The Trump presidency

[Plumdaff]

fall over, break hip, hospitalised, have hip replacement, have aftercare, ongoing pain relief, physio etc until mobility restored. That's what's happened with 2 out of the 3. I don't think that can be described as 'not improving quality of life'.

You've misread and overly personalised my post. It says that it often doesn't improve life quality, not always. I'm very pleased that your relatives had a brilliant service from the NHS - where I've worked for 15 years - but it doesn't mean that some older people suffer through needless interventions as they reach the end of their lives

 

[newbie]

You've misread and overly personalised my post. It says that it often doesn't improve life quality, not always. I'm very pleased that your relatives had a brilliant service from the NHS - where I've worked for 15 years - and seen some older people suffer through needless interventions as they reach the end of their lives.

fair enough, I thought your description was over-bleak and illustrated why, that's all.

 

[CrabbedOne]

The equivalent stat for here will be pretty high, too, I would think. Not bankruptcy per se, but selling your house and all other assets to pay for care home costs.

I got that from here and that's even higher.

A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.

I think paying for care is not really equivalent to straightforward medical expenses e.g. paying for a series of treatments. Note this is after Obamacare's introduction. Frankly folk in the UK and most of Europe don't know they are born when it comes to the US healthcare situation.

It works well enough for most people in a decent steady job but it's a fraught business. Americans are often terrified of losing their job and family cover because of this. Quality of care varies wildly by state and care plans can turn out to be rather crappy.

I know of people in the states who ended up selling their home to finance a child's treatment. And these people were comfortably middle class and had health cover they thought was excellent. It turned out to be just not good enough to cover what the child needed to survive. Any lengthy course of treatments can turn out to be difficult as the insurance start to work hard to wiggle out of expensive cover situations. A minor omission in declaration of prior conditions can be disastrous.

One friend showed me the itemised US bill for a pregnancy with some minor complications it was over $50K. He's only paid the prepay which was a fraction of that and was quite happy. At the same time an uninsured mate had a baby in France it cost about a tenth of that. The service was excellent and that included a full week in hospital and several return visits. If she'd worked there for a while it would have been free. This is often the case with Americans paying an order of magnitude more than Europeans though the vast cost is hidden by the insurance systems. Pharma companies count on making a disproportionate profit on a drug in the US simply because the US government lets them. American's effectively subsidise far lower RoW drug prices.

I also had a mate in Texas (a notoriously bad state in these things) who had thought her pregnant daughter was covered by her plan but due to some small print the girl wasn't. She started to have to pay full cost medical bills. This was quite shocking for her as it involved paying hundreds of bucks for simple individual lab tests; bloods that cost practically nothing to do. I've seen Texan medical bills with item charges of $500 for an orange juice. This is mainly because Texan hospital chains pay managerial staff oil exec salaries. The state doesn't regulate and the hospital chains have the insurers (who are meant to control costs) by the balls as they have created local monopolies.

Trumpcare was going to make cover unaffordable for what previously would have folk getting by reasonably well in their 50s potentially eating more than half their income. If you've not taken care of yourself and most Septics haven't this is when your body starts to go badly wrong and you often need regular preventative care. This particularly true for heavy manual workers who often accrue injuries. These folk would have been left to gamble on using the emergency room, facing a catastrophic medical bill or living in real poverty until they aged into Medicaid cover. It might have saved tax dollars as probably a fair few would have died prematurely.

That Trump backed this shows a degree of contempt for his duty of care to people who often voted for him that isn't surprising given his miserly record in business. The concessions he was making to the Freedom Caucus would have undermined the quality of cover greatly. That it also would have reduced Trump's and his peers tax bills considerably is just a cruel twist of the knife. The man is a treacherous mountebank.

 

[littlebabyjesus]

I got that from here and that's even higher.
I think paying for care is not really equivalent to straightforward medical expenses e.g. paying for a series of treatments. Note this is after Obamacare's introduction. Frankly folk in the UK and most of Europe don't know they are born when it comes to the US healthcare situation.

.

Fair enough. And you're right that mortgaging the house for medical treatment is different from mortgaging the house to move into a care home, which is what happens here.

The costs are staggering, and this must drive many Americans who understand that they're being ripped off up the wall. Anecdotally what I've heard is that, if you have decent insurance, doctors will not think twice about running a battery of tests on you that cost 1,000s, which you just wouldn't get given here. People in the UK moan about waiting times, and rightly so, but also about the reluctance to go straight for the expensive stuff, which is less fair - this stuff does need to be rationed.

 

[CrabbedOne]

Fair enough. And you're right that mortgaging the house for medical treatment is different from mortgaging the house to move into a care home, which is what happens here.

The costs are staggering, and this must drive many Americans who understand that they're being ripped off up the wall. Anecdotally what I've heard is that, if you have decent insurance, doctors will not think twice about running a battery of tests on you that cost 1,000s, which you just wouldn't get given here. People in the UK moan about waiting times, and rightly so, but also about the reluctance to go straight for the expensive stuff, which is less fair - this stuff does need to be rationed.

It's not just the providers US patients do tend insist on things like pointless MRIs and drugs being heavily over prescribed. This is particularly true in psychiatry where the head doctors now process 400% more patients by doling out things like powerful anti-anxiety drugs after a brief chat. More is always better. You've got this great plan from your Employer so you are going to damn well use it. I see the same thing in Europe with the insurance based systems but to a lower degree. It's quite unusual to find an insured Septic in their 30s not on medication which I find utterly bizarre. Healthcare systems are very linked to cultural expectations. In the US it's really just another consumer lifestyle experience. Better off folks tend to flaunt the quality of their care like owning a brace of shiny Teutonic SUVs. I suspect the fairly serviceable but threadbare universal NHS system that middle class Brits are often happy enough with would appall their American peers.

There's actually an oversupply of doctors in some areas and that's correlated with a greater incidence of intrusive, sometimes dangerous, procedures. I have found US doctors trying to resist this for the good of their patients but I suspect they are the exceptions.

I recall working round NHS labs in N.I. in the 80s. They used to run a routine battery of tests on each patient. They were cheap and sometimes caught something early which could save money. Then they started introducing "private sector efficiencies. Which meant there was suddenly a more precise use of tests with a far more complicated paper chain. I recall the lab staff being a little skeptical as simultaneously there was more bumf and three suits had moved into a mobile office on site who obviously were rather well paid. Doubtless chanting the mantra if you can't measure it you can't manage it.

If you want a cheap Healthcare system it's best to emphasise prevention but the profit is taken in expensive interventions. The US Healthcare system is profit led as is their very capitalist society. The US tax payer in the end does foot the bill for much of the system via the popular socialised Medicare but this kicks in when you retire and the damage is largely done. Very hard to reform in any sensible way without a great shift in US attitudes.

 

[littlebabyjesus]

It's not just the providers US patients do tend insist on things like pointless MRIs and drugs being heavily over prescribed. This is particularly true in psychiatry where the head doctors now process 400% more patients by doling out things like powerful anti-anxiety drugs after a brief chat. More is always better. You've got this great plan from your Employer so you are going to damn well use it. I see the same thing in Europe with the insurance based systems but to a lower degree. It's quite unusual to find an insured Septic in their 30s not on medication which I find utterly bizarre. .

More anecdote, but something I bet would never happen in the US with an insured patient. Last time I was at the doctor it was with a mahoosive allergic reaction that had covered my body with itchy red patches. It was so extreme that my GP asked if it was ok to show me to his colleague. Not for help with diagnosis, just as a spectator sport essentially - wow, look at this. *I was secretly proud*

Diagnosis: Allergic reaction, a pretty extreme one
Cause: Unknown, will probably remain unknown
Treatment: None. I could give you antihistamines, although you're best off getting them without a prescription as it's cheaper. If you want, I'll do that. But it'll go away on its own probably, and the drugs probably won't make much difference. We probably won't ever find out what caused it, and finding out is more hassle than it's worth, but we can try if you want.

Sure enough, it went away. Cost to the NHS: one short doctor's visit, so a few quid. Cost to me: zero.

 

[coley]

In Politico Inside the GOP’s Health Care Debacle
Rather revealing that. This is a country where nearly 20% of GDP goes on healthcare. Much of that is public spending. 30% of this huge bill is gobbled up in admin costs. Healthcare inflation is galloping along at 3.5% down from a long term average of 5.4%. Where 25% of all senior citizens declare bankruptcy due to medical expenses.

Trump tried to bully/charm/placate the Freedom Caucus and did turn a few of them but not enough. If they'd given more away they'd have started to lose other Republicans. A basic problem is Trump has no real grasp of policy he left it to the nerdy Ryan who is an able technocrat but a lousy salesman who took lock step party support for granted.

Trump pissed off a lot Republicans by running against the establishment and came into this with little political capital on The Hill. He has got even less now.

Trump simply doesn't want to wrestle with the complexities even when he finally realises they are there. He wants a nice clean sales pitch that glosses over problems like a few coats of paint on a crumbling Florida mansion. Now he's blaming everyone else and sailing towards tax reform just as confident that his real estate magnate superpowers will overcome any minor problem. After all what could be so difficult about that?

There's a kicker:
My bold.

While most rabid republicans would love to kick healthcare for the poor into the long grass, they have been stymied by a group of their own who see the issue as a 'vote loser' amongst sectors of their electorate.
Yet, Obviously TTT wanted to get obamacare 'out of the way' but he seems to have increasingly thought it as an annoying irrelevance (a campaign pledge) to be dealt with in order to get on with the main course of tax cuts for his cronies.
Surely he will get total support on tax cuts, now he's left Ryan to deal with the failure of Trumca, oops sorry, ryancare

 

[coley]

Cutting environmental regulations is not about helping "the 1%". Its about a small group of industries that are in some cases under existential threat. Among the worlds top economists and central bankers there has been talk for a few years of "the carbon bubble".
Carbon bubble - Wikipedia

Developing new oil reserves is very expensive, the big ones that are left tend to be places like ultradeep water or in the Arctic off shore. Coal is being strongly pressured by its health effects in places like China and its global warming impact across Europe. Coming down the other side of the road is a raft of new technologies that are rapidly approaching "grid parity" like solar pv, on shore wind. Others that are way way ahead of where we thought they would be a couple of years ago like grid scale lithium batteries and electric cars are starting to gain market penetration (new black cabs will be electric in a couple of years).

Most of the 1% will be little affected by this other than losses in their energy portfolios. People like the Kochs, al Sauds and Putin stand to lose massively. They are not stripping environmental regulations for more profits but to keep in business in the coming decade.

Aye, very well aware of that, but a large proportion of the one percenters are facing huge losses due to the facts you outline, so it's in their interests to pay the media and associated denier outlets in order to confuse the markets while they offload their more poisonous portfolios,
The Alberta tar sands is a good example, the big players are getting out, selling their rights to smaller companies who will go bust and disappear when the cleanup costs come due.

 

[coley]

Even in the NHS 90% of the money that will be spent on you will be spent during the final months of your life, and often this spending neither lengthens nor improves the quality of your end of life one iota. There's a real problem with a perfect storm of poor social care, expectations vs reality and the tendency of modern medicine to chuck the kitchen sink at you treatment wise to increasingly diminishing returns.

You have that spot on, but perhaps there is also the issue of health care professionals ( at every grade) being worried about being sued if they haven't done enough to prevent the totally natural event of death?

 

[coley]

I got that from here and that's even higher.
I think paying for care is not really equivalent to straightforward medical expenses e.g. paying for a series of treatments. Note this is after Obamacare's introduction. Frankly folk in the UK and most of Europe don't know they are born when it comes to the US healthcare situation.

It works well enough for most people in a decent steady job but it's a fraught business. Americans are often terrified of losing their job and family cover because of this. Quality of care varies wildly by state and care plans can turn out to be rather crappy.

I know of people in the states who ended up selling their home to finance a child's treatment. And these people were comfortably middle class and had health cover they thought was excellent. It turned out to be just not good enough to cover what the child needed to survive. Any lengthy course of treatments can turn out to be difficult as the insurance start to work hard to wiggle out of expensive cover situations. A minor omission in declaration of prior conditions can be disastrous.

One friend showed me the itemised US bill for a pregnancy with some minor complications it was over $50K. He's only paid the prepay which was a fraction of that and was quite happy. At the same time an uninsured mate had a baby in France it cost about a tenth of that. The service was excellent and that included a full week in hospital and several return visits. If she'd worked there for a while it would have been free. This is often the case with Americans paying an order of magnitude more than Europeans though the vast cost is hidden by the insurance systems. Pharma companies count on making a disproportionate profit on a drug in the US simply because the US government lets them. American's effectively subsidise far lower RoW drug prices.

I also had a mate in Texas (a notoriously bad state in these things) who had thought her pregnant daughter was covered by her plan but due to some small print the girl wasn't. She started to have to pay full cost medical bills. This was quite shocking for her as it involved paying hundreds of bucks for simple individual lab tests; bloods that cost practically nothing to do. I've seen Texan medical bills with item charges of $500 for an orange juice. This is mainly because Texan hospital chains pay managerial staff oil exec salaries. The state doesn't regulate and the hospital chains have the insurers (who are meant to control costs) by the balls as they have created local monopolies.

Trumpcare was going to make cover unaffordable for what previously would have folk getting by reasonably well in their 50s potentially eating more than half their income. If you've not taken care of yourself and most Septics haven't this is when your body starts to go badly wrong and you often need regular preventative care. This particularly true for heavy manual workers who often accrue injuries. These folk would have been left to gamble on using the emergency room, facing a catastrophic medical bill or living in real poverty until they aged into Medicaid cover. It might have saved tax dollars as probably a fair few would have died prematurely.

That Trump backed this shows a degree of contempt for his duty of care to people who often voted for him that isn't surprising given his miserly record in business. The concessions he was making to the Freedom Caucus would have undermined the quality of cover greatly. That it also would have reduced Trump's and his peers tax bills considerably is just a cruel twist of the knife. The man is a treacherous mountebank.

I have followed your contributions on here with interest, but relax your allowed to call him a twat, rather than a twit.

I understand your reticence, took me a while to use some of the more 'familiar' terms
Though, going to wander off and sort out 'mountebank'

 

[CrabbedOne]

I have followed your contributions on here with interest, but relax your allowed to call him a twat, rather than a twit.

I understand your reticence, took me a while to use some of the more 'familiar' terms
Though, going to wander off and sort out 'mountebank'

I just looked mountebank up. Oddly apt for a snake oil salesman like Trump.

 

[CrabbedOne]

On Forbes Florida Millionaire Hangouts: Just How Much Trump Will Cut Rich Residents' Taxes

He is a river to his people!

 

[newbie]

You have that spot on, but perhaps there is also the issue of health care professionals ( at every grade) being worried about being sued if they haven't done enough to prevent the totally natural event of death?

you and Plumdaff are both professionals and both seem to be saying that NHS medical care for the elderly is unbalanced, citing their own quality of life expectations as well as wider social and professional considerations. Perhaps there's scope for a medical ethics thread to try to understand what that might mean in practice for individuals and their families as they face inevitable decline?

 

[CrabbedOne]

On RawStory CNN analyst: Sources say Mike Flynn may have turned on Trump and become a witness for the FBI

Tout!

 

[ohmyliver]

yeah, there's a lot of traffic about Flynn turning. Which may corroborate with the information coming out about Flynn (i.e. working for Turkey, etc). The other interesting thing about his meeting with Turkish representatives about handing over Gulen, was that Nunez was also present. Which may explain the 'shitting it' panic of his recent actions.

 

[CrabbedOne]

From The Wilson Centre Immigration and Border Security in the Age of Trump

...
Ironically, restrictive immigration policies and increased border enforcement in the United States and Mexico seem to have had the unintended consequence of strengthening international migrant smuggling networks. In recent years, coyotes (smugglers) have operated less on a primitive, independent basis and instead have created sophisticated transnational networks. The new capacities and strength of such networks became visible in 2014 during the so-called “crisis of unaccompanied minors.” Transnational smugglers proved then to be both extremely well-organized and well aware of the failures and weak points of the U.S. immigration system. They demonstrated a remarkable capacity to mobilize thousands of unaccompanied minors simultaneously, utilizing new methods and alliances with organized crime in what has become a multi-million dollar industry.

In the past decade and a half, the Border Patrol has more than doubled its number of agents. At the same time, the U.S. Congress has massively expanded spending on fencing, infrastructure, and technology to secure the border. Mexico has supported the massive U.S. deportation efforts with its Southern Border Plan (Plan Frontera Sur). However, transnational networks of migrant smugglers and drug traffickers seem to operate very effectively in these allegedly more secure and militarized borders. The new U.S. administration’s migration plan does not seem to represent a change but, rather, promises a continuation and reinforcement of current trends, both in terms of policies and deficient results.

As Mexico faces tough trade negotiations with the U.S., many commentators, legislators, social leaders, and other influential Mexicans are urging the Mexican government to take a hard line with the Trump Administration on trade talks. Among other things, they are advising that Mexico suspend cooperation with the United States on immigration, an action that could lead to an even higher number of migrants eventually ending up in the United States even as the wall is built.
...

If Congress took the $22 billion Trump wants to spend on his daft wall and used it to collaborate with Mexico on addressing the causes of waves of Northward migration it might actually do some good on both sides of the border. Of course as with the Muslim Ban fixing anything is not the point. A large tranche of his voters relish the circus of Trump bullying out groups far more than any bread on the table results.

 

[CrabbedOne]

On Forbes Trump Unlikely To Find Trade Grass Greener

...
Nor is there reason to think that trade measures will be any easier to move through Congress than health measures. The last big trade legislation to move through Congress was Trade Promotion Authority in the early summer of 2015. That was a mess. It failed on the first attempt at passage and only squeaked through after creative legislative maneuvering by congressional leadership. Part of the reason it ultimately passed was that it was provisional. Members of Congress were just setting the rules of a process, still reserving the right to nix negotiated deals. The reason President Obama did not try to push the TPP through last year was that members seemed set to exercise that right; the votes weren’t there.

This raises yet another downside of President Trump’s bilateral approach: trade votes in Congress tend to be painful. For that reason, they have not been frequent in recent years. Each bilateral deal will stir up generic trade antipathy while summoning less agreement-specific enthusiasm than a broader deal would. Now, with a clearer understanding of Congress’ “arcane rules,” will the President really be enthused about doing this eleven times as he works through just the TPP, never mind the rest of the world?

It must be tempting for the White House to think that health care was the rare, unfortunate issue with difficult and complicated politics. Even a cursory look at the political terrain for trade policy may present the President with another unpleasant surprise.

My bold, which partly explains the Obama's preference for big multilateral deals that have been the global trend in trade.

Like senior but utterly inexperienced British Brexiteers Trump seems to think trade deals are simple. They're in fact often enormously complex often involving a very difficult balancing of domestic interest groups that will all be furiously lobbying Congress. Likely there will be some bitter losers.

 

[CrabbedOne]

On Bloomberg Trump’s Wall Is 30 Feet of Scary Politics for Builders

I'm a bit surprised at this one. A $25 billion statist boondoggle in the great American tradition of pointlessly porky redistribution of tax dollars to fat cats that I'd have expected to create a corporate feeding frenzy turns out to be politically rather toxic bit of business that many of them won't touch it.

 

[DotCommunist]

maybe he could make the wall a giant prison for Clinton, therby building the wall and locking her up. Then its MAGA and home for kippers

 

[Johnny Canuck3]

.

 

[Cloo]

Trump tweeters are today going all out on dubious 'proofs' that Obama wasn't born in America (an article from the beginning of his career saying he was Kenyan born! A US university ID card that was allegedly his that says 'Overseas student'!), and I'm thinking 'Uh, guys, that ship's kind of sailed now'.

 

[Idris2002]

Meanwhile, in another part of the forest:

Spoiler

"In hindsight, it occurs to me that if a left-wing militia and a right-wing militia, such as the ALG, cross paths at an future demonstration, there very easily could be bloodshed.

Both sides are loaded for bear. And I get the feeling both sides can rationalize their behavior after the fact, even if it comes down to killing someone.

I'm reminded of the 1979 shootout in Greensboro, North Carolina, when a "Death to the Klan" rally held by the Communist Workers Party was crashed by Klan and Nazi members.

Five people lost their lives, four of them CWP members.

It may be just a matter of time before history repeats itself.

However, this being Arizona, there's a lot more firepower on both sides, and I suspect, if it goes down, the body count will be higher."

Lemons: Gun-Totin' Left-Wingers Demonstrate at the Arizona Capitol: Is Bloodshed on the Horizon?

 

[Dan U]

that picture doesn't really fit the snowflake narrative

 

[Pickman's model]

that picture doesn't really fit the snowflake narrative

yeh not much snow in arizona

 

[Dan U]

yeh not much snow in arizona

apart from the ski resorts.

 

[Pickman's model]

apart from the ski resorts.

yeh. FAKE SNOW. sad.

 

[CrabbedOne]

On Politico Internal White House battles spill into Treasury

The raving nationalist Bannonites at war with the very comfortable with globalisation Goldman folk clustered around the treasury over things like trade policy. Apparently Ivanka and Jared favour the latter in this. I can see Trump's radical trade agenda going the same way as his embarrassingly unconventional bromance with Putin.

 

[CrabbedOne]

On Politico Kushner to lead new White House office offering business solutions to federal problems

...
Kushner, who raised eyebrows with his family ski trip to Colorado during last week’s ultimately unsuccessful scramble to pass legislation to repeal and replace Obamacare, characterized his new office as “an offensive team” in an interview with the Post. To begin its work, it will focus on opioid abuse, reforming the Department of Veterans Affairs, modernizing technology across the federal government, and working on “transformative projects” that would fit within the president’s promised infrastructure package.

“The government should be run like a great American company,” Kushner said in his interview with the Post. “Our hope is that we can achieve successes and efficiencies for our customers, who are the citizens.”

Says the kid with zero political background beyond this Whitehouse whose business experience is mainly running his dad's real estate empire while the old man was in prison. Oh and he's bringing peace to the Middle East at the same time while trying to manage his oafish stepdad with Ivanka. Just the last of those is probably a full time job.

 

[CrabbedOne]

In Politico California governor: We won't 'bring stupid lawsuits' against border wall

...
When asked by Todd about critics who say allowing undocumented immigrants who have only committed small crimes to stay encourages more people to come, Brown said that he has signed a bill that listed over 50 separate offenses where local police should cooperate with immigration services.

"So we're not here to protect criminals. But we do recognize that America's the land of opportunity. All of our parents came here at one time, our grandparents, our great-grandparents, they came here. That's what builds the state."

Brown added that some swing states don't have enough immigrants to build their economy.

"We're building it. And we're the gateway to the Pacific. Right now, more Mexican people are going back to Mexico than are coming. So I think we have to create a human, a decent sense with respect to our immigrants," Brown said. "And maybe I can convince the president that he has to take a more enlightened view."

Perhaps the second most powerful man in US politics.

 

[chandlerp]

Donald Trump's staff are 'wiping their electronic devices in anticipation of giving evidence'