Author: Andrew Sullivan

Avik Roy summarizes key parts of the Senate plan unveiled yesterday:

While the plan would repeal Obamacare, it would preserve some of the law’s most popular features, such as its ban on lifetime limits on insurer payouts, and its requirement that insurers cover adult children younger than 27. It would replace Obamacare’s premium hike on young people, known as age-based community rating, with a more traditional 5:1 rating band.

It wouldn’t maintain Obamacare’s individual mandate, nor its requirement that insurers offer coverage to everyone regardless of pre-existing health conditions. Instead, the plan would require insurers to make offers to everyone who has maintained “continuous coverage,” while aiding states in restoring the high-risk pools that served those who insurers won’t otherwise cover. Subsidy-eligible individuals who failed to sign up for a plan would be auto-enrolled in one priced at the same level as the subsidy for which they qualified.

Carpenter notes one major drawback:

[T]hose with pre-existing conditions that fail to maintain continuous coverage at any time could be denied coverage. Nearly 90 million Americans have a pre-existing condition. That’s quite the crack to fall through.

Beutler calls the proposal a “mess”:

If Republicans had offered this plan as an opening bid in 2009, they might have found Democrats willing to make a counteroffer and negotiate toward some kind of compromise — or they might have knocked the whole legislative process off the rails. But in 2014, a plan that devolves crucial aspects of Obamacare without any inducement for Democrats is a joke.

Yglesias thinks “key thing about this is that it doesn’t envision radically remaking the health care system along free market lines”:

Relatively to the status quo that existed in 2009, it would constitute modestly remaking the health care system along liberal lines. Most of all, as a political document it reflects an appreciation of the overwhelming political power of the status quo. You can’t kick those 25-year-olds off their parents’ insurance plan. You can’t deny the currently insured the peace-of-mind that comes from knowing that getting sick won’t make them uninsurable. You can’t change tax policy in a way that’s too disruptive. And this plan isn’t going to pass in 2014. It’s not going to pass in 2015. And it’s not going to pass in 2016. By 2017, Medicaid expansion and subsidized exchange plans will be the new status quo. Are the Coburns, Burrs, and Hatches of 2017 really going to be willing to blow that up?

Sarah Kliff’s related thoughts:

Obamacare has become the starting point for negotiations. This wasn’t really true a few years ago, or even a few months ago, before the health-care law’s insurance expansion started. It’s interesting that this proposal takes some of the contours of Obamacare and works around them, such as ending pre-existing conditions and continuing dependent coverage up to age 26. The health-care law’s $700 million in Medicare cuts stick around, too. Even though it’s a replacement plan, it also acknowledges that Obamacare isn’t totally going to disappear.

Yuval Levin talks up the plan:

It can … be called a very encouraging sign that congressional Republicans know that they will need a serious Obamacare replacement if they are to persuade the public that Obamacare must be repealed. It’s especially encouraging that Orrin Hatch – who is the ranking Republican on the Senate Finance Committee (the key committee with oversight for federal health-financing policy) and would likely become chairman of that committee if Republicans took over the Senate next year – is among the sponsors of this proposal. The ideas here are also very much in line with those laid out over the years by Paul Ryan, who is likely to become chairman next year of the equivalent House committee, the Ways and Means Committee.

This proposal is just a step, of course – an imperfect and an incomplete step, like any legislative proposal. But it is a major and important step, and a very encouraging one.

Philip Klein’s bottom line:

Ultimately, the new Coburn-Burr-Hatch plan would not usher in a free market for health insurance in the United States, which would require fully ending the distortion of the tax code and removing far more regulations. What it does do is offer individuals more freedom than now exists under Obamacare.

In light of the Grantland controversy, Parker Molloy defends transgender people who choose to stay in the closet:

I may meet someone, whether it be a coworker or acquaintance, and be treated with the same casual attitude I imagine they treat everyone. Then, should they find out that I’m trans, conversations start to take odd turns. Suddenly, the topic of my genitals becomes fair game in their minds. Suddenly, they feel the right to ask what my “real name” is. Suddenly, pronouns start slipping, and I find myself called “he” by these people who had just been referring to me as “she” five minutes earlier. Suddenly, I’m no longer a human being, but rather a biological freak show.

Is that something you’d like? For every conversation to veer away from you as an individual and to instead focus on one singular part of your history? As a writer, as an author, as an activist, this is a choice that I have made for myself. I am willing to endure the awkward questions, the stares, the misgenderings, and the gawking. I do this in an effort to urge society to come to terms with the fact that transgender people are just like anyone else. I do this because I choose to. Essay Vanderbilt did not choose to put her trans status front and center, and taking that from her is not journalism, but rather a betrayal of her right to privacy.

Update from a reader:

I read Parker Malloy’s piece on Dr. V and a lot of the commentary on the Grantland piece. And while I agree with Parker’s point of view – that no one has the right to “out” a person as transgender – I think Parker and others ignore an important fact:

Dr. V raised money from investors. When you do that, you may not make an untrue statement of a material fact or fail to disclose a material fact necessary to make the statements made, in the light of the circumstances in which they were made, not misleading. In almost all instances that means disclosing biographical information about key employees. I don’t know how Dr. V could have possibly done that without revealing, indirectly, that she was transgender.

Professional investors in businesses such as hers typically conduct background checks on the founders/inventors/key executives. How could they have conducted a thorough background check without knowing her prior stereotypically male name? I’m not saying that the fact she was transgender was itself material or the failure to disclose that fact was fraudulent, but it seems as though it would have been impossible to avoid revealing she was transgender in order to make accurate disclosures about other material details of her life, such as her work and credit history.

And ask yourself this question: what if you knew her background disclosures were misleading? The obvious course would have been to encourage her to update them or pull the offering, but what if she refused? A lawyer would be obligated to keep such information confidential, but probably would also be obligated to withdraw as her counsel (and perhaps make what’s called a “noisy” withdrawal).

But what if you were the CFO of the business, not subject to attorney-client confidentiality? Would the “you may not out a transgender person” rule apply to you? If you don’t say anything, you could find yourself in the legal crosshairs. Put another way, should you be forced to commit securities fraud because she chose to keep her transgender status a secret? Again, I’m not saying you’d be obliged to reveal she was transgender, but I can’t see how you could correct the misstatements and omissions without also inadvertently revealing she was.

People have rights – like a transgender person’s right to decide whether to keep her personal history secret – but they also have duties – like an entrepreneur’s obligation to make accurate and complete disclosures to investors. If a transgender person wants to keep that part of her personal history a secret, then she’s going to have a real hard time raising capital from investors in a manner that complies with law.

You may be doing it soon:

The obvious starting point for smell communication is the smartphone, a ubiquitous device we already bling to death, and for which a growing panoply of notifications, vibrations and ambient signals are added with each new release. Japan’s Scentee sells a plug-in atomizer for smartphones (currently selling for around $35 on Amazon.jp), which can be customized when triggered by an app to spritz standard aromas such as rose and lavender, as well as more unique tastes of curry, coffee or cinnamon roll, costing just over $5 for 100 sprays. The company suggests its product be shared by “lovers,” and lists use cases such as getting a whiff of your chosen scent each time you get a Facebook like or, as part of a wakeup alarm. There’s no word yet on whether it will come to the US.

Liz Stinson speaks to David Edwards about the oPhone, one of several “smellable” devices currently being developed:

There’s one big problem when it comes to doing this, says Edwards: “Odor transmission to date is not smart,” he explains. “If I give you the odor of a pizza, I have a difficult time immediately after giving you the odor of the sea and then giving you the odor of a cactus.” Basically what Edwards is saying, and what we already know from letting trash sit in our apartments a day too long, is that odors linger. Which makes it hard to craft any sort of cohesive and decipherable olfactive narrative.

The oPhone solves this problem with its main innovation: the oChip. This little cartridge, about the size of a fingernail, contains olfactive information that can produce hundreds (and soon thousands, says Edwards) of odor signals. The idea is that these chips can be installed in the oPhone, and via a bluetooth-connected app called oTracks, scents can be sent to yourself or an oPhone-carrying friend with the push of a button.

Amid serious drought in the American West, once-flooded towns are re-emerging:

Near this Sacramento suburb [of El Dorado Hills], man-made Folsom Lake has receded to less than one-fifth of its capacity amid bone-dry conditions in California, recently revealing outskirts of a ghost town called Mormon Island founded during the mid-19th century gold rush. On an unseasonably warm winter day recently, throngs of visitors descended on the cracked mud flats of the reservoir to inspect hand-forged nails, rusted hinges and other vestiges of frontier life that were inundated when the lake was created in 1955. …

Texas’s Lake Buchanan shrank in 2011 to reveal the original site of the town of Bluffton, drawing visitors to the remains of homesteads, a store and cotton gin that had been mostly under water since the reservoir was created in 1937, said Alfred Hallmark, a local historian. The town is one of more than 200 archaeological sites in Texas, including cemeteries, that have been uncovered by drought, said Pat Mercado-Allinger, director of the Texas Historical Commission’s archaeology division.

Geoff Manaugh stresses the fragility of these rediscovered locations:

Curious visitors and amateur collectors alike are beginning to pick the old sites dry, rambling through the ruins of these dead towns revealed by drought, carrying metal detectors and looking for worthy artifacts. In the process, they are removing old objects – even whole pieces of architecture – before local authorities have the time and resources to catalog and protect what is re-emerging there. This surreal and unexpected opportunity to explore what was lost – in some cases nearly 100 years ago – mummified by water and preserved beneath the rising waves of western reservoirs, might thus simply go to waste.

Instead, the best option might be for the sites to be drowned all over again, assuming the drought will end and that these historic locales can once more be inundated, taken off the tourist map and sealed for their own protection beneath the calm surfaces of artificial lakes. Perhaps, then, future archaeologists better prepared for moments like this might yet be able to explore these historic sites when yet another drought rolls through.

(Photos from Texas’s Lake Buchanan by Merinda Brayfield)

Space is a bad place to be sick:

As far as space dangers go, illness doesn’t get much attention, which is kinda strange given that one of the most distinct effects of microgravity on the human body are tanking immune systems. A 2012 piece in Time reports, “the immune system can go on the fritz in space: wounds heal more slowly; infection-fighting T-cells send signals less efficiently; bone marrow replenishes itself less effectively; killer cells— another key immune system player—fight less energetically.” Meanwhile, many pathogens have an awesome time in space, growing stronger and increasing their resistance to antimicrobials. In particular, both herpes and staph have been shown to thrive in the gravity-free, hyper-sterile environment of a space vessel.

A study out this week examining space-born Drosophila flies—often studied because of the similarity between the flies’ immune systems and that of humans—found that in the case of fungal infections, microgravity effectively nullified the immune response.

How the study worked:

To figure out why the space flies had trouble with the fungus, the scientists analyzed all of the flies’ genes. Both the space flies and the Earth flies were born with the same genes, but exactly which of those genes turned on and went to work differed between them. In Earth flies, the genes associated with their immune systems kicked into high gear after they got infected with the fungus. Among other genes, Earth flies activated something called the Toll signaling pathway, which scientists have long known flies use to fight off fungi. Humans have Toll-like genes, too, and they also work in immunity.

The space flies reacted differently from their stay-at-home siblings. They turned on some immunity genes after encountering Beauveria bassiana, so it’s not like they were totally helpless. But they didn’t use all of the genes the Earth flies used, and they didn’t turn up their Toll pathway genes. In their paper, the biologists called their spacefaring flies “severely immunocompromised.” Strangely, when the biologists raised flies in a centrifuge to simulate higher-than-Earth gravity, they were more likely to survive a fungal infection than normal Earth flies.