/McCarthyite use of wiretaps. Or the fact that Obama is a sleaze, which is guaranteed to excite the base.

In any case, our next White House press briefing should be interesting, don't you think?

UPDATE: Hmmph. Breitbart News ran a story yesterday summarizing a Mark Levin radio show that outlined a bunch of stuff that's already been reported, including the fact that a FISA warrant was obtained to monitor the communications of some Trump aides:

In summary: the Obama administration sought, and eventually obtained, authorization to eavesdrop on the Trump campaign; continued monitoring the Trump team even when no evidence of wrongdoing was found; then relaxed the NSA rules to allow evidence to be shared widely within the government, virtually ensuring that the information, including the conversations of private citizens, would be leaked to the media.

Is that it? The Washington Post reports that the Breitbart story "has been circulating among Trump's senior staff." How boring.

Just as I thought that Hilbert and Hopper had given up on sleeping with each other, suddenly they've decided to occupy the pod together. This mostly happens when Hopper gets in the pod and then Hilbert asserts his ownership rights1 by jumping on top of her. In the past, Hopper would usually just vacate. It wasn't worth the trouble of staying. But lately she's been holding her ground. For at least a little while each day, the pod is just an adorable mound o' cats.

1In fairness, it is his pod, by right of tenancy. Hopper never really liked the pods that much, but Hilbert has been a faithful pod companion on my desk ever since we brought him home.

I got curious about NATO spending today. We know that most NATO countries don't come close to meeting their goal of spending 2 percent of GDP on defense, and we know that past presidents have all urged them to spend more. Have they at least done that? Nope:

By my reckoning, only six of the 22 countries that are below the 2 percent goal spend more on defense today than they did in 2009: Luxembourg, Norway, Romania, Turkey, Latvia, and Lithuania. I guess we'll see how President Trump does at fixing this.

Donald Trump, three days ago on national TV:

We have cleared the way for the construction of the Keystone and Dakota Access Pipelines, thereby creating tens of thousands of jobs. And I’ve issued a new directive that new American pipelines be made with American steel.

Donald Trump, in a quiet update delivered today via a spokeswoman:

The Keystone XL Pipeline is currently in the process of being constructed, so it does not count as a new, retrofitted, repaired or expanded pipeline.

Impressive use of weasel wording, Mr. President! I'm glad we got that cleared up. I guess American steel mills will benefit from Trump's executive orders as much as coal workers will.

A reader emails with a question:

The repeal-Obamacare mania has been on for years, but I have NEVER read anything about what the insurance industry is thinking or doing about it.

Neither have I! And it's damn mysterious. Obviously the insurance industry was heavily involved in lobbying for Obamacare back in 2009, and just as obviously there are parts of Obamacare they don't like. The patient pools have turned out to be sicker than they projected and insurance companies have struggled to make money on Obamacare policies. This year, however, they're finally there—or close to it. The market has shaken out, premiums have risen to CBO-projected levels, and Obamacare is probably a break-even or better prospect for the insurers who have gutted through the first three years.

What's more, like it or not, they've spent years adapting the way they do business. Everything from computer systems to physician compensation now follows Obamacare's rules. This has cost tens of millions of dollars, but now it's done. The last thing they need is to rip it all out and start from scratch.

And yet insurance companies have been surprisingly silent about the Republican plan to kill Obamacare. Do they prefer getting rid of it even if there's an upfront cost? Have they given up, and assume that repeal is a foregone conclusion that's not worth fighting? Is all their lobbying behind the scenes? It's not clear. Insurers are pretty unanimous about wanting some certainty in the rules, but aside from that, this eight-week-old story from the New York Times still describes things pretty well:

Far from reflecting the magnitude of the moment, the most prominent message from lobbyists that lawmakers saw in their first week back at work was a narrowly focused advertisement from the U.S. Chamber of Commerce....Health care professionals are not totally silent, but industries that were integral to the creation of the Affordable Care Act in 2010 are keeping their voices down as Republicans rush to dismantle it.

....Some lobbyists have tacitly accepted the likelihood that major provisions of the health law will be repealed, setting their sights instead on shaping its replacement. They fear that if they come out strongly in opposition to repealing the law, they will lose their seats at the table as congressional Republicans and the Trump administration negotiate a replacement.

Insurers spent $150 million lobbying in support of Obamacare in 2009. So far they've spent virtually nothing in 2017. I continue to be mystified by this.

Buy American?

Apologies for the late start this morning. My alarm cat went off at 6:30 and I hit the snooze button. But instead of a ten-minute delay, it didn't go off again until 7:55. Very unreliable, these American cats. I'm thinking maybe next time I should get something made overseas, even if there's a tariff on it. Maybe something from Turkey or Siberia.

Reuters tells us what to expect from President Trump's budget:

Under the proposal, which was sent to the EPA this week, grants to states for lead cleanup would be cut 30 percent to $9.8 million, according to the source, who read the document to Reuters.

What an idiot. This is hardly the biggest issue in his budget, and I'll grant that the current allocation for lead cleanup is so pitiful that a 30 percent cut hardly matters. On principle, though, it's obvious that Mick Mulvaney's crew just saw a line item in their spreadsheet and slashed it without knowing anything about it. Nice work, folks. You get a gold star.

By coincidence, the Washington Post ran a piece yesterday that's all about lead—though the reporter didn't realize it:

In dozens of one-on-one meetings every week, a lawyer retained by the city of Philadelphia summons parents whose children have just been jailed, pulls out his calculator and hands them more bad news: a bill for their kids' incarceration….[He] is one agent of a deeply entrenched social policy that took root across the country in the 1970s and '80s. The guiding principle was simple: States, counties and cities believed that parents were shedding responsibility for their delinquent children and expecting the government to pick up the tab.

.…"It was a very different time, when too many parents frequently wanted to essentially 'dump' their adolescent children on juvenile courts when they found them unruly, ungovernable, uncontrollable,” Linda O'Neal, executive director of the Tennessee Commission on Children and Youth, said of the era decades ago when the laws were implemented.

Regardless of what you think about this policy, there's a reason it "took root" in the '70s and '80s: Kids of that era spent their early childhoods surrounded by lead fumes from automobiles, so they contracted lead poisoning in massive numbers. By the time they were teenagers they really were "unruly, ungovernable, uncontrollable," and parents didn't know what to do.

As it turns out, there was nothing they could do. The damage was done. But nobody knew that, so we put in place pointless laws based on the premise that if only they worked harder, parents could keep their kids under control. In reality, the only policy that ended up working came from Trump's hated Environmental Protection Agency, which banned leaded gasoline and put an end to our national epidemic of lead poisoning.

But the old laws are still around, even though they don't work, while the EPA's lead cleanup program is being slashed, even though it does work. Welcome to America.

Okay, I'm back from lunch. Have any more shoes dropped in the Jeff Sess—

Attorney General Jeff Sessions said Thursday he will recuse himself from any investigations related to the 2016 presidential campaign, which would include any Russian interference in the electoral process…The announcement comes a day after The Washington Post revealed that Sessions twice met with Russian Ambassador Sergey Kislyak and did not disclose that fact to Congress during his confirmation hearing.

Okey doke. I guess we all saw that coming. Anything el—

Michael T. Flynn, then Donald J. Trump’s incoming national security adviser, had a previously undisclosed meeting with the Russian ambassador in December to "establish a line of communication" between the new administration and the Russian government, the White House said on Thursday. Jared Kushner, Mr. Trump’s son-in-law and now a senior adviser, also participated in the meeting at Trump Tower with Mr. Flynn and Sergey I. Kislyak, the Russian ambassador.

Huh. Well, Kushner is supposedly going to be dealing with foreign policy issues, so I suppose that makes sense. It's all above board and—

Look, can I finish a question, please? Obviously we don't know what Sessions and Kislyak talked about, but is there any evidence at all linking their meeting to Russian hacking? Even something circumstantial?

Well, I'm sure there's an innocent explanation for all this. Probably lots of senators chat with Kislyak now and again just to size up Russia's intentions, don't you think? Especially those with direct concerns about Russia, like Sessions' fellow members of the Armed Services Committee.

Come on. All this happened while I was at lunch?

Yes.

I can hardly wait for dinner.