Alt-transcript of Yesterday’s Alt-reality Press Conference at the Alt-White House, Trump Tower

President Trump has an uncanny ability to spot moral equivalence, as demonstrated in this alternative transcript of yesterday’s press conference.

. . . .

Reporter: Senator McCain said that the alt-right is behind these attacks, and he linked that same group to those who perpetrated the attack in Charlottesville.

Trump: Well, I don’t know. I can’t tell you. I’m sure Senator McCain must know what he’s talking about. But when you say the alt-right…uh, define alt-right to me. You define it. Go ahead.

[Cross talk. Reporters shout questions.]

Trump: No, define it for me. Come on, let’s go.

Reporter: Senator McCain defined them as the same groups.

Trump: OK. What about the alt-left that came charging at-

[Indistinct.]

Trump: You know what? Listen. Last night I decided to do my own historical research. So, I watched the History Channel. You may not know about this, fake news, but there was a war. Not so very long ago. The alt-right was occupying France. There they were, the alt-right, minding their own business and you what? You know what? The alt-left came charging at them across the English Channel and attacked them. Surprise attack. Very violent. Very violent.

[Cross talk. Reporters shout questions.]

Trump: Excuse me, what about the alt-left that came charging at the, as you say, the alt-right. Do they have any semblance of guilt?

[Cross talk. Reporters shout questions.]

Trump: Wait a minute. I’m not finished. I’m not finished, fake news. That was a horrible day.

Reporter: Is it the same level as the Nazis?

Trump: I will tell you something. I watch TV very closely, much more closely than you people watch it, and you have- You had a group on one side that was bad and you had a group on the other side that was also very violent. And nobody wants to say that, but I’ll say it right now. You had a group, you had a group on the other side that came charging in without a permit, or visas, and they were very, very violent.

[Cross talk. Reporters shout questions.]

Reporter: Mr. President, are you putting what you’re calling the alt-left and alt-right on the same moral plane?

Trump: I’m not putting anybody on a moral plane.

[Stunned silence.]

. . . .

People of Good Will Unite!

We must overwhelm the attitudes of white supremacy, nationalism and insularity that take us backward and harm us all.

David Duke, KKK Imperial Wizard was correct in his weekend Tweet to @realDonald Trump: White Americans put Donald Trump in office.

By “White Americans,” though, he surely refers to members of a distinct minority for whom whiteness and white privilege is essential to identity. They cling to it desperately as they watch their whiteness diluted and dismissed as cultural and historic artifact.

Charlottesville is evidence of this virulent white minority and the sad fact that the fight for civil rights in America is not over. As hard as it is to imagine in this modern era, there are young, khaki-clad white Americans, wearing MAGA hats, who cling to a past of confederate white supremacy, anti-Semitism, slavery and segregation.

Don’t they see their mindset holds them and the rest of our society back? Overcoming such attitudes and practices has been essential to cultural and economic progress. Watch the movie Hidden Figures and wonder if we could have been first in space and sooner to the moon if American society had not committed the crimes of slavery and post-slavery segregation.

Even the Neanderthals intermingled with Homo sapiens and gave up their “big brow” identities.

Charlottesville was an odious clash between progress and those willing to do violence for their identities of color, race, religion and nationality. For what purpose?

Return to slavery? Segregation? Closed borders? Travel bans? Trade wars? All these hobble progress and diminish economic activity. The only modern hypothetical I can think of is a Walmart closing its doors to customers and allowing only its employees to do business within its walls. Its “economy” would shrink and failure would loom quickly.

Historic examples include the many failed “utopian” experiments where groups of people walled themselves away from the of rest society, “drank the Kool-Aid” and otherwise spiraled into dysfunction and self-destruction.

Diversity, acceptance, inclusiveness, respect, open doors: These are not just long-accepted American values, they are essential to American economic progress and prosperity.

Add smart investments in education, job growth and upward mobility, and the economy can soar—for the benefit of everyone.

Coming Soon: Dragging the Anchors of Economic Inequality

Charlottesville: Shadows of Darkness

The eclipse came early. The insanity abroad has been eclipsed by insanity at home. White nationalists invaded Charlottesville this weekend and the country is bathed in darkness.

When the president attributed blame for Charlottesville to “many sides,” he demonstrated an alarming moral emptiness and intellectual vacuity.

We need presidential resolve and encouragement at such a moment of national crisis.

Much has been said about this overnight, including a retributory Tweet from the “Grand Wizard” himself, David Duke. Among all the critiques, this one is perhaps the most gut wrenching.

Duke attacks the President for his ambiguity, for being an ingrate to the White Nationalists “taking back America” in Charlottesville, for his failure to take their side and for failing to condemn instead the counter-demonstrators who opposed their efforts to “preserve” White History, White Culture and White Identity.

And it was not just about color, these white boys flew and wore both Confederate and Nazi symbols, spewed anti-Semitism, pulled down rainbow flags and rejected every individual and collective quality of a diverse, pluralistic society.

This is White Darkness indeed. It expects to be unleashed from “political correctness” and “in control” with the license and leadership of a bouffant-blond, Aryan-looking White President.

These defenders of White History are the “spiritual” and intellectual descendants of the white American immigrants who, among other things, robbed the indigenous peoples of their land, killed them off with guns and disease, stole Africans from their homes, pressed them into the holds of ships to be transported like animals from Africa, and precipitated the death of millions in a civil war fought over the abominable practice of slavery. They evoke the Nazi crimes of World War II, defend the Holocaust and justify other nationalist horrors of the modern era.

Yes, Mr. President, please do look in your mirror. These people voted for you, echoed your words this weekend and proudly wore your absurd MAGA hats while they hissed their hate and wreaked their havoc. You have enabled them and by your example and, by your silence, you have left them unshackled.

I hope these White Americans represent just a small number of the white Americans who voted for you. But every white American who did, should also look in the mirror, especially the mirror of history.

Call on Idaho Senators to Protect Idaho from Trumpcare

Our Senators must have courage, beginning this week, to resist partisanship and stand up against the devastating effects the Senate version of the American Health Care Act (“Trumpcare”) will have on Idahoans.

Why such a partisan divide on health care? Why did the House pass a bill that will put health insurance beyond the reach of 23 million people? Why have Republican Senators scurried off to work in secret on the Senate version of the bill?

Putting aside partisanship and callousness, one significant part of the answer is highlighted in yesterday’s New York Times article about GOP Senator Dean Heller and his opposition to the Senate bill. About a week ago he said he could not support a measure that would deprive millions of health care and do nothing to lower insurance premiums.

According to the Times, “Now Mr. Heller is facing an intense backlash in Nevada, his home state, where there is talk of a primary race challenge against him next year and a pair of the state’s wealthiest Republican donors are fuming.”

The leading edge of the “backlash” is from President Trump and his rich supporters, in this case, billionaire Nevada casino magnates, Sheldon G. Adelson and Steve Wynn.

Meaning, the health care fight is largely over the taxes imposed on the wealthy to make health insurance affordable for the poor.

Money versus health. Greed versus individual and societal well-being.

Notwithstanding attempts by Republicans, including Raul Labrador and Paul Ryan, to explain otherwise, if the Senate version of Trumpcare passes, 22 million Americans will become uninsured and people will die.

A Harvard medical study published in the New England Journal of Medicine showed that for the states that adopted the Obamacare Medicaid expansion, mortality rates have declined. Many previous studies support the same, obvious conclusion that with access to health care, mortality rates decline — including for young people.

The Republican-controlled Idaho Legislature has already exposed tens of thousands of Idahoans to higher risk of mortality by refusing to adopt the Medicaid expansion. The further contraction of Medicaid with Trumpcare will make life even more difficult for tens of thousands of Idahoans.

Idahostats

Voting for Trumpcare is like voting to strip most of the Boise metro area of health insurance and allowing one whole neighborhood to die as a result.

Because of their disregard for the lives of their constituents, Raul Labrador and Mike Simpson should be ashamed for their votes in favor of the House version of the bill. Senators Crapo and Risch should be ashamed if they support the Senate version.

If you agree, please call or send emails to Senators Crapo and Risch. The Senate will come back to this terrible bill after their July 4th recess, so email as soon as you can. Encourage our Senators to follow Nevada Senator Heller’s example.

Mike Crapo, Phone: (202) 224-6142 Email: https://www.crapo.senate.gov/contact/email-me

James E. Risch, Phone: (202) 224-2752 Email: https://www.risch.senate.gov/public/index.cfm/email

Bodies Were Lying in the Street

One night in New York City, I happened upon a mafia hit, the result of competition for leadership of the Gambino crime family. Current events take me back to that night.

After law school I worked as a corporate finance lawyer at a prominent law firm and spent 10 years in the firm’s New York City office.

My wife and I had both grown up in the West and, to us, the East had always been distant and forbidding.

“It will be an adventure!” I said to her cheerfully. “We’ll spend a couple of years out there, and then move back West.” She glared at me.

I went out ahead to work and look for housing. For a week or so, I wandered Manhattan in the evenings, searching for an affordable apartment.

On one of those nights, as I made my way back to my humble Lexington Avenue hotel, I passed Sparks Steak House on 46th Street, close to Third Avenue.

It was the night “Big Paulie” Castellano, head of the Gambino crime family, was gunned down on his way to dinner. Police tape closed off 46th street. Lights were flashing. Sirens blared. Bodies were still lying in the street, covered with sheets.

John Gotti, who had ordered the hit, would become head of the Gambino family. Guess he thought he could do a better job than Castellano.

“Better not tell my wife about this,” I thought, as I skirted the crime scene.

This was a dramatic introduction to an ugly part the City at that time. The mafia was distinctly present and projected an image of being above the law, cocky, arrogant and unrepentant. Just look at this mug shot of John Gotti.

Gotti mug shot

At that time, some in the New York business world seemed to have inherited mafia-like arrogance, rudeness and winner-take-all attitudes. They showed little concern for relationship and trust. In negotiations, I experienced their blatant misrepresentations, threats, verbal abuse and crudeness. This always injected stress, distrust and delay in the transactional process.

At law school, in my business negotiations class, I had learned that a negotiator will more quickly achieve optimal outcomes with a collaborative approach. Humility, listening, honesty and respect build trust, foster cooperation and reach mutually beneficial outcomes.

In the face of the belligerent, bullying New York business style, I consistently applied what I had learned in school. My team succeeded in getting hard things done quickly and our practice grew.

This experience keeps coming back to mind (and you can probably guess where I am headed with the story).

I shudder watching from afar the negotiation style of our new President. So far, his lurching administration has left more bodies “lying in the street” than John Gotti.

This approach to “winning” shows little regard for the “other side,” or the greater good, and, with huge arrogance and a small attention span, fails to understand issues, details, process or people. It is, to me, mafia-like and poisonous to the political setting.

Our governing institutions, with checks and balances, exist to reach collaborative solutions and achieve optimal outcomes for the whole country, without regard to political party, group identity, winners or losers.

As citizens, we must demand collaboration and resist the “me-first” attitudes promoted by the new administration and worse-than-ever partisanship.

Those attitudes are causing our country, and the world, to become more fearful, angry and divided—and more dangerous and dispirited than ever.

“CSRs, We’re Not Doing That!”

The Affordable Care Act and healthcare for low-income families are held hostage as a Republican-controlled White House and Congress lunge for “victories.”

The newest “repeal and replace” healthcare plan will NOT be voted on today. Hurray! What a relief—for now.

Unfortunately, the Affordable Care Act remains in the hands of its enemies and they have shown they are willing to hold it and its beneficiaries hostage.

littlewhitehead-hostage1

A few days ago, the White House proposed an exchange of payments for President Trump’s wall for continued funding of the Cost-Sharing Reduction payments (CSRs) provided for in the Affordable Care Act. The administration said, in so many words, “For each dollar towards President Trump’s wall, we will not stop a dollar of Obamacare CSR funding.”

Stated otherwise, “we will not make health insurance unaffordable, if you will pay for the wall.”

CSRs are government subsidies provided for in the Affordable Care Act. They are paid to insurance companies to offset the cost of insurance for low-income families. Without CSR payments, health insurance for those families would be unaffordable.

The proposed “deal” (or threat) was met with immediate, negative political and industrial response. As a result, President Trump backed off both wall funding and the withholding of CSR funding—for now.

Republican hostility for the Affordable Care Act remains and the withholding of CSR funding is just one of the several tools in Republican hands to promote their self-fulfilling prophecy of “implosion.”

With the Trump administration, and a Republican-controlled Congress, it is hard to see this ending well for low-income families in need of health insurance. It has been made clear that political victories (and walls) are more important than American lives.

Resistance should remain on high-alert.

“You gotta knock the hell out of them — Boom! Boom! Boom!”

It’s amazing how blowing things up in the middle of nowhere can cover your faults and boost your reputation.

“If you look at what’s happened over the last eight weeks and compare that really to what’s happened over the past eight years, you’ll see there’s a tremendous difference, tremendous difference,” Trump told reporters after the military unleashed [the 22,000 pound “Mother of All Bombs”] on a largely unpopulated region of the Afghan wilderness. “This was another very, very successful mission.”

Washington Post, April 14, 2017

DISCLAIMER: THIS STORY WAS TOLD TO ME BY AN OLD FRIEND. I WAS NOT INVOLVED. IT REMINDS ME OF RECENT EVENTS—SERIOUSLY.

It was a hot summer night in a Western, sagebrush-covered desert. Another weekend gathering of “the guys,” high school boys, drinking beer away from the attention of parents and police.

This was the Pre-Game-Boy Era, when testosterone-infected young men competed with cars, guns, beer—and things that go “BOOM!”

On this particular night, around a blazing fire built in a remote clearing that had for years been the regular “drinking spot,” testosterone needles jumped when one of the guys showed up with his dad’s new Oldsmobile and a stick of dynamite.

oldsmobile Dynamite

DISCLAIMER: I DO NOT CONDONE WHAT HAPPENED NEXT.

One genius among the young, beery group suggested connecting the dynamite to a jackrabbit—the desert was full of them—and went to his pickup for a roll of duct tape. The rest of the guys eagerly went looking for a jackrabbit.

Black-tailed Jackrabbit Sniffing

After surrounding and grabbing a stringy male, the boys strapped the red stick to its back, like a rocket pack, and lit the fuse. The poor panic-stricken animal jetted away into the dry sagebrush darkness, trailing the sparks of the burning fuse.

The group howled in delight and the kid with dad’s new car felt proud of his accomplishment—manly and more accepted by his peers for this extraordinary, albeit impetuous and inhumane, show of manhood.

Burning fuse on black background

Everyone leaned forward, in anticipation of the blast. But then–“HOLY S#%T!”–the jackrabbit suddenly veered back, out of the sagebrush, toward the group. Everyone screamed and ran for cover.

The rabbit found cover too, moments before the blast—under dad’s new Oldsmobile.

“KA-BOOM!”

LESSON: BLOWING THINGS UP IN DESERTS (OR MOUNTAINS) CAN HAVE UNINTENDED CONSEQUENCES. IMPETUOSITY AND SHOWMANSHIP, WITHOUT A STRATEGY, ARE DANGEROUS.

“Lady, Obamacare sucks only because you think it sucks!”

Conservative Republicans have done their best to convince us Obamacare is a failure, even though conservatives designed the very Obamacare mechanisms they now vilify.

We were at our cabin in the mountains on Fourth of July. Someone, I think it was me, had brought fireworks. We began to set them off.

The rest of the family was gathered around in lawn chairs, except for my mother in law, who, because of her Parkinson’s Disease, was in a wheelchair.

Mid-firework, a Deputy Sheriff suddenly emerged from the darkness. She had seen our celebration from the road. “There’s a fire hazard warning in effect,” she said. “Stop it with the fireworks!”

My automatic reaction, when the sheriff first appeared, was to toss the remaining fireworks into my mother-in-law’s lap, just in case someone might get arrested.

I am reminded of this embarrassing moment as I listen to the “repeal and replace” debate.

AdobeStock_72170814 copy

For all the Republican chest beating and finger pointing, it is at least ironic that the mandates, penalties and subsidies that became part of Obamacare were first proposed by conservatives, principally the Heritage Foundation (a conservative “think tank”) and that they were adopted with success into “Romneycare” in Massachusetts. (Remember that “tar baby”?)

The conservative genealogy of mandates, penalties and subsidies enhanced the likelihood of passage of Obamacare. However, this resulted in an unpolished political amalgam of concessions and compromises, a sort of Rube Goldberg combination of government interventions and free-market “invisible hands.”

The Republicans have since consistently tossed the problems of these mechanisms into the laps of the Democrats–with hyperbolic rhetoric, the 60 or more attempts to repeal, the first Executive Order of the new administration, and now the Republican intimidation from President Trump and the Koch brothers (ouch! double whammy!).

The effort to repeal and replace Obamacare with Trumpcare (and now the right-wing flanking move against Trumpcare), highlight three conflicting sets of ideas, in increasing order of conservatism.

Least conservative is the view that our healthcare system should take care of everyone who needs health care and that market mechanisms should be regulated to reach that result. Financial aid should be available to help those in need. (This is “conservative” in contrast to the “liberal” idea of government-sponsored universal health care.)
More conservative is government regulation, but less of it, and financial assistance, but not so generous.
Most conservative is the approach that government should stay the hell out of health care, and just about everything else. No regulation. No assistance. Health care goods and services left to unregulated, “free” markets.

The first set of ideas explains Obamacare, with its conservative imprint. The second is Trumpcare, as presented to the House today. The third sheds light on the internecine opposition from the far-right. It also reflects the system (or lack thereof) prior to Obamacare.

Sure, Obamacare got off to a rough start, but it has had to drag the anchors of Republican opposition. Nonetheless, it has made material progress toward implementation of outcomes we should all agree on: making health care more affordable and more available to more people.

children in white bath tub on white background In its short six years, Obamacare has done that. More than 20 million more people are insured. Premiums have risen less quickly than they would have without Obamacare–although there are surely exceptions that deserve to be fixed.

Throwing out this progress is like throwing out babies with bathwater.

And here is something else, lost in the “repeal and replace” hubbub: individual health insurance costs will continue to rise as long as the costs of health care goods and services continue to rise.

Maybe we should focus on that.

5851ab550cd85.image copy

Medicare for Everyone!

If you think profit taking in the areas of accident and disease is wrong, if you support efficiency and if you believe we all do better if more people have access to health care, you should agree that Medicare for everyone is a good idea.

The Problems Caused by Healthcare Reform

Step back. Look at us. Trumpcare versus Obamacare? Obamacare versus Trumpcare? We are fighting over competing approaches to the same problems–and ignoring a solution that would be better than both combined. Medicare.

No matter what, we need a better solution, and quick. While Congress continues its political tug-of-war, we are suffering, individually and as a country. We spend more and get less. The system is rife with inefficiency. Tens of millions are still without health insurance, and tens of millions more stand to lose it. People are dying.

We spend more and get less. Of all the countries in the world, the US spends the most on healthcare (and health insurance), yet health outcomes here are worse. Our average life expectancy is shorter and we have more chronic health problems.

Medical goods and services are more expensive here. Citizens of other countries are charged far less. For example, an MRI in Switzerland is is ten times (10x) cheaper. Canadians pay at least half as much for medicine.

So we tend to put off taking care of ourselves. Sound familiar? Americans visit the doctor less often, even though an annual checkup and other preventative measures could avoid problems or catch them early. Or even save your life. If you are like me, this has too often been about saving money–with the hope/fantasy that the problem will go away.

And, as a group, we and the politicians are downright dumb. As a country, we spend less on social services than other countries, even though a few dollars for things like clothes and shelter could reduce chronic and expensive health issues among the most vulnerable members of our society. And face it, everyone else, including you and me, ends up paying for unpaid emergency health care, through rate or tax increases. In this case, an ounce of prevention really would be worth a pound of cure.

Oh, and by the way, of the 13 countries shown in the chart above, ours is the only one without a publicly financed or mandated health care system that assures coverage for all its citizens.

Are we fighting over wrong solutions? Market-centric mechanisms common to both Obamacare and Trumpcare fail to care for everyone and lead to economic exploitation. As argued in previous posts, free markets do not perform well in the health care arena.

I have already given examples of exploitation, with fabulous sums extracted by health insurance providers like Aetna and Humana. Under Obamacare, those two companies alone distributed around $22.0 billion to shareholders. They will do even better for their shareholders in the years to come, particularly if Trumpcare becomes the law.

And then there’s the inefficiency of this whole dog pile of insurance providers. Massive duplication of overhead expenses–identified in accounting as “Selling and General Administrative Expense.” (Think of stuff like management salaries, marketing and rent. Then think of competing insurance company each paying these kinds of costs, over and over and over again.)

Looking at just Aetna and Humana again as examples: Since 2010, under Obamacare, Aetna reported around $60.5 billion of Selling and General Administrative Expense. During this same period, Humana spent around $44.0 billion, for a combined total of over $104.0 billion. That’s a lot of overhead, and that’s just two companies.

Aetna and Humana argued that their combination would achieve efficiencies known euphemistically as “economies of scale” (aka “people losing their jobs”). Nonetheless, eliminating just one $15 million/year CEO could create savings that would pay for a lot of health care.

If you believe accident and disease are not conditions to be exploited by the “free market,” if you agree that squeezing some of the redundant costs out of the system is a good idea, and if you agree that more people having access to health care and taking care of themselves would be good for our whole society, you should want the efficiency and accessibility of a “single-payer” system.

Like Medicare. For everyone.

Medicare Green Road Sign Over Dramatic Clouds and Sky.

For comparative country statistics, see this report: Squires & Anderson, “U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries,” Issues in International Health Policy, The Commonwealth Fund (Oct 2015) at http://www.commonwealthfund.org/publications/

“Health Insurance? What Me Worry?”–Trumpcare for Dummies.

The “repeal and replace” debate has created more confusion than clarity. Cutting to the heart of it, the question is: “How do you incentivize young and healthy people to buy health insurance?”

1Sam_thumb_w_580 Health insurance seems so complicated: different plans, deductibles, out-of-pocket costs, premiums, enrollment periods. So many companies, so many options, so little time.

The American Health Care Act (AHCA) will be voted on in the House tomorrow.

Here is an effort to explain in simple terms the essential weakness of the AHCA, which has become known as “Trumpcare.” It is the same weakness that has plagued the Affordable Care Act (“Obamacare”).

In summary, both assume the costs of health insurance and health care will come down over time if more people are incentivized to buy health insurance. The difference is in the form of the incentive. How how do you get more people to participate? Negative incentive or positive? Stick or carrot?

Obamacare uses the stick. Trumpcare, the carrot. Both depend for success on which kind of incentive works best to get the most people to get with the program.

Why is it important to have more people participate? It has to do with the spreading of risk and cost.

Insurance is simply a financial tool to do that–spread risk and cost. Car insurance is a familiar example to those fortunate to have a car. The law requires everyone who drives (good driver or bad) to have car insurance. You may never have an accident, but your premiums go to help share the costs of those who do.

Health insurance plans do the same. They allow us to shift our individual health risk and cost to insurance companies, which then spread the risk to a larger population of participants (so called “risk pools”). Our own risk pool may include fellow workers (through employer-sponsored plans) or fellow citizens who buy on the state sponsored exchanges.

The larger and more diverse the risk pool, the further the risk is spread and the lower the costs of insurance should be to each participant, which brings us back to the central challenge faced by both Obamacare and Trumpcare.

Under Obamacare, if everyone without employer sponsored insurance had bought health insurance on the exchanges, premiums would be lower, mainly because younger and healthier people diversify the risk.

To put it another way, if younger and healthier people do not join the pool, or opt out, aggregate and individual premiums rise, because the risk ends up being shared only among an older, less healthy group.

This, in fact, was the cause of the premium increases in the Obamacare exchanges. Younger and healthier people opted out of the risk pools because it was less expensive to pay penalties than remain in the pools.

This problem also threatens Trumpcare, and it will continue to be a subject of debate. Instead of forcing participation (with the combination of mandates, penalties and subsidies) the AHCA hopes to attract younger, healthier people to participate by providing tax incentives (no mandate or penalty*). Carrots instead of sticks.

[* Trumpcare will have a 30% “penalty” (a premium surcharge) for a lapse in coverage. This will be payable to the insurance companies. They need the money.]

The challenge in both cases (Obamacare and Trumpcare) is that to maintain the now popular features of Obamacare–mandating coverage for those with pre-existing conditions and making health insurance affordable for more people–it is critical to have the participation of the younger and healthier crowd.

Obamacare mandates participation. Trumpcare bets younger, healthier people will opt for health insurance at the right price. This also assumes young and healthy people will be rational about their health care decisions and lose their “what-me-worry” attitudes of invincibility. If they buy health insurance only when they finally get sick, Trumpcare (and the country) will suffer a fate worse than Obamacare.

The what-me-worry attitude is just too familiar and too pervasive. The Trumpcare switch to a “free market,” hold-out-the-carrot set of incentives is bound to fail. Health insurance and healthcare costs will continue to spiral. Tens of millions will lose insurance.

It is no surprise that a senior officer of the American College of Physicians, which represents 148,000 doctors and medical students, on Monday said he had “never seen a bill that will do more harm to health.”