• ZipDialog Roundup: Breaking News for Tuesday, August 8

    Articles chosen with care. Your comments welcomed.
    Linked articles in bold purple

    ◆ BREAKING: North Korea now making miniaturized, missile-ready nuclear weapons, U.S. analysts say (Washington Post)

    North Korea has successfully produced a miniaturized nuclear warhead that can fit inside its missiles, crossing a key threshold on the path to becoming a full-fledged nuclear power, U.S. intelligence officials have concluded in a confidential assessment.

    The new analysis completed last month by the Defense Intelligence Agency comes on the heels of another intelligence assessment that sharply raises the official estimate for the total number of bombs in the communist country’s atomic arsenal. The U.S. calculated last month that up to 60 nuclear weapons are now controlled by North Korean leader Kim Jong Un. Some independent experts believe the number of bombs is much smaller. –Washington Post, reporting on Defense Intelligence Agency

     

    North Korea’s dangerous game: Trump is not Obama (BESA, Israeli think tank)

    Pyongyang uses the buzz that accompanies its ballistic missile and nuclear tests, as well as the obscurity that conceals the extent of its infrastructure for weapons grade fissile materials production and nuclear weaponization, as tools with which to challenge Washington. Trump is not Obama, however. Kim Jong-un will need to tread carefully to avoid provoking an American preemptive strike. — Raphael Ofek for the Begin-Sadat Center for Strategic Studies

     Robust US economy: Record number of job openings (Bloomberg)

    The gain in job openings underscores the need for workers in an economy that’s continuing to expand. At the same time, the pool of qualified Americans is shrinking and making some positions tougher to fill, one reason economists expect the monthly pace of hiring will eventually cool. –Bloomberg

    Comment: Great news. Now, to get wages moving up and people trained to fill those openings.

     Google fires author of viral memo on the downside of diversity hiring (Bloomberg)

    Google was already being sued for discrimination, and some executives said that, after the memo, they could not “in good conscience” assign some people to work the memo’s author, James Damore. They claimed his memo “perpetuated gender stereotypes.”

    Mr. Damore’s own response, which virtually nobody prints begins this way:

    I value diversity and inclusion, am not denying that sexism exists, and don’t endorse using stereotypes. When addressing the gap in representation in the population, we need to look at population level differences in distributions. If we can’t have an honest discussion about this, then we can never truly solve the problem.
    Psychological safety is built on mutual respect and acceptance, but unfortunately our culture of shaming and misrepresentation is disrespectful and unaccepting of anyone outside its echo chamber. –James Damore

    James Damore’s complete, original memo and response are here (Medium.com)

    Comment:

    • Expect him to sue.
    • Expect him to find it hard to gain employment in Silicon Valley.
    • Expect an honest discussion of these issues to become impossible.

    More troubles for Obamacare: Major insurers keep leaving the marketplace (Fox News)

    Exchanges are now down to 3 states. Insurers lost over $1 billion in last two years.

     

     

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  • Valerie Jarrett and Michelle Obama’s old hospital drops major Obamacare insurance program

    Valerie Jarrett chaired the board of the University of Chicago Hospitals until she moved to Washington.

    While there, she naturally employed her friend, Michelle Obama; this is Chicago and such favors are expected.

    Kudos to Valerie, though, for going above and beyond: she tripled Michelle’s salary after Barack was elected to the US Senate.

    Ah, coincidences.

    Now, the Chicago Tribune reports (link here)

    Thousands of low-income patients may have to scramble to find new doctors this month after University of Chicago Medicine became the latest major health system to break up with IlliniCare Health, an insurer that administers benefits for the state’s Medicaid program.

    U. of C. Medicine follows Northwestern Medicine and Advocate Health Care in walking away from IlliniCare Health, one of 12 Medicaid managed care organizations in the state. Medicaid managed care organizations are insurers that handle benefits for Medicaid, a state- and federally funded health insurance program for the poor. –Chicago Tribune

    Meanwhile, the deadbeat state of Illinois “still owes Medicaid managed care organizations about $3.5 billion,” according to the Tribune.

    Comment: Thank goodness the Republicans are busy repealing and replacing this clunker after 7 years of promising. Sarcasm off.

  • Dead: Two More Republican Senators says “No” to the Revised Healthcare bill

    This evening’s declarations by Utah’s Mike Lee and Kansas’ Jerry Moran, plus earlier statements by Maine’s Susan Collins and Kentucky’s Rand Paul, means there are four declared “no” votes. (Brief story here in the Washington Post.)

    With only 52 Republicans in the Senate and all Democrats and independents voting “no,” Senate Majority Leader Mitch McConnell cannot get to the minimum 50 he needs.

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    What happens now?

    The big questions now:

    • What happens to the American health insurance system, which is now melting down under the weight of Obamacare’s malfunctions and heavy subsidies?
    • What kind of patchwork reforms will be put in place this year?
      • Democrats will want a huge say, but rank-and-file Republicans won’t like that and may try to block the Democrats’ proposals.
    • Who pays the political price for this fiasco?
      • Who is hurt more politically? The Democrats by the Obamacare mess they inflicted on the nation? Or the Republicans by their failure to fulfill their repeated promise to repeal and replace it?
      • What happens to the split between moderate Democrats and progressive single-payer advocates?
      • What happens to the split between modern Republicans and more conservative legislators who want to roll back entitlements?
  • Using Smart Tech to Solve the Impass in US Health Care

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    The American health care payment system is stuck in the mud–mired down by traditional ways of delivering medical services.

    We can do better. Major, cost-effective technologies are available to be utilized.

    It is unlikely that the Senate Republican factions will resolve their health care related legislative differences, although last-minute compromise is possible. Also, it is unlikely that Congressional Republicans and Democrats will bridge their ideological and political differences. The American public demands lower cost, effective, appropriate health care coverage.

    Pragmatic economics, coupled with technology, is key because money to be saved by reducing Medicaid expenses can be used to provide increased health care coverage to the really Medicaid eligible, working Americans, and retired senior citizens.

    This reality concept will be regarded as mean-spirited by the 45 percent of American adults who do not have full-time employment, and the 94 million people who have decided to remove themselves the job market, and their political supporters. Requiring work as the consideration for receiving Medicaid social benefits is not necessarily mean-spirited.

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    Why Obamacare Failed

     The Obamacare (ACA) health care law concept and implementation has failed because it has substantially increased health care premia and reduced coverage.

    The Republican House alternative may be better than ACA, but it will be changed because the Republican Senate has three or more competing groups with conflicting approaches to health care legislation, none of which conform to the House version.  A two-party compromise Senate health care bill is unlikely to be reached because Democratic senators will not vote for Republican health care legislation, and the likelihood of a good faith compromise is nil.

    There is an impasse: a predicament affording no obvious escape. Meanwhile, the future health care of Americans is in limbo.

    The solution is apparent, but unperceived: patient data collection by smartphone, and the acquisition of an available personal health care profile and its adaptation.

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    Nobody’s happy with the Republican proposals, either

     The most recent health care public polling suggests dissatisfaction with both parties’ plans.

    For example, the Republican House bill, repeal and replace ACA, has only 16 percent approval.

    The public approval of ACA and whether efforts should continue to repeal and replace this law are almost evenly split among the public.

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    Self-interested players in Health Care . . . with different goals

     The health care discussion arena is composed of numerous self-interested players. Their interests are often different.

    Following are differing perspectives:

    • Provide what the public needs, rather than what they want
    • Older people use more than one-half of the health care money in the last few months before they die
    • The younger generation believes that they are health infallible, and they do not want to pay for older generation and senior health care expenses
    • What can the federal and state governments afford to pay for health care that competes with other national priorities such as road building and maintenance, education, national security, and military defense?
    • Compassion for the health care underclass has financial limits: single-parent families, the disabled, many of whom could be employed part-time, and alcohol and drug addicts
    • Many private health care insurance companies have and are canceling their participation in government sponsored health care plan coverage because of contemporary major losses and future financial uncertainty
    • The fallback solution that may emerge may be a federal government single payer, rather than the private sector insurance
    • Personal health responsibility:  stay healthy and save money for oneself and for the government is not part of American culture
    • High volume Medicaid provider hospitals provide high technology services that are duplicative and are expensive, although these devices are not fully utilized in many urban areas
    • Primary care physicians correctly believe that they are under-reimbursed for the essential Medicaid services that they provide. As a consequence, many primary care physicians are leaving the practice of medicine, or they decline Medicaid patients because of the high volume of paperwork documentation that is required

    Economics encompasses all of these issues: what can taxpaying citizens and their government afford, and what is the priority allocation among competing government services?

    Although there are no easy solutions, we need to use the best technology currently available and some emerging ones, and supplement them by training a new generation of medical-technology providers.

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    Medicaid’s Explosive Growth, Explosive Costs

     President Obama’s ACA increased Medicaid eligibility to 133 percent above the poverty line. However this Medicaid increase was challenged in NFIB v. Sibelius, finding that it was state coercive, and that the federal government could not compel states to increase Medicaid eligibility.

    The federal government pays states for a defined percentage of their Medicaid program expenditures. The Federal Medicaid Assistance Percentage (FMAP) varies by state based on criteria such as per capita income. The average federal payment made to states is 57 percent; 50 percent for wealthy states, and 75 percent for lower per capita income states.

    The 1965 Medicare amendment to the Social Security Act established the Medicare and Medicaid programs. The concept of Medicaid is that it is a social health care program for families and individuals with limited resources and special needs that is funded by federal and state governments. States manage the program and they have broad discretion to determine eligibility and benefits. Medicaid eligibility is an ideological and political battleground. Reduction of people who receive Medicaid benefits is regarded as mean-spirited – an estimated decrease of 20 million Medicaid recipients by the year 2027.  In contrast, there may be as many as 20 million Medicaid recipients who are not eligible.

    An estimated 1/3 of people who receive Medicaid payment are able-bodied who can work in the public or private sector. This concept – “get off the couch and go to work” – is now enforced by some states which have passed “Workfare” legislation wherein able-bodied persons must work to qualify for social program benefits.

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    Back to the States to Cope with Costs

     Consider another proposition that places health care responsibility with states, rather than the federal government.  States would receive a federal government payment, varying from 50 to 75 percent based on poverty eligibility levels. The states would have responsibility and flexibility to determine eligibility and the amount that they would pay for Medicaid expenses. The federal government responsibility would be to audit state health care payments to be certain that health care money provided by the federal government would not be diverted to other state programs. The advantage of total state responsibility would be administrative control, program efficiency, adherence to strict eligibility enforcement, and the political choices to be made by state citizens, that would vary by state.

    Economics drives political and social policy decisions because funding for Medicaid health care is finite. The FDA has provided an exception to the spiraling cost of Medicaid by reducing the cost of prescription medicine for patients. Many drugs do not face competition from cheaper generic alternatives even though their intellectual property protection rights have expired. When there are two or more generic competitors the drug cost to consumers drops by about 50 percent, saving consumers an estimated $250 billion dollars. Economic competition in medicine can result in major cost savings. The issue is whether economic cost saving and program efficiency can compete and overcome political differences.

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    Conclusion: Looking Forward

     Look to the future of medicine and health care. Hardware and software permeates all sectors of health care, but it has not been applied in medical practice. Sensors, imaging, patient genetic history, artificial intelligence, and home health monitoring, if used nationally, can retard or reduce the $3 trillion annual health care expense.

    US health care is the primary responsibility of doctors and hospitals that have made marvelous contemporary advances in patient diagnoses and care. The future improvement will be to exponentially advance contemporary health care by focusing on available, cost-effective technology.

    This is an opportunity to create a new, innovative profession: data-based health care consulting, with or without traditional M.D. degrees; and for medical schools to adopt emerging technology in their curricula.

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    Richard Friedman worked on Medicaid and Medicare cost containment for the US Department of Health, Education and Welfare 1974-76 when these programs were 9 percent of GDP – now at 18 percent. He has provided legal representation to hospitals and physician groups while in the private practice of law.

     

     

  • ZipDialog Roundup for Tuesday, July 11

    Articles chosen with care. Comments welcomed. Linked articles in bold purple

     NYT: Trump Jr was told by email that his meeting with a Russian lawyer was part of a Kremlin effort to aid their campaign  The NYT has not seen the email but has been told about it by 3 anonymous people.

    Trump Jr’s lawyer says it is “much ado about nothing” and that he was simply meeting with someone who might have info that could help the campaign.

    In fairness, the Times notes that Trump Jr. has said he would be willing to meet with Congressional investigators and that he

    had a reputation during the campaign for having meetings with a wide range of people eager to speak to him, did not join his father’s administration. He runs the family business, the Trump Organization, with his brother Eric.

    Comment: The fact that Jr’s story has changed several times is not a good sign for him; it suggests he has something to conceal.

    The better news for him is that it strongly indicates to me they did not already have good contacts with the Russians (a point that I have not seen made elsewhere). If that is true, it is strong evidence that they had not been colluding prior to the June 2016.

    Final point: we don’t know yet if this meeting was a dirty trick. Could be–but if it was then why wouldn’t the Clinton people have revealed it during the campaign? They would have. So that seems unlikely.

     US soldier arrested in Hawaii for allegedly joining ISIS  (NBC)

    Ikaika Erik Kang was a convert to Islam and some of his statements lauded Hitler.

    Comment: Proper sentence: send him to Mosul for join his friends.

     Two studies say drinking more coffee leads to longer life (CNN)

    Comment: More fine research from the Starbucks Institute for Science.

     FDA: opioid pharma companies must comply with new, tougher rules to train doctors on using the painkillers properly  (Washington Post)

    Comment: A small but welcome step.

     Chicago Sun-Times Editorial: Illinois should lead the way in solar energy

    Comment: No it shouldn’t. States with a lot of sunshine should lead the way.  They have the obvious advantage.

    If Illinois wants to lead the way in energy, it should use its advantage and focus on better energy use in cold weather. Conservation is an equally important part of an overall energy strategy.

     Texas judge suspended after admitting she used ecstacy and marijuana and sexted her bailiff (Daily Mail) She also misrepresented her relationship with a convicted swindler to conceal drug purchases from him.

    Her former boyfriend [whom she was seeing while she was married] also said that they used Backpage.com on two occasions to hire prostitutes for threesomes. He said Green paid $150 to a prostitute in Houston on one occasion, and $200 to a prostitute in Austin on another.  –Daily Mail

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  • ZipDialog Roundup for Friday, July 7

    Articles chosen with care. Comments welcomed. Linked articles in bold purple

     Trump’s speech in Poland: The most important foreign-policy statement of his presidency  (The White House text of the speech is here)

    It was actually quite eloquent, especially in its recitation of Poland’s uprising against the Nazis in August 1944 and the Soviet Army waiting across the river until the Nazis killed all of them. It offered a clear statement about the achievements of the West–achievements worth defending. And it promised strong US participation in NATO.

    It offered a sharp criticism of Putin’s expansive foreign policy and the risks it posed in Europe and the Middle East

    Comment: The Poles welcomed the speech, understandably so.

     McConnell indicates he may not have the votes for a Republican healthcare bill  (The Hill)

    “If my side is unable to agree on an adequate replacement, then some kind of action with regard to private health insurance markets must occur,” McConnell said at a Rotary Club meeting in Kentucky on Thursday, according to multiple reports.

    Comment: In other words, I’ll work with the Democrats to do something. In that case, the Republicans might defect. 

    This is turning into one fine mess.

     Leftists, Anarchists clash with German police ahead of G20 summit in Hamburg (Deutsche Welle)

    DW calls them “anti-capitalist protests”

     Muslim groups in Indonesia, Malaysia call for boycott of Starbucks because of its support for gay rights  (Chicago Tribune)

    The groups were apparently reacting to comments made several years ago by former CEO Howard Schultz in support of gay rights that drew renewed attention amid an increasingly anti-LGBT climate in both of the predominantly Muslim countries. –Chicago Tribune

    Comment: Gee, I hope this isn’t a setback for “intersectionality” among US progressives.

     CNN’s troubles show up in the ratings. It is now #13. Fox (#1), MSNBC (#2) both doing well. (Scribd)

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  • ZipDialog Roundup for Tuesday, June 26

    Articles chosen with care. Comments welcomed. Linked articles in bold purple

     After indications that Syria’s Assad might use chemical weapons again, Trump warns he will pay “a heavy price” for “mass murder” (New York Times)

    Comment: As with most deterrent threats, it is hard to know whether it will work.

    What we do know is that it is could work because it is credible.

    That is, the target (Syria, in this case) has good reasons to believe we will do what we threaten if he acts.

    After Pres. Obama’s failed “red line” and other missteps, our threats were heavily discounted.

    It is worth noting, then, that Trump has managed to reestablish America’s deterrent threat quickly after 8 years of neglect and decline.

     CNN has made several major errors in reporting the Trump-Russia investigation, all adverse to the Administration.

    After the retractions, three CNN journalists are going to spend more time with their families. Story here (Washington Post)

    Comment: My sense is that CNN’s main viewership is airport passengers delayed in boarding.

    I hope the transportation industry survives this setback.

     Amazing story, if further proof emerges. Circa reports that the FBI investigation of Michael Flynn began after he intervened to help a (purported) victim of FBI sexual discrimination.  Circa’s John Solomon and Sara Carter have done first-rate reporting on scandals, so their coverage should be taken seriously. The key here is that the person accused of discrimination is very high-ranking. Indeed, he was acting head of the agency after Comey stepped down.

    The FBI launched a criminal probe against former Trump National Security Adviser Michael Flynn two years after the retired Army general roiled the bureau’s leadership by intervening on behalf of a decorated counterterrorism agent who accused now-Deputy FBI Director Andrew McCabe and other top officials of sexual discrimination, according to documents and interviews.

    Flynn’s intervention on behalf of Supervisory Special Agent Robyn Gritz was highly unusual, and included a letter in 2014 on his official Pentagon stationary, a public interview in 2015 supporting Gritz’s case and an offer to testify on her behalf. His offer put him as a hostile witness in a case against McCabe, who was soaring through the bureau’s leadership ranks.

    There is more than simple correlation here, according to Solomon and Carter.

    McCabe eventually became the bureau’s No. 2 executive and emerged as a central player in the FBI’s Russia election tampering investigation, putting him in a position to impact the criminal inquiry against Flynn.

    Three FBI employees told Circa they personally witnessed McCabe make disparaging remarks about Flynn before and during the time the retired Army general emerged as a figure in the Russia case.

    Comment: The report is stunning and looks like corruption, in the form of personal animus. 

    The weak part of the Circa allegation (so far) is that the Russia investigation began fully two years after the contretemps.

    The strong part is that McCabe seemed to have a personal grievance against someone he was investigating. That cannot be acceptable within any neutral investigative agency.

    This alleged corruption must be part of Mueller’s investigation.

     California regulators are moving to require Roundup weed killer to come with a “cancer-causing” label.  They say the main ingredient, glyphosate, is the problem. Monsanto, which makes the product, disputes the claim. Story here (ABC News)

     That attempted mass assassination of Republican lawmakers? The one by the rabid Bernie Sanders supporter?

    Rep. Keith Ellison (D-MN), the No. 2 official in the Democratic National Committee, blames . . . go ahead, guess. You are correct. Trump.

    Story here.

    Comment: Check the man for rabies.

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    zd-hat-tip-facing-inward-100px-w-margin♥ Hat Tip for helpful suggestions:
    ◆ Tom Elia
    for the Circa story on the FBI

    ◆ Sam Stubbs for the CNN story.

    Sam reported it correctly, unlike CNN