Trumpcare https://www.scienceblogs.com/ en Graham-Cassidy isn't a health care solution. It's a blueprint for less access, less value and less coverage. https://www.scienceblogs.com/thepumphandle/2017/09/25/graham-cassidy-isnt-a-health-care-solution-its-a-blueprint-for-less-access-less-value-and-less-coverage <span>Graham-Cassidy isn&#039;t a health care solution. It&#039;s a blueprint for less access, less value and less coverage.</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>In yet another attempt to repeal and replace the Affordable Care Act, much of the GOP justification boils down to one argument: that the ACA isn’t working. Never mind that we don’t really know what constitutes a “working” health care system for Republicans.</p> <p>For a while, Republicans said the ACA wasn’t working because some U.S. counties didn’t have an insurer. Today, no county is without an insurer. Then there’s the argument that ACA premiums are too high. However, the research shows that while premiums have gone up, the rise in premiums <a href="http://www.factcheck.org/2015/02/slower-premium-growth-under-obama/" target="_blank" rel="noopener noreferrer">has been slower</a> under the ACA than it was before the ACA. Other health policy experts have <a href="http://healthaffairs.org/blog/2016/07/21/obamacare-premiums-are-lower-than-you-think/" target="_blank" rel="noopener noreferrer">pointed out</a> that average premiums dropped fairly significantly early in the ACA’s implementation, even as many people were receiving much more comprehensive and valuable health coverage. </p> <p>It's true that premiums did rise — sometimes dramatically and it’s an issue that lawmakers in both parties agree needs to be addressed. But on the other hand, policy experts and lawmakers knew it would take insurers time to adjust to the ACA’s new rules and protections and settle on premium rates that matched the new marketplace. That’s why ACA designers included measures like the “risk corridor” program to protect insurers from too much loss and ensure their continued participation in the ACA. Plus, ACA subsides <a href="https://aspe.hhs.gov/system/files/pdf/212721/2017MarketplaceLandscapeBrief.pdf" target="_blank" rel="noopener noreferrer">generally shield</a> marketplace customers from premium hikes.</p> <p>Now, the GOP argument is that block granting the health care system and handing over (dramatically reduced) funds to states is a magic panacea for all of our health care woes. It's an argument that falls apart once you remember that 19 states chose not to expand their Medicaid programs, even though nearly all of the costs of expansion were picked up by the federal government. That decision — made by state lawmakers — left millions of Americans in a completely preventable health insurance gap.</p> <p>The Graham-Cassidy bill isn’t a new health care system — <em>it’s the old health care system</em>. (Except likely even worse since it devastates Medicaid funding.) The Graham-Cassidy plan strips American consumers of <em>guaranteed</em> health protections and puts coverage decisions back in the hands of the free market and the political whims of ever-changing state governments. We already did that — before the ACA. That old system delivered higher and higher uninsurance rates every year, higher premiums every year, no guarantee to basic health services, discrimination based on pre-existing conditions and bankruptcy-inducing lifetime limits. Graham-Cassidy threatens to do the same thing. It isn’t innovative; it’s a relic of the past.</p> <p>The real story is that the ACA isn’t perfect, but it’s ushered in some extremely positive changes that deserve more attention and credit in the health care debate. Premium rates can’t be the only way we define success or failure in a health care system. We should also be focused on how well a health care system is working to broaden access to care, create affordability and improve health metrics. In that vein, let’s take a look at just a few recent studies on the impacts of the ACA — gains we risk losing under the GOP plan as well as under pressure of constant uncertainty coming from the White House.</p> <ul><li>In a <a href="http://content.healthaffairs.org/content/36/9/1656.short" target="_blank" rel="noopener noreferrer">study</a> published this month in <em>Health Affairs</em>, researchers examined data from the Urban Institute’s 2017 Health Reform Monitoring Survey to assess recent gains in coverage, access and affordability under the ACA. They found that the gains made in the early days of ACA implementation have persisted into 2017, with adults in all parts of the country, of all ages and of all income groups benefiting from gains in the U.S. insurance rate. In particular, just 10.2 percent of nonelderly U.S. adults are now uninsured, compared to nearly 41 percent before ACA implementation. Adults with low and moderate incomes experienced the greatest reductions in uninsurance. For example, among adults with family incomes at or below 138 percent of federal poverty, uninsurance decreased by more than 42 percent following ACA implementation; among adults between 139 and 399 percent of poverty, uninsurance decreased by more than 49 percent. The study also found that the share of adults without a usual source of care decreased, the share without a routine check-up in the last year decreased, and fewer adults reported unmet medical needs due to cost.</li> <p><br /></p> <li>This <a href="http://journals.sagepub.com/doi/abs/10.1177/1077558717725164" target="_blank" rel="noopener noreferrer">study</a>, recently published in <em>Medical Care Research and Review</em>, analyzed credit bureau data to get a clearer picture of how the ACA Medicaid expansion impacted people’s finances. In states that decided to expand Medicaid, researchers found financial improvements as measured by: improved credit scores; reduced balances past due as a percent of total debt; reduced probability of a medical collection balance of $1,000 or more; reduced probability of having one or more recent medical bills go to a collection agency; reduction in the probability of experiencing a new negative balance of any type; and a reduced probability of a new bankruptcy filing. The study states: “This work demonstrates how the ACA Medicaid expansions have improved economic well-being of low-income Americans, which at the same time has implications for providers and payers of medical services.”</li> <p><br /></p> <li>A new <a href="http://www.drugandalcoholdependence.com/article/S0376-8716(17)30362-9/pdf" target="_blank" rel="noopener noreferrer">study</a> published in the journal <em>Drug and Alcohol Dependence</em> examined the impact of the ACA on opioid addiction treatment. (FYI: Another <a href="http://time.com/4947004/opioid-overdoses-life-expectancy/" target="_blank" rel="noopener noreferrer">recent study</a> found that the opioid overdose epidemic has become so bad in the U.S. that it’s contributed to a decline in overall life expectancy.) The ACA study analyzed data from the National Survey on Drug Use and Health on more than 4,000 people with an opioid use disorder between 2008 and 2004. The researcher found that the odds of insurance coverage increased by 72 percent for people with an opioid use disorder between 2008 and 2014. In addition, the odds of not receiving addiction treatment due to financial concerns dropped by 50 percent. After ACA implementation, the study found, the odds of receiving opioid addiction treatment increased by 158 percent, with the odds of a person’s insurance paying for the care going up by 213 percent. (The Graham-Cassidy bill would allow states to waive essential health benefits, such as substance abuse treatment.)</li> <p><br /></p> <li>A 2017 <a href="http://www.commonwealthfund.org/publications/issue-briefs/2017/may/effect-aca-health-care-access" target="_blank" rel="noopener noreferrer">study</a> from the Commonwealth Fund, based on data from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System, found that ACA expansions decreased the probability of not receiving medical care by between 21 percent and 25 percent. It also found that gaining insurance coverage increased the probability of having a usual source of care by up to 86 percent. Before the ACA, about 47 percent of uninsured people reported they were unable to get medical care because of cost. Gaining health insurance cut that number by half.</li> <p><br /></p></ul><p>Graham-Cassidy isn’t the future of health care — it’s not a bill informed by evidence-based ways of improving people’s health and lives. It’s a bill based on political calculations, not medical ones.</p> <p>Yes, the ACA isn’t perfect. But it’s making real progress that lawmakers should be working to improve upon, not tear down. If you’d like to voice your opinion on Graham-Cassidy, the American Public Health Association has an <a href="https://secure3.convio.net/apha/site/Advocacy?cmd=display&amp;page=UserAction&amp;id=1293" target="_blank" rel="noopener noreferrer">easy-to-use template</a> to help you reach your representatives in Congress.</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Mon, 09/25/2017 - 13:35</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/pres-trump" hreflang="en">Pres Trump</a></div> <div class="field--item"><a href="/tag/public-health-general" hreflang="en">Public Health - General</a></div> <div class="field--item"><a href="/tag/research" hreflang="en">Research</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/access-care" hreflang="en">access to care</a></div> <div class="field--item"><a href="/tag/addiction-treatment" hreflang="en">addiction treatment</a></div> <div class="field--item"><a href="/tag/graham-cassidy" hreflang="en">Graham-Cassidy</a></div> <div class="field--item"><a href="/tag/health-insurance" hreflang="en">health insurance</a></div> <div class="field--item"><a href="/tag/medicaid" hreflang="en">Medicaid</a></div> <div class="field--item"><a href="/tag/medical-bankruptcy" hreflang="en">medical bankruptcy</a></div> <div class="field--item"><a href="/tag/opioid-use-disorder" hreflang="en">opioid use disorder</a></div> <div class="field--item"><a href="/tag/pre-existing-conditions" hreflang="en">pre-existing conditions</a></div> <div class="field--item"><a href="/tag/prevention" hreflang="en">Prevention</a></div> <div class="field--item"><a href="/tag/public-health" hreflang="en">public health</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/uninsurace" hreflang="en">uninsurace</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/research" hreflang="en">Research</a></div> </div> </div> <section> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/09/25/graham-cassidy-isnt-a-health-care-solution-its-a-blueprint-for-less-access-less-value-and-less-coverage%23comment-form">Log in</a> to post comments</li></ul> Mon, 25 Sep 2017 17:35:06 +0000 kkrisberg 62933 at https://www.scienceblogs.com Doctors, public health workers, patient advocates — even insurers — oppose latest ACA repeal https://www.scienceblogs.com/thepumphandle/2017/09/20/doctors-public-health-workers-patient-advocates-even-insurers-oppose-latest-aca-repeal <span>Doctors, public health workers, patient advocates — even insurers — oppose latest ACA repeal</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Senate Republicans are again trying to ram through an Affordable Care Act replacement that threatens the health and well-being of millions of Americans. It’s shameful. But don’t take my word for it. Let’s look at what people who actually work in health care are saying about the Graham-Cassidy-Heller-Johnson bill.</p> <p>In <a href="https://www.youtube.com/watch?v=dzhK81GzSWw" target="_blank" rel="noopener noreferrer">this interview</a>, Sen. Bill Cassidy insists that his bill would protect people with pre-existing conditions. Blue Cross Blue Shield Association disagrees. (Cassidy also says in that same interview that his bill would work through the Children’s Health Insurance Program (CHIP), which he said has been reauthorized. That’s totally false — CHIP has not been reauthorized and its funding expires Sept. 30.) But back to pre-existing conditions — here’s what <a href="https://www.bcbs.com/news/press-releases/blue-cross-blue-shield-association-statement-graham-cassidy-health-care-reform" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield</a> had to say:</p> <blockquote><p>Although we support providing states with greater flexibility in shaping health care options for their residents, we share the significant concerns of many health care organizations about the proposed Graham-Cassidy bill. <strong>The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. </strong>The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.</p></blockquote> <p>America’s Health Insurance Plans just released <a href="https://www.ahip.org/wp-content/uploads/2017/09/AHIP-Letter-to-Leaders-McConnell-and-Schumer-re-Graham-Cassidy-Heller-Johnson-Proposal-9-20-2017.pdf" target="_blank" rel="noopener noreferrer">this letter</a> that was sent to Senate leaders Mitch McConnell, R-KY, and Charles Schumer, D-NY. Guess what? They also read the proposed repeal as taking away protections for pre-exiting conditions:</p> <blockquote><p>The Graham-Cassidy-Heller-Johnson proposal...would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; <strong>pulling back on protections for pre-existing conditions</strong>; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single-payer health care to grow.</p></blockquote> <p><a href="http://www.aarp.org/content/dam/aarp/politics/advocacy/2017/09/graham-cassidy-letter-final-september-2017-aarp.pdf" target="_blank" rel="noopener noreferrer">AARP</a> thinks so too:</p> <blockquote><p>Overall, the Graham/Cassidy/Heller/Johnson bill would <strong>increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections</strong>. In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing homes.</p></blockquote> <p>Cassidy insists more people will have coverage under his plan. But strangely, people that actually deliver medical care to people disagree. Here’s what the <a href="https://www.childrenshospitals.org/Newsroom/Press-Releases/2017/CHA-Statement-on-Graham-Cassidy-Repeal-Bill" target="_blank" rel="noopener noreferrer">Children’s Hospital Association</a> had to say:</p> <blockquote><p>Their legislation <strong>would slash funding for Medicaid, the nation’s largest health care program for children, by one-third, reducing access and coverage for more than 30 million children</strong> in the program. Furthermore, the legislation weakens important consumer safeguards, and as a result, millions of children in working families would no longer be assured that their private insurance covers the most basic of services without annual and lifetime limits and regardless of any underlying medical condition. This bill would have devastating consequences for children and families.</p></blockquote> <p>In a letter to Senate leaders, the <a href="https://searchlf.ama-assn.org/undefined/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2017-9-19-AMA-Letter-on-Graham-Cassidy-Amendment-Final.pdf" target="_blank" rel="noopener noreferrer">American Medical Association</a> writes:</p> <blockquote><p>Similar to proposals that were considered in the Senate in July, <strong>we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage</strong>, destabilize health insurance markets, and decrease access to affordable coverage and care. We are particularly concerned with provisions that repeal the ACA’s premium tax credits, cost-sharing reductions, small business tax credit, and Medicaid expansion, and that provide inadequate and temporary block grant funds (only through 2026) in lieu of the ACA’s spending on marketplace subsidies and the Medicaid expansion.</p></blockquote> <p>Not surprisingly, the Republican replacement is bad for women’s health too. According to <a href="https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-blasts-cassidy-graham-heller-proposal-worst-aca-repeal-bill-yet-proposes-to-defund-planned-parenthood" target="_blank" rel="noopener noreferrer">Planned Parenthood</a>:</p> <blockquote><p>The Graham-Cassidy-Heller proposal includes a provision that <strong>would block millions of people from going to Planned Parenthood for preventive care</strong>, including birth control, cancer screenings, and STD testing and treatment.</p></blockquote> <p>And because Cassidy’s bill would allow states to weaken pre-existing condition coverage and the requirement that insurers cover a set of essential health benefits, coverage of maternity care would be at serious risk. According to an analysis from the <a href="https://www.cbpp.org/research/health/like-other-aca-repeal-bills-cassidy-graham-plan-would-add-millions-to-uninsured" target="_blank" rel="noopener noreferrer">Center on Budget and Policy Priorities</a>:</p> <blockquote><p>While insurers would still be required to offer coverage to people with pre-existing conditions, insurers could charge unaffordable premiums of thousands or tens of thousands of dollars per month, effectively resulting in a coverage denial. Insurers could also offer plans with large benefit gaps.  For example, <strong>before the ACA introduced the requirement that all plans cover a defined set of basic services,</strong> <strong>75 percent of individual market plans excluded maternity coverage</strong>, 45 percent excluded substance use treatment, and 38 percent excluded mental health care, according to analysis by the Kaiser Family Foundation. This would leave many people — especially those with pre-existing conditions — without access to the health services they need.</p></blockquote> <p>And let’s not forget public health. The ACA’s Prevention and Public Health Fund (PPHF) has become an absolutely critical source of funding for the nation’s public health agencies. Cassidy’s bill would eliminate that fund. Here’s what the <a href="http://www.bigcitieshealth.org/graham-cassidy" target="_blank" rel="noopener noreferrer">Big Cities Health Coalition</a>, a forum for the country’s largest metropolitan health departments, had to say about the fund’s potential elimination:</p> <blockquote><p>Among the programs at risk at the CDC are the 317 Immunization Program, Epidemiology and Laboratory Capacity Grants, the Childhood Lead Poisoning Prevention Program, and a host of chronic disease programs. The PPHF provides vital resources to governmental public health at all levels, and its elimination will further erode our fragile health system.</p> <p><strong>Eliminating public health programs that are now funded by the ACA would seriously undermine the ability of cities and counties to protect and promote health.</strong> The loss of hundreds of millions of dollars would hamper efforts to respond to food borne illness outbreaks, prevent emerging infectious diseases like Ebola and Zika, and respond to natural disasters like Hurricanes Irma and Harvey.</p></blockquote> <p>And in a letter to senators from the <a href="https://www.apha.org/~/media/files/pdf/advocacy/letters/2017/170918_apha_graham_cassidy.ashx" target="_blank" rel="noopener noreferrer">American Public Health Association</a>, Executive Director Georges Benjamin writes:</p> <blockquote><p>The Graham-Cassidy plan would also eliminate the Prevention and Public Health Fund, the first and only mandatory funding stream specifically dedicated to public health and prevention activities. The fund has already provided more than $6 billion to support a variety of public health activities in every state including tracking and preventing infectious diseases like the Ebola and Zika viruses, community and clinical prevention programs, preventing childhood lead poisoning and expanding access to childhood immunizations. <strong>Eliminating the fund would devastate the budget of the Centers for Disease Control and Prevention.</strong> The fund currently makes up 12 percent of CDC’s budget and eliminating this funding stream would force Congress to replace the funding through the regular appropriations process where resources for nondefense discretionary programs are already too low.</p></blockquote> <p>Graham-Cassidy-Heller-Johnson is a threat to America’s health. If you’d like to voice your opinion, the American Public Health Association has an <a href="https://secure3.convio.net/apha/site/Advocacy?cmd=display&amp;page=UserAction&amp;id=1293">easy-to-use template</a> to help you reach your representatives in Congress. For more information on the ACA replacement, NPR has a <a href="http://www.npr.org/sections/health-shots/2017/09/19/552044236/latest-gop-effort-to-replace-obamacare-could-end-health-care-for-millions?utm_source=twitter.com&amp;utm_medium=social&amp;utm_campaign=npr&amp;utm_term=nprnews&amp;utm_content=20170920" target="_blank" rel="noopener noreferrer">fantastic explainer</a>.</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Wed, 09/20/2017 - 12:20</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/pres-trump" hreflang="en">Pres Trump</a></div> <div class="field--item"><a href="/tag/public-health-general" hreflang="en">Public Health - General</a></div> <div class="field--item"><a href="/tag/trump-administration" hreflang="en">Trump administration</a></div> <div class="field--item"><a href="/tag/womens-health" hreflang="en">women&#039;s health</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/cdc" hreflang="en">CDC</a></div> <div class="field--item"><a href="/tag/child-health" hreflang="en">Child health</a></div> <div class="field--item"><a href="/tag/graham-cassidy" hreflang="en">Graham-Cassidy</a></div> <div class="field--item"><a href="/tag/health-insurance" hreflang="en">health insurance</a></div> <div class="field--item"><a href="/tag/medicaid" hreflang="en">Medicaid</a></div> <div class="field--item"><a href="/tag/pre-existing-conditions" hreflang="en">pre-existing conditions</a></div> <div class="field--item"><a href="/tag/prevention-and-public-health-fund" hreflang="en">Prevention and Public Health Fund</a></div> <div class="field--item"><a href="/tag/public-health" hreflang="en">public health</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/trump-administration" hreflang="en">Trump administration</a></div> <div class="field--item"><a href="/tag/womens-health" hreflang="en">women&#039;s health</a></div> </div> </div> <div class="field field--name-field-blog-categories field--type-entity-reference field--label-inline"> <div class="field--label">Categories</div> <div class="field--items"> <div class="field--item"><a href="/channel/policy" hreflang="en">Policy</a></div> </div> </div> <section> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/09/20/doctors-public-health-workers-patient-advocates-even-insurers-oppose-latest-aca-repeal%23comment-form">Log in</a> to post comments</li></ul> Wed, 20 Sep 2017 16:20:00 +0000 kkrisberg 62929 at https://www.scienceblogs.com Study: ACA-backed efforts to reduce hospital readmissions also reduced mortality https://www.scienceblogs.com/thepumphandle/2017/07/22/study-aca-backed-efforts-to-reduce-hospital-readmissions-also-reduced-mortality <span>Study: ACA-backed efforts to reduce hospital readmissions also reduced mortality</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>With the future of the Affordable Care Act still up in the air, most of the news coverage has gone to insurance coverage, premiums and Medicaid. And rightly so. But also included in the massive health reform law were a number of innovative measures to improve the quality and value of the medical care we actually get in the doctor’s office. With repeal still on the table, those measures are at risk too.</p> <p>One of those ACA efforts is the <a href="http://www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/" target="_blank" rel="noopener noreferrer">Hospital Readmissions Reduction Program</a>, which reduces Medicare payments to hospitals with relatively high rates of often-preventable hospital readmissions. The program is focused on readmissions after an initial hospitalization for a select group of conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, elective hip or knee replacement, and coronary artery bypass graft.</p> <p>The idea is to incentivize hospitals to adopt protocols that improve the <em>quality and coordination</em> of care so that patients can avoid costly and stressful readmissions to the hospital. Luckily, there are a number of protocols shown to work, such as providing patients and caregivers with better discharge instructions, coordinating post-hospital care with a patient’s primary care doctor, and improving efforts to prevent surgical site infections.</p> <p>So far, research shows such readmission rates have been falling since 2012, when the ACA financial penalties kicked in (though it’s important to note that hospitals began receiving and reviewing their Medicare readmission data back in 2009). Federal officials <a href="https://phhp-bahealthscience-new.sites.medinfo.ufl.edu/files/2016/08/jsc160013.pdf" target="_blank" rel="noopener noreferrer">estimate</a> hundreds of thousands fewer readmissions between 2010 and 2015. Still, every new initiative comes with concerns, as did this one: Would financially penalizing hospitals for readmissions encourage them to deny patients needed care? Does reducing readmissions among Medicare patients increase death rates after discharge?</p> <p>Kumar Dharmarajan set out to examine that question in a <a href="http://jamanetwork.com/journals/jama/article-abstract/2643762" target="_blank" rel="noopener noreferrer">study</a> published this month in <em>JAMA</em>. He and co-authors not only found no increase in death rates; they actually detected a slight decrease in death rates associated with heart attack, heart failure and pneumonia.</p> <p>“It was an important question because the financial penalties for readmissions have been one of the biggest changes in payment policies in recent years,” Dharmarajan, chief scientific officer at Clover Health, a Medicare Advantage insurer, told me. “Honestly, I wasn’t surprised at the results. Strategies that hospitals take to lower readmissions are generally very patient-centered and they should really be standard patient care. …Plus, the idea that hospitals would keep sick patients out isn’t in the DNA of doctors.”</p> <p>But it’s still important to look for any unintended consequences of such a big policy change — one that essentially changed a key hospital revenue stream from paying based on quantity to paying based on quality.</p> <p>To conduct the study, Dharmarajan and colleagues analyzed Medicare data on patients ages 65 and older who were hospitalized for heart failure, heart attack and pneumonia between 2008 and 2014. During that same time period, 30-day readmission rates declined across hospitals for the three conditions. The study found that the decrease in readmission rates for the three health conditions did not coincide with an increase in death among patients. Instead, they actually found a slight decrease in death for the three conditions. To quote the study directly: “Reductions in 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge.” In fact, researchers found an even stronger link between reduced readmissions and reduced mortality at 90 days after initial discharge from the hospital.</p> <p>Dharmarajan and co-authors Yongfei Wang, Zhenqiu Lin, Sharon-Lise Normand, Joseph Ross, Leora Horwitz, Nihar Desai, Lisa Suter, Elizabeth Drye, Susannah Bernheim and Harlan Krumholz write:</p> <blockquote><p>Researchers and policymakers have also expressed concern that penalizing hospitals caring for patients with low socioeconomic status could worsen disparities for this vulnerable group of patients. However, recent national declines in readmission rates have been greater at hospitals caring for patients with low socioeconomic status and have therefore reduced disparities in readmission across hospitals. In this context, this study has shown that hospitals with greater readmission reductions have had greater improvements in mortality. Hospitals nationally have made significant efforts to lower readmissions through improved transitional and postacute care.</p></blockquote> <p>“Hospitals really pushed to increase responsibility and accountability for patient outcomes after discharge,” said Dharmarajan, also an adjunct faculty member of Yale School of Medicine. “It’s a win for patients and for the health care system. This policy really did lead to physicians breaking down the siloes that had separated the inpatient and outpatient world.</p> <p>“And it’s an example of a win that didn’t occur because of an expensive new technology or new drug, but because of very purposeful collaborations between patients, providers, hospitals and providers out in the community,” he said.</p> <p>Dharmarajan noted that while some hospitals were aware of and even working on their readmission rates before the ACA, the law certainly motivated hospitals to further invest in the kinds of care coordination strategies shown to improve patient outcomes. In other words, the ACA aligned payment incentives in way that put long-term patient health outcomes front and center.</p> <p>“Initially, I think hospitals were very uncomfortable with the idea of being held accountable for patients after discharge because so much is out of a hospital’s control,” Dharmarajan said. “But there are times that readmission is the result of suboptimal care, like not setting up adequate supports for a patient after discharge. …Now, this idea of reducing readmission is becoming a common part of clinical practice.”</p> <p>Of course, the future of the Hospital Readmissions Reduction Program, which is overseen by the <a href="https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html" target="_blank" rel="noopener noreferrer">Centers for Medicare &amp; Medicaid Services</a>, is uncertain if the GOP succeeds at repealing the ACA. It’s yet another example of the significant, often life-saving, health gains made under the ACA that are now at risk.</p> <p>“Even if the financial penalties were taken away (under an ACA repeal), I’d like to believe the effort would continue because it’s the right thing to do,” Dharmarajan told me. “It would be an interesting national experiment, but I really hope we don’t go there.”</p> <p>To request a full copy of the new study, visit <a href="http://jamanetwork.com/journals/jama/article-abstract/2643762" target="_blank" rel="noopener noreferrer"><em>JAMA</em></a>.</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Sat, 07/22/2017 - 08:36</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/pres-trump" hreflang="en">Pres Trump</a></div> <div class="field--item"><a href="/tag/public-health-general" hreflang="en">Public Health - General</a></div> <div class="field--item"><a href="/tag/research" hreflang="en">Research</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/aca-repeal" hreflang="en">ACA repeal</a></div> <div class="field--item"><a href="/tag/cms" hreflang="en">CMS</a></div> <div class="field--item"><a href="/tag/hospital-care" hreflang="en">hospital care</a></div> <div class="field--item"><a href="/tag/hospital-readmissions" hreflang="en">hospital readmissions</a></div> <div class="field--item"><a href="/tag/hospital-readmissions-reduction-program" hreflang="en">Hospital Readmissions Reduction Program</a></div> <div class="field--item"><a href="/tag/medicare" hreflang="en">medicare</a></div> <div class="field--item"><a href="/tag/mortality-rates" hreflang="en">mortality rates</a></div> <div class="field--item"><a href="/tag/prevention" hreflang="en">Prevention</a></div> <div class="field--item"><a href="/tag/public-health" hreflang="en">public health</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/research" hreflang="en">Research</a></div> </div> </div> <div class="field field--name-field-blog-categories field--type-entity-reference field--label-inline"> <div class="field--label">Categories</div> <div class="field--items"> <div class="field--item"><a href="/channel/medicine" hreflang="en">Medicine</a></div> </div> </div> <section> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/07/22/study-aca-backed-efforts-to-reduce-hospital-readmissions-also-reduced-mortality%23comment-form">Log in</a> to post comments</li></ul> Sat, 22 Jul 2017 12:36:11 +0000 kkrisberg 62895 at https://www.scienceblogs.com GOP health care bills would cripple public health opioid response: ‘We’d essentially be putting up the white flag’ https://www.scienceblogs.com/thepumphandle/2017/06/30/gop-health-care-bills-would-cripple-public-health-opioid-response-wed-essentially-be-putting-up-the-white-flag <span>GOP health care bills would cripple public health opioid response: ‘We’d essentially be putting up the white flag’</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>In Cuyahoga County, Ohio, nearly 200 people have died from opioid-related overdoses in the first five months of this year. That means that this one U.S. county is on pace to lose more than 700 people to fatal overdoses by the end of 2017.</p> <p>Terry Allan, health commissioner at the Cuyahoga County Board of Health, and colleagues across the county have spent years building and scaling up a multifaceted response to the opioid addiction and overdose epidemic that includes getting people into treatment, changing clinical prescribing habits, preventing deadly overdoses, and dealing with the often-heartbreaking social and economic fallout for families and children. There’s no “one magic pathway” for dealing with this problem, Allan told me, “it’s a continuum that has to be well-supported given the trend we’re on.” Ohio now leads the nation in opioid overdose deaths.</p> <p>Allan said work is paying off — for example, nearly 1,000 lives in Cuyahoga County have been saved from a fatal opioid overdose in the last few years thanks to expanded access to naloxone — but the opioid problem in no where even close to subsiding. The reality, Allan said, is “we’re not seeing this trend abate.”</p> <p>He was just as honest about the kind of impact the GOP health care bills would have on the county’s opioid epidemic: “You’d end up with a lot of people being turned away from lack of services. …We’d essentially be putting up the white flag — and now is not the time to pull back.”</p> <p>The most obvious impact from the GOP health care proposals, both of which severely cut Medicaid funding and are expected to result in more than 20 million additional Americans without insurance, is that people would lose access to addiction and behavioral health services. The loss of access would be the result of losing insurance, whether Medicaid or private coverage, or from scaling back the Affordable Care Act’s essential health benefits, which required insurers cover substance use disorder services along with a number of other basic health services. Both the House and Senate repeal-and-replace bills would allow states to redefine or opt out of the essential health benefits requirement.</p> <p>But another, less talked about setback for those suffering from opioid addiction would be elimination of the ACA’s <a href="https://www.apha.org/~/media/files/pdf/factsheets/160127_pphf.ashx" target="_blank" rel="noopener noreferrer">Prevention and Public Health Fund</a> (PPHF), which the House bill eliminates in fiscal year 2019 and the Senate bill eliminates in fiscal year 2018. The PPHF — the nation’s first mandatory stream of funding for improving the public’s health — is now the sole source of funding for the Centers for Disease Control and Prevention’s Preventive Health and Health Services Block Grant. That block grant is a critical source of flexible funding for health departments in every state, where officials use the flexible monies to address localized problems, from improving food-borne illness outbreak response to ensuring access to emergency medical services in rural communities. If the GOP succeeds at eliminating the PPHF, the block grant goes away with it.</p> <p>In Cuyahoga County, that flexible block grant money has gone to support its injury prevention work — and the biggest injury threat now facing the county is opioid addiction. Allan said his agency uses the grant money to procure and distribute naloxone (which is now being carried by police in nearly every jurisdiction in the county), educate local clinicians on better prescribing practices (this is essential, as prescribing is a main driver of the opioid epidemic) and for convening the <a href="http://opiatecollaborative.cuyahogacounty.us/" target="_blank" rel="noopener noreferrer">Cuyahoga County Opiate Task Force</a>, which coordinates a multisector response to the epidemic. Allan said the health board organizes its opioid response according to five buckets: prevention, education, treatment, enforcement and recovery. If the response effort doesn’t account for and coordinate across those five buckets, “we’re just playing whack-a-mole,” he said.</p> <p>Cuyahoga’s opioid addiction and overdose problem is a complex one that requires the kind of equally complex response that public health is uniquely adept at leading. The loss of the Preventive Health and Health Services Block Grant would put all that work at risk.</p> <p>“All those dollars are tied to the ACA and without those dollars, this work would really be in dire straits,” Allan told me. “I’m not sure the state would be in a position to fill in the budget gap if the block grant went away. …Our concern is that we’d likely see, on a statewide basis, the support system we’ve built begin to atrophy. We’d be at a loss to deal with the volume that we’re dealing with right now.”</p> <p>Beyond the public health response, about 700,000 Ohioans have gained insurance coverage through the ACA Medicaid expansion that the GOP bills would eventually eliminate. The expansion has meant many more Ohioans are able to access addiction treatment services, Allan said. If that Medicaid coverage went away, he said, the fear is that many of those saved from a fatal overdose via naloxone would have no where to go for help after being released from the hospital. It’s a wasted opportunity to get people into treatment and keep them from ending up back on the streets and using, he said.</p> <p>“The impact of this isn’t just to the individual,” Allan told me. “It has communitywide implications for families and to our economy.” To put it even more bluntly, Allan said a loss of coverage for and access to addiction services will simply mean “more people will die.”</p> <p>Research has shown that the ACA Medicaid expansion has improved access to opioid addiction treatment. In a <a href="http://www.urban.org/research/publication/medicaid-coverage-effective-treatment-opioid-use-disorder" target="_blank" rel="noopener noreferrer">June report</a> from the Urban Institute, researchers found that many low-income adults in the 32 expansion states have gained access to buprenorphine, which reduces the symptoms of opioid withdrawal and cravings. But while researchers found a more than 70 percent increase in buprenorphine prescriptions per enrollee in Medicaid expansion states, programs are still struggling to meet the needs of such a large addiction epidemic. Another <a href="http://www.urban.org/research/publication/how-repealing-and-replacing-aca-could-reduce-access-mental-health-and-substance-use-disorder-treatment-and-parity-protections" target="_blank" rel="noopener noreferrer">recent report</a> from the Urban Institute found that the ACA Medicaid expansion did indeed fill a significant access gap in substance use disorder treatment, and that efforts to repeal the ACA — such as the House GOP bill — would likely result in millions losing addiction treatment coverage.</p> <p>“We feel like we’ve been able to make some significant progress with this problem because of the resources the ACA has provided,” said Jeff Duchin, health officer at Public Health — Seattle &amp; King County. “All that would be lost if we lose the funding that’s given people access to (opioid addiction) treatment. It’s very worrisome.”</p> <p>Like communities across the country, the Seattle and King County area has experienced an increasing number of people addicted to opioid drugs and heroin, with about one person dying every one-and-a-half days from an opioid overdose, Duchin told me. Because of the increasing number of deaths and rising prevalence of addiction, the opioid epidemic has become a high priority for the public health agency in the past two years. In 2016, city and county officials convened a <a href="http://www.kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/task-forces/heroin-opiates-task-force.aspx" target="_blank" rel="noopener noreferrer">Heroin and Prescription Opiate Addiction Task Force</a>.</p> <p>Duchin said Public Health — Seattle &amp; King County works particularly close with its sister agency in the county, the Department of Community and Human Services, which coordinates inpatient and outpatient addiction treatment for residents. In addition, ACA-funded Community Transformation Grants are slowly enhancing the effectiveness of that care by supporting efforts to integrate physical and behavioral health services in a single location, Duchin said. Work is now underway to develop these more integrated models of care, where patients can access all the services they need at one place, including housing and social services, but such work takes time.</p> <p>“It makes the most sense if you want to help people — it’s a big way to lower barriers and allow people to get all the care they need at one stop,” he said of such efforts. “We can’t achieve it overnight, but we’re moving in that direction. …But until we get there, we need to provide low-barrier access to treatment in more traditional contexts. That means increasing the treatment capacity in the community for people with addiction and at the same time, trying to make much of that treatment available where people can also get care for their physical health needs.”</p> <p>Public Health — Seattle &amp; King County now operates a number of safety net services that reach at-risk, marginalized and underinsured populations. For example, its needle exchange offers access to buprenorphine and its mobile medical units provide access to naloxone, as does its health care program for the homeless, to which Duchin said they hope to add buprenorphine access as well.</p> <p>Right now, Duchin said the city and county are doing a good job of meeting demands for inpatient addiction care, “but we’re not anywhere close” to meeting demands for outpatient care. To fill that gap, Duchin and colleagues hope to recruit many more primary care physicians willing to integrate buprenorphine treatment into their practices.</p> <p>“Without a doubt, the Medicaid expansion has greatly strengthened our safety net,” Duchin told me. “We can serve many more lower-income adults not only with physical medical care and preventive care, but we’re able to get them access to behavioral services too. Without that expansion, many would just lose access to those services and we don’t have the local revenues to continue to provide them. …Letting people progress untreated to more complicated stages of disease is not only inhumane and leads to unnecessary human suffering, but it’s more costly to the community.”</p> <p>Allan in Ohio put it in even simpler terms: “This level of addiction is unprecedented. It needs to be a national priority, and we need to demonstrate that by putting resources toward it. We need to put our money where our mouth is.”</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Fri, 06/30/2017 - 00:31</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/mental-health" hreflang="en">mental health</a></div> <div class="field--item"><a href="/tag/pres-trump" hreflang="en">Pres Trump</a></div> <div class="field--item"><a href="/tag/public-health-general" hreflang="en">Public Health - General</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/addiction-treatment" hreflang="en">addiction treatment</a></div> <div class="field--item"><a href="/tag/budget-cuts" hreflang="en">budget cuts</a></div> <div class="field--item"><a href="/tag/essential-health-benefits" hreflang="en">essential health benefits</a></div> <div class="field--item"><a href="/tag/health-insurance" hreflang="en">health insurance</a></div> <div class="field--item"><a href="/tag/medicaid" hreflang="en">Medicaid</a></div> <div class="field--item"><a href="/tag/opioid-abuse" hreflang="en">opioid abuse</a></div> <div class="field--item"><a href="/tag/opioid-overdose" hreflang="en">opioid overdose</a></div> <div class="field--item"><a href="/tag/opioids" hreflang="en">opioids</a></div> <div class="field--item"><a href="/tag/prescription-drug-abuse" hreflang="en">prescription drug abuse</a></div> <div class="field--item"><a href="/tag/prevention" hreflang="en">Prevention</a></div> <div class="field--item"><a href="/tag/prevention-and-public-health-fund" hreflang="en">Prevention and Public Health Fund</a></div> <div class="field--item"><a href="/tag/public-health" hreflang="en">public health</a></div> <div class="field--item"><a href="/tag/substance-abuse-treatment" hreflang="en">substance abuse treatment</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/mental-health" hreflang="en">mental health</a></div> </div> </div> <div class="field field--name-field-blog-categories field--type-entity-reference field--label-inline"> <div class="field--label">Categories</div> <div class="field--items"> <div class="field--item"><a href="/channel/medicine" hreflang="en">Medicine</a></div> </div> </div> <section> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/06/30/gop-health-care-bills-would-cripple-public-health-opioid-response-wed-essentially-be-putting-up-the-white-flag%23comment-form">Log in</a> to post comments</li></ul> Fri, 30 Jun 2017 04:31:02 +0000 kkrisberg 62881 at https://www.scienceblogs.com We’re close to universal insurance coverage for kids. The GOP health care bills would reverse that. https://www.scienceblogs.com/thepumphandle/2017/06/23/were-close-to-universal-insurance-coverage-for-kids-the-gop-health-care-bills-would-reverse-that <span>We’re close to universal insurance coverage for kids. The GOP health care bills would reverse that.</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The House and Senate health care bills are overflowing with proposals that will strip Americans of access to quality, affordable health care. But perhaps the cruelest part is what they do to children — the most vulnerable and powerless among us. Children can’t show up at the ballot box to protect their health and so it truly is up to the rest of us.</p> <p>Right now, after decades of hard work, the U.S. has achieved near-universal insurance coverage of its littlest residents. About 95 percent of U.S. kids have health insurance. Unfortunately, the House and Senate proposals to replace the Affordable Care Act and gut Medicaid, in combination with Trump’s federal budget proposal, could send the children’s insurance rate tumbling downward. It’s particularly cruel because while there’s no official policy on the books that explicitly guarantees a child’s right to health care, our collective policymaking over the years has tended toward ensuring that children don’t go without timely and necessary medical attention. It’s one of those issues we used to describe as “bipartisan.” (Remember those days?) Today, the health of America’s children sits squarely on the budgetary chopping block, as if their health and well-being aren’t intrinsically connected to all of our future prosperity.</p> <p>According to a <a href="http://www.urban.org/sites/default/files/publication/91321/2001371-medicaid-and-chip-for_children-trends-in-coverage-affordability-and-provider-access.pdf" target="_blank" rel="noopener noreferrer">recent report</a> from the Urban Institute, children’s enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased nearly one-third between 2008 and 2015, pushing down the child uninsured rate by nearly half. During that time period, children in Medicaid and CHIP experienced improved access to providers and received more routine health care services, while their families faced lower financial burdens related to their children’s medical care. Also in that time span, fewer children went without needed medical care because their families couldn’t afford it, fewer children had to delay care because of cost, and fewer families had problems paying their medical bills. Currently, about <a href="https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/child-and-chip-enrollment/index.html" target="_blank" rel="noopener noreferrer">35 million children</a> get their care through Medicaid and CHIP.</p> <p>However, all that could change if Republican proposals to massively cut and cap federal Medicaid funding as well as cut CHIP become law (more on the Medicaid cuts <a href="http://scienceblogs.com/thepumphandle/2017/06/22/senate-health-care-bill-wont-improve-the-nations-health-but-it-will-make-rich-people-richer" target="_blank" rel="noopener noreferrer">here</a>). On those GOP policy proposals, Urban Institute researchers Emily Johnston, Jason Gates, and Genevieve Kenney write:</p> <blockquote><p>Altogether, these policy changes raise the risk that Medicaid/CHIP eligibility will decline among children, reversing the downward trend in uninsurance that has prevailed over the last several decades. Even if policy changes do not directly target children, changes that reduce Medicaid coverage among parents could still cause a decline in Medicaid and CHIP coverage among children; earlier research has shown that children are more likely to enroll in Medicaid/CHIP when their parents also qualify for public coverage. With less federal funding for Medicaid and CHIP, states may reduce benefits and/or provider payments, which in turn could adversely affect access to care among children covered by these programs. Monitoring is critical to ensure that children, particularly those from low- and moderate-income families, continue to have adequate access to health care.</p></blockquote> <p>On CHIP, Trump’s fiscal year 2018 budget proposal “fundamentally restructures” the program, according to <a href="https://firstfocus.org/resources/fact-sheet/impact-of-the-presidents-fy-2018-budget-request-on-childrens-health" target="_blank" rel="noopener noreferrer">First Focus</a>, a nonpartisan children’s advocacy group. In particular, Trump’s budget extends CHIP’s funding through 2019 (its funding officially expires this September), but cuts allotments by $5.8 billion — that’s a cut of 21 percent. That 21 percent cut is achieved through a number of policy changes, including ending the ACA’s increased CHIP matching rates and capping CHIP’s income eligibility. Trump’s budget proposal also calls for cutting Medicaid funding by $610 billion — and keep in mind, that’s separate from the House and Senate health care bills that also cut Medicaid funding by the billions. Just exactly how all these proposals to slash and burn people’s health care will come together remains to be seen, but none of it looks good for kids.</p> <p>That’s why earlier this month, more than 1,200 organizations from around the country sent a <a href="https://firstfocus.org/news/press-release/first-focus-and-1200-groups-tell-congress-save-chip" target="_blank" rel="noopener noreferrer">letter</a> to leaders in Congress asking them to save CHIP. They wrote: “It is worth noting that the children who stand to lose CHIP would likely have no other affordable coverage option available to them. The resulting increase in the rate of uninsured children would be an enormous step backwards.”</p> <p>The most recent health care bill out of the Senate, released just yesterday, would end the ACA’s Medicaid expansion and radically restructure and cap its federal funding. Bruce Lesley, president of First Focus, <a href="https://firstfocus.org/blog/the-better-care-act-is-worse-for-kids-a-lot-worse-2" target="_blank" rel="noopener noreferrer">said</a> of the Senate bill (which is nearly tauntingly titled the “Better Care Reconciliation Act):</p> <blockquote><p>There is no way to shield our nation’s most vulnerable children from Medicaid cuts of this magnitude. In fact, contrary to the President’s promise not to cut Medicaid and eliminate onerous regulations, the bill slashes Medicaid by hundreds of billions of dollars out of health coverage and gives states incentives to impose new bureaucracy and red tape barriers to coverage.</p> <p>For cover, the “Better” Care draft bill attempts to include a few provisions to make the draconian bill appear less harmful to children and families. But, under scrutiny, they will do nothing to prevent the oncoming disaster this legislation would unleash.</p></blockquote> <p>Lesley wasn’t the only one opposing the proposal’s treatment of children. Here’s what the <a href="https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/SenateHealthCareBill.aspx" target="_blank" rel="noopener noreferrer">American Academy of Pediatrics</a> had to say about the Senate’s supposed carve-outs to protect children:</p> <blockquote><p>The bill includes misleading 'protections' for children by proposing to exempt them from certain Medicaid cuts. A 'carve-out' for some children determined to be 'disabled' does little to protect their coverage when the base program providing the coverage is stripped of its funding. Doing so forces states to chip away coverage in other ways, by not covering children living in poverty who do not have complex health conditions, or by scaling back the benefits that children and their families depend on. This bill would make a child's access to health care dependent on his or her ZIP code and force states to make decisions about which vulnerable population gets services. Put simply, this bill is bad policy for children.</p></blockquote> <p>The Children’s Hospital Association <a href="https://www.childrenshospitals.org/newsroom/press-releases/2017/childrens-hospitals-call-on-senate-to-protect-kids-and-reject-better-care-reconciliation-act-of-2017" target="_blank" rel="noopener noreferrer">panned</a> the Senate bill too:</p> <blockquote><p>Compared to the (House bill), the new Senate bill calls for even steeper cuts to the Medicaid program by restricting Medicaid’s funding to a slower growth rate. An Avalere Health <a href="http://go.avalere.com/acton/attachment/12909/f-0483/1/-/-/-/-/Avalere%20-%20Childrens%20Hospital%20Association%20Report%20on%20Medicaid%20Capped%20Funding%20embargo.pdf?utm_source=Avalere%20Report&amp;utm_medium=Press%20Release&amp;utm_campaign=Avalere%20Report" target="_blank" rel="noopener noreferrer">analysis</a> of the (House bill) concluded that cuts to Medicaid funding for children would be at least $43 billion over 10 years. Ultimately, Medicaid coverage and benefits for the over 30 million children who rely on Medicaid would be threatened in both the House and Senate bills. Congress should not consider any legislation undermining health care for tens of millions of children.</p> <p>Children’s hospitals across the country call on senators to reject this bill, a bad bill for kids.</p></blockquote> <p>The nation’s experts in child health and well-being are trying to warn us: children will suffer if Republicans succeed at defunding Medicaid and CHIP. Adults should listen to them.</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Fri, 06/23/2017 - 14:43</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/pres-trump" hreflang="en">Pres Trump</a></div> <div class="field--item"><a href="/tag/public-health-general" hreflang="en">Public Health - General</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/budget-cuts" hreflang="en">budget cuts</a></div> <div class="field--item"><a href="/tag/child-health" hreflang="en">Child health</a></div> <div class="field--item"><a href="/tag/childrens-health-care" hreflang="en">children&#039;s health care</a></div> <div class="field--item"><a href="/tag/childrens-health-insurance-program" hreflang="en">Children&#039;s Health Insurance Program</a></div> <div class="field--item"><a href="/tag/chip" hreflang="en">chip</a></div> <div class="field--item"><a href="/tag/medicaid" hreflang="en">Medicaid</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> </div> </div> <section> <article data-comment-user-id="0" id="comment-1874348" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1498256098"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>California, the Golden Liberal State, is close to universal care. Sort of.<br /><a href="http://www.sacbee.com/news/politics-government/capitol-alert/article157974029.html">http://www.sacbee.com/news/politics-government/capitol-alert/article157…</a></p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1874348&amp;1=default&amp;2=en&amp;3=" token="6H7vNhsn90Q8Q5hI1Xc3wis0OxZA1AsrfC06J4t-wNU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">See Noevo (not verified)</span> on 23 Jun 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1874348">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/06/23/were-close-to-universal-insurance-coverage-for-kids-the-gop-health-care-bills-would-reverse-that%23comment-form">Log in</a> to post comments</li></ul> Fri, 23 Jun 2017 18:43:00 +0000 kkrisberg 62879 at https://www.scienceblogs.com Senate health care bill won’t improve the nation’s health, but it will make rich people richer https://www.scienceblogs.com/thepumphandle/2017/06/22/senate-health-care-bill-wont-improve-the-nations-health-but-it-will-make-rich-people-richer <span>Senate health care bill won’t improve the nation’s health, but it will make rich people richer</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>This is the harsh reality of the Senate health care bill: it provides tax cuts to the wealthiest Americans, while taking away access to timely medical care from the poorest, most vulnerable Americans. You’ve probably been hearing this point a lot about the GOP’s repeal-and-replace efforts, and it’s easy to relegate it to partisan hyperbole. But the sad truth is that, well, it’s the sad truth.</p> <p>The Senate’s <a href="https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf" target="_blank" rel="noopener noreferrer">“draft” health care bill</a>, released this morning, proposes sweeping changes to the Medicaid system, which now provides health coverage for 76 percent of poor children, 60 percent of children with disabilities, 64 percent of nursing home residents and 40 percent of poor adults. Medicaid also covers about half of all births in this country (adding this in just in case “pro-life” Republicans didn’t realize that Medicaid helps ensure healthy pregnancies and newborns. The more you know…). The Senate bill would phase out the Affordable Care Act’s Medicaid expansion, which covered about 11 million additional Americans, though over a longer period of time than the House proposal.</p> <p>But then the Senate GOP really brings down the ax on Medicaid. In addition to ending the ACA expansion, it would also cap federal funding to states for traditional Medicaid. That is HUGE. Right now, there’s no pre-set limit on federal Medicaid matching funds — that means states have a lot of flexibility in designing a Medicaid program that actually meets the health care needs of their residents. Under the Senate’s health care proposal, states would basically get a pre-set lump sum of federal Medicaid money. Health policy experts predict that a funding formula change of that magnitude would likely force states to ration Medicaid services, cut back on benefits or limit enrollment. It also means Medicaid would lose that nimble flexibility that lets it respond to unexpected rises in hardship, like what we saw during the Great Recession.</p> <p>Overall, it is extremely hard to imagine how both the Senate and House proposals wouldn’t result in many more people suffering from poorer health and preventable disease — which should really be the main metric by which we measure any health care proposal.</p> <p>But back to the tax cut issue, which is particularly important because a health care bill should be focused on making people healthier, not making rich people richer. And frankly, this bill seems more interested in tax cuts than in people’s actual health. The Senate health care proposal repeals just about all the taxes in the ACA that paid for the law’s expansion efforts and because those taxes were primarily levied on rich Americans and industry, the average American won’t see a cent of those tax cuts back in their pockets. To be clear, these are tax cuts for the rich paid for by cutting back health care access for low-income Americans.</p> <p>So, what does that tax cut look like on the ground? Thankfully, the Center on Budget and Policy Priorities (CBPP) crunched the numbers and <a href="http://www.cbpp.org/research/health/harsh-tradeoff-at-core-of-gop-health-bill-keep-medicaid-expansion-or-cut-taxes-for" target="_blank" rel="noopener noreferrer">released a report</a> on just that. The report was released yesterday and so it’s based on the House GOP replacement bill, but surprise!, the Senate proposal does the same thing. Here’s what researcher Brandon DeBot found when examining the House GOP health care/tax cut bill:</p> <ul><li>The 400 highest-income taxpayers would get tax cuts worth about $33 billion from 2019 through 2028. That’s more than the federal spending cuts from ending the Medicaid expansion in 20 states and Washington, D.C.</li> <li>The tax cuts for the top 400 are about equal to the federal cost of maintaining the Medicaid expansion in Nevada, West Virginia, Arkansas and Alaska combined. Those 400 households already have annual incomes that average more than $300 million each.</li> <li>Households earning more than $1 million a year would receive yearly tax cuts of more than $50,000 each — that’s more than the cost of sustaining Medicaid expansion coverage for eight people.</li> <li>The tax cuts contained in the House bill, which overwhelmingly benefit wealthy Americans, total $699 billion. The Medicaid cuts proposed in the House bill total $702 billion.</li> </ul><p>DeBot concluded:</p> <blockquote><p>“These estimates reveal misplaced priorities in the Republican approach to health reform, and the harsh consequences for millions of people if the policies are enacted.”</p></blockquote> <p>Jacob Leibenluft, also at CBPP, warned <a href="http://www.cbpp.org/health/commentary-once-passed-medicaid-cuts-wont-be-easily-reversed" target="_blank" rel="noopener noreferrer">in a commentary</a> published today that once Medicaid is cut, it won’t be easily undone. He writes:</p> <blockquote><p>“History suggests that structural changes to Medicaid would be very difficult to reverse. The basic concept behind the per capita cap is to impose a cap on federal funding per beneficiary, replacing the existing commitment of the federal government to pay a fixed share of state Medicaid costs. Experience with other programs suggests that such radical structural changes won’t be reversed.”</p></blockquote> <p>If you’d like to <a href="http://familiesusa.org/initiatives/protect-our-care" target="_blank" rel="noopener noreferrer">voice your opinion</a> on the Senate health care bill and cuts to Medicaid, Families USA has all the information and tools you need.</p> <p><em>Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — </em><a href="http://www.twitter.com/kkrisberg" target="_blank" rel="noopener noreferrer"><em>@kkrisberg</em></a><em>.</em></p> </div> <span><a title="View user profile." href="/author/kkrisberg" lang="" about="/author/kkrisberg" typeof="schema:Person" property="schema:name" datatype="">kkrisberg</a></span> <span>Thu, 06/22/2017 - 11:45</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/government" hreflang="en">government</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/affordable-care-act" hreflang="en">Affordable Care Act</a></div> <div class="field--item"><a href="/tag/budget-cuts" hreflang="en">budget cuts</a></div> <div class="field--item"><a href="/tag/low-wage-workers" hreflang="en">low-wage workers</a></div> <div class="field--item"><a href="/tag/medicaid" hreflang="en">Medicaid</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> <div class="field--item"><a href="/tag/womens-health" hreflang="en">women&#039;s health</a></div> <div class="field--item"><a href="/tag/gopcare" hreflang="en">GOPcare</a></div> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> </div> </div> <section> <article data-comment-user-id="0" id="comment-1874343" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1498200147"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p><b><i>Aux barricades!</i></b></p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1874343&amp;1=default&amp;2=en&amp;3=" token="sHGiMDVFNSQtQ9XtDOzTWsEG_Qwnwtq465WnhO82g60"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Mentifex (Arthur T. Murray)">Mentifex (Arth… (not verified)</span> on 23 Jun 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1874343">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/thepumphandle/2017/06/22/senate-health-care-bill-wont-improve-the-nations-health-but-it-will-make-rich-people-richer%23comment-form">Log in</a> to post comments</li></ul> Thu, 22 Jun 2017 15:45:57 +0000 kkrisberg 62876 at https://www.scienceblogs.com The Republican Trump Health Insurance Plan Is Not Well Supported https://www.scienceblogs.com/gregladen/2017/04/25/the-republican-trump-health-insurance-plan-is-not-well-supported <span>The Republican Trump Health Insurance Plan Is Not Well Supported</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>In a current <a href="https://www.washingtonpost.com/page/2010-2019/WashingtonPost/2017/04/25/National-Politics/Polling/release_467.xml?tid=a_inl">poll</a>, 61% of Americans want to retain Obamacare, and improve this already implemented and existing program. A mere 37% want to "repeal and replace" it. </p> <p>About 69% of American want the Republicans, including the Republican President, to to do some combination of working with Congressional Democrats or a combination of Democrats and Republicans to improve the plan. The preference for having the Democrats do this as opposed to a combination is about 2:1. People have apparently observed that the Republicans are not capable of coming up with a usable plan.</p> <p>The Republicans, including the Republican President, seemed to threaten Obamacare a while back, saying that through executive order and cabinet level actions, they should damage the existing Obamacare plan to make it look bad so people want it less. A tad under 80% of Americans oppose this idea. A mere 13% support it. </p> <p>One of the major changes in the newly proposed plan, which the Republican Congress and President intend to pass into law by Friday, is that states would have more power to ignore parts of the plan or change it. The new survey clearly indicates that Americans are very opposed to this idea, which is the main new feature of this plan. About 62% of Americans want things like preventative services, maternity and pediatric care, prescription drugs, etc to be covered in all states. About 70% want pre-existing conditions covered in all states. </p> <p>This very negative view of Paul Ryan and Donald Trump's version of a health insurance reform plan comes at the same time as parallel polling indicates that the Republican President is at this moment the least popular president known to polling science. There were a couple of real doozies in the past, but there is no polling data to show just how much the country disliked those individuals. For all the measured presidents, the current Republican president has the lowest ranking, and not by a small amount. </p> </div> <span><a title="View user profile." href="/author/gregladen" lang="" about="/author/gregladen" typeof="schema:Person" property="schema:name" datatype="">gregladen</a></span> <span>Tue, 04/25/2017 - 02:32</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/healthcare" hreflang="en">healthcare</a></div> <div class="field--item"><a href="/tag/health-insurance" hreflang="en">health insurance</a></div> <div class="field--item"><a href="/tag/obamacare" hreflang="en">ObamaCare</a></div> <div class="field--item"><a href="/tag/ryancare" hreflang="en">Ryancare</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> </div> </div> <section> <article data-comment-user-id="0" id="comment-1481313" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493104342"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Paul Ryan: I'm amazed that someone who so clearly hates anyone that is not a white christian male managed to gain power and still be considered "christian".</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481313&amp;1=default&amp;2=en&amp;3=" token="8EEuivpU5EE0HDady6jy3FwZJSn73rAi50rz8t4eV90"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481313">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481314" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493111622"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><blockquote><p> For all the measured presidents, the current Republican president has the lowest ranking, and not by a small amount. </p></blockquote> <p>And he's only just getting started.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481314&amp;1=default&amp;2=en&amp;3=" token="yZV8bTY2w2bKDYQU4jCXcF4xy0hpxFlFyR-DJYbpJhI"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">BBD (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481314">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481315" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493116098"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Who? I thought that dude was called "Ron".</p> <p>:-P</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481315&amp;1=default&amp;2=en&amp;3=" token="k077261AIZR4j68b4QhmeEYOgPNQFU_wrsTtuKQ696Y"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481315">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481316" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493116882"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>BBD and with about 1000 days to go - He should be pegged at zero by the</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481316&amp;1=default&amp;2=en&amp;3=" token="HEJ_3Cn1QbIXCBqd4ax0Oqu25kyGjmuI0b0_nupzgfs"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Doug Alder (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481316">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481317" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493117382"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>rePUKEian health plan not well supported??? Not surprising when their health plan is essentially ......<br /> Poor get sick...now DIE!!!!!</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481317&amp;1=default&amp;2=en&amp;3=" token="HgAOs0AhBoghJW9mmx70TEyx7CqK4YXRrA90SNBWEEQ"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">L.Long (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481317">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481318" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493117861"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>And yet:<br /><a href="https://www.washingtonpost.com/news/the-fix/wp/2017/04/23/trump-voters-dont-have-buyers-remorse-but-some-hillary-clinton-voters-do/?utm_term=.bf180548eda2">https://www.washingtonpost.com/news/the-fix/wp/2017/04/23/trump-voters-…</a></p> <p>Which suggests to me that a significant portion of people, however they feel about individual policies, mainly just want to burn it all down. </p> <p>Meanwhile, as Colbert pointed out last night, Trump is more concerned with his TV ratings. And who knows, we may have come to the point where despite all, what people care about most is celebrity anyway.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481318&amp;1=default&amp;2=en&amp;3=" token="tlPsqX79zkDTfLoAuUVBTWX7zwD40iw26Ai6PxmaHdU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481318">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481319" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493119294"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Interesting point:</p> <blockquote><p>Without language, there is no accountability, no standard of truth. If Trump never says anything concrete, he never has to do anything concrete. If Trump never makes a statement of commitment, Trump supporters never have to confront what they really voted for. If his promises are vague to the point of opacity, Trump cannot be criticised for breaking them. If every sloppy lie (ie: “Just found out that Obama had my ‘wires tapped’ in Trump Tower … This is McCarthyism!”) can be explained away as a “generality” or “just a joke” because of “quotes”, then he can literally say anything with impunity. Trump can rend immigrant families in the name of “heart”, destroy healthcare in the name of “life”, purge minority voters in the name of “justice”, and roll back women’s autonomy in the name of “freedom”. The constitution? Probably sarcastic. There are “quotes” all over that thing!</p></blockquote> <p>from </p> <p><a href="https://goo.gl/syFcMW">https://goo.gl/syFcMW</a></p> <p>Basically, the current president talks a good deal but never says anything - and since his positions are as solid as liquid Jello (but not as flavorful) his supporters will never be disappointed. Rational people - entirely different story.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481319&amp;1=default&amp;2=en&amp;3=" token="Pc__i-LPwwT0g4BM0qcTnlLaX_A1kjTs5rZSttjpjGw"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481319">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481320" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493121610"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Hmm, Trump as tabula rasa. Supporters have certainly been well prepped to see in him what they want, what the've been told to want as consumers of stite.</p> <p>Kasich, the so called adult in the Republican room, was lecturing the other day echoing what a lot of people have been saying, that everyone should just start getting along. Never mind that he's been pretty passive when it comes to dismantling the wingnut propaganda machine that effectively turns brains into flavorless liquid jello.</p> <p>It's as though he stood by watching as his cohort were happily pushing people over the edge of a cliff. And now, when they're half way down, he says "oops" leans over the edge, and yells at them to stop falling and just grow up.</p> <p>When they finally go splat at the bottom, you just know he'll straighten up and say, "Serves 'em right! They should have listened to me."</p> <p>Rationality is always correct. But when the mob starts to riot, and they begin burning down the stores that support the community, rational people are left pissing in the wind.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481320&amp;1=default&amp;2=en&amp;3=" token="KmcQCST1__6btwwzhtsX9jX5TtE8BT7lLPZPtX1Akw0"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481320">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481321" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493122064"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>More to the point of the willful dishonesty of the right:</p> <p>Locally (here in W MIchigan) the conservative rallying cry is that people have had enough of the years'-long tradition of obstructionism by the Democratic Party.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481321&amp;1=default&amp;2=en&amp;3=" token="L4tKRMjTqURGKAqJeP7t5hM35X0FFoccDULprvb036o"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481321">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481322" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493125047"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Outside talkers, alibi stores, flaties, flash, and a great big house of mirrors. Welcome to the carnival suckers.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481322&amp;1=default&amp;2=en&amp;3=" token="gH3-XStHlYglVFzxcZLU6k9NqikGDfeOCjdgGbUJq2g"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481322">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481323" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493139460"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p><a href="https://www.washingtonpost.com/news/monkey-cage/wp/2017/04/17/racism-motivated-trump-voters-more-than-authoritarianism-or-income-inequality/?hpid=hp_hp-cards_hp-card-politics%3Ahomepage%2Fcard&amp;utm_term=.0463a5ccadf8">https://www.washingtonpost.com/news/monkey-cage/wp/2017/04/17/racism-mo…</a></p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481323&amp;1=default&amp;2=en&amp;3=" token="wjR0cAvbMqkK7tQYws-apbXa6AHT5kNjpKuf6xtBJzA"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">zebra (not verified)</span> on 25 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481323">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1481324" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1493196542"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>While it might give some comfort to some, I think it is now clear that polls of what the American public likes, dislikes, wants, or doesn't want no longer translates into political advantage or disadvantage. As we've seen in the recent presidential election, much more important is a timely barrage of lies and obfuscation at election time along with vague promises of rewards to come (more jobs, greater security, thwarting unpopular ethnic minorities, etc.)</p> <p>Consider:<br /> (1) A few years back, the public was over 90% in favor of universal background checks for gun purchase. Even NRA members were 75% in favor. What was the legislative result? Essentially nil.<br /> (2) The popularity of the U. S. Congress prior to the 2016 election was at an all-time low. Who did the public blame at election time? Not the obstructionist GOP apparently. They now control both houses.<br /> (3) During the campaign for nomination and for president, Trump's approval numbers prior to the election were so low with both Democrats and Republicans that many pundits foresaw the whole GOP slate going down to defeat. Result: the GOP now has all three branches of the federal government in hand, along with nearly 2/3 of the states.</p> <p>Now that we are truly living in a conservative fantasyland where it will soon be 1950 again (and heading for 1850?), I suggest that the national capital be moved to Hollywood.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1481324&amp;1=default&amp;2=en&amp;3=" token="WbQQ6ARaiKdIjBusKObAdSazNGqnunngkr44l-mjbL0"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Tyvor Winn (not verified)</span> on 26 Apr 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1481324">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/gregladen/2017/04/25/the-republican-trump-health-insurance-plan-is-not-well-supported%23comment-form">Log in</a> to post comments</li></ul> Tue, 25 Apr 2017 06:32:25 +0000 gregladen 34358 at https://www.scienceblogs.com Trump's Take It Or Leave It Approach Makes Sense https://www.scienceblogs.com/gregladen/2017/03/24/trumps-take-it-or-leave-it-approach-makes-sense <span>Trump&#039;s Take It Or Leave It Approach Makes Sense</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>In real estate. </p> <p>I'm not an expert on this but I've seen the sausage being made a few times. Individuals with investment money, commercial businesses that might use new space, other possible tenants, maybe or maybe not some designers or builders, municipal or other government stakeholders, community stakeholders such as neighborhood associations, etc. consider a real estate deal. Perhaps there is a bit of condemned land the county wants to sell cheap if only you clean up the brownfield and develop something nice. Maybe the investors include a person who owns an underexploited business venture in a particular property, and some other investor owns the property, and they're building a subway stop down the street. </p> <p>All kinds of possibilities for a bigly deal. Plans are made, temperatures checked, conversations happen, money is put down on options to buy, a partnership is formed, etc.</p> <p>And then, at some point, bait has to be cut, or put on the hook. One must do number two or leave the loo. All the parties involved have to agree on the deal, so they do.</p> <p>Or, they don't. </p> <p>If they don't, you move on to some other deal. You have not, most of your life, committed to seeing a 7-11 market in a mixed use housing project on the corner of Main and First Ave. It was never really your your dream to build a strip mall on that old landfill by the bus station. You have not woken up every morning of the last 30 years wondering how you could achieve an office building by the new cloverleaf next to the park and ride. Any of those things might have been nice, bit it didn't work out.</p> <p>Even more importantly, you are smart if you figure out sooner than later that it won't work out, and move on sooner rather than later. You may even be smart to move on even if there is a small chance of pulling off the deal. </p> <p>Donald Trump, as of this writing (and things are happening very fast at this moment, so this could change) is saying, vote on Trumpcare now, if the vote is no in the House, drop it. We'll do something else unrelated to health care. That is a wise thing to do, in the real estate world. I'm actually surprised to see Trump doing something that makes sense in any context at all. Maybe he isn't a total failure as a businessperson after all!</p> <p>Unfortunately, Trump is the President of the United States and the deal we are talking about is with Congress and the People, and it is not a strip mall somewhere, but the health care insurance system. </p> <p>There are people who have a life-long commitment to seeing affordable healthcare. It was always their dream to build a system of insurance that would be affordable and fair for all. They woke up every morning of the last 30 years wondering how to achieve this goal. </p> <p>They've tried before, failed, and got back up and dusted themselves off and tried again. Obamacare was the first real success since the old days, but even that was not enough and there are people ideologically, politically, and for humanitarian reasons committed to an even lofter goal.</p> <p>The arc of justice is long but bends gently to the left, in this case to the more universal and fairer health care system. It is convenient that the path Trump has decided to take is a hard right turn followed by ... well, parking the car on the side of the road and taking a bus to some other place. Maybe go golfing or something. </p> <p>We'll see what happens today (over the next two or three hours). I wonder if Trump will address all of his issues this way. I wonder if he'll address the presidency this way. I wonder if some day, soon, Trump will say to Paul Ryan, "Build the wall, and get Mexico to pay for it. I'll be at the Florida White House while you work that out."</p> <p>Then, when Ryan tells Trump, "There is no way. It can't be done. There isn't a mechanism for that, and we don't have the votes anyway," that trump will respond in the same way, but more bigly. </p> <p>"Call the vote," Trump tells Ryan. In my fantasy. "If it doesn't pass, I'm outa here." </p> </div> <span><a title="View user profile." href="/author/gregladen" lang="" about="/author/gregladen" typeof="schema:Person" property="schema:name" datatype="">gregladen</a></span> <span>Fri, 03/24/2017 - 08:02</span> <div class="field field--name-field-blog-tags field--type-entity-reference field--label-inline"> <div class="field--label">Tags</div> <div class="field--items"> <div class="field--item"><a href="/tag/president-donald-trump" hreflang="en">President Donald Trump</a></div> <div class="field--item"><a href="/tag/aca" hreflang="en">ACA</a></div> <div class="field--item"><a href="/tag/obamacare" hreflang="en">ObamaCare</a></div> <div class="field--item"><a href="/tag/politics" hreflang="en">Politics</a></div> <div class="field--item"><a href="/tag/real-estate" hreflang="en">Real Estate</a></div> <div class="field--item"><a href="/tag/trump" hreflang="en">Trump</a></div> <div class="field--item"><a href="/tag/trumpcare" hreflang="en">Trumpcare</a></div> </div> </div> <section> <article data-comment-user-id="0" id="comment-1479440" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490367088"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Well, the vote was a no show, as (apparently) Ryan and the great negotiator couldn't get enough of their right wing folks to go along with their plan. The words coming out indicate that the votes weren't there not because of any sense of decency or integrity on the part of the Republicans -- they haven't gone that far -- but because they were afraid of the anger of the people they represent: they had a feeling people would be royally pissed off that they were getting screwed out of the few promises Trump had made: no change to coverage for people with preexisting conditions, no kids getting tossed off parents' plans, and so on.</p> <p>I'm not, however, sure that this is not what the president wanted. The chance is essentially nil that it would have been passed by the Senate, so they had to know it was dead before it started. The next move will be to lay blame everywhere but at their own feet, warn the public that the same forces will want to stop Trump's other plans, and use that to marshal support for his other (worse for the public and economy) plans. </p> <p>I have no doubt that they wanted to get rid of the ACA -- you can't have anything done by a black man left in place after all, if you're a modern Republican, and poor people don't deserve care anyway -- but in the grand scheme of their plan, it was not a major foundation stone.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479440&amp;1=default&amp;2=en&amp;3=" token="B42msERBoG-3CxD32I6iXoggpfqCKavM3XGlkLaKoqg"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 24 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479440">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479441" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490368491"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Trump caved and asked Ryan to pull the bill.</p> <p>It is to bad the Republicans couldn't get the first of their three part plan through the House.</p> <p>Now they will have to think of another approach.</p> <p>Perhaps a simple repeal will pass and then it will be easier to pass the replace with the repeal already done.</p> <p>Perhaps they can just repeal the mandate.</p> <p>Perhaps they will just let Obamacare fail on its own (almost there already).</p> <p>I guess we will see what happens next.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479441&amp;1=default&amp;2=en&amp;3=" token="mIWStxlj1d2SCSNHHRUnG2Zmn1B10lN1ggoAUe8dCos"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">RickA (not verified)</span> on 24 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479441">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479442" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490368717"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Perhaps they will just let Obamacare fail on its own (almost there already)"</p> <p>Another blatant piece of shit from the biggest congenital liar around.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479442&amp;1=default&amp;2=en&amp;3=" token="CreNXTWcaSY3o31OFBmMp0YD75NBu5837cW1JVpb3cA"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 24 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479442">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479443" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490369652"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>The third part is the sucker bait.</p> <p>And when are you going to acknowledge the hypocrisy of their bleating about Obamacare being a hack job because it was rushed behind closed doors with blandishments and deals struck to entice votes for it and their amping up of the same scheme TIMES TEN?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479443&amp;1=default&amp;2=en&amp;3=" token="DluMZXZ-PvMnKWMhuRsB_UPjJwQbprjXkASunDnzUnA"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 24 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479443">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479444" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490371453"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>RickA stains his undies which are tied in a knot by saying:</p> <p>"Perhaps a simple repeal will pass and then it will be easier to pass the replace with the repeal already done.</p> <p>Perhaps they can just repeal the mandate."</p> <p>Nope. They're done for this session. They've said so. And both of those would take 60, not 51, votes to get through the Senate anyway.</p> <p>"Perhaps they will just let Obamacare fail on its own (almost there already)."</p> <p>There you go. They're going to kick it down the stairs hoping it breaks its back. However, their re-election message in 2018 is going to sound quite lame. "We promised to repeal Obamacare with something better, but couldn't figure out how, so reward me with re-election!". That's not going to go down as well as you might think, especially since the black man is no longer available as Boogie-man In Chief.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479444&amp;1=default&amp;2=en&amp;3=" token="eWDwWXvRLiaS8VNgI01utez_cI4lw6iSwR8omNT53C8"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dhogaza (not verified)</span> on 24 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479444">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479445" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490428237"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>I think that the House should write up and introduce all three phases of their Health Care Reform Bill - even if they won't pass currently.</p> <p>Once Obamacare collapses, if would be nice to have had a chance to study the whole replacement package and give people time to get used to it - so we are ready to go when the democrats start begging for an Obamacare fix.</p> <p>Lets put it all out there, I say.</p> <p>I for one, would like to read it.</p> <p>And I am sure the Senate Republicans would like to see it also.</p> <p>It would be a good idea to even tweak it so the Senate is on board and it won't collapse once it gets out of the house (like the Current House bill would have when it got to the Senate).</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479445&amp;1=default&amp;2=en&amp;3=" token="70OrU20qmLefaIfe03xSAPKKchPsRTgZwM3B0SXByuE"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">RickA (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479445">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479446" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490431274"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Once again the head moron asserts the ACA is on its way to collapse. Once again, the only conclusion: what an ass he is.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479446&amp;1=default&amp;2=en&amp;3=" token="2AjTH6uKwLxsluM_C_xYb0mkGP53OsltGPP1VR7x6hU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479446">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479447" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490432185"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"I for one, would like to read it."</p> <p>It doesn't exist. That would be one major reason to avoid putting it out there.</p> <p>You are right, what they say they want to push out MUST be provided if they want to claim anything about how good their bucket list is, but they do not have to and failing to do so will never stop anyone on their side believing that it's all great. So when given that putting their ideas out, when they actually have one to put out, could cause a lot of people to treat it like a dog turd sandwich, yet not putting it out there will make no dent in their support, it's pretty clear that unless their supporters insist on this and take a "If you have nothing to fear, you have nothing to hide, so you must have a really shit proposal to be hiding it" stance publicly, they will NEVER produce a plan. There's no upside to that, and no downside to failing to.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479447&amp;1=default&amp;2=en&amp;3=" token="9CKN0LRezd_zSa6SkEXcBqGOHzZjPaBlW81if2_Rkl8"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479447">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479448" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490432212"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Once Obamacare collapses"</p> <p>How?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479448&amp;1=default&amp;2=en&amp;3=" token="htvQeIXKOWXPaHgGY-5Q2eQol2nYzOZw4cM0nU-ZfnI"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479448">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479449" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490432413"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>And surely you should have said "IF Obamacare collapses". What about once Obamacare continues to run? It's currently running, and it's been running for a long time now. Not collapsed at all. Since Obamacare hasn't collapsed, what will you and your side do?</p> <p>Deliberately sabotage it? Keep waiting for it to collapse and until then (and only after it collapses, having rendered whatever doom scenario you are gleefully waiting for to punish people for not voluntarily refusing the benefits or making it collapse themselves by sabotage) keep not providing any alternative?</p> <p>Once it doesn't collapse, what then? Deliberately wreck the plan?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479449&amp;1=default&amp;2=en&amp;3=" token="ad_Uf_aXuMwX4w_-_QcoRxcf1seN5TeUAly4IDXnMPM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479449">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479450" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490436506"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Deliberately sabotage it?"</p> <p>They've been working on that since its introduction, despite the fact that it was originally an invention of theirs: it is essentially the plan the Heritage Foundation developed in the 90s when those evil folks the Clintons were around.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479450&amp;1=default&amp;2=en&amp;3=" token="QZr22dWn_QFI0Z3eE9VZGjkg3OSQFqColCSbWV7xYkU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479450">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479451" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490460365"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Wow: “Deliberately sabotage it?”</p> <p>They've been doing that, for instance by not stepping in to fund relief for insurance companies faced with too few healthy young signing up, a major cause in the large jump in premiums for 2017.</p> <p>Trump already shut down the email reminders sent to folks as the end of open enrollment approached to tell them that they had until the end of Jan 2017 to enroll.</p> <p>Trump already told the IRS to back off on enforcement of the mandate, which has resulted in a change in IRS policy being announced.</p> <p>Price has already stated that he wants to shrink the open enrollment period from three months to six weeks, and to make it more difficult for those who fall into the "change of life" (i.e. those who've gone through a change in marital status and the like outside of open enrollment) status to sign up outside open enrollment.</p> <p>Price's response to yesterday's vote was to hint that HHS will do as little as possible to support the ACA, via twitter.</p> <p>So, yes, causing it to collapse and then blaming Democrats for it is exactly their plan. The above are just some of the executive branch efforts that have taken place or are planned. The House won't be idle, either, though the Senate's a bit of a wild card here.</p> <p>RickA thinks that the result will be that Dems will "start begging for an Obamacare fix". Ha ha.</p> <p>The reality is this: Republicans own the ACA for until 2018 at least, due to their failure to kill it this past week. Their efforts to cause it to fail, even if successful, will lie on their shoulders. People are tuned into health care as an issue and the moves the Republicans are going to make aren't going to be the least bit stealth-like.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479451&amp;1=default&amp;2=en&amp;3=" token="d8outoBy_ANO6e6Nj-Ts_OP8i4KcgVbp3PdCyr39Gbo"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dhogaza (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479451">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479452" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490469627"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Hey Republicans. Trump only has a short amount of time before his franchise runs out. His Russian mission planners undoubtedly would like him to do as much damage to Murka as he can before he gets impeached or otherwise removed. He has already done a great job of dinging our national institutions, and dinging our relationships with our western allies, and he has helped whip up divisive racial attitudes within the country since shortly after he first opened his mouth. It is doubtful that the old codger even has a clear idea of what is going on around him, especially the fact that he is unwittingly doing the work of his slavic puppet master..... As is his boy wonder Paul Ryan, who literally worships the philosofecal ( see what I did there? ) works of Russian Alisa Zinov'yevna Rosenbaum ( Ein Rand), (but that is a whole other conspiracy theory, to be saved for another day.). Trump loves the Slavs, lets admit it.Two of his three wives were foreign born slavic ladies if I am not mistaken. Heck. I love slavic ladies too. Trump's warm-up act, soviet born Orly Taitz, helped stir the pot of corruption that became birtherism. Trump's former National Security Adviser Mike Flynn had to leave because he was way too cozy with the Ruskies. His former campaign manager Paul Manafort had to quit because he was way too cozy with the Ruskies.... to the tune of ten million dollahs a year at one point.... ten million dollahs per year that he received from one of Putin's closest buddies. Trump's attorney general lied about having had contact with Russians before his confirmation. WTF! WTF Republicans! WTF! Shit , Republicans, can't you get your heads out of your asses long enough to see that your man Donald is being propped up by a bunch of Russia lovers like Steve Bannon, who openly admire our global opponent, the murderous Russian Putin? Can't you see that Trump has been manipulated ( easy to do with a narcissist!!!) by a bevy of people who have all been close enough to the Russians to have acquired Inductively Coupled Ruskie Cootie Disease? You can't see that? Oh. </p> <p>Well, then don't forget to bite Putin's polyps while you are up there then, you fucking idiots.</p> <p>And have a nice day :&gt;)</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479452&amp;1=default&amp;2=en&amp;3=" token="5uVUyiz7us8xT9H-IlQ9AblPSI8PhplvxUzA1-gWejw"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">SteveP (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479452">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479453" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490474936"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Dhogaza, that is two sets of policies working against each other. Changing the open enrollment period, is something that would lower premiums, and or reduce insurance company losses, because it makes it harder for people to wait until they get sick to sign up for insurance. This is not sabotage, and is something considered by Obama except that he wanted to show high number of signups for political reasons. Eliminating the individual mandate would raise premiums and is sabotage..</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479453&amp;1=default&amp;2=en&amp;3=" token="DHuG5afXR1PyPjsHW6dE0zRMLq-6W9cAZg_Lw0pxf10"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479453">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479454" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490482647"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>MikeN:<br /> "Changing the open enrollment period, is something that would lower premiums, and or reduce insurance company losses, because it makes it harder for people to wait until they get sic"</p> <p>In other words, the open enrollment period should be reduced to zero days.</p> <p>Thank you for playing.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479454&amp;1=default&amp;2=en&amp;3=" token="UJ1msSZp68hf9V1-OGldK3uhSfpBK5erN5I41Sl9YFQ"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dhogaza (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479454">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479455" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490489239"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Because cutting in half, from a quarter of the year to an eighth, is the same as cutting to zero?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479455&amp;1=default&amp;2=en&amp;3=" token="NJSnu79UUA5NrKIq6QCE3gh9u2BM-RWbIacqHjGejpY"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479455">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479456" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490494213"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>No, because the logical endpoint is zero.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479456&amp;1=default&amp;2=en&amp;3=" token="OH077fWV9XbkS-1go6cYSHYEO0uE3lnEpkiFdXSGyKE"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 25 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479456">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479457" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490506458"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Anything that makes it harder for people to obtain ccess to health care is good (from the point of view of the right). It keeps all those icky non whites out of the way dontya know. </p> <p>The real message from the current administration and its low life backers is simple: if you don't get sick you won't need health care. If you plan on getting sick make sure you're rich before you do it.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479457&amp;1=default&amp;2=en&amp;3=" token="JvcPbGVdt6Vs4YS9O2P7Q6cS88qrki6lwhlI4TKqluk"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 26 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479457">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479458" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490545653"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>If you can sign up year round, then it's a better deal to wait until you are sick to sign up. </p> <p>If you can sign up zero days a year, then no one will sign up.</p> <p>But it's not zero signups when you have some number of says when people can sign up.</p> <p>The goal is to not have people wait until they are sick to sign up for insurance. So they shorten the signup period, and I believe made some other changes as well.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479458&amp;1=default&amp;2=en&amp;3=" token="bzPxfog8VMzOFuStqr7VvB8k_EjBl-H8MFzRJwDROys"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 26 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479458">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479459" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490553498"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>The goal is to reduce the number of people who sign up, and they're not even trying to hide that fact.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479459&amp;1=default&amp;2=en&amp;3=" token="HW1FOM0LjuoMavwoVNJmsrm-t9ivG3R1bHBs8Tn5rBM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dhogaza (not verified)</span> on 26 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479459">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479460" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490565078"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>If that were the goal, then instead of reducing the essential health benefits package, they would increase it to make premiums rise even more. Cover acupuncture, dental, glasses, etc.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479460&amp;1=default&amp;2=en&amp;3=" token="kF-kGgg7NuJqbeicrSyZjRgF3_uwhIMkyda35d0b7CM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 26 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479460">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479461" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490575841"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>No, because they'd be blamed for increasing the premiums, dumbass.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479461&amp;1=default&amp;2=en&amp;3=" token="JFOp42Tz3DmXC5JMjTShgB3Romqu0vmqjGiXZ-g6Dxo"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 26 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479461">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479462" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490604086"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p><a href="http://scienceblogs.com/gregladen/2017/03/24/trumps-take-it-or-leave-it-approach-makes-sense/#comment-645524">Wow</a>:<br /></p><blockquote>No, because the logical endpoint is zero.</blockquote> <p>Sure, but when has the logical endpoint of any argument ever become law? </p> <p>Greg's reference to sausage in the OP (please correct me if I'm wrong, Greg) is an allusion to: “Laws, like sausages, cease to inspire respect in proportion as we know how they are made" (incorrectly attributed to <a href="http://quoteinvestigator.com/2010/07/08/laws-sausages/">Bismarck</a>). With few exceptions, every bill that goes to the President is the point of compromise among multiple contending interests, all of whom had to abandon some of their goals (to say nothing of their principles) to achieve others. It's not the logical endpoint for any of them.</p> <p>We should bear in mind that the ACA that emerged from the sorry spectacle of its passing was itself a point of exhausted compromise. It started out as Romneycare FFS!</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479462&amp;1=default&amp;2=en&amp;3=" token="ibgI1SkKJyGJLVD1nLSw5rK1uI-vrbXqJ8RpR-GSZ54"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Mal Adapted (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479462">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479463" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490607710"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Well, since President Trump says he never claimed that the ACA (sorry, for you racists who defend Trump, Obamacare) would be repealed quickly, this isn't really a setback.</p> <blockquote><p>Speaking to reporters in the Oval Office, Donald Trump suggested that this was simply all part of his plan.<b> “You've all heard my speeches,” he said. “I never said ‘repeal it and replace it within 64 days</b>.</p></blockquote> <p>Oh, wait:</p> <p>From November 1:</p> <blockquote><p>“When we win on Nov. 8 and elect a Republican Congress, we will be able to<b> immediately repeal and replace Obamacare</b>. We have to do it,” Trump said Tuesday afternoon in an address on the Affordable Care Act in King of Prussia, Pennsylvania.<br /> “I will ask Congress to convene a special session so we can repeal and replace,” he continued. “And it will be such an honor for me, for you and for everybody in this country because Obamacare has to be replaced. <b>And we will do it, and we will do it very, very quickly</b>. It is a catastrophe.”</p></blockquote> <p>January 10:</p> <blockquote><p>“We have to get to business,” Mr. Trump told The New York Times in a telephone interview. “Obamacare has been a catastrophic event.” Mr. Trump appeared to be unclear both about the timing of already scheduled votes in Congress and about the difficulty of his demand —<b> a repeal vote “probably some time next week” and a replacement “very quickly or simultaneously, very shortly thereafter.”</b> </p></blockquote> <p>Same crap numerous other times. You have to wonder</p> <p>* How the losers who support him can reconcile his past statements with these events and what he said afterwards<br /> * Why people would still defend him on this</p> <p>But, given people still repeat the lie that the ACA was going to implode on its own, we can't bet against the ingrained stupidity (dishonest? combination of the two?) in his supporters.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479463&amp;1=default&amp;2=en&amp;3=" token="xwPywd1bO8wbyi2JXmD5qsnMw-5e7qb6JZnQOE60Mlg"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479463">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479464" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490609414"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><blockquote><p>"I could stand in the middle of 5th Avenue and shoot somebody and I wouldn't lose voters."<br /> ~ Donald Trump</p></blockquote> <p>Probably the only time something spewed forth from his brain that wasn't a falsehood. He knows his mojo works best on those with the attention span of a gnat--and they are Legion. The irony is it shows how much contempt he has for his own base... OTOH, I guess they've earned it.</p> <p>There's one born every minute.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479464&amp;1=default&amp;2=en&amp;3=" token="xZfPHy1eWuc4rj5fRuDLuFiOGqVWlu97Eo2FiR8JIW0"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479464">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479465" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490612826"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>A number years ago, (in the state I worked) health departments were told to not inform eligible families about the CHIPS program because to many were signing up for the benefits.</p> <p>I obtained the application forms and sent them to newspaper editor that I knew. He wrote a long editorial about this issue and said his paper would supply application forms to anybody requesting them. Other papers in the state picked up on this and ran similar editorials. The state quickly backed off and made the applications available to everyone.</p> <p>We need more support like what the newspapers this case provide to protect healthcare in the US.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479465&amp;1=default&amp;2=en&amp;3=" token="MrD8LFeomHY20KN1YMrWfA-29S9h5qy1S1Rzn7pzvsM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Rich Bly (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479465">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479466" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490614345"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"There’s one born every minute."</p> <p>Sometimes from inbreeding, it would seem. We just had some local Republican spokesman interviewed on the radio.</p> <p>Him: "Look, we know the American people wanted President Trump to make these changes. If they hadn't he wouldn't have had a majority of the votes cast in the last election go to him. "</p> <p>Interviewer: "He lost the popular vote."</p> <p>Him: "Not after you account for all the fraud her people pulled at the polls. Do your research."</p> <p>Nothing more was said to him on that. With people that dishonest being willing to advertise it on the air it is no wonder others are willing to advertise their stupidity and support President Trump's claim that he was wiretapped by President Obama in spite of a complete lack of evidence. </p> <p>After Nixon and Reagan I never though I would live to see a third president who was so completely lacking in his own integrity with such a strong following of people who are themselves lacking in so many important ways. It isn't good to be proven wrong.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479466&amp;1=default&amp;2=en&amp;3=" token="Ncyxz6SLjOdr1mGI-nL8ruyXD5BmmfSWjGa5muastVM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479466">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479467" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490616100"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>It's a trend. Each one opens the door a little wider for the next advancement in crazyevilstupid: </p> <p><a href="http://www.jokelibrary.net/xOtherNtoZ/polit/polit-supp3-Darcy.gif">http://www.jokelibrary.net/xOtherNtoZ/polit/polit-supp3-Darcy.gif</a></p> <p>Sure can't wait to see what the Republicans come up with next. Boy-oh-boy, won't that be something?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479467&amp;1=default&amp;2=en&amp;3=" token="rkMeIx1jAtvCrhi52FSIJuonfbMWKr57SrvZDxVODfw"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479467">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479468" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490619530"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Right now, Democrats are arguing they'd love to have President Romney, and were praising W as a model of intellect. Only a matter of time before liberals are complaining that the current nominee is not a good guy or reasonable or intelligent or competent like President Donald J Trump.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479468&amp;1=default&amp;2=en&amp;3=" token="rmMKE-V-_VpRTGEvm3dv3mpxYAjz9rO9QhNDCehj5YU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479468">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479469" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490621224"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Romney? It is ironic that Republicans rejected a Republican plan just for the sake of being a bunch of jerks to Obama. </p> <p>NOBODY is praising W for his intellect. They are laughing at Republicans for coming up with somebody even more ridiculous.</p> <p>Crazy Don Trumpetpants and his Republican House of Horrors will go down in history for their astounding incompetence and for swamping the drain if they don't wise up soon.</p> <p>Dreaming, irony challenged M@29 presents as incisive commentary the kind of lame fantasy you hear on wingnut radio.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479469&amp;1=default&amp;2=en&amp;3=" token="X6QGco_6tyCYvmDEH0fmDqZ9wsfTKsa8_lfJmkmzFSs"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479469">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479470" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490621366"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>MikeN, I don't know anyone referring to W the way you imply. Nor do I know anyone who is arguing they want Romney as president .<br /> Bush wrecked the economy and destroyed what stability there was in the middle East. President Obama set the path to restoring much of the economy - that's been setback now.</p> <p>Romney would have sent things further over the cliff.</p> <p>What color is the sky in your mind?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479470&amp;1=default&amp;2=en&amp;3=" token="2J1bRQDPeZbN6O5aMSBbf5v5Fd99XvvMKk1bJv8zLAc"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479470">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479471" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490621820"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>I can remember all our presidents back to Eisenhower (although not well for him) and I can say that everyone them was out to try better America; except one. I may not have agreed with their methods and policies but they were putting America first. </p> <p>To this day JFK's, Ask not what your country can do for you but what you can do for country means a lot to me. With our current LOTUS (Loon of the US) the quote would now be Ask not what Trump can do for you but what you can do for your Trump.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479471&amp;1=default&amp;2=en&amp;3=" token="GPFZA1darIg57gQJ5RFpPJAOssBZE2EN9xk8LXGd8rI"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Rich Bly (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479471">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479472" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490623284"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Sure, but when has the logical endpoint of any argument ever become law? "</p> <p>Since when has something never have happened before meant it cannot happen?</p> <p>Moreover, look at orangina loofa-faced. Nobody ever thought it would be necessary to make the pres show their tax returns, or empty positions on the day they make office and not have anyone to fill those vacant post. Nor thatthey'd have to write the law without assuming that the POTUS would not bother following the laws of every other government employee regarding bribes.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479472&amp;1=default&amp;2=en&amp;3=" token="VpyJsc08U470JnVe1IvW5TIy_uXyXCC5w_MDcmwS-NY"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479472">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479473" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490623471"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Him: “Not after you account for all the fraud her people pulled at the polls. Do your research.”"</p> <p>Yes. If he and his cronies and voters hadn't committed all that fraud or pulled people out of voting, he'd have lost the electoral college too.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479473&amp;1=default&amp;2=en&amp;3=" token="NDncBe03dMWyjc9KPlVI-OcuBeUJHi2P2vrJjY7KrRU"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479473">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479474" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490623566"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Right now, Democrats are arguing they’d love to have President Romney"</p> <p>Proof plz. Because I could just as well claim that Repubicans are arguing they'd love to have President Sanders (look at his approval rating).</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479474&amp;1=default&amp;2=en&amp;3=" token="Jr_cxKVISBdyNYProCyY4Fc_aCUQyjjOWxOpyihUYVA"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479474">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479475" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490624732"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Dean, Bill Maher said it about Romney. </p> <p><a href="https://www.washingtonpost.com/opinions/donald-trump-makes-me-miss-george-w-bush/2016/02/16/f72a533e-d4ea-11e5-be55-2cc3c1e4b76b_story.html?utm_term=.fa673fe5a949">https://www.washingtonpost.com/opinions/donald-trump-makes-me-miss-geor…</a></p> <p>Aziz Ansari laughed at himself on SNL for praising George Bush, "16 years ago...Now I'm saying, He guided us with his eloquence!"</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479475&amp;1=default&amp;2=en&amp;3=" token="HhSuqI3ip7U-3BLp3qofamH-53R6g46Ar_Uk0rFBd2o"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479475">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479476" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490625717"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Dana Milbank's article: dated February 16, 2016, over a year ago, on the campaign trail, with the subject the difference between the demeanor with which W carried himself and the way the Republican suite of candidates (in 2016) were behaving. Hardly a current wish for a return of him as president. </p> <p>Ansari's quote was in reference to Bush's speech after September 11 - where Bush did shine. (He then proceeded to fuck up everything that followed and destroy the goodwill from other countries, if you remember). It wasn't about his entire presidency.</p> <p>And Maher's "anyone but Trump" choice of Romney -- selecting someone who was marginally the least heinous of the recent Republican candidates? That's a major endorsement? </p> <p>I'm amazed at the distances people on the right go in these attempts to distort reality.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479476&amp;1=default&amp;2=en&amp;3=" token="6NddtBnHYwTPFexNg8_HS91yNM0UqMmlPBb8Bde5DZ4"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479476">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479477" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490626479"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Dean, Bill Maher said it about Romney. "</p> <p>And he's a comedian.</p> <p>Kinda weird that you picked a comedian as the universal "democrats" (especially since you're a loon), and never actually quoted him.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479477&amp;1=default&amp;2=en&amp;3=" token="yvKb9uiynmEjaf8TJ8zTNFGARSplxE4XOYYsDGD9NSk"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479477">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479478" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490626529"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Aziz Ansari laughed at himself on SNL for praising George Bush"</p> <p>Yeah. Right. You clearly do not understand language,"mike".</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479478&amp;1=default&amp;2=en&amp;3=" token="bNhktivGcHY4NSdoZLoZJ7D11a8sO85ZeuoFMGvMflw"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479478">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479479" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490627111"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Meh.</p> <p>Bill Maher describes himself as a Libertarian and would-be Republican:<br /><a href="http://www.politico.com/story/2012/03/10-little-known-facts-about-bill-maher-074107">http://www.politico.com/story/2012/03/10-little-known-facts-about-bill-…</a></p> <p>Dana Milbank is a contrarian who votes for Republicans not on the ballot.<br /><a href="https://en.m.wikipedia.org/wiki/Dana_Milbank">https://en.m.wikipedia.org/wiki/Dana_Milbank</a></p> <p>Aziz Ansari is a comedian. Take what he says in context and understand why he says it. He also said:<br /> "If you’re excited about Trump, great. He’s President. Let’s hope he does a great job. If you’re scared about Trump and you’re very worried, you’re going to be O.K. too."<br /><a href="http://time.com/4642747/aziz-ansari-snl-monologue-transcript/">http://time.com/4642747/aziz-ansari-snl-monologue-transcript/</a></p> <p>But hey, if you want to say that any given handful of people represent liberals, whatever vato.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479479&amp;1=default&amp;2=en&amp;3=" token="yL3BuqCjL2js8qRwttAOw0KZs1s9UEFsI3z1RZ4YcW8"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479479">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479480" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490632379"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"But hey, if you want to say that any given handful of people represent liberals, whatever vato."</p> <p>Well, all three of those people do make a living off of their abilities with written and spoken words -- that has to be enough to qualify them as liberal, right? It's not like using words is something a real 'Merican would be doing, right?</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479480&amp;1=default&amp;2=en&amp;3=" token="csP1TeCpbP5Wwqe6H-1XuHe0FIl6nvpURBTU8u8Ca_o"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479480">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479481" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490635312"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Of course W is not their first choice as president, or Romney. With the electoral college vote looming, there were a number of liberals asking for votes for Romney, and ended up with some Democrats voting for Colin Powell(and Bernie).<br /> When Bush was there, people said, Reagan actually thought things through, unlike W. Now, it's W's turn as the new 'He was actually not that bad'. It started when they contrasted with Sarah Palin. </p> <p>It's just a matter of time, some of the people talking about Trump will eventually be praising him to attack the new guy.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479481&amp;1=default&amp;2=en&amp;3=" token="WTnXfOx-DY4YXFv0TYyztlAV76LY7hMdG4MmzOOP9uc"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">MikeN (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479481">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479482" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490635448"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>"Reagan actually thought things through,"</p> <p>People who are willing to overlook the reality of what a shitstorm Reagan was in favor of the myth he's been built into, maybe.</p> <p>People with common sense and a memory of those 8 years: nope.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479482&amp;1=default&amp;2=en&amp;3=" token="sw8vTTKYGXmjTVgspWSDsi3EkUwyydGv8s-EqLLLRsM"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">dean (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479482">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479483" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490637351"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Reagan got shot in the head IIRC, and also had some brain surgery to remove some brain (cancer). Yet was still smarter than Bush Jr (though that is a very low bar).</p> <p>Still Shrub was smarter than trumpistan.</p> <p>Both he and Maggie both benefitted from the inertia of a economy that bourne on the backs of the massive middle class, had a good 15-20 years of growth built in before their idiotic economic policies started to cut back on the middle class.</p> <p>The middle class is what government makes money off. The poor have no money to tax, and the rich either avoid or withhold tax successfully.</p> <p>And the growth of the middle class through the late 50's to the early to mid 70s meant a buffer of untapped wealth to mine for the benefit of the wealthy.</p> <p>Libertarians are, of course, all wealthy, or potentially so if it were not for the "commie policies" of government making them unsuccessful....</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479483&amp;1=default&amp;2=en&amp;3=" token="AuSeaCbDPuo2DdqTGMgzjPF-WzTSKZCMurKvRD39778"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479483">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="31" id="comment-1479484" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490638869"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Reagan was not shot in the head.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479484&amp;1=default&amp;2=en&amp;3=" token="1VDaaqWjMfQ76TAMfVsMy2yCCNApGaQPYArvTT3-QV0"></drupal-render-placeholder> </div> <footer> <em>By <a title="View user profile." href="/author/gregladen" lang="" about="/author/gregladen" typeof="schema:Person" property="schema:name" datatype="">gregladen</a> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479484">#permalink</a></em> <article typeof="schema:Person" about="/author/gregladen"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/author/gregladen" hreflang="en"><img src="/files/styles/thumbnail/public/pictures/HumanEvolutionIcon350-120x120.jpg?itok=Tg7drSR8" width="100" height="100" alt="Profile picture for user gregladen" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479485" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490640922"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Ah, shoulder or something? I remember the scene, though it wasn't the only time he got shot, I remember that too. It might, at the report of it on the news, have been wondered if he'd been shotin the head (not dead)</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479485&amp;1=default&amp;2=en&amp;3=" token="gmjEFBnf3spxeEjF0WMi-q2uyz5pUfalRisqay58n3Y"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479485">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479486" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490641448"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>Reagan =&gt; Alzheimer's not bullet.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479486&amp;1=default&amp;2=en&amp;3=" token="Ib5j_X_NS5-KPol8OANn_v4p0JVQxxE6SzlGaBMPcfw"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="" content="Obstreperous Applesauce">Obstreperous A… (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479486">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479487" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490642067"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>He was shot/</p> <p><a href="https://en.wikipedia.org/wiki/Attempted_assassination_of_Ronald_Reagan">https://en.wikipedia.org/wiki/Attempted_assassination_of_Ronald_Reagan</a></p> <p>And so fairly sure he wasn't universally popular.</p> <p>So if "democrats" liked him, it musta been republicans. Or libertarians...</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479487&amp;1=default&amp;2=en&amp;3=" token="GNl68JKfIrFjdr6Xp2BbBfX6IYZoVRtXqHGHEukK2I4"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">wow (not verified)</span> on 27 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479487">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> <article data-comment-user-id="0" id="comment-1479488" class="js-comment comment-wrapper clearfix"> <mark class="hidden" data-comment-timestamp="1490677156"></mark> <div class="well"> <strong></strong> <div class="field field--name-comment-body field--type-text-long field--label-hidden field--item"><p>And it may merely have been not the first attempt, rather than the first actual wounding.</p> </div> <drupal-render-placeholder callback="comment.lazy_builders:renderLinks" arguments="0=1479488&amp;1=default&amp;2=en&amp;3=" token="bdTzL1UVtXr3_aS3h2weY4CarWpMVrAujIET2oV7Zxc"></drupal-render-placeholder> </div> <footer> <em>By <span lang="" typeof="schema:Person" property="schema:name" datatype="">Wow (not verified)</span> on 28 Mar 2017 <a href="https://www.scienceblogs.com/taxonomy/term/8201/feed#comment-1479488">#permalink</a></em> <article typeof="schema:Person" about="/user/0"> <div class="field field--name-user-picture field--type-image field--label-hidden field--item"> <a href="/user/0" hreflang="und"><img src="/files/styles/thumbnail/public/default_images/icon-user.png?itok=yQw_eG_q" width="100" height="100" alt="User Image" typeof="foaf:Image" class="img-responsive" /> </a> </div> </article> </footer> </article> </section> <ul class="links inline list-inline"><li class="comment-forbidden"><a href="/user/login?destination=/gregladen/2017/03/24/trumps-take-it-or-leave-it-approach-makes-sense%23comment-form">Log in</a> to post comments</li></ul> Fri, 24 Mar 2017 12:02:46 +0000 gregladen 34319 at https://www.scienceblogs.com