Kevin Drum

Health care, in broad outline, is pretty simple. The free market, for obvious reasons, doesn't do universal. It sells stuff only to people who can pay for it. That’s why, for things like roads, national defense, the postal service, and old-age pensions—all of which we’ve decided ought to be available to everyone—we let the government do the job.

So if you want universal health care—or close to it—you have two options:

• Expand Medicaid or Medicare so everyone is covered. This is the simplest solution, but not all that popular.
• Keep private insurance but with changes. Obviously, if you want universal, that means private insurers have to accept anyone who wants coverage. They also have to charge reasonable prices even to those with expensive preexisting conditions, or else it's just a sham. But that means they'll lose money on those expensive patients, so they have to make up for it by charging more to healthy, low-risk customers. Poor people can't afford this, so the government has to subsidize them. And to make sure insurance companies don't game the system by selling stripped down plans, you have to mandate some level of minimum coverage.

There's no way around this. If you want to broaden access to health care, the requirements unfold with geometric logic. In wonkese, it means you need guaranteed issue, community rating, means-tested subsidies, and essential health benefits.

But conservatives don't like this stuff because (a) it costs money and (b) it requires a lot of government regulation. So they always end up ditching one or all of these requirements and retreating to their standard package: high-risk pools, HSAs, tax credits, interstate insurance sales, and “tort reform.” It's a mantra—and it wouldn't work. But who cares? Conservatives don't want to broaden health care in the first place, so it hardly matters if it works. They just want something that sounds plausible.

That explains why J.D. Vance said this on Meet the Press about Donald Trump's "concept of a plan" for health care:

He, of course, does have a plan for how to fix American health care, but a lot of it goes down, Kristen, to deregulating insurance markets, so that people can actually choose a plan that makes sense for them.”

....We want to make sure everybody is covered, but the best way to do that is to actually promote more choice in our health-care system and not have a one-size-fits all approach that puts a lot of the same people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families.

Regulating insurance markets is essential to health care reform. Putting everyone in the same risk pool is essential to health care reform. By placing them on the chopping block Vance is saying Trump doesn't want to make sure everyone is covered—but without actually saying it.

But make no mistake: that's what he's saying. Don't let a little bit of wonkese throw you.

Adjusted for inflation, retail sales and food services declined 1.6% in August at an annualized rate. But despite more than three years of flatness, it's still above its pre-pandemic trend:

In March 2021 there was a sudden spike in retail sales, and that level has been maintained for more than three years. But what happens next?

Exciting news! Next week I'll be starting a new multiple myeloma treatment called Talvey, aka talquetamab. Technically, it's similar to the Carvykti CAR-T treatment I had last year, but instead of targeting the BCMA antigen it targets two receptors called GPRC5D and CD3. Because it targets two things it's called a bispecific. Unlike Carvykti, it's not genetically engineered for each patient.

But that's not the exciting part. Like Carvykti, Talvey has a risk of causing cytokine storms and neurological problems, which means I have to spend a week in the hospital so they can observe me as they ramp up the dosage. Blah. But I'll take my tablet and continue to amuse myself with the blog.

For the record, this is now my eighth treatment for multiple myeloma:

1. Velcade
2. Autologous stem cell transfer
3. Revlimid
4. Darzalex
5. Pomalyst
6. Empliciti
7. Carvykti CAR-T
8. Talvey

There was no change in border crossings in August:

Out of a total of 107,000, about 58,000 were caught trying to cross the border illegally. The rest were asylum seekers who presented themselves at border stations or gave themselves up after crossing between stations.

Over at National Review, Noah Rothman laughingly calls yesterday's wannabe assassin of Donald Trump "a highly impressionable figure radicalized in the support of progressive causes":

That might shock the press, but finding a single Trump supporter who is surprised by Sunday’s news would be a struggle. The political media are constantly on the lookout for right-wing violence; but much of the “sustained spate of political violence” to which Americans have been treated over the course of this election cycle has come not from Trump’s supporters but from his opponents.

Rothman's evidence is largely related to the pro-Palestine demonstrations on college campuses earlier this year. Fair enough, I suppose, although the protesters were considerably more concerned about denouncing "Genocide Joe" than Donald Trump.

But Ryan Wesley Routh didn't "support progressive causes" unless Rothman considers being pro-Ukraine progressive. Aside from that, he was apparently in favor of Obama's Iran deal and distraught by Biden's withdrawal from Afghanistan. He voted for Trump in 2016, Tulsi Gabbard in 2020, and supported Vivek Ramaswamy and Nikki Haley in 2024. This is hardly the portrait of a radicalized progressive.

More to the point, the reason the media spends a lot of time reporting on right-wing violence is because there's a lot of right-wing violence:

During the 2020 election, violent rhetoric on Twitter came overwhelmingly from conservatives:

This is not the 1960s. It's the 21st century. And in the 21st century extreme conservatives are overwhelmingly more violent in both word and deed than liberals. Donald Trump talks of retribution. Laura Loomer wants his Democratic opponents executed. White supremacist groups threaten violence and carry out their threats with dismal regularity. Gun supporters endlessly promise "Second Amendment solutions" toward people they dislike. And polls regularly show that Republicans are far more likely than Democrats to believe violence might be necessary to save America:

Liberals simply aren't the main source of aggressive rhetoric or violent action in the contemporary United States. That's why everyone focuses more on conservative violence: because there's more of it.

It's the same reason the press focuses more on Trump's lies than Kamala Harris's lies: because Trump lies with wild abandon and Harris doesn't. It's got nothing to do with bias, just reality.

This is a Red River hog at the Los Angeles Zoo. The zookeepers have hung a 5-gallon water bottle from the fence and the hog plays with it continually. Basically, he just knocks it around with his snout and seems to get endless joy from it. Kinda strange.

Republicans are chattering once again about imposing work requirements as a condition for receiving Medicaid. The CBO has estimated the effect this would have:

This option would decrease federal spending...about $15 billion per year, on average, because about 2.2 million adults would lose Medicaid coverage. That reduction in enrollment represents a substantial portion of the adults who would be subject to the work requirements.

This represents a cut in Medicaid spending of less than 3%. Aside from symbolism and performative cruelty, what's the point?

According to the Washington Post, here is the partisan lean for all men in the US with names that start with "Ke":

I'm pleased to note that Kevin is the most bipartisan name of the bunch, leaning only slightly Republican.

Oddly, Kenneth is +14 Republican while Kenny is -15 Democratic. Apparently there's something Republican about insisting on using your full name.

Here's a timeless story about the way a widely cited pseudo-statistic managed to worm its way into the discourse. It all starts with a brief funding request 20 years ago that describes the outcome of a program among the Kalinga and Umili peoples in the Philippines:

2004: "From 1990-1996, a total of seven indigenous communities in Kalinga — with 1,071 households or families — were served and have benefited from this SIPAT program.... Because of this project, 81% of regional forest lands were maintained in the Province of Kalinga.  For this reason, the old growth forests remain largely intact in Kalinga and continue to contain rich biodiversity."

This is the original claim: one of the benefits of a single small program in the Philippines was maintenance of most of the forest lands in the area. This was picked up the following year in a World Resources Institute report:

2005: "The combination of watershed protection and good irrigation management raised annual incomes for over 1,000 poor families in seven indigenous communities by an average of 27 percent, all while maintaining over 80 percent of the original high-biodiversity forest cover."

This is an accurate enough paraphrase but highlights the fact that the Kalinga forest is rich in biodiversity. This apparently led a World Bank report to go a good bit further:

2008: "Traditional Indigenous Territories...coincide with areas that hold 80 percent of the planet’s biodiversity."

We've gone from Kalinga lands in the Philippines to all indigenous territory, and from 81% of the forest to 80% of all biodiversity. After that, things took off:

2008-2023: Grist says, "Indigenous land contains 80 percent of the world’s remaining biodiversity." Amnesty International says, "Although they comprise only 6.2% of the world’s population, Indigenous Peoples safeguard 80% of the planet’s biodiversity." One Earth says, "The territories of Indigenous peoples and local communities contain 80% of the world’s remaining biodiversity."

This is all documented in a Nature article that says the bullshit version of this claim is now everywhere:

2024: "Among the 348 documents that we found to include the 80% claim are 186 peer-reviewed journal articles, including some in BioScience, The Lancet Planetary Health and Philosophical Transactions of the Royal Society, and 19 news articles targeted at a specialist audience."

In a classic game of telephone, we went from 81% of regional forest being maintained by the indigenous people of Kalinga to 80% of all biodiversity in the world being maintained by indigenous communities. There's literally nothing to back it up. And just to twist the knife, the authors of the Nature article note that there's no way to measure biodiversity anyway. The 80% thing would be a pointless statistic even if it were based on something. Which it isn't.

What a classic bit of nonsense.

The whole Haitian cat-eating hoax has highlighted one of the most stunning things about the Trump era: whenever Trump makes up a story, even one that's absurd and quickly debunked, his allies immediately start up a desperate attempt to prove that he was right anyway.

In the case of Springfield, we get a picture of some guy, somewhere, carrying a dead goose. We get a stupid video of someone, somewhere, grilling something that's obviously chicken but looks vaguely like a cat. We get viral memes about Trump protecting the nation's cats and dogs. We get stories about Haitians being "dropped" in massive numbers on an unsuspecting Springfield (they came because the town wanted them to fill jobs). We get claims that a Haitian immigrant murdered an 11-year-old boy (it was a traffic accident). We get claims that the Haitians in Springfield are illegal immigrants (they aren't). Or that they were let in by Joe Biden (most have been in the US far longer). In Springfield itself we get death threats and bomb warnings against anyone with dark skin. We get claims of a huge surge in crime based on misunderstanding the FBI figures. We get claims that Haitians all have low IQs and have turned Springfield into the third world. We get J.D. Vance finally just admitting that "If I have to create stories so that the American media actually pays attention to the suffering of the American people, then that’s what I’m going to do."

None of this stuff is remotely true, but Trump's fans live in a universe where everything he says has to be true, by definition. Even if it obviously isn't, they spring into action on talk radio, on Fox News, on social media, and elsewhere to flood the discourse with bizarre nonsense meant to show that Trump was right in a "deep" sense even if he wasn't right in an actual sense. It's scary.