Biden's claim that tens of millions of people would lose insurance coverage if he ended the public-health pandemic emergency is a sham and a shame

The Centers for Medicare and Medicaid Services (CMS) report, “Although Medicaid enrollment is expected to decrease significantly,” CMS explains, “many individuals who were not disenrolled from Medicaid during the public health emergency already had comprehensive coverage from another source (such as through an employer) and thus remain insured even when disenrolled from Medicaid.”

Hat tip to the Editorial Board of the Wall Street Journal.

Leor Shapir fears that the Systematic Review of "Gender-Affirming Care" will be a Sham and a Shame

Leor Shapir asks "Two key questions: Will the systematic review follow a transparent, impartial scientific process? And what should the [American Academy of Pediatrics (AAP)] do in the meantime?"

Mr. Shapir's fears that the process will not be a transparent, impartial scientific process and that the AAP will make a bad decision in the meantime stems from several factors. The grounds for his fears are:

1. "The AAP is, first and foremost, a trade union ... [and] has strong incentives to defend its own interests and those of member doctors—especially those who have publicly endorsed or facilitated sex-trait modification—even when that is harmful to patients."
2. "The existing systematic reviews on the benefits and risks of puberty blockers and cross-sex hormones, conducted by health authorities in three European countries, all found “very low” quality evidence for these interventions."
3. "the AAP should immediately recommend extreme caution in the use of puberty blockers, cross-sex hormones and surgeries in treating youth gender dysphoria. This is a no-brainer; health authorities in the U.K., Norway, Sweden, Finland and France have done it. 'There is not enough evidence to support the safety, clinical effectiveness and cost effectiveness to make the treatment routinely available at this time,' said the statement from England’s National Health Service."
4. The process will exclude or demean the comments from opponents of gender-affirming care.
5. "The organization’s consistent attempts to suppress debate on this sensitive issue, the recent remarks of its chief executive, and its profound conflict of interest as a trade association don’t inspire confidence that it will act scientifically and in the best interests of children and families."

Rs focus on taxes when attacking Medicare for All

The focus by Rs on taxes when the attack proposals for Medicare for All is a sham and a shame. Yes, taxes will increase; the US is currently spending over $3 billion on health care and the government, therefore, needs about that much to pay for Medicare for All. However, Medicare for All would also eliminate most health insurance premia and payments to health care providers. We need an honest debate to solve the difficult problems we face, not scare mongering. 

Warren's focus on who bears "costs" in her Medicare for All plan

Warren's focus on "costs" when she defends her Medicare for All plan is a sham and a shame. She is unwilling to state that taxes will increase for just about everyone and refuses to disclose why costs for anyone would decrease and by how much. We need honest debate to solve the difficult problems we face, not vague promises.


Why doesn't she say something like this?

Costs for rich people would increase by $500 because their health insurance premia and health care payments would decrease by $1,000 but their taxes would increase by $1,500.

Costs for middle-income people would decrease by $200 because their health insurance premia and health care payments would decrease by $600 and their taxes would decrease by  $800.

I suspect that four reasons drive her to avoid such clear statements. First, repeating that, "costs will increase for rich people and large corporations and costs will decrease for middle-income people" may be a brilliant political tactic. Second, clear statements about the plan might reveal flaws in the plan. Third, clear statements might reveal how little impact is has on people with middle incomes. Fourth, individual outcomes differ from averages.

The first reason to repeat endlessly that, "costs will increase for rich people and large corporations and costs will decrease for middle-income people" is that it might be a brilliant political tactic. At a recent debate, she got to repeat the line about six times. I suspect if middle-income people hear the line enough, they might believe that the plan would be good for them. If people simply want to know whether or not to "like" something and want to avoid cognitive load, her tactic may be the best way to build and maintain support for her candidacy. 

A second reason to avoid clear statements about the plan is that they might reveal flaws in the plan. They might reveal that the analysis is flawed because the numbers "don't add up". They might reveal that her plan treats people who think she is talking about them when she says "middle income" as rich people. 

The third reason for obfuscation is that clear statement reveal how little impact is has on people with middle incomes. I am having trouble finding big reductions in costs for middle-income folks in my back of the envelope calculations because middle income is where the tax revenue is. Bank robbers rob banks and politicians tax the middle class because that's where the money is. If the decrease is small, the middle income folks she is counting on to support her may say, "Why bother?" 

The final reason for obfuscation is that details might reveal that individual outcomes differ from averages. For example, costs might decrease for most middle-income people but increase for others. Once the others recognize that the plan increases their costs, she begins to lose support. Moreover, even people with projected cost decreases may wonder if they will benefit when revision occurs, and they are smart enough to know that revision will occur. 

Using Nordic health care as an argument for Medicare for All

Using idyllic portrayals of Nordic health care without any description of the realities there to buttress arguments in favor of Medicare for All is a sham and a shame. In this opinion in the WSJ (Aug. 2019) Adam O'Neil reports what Johan Norgberg says about capitalism in Sweden. Here are some money quotes:

1. "Trouble is, most Swedes aren’t in line with American socialists like Ms. Nixon, Sen. Bernie Sanders and Rep. Alexandria Ocasio-Cortez. 'All of their models that they could point to, given a couple of years, they end up in famine and killing,' Swedish author and historian Johan Norberg tells me. 'So they always come back to Scandinavia in the end.' True, Sweden has a significant welfare state, but Mr. Norberg says it’s underpinned by 'ruthless capitalism.'"
2. “'One thing the left gets wrong is that they think that Sweden has this sort of warm, friendly, fuzzy capitalist thing—no layoffs, no fierce competition, protecting the old companies and so on. And it’s really the total opposite,' Mr. Norberg says. 'It’s more deregulated. The product markets are much fiercer competition, much more free trade. All of the companies know that they have to be world champions or they will be destroyed.'
   
   "American leftists, even those who shy away from the 'socialist' label, generally call for higher taxes on 'the rich' to support an expanded welfare and entitlement state. That, too, misapprehends the Swedish example. 'We have much higher taxes on the poor and the middle classes than you do,' Mr. Norberg says. 'And this is the dirty little secret that no one in the American left wants to talk about.' Nonprogressive taxes on consumption, social security and payroll are 27% of Swedish gross domestic product, 16 points higher than in the U.S.
   
   "Assumptions about Swedish health care often are wrong too".