Drawing Contrasts

Mind you, I've never been a Biden fan. There's just too much about the guy that rubs me the wrong way.

That said, he's a good and decent man - capable and competent - and I have to give him props where it's due.

Here's one:

He took a 10-hour train trip across a country at war, and entered Kyiv when it was under almost daily missile attack. Then he took that same train 10 hours back, and he did all that without benefit of air cover, or a Special Ops unit to look after him.

So he's not my favorite hero, but at least he didn't hide in a fucking beverage cart, leaving dozens of press and crew and staffers to serve as decoys while he tucked tail and ran.

Fuck that Trump guy.

It's Jesus?

Christina

Lying Liars

The Trump gang just makes shit up.

Medicaid work requirements built on invented evidence will harm the people they claim to help

The Centers for Medicare and Medicaid Services (CMS) has issued a new Interim Final Rule with comment period (IFC) implementing the Medicaid “community engagement” requirements included in H.R. 1. The IFC is fundamentally defective in both its substance and its analysis.

With respect to the analysis justifying the rule, the agency’s mandated Regulatory Impact Analysis (RIA) does not conform to the standards required of such analyses, as stipulated in Executive Order 12866 and the Office of Management and Budget (OMB) Circular A-4. It substitutes unsupported assumptions for the best available empirical evidence, counts speculative benefits while omitting well-documented costs, and produces estimates of coverage loss and federal savings that are inconsistent. With respect to the substance of the rule, CMS has added conditions, not required under the statute, that will make it even more difficult than the statute intended for people with mental illnesses and substance use disorders to retain coverage.

These are not technical shortcomings. This rule will determine whether millions of low-income Americans retain health insurance.

H.R. 1 requires certain Medicaid beneficiaries to document 80 hours a month of work or other qualifying activities to retain their eligibility for Medicaid. This IFC sets forth the rules defining which beneficiaries will and will not be exempt from this “community engagement” requirement. Under Executive Order 12866, economically significant regulatory actions, such as this IFC, must be accompanied by an RIA that assesses the costs and benefits of the action. In this case, the key parameter that will drive the costs and benefits of the regulatory action is how many people will become employed or otherwise community-engaged under the threat of losing Medicaid coverage. OMB requires agencies to base regulatory analyses on the best reasonably obtainable scientific, technical, and economic information. CMS acknowledges that it does not estimate this key behavioral response parameter from any such information. Instead, it assigns subjective weights to hypothetical scenarios. In its assessments of costs and benefits, CMS simply assumes that roughly one-third of affected beneficiaries will move into qualifying activities because of the requirement.

That assumption is wildly out of line with a substantial body of empirical evidence. Three distinct, robust lines of research, all consistent with one another, could have been used to estimate the likely impact of the requirement. First, studies of welfare-to-work programs, which condition receipt of cash benefits on employment, generally find small employment effects, with effects of under 5% even in scenarios where the work requirements in the programs are accompanied by childcare, transportation assistance, case management, and other supports—no such supports are included in the Medicaid rule. Second, studies of the Affordable Care Act’s Medicaid expansion—the converse of the new work requirements—find that gaining Medicaid has little or no effect on employment, implying that withdrawing coverage is unlikely to produce a substantial increase in engagement. Finally, studies of recent work requirements in the Supplemental Nutrition Assistance Program (SNAP) and Medicaid—including Arkansas’s Medicaid work requirements waiver—have found substantial coverage losses but no measurable increase in employment.

CMS’ assumption that one-third of those subject to the work requirement will become community-engaged is over six times greater than the largest estimate in any of these literatures. That assumption is an invention from which the agency mechanically generates its estimates of employment, earnings, costs, benefits, and government savings.

Because those estimates carry through the entire analysis, they generate further inconsistencies and distortions. The one-third engagement estimate leads CMS to predict that only about 3.1 million to 3.3 million people will lose Medicaid coverage annually. By contrast, the Congressional Budget Office (CBO) estimated that the statutory work requirement would reduce Medicaid enrollment by approximately 5.7 million people. Yet despite this much smaller headcount, CMS simultaneously projects approximately $350 billion in federal savings over 10 years—10% more than CBO’s estimate of $317 billion.

These figures are difficult to reconcile. If CMS expects fewer people to lose coverage but more money to be saved, it must implicitly assume that those losing coverage are dramatically more expensive than the beneficiaries reflected in CBO’s calculation. CMS’s numbers appear to imply average federal Medicaid spending of roughly $11,000 for each disenrolled person, compared with about $5,600 in CBO’s estimate.1 But Medicaid spending is highly concentrated. Many of the most expensive beneficiaries have serious health conditions that should qualify them for exemptions or temporary hardship protections. CMS does not adequately explain how its relatively small group of projected disenrollees can generate such large savings.

The implausible engagement assumption shows up again in the agency’s claims about the IFC’s benefits. Here, the agency claims that those shifted to engagement through the work requirement will become healthier from being induced into employment. The research basis CMS cites for the assumption that work makes you healthy is entirely based on associational studies of the health of workers and non-workers.

Healthier people are more likely to work. Poor health makes it harder to obtain and retain employment. Education, family resources, housing stability, and other factors affect both employment and health. Studies showing that employed people are healthier than unemployed people in no way establish that requiring a Medicaid beneficiary to work will make that person healthier. Indeed, the limited causal research, which relies on changes in retirement rules and other sources of plausibly exogenous variation, has produced mixed results: some studies find benefits from continued work, while others find that working harms health (for example, by increasing the risk of workplace injuries). There is no credible basis for assigning large health benefits to the hypothetical employment increases assumed to be generated by this rule.

At the same time, CMS largely omits the strongest causal evidence in this area: Medicaid coverage improves access to care, financial security, and health. Randomized and quasi-experimental studies have linked insurance coverage to improved treatment and, in several very credible studies, lower mortality. Other research shows that, at least for some populations, access to effective treatment can improve employment. Randomized studies of depression care, for example, have found increases in job retention, hours worked, and employment.

In other words, health coverage keeps people healthy and may help people work. Taking coverage away has direct harms and may make employment less likely. CMS’s analysis largely reverses this relationship: it assumes that work produces health while ignoring the possibility that health care produces both work and health.

The rule is especially poorly designed for people with mental illnesses and substance use disorders.

In the original statute, Congress provided exemptions for people with qualifying behavioral health conditions. CMS, however, would require many individuals to demonstrate not merely that they have a qualifying diagnosis, but that the condition significantly impairs their ability to comply with the work requirement.

Standard administrative reporting, such as medical claims, does not contain information on functional ability. That means that meeting the exemption will require a new miniature disability determination. States and clinicians will have to assess functional capacity, collect documentation, and decide whether a particular condition prevents compliance with 80 hours of monthly activities. States conduct such capacity determinations in conjunction with Social Security disability determinations; a costly, challenging process that provides applicants with important procedural protections (but nonetheless makes consequential errors).

Requiring such functional status determinations for people with mental illnesses and substance use disorders is particularly damaging because these conditions can impair memory, concentration, planning, and motivation. People with these conditions are likely to find it particularly difficult to navigate bureaucratic systems. The people most impaired may be those least able to prove that impairment.

The functional status criteria also fail to account for the fact that behavioral health conditions are chronic and recurring. A person with opioid use disorder, schizophrenia, bipolar disorder, or recurrent major depression may be stable enough to work for one month, experience a relapse the next, miss a reporting deadline, and lose the Medicaid coverage financing the treatment that helped maintain stability and employment. Current functioning while under treatment is not proof that an exemption is unnecessary. It may instead be evidence that treatment is working.

The statute particularly called for an exemption for those participating in substance use treatment programs. The CMS rule places very restrictive conditions on what participation means. In particular, it limits the exemption to care provided by nonprofit providers. However, nearly half of people receiving substance use treatment are served by for-profit organizations, and the share is particularly high among opioid treatment programs providing methadone. That means that patients receiving substance abuse treatment could lose exemption from work requirements because the providers who happen to be available in their communities are for-profit. That will be particularly damaging in rural areas and other places with thin treatment networks.

The IFC is defective in its substance and its design. A defensible Regulatory Impact Analysis would use the following information:

• The extensive causal literature to estimate employment effects,
• Quantify the health consequences of coverage loss, and
• Reconcile its enrollment estimates with its claimed federal savings.

A defensible rule under the statute would:

• Automatically identify behavioral health exemptions using claims, pharmacy, managed-care, and behavioral health agency data;
• Accept attestations from clinicians, case managers, and treatment programs;
• Recognize relapse and fluctuating functioning; and
• Provide rapid reinstatement when illness contributes to noncompliance.
• Instead, CMS’s analysis assumes away the central empirical question, inflates speculative benefits, omits documented harms, and then adds administrative barriers that are likely to exclude precisely the people Congress intended to protect.

Daniella

Radicalization By Algorithm works both ways.

• Viewers get roped into a certain strain of content when they hit the 'Like' and 'Share' buttons
• Creators get roped in by gradually altering their content, tailoring it to attract more of those Likes and Shares

Hawk

A concentration camp by any other name still stinks of fascism.

Amanda On Tuesday

Trump is now 0-fer-23.

Dogs Know

This Is The Plutocracy

Today's Word

Today's Pissed Off Woman

The people up at the front - whether "the front" is a war zone or a workplace or a classroom - the people doing the work and taking the risks are telling us things are pretty fucked up, and I'm not hearing much agreement, or seeing practically any action at all, coming from the higher-ups.

What the fuck are we doing?

What They're Selling

The pretense of expertise will never prevail. But we have to pay attention.

Erika Jordan

" ... dressed like a coupon, but acting like a ransom note."

Changes

I knew a retired Army 4-star. He said most members of the military voted Republican because they gave the DOD big budgets, and hardly used them for anything, while the Democrats kept wanting to cut their budget, and use them for every stupid thing that came along. That started to change with Iraq, and 2 cycles later, he voted for Hillary.

That culture changes slowly, but for several years before he died, he couldn't hear "Trump" or "GOP" without muttering, "Those fuckin' jerks".

The good and honorable ones know that while politics is a factor, their oath is what counts. And they're not stupid - they know when leadership is totally FUBAR, and they know they can vote to change it.

This is NOT the typical fun one, but it needs to be said... military members, and those who claim to "support our troops, need to start taking a close hard look at how they vote.
by u/JMaryland47 in LeopardsAteMyFace

A.I. Nonsense

Have Buck, Will Pass

The buck stops somewhere else: A look at Trump’s tendency to avoid blame when things go awry

WASHINGTON (AP) — It is among the most famous phrases in presidential history: “The buck stops here.” Except with President Donald Trump, it almost never does.

Concerns about a weak economy and still-high inflation? His predecessor, Joe Biden, saddled him with that, he says, even though the Democrat has been out of office for 18-plus months and despite Trump once promising an immediate turnaround.

The problem-plagued revamp of the Lincoln Memorial Reflecting Pool? That was marred by vandalism, the Republican president insists, even though the office of a prosecutor he put in the job has said the damage was due to shoddy workmanship.

The increasingly unpopular war in Iran that has kept oil prices high, Trump’s approval rating low and sent shock waves through the global economy? Actually, this was Trump making up for timid earlier presidents who, he argues, squandered nearly 50 years of opportunities to curb Tehran’s nuclear ambitions.

Pithy slogans aside, all modern presidents shift responsibility onto others to some degree, frequently blaming the commander-in-chief who preceded them, Congress — or both. But Trump has taken it to a new level, effectively embracing a de facto political strategy of being in charge of everything but responsible for nothing when things go badly.

“Taking responsibility being a characteristic of presidential leadership — or any kind of leadership — is absolutely true,” said Nicole Anslover, a history professor at Florida Atlantic University and author of “Harry S. Truman: The Coming of the Cold War.”

Trump’s tendency to point fingers at others is increasingly in the spotlight before November’s midterm elections, when Republicans are trying to retain control of Congress. His unwillingness to accept blame sometimes leads him to deny that there are problems at all, and could leave GOP leaders in tight races with little reassurance for voters that their concerns are being addressed.

The White House counters that Trump is working to correct long-festering challenges, not simply throwing up his hands and ignoring them.

The president is “rightfully addressing the failures of his predecessors while taking action to deliver big wins for the American people,” spokesperson Taylor Rogers said, pointing to a series of policies that she said Republicans can run on, including tax cuts, efforts to lower prescription drug prices, cracking down on immigration and the U.S.-Mexico border, increasing domestic energy production and a strong stock market.

Ducking responsibility dates to Trump’s first term

Truman famously kept a “The Buck Stops Here” sign on his desk as president. That came from “pass the buck,” which, according to Truman’s presidential library, dates to frontier times, when poker players would pass a buckhorn handle knife to the person whose turn it was to deal the cards.

“The president, whoever he is, has to decide,” Truman said during his farewell address in 1953. “He can’t pass the buck to anybody. No one else can do the deciding for him. That’s his job.”

The understanding of the phrase has broadened over the years to include taking responsibility for the outcome of tough decisions. Trump used to espouse similar beliefs, saying back in 2013 that in running a business, “Whatever happens, you’re responsible. If it doesn’t happen, you’re responsible.”

Accepting the 2016 presidential nomination, Trump said, “Nobody knows the system better than me, which is why I alone can fix it.” But as president, he has often suggested that the solution and blame rest elsewhere.

“The buck stops with everybody,” Trump said in 2019, during a lengthy government shutdown. In 2020, on the same day he declared the coronavirus pandemic a national emergency, he said, “I don’t take responsibility at all” for a lack of COVID-19 testing.

Anslover said Truman took full responsibility for dropping atomic bombs on Japan even though he was not informed that the U.S. was developing such weapons until his predecessor, Franklin Delano Roosevelt, died.

John F. Kennedy saw his approval ratings rise after he acknowledged he was to blame for the failed Bay of Pigs invasion in Cuba. Ronald Reagan said he was sorry for any involvement he may have had in the Iran-Contra scandal even while saying he wasn’t sure he was to blame. “The buck stops here with me,” he said then.

At his final news conference in early 2009, George W. Bush listed a series of mistakes he had made, including failing to find weapons of mass destruction in Iraq. His successor, Barack Obama, said, “I screwed up,” after his nominee for health chief, Tom Daschle, withdrew because of unpaid back taxes.

Presidents before Trump “really usually take accountability,” Anslover said.

‘We inherited a total catastrophe,’ Trump says

The president acknowledged in a recent Punchbowl interview that voters are angry, but he said they are not mad at him but at congressional Republicans.

Trump believes his party can hold its congressional majorities after November, but he was clear that if Republicans lose, it won’t be his fault — echoing his comments before the 2018 midterms that he would not accept blame if his party lost control of the House, which it did.

Trump’s approval rating on the economy, once seen as among his strongest issues, has fallen throughout his time in office, from 40% in March 2025 to 32% in July, according to Associated Press-NORC Center for Public Affairs Research polling. About 6 in 10 U.S. adults say Trump’s economic policies have made economic conditions worse, according to Pew Research Center polling.

“The public certainly expects the president to be concerned about, and focused on, making life more affordable,” Republican pollster Frank Luntz said.

Trump instead points to Biden, under whom inflation hit a four-decade peak of 9.1% in 2022 as the pandemic was still roiling the world economy, before declining to 2.7% by November 2024. Last month, pressured by the Iran war, it was 3.4%.

“When we took office, we inherited a total catastrophe,” Trump said at a recent rally, later adding, “I inherited those high prices, just so you understand.”

Andrew Bates, a Democratic strategist and former Biden White House spokesperson, noted that Trump no longer mentions his campaign promise to “immediately end inflation” on Day One.

“He may not remember having made those promises, but swing voters sure as hell do,” Bates said.

Trump has shown the same pattern with Iran and the Reflecting Pool

The president has characterized the Iran war as “a little excursion” or “detour.” To play down how long it has lasted, he frequently notes that U.S. wars in Vietnam and Afghanistan dragged on for years, though the Iran conflict — which he initially said would be over in four weeks to five weeks — is now in its sixth month with no clear end in sight.

Trump has sought to shift blame to the past on the Reflecting Pool, falsely suggesting that Biden and Obama spent “hundreds of millions of dollars” trying unsuccessfully to fix it.

But Trump’s main defense has been vandalism. And, so far, at least four cases alleging that, including the most prominent case against an Olympic canoeist, have been dropped because of a lack of evidence.

Anslover said that, after 11-plus years in politics, Trump has proved he is not afraid to violate norms of presidential comportment. Lots of his core supporters do not seem bothered.

“For many Americans, it has either been a shift in how they view the presidency, or, like with so many things, they just feel empowered to say, ‘These are my priorities. My priority is not the facts,’” she said.

Reality's A Bitch

Little by little, and one by one,

the Red Hats are realizing

they've been left on the Bait Plane too.

Give Her Hell

202-224-3121

The Right To Resist

The right to resist is a nearly universally acknowledged human right, although its scope and content are controversial. The right to resist, depending on how it is defined, can take the form of civil disobedience or armed resistance against a tyrannical government or foreign occupation; whether it also extends to non-tyrannical governments is disputed. Although the distinguished jurist Hersch Lauterpacht called the right to resist the supreme human right, this right's position in international human rights law is tenuous and rarely discussed. Forty-two countries explicitly recognize a constitutional right to resist, as does the African Charter on Human and Peoples' Rights.

The Lincoln

I had the extraordinary privilege of making a sales call aboard the USS Lincoln just before her first commissioned shakedown cruise in 1989.

I wasn't allowed to see the whole thing, but what I saw - and who I talked with - impressed the shit outa me. And not because I was some wide-eyed puppy. It was because the people in the US military back then were pretty fuckin' impressive. They all knew the mission, they all knew what they were doing, and they all had an air of quiet confidence, and a real pride of service.

Trump and Hegseth will never be forgiven.

I know carrots when I see them,

but what the fuck is that other shit?

Trump's callous response as US sailors throw themselves overboard in Iran war and grim photos of food emerge

Donald Trump brushed aside mounting alarm over conditions aboard the USS Abraham Lincoln, even as accounts pile up of desperate sailors trying to go overboard during a record-shattering Iran war deployment.

The Lincoln and its more than 5,000 servicemen have spent more than 250 days at sea since leaving San Diego last November, diverted to support the war with Iran.

Navy families have described collapsing morale and suicidal ideation on the ship, with one sailor's wife telling Navy Times her severely burned-out husband attempted to jump overboard.

On August 3, a sailor assigned to the carrier's air wing went into rough seas wearing a life vest in what the Navy deemed a mental health episode, according to CNN. He was pulled from the water by a search and rescue helicopter within the hour.

Confronted with the fears of military families over conditions on the carrier, the President flatly denied those fears existed: 'Well, no, that ship is moving. No, they're not.'

'That ship is moving right now, or very shortly, and it's being replaced with another very similar ship,' Trump added. The USS George Washington warship is now steaming toward the Middle East to relieve the Lincoln in a swap officials insist was already planned.

Asked whether the deployment had simply gone on too long, the president shot back: 'No. Not nearly long enough.'

Since the start of Trump's war, reports have surfaced of food shortages and rationing aboard the Lincoln, accompanied by grim images of sailors' meals.

Donald Trump brushed aside mounting alarm over conditions aboard the USS Abraham Lincoln, even as accounts pile up of desperate sailors trying to go overboard during a record-shattering Iran war deployment

The Lincoln and its more than 5,000 sailors and Marines have spent over 250 days at sea

Asked whether the deployment had simply gone on too long, the President shot back: 'No. Not nearly long enough'

Anxious family members also vented their anger to Navy leaders in San Diego last Thursday, according to Stars and Stripes.

One spouse reportedly said conditions aboard were so bad that her husband texted her saying, 'he hopes he doesn't wake up tomorrow.'

Another woman accused naval officials of breaking the 'trust between us and the leadership' by failing to be more transparent about their loved ones' living conditions.

Democratic Senator Richard Blumenthal and other lawmakers are demanding answers from Pentagon chief Pete Hegseth.

Lawmakers want a bipartisan congressional visit to the ship, while Hegseth has waved off the reporting as a complete mischaracterization.

'Listen, we make sure that every ship, every crew, every captain has everything we can provide them at every single moment,' Hegseth told Newsmax on Thursday.

Eighteen US service members have died in Iranian strikes across the region since the war began in February, with hundreds more wounded.

US Central Command has pushed back hard, calling the reports of dire conditions aboard the carrier 'false' and insisting its crews 'remain resilient and resolved.'

Retired Vice Admiral Robert Murrett, now a professor at Syracuse University, told Newsweek that extended Navy deployments can certainly lead to an increase in mental health challenges.

Most carrier deployments run about six months with port calls along the way to refuel and let crews rest on land.

The military should launch an independent review
Amid these alleged conditions, the wife of the sailor who jumped off the aircraft carrier told MSNow that she was kept in the dark about what happened.


She said her husband was in the water for an hour before he was rescued from what she described as a suicide attempt.

'I think that it was handled very poorly because they didn't inform me and they didn't want me to know, and they're just trying to cover this up,' she said.

She shared her last text with her husband on July 21, in which he said life on the ship was getting to him.

'I'm really trying to not feel negative or hopeless but between the wifi and not knowing when I will come home and not knowing what is happening back at home, it's really getting me,' he wrote in the message, noting that he had been due to leave on July 15 but the plan was canceled.

'I don't think I can do another deployment after this and i don't even know if i can finish this deployment,' the sailor added.