Jordan Weissmann writes this today:

One of Tom Price’s go-to criticisms of the Affordable Care Act is that it does not, in fact, provide people much in the way of care. The law has helped many Americans obtain insurance, sure. But because the policies have such high deductibles, he argues, patients still can’t afford medical help. "People have coverage, but they don’t have care," the Health and Human Services secretary likes to say.

We can all agree that high deductibles are a problem. Weissman, however, describes a new study which shows that actual medical care, not just insurance coverage, has increased under Obamacare. This is true of both people covered by the Medicaid expansion and people covered by the exchanges.

But did we really need a lot of fancy statistics to figure this out? Focusing only on the exchanges (since Medicaid has no deductibles):

  • CBO estimates that total federal subsidies this year will amount to $31 billion.
  • Add another third or so paid out of pocket, and we get to $40 billion in total premiums paid to insurance companies.
  • Insurance companies are required to spend 80 percent of premiums on actual medical care, which comes to $32 billion.
  • Finally, the exchanges cover about 10 million people, which means the average Obamacare recipient will receive about $3,200 in medical care this year.

My arithmetic might be off a bit here and there, but not by a lot. One way or another, the average person insured through the Obamacare exchanges receives $3-4,000 in medical care. There's no way around that.

High deductibles may be a problem, but they aren't preventing people from getting a pretty considerable amount of medical care that they weren't getting before. Where do Republicans get this stuff, anyway?

I Am Still Not A Lawyer, and I don't want to go too far down this rabbit hole, but I've gotten a fair amount of pushback to my post last night suggesting that the folks who did the undercover Planned Parenthood videos shouldn't be prosecuted. The pushback takes two forms. First, they're horrible people who did horrible things. Second, California law requires consent from both parties for any kind of recording, and they broke that law. They should pay for this.

As to the first, I agree that they did horrible things and endangered people. But that's not what they're charged with. As to the second, California law (link here) is not as clear-cut as you might think:

If a real live California attorney with specific experience in this area wants to chime in, I'm all ears. For now, though, no matter how much I loathe what they did, I don't like the idea of prosecuting people for political activities unless their violation of the law is very serious and very clear. This is neither.

Criminal prosecution of secret recordings is rare in California, and I'd just as soon keep it that way. There's a huge amount of prosecutorial discretion involved in this case, and that's a recipe for political retaliation against ideas we don't like. That's where I get off the train.

UPDATE: Then again, we have this:

The penal code is stricter than the civil code, "but excludes a communication made in a public gathering." I don't know if this refers only to public meetings (town halls, protests, etc.) or to any public place, like a restaurant. Probably the former.

This is all kind of strange. Why would there be an "investigatory" exception for lawsuits but not for criminal prosecutions?

Ross Douthat raised a common conservative talking point in his column this weekend:

It’s worth raising once again the most counterintuitive and frequently scoffed-at point that conservatives have made about Obamacare:

It probably isn’t saving many lives.

One of the most powerful arguments in the litany that turned moderate Republican lawmakers to jelly was that they were voting to “make America sick again,” to effectively kill people who relied on the Affordable Care Act for drugs and surgery and treatment....So far the evidence is conspicuously missing.

The words probably and many are doing a heavy lift here, but let's set that aside. Douthat is almost certainly right. Here's why:

People in the US don't die much before age 65, so health insurance for working-age folks has never been likely to have much effect on death rates.1 Below age 55, it's even less likely: the death rate is so minuscule that it would take a miracle to invent any kind of health-related practice that had a measurable effect on life expectancy. If the crude death rate is already below 0.5 percent, there's just no way to reduce it much more.

And yet, people like health care anyway. They like it so much that we're collectively willing to spend vast amounts of money on it. As you've probably heard many dozens of times, health care is one-sixth of the economy. On average, that means we all pay about one-sixth of our income to provide health care for ourselves.

Why? At the risk of repeating the obvious, most medical care isn't about lifespan. Before age 65, almost none of it is about lifespan. It's about feeling better. I'm taking a very expensive chemotherapy drug that probably won't delay my eventual death by much, but it will improve my life considerably in the meantime. Ditto for the antidepressant I take. And for the arthroscopic knee surgery I had a couple of decades ago.

The same is true for putting a leg in a cast; prescribing an asthma inhaler; replacing a hip; treating an infection; inserting an IUD; treating a hernia; removing a cataract; prescribing a statin; or a hundred other medical procedures. Only a small percentage of what doctors do is lifesaving.

It's a measure of our impoverished sense of empathy that we spend so much time focused on whether health care saves lives. Liberals do it because it's the only thing guaranteed to get a positive reaction. Even stone conservatives don't want people dying in the streets. If progressives focused instead on the fact that health coverage saves money and makes you feel better, there's a good chance that support for wider health coverage would suffer substantially. To an awful lot of people, just making others "feel better" doesn't seem worth paying taxes for.

So instead we end up in a proxy war about people dying. It's not the sign of a mature society, but then again, who ever said we were a mature society?

1The big exception is dying at birth or during the first year of life. The United States has an appallingly poor record on that score, especially among the poor and non-white.

Lunchtime Photo

It's wildflower season in the desert, and nearby Anza-Borrego was said to have a "superbloom" this year. I didn't feel like making the trek out there, especially since I'd have to wake up around 4 am to get there for sunrise, but a reader suggested that I check out Upper Newport Bay instead. That's a more civilized 6:30 am wakeup call. So that's where I was last Saturday.

The Wall Street Journal says that globalization is dead, killed on a rising tide of financial crisis, populism, and nationalist politics. Some threads of their evidence are more convincing than others, but a quick look at global trade shows that they have a point:

Since 2011, world trade (in both merchandise and services) has grown at a rate of about 0.8 percent per year. By 2014 it had barely recovered to its pre-recession high. That compares to a growth rate of over 17 percent per year in the first eight years of the century. Globalization may not be dead, but it's definitely taking a nap.

Over at the Intercept, Josh Begley has a story that's disturbing—but not in the usual Intercept way:

Five years ago, I made a simple iPhone app. It would send you a push notification every time a U.S. drone strike was reported in the news. Apple rejected the app three times, calling it “excessively objectionable or crude content.”

....In 2014, after five rejections, Apple accepted the app....But the following September, Apple decided to delete the app entirely. They claimed that the content, once again, was “excessively objectionable or crude.”...Well, Apple’s position has evolved. Today, after 12 attempts, the Metadata app is back in the App Store.

....Update: 2:32pm. Apple has removed Metadata from the App Store.

There is, needless to say, nothing objectionable or crude about this app. It merely aggregates news on a particular subject. Drone strikes themselves may be objectionable and crude—opinions differ, obviously—but reporting on them isn't.

This matters. Upwards of half of all Americans get some or most of their news from their mobile devices, and for all practical purposes there are only two options in the mobile device world: iOS and Android. If you can't get an app accepted on either platform, then no one will ever see your app. Apple and Google are the sole gateways to what we can and can't see.

Now, there are obviously other ways of getting the news. There may even be a website that aggregates drone news the same way Begley's app does. Still, there's no question that an app can do things a news site can't. It can make the news more immediate. It can make sure you don't miss anything. It can allow you to share more easily with fellow activists.

When Google and Apple are just keeping out porn sites, no one really cares. Even when they're nixing apps that happen to compete with Apple or Google, people mostly shrug. But when they start censoring apps based on their news content, we're in trouble. If there were dozens of mobile platforms, and none of them had a big market share, it might not matter too much. Competition would probably sort things out. But when there are only two, it matters a lot. There may still be plenty of news outlets, but in a real-world sense we're increasingly outsourcing our news to a tiny number of players—mostly Apple, Google, and Facebook. We may wake up some morning and be sorry we did that.

Prime Minister Theresa May submitted an official notice today the Great Britain will be exiting the European Union:

Now that Prime Minister May has officially given notice to Tusk, the next step is to begin negotiations about the negotiations. In about a month, the UK and EU will formally sit down to come to terms on how the negotiations will work.

“Most of the formal stuff that will be agreed upon in the big meetings has already been penciled in,” Tim Oliver, an expert on the EU at the London School of Economics, tells me....Ultimately, Oliver believes, “nothing substantive” will be agreed upon until after the French presidential election in April and the German parliamentary election in late September. That’s because the French and Germans are, by far, the two most important EU member states. Without a firm sense of who their leaders will be in the coming years, it will be impossible to know what terms the EU might agree to.

In other words, nothing really happens for the next six months. And that's totally OK because, hey, that still leaves 18 months to negotiate the biggest, messiest divorce in treaty history. Plenty of time. No need for any sense of urgency here.

Remember the undercover Planned Parenthood videos that caused such a fuss last year? Their creators, David Daleiden and Sandra Merritt, are back in the news:

Two antiabortion activists whose controversial undercover videos accused Planned Parenthood doctors of selling fetal tissue were charged Tuesday with more than a dozen felonies by California prosecutors.

....Prosecutors contend Daleiden and Merritt used fake identities and a fabricated medical research company, BioMax Procurement Services, to secure the meetings with healthcare providers, according to court papers filed in San Francisco Superior Court. Prosecutors also contend they made secret recordings of attendees and speakers at the National Abortion Federation’s 2014 conference in San Francisco.

I continue to have zero sympathy for these two. They edited their videos deceptively and basically lied about everything they did. Nevertheless, I don't like the idea of prosecuting them. This was a legitimate investigation, and no level of government should be in the business of chilling it. The First Amendment doesn't say anything one way or the other about how honest one's speech has to be.

This also strikes me as political grandstanding. I imagine that if this were a couple of liberal activists secretly recording meetings with anti-immigration groups, Attorney General Xavier Becerra wouldn't so eager to go after them.

Needless to say, I Am Not A Lawyer, and there might be a good case that they broke California law. If they did, though, so much the worse for California law.

Not satisfied with proposing $54 billion in domestic spending cuts for next year, today President Trump asked Congress to cut $18 billion in what's left of the current fiscal year:

The White House is asking Congress to cut $18 billion from discretionary spending bills for the current fiscal year that have been long settled — a move that could threaten a major showdown just a month ahead of the deadline to keep the government funded....The $17.94 billion cut would help pay for Trump’s military supplemental request, which was sent to Congress earlier this month. About $2 billion would also go towards Trump’s proposed wall along the Mexican border.

This is yet another half-baked Trump idea, and it's the last thing Congress needs on its plate right now. Health care failed because they tried to rush it through, and now they have a grand total of 65 legislative days to work on tax reform and finish up the budget for next year. They really can't afford to waste their time on dumb stuff like this.

Aside from that, I continue to be perplexed about this whole thing. These cuts are supposed to pay for Trump's $30 billion supplemental military request, $25 billion of which is targeted for the Pentagon's base budget. But Congress can't do that. The sequester caps prevent it, and there's no way to increase the caps without Democratic cooperation. John Boehner struck a bipartisan deal to do that in 2015, but there's no way Republicans are going to get a similar deal while also proposing whopping big domestic cuts.

The same is true of Trump's proposal to increase military spending $54 billion next year. So what's the point of all this? I can think of three basic scenarios that Trump might be hoping for:

  1. Ask for the extra $54 billion in military spending, and then settle for less by agreeing to smaller cuts in domestic spending.
  2. Do a deal with Democrats that increases both military and domestic spending, but increases military spending more.
  3. Same as #2, but also kills sequester caps permanently.

None of these seem especially likely, and only #2 seems even remotely within the realm of the plausible. The Democratic position right now is that they'll increase military spending caps only if domestic caps are raised by the same amount. They might agree to a smaller increase for domestic spending, but there's no chance they'll go any further. Why should they? Trump really doesn't have any leverage here.

One possibility, of course, is that Congress will put all $54 billion into the Overseas Contingency Operations fund, which isn't affected by the sequester caps. But if that's the plan, why not propose the same thing for this year's request? Am I missing something?

Lunchtime Photo

This is our new Hello Kitty Cafe at the Spectrum shopping center. You're jealous, aren't you? You wish you had a Hello Kitty Cafe.

This picture was taken shortly before I was kicked off the property.1 Snapping pictures with cell phones is fine, it turns out, but the security guards are told to watch out for anyone with a "high end" camera. No management pass, no picture taking.

1Not really kicked off, actually. Just told to stop taking pictures by the security guard, who was very nice. But there was no point in staying if I couldn't take any pictures.