Monthly Archives: December 2021

“Coy,” Is It?

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The Biden-Harris administration, in its argument for the government’s appeal in the 8th Circuit of a trial court’s rulings in Religious Sisters of Mercy v Azar and Catholic Benefits Association v Azar, steadfastly refused to say whether, in fact, these entities would be subject to government suit were those entities, in fact, to refuse to provide and cover so-called “gender transition” procedures. The case and the government’s “enforcement” vagaries center on

how the Department of Health and Human Services (HHS) and US Equal Employment Opportunity Commission (EEOC) interpret Section 1557 of the Affordable Care Act, which prohibits discrimination by gender identity, and Title VII of the Civil Rights Act in relation to RFRA [Religious Freedom Restoration Act].

Just the News mildly referred to that as the government being coy.

The government’s attorney, Assistant US Attorney Ashley Chung, then went so far as to tacitly threaten the judges:

She warned the judges not to “open the floodgates to premature litigation” based on “uncertainty” over how agencies might respond to new legal interpretations or court rulings.

This is a cynical argument by Chung. The judges won’t be opening floodgates for “premature” litigation. HHS and EEOC already have opened those floodgates with their carefully thought out decision to be “uncertain” in their “interpretation” of Obamacare, Title VII, and associated regulations and to be vague on their enforcement procedures for those.

Ego and Job Avoidance

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The Senate has before it some 50 nominees for various ambassadorships that still need floor confirmation votes. Senator Ted Cruz (R, TX) is holding them up by refusing to give unanimous consent to their confirmation unless and until he gets a floor vote on sanctioning constructors of the Russian Nordstream 2 pipeline. In response, Majority Chuck Schumer (D, NY) is…threatening.

Democrats are working to clear as much of the backlog as possible by consent. If we cannot make much progress, we may need to stay and hold votes on nominees this weekend and next week until we do[.]

That would really eat into Senators’ Christmas break. Oh, the angry sacrifice.

At 30 hours of debate per confirmation vote, though, those 50 nominations would require more than just a couple of weeks’ intrusion into playtime. Those 1,500 hours accumulate to a bit over two months to get all of them voted on, even were the Senate in session 24/7 for those two months.

Unanimous consent occasionally is an administrative convenience for getting minor matters done—post office and park namings, for instance—however, it’s far too often a mechanism for ducking being on the record on substantive issues. Nominee confirmation votes on controversial nominees, for instance.

Cruz is entirely correct to not give his unanimous consent, especially given his terms.

All Schumer has to do is allow a vote—a vote, mind you, not a guarantee of passage—on a Nordstream 2 sanction. The Progressive-Democrat Senators and the Progressive-Democrat Vice President would promptly vote down the sanction, and the nomination consents could proceed. Of course, this would put the Progressive-Democrat Senators on the record as opposing sanctioning Putin’s pet project, and that might not play well in Arizona, or Georgia, or Nevada, or….

Apart from any of that, this is just Schumer exercising his ego in trying to face down a Republican Senator.

It’s not all bad, though. If Schumer backs up his threat, at least the Senators would remain in session doing their jobs, which includes voting, explicitly on the record, on substantive matters so their constituents have material with which to evaluate them in the coming election.

Another Reason

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…to get Government—at the Federal and at the State level—out of the way of a free market for health care and for health care coverage, which must include price transparency if there’s to be true price and quality of product/service competition. This illustration is in Boston.

An Emergency Room visit to Massachusetts General Hospital for a particular problem covered by Blue Cross Blue Shield of Massachusetts would cost the patient and his employer together nearly $950. In fairness to BCBSoM, some other providers of health coverage for the same problem at MassGen charge substantially the same total price. At Carney Hospital, just three miles away, though, the same problem with the same provider would be only a bit under $550—$400 less.

It gets more variable. An ER trip to MassGen for a patient with substantially the same problem and whose coverage was through an Aetna PPO would cost $2,170. At Carney the cost would be in the range of $550.

But never mind, Government Knows Better:

The Massachusetts Health Policy Commission…called for capping the prices of the state’s costliest hospitals.

No. Price caps provide no incentive to innovate, to improve quality, to lower prices. Secretive negotiations between health coverage providers and health providers provide no such incentives, either. Secretive pricing by health providers provides no incentives.

Competition among health coverage providers and among health providers provides those incentives because superior quality of care and lower prices are what attract customers, and open competition is what produces those outcomes. The lack is especially insidious with hospital ERs, since those “customers” are in dire straights and in no position to shop around.

Those folks (all partakers of health provision and health coverage provision, but especially prospective ER users) need to prior plan before the trip becomes necessary. That requires an ability to compare among health coverage providers and among health providers. That, in turn, requires price transparency among health coverage providers—not just for premiums charged the customer and his employer (which already are pretty visible), but the prices paid each of the hospitals in the area.

Transparency also requires hospitals to make their prices publicly available. An example of this is with Surgery Center of Oklahoma. This facility doesn’t have emergency room facilities, but their model is easily extensible to all hospital and all prompt care facilities.

Playing Chicken with Trains

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Bob Brody wrote of playing chicken with railroad trains when he was a high schooler and of the thrill of running those risks. Until he and his buds who saw an animal corpse on the tracks, an unfortunate who had neither won nor lost its race with fate, but who had run to a tie.

Brody then went on regarding the need for analysis rather than blind risk-taking.

He’s right, to a point, but only to a point.

You can win, or you can lose, but you’ll die if it’s a draw. And the train won’t chicken out.

Take all the risks you deem useful, hopefully after a risk-reward analysis. Just don’t settle for breakeven.

BDS Comes to the White House

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Boycott, Divestment, and Sanctions have come to the Biden-Harris Presidency.

The US has rejected a request from Israel to speed up the delivery of pre-ordered KC-46 refueling jets, amid escalating tensions between the country and neighboring Iran.

Those modern tankers would greatly extend the reach and endurance of Israel’s combat aircraft, a capability increasingly needed for Israel’s own defense as Iran progresses inexorably toward obtaining nuclear weapons.

The denial, though, is a measure of how desperate Biden-Harris is to get from the kiddie table to a nuclear weapons deal with Iran. He doesn’t want to risk offending Khamenei by facilitating Israel’s ability to defend itself.