A second Trump term would almost certainly be “Trumpier†than the first. For much of his first term, Mr. Trump surrounded himself with well-known conservative foreign-policy figures and senior military leaders, often deferring to their advice. More experienced, more confident in his own judgment and less deferential to others’ expertise, Mr. Trump likely will fill senior positions with people who reflect rather than challenge his instincts and priorities.
There will be resistance from inside the government, but this time around it won’t come from senior officials, only from career civil servants in the Pentagon, State Department and the Treasury, aided by allies in the intelligence world. Expect explosive leaks, bureaucratic slow-walking and a permanent state of trench warfare in the government machine.
suggesting he’s likely to drive a wedge between the U. S. and our NATO allies, focus more closely on the Western hemisphere (immigration in particular, and devote less attention to climate change.
This is not because people haven’t tried hard enough. Obamacare contained a lot of elements that were expected to realize significant cost savings while actually improving the quality of care.
Among the strategies considered was innovations in preventive care. Despite the considerable sums of money spent that hasn’t been effective:
Preventive care turned out to cost more than it saved, in part because doctors may need to treat a lot of minor conditions to prevent one serious health crisis.
Here are some of the other missteps:
Expanding the number of insured turns out to make emergency room visits rise, not fall, because newly insured people worry less about the cost. A program to reduce hospital readmissions among Medicare patients may have killed thousands, as hospitals tried to avoid admitting patients who might trigger a readmission penalty. A plan to promote new insurance co-ops, a kind of voluntary public option, saw almost all of them fail within six years.
BTW declines in life expectancy are not due to COVID-19: Source
unless COVID-19 is a time traveller since the decline began in 2014.
She concludes that controlling healthcare costs is politically impossible:
It’s not that we don’t know ways to save money. The system could be run more efficiently by reducing slack, but this would make people wait longer for many tests and treatments, as Canadians and Brits do. Doctor salaries, which averaged $316,000 in 2021, could be trimmed to the levels of German doctors ($183,000) or those in Britain ($138,000). The government could mandate lower drug prices, which would result in Americans losing access to medicines that aren’t worth making at the mandated price, as well as many that aren’t yet developed.
The problem is that these savings aren’t free. Nor are many other potential savings that space prevents me from naming, and that you are perhaps even now preparing to shoot me an email about.
The savings come attached to significant other costs, making them too politically expensive to contemplate. Try to cut doctors’ salaries almost in half, and they will freak out. Tell everyone else that they can’t have the fancy new drug they just read about, or that they have to wait half a year to see a specialist, and they will freak out, too. Politicians know this and won’t take the risk.
Sadly, that dodges the question: can healthcare costs continue to rise? Increasing healthcare spending was one thing when, as in 1960, we devoted 5% of GDP to it. Spending 20% of GDP on it is a different matter.
Putin is desperately grasping at the final two things that can save him – time and the splitting of the international community. Britain can do something about both. We must help Ukraine maintain its momentum – and that will require more munitions, ATACMSs and Storm Shadows. And the best way to keep the international community together is the demonstration of success.
Ukraine can also play its part. The average age of the soldiers at the front is over 40. I understand President Zelensky’s desire to preserve the young for the future, but the fact is that Russia is mobilising the whole country by stealth. Putin knows a pause will hand him time to build a new army. So just as Britain did in 1939 and 1941, perhaps it is time to reassess the scale of Ukraine’s mobilisation.
I have no idea how he would know that, whether that’s accurate, or what it implies. I also have no idea how fit a 40 year old Ukrainian is.
For comparison the average age of U. S. soldiers in Europe in 1945 is estimated at 26.
Even now, the peace Putin wants would leave Ukraine indefensible and dismembered. So unless the US opts for disengagement — tantamount to Ukrainian defeat — it needs to start addressing the problems a longer war will confront.
The first involves assessing, and perhaps adapting, military strategy. Ukraine’s current offensive initially struggled because the country sought to mimic Western tactics without the advantages, such as air superiority, Western militaries have come to expect.
The US and its allies need to start equipping Ukraine now for operations in 2024 and after. The question is whether they should be preparing Ukraine for a similar offensive next year, or perhaps helping it employ a more familiar, if less ambitious, strategy of attrition. This would involve localized offensives combined with ramping up long-range strikes meant to sever Russia’s supply lines and gradually make its military position unsustainable.
Second, a longer war may require accepting higher risks of escalation. At the outset, Washington stepped across Putin’s red lines gingerly. More recently, the US has committed to provide sophisticated capabilities such as Abrams tanks and F-16 fighter jets.
These commitments are meant to show that Putin can’t simply outwait the West. But if a new theory of victory involves coercing, rather than directly evicting, Russian forces, Ukraine will need longer-range ATACMS missiles and other systems to vastly increase the pain it inflicts by targeting Putin’s forces wherever they occupy Ukrainian soil.
Third, Washington must tighten the economic squeeze. Sanctions have injured but not crippled Putin’s economy, which continues to churn out weapons for the war. The Treasury and State Departments are already cracking down on sanctions evasion, with the announcement last week of further penalties on 150 individuals and entities. The next step might be lowering the price cap the Group of 7 imposed on Russian oil sales, to reduce Putin’s revenue without throwing global energy markets into chaos.
Fourth, Washington must prevent a long war from becoming a source of weakness and distraction. The record to date is encouraging: Since February 2022, the US has dialed up production of artillery shells and other weapons, while expanding and strengthening its global alliance network.
There are several points missing from Mr. Brands’s outline. Most critical is who will be fighting the war in Ukraine? We don’t actually know what Ukraine’s casualty rate has been. We can assume that the figures we’re receiving from both the Ukrainian and Russian governments are lies. Is the plan to add NATO regulars in addition to the irregulars who are already fighting? How can that be accomplished without the conflict turning into a nuclear exchange?
At this point Ukraine is using the annual U. S. production of artillery shells in a matter of days. In order to supply Ukraine with the munitions it needs to fight a long war of attrition, we will need to produce many more faster and to do that we must increase our base of heavy industry and the high-density energy that requires. We can support Ukraine or decarbonize our economy. We cannot do both.
Economic forecasters provide useful information about the future state of the economy. But making predictions is hard, especially about the (distant) future. Even though forecasts can help, we must live with significant uncertainty about future economic conditions.
The TL;DR version of the piece is that although economists are pretty good at telling whether we’re in a recession now the precision of their forecasts decreases rapidly the farther in the future they’re projecting. When we say “future” we’re talking about quarters, 90 day periods, not years.
The numbers paint a picture of small, positive productivity gains for hybrid work. The savings in commuting time more than offset the losses in connectivity from fewer office days. In contrast, the impact of fully remote working on productivity is typically mildly negative. Fully remote workers can struggle with mentoring, innovation and culture building. However, it appears this can be reversed with good management. Running remote teams is hard but done well can deliver strong performance.
But this is about more than just worker output. Firms care about profits — not productivity.
Working from home massively reduces overhead. It drives down recruitment and retention costs, as employees value working from home. Fully remote companies also slash office costs, and cut wages bills by enabling national or global hiring. Indeed, the widespread adoption of working from home has been a triumph of capitalism. Higher profits have led millions of firms to adopt this, generating the five-fold increase in home working many of us now enjoy.
It’s hidden a bit but that “global hiring” aside is important. I am presently leading a team of about 20 people. I’m the only one in the United States. The rest are in India, Ukraine, Serbia, and Mexico. The cost of paying that team is significantly lower than paying a comparable team comes into the office every day. The trick is in “comparable”. IMO the productivity of the team is not comparable to a completely local, stateside team on a head to head basis.
I actually think the issue is more complex than Mr. Bloom realizes and than the way it is usually presented. I think that WFH works for the people for whom it works and for the jobs for which it works. I can’t tell you who those people or what those jobs are but it isn’t everyone or everything. I can tell you some of the qualities the people for whom WFH works must possess. They must be self-starters, conscientious, and focused as a start. I could be wrong but I think that fewer and fewer people have those qualities.
Speaking of strikes and Kaiser, at The Hill Miranda Nazzaro reports on the imminent strike of Kaiser-Permanente by 75,000 of its employees:
The Coalition of Kaiser Permanente Unions, which represents over 85,000 health care workers in seven states and the District of Columbia, said Sunday it did not reach an agreement with the organization ahead of the contract’s expiration, setting the stage for the possibility of the largest health care strike in U.S. history late this week.
Hours before workers’ contracts were set to expire after 11:59 p.m. PT on Saturday, the coalition said it remains far apart from nonprofit Kaiser Permanente on important issues like across-the-board pay increases, retiree medical plans and protections against subcontracting and outsourcing.
“Kaiser continues to bargain in bad faith over these issues and, so far, there is no light at the end of the tunnel,†the coalition said in a statement Saturday night.
Very nearly every criticism you might make of the Big Three automakers is true of Kaiser-Permanente in spades. For example, CEO pay is around $15 million at a company half the size of Ford. Kaiser is more profitable than Ford, too, when you compare apples to apples, difficult when comparing a notionally not for profit organization with a for profit one.
Today marks the 10th anniversary of the opening of the Affordable Care Act’s portal, Healthcare.gov. Ignoring the disastrous first few days, as good an illustration of the federal government’s shortcomings in managing technology as any, how would we evaluate the success of the Affordable Care Act (ACA)?
Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax creditsâ€) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
Expand the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs.
Support innovative medical care delivery methods designed to lower the costs of health care generally.
Since 2012 the percentage of Americans with some form of healthcare insurance has increased from 84.6% to 92.1%. The percentage of people covered by Medicaid has increased from about 12% to 18.8%. However, according to Peterson-KFF per capita spending on health care has increased from $3,152.30 in 2012 to $4,255.10 in 2021 (in constant 2021 dollars). On that basis I think we should consider the ACA a qualified success. That can be explained a variety of ways but most of those ways were known in 2012 and the opposite was claimed. The bottom line is that costs have increased while life expectancy has decreased.
Where to go from here? Will we be able to continue spending a greater percentage of the national income on healthcare indefinitely? It seems unlikely that covering the remaining 8% of people under Medicaid will reduce costs. Will it increase life expectancy?
One of the key provisions that the Writers Guild of America secured was a minimum staffing level guarantee. Exempt from that are shows in which all episodes are written by a single writer.
Will the provision:
Improve the quality of scripted shows
Reduce the quality of scripted shows
Both (improve some; reduce others)
Have no effect
I think that scripts written by focus groups or committees other than sitcoms become worse the more writers are involved in the process. Option D would be an indictment of writers 9in general.
I should add that otherwise I have no problem with what the WGA achieved.
Unlike unemployment, inflation does affect everyone. But what matters to working people is not the monthly or yearly price change taken alone. What matters is the effect on purchasing power and living standards over time. Whether these are rising or falling depends on the relationship of prices to wages. When wage growth exceeds price increases, times are generally good. When it doesn’t, they aren’t.
It is here that Biden has a problem. During his presidency, living standards have not risen. From early 2021 to mid-2023, prices have increased more than wages, implying that real (inflation-adjusted) hourly wages and real weekly earnings have fallen, on average. Not by much, but they have fallen. Worse, the average figure probably masks a larger fall, in real terms, for families that started out below the average. And given how income distributions work, there are always many more families earning less than the average than there are who earn more.
The only strategy working people have to pay their bills is to take on extra work and a lot of them are. The number might be as many as 10% of American workers. Telling them they should be happy about that is probably not a winning political strategy.
