Comically overcomplicated healthcare -- that can also be cruel

A heck of a way to get to a napkin ...

I know I don't understand US healthcare policy. That's in part because I am personally fortunate enough to enjoy a reasonable facsimile of access to adequate medical care via Medicare and the Kaiser Permanente system. 

And it is also because the whole thing is a "Rube Goldburg machine," defined by Wikipedia as "a chain reaction–type machine or contraption intentionally designed to perform a simple task in a comically overcomplicated way."

We can't seem to enact a better way, though I give Democrats credit for sporadically trying to get us there.

But I can refer here to Katelyn Jetelina and Hayden Rooke-Ley's totally lucid description of our mess at Your Local Epidemiologist, timed for the season when many of us have to make decisions about how we'll try to protect ourselves for another year.

5 ways our health care system has become utterly insane

1. Costs vs. wages: A 20-year disconnect. 

Over the past two decades, the cost of employer-sponsored health insurance—how the vast majority of privately insured Americans obtain their health care—has skyrocketed. Premiums, deductibles, and out-of-pocket costs have all soared—far faster than wages. ...

2. We pay the most and get the least.

The United States spends far more on health care than any other wealthy country yet achieves worse outcomes, less access, and a more demoralized workforce. ...

3. Americans don’t “overconsume” health care. Prices and private bloat drive costs.

There’s a common myth, especially amongst policymakers, that we spend too much on health care because we consume too much of it. A similar narrative has taken hold about doctors: because they get paid for each service, they provide too much care. Certainly, there is low-value care in the U.S. health care system. And as profit-seeking corporate actors own more and more of the system, they’re finding ways to bill for more—and more expensive—services.

But Americans don’t visit the doctor more, we don’t go to the hospital more, and we don’t stay in the hospital for longer. ...

4. Corporate and financial firms have taken over care. 

Perhaps the most underappreciated transformation of the past 40 years is the corporate consolidation and financialization of medicine. Care delivery—once local and community-based—is now dominated by corporations. ...

5. Existing approaches have failed—and the latest proposals are more of the same. 

None of this happened by coincidence. Our current governing approach began in the 1980s, when a bipartisan consensus emerged around how to address accelerating costs in the system. The idea was to embrace more free market principles in health care ...

If you want to take a stab at understanding why you hate your health insurance and sometimes even your medical providers, I can't recommend this article too highly. 

Preparations for a looming invasion

Indivisible Brooklyn volunteers with the Hands Off NYC campaign handing out materials to defend neighborhoods from ICE.

 

I love this photo. I haven't lived in New York for many years now, but I can still readily imagine this scene. New Yorkers are tough. They have to be. No wonder Donald hates them and the sentiment is reciprocated.

Boycott Starbucks!

When we lack direct political power -- that is, have enough elected officials who stand for what we might believe in -- it is normal to turn to consumer power to make our point. This is a good impulse. How could I say otherwise as a veteran worker on the great farm worker grape boycott, back in the day?

In this moment of relative powerlessness we are encouraged to participate in plenty of consumer boycotts of firms that one way or another support the Trump regime: Tesla (that's easy for most of us), T-mobile, Amazon, Target. 

But here's another call for a boycott of a more traditional sort: workers are trying to unionize and win contracts at one of the most widely distributed consumer outlets in the country.

With more than a thousand Starbucks baristas on strike across 40 cities and growing, the No Kings Alliance is announcing its support for striking baristas and calling on consumers to pledge not to shop at Starbucks while baristas are on strike. 

For the last four years, Starbucks baristas have powered a historic, inspiring union organizing campaign, taking on one of the most powerful corporations in the world. Yet, the coffee giant continues to fight workers at every turn, cozying up to the anti-union Trump administration and racking up more federal labor law violations than any other corporation in U.S. history. 

Meanwhile, Starbucks CEO Brian Niccol was paid $96 million for just 120 days of work in 2024, paying himself 6,666 times what the average barista made — the worst CEO-to-worker pay inequity in the country. At the same time, Trump and his billionaire backers are doing their best to scare people out of speaking up for their rights on the job and in their communities. 

“We're sick of Starbucks executives seeking to lord over our workplaces, ignore our basic needs, and break labor law—all while the CEO makes millions. That's why we're on an unfair labor practice strike,” said Diego Franco, a Starbucks Workers United barista in Chicago. “Allies like the No Kings Alliance are helping power our movement forward, and we look forward to uniting together on the picket line.” 

Union baristas are demanding higher take-home pay, better hours to improve staffing in stores, and the resolution of hundreds of outstanding unfair labor practice charges for union busting.  

You can sign a boycott pledge here.

The barista role is too many peoples' entry level job these days. If that's to be the case, let's help these workers make it a good one! 

Roman Catholic bishops do right by immigrants

 

As pastors, we the bishops of the United States are bound to our people by ties of communion and compassion in Our Lord Jesus Christ. We are disturbed when we see among our people a climate of fear and anxiety around questions of profiling and immigration enforcement. We are saddened by the state of contemporary debate and the vilification of immigrants. We are concerned about the conditions in detention centers and the lack of access to pastoral care. We lament that some immigrants in the United States have arbitrarily lost their legal status. We are troubled by threats against the sanctity of houses of worship and the special nature of hospitals and schools. We are grieved when we meet parents who fear being detained when taking their children to school and when we try to console family members who have already been separated from their loved ones. ...

... To our immigrant brothers and sisters, we stand with you in your suffering, since, when one member suffers, all suffer (cf. 1 Corinthians 12:26). You are not alone!

We note with gratitude that so many of our clergy, consecrated religious, and lay faithful already accompany and assist immigrants in meeting their basic human needs. We urge all people of good will to continue and expand such efforts. 

We oppose the indiscriminate mass deportation of people. We pray for an end to dehumanizing rhetoric and violence, whether directed at immigrants or at law enforcement. We pray that the Lord may guide the leaders of our nation, and we are grateful for past and present opportunities to dialogue with public and elected officials. In this dialogue, we will continue to advocate for meaningful immigration reform. 

The Roman Catholic hierarchy is not where I am accustomed to look first for affirmation of universal human dignity. 

But the MAGA agenda of deportation and cruelty offends them and most of us. 

Here they speak bravely and broadly for compassion and justice. 

The fury to come

 

Even the complicated, partial release of the Epstein files has revealed and confirmed enough to make decent women (and men) see red -- and should help push our mad king off his phony pedestal.

I don't know how this plays out in younger age groups, but casual sexual exploitation of very young women is all too recognizable to most women in my age group. These guys, these powerful men, just assumed that women's bodies existed for their pleasure. (In their eyes, we had no souls.) Least culpably, some merely leered without remorse at young women; many of the richest and most powerful felt entitled to molest.

Some women can only deal with our dehumanization by men by denying it happens. A small number aid the perpetrators. In my generation, a lot of us gave up on men, even those men who were not personally guilty, but who couldn't see the burden women carry under the male gaze. Most women just soldiered on, living on a hurtful battlefield that is barely recognized by their male peers, even the men they love. 

And, if the good women and men with any power have the strength to pursue the Epstein revelations and implications, the nation faces a protracted release of stifled fury and agonizing confusion, necessary but terribly painful. Thanks Donald.

Cartoon via The Guardian. 

Let those migrants go!

So many bits of good news for both small "d" democracy and also Democrats in the recent election! I want to highlight one that most of us in much of the country didn't know about.

Voters Ousted This Pennsylvania Sheriff After He Signed Up to Collaborate With ICE

A populous, swing Pennsylvania county replaced its GOP sheriff on Tuesday after months of controversy over his joining ICE’s 287(g) program. The Democratic winner promises he’ll end the contract. 

... Since Donald Trump’s return to office, local and state agencies across the country have rushed in huge numbers to aid his deportation campaign by joining 287(g), which authorizes local law enforcement officers to act as federal immigration agents. The agreement in Bucks County granted [Sheriff Fred] Harran’s deputies the power to question the immigration status of people they encounter and to serve and execute arrest warrants on ICE’s behalf.  ...

... [Harran's] Democratic challenger, Danny Ceisler, a 33-year-old attorney and Army veteran, spoke up against the ICE partnership, putting the issue at the center of his campaign.

Ceisler defeated Harran by 11 percentage points last week, a margin of roughly 25,000 votes. He confirmed to Bolts after his victory that he intends to terminate the 287(g) agreement once he enters office. 

• • •

County sheriffs are part of "law enforcement" but they usually not the cops on the streets. They mostly run the jails (an important job) and guard public buildings. 

That's the case in my home county of San Francisco. I figured I should find out what our elected sheriff, Paul Miyamoto, is doing in ersponse to over-reaching federal immigration invaders. After all, San Francisco is a "sanctuary city" for migrants; we sure don't want our sheriff working with them.

On the one hand, in July, Miyamoto insisted 

he will not act as an "arm of immigration enforcement," refusing to hand over inmate information. 

We certainly hope that is the case.

But also, Miyamoto seems attracted to strange political buddies for a San Francisco sheriff.  In July he endorsed a MAGA Trump supporter for governor.

His reasoning seems shallow.

“I support Sheriff Chad Bianco, alongside other sheriffs in California, as a peer leader in law enforcement and in the work we do to keep our communities safe,” Miyamoto wrote in a statement to Mission Local. “Law enforcement is not defined by political parties, but grounded in a commitment to public safety and the integrity of the profession.” 

Maybe we ought to pay attention when Miyamoto comes up for re-election. This choice of friends seems madness.

San Francisco has had some quite benign sheriffs in my time here, especially the excellent Mike Hennessey. The job is not a stepping stone to anything so candidates are few.

Remembrance Day reflection

In most of the European world, this day -- November 11 -- is Armistice Day or Remembrance Day. The event commemorated is the silence after four bloody years of the guns on the Western front ending combat there in what we call the First World War. 

That First World War shaped and reshaped modern Europe, destroying empires and unleashing anti-capitalist, nationalist, and democratic forces that had been checked by old regimes. Those of us who observed the collapse of the Soviet Union have seen changes of somewhat comparable magnitude and import -- and those very changes were still part of the backwash of that First World War that is scarcely marked in the US today.

This informational plaque hangs at the Imperial War Museum in Manchester, England, a remarkable institution which seeks to bring to life this formative history. Like the United States, Britain is a multi-racial and consequently multi-historical society where citizens with origins all over the (mostly imperial) world can strive to learn from each other's past.

Perhaps, as we live the collapse of the American world empire facilitated by our greedy madman of a President, we should pause to remember our ancestors who lived a similarly disorienting, murderous transition. It ain't easy or safe living in a collapsing empire ...

When we fight, we win!

My friends in the hospitality union UniteHERE routinely end their meetings with the chant that serves as the title for this post. 

It seems a good day, a week after our huge election victories, to pass along the words of a veteran fighter.

Sherilyn Ifill, civil rights lawyer and the former head of the NAACP Legal Defense Fund, has been in the trenches for freedom and wider democracy all her life. Her evaluation of where we sit after the recent election is both heartening and bracing.

Opponents of the Trump regime won just about everywhere as all observers note. But along with that happy outcome, we are seeing the rapid decline of the fascist project.

... As exhausted and overwhelmed as we feel, we should remember that they likely feel the same. They have taken on the extraordinary project of destroying one of the most powerful nations in the world – a nation with a national government, fifty state governments, tens of thousands of cities and local governments, a Supreme Court, hundreds of federal trial and appellate courts, fifty state court systems, and tens of thousands of courts within those systems. And they are attempting to do this with a skeleton crew - well-trained in harsh rhetoric, insults, petulance, and cruelty -- but almost entirely inexperienced in running anything of substance. 

They are destroying the apparatus of government because they know they cannot manage it. The ranks of those with even marginal competence available to work at a high level in this Administration are severely diminished. This is why embarrassingly subpar attorneys like Lindsey Halligan and Alina Habba are put in charge of key U.S. attorneys’ offices to prosecute Trump’s enemies, where they and their assistants stumble through the choreography of litigation, garnering ever-increasing impatience from federal district court judges. The Trump administration fires thousands of workers, and then hires back those same workers as agency heads realize that they’ve left no one sufficiently competent to log on to manage critical functions.

It's not as if the electorate finds these clowns inspiring.

... Trump is deeply unpopular. His poll ratings remain underwater. He has even lost podcast king Joe Rogan. ... Moreover, Trump is looking even more enfeebled than usual. He is mocked and sub-tweeted on the world stage by leaders who play to his vanity in the place of trying to negotiate with the erratic and unserious U.S. leader. 

Yes, J.D. Vance is waiting in the wings. But as a graduate of the Peter Thiel School of Charm and Deportment, he has neither the charisma nor the people instincts needed to garner the kind of support that Trump has enjoyed. ... 

... Trump’s lack of vigor has forced the egos that surround him to the top. No longer satisfied with being the ghoul behind the scenes, Stephen Miller wants everyone to know that he is in charge and that the plans being advanced are his. That is why we are seeing and hearing him more frequently, as he pauses for interviews outside the White House as though he is the President, shows up on news programs with regularity and even dispatches his wife as a (very uninformed and ineffective) talking head. 

But Miller is repulsive by any impartial standard. Watching him spew bile at endlessly increasing levels of manic zeal – has the effect of holding up a mirror to the worst of MAGA. It cannot be pleasant to look in the mirror when the image looking back at you is Stephen Miller. 

Secretary of Defense Pete Hegseth is a disaster. ... 

... The Supreme Court has handed Trump some big wins. And there are more likely to come. But even members of the Court must be feeling the pressure of association with the images we are all seeing every day of masked ICE agents patrolling suburbs while dressed for battle in Fallujah. ...

Ifill suggests it is time to focus our resistance on Congress. (And how much more is this true when we've watched the Democratic Party leaders of the Senate fumble a potentially winning hand on health care and other issues.) Ifill focuses on the House. 

... And as I have often said, the abiding obsession of Republican House members is keeping their jobs. [Last Tuesday's] election was a wake-up call. Next year every seat in the House is on the ballot. No matter what they say before the cameras today, Republicans in the House are seeing the writing on the wall this week and they are feeling queasy. We should be prepared to challenge Republican incumbents. Show up and out at town halls. Democrats living in Republican districts should apply pressure to their Republican representatives. ... 

... [The November] election outcomes provided some critical lessons for Democratic leadership and donors. The Party’s base is not an optional constituency. Black women continue to power Democratic wins around the country. Democrats who stand by their convictions and the constituencies in our “big tent” do better than those who run on being “Republican-light” and who sacrifice inclusion to chase the white whale of “centrist voters.” The wins came in California and in New York City, but also in Bucks County, Pennsylvania, Mississippi, and Cincinnati, Ohio.

She prescribes hope to the resistant:

None of this guarantees that we will be saved from the abyss. But these are all encouraging signs that the fight is not finished. In the words of Yogi Berra, “it’s not over ‘til it’s over.” And even then, we fight.

Democratic Party leadership -- nothing to write home about. People rising -- a better power being born! 

Traitors to the people who elected them

Were they afraid they might not be able to fly off on vacation over Thanksgiving?

Ashamed to say, I worked to elect two of these.

On erasing transpeople

When Ibrahim Farajajé approached the TSA inspection station on his way to board a flight, he apparently aroused the suspicions of one of the agents. A 6-foot plus, skinny, Black, bearded older man wearing flowing robes, he was not your average American passenger. He wore cotton balloon pants that day.

"Drop your pants!" demanded the official.

"You don't want me to do that," replied Ibrahim.

His authority questioned, the official yelled fiercely: "Drop your pants!!"

"You don't want me to do that," replied Ibrahim softly.

So ordered, Ibrahim eventually complied -- only to have the inspector screaming at him the next minute -- "cover yourself up!" 

Apparently he didn't want Ibrahim's uncovered genitals hanging loose in the TSA line.

Ibrahim, since unhappily deceased, was both a distinguished academic scholar of religions and also a Russian Orthodox archpriest who later in life converted to Sufi Islam. You couldn't mess with Ibrahim.

• • •

The Supreme Court's off-hand order last week that transpeople should be forced to carry passports which name the sex they were assigned at birth reminded me of this anecdote which Ibrahim told delightedly.

One has to ask, why does the Court care so much that appearance should match historical record? They don't say. Appearance is not necessary for confirmation of identity. 

M. Gessen comments about carrying a passport which marks their gender as X...

[it] attests to the meaninglessness and uselessness of all gender designations. Why did the border officers need to know my gender at all? I match the age indicated in my passport. The photo is mine. New technology makes it close to impossible to travel using a look-alike’s documents; many passports contain iris scans and fingerprints.

The existence of transpeople and others of indeterminate gender evidently triggers anxiety and an icky feeling in some powerful Justices. 

Is that response rooted in a kind of essential prurience about sexuality that apparent gender fluidity triggers? Perhaps. 

Without explanation, the Court majority reveals that what they care about is their unease with the permanence of a social structure which privileges white, European, Christian maleness, and cisgender individuals. Their world is shaken.

That discomfort will expose some people to humiliation and even actual danger.

They cannot abide recognizing that some humans live outside their lines and others may color there. People like the Republican Justices are frightened by a society that affirms such a reality. 

The inability of live with harmless difference is a sickness of the soul. Courage in the recognition of difference is not automatic. It takes work. But a decent society strives to aid its members to do that work.

Am I Next?

When masked men wearing no badges start grabbing people off the streets, it's natural to ask "Am I Next?" Los Angeles artists are responding to ICE raids and an attempted federal militarized occupation with images that project the question on downtown buildings, according to a press release from the California Community Foundation. 

The project, "Am I Next?" will feature images, measuring about 20 by 30 feet, to confront attacks on civil liberties and the undermining of democratic norms that weaken civic life. The portraits feature a cross-section of Angelenos united in protest over recent U.S. Immigration and Naturalization Service raids that have swept up hundreds of residents—many with no criminal record—and placed them in detention.

"We ask the question, 'Am I Next?' because when basic rights are taken away, anyone can be taken away, for any reason," said CCF President and Chief Executive Officer Miguel A. Santana. "If anyone's right to speak, protest or create can be stripped, if anyone can be targeted for their race, religion, identity or who they love, we are all in danger. Until justice is restored, no one is safe. Not one of us. Any one of us could be next."

 

This is not the first time Californians have asked a similar question. During a political campaign in 1994 when a Republican governor sought to reduce immigrant rights by initiative, opponents also asked "Who's Next?"

In those days, the majority of Californians went along with a fear-based attack on their neighbors. Today the vast majority of Californians have shown, by passing Prop. 50 by a 25 point margin to stiffen opposition in Congress against the Trump regime, that we understand that immigrants are our neighbors and ourselves.