Archive for October, 2020

The Attic Door Is Opening

Friday, October 16th, 2020

Today is the 166th birthday of the controversial, but brilliant Irishman and playright Oscar Fingal O’Flahertie Wills Wilde. In his day, the wittiest man in Dublin, or anywhere else for that matter. And it’s the 129th anniversary of the publication of his only novel, The Picture of Dorian Gray. We’ll come back to that in a bit.

Moving to the present, we have 18 days to go, and I know you know what I mean. Eighteen unpredictable, but grueling days until 3 November, the official election day, although the election is well underway with more than 17 million votes already cast across 44 states and the District of Columbia. Democrats have voted early at four times the rate of republicans, most of whom plan on voting in person on the 3rd.

I confess for me it’s hard to focus on anything else, workers’ compensation, for instance. I’ve tried, but I keep getting sucked back into the political black hole.

Because not all states treat early balloting the same, it is highly unlikely we will know the result on the night of the 3rd, but we will certainly know at some point. To get to that point, the parties will face off in a fight to the death. Neither of them will bring a knife to that gunfight. The Supreme Court may step in à la Bush v. Gore. Given recent shenanigans, won’t that be interesting?

Last night during Joe Biden’s Town Hall in Philadelphia, George Stephanopoulos asked the former Vice President what he’d do if he lost. Biden said he’d probably go back to teaching and working at The Biden Institute within the Biden School of Public Policy and Administration at the University of Delaware (he taught constitutional law from 1991 to 2008 – bet you didn’t know that). He said he’d also continue working on the causes he’s advocating during the campaign.

Samantha Guthrie asked the same question of President Trump at his simultaneous, split screen Town Hall in Miami, but couldn’t get a similar rational response that he’d go quietly into that good night. I have the feeling that if the President loses we’re in for Hellzapoppin’.

During his presidency, Donald Trump, who, during the 2016 campaign famously said, “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK?”, has been more teflon-coated than any of your expensive kitchenware. Fiascos that would annihilate Paul Bunyan just bounce off. But since mid-way through the pandemic, things seem to have changed. Recent polling from Reuters/Ipsos shows 59% of likely voters believe he has managed our healthcare horrendoma poorly. And in the last few weeks it’s been one thing after another tarnishing his image. While his followers remain religiously devoted, the rest of the nation seems to be turning on him. At last night’s Town Halls, Biden was calm, thoughtful and engaging with his questioners, going so far as to ask one young man to stay after the Town Hall so they could talk some more. Trump, on the other hand, was, well, Trump, on defense, but in fighting mode, nonetheless.

All of which brings us back to Oscar Wilde and The Picture of Dorian Gray. In the novel, Dorian Gray, a handsome and hedonistic young man, sells his soul à la Faust, but with a twist. A famous artist paints his portrait, which Dorian puts in the attic of his home. Over the years, the young man in the portrait in the attic ages in a gruesome, hideous way, but not Dorian himself, who lives a life of debauchery and cruelty. Finally, in a fit of remorse, he slashes the painting. Servants below hear agonizing cries, rush to the attic and break down the door, only to find an unrecognizable and very dead old man lying in front of the painting, restored to its original beauty.

Donald Trump’s attic door is beginning to crack open.

Like BBs In A Boxcar

Monday, October 12th, 2020
Turning and turning in the widening gyre   
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world….
The best lack all conviction, while the worst   
Are full of passionate intensity.
          The Second Coming, by William Butler Yeats

 

One thing COVID-19 has certainly done is to expose many of the foundational flaws in America’s healthcare house that Jack built, the house that “cannot hold.” From the Trump administration’s helter-skelter response, to the unequal treatment of Blacks and Latinos, to the near total reliance on China for PPE, to the exacerbating plight of rural hospitals, to jaw-dropping surprise bills, to something as granular as the price of insulin, and the list goes on.

To illuminate the dire situation even more, the Kaiser Family Foundation last week published its annual Employer Health Benefits Survey, which showed the average annual premium for a family of four has grown 4% over the last year, more than doubling the rate of inflation, and has now reached $21,342, with worker contributions averaging $5,588. Add in the average deductible of $4,000, along with copays of $40, and employees get their hair-raising, once-a-year healthcare sticker shock.

In 2020, the U.S. is spending 18% of GDP on healthcare, according the Office of the Actuary within the CMS. For years, I’ve been quoting Herb Stein’s Law: “If something cannot go on forever, it will stop.” And for years, I’ve been wrong. This cannot be sustainable, but so far it has been.

A distant second-most-costly-country-in-the-world is Switzerland, at 12.1% (which is what the U.S. spent 30 years ago in 1990). The Swiss, as do many other OECD countries, have a decentralized system similar to ours, a blend of public and private-pay healthcare, with two important differences: First, since 1996, government, wanting to spread the pool, has required the Swiss people to purchase healthcare insurance, similar to the Affordable Care Act’s individual mandate (which Congress eliminated when it passed the Tax Cuts and Jobs Act of 2017, effective 1 January 2019). The result is for more than 20 years the Swiss have nearly 100% participation, but not the U.S.; our rate of the uninsured is going up, not down, made worse, much worse, by job, and consequently health insurance, losses due to the pandemic. Second, government plays a large role in establishing prices, especially for pharmaceuticals.

I think we can say with total certainty that, regardless of what you hear or read, nobody knows what healthcare in America will look like a year from now. If Trump wins reelection and republicans hold the senate, the ACA, or what’s left of it, could find itself buried deep beside Davy Jones’s locker at the bottom of the ocean, and what would come after that? Back to square one. People, our fellow citizens, our friends and relatives with chronic conditions, would once again find themselves walking down the edge of an economic razor blade.

There are four possible outcomes:

  1. Trump wins and republicans hold the senate, as above;
  2. Trump wins and democrats take the senate, resulting in stalemate, but the Trump reality show continues;
  3. Biden wins and democrats take the senate, in which case big changes are coming; and,
  4. Biden wins and republicans hold the senate, resulting in stalemate, but we’re saved from Trump’s histrionics (one hopes).

Options three and four spare us the president’s governing style, which is to say, chaos. For four years we have been subjected to his whipsawing and dangerous administration. His policies, personality and pronouncements seem to bounce around like BBs in a boxcar. Never more so than in the last few weeks. Things change by the hour. Nothing is predictable, except unpredictability.

We are moving inexorably into the winter of our continuing discontent. God help us all.