You’ve probably signed away your right to sue your cell phone carrier, your cable company, and maybe your doctor and dentist too. Instead, if you have a complaint, you’re required to take it to arbitration, whether you want to or not.

How do they get away with this? Mostly by giving you no choice. You probably have only one cable company to choose from. There are four big cell phone carriers, but they all mandate arbitration. And it’s so common among doctors that you’d have a hard time finding one who doesn’t require it. In practice, they require it because they have enough market power to make it stick.

It’s ironic, then, that nursing homes don’t like it when someone with even more market power than them turns the tables:

In October 2016, the Centers for Medicare and Medicaid Services (CMS) decided to push back on mandatory arbitration. By rule, CMS adopted a novel “condition of participation” for Medicare and Medicaid. Nursing homes that participate in the programs—which is to say, all nursing homes—could no longer ask their residents to sign away their right to sue upon entering the nursing home.

….Predictably, the nursing home industry sued, arguing that the rule exceeded CMS’s authority….Then President Trump took office. In early June, with little fanfare or notice, the administration dismissed the appeal and proposed to undo the change altogether. “Upon reconsideration, we believe that arbitration agreements are, in fact, advantageous to both providers and beneficiaries because they allow for the expeditious resolution of claims without the costs and expense of litigation.”

That’s from Nicholas Bagley, who says, “With health reform dominating the news, this volte-face has been overlooked. That’s a shame: it’s a big deal.” He promises to dive into it in more depth over the next couple of weeks.

The Trump White House has been unusually quiet about its campaign to defeat ISIS. Kimberly Dozier might have an explanation:

U.S. special operations forces have removed roughly 50 top ISIS leaders off the battlefield since President Donald Trump took office, down from 80 killed in the last six months of the Obama administration, according to figures obtained by The Daily Beast. “The pace and the way they have gone about going after these HVT’s [High-value targets] hasn’t changed,” said coalition spokesman Col. Ryan Dillon of the U.S. special operations’ campaign to take ISIS commanders off the Iraqi and Syrian battlefields.

….Trump’s changes to the campaign so far have been tactical—namely, giving the military more autonomy to strike, including special operators….That’s presented a dilemma for those working on the Trump anti-ISIS strategy and slowed its public unveiling, U.S. officials tell The Daily Beast. The White House has asked defense officials to come up with new ideas to help brand the Trump campaign as different from its predecessor, according to two U.S. officials and one senior administration official. They spoke on condition of anonymity to discuss the sensitive debates.

The senior administration official described Trump’s plan as “relying even more” on special operations working together with local partner forces. “But that’s nuanced, like most of the suggested changes” and doesn’t easily translate to a talking point, he said. That could help explain why Trump has twice missed his own deadline for unveiling the new anti-ISIS strategy.

I can hardly wait for the new branding campaign. But I’m surprised it’s taken this long. Whatever else you can say about Trump, he’s a master marketer and slogan creator. He has an almost animal cunning for drilling in on weak points and inventing Twitter-friendly catchphrases to bring them to the masses (“low energy,” “lock her up”).

Maybe he’s off his game because he’s too busy stewing about CNN or something. But he should get with it. There’s a whole army of Trump defenders out there who are waiting to take whatever he makes up and parrot it far and wide on every media channel in the galaxy.

I know the White House probably has a handy explanation teed up just in case someone asks, but, um, what is Donald Trump doing here?

Over at the New York Times, Nikil Saval asks, ‘Who Wants to Be ‘Liberal’ Anymore?” According to Pew Research, here’s the answer:

Nearly half of millennial Democrats are willing to identify themselves as liberal, and the overall share of Democrats who call themselves liberal has been rising steadily since 2000.

The question Saval is asking is at least as old as the 60s, maybe older (though I’m too lazy to check): is the label “liberal” so associated with mainstream Democrats that it’s anathema to young lefties? Back then, the Vietnam War turned young activists against big labor and establishment Democrats, represented by people like Hubert Humphrey, Robert McNamara, George Meany, and so forth. Today, we have a new generation of Bernie admirers who feel the same way about contemorary Democrats like Hillary Clinton, Rahm Emanuel, and John Kerry—and sometimes even Barack Obama, who doesn’t always earn a pass for being the first black president.

So in 50 years we’ve gone from the SDS to Chapo Trap House, which may or may not be an improvement. But it’s nothing new. In the meantime, whether you want to call it liberalism or progressivism or anything else, Democrats have gotten a lot more friendly toward it over the past decade.

The big social media news of the weekend was Donald Trump’s posting of a video that showed him tackling and beating up a man with a CNN logo for a head. This was criticized as (a) unpresidential (duh) and (b) a call for violence against the media. I’m not so sure about that, but in any case I managed to avoid wasting time on it.

But no more! The sleuths at CNN have tracked down the guy who originally created the video that Trump retweeted. See if you can spot the part that had me in stitches:

Now the user is apologizing, writing in a lengthy post on Reddit that he does not advocate violence against the press and expressing remorse there and in an interview with CNN for other posts he made that were racist and anti-Semitic.

…. “The meme was created purely as satire, it was not meant to be a call to violence against CNN or any other news affiliation,” he wrote. “I had no idea anyone would take it and put sound to it and then have it put up on the President’s Twitter feed. It was a prank, nothing more.”

….The apology has since been taken down by the moderators of /The_Donald subreddit.

Reddit is famously the Wild West of the internet, opposed to censorship of any kind, but apparently we’ve finally plumbed the edges of their tolerance. Racism, anti-semitism, and violent misogyny are all OK. But apologizing for them? That’s going too far.

Welcome to Reddit, ladies and gentlemen.

Is it lunchtime already? Sure! It’s July 4th! Have a happy and safe day.

Avik Roy finally explains in plain language why he’s really so enthusiastic about the Senate version of Trumpcare:

Repealing and replacing Obamacare does very little to address the fundamental trajectory of the growth of federal involvement in our health care system. To do that, you have to tackle the two big Great Society entitlements: Medicare and Medicaid.

Unfortunately, the Senate is barred from using the reconciliation process to change Medicare. And even if it wasn’t, President Trump has made clear his opposition to Medicare reform. But the Senate bill does historic work to rein in the Medicaid program, putting it on a fiscally sustainable path and reducing its future spending by trillions of dollars.

Most of us think that slashing Medicaid is a bad thing that will devastate the poor, but to Roy it’s the main reason to support the Republican bill.

In fairness, Roy has been sounding the alarm about Medicaid and Medicare pretty much forever, so this is nothing new. But there’s still an odd thing here. The reason to favor Medicaid cuts in the first place is to improve the country’s finances, which the Republican bill doesn’t do. It just hands the money over to the rich. But Roy is enthusiastic anyway. Conversely, he never seemed all that thrilled with Obamacare’s cuts to Medicare, even though they were actually done right: they reined in spending growth by cutting payment levels to doctors and hospitals rather than reducing benefits or tossing people out of the program. The result was a significant boost to the solvency of the Medicare trust fund according to both the CBO and the Medicare trustees.

In any case, even if the rest of the bill is disappointing, kicking 15 million people off Medicaid and saving $772 billion apparently makes the whole thing worth it. Hooray.

Jeff Malet/Newscom via ZUMA

Republicans want to kill off Obamacare’s individual mandate:

Congress is moving to prevent the Internal Revenue Service from enforcing one of the more unpopular provisions of the Affordable Care Act, which requires most Americans to have health insurance or pay a tax penalty.

The plan is separate from Republican efforts to repeal the health care law….In case that effort fails or bogs down, the House Committee on Appropriations has drafted a provision to stop the I.R.S. from enforcing the mandate. The restrictions, for the fiscal year that starts Oct. 1, are included in an appropriations bill that was approved on Thursday by the Subcommittee on Financial Services and General Government.

There’s more here than meets the eye. Sure, eliminating enforcement of the individual mandate would be politically popular, but that’s only part of the reason for this. You see, back in March the CBO handed Republicans an unpleasant surprise: it turns out that they take the individual mandate very seriously. Here’s what CBO’s analysis of the very first House health care bill says:

CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate.

What is “most”? CBO doesn’t say, but it’s probably 10-12 million. Add in a little bit more for the years after 2018, and elimination of the mandate is probably responsible for around 12 million or so out of the total 24 million who would be newly uninsured by the Republican bill.

CBO is required to base its estimates on current law. If Republicans do away with the mandate, that’s the baseline CBO has to use. So if Republicans fail this year but re-introduce a health care bill next year, CBO will compare it to a baseline in which the mandate doesn’t exist. This is a win-win for Republicans. If they fail to repeal Obamacare this year and decide to pack it in, killing the mandate is still good politics. But if they decide not to give up, it means their next bill will automatically get a much better score. Compared to a world where the mandate is already gone, their bill won’t take away insurance from 24 million, it will take it away from 12 million or so. Fiddle around with Medicaid funding and maybe you get that down to 5 million.

To you and me, that’s still a lot. But in newspaper headlines it’s far less dramatic. Bottom line: even if Republicans fail this year, Obamacare isn’t safe. Republicans can spend the next year sabotaging Obamacare¹ and giving some real thought to a new replacement bill. They’ve learned a lot about how CBO scores things, and that will allow them to craft a bill that’s carefully tailored to get the best possible score while still reducing taxes the maximum amount. No matter what happens with Trumpcare this year, the fat lady has definitely not sung.

¹As a bonus, killing the mandate helps with this. It mostly affects healthy folks who are buying insurance only because the law says they have to. Get rid of the mandate and they stop buying insurance. This will unbalance the Obamacare insurance pool even more and lead to premium increases for everyone else.

Donald Trump has finally figured out that China doesn’t plan to do much about North Korea, so today he told the Chinese president that the US was prepared to act unilaterally. A few hours later North Korea launched another missile into the ocean. Trump’s response was to tweet, “Hard to believe that South Korea and Japan will put up with this much longer.”

OK then.

I’ve been a little negligent about these updates, but that’s because nothing much is happening. My M-protein level, which is a good proxy for the total cancer load in my plasma, has been stable for the past three months, with a slight uptick in the most recent test:

I saw my doctor today, and he seemed happy enough with everything, especially since my lactate dehydrogenase levels were also OK. I’ve never heard of this before, but apparently if it’s high it indicates cell damage, so a low number is good. All the other test results have also been nice and stable over the past three months.

The only side effects of the chemo are tiredness, which is normal, and a slowly increasing case of peripheral neuropathy, which is also normal. The neuropathy is more-or-less untreatable, and a couple of months ago I started to feel it in my hands for the first time (it usually affects the feet first). My doctor suggested a couple of OTC remedies that some of his patients have reported success with. Unfortunately, he agreed when I told him I’d looked at some of those and there was no clinical evidence that they had any effect. I’d be happy to take them as a placebo, but I suppose that won’t work if I don’t believe in them to begin with. This is one of the downsides of having access to clinical literature via the internet. Oh well.