It’s not the heat, it’s the…smoked meat

The New Neo Posted on by

Look how uniform the temperature is in the entire eastern half of the country:

Seems unusual to me. We’re certainly having unseasonably hot weather in New England.

I was in Montreal this past weekend, and it was bordering on the uncomfortably hot. People there were exclaiming that they haven’t had much of a summer this year—wet and coolish—and that this past few days constituted the first real summery weather they’d had. So it was party time in Montreal; the streets were loaded with pedestrians well into the evening, taking in the balmy night air.

Ever been to Montreal? It’s the inexpensive way (for us in New England, anyway) to get a soupé§on of Paris. About 80% of the conversations you overhear on the street are in French, which for me (because I understand hardly a word of French) means they sound a great deal more interesting and mysterious than the same conversations would in English.

In addition, great clothes and shoes for sale, and not too expensive.

And to top it all off we have the smoked meat sandwich.

“Smoked meat” is a Montreal specialty, a variant of the classic pastrami sandwich that to me tastes somewhat like a cross between pastrami and corned beef but is an improvement on both. And since good pastrami and good corned beef can be improved upon only rarely and with great effort, we’re talking very very very good indeed. Fatty but not too fatty, salty but not too salty. Just plain flavorful and succulent.

The most famous place in Montreal for smoked meat is called Schwartz’s. It’s been around since 1928, and:

…The staff of Schwartz’s credits the unique flavour of their smoked meat to their mandatory 10-day meat curing time, the high turnover of their meat, and their brick smoke-house covered with over 80 years worth of buildup.

That may not sound too appetizing, but believe me, this stuff is great.

Schwartz’s signature dish is a smoked meat sandwich served on rye bread with yellow mustard. The meat is served by the fat content; lean, medium, medium-fat or fat. Medium and medium-fat are the most popular. According to journalist Bill Brownstein, the classic Schwartz’s meal includes a medium-fat sandwich, fries, half-sour pickle, coleslaw, red pepper, and a black cherry soda.

For me, the rest of those things are of little interest. I don’t drink flavored soda. Fries with a deli sandwich seems just plain wrong, although I noticed that in Montreal, fries are absolutely ubiquitous. Coleslaw’s fine, but I don’t need it for that sandwich. Red pepper? Non. As for half-sour pickles—give me a full sour every time, and at Schwartz’s that’s exactly what I ordered, and it was great.

The mustard is good and the rye bread is good. So who could ask for anything more?

I had several other meals in Montreal, which is a foodie capital. But none compared. I was tempted to stop at Schwartz’s on the way out of town to get a sandwich (or two or three) to go, but I desisted.

But just now I learned—to mixed feelings of joy and horror—that you can mail order the smoked meat from Schwartz’s— that is, according to Wiki, but when I went to the Schwartz website I couldn’t find a word about it. It’s possible they experimented with it for a while but ended the practice.

I’m not sure. You’ll have to do your own research on that and report back. As I said, I have mixed feelings about the idea of having constant access to such temptation. And I’m not at all sure that a mail-order version would be anywhere near the same as what I had in the restaurant.

I also found this on HuffPo in 2013, but I don’t know if the information is obsolete:

…if you’re looking for a present for that special someone, nothing says love like getting a vacuum-pack shipped ”” just e-mail the deli at info@schwartzsdeli.com and get it delivered that week. We recommend getting at least the medium cut.

Wiki offers us this bit of history:

Schwartz’s is considered a cultural institution in Montreal; when the Charter of the French Language became law in 1977, the deli kept its name as is with the apostrophe, despite the French language not using it. The new law still forced the change from “Hebrew delicatessen” to “charcuterie Hébraé¯que.”

When I was in Montreal but before I decided to go to Schwartz’s, I did online research about the smoked meat choices, as you might imagine. Montreal is full of smoked meat delis, and the discussion of which is best is hot and heavy (like the sandwiches) and contentious. No small number of people say Schwartz’s is overrated. I disagree vehemently. Some of those people preferred various other establishments, and I had a few bites of a smoked meat sandwich at one of those places and it was inedible. ‘Nuff said.

I’m with this writer:

Okay. Okay. We Get It. Schwartz’s Makes the Best Smoked Meat in Montreal.

Wrong. Schwartz’s makes the best smoked meat in the world. Cured and/or wet brined, smoked and/or baked, steamed, or not, or all of the above, copycats would have to replicate the spices and traditional preparation process to even begin dreaming of giving Schwartz’s a run for their money.

P.S.: How could I have forgotten to add this?

Giving the song the Angelica Hale treatment

The New Neo Posted on by

Angelica Hale was nine years old when she first appeared on this season’s “America’s Got Talent” and wowed the audience. She turned ten before it was over and sang the following song in the finals of the show.

Angelica sings in a style I’m usually not at all fond of; let’s call it “pop diva.” It doesn’t matter, because I’ve become very fond indeed of Angelica’s performances. She’s cute, but that’s not really the point. She’s much more.

Angelica does cover versions of songs that originally were quite popular (or so I’ve heard; I don’t have the finger on the pulse of pop music today). To me, they’re not such great songs—not my style at all—but Angelica’s covers of them are far more interesting than the originals.

Now, cover versions by 10-year-olds are not usually better, and cover versions by 10-year-olds in the pop-diva genre are certainly not usually better. And yet her versions are not just better in terms of voice quality and control, they are usually more moving and exhibit more depth of feeling. That’s not what you expect from a 10-year-old, either. Music prodigies are not all that unheard-of, but ordinarily not in this genre.

Here’s a video of her performance in the finals. She didn’t win, by the way. Another girl—a 12-year-old singing ventriloquist, of all things (who is phenomenally skilled)—did. I offer this video because it shows both Angelica and the original adult performer of the song. I’ve queued it up so that you hear the adult’s version:

Now here’s Angelica:

To me, the original is bubble-gum stuff. Angelica’s version is much more. It’s paradoxical that the adult sounds more like a child than the child does.

Aaron Hernandez and CTE

The New Neo Posted on by

This is sad, although it may offer Hernandez’s family mild comfort and some evidence that might help them win a lawsuit against the NFL:

Aaron Hernandez, the former NFL star who took his life while serving a murder sentence in prison, had chronic traumatic encephalopathy — commonly known as CTE — attorney Jose Baez said Thursday.

Baez cited study results compiled by the Boston University CTE Center, which examined Hernandez’s brain for the neurodegenerative brain disease.

Hernandez played for the New England Patriots from 2010 to 2012 after a standout collegiate career at the University of Florida.

According to a statement from BU, Hernandez’s brain was examined by Dr. Ann McKee, director of the CTE Center. The neurodegenerative brain disease has Alzheimer’s-like symptoms, including memory loss, confusion, aggression, rage and, at times, suicidal behavior. It is believed to result from repeated trauma to the head, which results in a buildup of the abnormal protein tau that clumps in the brain.
The disease is categorized in four degrees, with Stage 4 being the most severe. According to McKee’s analysis, Hernandez was found to have Stage 3 CTE, which is commonly associated with cognitive and memory loss, as well as behavioral changes and impaired judgment.

Perhaps Hernandez wouldn’t have gone so far as murder without this added push from his own brain. However, a caveat—a huge caveat—is that most people with CTE don’t commit murder and don’t kill themselves. There is no way to know how much effect his CTE had on Hernandez’s behavior, and to what extent it may have intensified the emotional reactions that led to his crimes.

I doubt that CTE alone would be considered enough to get him off the hook in the legal sense even if it had been diagnosed before his trial, and of course there was no way to have discovered it before his trial because it can only be diagnosed by autopsy. The legal system has to go on symptoms: does the person have dementia or a mental illness with hallucinations, for example, that might lead to a case of diminished responsibility?

There actually was a case in which CTE (undiagnosed, of course) was raised in a murder trial by a former wrestler—not for the crime itself, which had happened 32 years before the trial, when the accused was a young man—but in the context of deciding whether he was competent to stand trial:

His lawyers argued that decades of getting banged around in the ring had caused dementia, rendering him incapable of understanding what was happening. Frank M. Dattilio, a forensic psychologist hired by the defense, called Snuka a “shell of a man.”

Some think that the defense is taking advantage of the recent media coverage of sports-related CTE, or chronic traumatic encephalopathy. A degenerative brain condition caused by head injuries and concussions, it’s often associated with professional athletes from the football and hockey worlds who suffer blow after blow in play.

“I think they’re using it as a strategy, and the goal was to find him incompetent, which was successful,” says John O’Brien, a forensic psychiatrist and physician, who testified for the prosecution during Snuka’s competency hearing.

Snuka was found not competent* to stand trial. But it sounds as though he exhibited strong signs of dementia, and he died about a year later.

[* NOTE: A lot of people confuse competence to stand trial with the insanity defense. They are different. The latter defense is used in the body of a trial, and involves state of mind as an element of the crime. The former has to do with whether a trial will even take place if the person is found incompetent and therefore unable to stand trial—meaning that he or she lacks the requisite mental capacity or state of mind to understand the charges and/or to cooperate in his/her defense. It’s a tough standard to meet unless the defendant is really far gone.]

The return of Valerie Plame Wilson

The New Neo Posted on by

Valerie Plame Wilson has returned, this time as an anti-Semite.

Here’s what Alan Dershowitz had to say:

Harvard University law professor Alan Dershowitz says this story is “much, much worse” than the media has presented it.

On “Fox & Friends” this morning, he said that the author of the article [that Plame had recommended as “thoughtful”], Philip Giraldi, is a “well-known anti-Semite.”

“In this article, he says that Jews like me or Bill Kristol, when we appear on television, should have on the bottom of the screen identification saying we’re Jews. And he says it’s ‘like a warning label on a bottle of rat poison. Ingest at your own peril,'” Dershowitz said.

Much more on the story here.

And the MSM is playing the role you’d expect:

Imagine, if you will, a conservative tweeting that Jews in America are causing the country’s wars. That person would rightly be denounced by his fellow conservatives and pilloried in the media. But if you’re a progressive media darling, you get a hand-waving pass. This brings us to the way the media covered former CIA analyst Valerie Plame and her long history of anti-Semitic tweets…

The media’s coverage of this story was an epic journo-fail.

McCain (“Lucy”) the maverick strikes again, this time on Obamacare

The New Neo Posted on by

John McCain is an odd duck who infuriates the right. The term he loves for himself is “maverick,” the definition of which is “an independent individual who does not go along with a group or party.”

True to form, he has now indicated he won’t go along with almost all of the other GOP senators in voting for the Obamacare reform bill known as Graham-Cassidy. What’s more, his main reason seems to be that no Democrats support it. From McCain:

We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009. If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do. The issue is too important, and too many lives are at risk, for us to leave the American people guessing from one election to the next whether and how they will acquire health insurance. A bill of this impact requires a bipartisan approach.

Sure, John. And you know what I’d like? I’d like to teach the world to sing in perfect harmony. And I’d also like to buy the world a Coke, and keep it company. And raindrops on roses and whiskers on kittens.

Have I left anything out?

Because the only thing that would make McCain’s dream come true is if the GOP passed a bill that the left likes. Which would make the GOP the left, essentially.

These days politics has become party-line these days, especially on Obamacare. That’s reality.

This is a bizarre act even for the bizarre McCain. It makes one wonder (and I’m saying this in a kindly way rather than a nasty one) if his brain tumor has affected his judgment. I think not, if only because this sort of mavericky, grandstanding, attention-getting, left-pleasing, holier-than-thou, come-let-us-reason-together act is vintage, classic McCain.

The bill had a chance before. Now it hangs by a very slender thread, a thread I believe will be broken.

If it is broken, a lot of people on the right will blame the entire GOP as betrayers. It may even sound the GOP’s death knell. No wonder the left loves John McCain.

Well, the entire GOP is not McCain, and the entire GOP has absolutely no control over him. I suppose you can blame them for that, but I don’t. If anyone is to blame (besides McCain, of course), it’s the people of Arizona who voted in the 2016 Arizona GOP primary for McCain rather than his more conservative challenger. It’s not as though they didn’t know what was coming:

After his [Senate] re-election in 2010, McCain adopted more orthodox conservative stances and attitudes and largely opposed actions of the Obama administration. By 2013, however, he had become a key figure in the Senate for negotiating deals on certain issues in an otherwise partisan environment. By early 2014, McCain’s apostasies were enough that the Arizona Republican Party formally censured him for having what they saw as a liberal record that had been “disastrous and harmful”…Tea Party leaders have said that they are “sick to death” of McCain and will oppose him.

The state of Arizona state law allows independents to vote in the GOP primary, although I don’t know whether that was a factor. During the campaign, McCain made Obamacare repeal the center of his re-election bid:

No doubt when McCain was campaigning against Obamacare during 2016, he thought that repealing it—which he was advocating—would have strong bipartisan support.

Not.

As Lucy said to Charlie Brown:

Were Medevacs in Vietnam armed?

The New Neo Posted on by

In yesterday’s post I mentioned that during 1968-1969 my boyfriend had been a door gunner for a Medevac helicopter. Commenter “Bumsrush” raised an interesting question in response:

I was there 67-68. Huey gunship pilot. Nine months Vietnam, 3 months NKP Thailand…

As for your boyfriend being a Medevac helicopter door gunner”¦ I always thought Medevac helicopters were unarmed. Whether they were or not my hat is off to those guys.

I remember clearly that my boyfriend indeed held that position, and I even have a photo of him with the helicopter, red crosses and all. But still, I wondered. Memory can play tricks on you, and wouldn’t arming such a helicopter violate some sort of rule?

Well, it turns out that these days they’re not armed, which has stirred some controversy (the following is from 2012):

…Due in part to the lack of an armed escort for the medevac chopper, it took medics about an hour to get Clark, who lost an arm and both legs in the explosion, back to the hospital at Kandahar Airfield.

Yon blamed Clark’s death on Army policies, which require the medevac helicopters to prominently display the Red Cross emblem and be unarmed to conform to rules of the Geneva Conventions. Army commanders also require armed escorts for such helicopters, because Afghan insurgents do not honor the rule that protects the aircraft from hostile fire.

The military’s answer can be found here. I’ll summarize it by saying that they feel that arming Medevacs would impede their work by adding too much weight, and anyway such aircraft almost always are accompanied by a second aircraft that is armed.

But what about Vietnam? I found a bit of confusion when I did a search for answers. Here you can find a discussion where some of the people mention having been gunners on Medevac helicopters in Vietnam. But here’s a discussion where some Vietnam veterans say Medevacs were armed and some say they don’t remember that.

And here’s a Vietnam memoir where someone talks about having been a doorgunner on a Medevac.

But I finally found what I think is the definitive word here.

The brave crews of medical evacuation (Medevac) helicopters, commonly known as Dustoffs and Medevacs, were often required to perform heroic feats when evacuating wounded combat troopers. However, there was an important difference between a Dustoff and a Medevac. The 44th Medical Brigade was responsible for Dustoff operations for all the divisions in Vietnam with the notable exception of the 1st Cav Div. The 1st Cav Div had a dedicated Medevac capability directly under their control for very good reasons; faster reaction, crews were familiar with our concept of operating, and it fostered a closer bond with 1st Cav Div crews evacuating their “own” troops.

My boyfriend was in the 1st Cav Div.

Here’s more [emphasis mine]:

The primary evacuation helicopter used by the1st Cav Div was a specially equipped Huey designed to carry three stretcher patients or six walking wounded. A Medevac crew consisted of the Aircraft Commander, Co-Pilot, Crew Chief, Door Gunner and a Medic. During some missions, gunships provided protection for a Medevac. Although most Dustoffs were unarmed, the 1st Cav Div Medevacs carried two M-60 machine guns for defensive purposes only (the Crew Chief manned the other M-60). The Red Cross on a Medevac Huey did not provide them with immunity and many were shot down. Consequently, when we were in desperate need of resupply, they were known to drop off critical supplies and ammo to us, referred to by one pilot as “preventative medicine”.

In response to our request for a Medevac, the pilot would contact us by radio announcing that he was inbound and request that we pop smoke as he approached our location. This triggered an exchange on the correct smoke color as our enemy also tried to mislead Medevac pilots and lure them to other locations with the use of smoke grenades. As we frequently sustained casualties in jungle or mountainous terrain, suitable landing zones were not always available and a hoist system was used to retrieve wounded soldiers from these locations. As the Huey hovered over the jungle pick-up location, the Medic would lower a litter or jungle penetrator (a folded seat with a harness) to the Bravo Company troopers on the ground. The wounded troopers would be strapped into these devices by a qualified person, usually the platoon medic, and hoisted up.

I’m pretty sure that’s the bottom line.

It was an exceptionally dangerous job, and I remember my boyfriend remarking on the high casualty rate.

Kimmel: emotion and health care insurance policy

The New Neo Posted on by

Jimmy Kimmel is a late-night talk show host with an audience of millions. He’s a genial guy who usually steers clear of politics except for the jokes.

But by now you probably know that he’s weighed in heavily on the subject of the reform of Obamacare. And whatever the GOP proposes, he’s against it if it cuts (or even leaves the states to potentially cut) a single thing about Obamacare.

And this despite the fact that, by Kimmel’s own admission, “Health care is complicated, it’s boring. I don’t want to talk about it. The details are confusing.”

I can attest to the fact that Kimmel is correct about how confusing it is, and how complicated. I would add that no one—not even bona fide health care insurance policy wonks—can see into the future and predict exactly what will happen as a result of any bill or program. It’s difficult enough to analyze the effects ex post facto, much less to predict them when a policy is merely some words on paper.

It’s also the case (as anyone who reads a wide variety of supposed experts on the matter will immediately discern) that there is a great deal of disagreement on any new bills’ effects, based mostly on what side of the political aisle a person is coming from.

Fancy that.

Kimmel’s got an emotional investment in the subject, and he’s got the right to speak, however much or little he knows. But why would Americans pay attention to him? And do they?

I don’t know the answers. I’ve not seen a poll that asks respondents, “Is Jimmy Kimmel your go-to guy for explaining health care insurance policy?” My guess is that people are influenced by such things, at least somewhat—as Kimmel himself probably knows, or he wouldn’t be so eager to speak out. The impetus for speaking out is emotional (his son was ill at birth, and it was no doubt a difficult and frightening experience for the new father), and the attraction of listeners to what he says is emotional as well.

The truth is that health care insurance is a deeply emotional issue for most people. Kimmel knows it, you and I know it, and politicians on both sides most assuredly know it. The Democrats have the advantage there, because their message plays to that emotion. The GOP holds the weak hand in the emotional arena, for obvious reasons.

But health care insurance is not only a deeply emotional issue, it’s a very complicated policy issue with many moving parts, and an understanding of those parts requires attention to the details of boring and sometimes legalistic policy and knowledge of math and economics. Not a mix that most people possess, and so the emotional appeals tend to win out with the public.

[NOTE: More here.]

Two Mexico earthquakes

The New Neo Posted on by

The terrible earthquake that occurred on September 19 in Mexico brings to mind the one that happened exactly 32 years—to the day—earlier. The 1985 earthquake had a large death toll, variously estimated to have been between 5,000 and 10,000 people, and over four hundred buildings collapsed.

I certainly hope the recent one doesn’t amass anywhere near that amount of destruction when all is said and done.

I remember the older one so vividly because I had a relative who was in Mexico City at the time, and it took us a while to find out she was okay. But, looking that earthquake up now, I found some information that may be relevant to what has happened there 32 years later.

The key thing is that Mexico City is built on an old lakebed:

Mexico City’s downtown area mostly lies on the silt and volcanic clay sediments of the bed of the historic Lake Texcoco, which are between seven and thirty-seven meters deep and have a high water content. Above this is a layer of sand and above this is a layer of sand and rock. The western and northwestern parts of the city are outside the old lakeshores and are located on sands from eroding volcanic cones that surround the Valley of Mexico. The southern part of the city rests on hardened basalt lava flows. The old lakebed, with its high water content, is easily moved or compressed. The old lakeshore area also has a fairly high water content, allowing movement, though not as much as the lakebed. The old lava flows have little water content or movement in comparison and are therefore stable.

Another factor is that the old lakebed resonates with certain seismic waves and low frequency signals. This lakebed has a natural “pitch” of one cycle every 2.5 seconds making everything built on the bed vibrate at the same frequency. This is the same “pitch” as a number of shallow earthquake waves. This resonance amplifies the effects of the shock waves coming from an earthquake far away.

However, only certain types of structures are vulnerable to this resonance effect. Taller buildings have their own frequencies of vibration. Those that are six to fifteen stories tall also vibrate at the 2.5-second cycle, making them act like tuning forks in the event of an earthquake. The low-frequency waves of an earthquake are amplified by the mud of the lakebed, which in turn, is amplified by the building itself. This causes these buildings to shake more violently than the earthquake proper as the earthquake progresses

I picture the phenomenon as being something like the famous Tacoma Narrows Bridge collapse. In that case it was wind that was the culprit:

After the 1985 Mexico earthquake:

A survey by the government of the damage done found that few buildings from one to five stories suffered serious damage; the same was true for buildings over fifteen stories. When the buildings were built seemed to have an effect as well. Before the 1957 earthquake, there were no building codes with respect to earthquake resistance. Some regulations were passed in that year and more in 1976 after another, stronger earthquake shook the city. However, none of these regulations had an event like 1985’s in mind when passed. Most of the seriously damaged buildings were built between 1957 and 1976, when the city was starting to build upwards, in the six-to-fifteen floor range. In second place were buildings from before 1957, possibly because they were weakened by the earlier earthquakes. Structures built between 1976 and 1985 suffered the least damage…

At the time of the earthquake, Mexico City had one of the most stringent building codes, based on experience gained from earthquakes in 1957 and 1979. However, the codes were not designed for seismic activity of the intensity experienced in 1985. The event was one of the most intense of any recorded in the world, allowing for macroseismic waves to arrive in the Valley of Mexico with unusually high energy content. Prior to the event, estimates about ground movement on the lakebed were generally accepted and a number of buildings were built on these estimates.

This year’s earthquake was of smaller magnitude than the one in 1985. So far, the indication is that fewer buildings have collapsed and although there is much loss of life, it probably will not compare to the 1985 toll (fortunately). But my guess is that the buildings that were affected in Mexico City in 2017 were similar in height and construction years to the ones that encountered the most trouble 32 years ago. Of course, each quake is different (distance from city, depth, magnitude, duration, and probably many other factors), and the resonance pattern might be quite different as well.

Ken Burns’ “The Vietnam War”

The New Neo Posted on by

Have you watched the series so far?

I haven’t. I’ve actually heard good things about it. But I can’t bring myself to watch it. Maybe someday.

I’ve read many books about Vietnam, and countless articles. I’ve written a lot about it, too (I can count that number: 86 posts, and with this one it’ll be 87).

So it’s not as though I’ve ignored Vietnam. But I’ve avoided the series for two reasons. The first is that I don’t want to see something one-sided (although I’ve heard it’s pretty fair). The second is that my own memories of the time are so upsetting, even all these years later. I’ve written a little bit about my story here, but the truth is that the year that my boyfriend was in Vietnam in 1968-1969 as a Medevac helicopter door gunner was one of the most stressful of my life.

The trauma was all emotional for me. After all, it’s not as though I was in any physical danger. But he was. And in those days, the only way to reach a loved one in Vietnam was through letters. No email. No internet. No support groups. I was in college and didn’t know one single person (except me) with a loved one in Vietnam, much less in combat in Vietnam. I felt profoundly alone.

I only spoke to my boyfriend once during that year, when he was on R&R in Australia (or was it New Zealand?). The cost was so exorbitant that we only talked for ten minutes or so. Letters came to me in bunches sometimes, but sometimes there were weeks without them because the mail was very unreliable.

How does this relate to the Ken Burns program? It’s just that I have tremendous difficulty watching any footage of Vietnam. It brings back that year of high anxiety, and the mixed feelings of being drawn to watching the news on TV at the same time I was trying to avoid it. All the soldiers looked like my boyfriend—young and handsome and vulnerable.

I wasn’t a wife. I wasn’t a relative of any kind. But I was a young girl in love and the stress was almost unbearable.

So I’ll skip the visuals this time around.

The latest GOP effort to repeal Obamacare

The New Neo Posted on by

It’s not easy to evaluate each new Obamacare repeal bill as it comes down the pike, for two simple reasons.

The first is that these sorts of bills are inherently complex, and unless we’re in the health care insurance policy business we don’t have the time to read them or the math skills to analyze what their real effects might be. So we (that includes me) tend to leave the evaluation to the “experts.”

The second is, of course, that the “experts” (that is, pundits and politicians and even people in the health care insurance policy field who write about or lecture about such things) are mostly not objective about the topic. Politics and bias is huge here.

So when I read that there’s a new Obamacare repeal effort, I feel a sense of weary deja vu and here-we-go-again. When I look at a page such as today’s memeorandum, my weariness increases.

In the past I’ve spent many an hour trying to sort through all the hype and propaganda, and in the past I’ve found Avik Roy to be the most reliable and objective guide. So I turn to him once again, and I suggest you do so as well.

Roy’s article describes the provisions of the bill and their possible/probable effects, and my take-away from it is that the Graham-Cassidy bill is a case of leaving it to the states rather than the feds to decide what to do with the money the federal government will give it.

First, a little bit about Cassidy, from the article:

Sen. Cassidy is relatively new to Washington, but his star has been rising for some time. Cassidy, an M.D. who specializes in liver diseases like hepatitis, was first elected to Congress in 2008. I first got to know him in 2011, when he emerged as Congress’ leading critic of Medicaid’s poor health outcomes, and as one of the first Republicans to embrace Bill Clinton’s approach to Medicaid reform, called “per-capita caps.”

In 2014, Cassidy ran for the U.S. Senate against incumbent Mary Landrieu, and won in large part because of her vote in favor of Obamacare. Today, Cassidy serves on both of the key health care committees in the Senate…

Now we have what the bill is basically about:

The [previous GOP bill] replaced Obamacare with a system of means-tested tax credits that individuals could use to shop for private coverage that fit their needs. By contrast, Graham-Cassidy gives block grants to states, which states could then use to design the health care system of their choice: left, right, or center.

That sounds very federalist: leave it to the states. If a place like Vermont wants to experiment with single-payer, that’s fine with me.

More:

Given the renewed enthusiasm on the left for the abolition of private health insurance through single-payer systems, there can be little doubt that this is the direction that blue states will take under Graham-Cassidy.

On the other hand, states could also use their block grant funds to create liberalized, lower-cost insurance markets for subsidy-eligible enrollees. Section 106 of the bill specifies that states would have the ability to seek waivers from many of Obamacare’s insurance regulations, including those that force insurers to overcharge the young and the healthy, and those forcing insurers to cover services that enrollees don’t want…

The bill would institute a per-capita allotment for the legacy Medicaid program that is quite similar to the one in the BCRA. This per-capita approach is essential to ensuring that Medicaid is fiscally sustainable in the future. Both bills allow states to institute work requirements for Medicaid.

Please read the whole thing.

It all seems to come down to how much federal regulation you want in terms of requirements, and how much freedom the states ought to have.

Roy’s article doesn’t talk about pre-existing conditions or high-risk pools. But plenty of other writers do, and those on the Democratic side frame the bill as likely to deprive those with pre-existing conditions of coverage or make their coverage unaffordable. Vox offers one of the fairer treatments of the subject:

The new bill has been championed by its sponsors, Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC), as giving states more flexibility in how they run their health care systems. One of those flexibilities includes a waiver system that would let states opt out of many key Obamacare regulations.

Those waivers do have some guardrails. The bill says states cannot tether an individual’s premiums to “sex or membership in a protected class under the Constitution of the United States.”

Anything else ”” a cancer diagnosis, a history of breast cancer, a mild case of asthma ”” is fair game. In states that did pursue and receive these waivers, health plans would have full authority to charge sicker patients higher premiums to offset their costs.

Cassidy argues that his plan would still protect people with preexisting conditions. It requires that any waiver application must include a description of “how the state intends to maintain adequate and affordable health insurance coverage for individuals with preexisting conditions.”

“Knowing that states may want to experiment, we specify that in the waiver request they must have adequate and affordable coverage for those with preexisting conditions,” Cassidy said in a briefing I attended last Friday.

Outside experts, however, question how strong these protections actually are. For one thing, there is no definition in the bill of what counts as “affordable” coverage. This would largely be left up to future bureaucrats in Washington to decide.

So, there are built-in protections, but do we trust them? The conundrum with pre-existing conditions is that once you prohibit insurance companies from charging more for those who have them when they sign up, then you have to charge the rest of the population more. The money has to come from somewhere. What’s more, blanket coverage for pre-existing conditions with no penalty means that the well will tend to wait till they become sick to sign up, and that will tend to increase premiums in the entire system in order to sustain it.

Articles that discuss pre-existing conditions commonly ignore or distort a great many things about insurance and pre-existing conditions. One thing that’s usually ignored is that, even before Obamacare, there was quite a bit of coverage at the state level for pre-existing conditions (I have documented the situation in some depth in this post as well as this one, and I suggest you read them both). In general, there’s a lot of ignorance about health care insurance—including a lack of understanding of the fact that if you have had continuous coverage when you get sick, the issue of pre-existing conditions is moot unless you’ve committed fraud or drop your coverage and have to pick it up again after your illness.

I’m not at all sure this most recent bill will pass. But the rush to do so is connected with the process of reconciliation and the widely-reported September 30 deadline for passing the bill that way (see this for a critique of whether that deadline actually exists or not).

[NOTE: By the way, Jimmy Kimmel (I’m only mentioning him in this context because he’s been speaking out on the pre-existing condition situation re Obamacare and replacement bills) is one of the many people who has no idea how pre-existing conditions used to work in the insurance business.]