Letter to Rodney Davis on the Affordable Care Act

Below is the letter I just sent to my congressman.

I undoubted spent way more time drafting this letter than it was worth. I have no illusions that my congressman will read it and be swayed by my logic. As a practical matter, the best I can hope for is that someone on his staff will look at it carefully enough to add one tick to the column for “constituents opposed to repealing Obamacare.”

And yet, I think it was worth the effort I put into writing it—partially for my own benefit, as a way to clarify what I thought the most important points were, and partially for any local folks who might read it and be moved to weigh in with their own thoughts on the matter.

The Honorable Rodney Davis
1740 Longworth House Office Building
Washington, DC 20515

Dear Congressman Davis:

I am writing to urge you to preserve three key elements of the Affordable Care Act, which Speaker Paul Ryan’s “A Better Way” agenda does not protect: that policies cover the full range of essential care, that coverage be available at standard rates regardless of preexisting conditions, and that credits be available to help lower-income people buy health insurance.

With the Affordable Care Act’s rules, it’s possible to buy an insurance police and know that a full range of important care is covered. The “more choices” supported by Speaker Ryan’s plan would mean that people could “chose” to buy insurance with incomplete coverage. I have first-hand experience with how much work it is to analyze and compare insurance policies, trying to read between the lines to see what essential coverage is missing. The result of the Speaker’s plan would be many people who thought they were getting a good deal on their insurance would face bankruptcy because of hidden gaps.

With the Affordable Care Act, the last four years have been wonderfully free of the anxiety that any illness could turn into the “preexisting condition” that would make health insurance unavailable. Speaker Ryan’s plan to condition this on “continuous coverage” is a poor substitute. Sometimes people suffer a financial catastrophe and are temporarily unable to afford to maintain their insurance. It is terribly cruel to compound such a catastrophe with the additional penalty that health insurance—once they can afford it again—be unavailable or unaffordable.

My wife and I have modest incomes, and make some use of the credits available through the Affordable Care Act, which have made my insurance much more affordable. Speaker Ryan’s plan would eliminate these credits and replace them with a single credit which would probably be much smaller—and if as large, would be enormously generous to people with high incomes who scarcely need help affording their health insurance. The current means-tested credits seem much more likely to advance to goal of making health insurance available to everyone.

I urge you preserve these key elements of the Affordable Care Act.

Yours sincerely,

Philip M. Brewer

There are plenty of other things I might have included as well. For example, under the Affordable Care Act an older person can only be charged 3 times as much as a younger person for the same policy, whereas the Speaker’s plan would increase the multiple to 5x. If enacted, that change would cost me a lot. But I thought these were the most essential points: That insurance actually be insurance, that it be available, and that it be affordable.

Progressive policies with conservative rhetoric?

I wonder whether it would be possible to advance a progressive policy agenda that was cloaked in conservative rhetoric.

For example, it is currently legal for police to use unlimited force to produce compliance with their orders, even illegal orders. Essentially, you are forced to stop going about your business, comply with whatever the police tell you to do, allow them to search you and whatever you’re carrying, tolerate an indefinite delay, even let them take you to the police station if they chose, all without offering any sort of resistance.

Any questioning of their actions or inquiry into its lawful basis can be interpreted as “resistance,” and any degree of resistance, no matter how minimal, is considered legal justification for the police to beat you up, taser you, pepper-spray you, or even shoot and kill you—and they will suffer no consequence beyond (perhaps) a brief period of paid leave.

People of color have borne the brunt of these sorts of police actions for a long time. With the advent of ubiquitous cameras we have now seen many people of color murdered while offering up either no resistance at all, or such minimal resistance that it should shock the conscience to see lethal force used. We have also seen many white people granted great deference by police under circumstances where a black person would have been killed.

This is the circumstance that led to the “black lives matter” slogan.

Many people—especially, I suspect, many Trump voters—object to this slogan, preferring to suggest that “all lives matter.”

Many liberals and leftists look to a willingness to say “black lives matter” as a marker that you’re on the right side of this issue.

My question is, could a political candidate who was on the right side of this issue (and many other issues, such as using the threat of jail to balance town budgets on the backs of indigent people) couch his objections in terms that would not offend Trump voters, while still pushing for good policies? And would such a politician be able to get support from both sides of the political divide?

For example, I’d like to see a policy that said that resistance to an unlawful order from a police officer was legal and that any force used by the officer to produce compliance was an illegal assault—the officer should be prosecuted. I’d like to see a policy that any monies extracted from an indigent person under threat of jail be considered the proceeds of an illegal extortion scheme—everyone involved in the extortion should be prosecuted, the money returned, and the original fine forgiven.

If a politician were to propose such ideas, but describe them with terms like “all lives matter,” or “protecting liberty and private property rights,” could such a politician draw support from both sides?

I’m doubtful. But I’d like to see it.

Rodney Davis questionnaire response

Congressman Rodney Davis has a questionnaire asking for constituent input on questions of the day.

I filled it out some weeks ago (in mid-December) and found some of the questions to be . . . . Well, here. This is what I sent to his office after I posted my questionnaire response:

Several of the questions on your recent survey were hard to answer, because an accurate answer might be taken as supporting a position that is the opposite from what I intend. These two in particular:

“Do you believe we need to shore up Medicare so it’s available to future generations?”

Of course I support preserving Medicare. However, I would  oppose any changes in the basic design of how Medicare makes healthcare available to seniors. In particular, I would strongly oppose turning it into some kind of voucher program.

My understanding is that, together with the cost savings provided by Obamacare, Medicare is very close to being fully funded. It seems quite possible that no changes are needed going forward. Depending on the details of health care costs and payrolls in the future, it may be that some additional funding will be required, but that is the question for the future.

“Do you believe Congress must provide proper oversight of the VA to ensure our veterans are receiving the care they deserve?”

Again, providing oversight is exactly what Congress should do. However, I would oppose giving the VA additional mandates—either in terms of the care they are to provide, or in terms of the reporting they are required to provide—unless those mandates are fully funded.

I have no sense that the VA is doing anything other than providing the best care they can with the resources provided. Congress’s deeper obligation, beyond oversight, is to provide the resources necessary to care for our veterans.

I expect to go on pestering Congressman Rodney Davis on a near-monthly basis for the next two years.

Rodney Davis: Please take a stand against Trump’s immigration order

I just sent the following to my representative in Congress via the web form on his page at the House website:

Based on media reports and what I can find on your website and twitter feed, it appears that you have not yet taken a stand against Trump’s illegal and unconstitutional executive order blocking entry by nationals from certain countries.

Can I count on you to do so in short order?

I didn’t mention in my note, but wanted to mention here, that Davis’s words for his constituents after the recent election invoked Lincoln’s phrase “With malice toward none, with charity for all,” so I’m a little concerned that he may be putting a dangerous strain on our nation’s limited supply of irony.

I also refrained from once again pointing out that the Republicans in Congress are straight-up cowards, afraid of widows and orphans.

What cell phones teach us about the power grid

Back in the day the telephone network was a regulated monopoly. As long as the phone company kept the regulator happy, they were permitted to earn rate of profit on their investment. This resulted in a couple of interesting effects.

First of all, the company was incentivized to invest more in infrastructure: The more they invested, the higher their profit (which was a regulated rate times the size of their investment). This is very different from an unregulated company, where investment is viewed as a cost.

Second, while keeping the regulator happy was always a complex dance, the regulator tended to focus on a few key metrics, one of which was network uptime. This incentivized the phone company to use that large infrastructure investment to produce a network of extreme reliability.

And that network was reliable. In my personal experience with wired phones in that era a wired phone always had service: For two decades as a youth I had literally 100% success picking up a phone and getting a dial tone. Likewise, calls did not drop. Service was rated in nines: 99.999% uptime was 5 nines, 99.9999% uptime was 6 nines.

Of course, that sort of reliability is impossible with cell phones. They move around. Worse yet, they go places where radio signals simply can’t reach.

Cell phone reliability is pretty darned good—let’s call it 98%, as long as you’re not trying to get service in places where nobody else cares if there’s service (the middle of the desert, the middle of the ocean, etc.). But people are not surprised when they find a spot where there’s no service, nor are they surprised if a call drops when elevator doors close or they drive into a tunnel.

This is not to say that cell phone service is bad. My point is simply this: To get the advantages of cell phones, people have accepted a drop in telephone service reliability from six nines down to less than two.

I think this is particularly of interest because I see a potential parallel with the power grid.

The big problem with solar and wind power is that they’re crappy at providing baseline power, for obvious reasons: nighttime, cloudy days, calm days, etc.

If you want a power grid to provide five or six nines of availability, you really need to have enough fossil fuel (or nuclear) generation capacity to provide a large fraction of your total power needs—at least 80%, probably more if you don’t have considerable diversity in your renewable sources (both diverse sources: solar and wind, and geographic diversity: the wind is always blowing somewhere and the sun shines different hours different places).

But just as people learned to get by with less than two nines of phone network reliability, people could certainly learn get by with a less reliable power grid as well.

Thinking of household use, there are certain things that really need fairly reliable power (refrigerator, freezer, furnace), but beyond those few things, we only require a high-availability grid because we’ve set things up with the expectation that it would be there.

Just two or three modest changes to the way we use power could easily accommodate a less-reliable grid.

The easiest one would be for each household to have a guaranteed level of power—enough to keep your food fresh, your pipes unfrozen, and a couple of lights turned on—and then make additional power available on an as-available basis. Alternatively, you could go with a market-based measure where power was cheap when it was plentiful and expensive when it was scarce. A third option would be to distribute the resiliency, with each household providing its own backup power storage or generation capability.

My point here is not to solve the issues for a smart grid, but just to make this point: For a big enough payoff—like the payoff of a internet-connected supercomputer that you can carry in your pocket—we would accept a considerable downgrade in reliability from our power grid.

The payoffs from renewable energy arguably are that big. (In particular, not rendering the planet uninhabitable for humans. But that’s a payoff that’s uncertain and diffuse, with the gains—especially the early gains—going to people other than the ones who need to make the sacrifices.) But there are payoffs to everybody: less particulates in the air, fewer pipeline and tanker spills, fewer truck and rail accidents hauling coal and oil through towns and cities, fewer worker deaths in the coal-mining and oil-drilling industries. And then there are the cost savings: Renewable power has the potential to be very cheap and very reliable in the out-years, once the infrastructure has earned out its initial capital costs.

It might well be worth getting past the idea that the power grid should provide near-perfect reliability, given the payoffs involved in accepting a bit less.

Second passports for expensive

This sort of thing was a fantasy of mine, back in the 1980s. I could see things getting worse in the US, and the idea that a foreign passport and foreign residency could provide an escape if things got too bad was pretty appealing.

Nowadays not so much. It’s not that things have gotten better in the US; it’s that things have gotten worse other places at least as quickly. More to the point, things getting worse in the US seems to make things worse other places, so the conditions that make the idea appealing are the same conditions that make it pointless.

One book that substantially influenced my thinking in this area is Emergency: This book will save your life by Neil Strauss. I recommend it highly. In entertaining and informative prose, he documents his transformation from just the sort of kook I was in the 1980s into somebody with a much more practical perspective.

Still, an EU passport might have its upsides. Anybody got a spare quarter million euros and an interest in learning Greek? (If money is no object, a half million euros will let you buy in to Ireland, and I expect learning Gaelic is optional.)

Graphic from Citizenship for Sale on the International Monetary Fund’s IMFDirect blog.

 

Are we reaching the end of “escalate faster”?

For about a generation now the police in the U.S. have followed a general practice of escalating any confrontation, with the intention of escalating faster than the opposition can respond. This has saved lives, but I think we’ve reached the point where the negative consequences of this practice are becoming highly visible in a way that’s going to force changes.

The police still patrol in ones and twos the way they always did, but starting in maybe the 1970s they quit responding to confrontations that way. At the first sign of trouble, they’d call for backup. A confrontation with one person would be met by four or six officers. A confrontation with several people would be met by a dozen officers. A confrontation with an armed individual would be met by countless officers with rifles and shotguns.

In many cases this has no doubt saved lives. Certainly it has saved the lives of police officers, but it has probably saved the lives of suspects who were persuaded to surrender in the face of overwhelming force.

The problem with this tactic is that it’s obviously inappropriate in many circumstances. It’s basically a military tactic—hit with overwhelming force—and the general public views it that way and reacts with scorn (when used against people who are obviously harmless) together with either fear (when used against people like them) or shame (when they see it used in their name).

And that last, I think, is the change that’s going to make a difference: People feel shame when they see a rapid escalation to a disproportionate use of force done in their name, and they’re seeing it more in this age of smart phones.

So far when rapid escalation leads to uses of force that seem clearly unnecessary or disproportionate, and yet police officers face few or no consequences, people have been surprised. They shouldn’t be. The whole point is that these practices are codified in law and in the procedures the police departments follow. When the police rapidly escalate a confrontation they aren’t doing anything illegal, and they aren’t violating police department policies.

And those things—laws and procedures—are what need to change. Fortunately, in a democracy, when the public decides something ought to change there is a real chance of change forthcoming.

So, what do we do instead? We can go back to what policing ought to be—attempting to deescalate confrontations, reserving escalation for cases where public safety really requires it.

There are many instances where violence is a possible result—where somebody is angry or drunk or stoned or stupid or having a psychotic break or just a really bad day. In many instances violence could be avoided with deescalation.

For a very long time—as long as there has been government, right up until recent decades—escalation had to be slow, because the communication options and the manpower available didn’t allow for rapid escalation. There tended to be one representative of the government—a sheriff or tax collector—who kept order largely through moral suasion, together with having some call on overwhelming force (in the form of a posse or a platoon of redcoats or something). Unless a situation was such that calling in the marines would be appropriate, it pretty much had to be handled through deescalation rather than escalation.

Many of the lives saved by rapid escalation are police officers’ lives. Many of the people who will be saved through deescalation are not especially sympathetic—the petty criminal, the drunk, the mental patient, the burly man who is developmentally disabled. But others are, and we’re beginning to see the losses as part of a pattern, rather than as a series of unfortunate incidents.

When a guy has a stroke at the wheel of his car, manages to stop it, but is unable to respond to a police officer’s instructions (“Show me your hands! License and registration! Get out of the vehicle!”), what is the police officer’s appropriate response? Knowing the situation, obviously calling an ambulance. But under current polices there’s far too much chance that the guy will be dragged out of his car, roughed up, and dumped in the drunk tank until brain damage from the stroke is irreversible. Or, if he doesn’t have white skin, very possibly shot instead.

Now that we’re seeing people die at the hands of the police, and now that we’re hearing the testimony that these killings are legal and are in accordance with police department policy, we may finally see some changes in the laws and the policies.

Because that, rather than feelings of anger or shame, is what will make the difference.

A shift to deescalation will probably mean that people will die who might have lived. But people are dying now. People will die either way. A shift to deescalation may mean fewer people will die. It will almost certainly mean that fewer people will be shamefully killed in my name.

The myth of age-related illnesses of middle age

You know this, right? Age-related diseases—at least, those of middle age—mostly aren’t. Rather, they’re lifestyle diseases that seem age-related because it takes years or decades for the harm done by the lifestyle to start showing up as symptoms.

I’m prompted to write this by something Charles Stross wrote over a year ago, where he talks about the symptoms of aging. I almost didn’t link to that post, because he’s really talking about something else—his post is about the political effects of reasonably foreseeable improvements in medicine—but along the way, he describes his current circumstance:

. . . chronic low-grade pain of the middle-aged body: joints that creak and pop, muscles that need an extra stretch, sore feet.

And goes on to compare it to his hypothetical world with science-fictional medicine:

Unlike today’s senior citizens, you don’t ache whenever you get out of bed, you’re physically fit, you don’t have cancer or heart disease or diabetes or Alzheimer’s, you aren’t deaf or blind or suffering from anosmia or peripheral neuropathy or other sensory impairments, and you’re physically able to enjoy your sex life.

Of course there are age-related diseases—Alzheimer’s and anosmia probably are. But especially the ones in the first quote—the age-related difficulties of the middle-aged body—aren’t age-related at all. To imagine that they are is to make a category mistake—and a serious one, because the error makes it much more difficult to recover your health.

I’ve hesitated to write this post, because I realize that I’m speaking from a position of privilege—I’m healthy. This is partially a matter of luck, partially a matter of good genes, partially a matter of a lifetime history of good health care, access to adequate nutrition, and so on.

Even so, I’ve got real first-hand experience with exactly the list of middle-aged body problems that Stross lists.

Eight or ten years ago, I was feeling old. Tasks that required strength were more daunting than they had been—especially ones, such as carrying things up or down steps, that added additional weight to my already excessive body weight. My balance wasn’t as good, making slippery tubs and icy sidewalks seem like serious threats. My plantar fasciitis was kept at bay only by being scrupulous about wearing supportive shoes and by limiting the amount of standing I did. I could still get down on the floor and get up again, but it was hard enough that I didn’t do it when I didn’t have to. I had trouble getting a good night’s sleep, because my back would ache when I lay still too long, and when I did sleep through the night I’d need considerable stretching before I could move normally the next morning.

I viewed all this as normal aging. Partially, I think that was because I was actually in pretty good shape. I could walk 5 or 6 miles. I routinely bicycled to work when the weather was nice. I went to the fitness center two or three times a week to use the weight machines and do some stretching. Despite all that, my physical capabilities were declining, and I didn’t see anything I could do about it, except perhaps spend even more time exercising, which didn’t seem practical for someone with a day job.

It wasn’t true, though. Over the past six or seven years, I have felt better each year. It is not a strain to carry things of ordinary weight, even going up and down stairs. My static balance is excellent—I no longer fear slippery tubs, although I do still try to be careful on ice. My feet don’t hurt when I stand a lot, even when I’m barefoot. I make a point of sitting on the floor, just to add some variety to the day. I sleep well, and I wake up able to move.

What did I do? Nothing extraordinary.

Starting to do tai chi was probably the key shift, because it changed so many things at once about my movement practice. Somewhere along the line I ran across parkour, and then even before I had done more than play with that I discovered natural movement as a thing—and that was what gave me a framework for thinking about movement the same way I’d come to think about food.

Trying to figure out the best diet is a waste of time. It’s computationally infeasible, and anyway unnecessary—just eat a wide variety of foods (and limit your consumption of industrially produced food-like substances) and your body takes care of the rest. (See Michael Pollan’s In Defense of Food for details.)

Similarly, trying to figure out the best exercise regime is a waste of time. You are far better off to get a wide variety of movement (and limit the time spent doing things like sitting in chairs and wearing shoes). Once again, your body will take care of the rest.

What struck me—what prompted me to write this post—was that Stross’s description of what his science-fictional medicine feels like is what I’ve felt like. It’s not exactly aging backwards, but it is a recovery of a feeling of ease and comfort that had slipped away under cover of “normal” aging.

My life feels kind of like a science fiction story, with the science-fictional medicine being just recovering normal patterns of movement.

It makes me want to advocate these lifestyle changes, perhaps more strongly than is advisable. As I say, I recognize that I’m writing from a position of health that isn’t available to just everyone. I can’t say that if you’ll just start walking and running and bicycling and lifting weights and doing taiji and experimenting with parkour and natural movement, you will reverse the aging process and feel young again. There are kinds of impairments that cannot be completely recovered from, and perhaps some that cannot even be improved.

And yet, I do advocate these lifestyle changes. Move better. Move more. Eat food. I bet you’ll feel better—especially if you’re starting to suffer from the symptoms of “normal” aging.

Coming around on gun control

I have long opposed most sorts of gun control. The main reason is the same reason I oppose drug prohibition: There is no way to enforce a ban on a thing, except through police-state tactics (and I don’t like living in a police state).

How do you ban a thing? You can pass a law against possession, but that law is unenforceable except by house-to-house searches. You can’t even enforce a ban on carrying concealed weapons except by stopping and frisking everyone out on the street. (Please don’t suggest only stopping and frisking “suspicious” people, unless you have first-hand experience with looking like one.) Since there’s no victim to report the crime (“I was illegally possessed at!”), you only find the criminals by chance, unless you’re willing to go full war-on-drugs with undercover agents, coerced informants, wiretaps, search warrants executed by SWAT teams and so on.

You could impose a high penalty on possession of a gun, and then only enforce the law when a gun came to the attention of the police. That would probably get the guns off the street—a gun hidden under the floorboards isn’t much of a threat—except of course for the “only criminals will have guns” issue: High penalties don’t much deter people who are already committing crimes with high penalties. Plus, it leads to all the classic slippery-slope arguments. Selective enforcement (searches used to harass disfavored people) and unfair results (unlucky people spending 20 years in prison for a gun they didn’t know was in the boxes of grandfather’s personal effects) being just two of the downsides.

Besides, guns are useful tools. If we have a ban that applies as well to the police and the military, then we’ve denied them tools that they may need to do their jobs. But if the ban doesn’t apply to them, then we have to draw the line in a specific place—or a series of specific places. If police qualify, how about campus police? Transit police? Park rangers? Do bodyguards qualify? How about armored-truck guards? Stalking victims? The result is once again selective enforcement and unfair results, this time with a side order of political shenanigans.  Some people who need the tool will be denied it. Other people who thought they were allowed the tool will have their lives destroyed when a court rules that they were not.

Much more sound than laws against things is laws against behavior. It’s illegal everywhere to shoot someone or to threaten someone with a gun or even to discharge a gun in a populated area. These are the sorts of laws that gun-control opponents always point to as the right way to control guns. But they self-evidently don’t work. Even if you discount suicides and accidents, there are 12,000 homicides a year in the United States—with about 90% committed with a firearm.

So, what other behaviors could we regulate? There is often talk of regulating the sale of firearms. Being in the business of selling firearms is already extensively regulated, but currently it’s legal to sell (or give away) a firearm without being in the business—sales between friends and gifts between relatives are legal, and don’t require that you be a licensed firearms dealer. That could be changed. You could make selling firearms be like selling prescription drugs, which only a licensed pharmacist can do. Many currently legal, perfectly ordinary behaviors would be illegal, or else the laws would have to be very carefully drafted. Could a father buy his son his first .22 rifle? Could an Olympic-champion riflewoman let her aspiring-sharpshooter daughter take mom’s match-grade pistol to the shooting range to practice with? If a down-on-his luck man pawned a family heirloom firearm, would he be committing a crime if the pawn shop owner’s firearms license were not in order? What if the pawn shop clerk were a felon?

Registering guns is often proposed, although I don’t see how doing so would reduce violence. Further, I think gun-owner fears of gun registries being useful primarily as a tool for eventual confiscation is well-founded: What other use would a registry have? The parallel is less with registering cars (which are big and operate in public where people can see them) and more with registering typewriters (which are small and are generally used in private).

Illinois has long had a registry of “allowed gun buyers,” which is somewhat less pernicious than a list of guns: It would still provide a list of places to search, if things trended even further toward a police state, but it would do so without providing what amounts to a master of list of guns to be seized. In fact, I would fully support such a scheme, if it were automatic: Every adult who has not been convicted of a felony or violent misdemeanor, nor adjudicated as dangerous or incompetent in some other fashion, should be on the list of those allowed to buy guns. The government could automatically strike people from the list upon conviction or commitment to a mental institution (with an appropriate appeals process to correct errors). Or people could file a simple form to ask to be taken off the list, if they had some personal objection. It’s basically the instant background check from the opposite direction.

I will say this, though—gun control advocates are finally on the right track, in attempting to mobilize public opinion. For the past thirty years, members of a small, mostly liberal elite have been trying to use their influence over government officials to pass gun control. But with public opinion so divided, legislative sausage-making has produced laws that are pointless and ineffective, full of easily ridiculed loopholes, but still with traps for the unwary gun-owner to commit a technical violation that leads to harsh sentences, without reducing the number of guns or making them less dangerous. (I am thinking in particular of the so-called assault rifle ban that ended up merely banning a handful of cosmetic details.)

And yet, I am nearly brought around. I am ready to support gun control legislation, if something can be found that would actually reduce violence (or at least its severity), doesn’t require police-state tactics to enforce, and doesn’t send people to prison simply because their papers are not in order.

That last is non-negotiable for me, an attitude puts closer than I’d like to be to unsavory company on other issues, such as immigration, where I agree with many Republicans that I think we should control our borders better. It’s because the other tactics of keeping our population density low are ineffective, unless we empower the police to check people’s papers. If we want the higher standard of living that comes from living well below carrying capacity—and I do—we can’t let just everybody live here. But having a category of “illegal” people forces immigrants to live outside the rules that promote the health, safety and prosperity of everybody, for fear of deportation. That risks the health, safety, and prosperity of all of us.

I’m no happier with letting police demand my firearm paperwork, and send me to prison if it’s not in order, than I am with letting police demand my citizenship papers against similar consequences.

I also think playing with guns is fun, and would be sad if they were banned. But I would give up playing with guns, if I thought it would prevent a large fraction of 11,000 murders a year. I don’t see a clear path from here to there, but I have joined the mass of people trying to find one.