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)?

According to the Department of Health and Human Services (HHS), the objectives of the ACA are:

• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) 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:

1. Improve the quality of scripted shows
2. Reduce the quality of scripted shows
3. Both (improve some; reduce others)
4. 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.

The problem with Bidenomics is summed up pretty well by economist James K. Galbraith in a piece at Project Syndicate:

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.

I’m a sucker for taxonomies and this one of foreign policy views by Ash Jain at Foreign Policy is no exception. Mr. Jain divides the spectrum of foreign policy thought into six “camps”:

I found his “camps” a bit jumbled—he probably needs more than one axis rather than just the internationalist to non-internationalist one. Is it actually possible to be “unilateral” and “internationalist” simultaneously? Similarly, are realists internationalists at all? Furthermore, I think that ascribing any policy to Donald Trump is a stretch. I think he is much more transactional than that. His classification of the late John McCain as a “democratic internationalist” ignores his stated views on American greatness. I think that any taxonomy of American foreign policy views that places John F. Kennedy, John McCain, Ronald Reagan, and Joe Biden in the same “camp” is puzzling.

For one thing I would place “multilateral” at one end of the spectrum and “unilateral” at the opposite end.

If I had to place myself into a “camp”, it would be realist. Here’s how he describes it:

• View great-power rivalry as inevitable in the global system and support U.S. alliances and active efforts to deter rival powers and maintain global order
• Are willing to engage adversaries and work with all nations, regardless of regime type, to advance strategic objectives
• Are prepared to make mutual accommodations with rivals, or seek to divide them, to achieve a stable balance of power
• Are inclined to “accept the world as it is” and are wary of U.S. intervention and democracy promotion efforts
• Support a strong U.S. defense posture and are willing to use force when required to defend vital national interests

I think that “realistic Jeffersonian” is actually a better description of me. Like Jefferson I think that the U. S. is an outlier and too great a reliance on international institutions will inevitably destroy what makes the United States the country it has been.

I have just learned that California Sen. Dianne Feinstein has died. She was a great woman with many accomplishments, not the least of us was providing some stability to San Francisco under tragic circumstances. I thought she would have made an excellent president. I would have preferred her over Al Gore in 2000.

More recently she has become a lightning rod for controversy around her age. I suspect there will be some turmoil in California over replacing her. Presumably, Gov. Newsom will appoint someone to serve at least temporarily. His choice may have some impact on his presumed presidential candidacy.

Did anybody listen to the Republicans’ second candidates’ debate? I don’t mean anybody here—I certainly didn’t. I mean anybody at all who wasn’t being paid to listen.

I was startled by Janan Ganesh’s speculation at Financial Times on what Donald Trump’s foreign policy would be like should he be elected for a second time. There’s one thing I think he gets absolutely correctly:

Elsewhere, expect more continuities than ruptures. This is because, on protectionism, on Iran, on the withdrawal from Afghanistan, Joe Biden hardly deviated from Trump in the first place. Even his detachment from Saudi Arabia on ethical grounds has given way to the more transactional approach of his predecessor.

There are actually two points combined in that brief passage. First, that what is notable about U. S. foreign policy is the continuity from administration to administration rather than the differences but, second, that President Trump tended to use a highly transactional approach.

Beyond that I have few insights into the workings of Trump’s mind and no real sense of what his second term foreign policy might be. Will he, as Mr. Ganesh avers, “jilt” Ukraine? Reduce the scope of sanctions against Russia? Moderate our opposition to China? I have no idea.

Something unmentioned by Mr. Ganesh is that I think it’s almost a certainty that if he were re-elected President Trump would dispatch the National Guard to our southern border as some of the Republican presidential aspirants have been saying. The situation there is pretty dire, it’s well within his authority, and there is no prospect for an additional term to stay his hand. I also think the “stay in Mexico” policy for asylum-seekers would be revived.

Jake Beardslee’s coverage of Bill Maher’s interview of James Carville at LightWave is pretty interesting. Here are a few choice snippets:

Legendary Democratic strategist James Carville did not hold back in mocking the far-left wing of the Democratic Party, calling them “stupid” and “naive” on Bill Maher’s “Club Random” podcast.

and

Carville revisited his criticisms of progressive Democrats later in the program, calling them a burden to the party. He argued that while only 10% of the party actually identified as progressive, they drag the entire party down.

and

“If we could just get the humanities faculty at Amherst [College] to shut the F up, we’d be a lot better off,” Carville said.

I found this the most telling:

Both Carville and Maher went on to voice concerns that President Biden’s age could hurt him in a potential 2024 rematch against Trump.

“He cannot run for president. He’ll look bad in the debates,” Maher said.

I don’t disagree with him but I think it illustrates just how far the Clintonistas are removed from the locus of power in the party. Nancy Pelosi is a progressive. Hakeem Jeffries is a progressive. Katherine Clark is a progressive. Chuck Schumer is more closely aligned with Congressional progressives than he is with centrists. Power is concentrated in the leadership these days.