As The Washington Post reported in December:
The story of Avastin and Lucentis, two nearly identical drugs for blindness, offer a glimpse into the problematic world of Medicare pricing.
A dose of Avastin costs only $50. A dose of Lucentis costs $2,000. Both Avastin and Lucentis are made by the same company, and they're remarkably effective in treating a form of macular degeneration that was long the leading cause of blindness among the elderly, The Post reported. They are very similar on a molecular level and probably cost about the same amount to manufacture.
Nonetheless, doctors prescribe Lucentis almost as often as Avastin. They also make more money doing so. Medicare is legally obliged to pay for any drug a doctor prescribes, and doctors also receive commissions of 6 percent to cover their own expenses. The commission a doctor collects on each dose of Avastin would be only about $3, as opposed to $120 on each dose of Lucentis. Congress and the courts have refused to allow Medicare to save money by scrutinizing doctors' decisions.
As a result, taxpayers spent about $1 billion in 2012 more than they would have if doctors had been prescribing Avastin. Avastin, for all intents and purposes, has been shown to be equivalent to Lucentis in six studies and one massive review of Medicare records.
From The Angry Bear, on the Hobby Lobby silliness which our Republican federal courts are using to cripple the Affordable Care Act and expand the already enormous control that corporations exercise over our government.
The second momentary jolt for me was [Justice] Kennedy’s repeated indication that he believes that the constitutional rights that he said in Citizens United — he wrote that opinion — accrued to the corporation only derivatively as an “association of citizens,” in other words, through its members rather than as a separate entity, extend to all constitutional rights…
The First Amendment right Kennedy proclaimed of people unaffiliated with the corporation to hear the speech of the corporation was, of course, as I said yesterday really a proclaimed right of unaffiliated people to hear the corporation’s CEO’s speech, funded, though, by all the shareholders — or, as Kennedy out it, the association of citizens. The idea was that the political speech advanced the financial interests of all of the association’s citizen members, because they shared an interest in the financial success of the corporation and the political speech they were funding concerned financial matters. The premise was ridiculous; union members who owned shares of the company through their pension fund probably would not have supported anti-union candidates, for example.
In comments to my last post, James Kelly writes, “I’m not sure why you posted this. Patently untrue statements.” Fair question.
The quoted excerpt is by Stewart Brand, who was regarded as an eminently reliable source by millions of Baby Boomers back in the day. I never read The Whole Earth Catalog myself, being a Depression Era baby who was busy manning freedom’s ramparts in Southeast Asia during the ’60s. But I gathered that Brand was pretty much a back-to-the-earth greenie and I was surprised to see what had become of him.
I’m personally aware of the dangers posed by radiation poison; my grandmother died a horrible death from it shortly before I was born, the bones of her skull eaten away. The cancer was caused by a miracle elixer of the day called Radithor, the active ingredient of which was radium.
What, then, was Brand talking about? My own first reaction to his argument had been the same as that of James and the other commenters. Now that you’ve pushed me into looking further, though, it seems as if Brand might have hold of a little something — at least as far as Fukushima goes:
My own theory is that Earth itself is a tumor, just now beginning to metastasize. This explains the space race.
Happy New Year.
…I never knew that. But Stewart Brand does, so it must be true:
The linear no-threshold (LNT) radiation dose hypothesis, which surreally influences every regulation and public fear about nuclear power, is based on no knowledge whatever. Panic-mongers said Fukushima would kill thousands, but no one has died.
At stake are the hundreds of billions spent on meaningless levels of “safety” around nuclear power plants and waste storage, the projected costs of next-generation nuclear plant designs to reduce greenhouse gases worldwide, and the extremely harmful episodes of public panic that accompany rare radiation-release events such as Fukushima and Chernobyl. (No birth defects whatever were caused by Chernobyl, but fear of them led to 100,000 panic abortions in the Soviet Union and Europe. What people remember about Fukushima is that nuclear opponents predicted that hundreds or thousands would die or become ill from the radiation. In fact nobody died, nobody became ill, and nobody is expected to.)
Ezra Klein pinpoints the real villains in our atrociously overpriced health care system, and claims it’s not so much those greedy insurance companies:
A health-care system that followed international best practices would direct the government to set rates. Or it would let insurers band together and negotiate rates collectively — a practice called “all-payer rate setting.” But it wouldn’t need to eliminate private insurers. It’s good for consumers to have a choice of insurers, who have real incentives to innovate and devise better ways to keep customers healthy and costs down.
It’s health-care providers — not insurers — who have too much power in the U.S. system. As a result, they have the most to lose if health-care prices fall. But, as is often the case, political power flows in part from popularity. So politicians who routinely rail against for-profit insurers are scared to criticize — much less legislate against — for-profit hospitals, doctors or device manufacturers (though drug companies come in for a drubbing now and then). These are the people who work every day to save our lives, even if they make us pay dearly for the privilege. No one cheers when you take them on…
Rubber Hose spells out what should be obvious to anybody who doesn’t mainline Fox News. Apparently it isn’t, though, to judge by the polls. You’d think that nobody on God’s little green footstool ever had an insurance policy cancelled until Obama came along.
One annoying thing about the ACA is anything bad related to health insurance is deemed to be an Obamacare problem even if it is a problem that long predated the health reform law.
For as long as I have been aware of this stuff, companies have cut employee hours to avoid giving them benefits. Just after I graduated high school, a friend of mine worked 29 hours per week at a book store. Why such an odd number? The company gave benefits to “full time employees” and defined people as full time if they worked 30 hours or more. This was in 1988. But when it happens today, it is all Obamacare’s fault. Labor stats don’t back up the notion that the ACA is causing any cutback in hours. But any company that cuts its hours has an incentive to say that it is doing the cuts because of Obamacare because then the law, and not the company, becomes the bad guy.
Likewise, business have been reducing the number of employees who get health insurance for decades. That phenomenon is what people were calling the “health care crisis” back in the early 1990s and the reason that Obama campaigned on health care reform as an issue which led to the ACA’s passage. But whenever any employer drops health insurance after the ACA’s passage, it must be Obamacare’s fault. And private insurance carriers have long been restricting the doctors and medical facilities you can visit (in-network vs. out-of-network), changes in policies, etc. This stuff was not invented by the 2010 law.
A retired insurance executive sends along this discouraging analysis of Obama’s latest cave-in to the insurance companies and the Republicans or — as the president no doubt considers it — to reality.
I am appalled that Obama’s advisers, in trying to get him out of the jam created by promising that the insurance companies would not kick anyone off a plan they liked, allowed him to go out there and promise to fix the problem by allowing the insurance companies to continue offering the old plans for another year.
It’s repeating the exact flaw from the first pledge: in order for the promises to work, both rely on totally voluntary actions by the insurance companies! No government official can force an insurer to offer any policy, ever. There are some options governmental players can use to force insurers to comply with certain requirements once they do decide to issue a policy or a plan — but that presumes that the carriers have decided to offer a plan. No one — President, governor or insurance commissioner — can force an insurer to offer a plan in the first instance.
So Obama’s political advisers are telling him to fix a problem caused by implicitly promising that insurers will continue to offer certain plans by ... promising that insurers will resume offering certain plans.
It is not unlikely that the insurers will behave that way — it is impossible. Even if they wanted to do this, which they don’t (who wants the headache and expense of offering a bunch of small little plans for a dwindling number of policyholders when the business is shifting to a new and much larger arena with much better economies of scale) they actually physically, logistically and legally can’t do it.
Issuing a health care plan is incredibly difficult, cumbersome and complex. Launching a new plan requires at least a year of hard work and prep — designing the benefit, underwriting it, getting the actuarial work done, getting the state rate filing process accomplished including time for a rate appeal, making sure the right network of providers are in place ... on and on it goes.
Bottom line is that the fix the president just promised can’t happen until January 2015, even if it was a good idea, which it is not. And even if the issuers wanted to keep offering the old plans, which they don’t — something we know to a 100% certainty because they dropped these grandfathered plans even though they already are currently free to continue to offer these plans.
Obamacare allowed the issuers to continue the grandfathered plans — and the plans chose to drop them instead. So now the president announces that the plans can re-offer the grandfathered plans they were already allowed to offer, but chose to drop. Which the plans not just won’t, but can’t do, making the president again look like a liar.
This is political malpractice — the president has just made another healthcare promise on which he cannot deliver. And just like the first time, he appears to have no clue that he is doing so. This is going to be like chickenpox — the first time, it is bad enough. But when the same virus comes back the second time you get shingles, a much worse and more painful condition.
It’s almost as if no Democrat has ever worked in the health insurance industry or at least the White House isn’t checking with them. You’d think the political and communications advisers would want to get the policy part right to make sure the reality would match the message, but they appear oblivious.
So weird. Potentially devastating and entirely self-inflicted.
…The Guardian’s got you covered:
While it is true that if e-coli bacteria from fecal matter is ingested, that it can can cause ailments such as cramps, fever, diarrhea, stomach pain, and other illnesses, the likelihood of anyone contracting these ailments from holy water under most circumstances is small…
Lest we forget, what Obama is trying to undo is what Clinton did. From CounterPunch:
The Clinton crime bill of 1994 introduced mandatory life imprisonment for persons convicted of a third felony in certain categories. It maintained the 100-to-1 disproportion in sentencing for crimes involving powder and crack cocaine, even though the US Sentencing Commission had concluded that the disparity was racist. It expanded to fifty the number of crimes that could draw the death penalty in a federal court, reaching even to crimes that did not include murders–the largest expansion of the death penalty in history. Pell grants giving prisoners an avenue to higher education were cut off. Federal judges were stripped of their powers to enforce the constitutional rights of prisoners and the power of states to set sentencing standards for drug crimes was greatly diminished.
The curtailment of states’ rights went further. Grants for new prisons contained the provision that receipt of the money was dependent on the states ensuring that prisoners served at least 85 percent of their sentences. These inmates, remember, had been convicted in state, not federal, courts so this was simply federal blackmail to curtail parole at the state level. The Clinton administration also pressed the states to try juvenile offenders as adults. Gore articulated the administration’s position: “When young people cross the line, they must be punished. When young people commit serious, violent crimes, they should be prosecuted like adults.” Nonviolent offenders were to be sent to boot camps. Not, it should be noted, his own kids, who evaded punishment for nonviolent infractions such as smoking pot and having an open alcohol container in the car.
Read it all, of course, but here’s your thought for the day:
…If you go into the hospital for heart surgery and you end up getting a central-line infection, you’d hope that the hospital would be penalized for it. The opposite, in fact, is true. According to a new study in the Journal of the American Medical Association, surgical complications increase the margin the hospital makes on the patient by 330 percent for the privately insured and 190 percent for Medicare patients.
This, too, is a legacy of a health system built for acute care. Hospitals make money when they do more to patients. They lose money when their beds are empty. Put simply, Health Quality Partners makes hospitals lose money. “There’s no doubt that it’s a hit to the bottom line,” says Rich Reif, the former CEO of Doylestown Hospital, which worked with HQP…
I did not know that:
Today, new problems have emerged in the process of resolving old ones, but the solution is not to go back to the past. Some people may long for an era when divorce was still hard to come by. The spread of no-fault divorce has reduced the bargaining power of whichever spouse is more interested in continuing the relationship. And the breakup of such marriages has caused pain for many families.
Yet, according to the economists Betsey Stevenson and Justin Wolfers, whenever a state adopted a no-fault divorce law, the annual rate of female suicide there dropped by 8 to 16 percent, and the incidence of domestic violence declined by roughly 30 percent.
…Mother Nature has her little ways of upgrading the gene pool. From Raycom News Network:
“Urologists across the country have noticed a trend in men over the last few years who are getting their vasectomies at the time of March Madness,” Schwartz said. “You have a perfect excuse to watch basketball all weekend.”
Many urology centers report a dramatic increase in the number of vasectomies they perform this time of year, saying business increases by as much as 50 percent.
At least a portion of our national screaming match about guns has turned to actions that can be unilaterally taken by the Executive Branch. Robert Reich offers some of them here. There is one suggestion I have yet to see offered.
Call up the militia.
Guess who is the commander-in-chief of the militia referenced in the part of the Second Amendment that no one seems to know about? That’d be the President of the United States, according to Article II. So the commander-in-chief should activate the militia. Clearly, “security of a free State” is at stake if ordinary citizens are not safe to go to schools, shopping malls, movie theaters, public appearances of their elected representative, and Unitarian churches. (To name but a few of the sites of mass shootings in the last few years.)
So, President Obama should call up the militia. Anyone who owns a gun is ordered to report with their weapons for militia training and assignment. They would be evaluated as to their fitness for duty — including a mental health screening — as well as the condition of their arms and their proficiency in handling them. They would be furnished with proof that they reported for and completed this training. Thereafter, any gun owner who cannot furnish such proof would be subject to penalties, and still be required to report for militia duty.
It’s simple. It’s in the Constitution. And, of course, it is 100% unworkable.
For starters, I think we know the people screaming loudest about the Second Amendment would never submit to this sort of “tyranny.” (For rather a lot of them, the definition of “tyranny” is having to do anything a black person says.) It would cost a lot of money and time, both for organization and enforcement. Military resources would almost certainly have to be diverted to the task. And last, but certainly not least, “the militia” was redefined in 1903 to mean The National Guard.
Which brings us to the fun part. Just who do you think would waste no time at all in loudly and repeatedly bringing up that last fact? I’m gonna go with “Gun Owners” on that one. Maybe even Wayne LaPierre his own self. But even if they don’t point to that particular law, one way or another it’s a safe bet that they will themselves make the point that they are not subject to being a militia in the sense that the Founders not only intended, but specified.
And once we’ve established that the first clause of the Second Amendment is outdated and inapplicable, maybe — just maybe — we can have a sensible conversation about the amendment in its entirety. (Yeah, I know. But I said “maybe” twice, so cut me some slack...)
Sure, it’s kind of a convoluted way to make a point. But our Republican friends do that sort of thing all the time — how many votes has the House held to repeal Obamacare? (Also, too, Clinton Impeachment. Heck, the war in Iraq.) Government-as-performance-art can work for our side too, once in a while...
…are sisters under their skins, as Rudyard Kipling wrote. So are Republicans and Democrats, at least when it comes to Obamacare.
The best explanation of this latest chapter in America’s efforts to join the civilized world that I’ve come across is in today’s New York Times. It starts out this way:
If Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.
This fundamental ideological paradox, drowned out by partisan shouting since before the plan’s passage in 2010, explains why Obamacare has only lukewarm support from many liberals, who wanted a real, not imagined, “government takeover of health care.” It explains why Republicans have been unable since its passage to come up with anything better. And it explains why the law is nearly identical in design to the legislation Mr. Romney passed in Massachusetts while governor…
It continues here.
—It’s Raining Violet…
“We both woke up to a very loud bang. I looked around — no breeze, no rain, nothing,” homeowner Lois Farella told CBS Local New York as she pointed to a basketball-sized hole in her roof…
“It’s hard to understand what could have done this. It had to have come from a plane,” roofer Bryan Lanzello told CBS Local New York. “A bird couldn’t have done it.”
So the FAA investigated the incident as possibly involving blue ice. “Blue ice” is a euphemism for the mixture of frozen human waste and industrial-strength chemical that occasionally drops from planes’ waste tanks.
Memories, memories. For two years in the late 1970s I was head of public affairs for the FAA. We knew all about blue ice. It was caused by failure to make sure the valve was closed after the toilet tanks had been drained and refilled.
On the next flight the leakage would freeze in the upper air, forming balls of ice outside the plane. When these got heavy enough they would break loose, typically as the plane descended into lower, warmer air in preparation for landing.
Mostly these missiles landed harmlessly and unseen. Sometimes not. Sometimes my regional public affairs people could claim ignorance or blame the weather. Sometimes not. But if anybody were actually to get hit, it wouldn’t be my regional guys on the hot seat. It would be me. So I went to Bill, the man in charge of flight safety, and said, more or less:
“Sooner or later one of these balls of frozen shit is going to crush the skull of a cute little three-year-old blond girl playing with her dolly in the back yard and I’ll be the guy stuck with explaining to the world press why we can reach the moon but we can’t manage to keep our planes from leaking on innocent children.”
And so he explained patiently that enforcement was difficult because you never knew which plane had dropped which load. But you could at least find out which airline, I said. The toilet water doesn’t have to be blue, does it? Make United dye it read. Pan Am could be green. See where I’m going?
He laughed, thinking I was joking. And that, children, is why the ice that falls from heaven is blue — and will still be blue on the inevitable day when that photogenic little girl is untimely called to meet her Maker.
Mitt the Twit offers us this assessment of the choices we face in November:
...I hope people understand this, your friends who like Obamacare, you remind them of this, if they want more stuff from government tell them to go vote for the other guy — more free stuff. But don’t forget nothing is really free.
Mitt, Mitt, Mitt… “stuff from government” is not free. We pay for it. That’s what those things we call “taxes” are supposed to be used for. It’s not free. And most of us realize it’s not free. You only think “stuff from government” is free because you’re not paying those same taxes.
I hope this has been helpful, Mitt. Feel free to drop me a line if you find any other fundamentals of the social contract to be confusing.
Einer Elhauge, writing in The New Republic, reports that while this Supreme Court’s Originalists may oppose federal mandates, the Originals themselves didn’t:
…In 1790, the very first Congress — which incidentally included 20 framers — passed a law that included a mandate: namely, a requirement that ship owners buy medical insurance for their seamen. This law was then signed by another framer: President George Washington. That’s right, the father of our country had no difficulty imposing a health insurance mandate.
That’s not all. In 1792, a Congress with 17 framers passed another statute that required all able-bodied men to buy firearms. Yes, we used to have not only a right to bear arms, but a federal duty to buy them. Four framers voted against this bill, but the others did not, and it was also signed by Washington. Some tried to repeal this gun purchase mandate on the grounds it was too onerous, but only one framer voted to repeal it.
Six years later, in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. That’s right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams…
In case you have any friends who are opposed to Obama’s health care plan but amenable to reason — admittedly a tiny demographic — you might direct them to this article by Sarah Kliff in The Washington Post.
Two-and-a-half years later, Baptists’ surgeons have earned more than $950,000 in bonuses. Medicare, meanwhile, has netted savings: Its bundled rate is about 5 percent lower than all the fees it used to pay out for the same services. “It wasn’t a home-run,” says Zucker, noting the start-up costs in administering the program — not to mention a handful of lost employees. “But I’d call it a solid triple…”
Although it’s not fully implemented, some say the Affordable Care Act has already significantly catalyzed the health-care system. Leaders know where Medicare wants to go, even if they didn’t chart an especially aggressive path for how it would get there. “Forever and a day, everybody had been saying we had to change the way we paid for health care,” Roades says. “Now, we have a sense of direction of where the country’s biggest payer is headed. And that provides cover for everybody else to move in that direction…”
But the system, he says, is shifting away from it. “The goal, quite simply, is to improve our quality metrics and bring down per-capita costs,” Blum continued. “That’s going to be the ultimate success.” When Baptist Health Systems started down this path in 2008, it had little idea where it would lead or whether the doctors would revolt. Now that 78 percent of his doctors have received bonus checks, Zucker is more confident.
Ohio state legislator Nina Turner has decided to dramatize the War On Women: Contraceptive Theater of Operations by attempting to place an equivalent burden on men:
...the Democrat has become the latest in a series of female state legislators to give her male colleagues a taste of their own medicine by introducing a bill that limits men’s ability to get a Viagra prescription without meeting certain government conditions.
Not bad. But I suggest we think in different terms. This is a calculated burden on a settled issue of the rights of American citizens. I modestly propose we burden another settled right, to dramatize that fact. Therefore, no one should be allowed to purchase a firearm in this country without being required to watch a 30-minute montage of coroner’s photos of children who have been killed by firearms in this country. The montage’s soundtrack should include “Tears in Heaven” by Eric Clapton and “My Heart Will Go On” by Celine Dion. Remaining music should be left up to the states, in acknowledgment of the Tenth Amendment.
Undoubtedly we will hear that this violates the Second Amendment. But since it doesn’t actually prevent anyone from acquiring the means to slaughter additional children, that argument should be easily countered.
WASHINGTON (CNN) — A federal mandate requiring tobacco companies to place graphic images on their products warning of the dangers of smoking was tossed out Wednesday by a judge in Washington, with the judge saying the requirements were a violation of free speech…I pass this along as a particularly striking example of cognitive dissonance. The second sentence directly contradicts the first, as the author hastens toward the greater good of freeing Big Tobacco from Big Government’s shackles. You may be surprised to learn that Leon was appointed to the bench by George W. Bush. Then again, you may not.
“The graphic images here were neither designed to protect the consumer from confusion or deception, nor to increase consumer awareness of smoking risks” said federal judge Richard Leon. “Rather they were crafted to evoke a strong emotional response calculated to provoke the viewer to quit or never start smoking.”
Lauren Unger-Geoffroy writes from Cairo:
After the long weekend of revolution participation here, I had to pay 13 Egyptian pounds — the equivalent of three U.S. dollars — to have an X-ray of my stress-fractured ankle. The hospital was part of a labyrinthine and crowded complex, and I had to ask directions repeatedly. But eventually a cast and a containment brace were put on my ankle, all for the cost of the equivalent of an additional 45 U.S. dollars. I tsk-tsked and said to the young doctor, “That is expensive! Much more than last year.” He replied apologetically, “Yes, I know, I am sorry, but now we are using some American products.”
I did not mention that these American products would cost at least 300 times more in the U.S. than they cost here, or that in America I would have to pay $600 to health insurance extortion every single month for life in order to afford medical treatment. As I limped back to the taxi, accompanied by the typical sympathy, offers of help and well-wishing of strangers, I reflected on the strange chasm of values, self-interest, the evils of capitalism, human decency, pragmatism, social unity, and the vacuum of understanding into which can rush ... anything.
From a New York Times story about the grimness of life in Wyoming’s Wind Mill River Reservation:
On one section of the reservation, people must boil drinking water because chemicals, possibly the result of the oil and natural gas drilling method known as hydraulic fracturing, have contaminated the water supply. And fearing that the chemicals might explode in a home, the Environmental Protection Agency ordered residents to run fans and otherwise ensure ventilation while bathing or washing clothes.
This went into effect Monday. I’ve waited a while to see whether the MSM would jump on the good news with its customary enthusiasm. Oddly, no.
On Friday, the federal government launched an element of the Affordable Care Act that is likely to have far-reaching consequences on the cost of health care in the United States in the form of new regulatory controls on how private health insurance companies spend the money they collect in premiums. Rick Ungar, a left-leaning specialist on health care policy who writes for the corporatist site, Forbes.com, explains:
That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80 percent of the consumers’ premium dollars they collect — 85 percent for large group insurers — on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.
This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare — but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.
Kerry Trueman at AlterNet explores the question of why those irritating Danes go around smiling all the time:
KT: Denmark is famous for having so much less income inequality; do kitchen workers in Danish restuarants make a decent salary?
TH: Yes, a dishwasher in Denmark gets $25 an hour.
KT: Do they get sick days and benefits, too?
TH: Yes, and a pension, and health care, and maternity leave. To me, the more equal your society is, the better it is for everybody. It’s not right for a country as rich as yours to have so many poor people. This thing with Americans and taxes, I don’t understand it.
I make quite a lot of money, I pay 67% tax on much of it, and I don’t mind. I like the idea that the girl who’s sitting next to my daughter, whose mother is a cleaning lady, has exactly the same opportunity to get an education that my daughter has. I don’t think that’s socialism. To me, that’s human decency. That girl didn’t choose her parents, why shouldn’t she have the same opportunities?
The New Yorker has a wonderful story this week about the only pharmacist in Nucla, Colorado (population 700). His name is Don Colcord, and he does his best to serve an area of 4,000 square miles. Somehow he manages in spite of Medicare Part D, George W. Bush’s unfunded gift to the insurance industry and the nation’s deficit:
…He keeps watch-repair tools behind the counter, and he uses them almost as frequently as he complains about Walmart, insurance companies, and Medicare Part D. Since 2006, the program has provided prescription-drug coverage for the elderly and disabled, insuring that millions of people get their medication. But it’s also had the unintended [Editor’s note: my ass] effect of driving rural pharmacies out of business.
Instead of establishing a national formulary with standard drug prices, the way many countries do, the U.S. government allows private insurance plans to negotiate with drug providers. Big chains and mail-order pharmacies receive much better rates than independent stores, because of volume. Within the first two years of the program, more than five hundred rural pharmacies went out of business.
Don gives the example of a local customer who needs Humira for rheumatoid arthritis. The insurance company reimburses $1,721.83 for a month’s supply, but Don pays $1,765.23 for the drug. “I lose $43.40 every time I fill it, once a month,” he says. Don’s customer doesn’t like using mail-order pharmacies; he worries about missing a delivery, and he wants to be able to ask a pharmacist questions face to face. “I like the guy,” Don says. “So I keep doing it.” Don’s margins have grown so small that on three occasions he has had to put his savings into the Apothecary Shoppe in order to keep the doors open…
More evidence that we are, as a species, just pathetic…
This (All links to PDFs):
In a field study, we collected data in a restaurant and manipulated bite size by providing diners with small or large forks. We found that diners consumed more from smaller rather than larger forks.
Very small but cumulated decreases in food intake may be sufficient to erase obesity over a period of years. We examine the effect of slight changes in the accessibility of different foods in a pay-by-weight-of-food salad bar in a cafeteria serving adults for the lunch period. Making a food slightly more difficult to reach (by varying its proximity by about 10 inches) or changing the serving utensil (spoon or tongs) modestly but reliably reduces intake, in the range of 8-16%.And this:
In two studies, one a lab study and the other a real-world study, we examine the effect of manipulating the position of different foods on a restaurant menu. Items placed at the beginning or the end of the list of their category options were up to twice as popular as when they were placed in the center of the list. Given this effect, placing healthier menu items at the top or bottom of item lists and less healthy ones in their center (e.g., sugared drinks vs. calorie-free drinks) should result in some increase in favor of healthier food choices.
A San Francisco-based advocacy group known as Male Genital Mutilation Bill has collected enough signatures on its petition to ban circumcision that the proposal will appear on the city's November electoral ballot…
The rate of complications resulting from circumcision is lower than ear piercing, between 0.2% and 0.6%, with some bleeding as the most frequent complication…
Claims about psychological harm caused by neonatal circumcision are based mainly on anecdotes and Freudian psychoanalysis. If circumcision had the traumatic effects some opponents maintain it has, roughly two out of every three American males would be in trouble.
That last sentence settles it for me. Two out of three American males in fact are in psychological trouble, and possibly a good many more. Concern for the general welfare argues that we should leave future foreskins alone.
A couple of particularly stupid remarks from Republicans have been bothering me for a while, so I thought I’d get them off my chest.
Rep. Rob Woodall, a Georgia Republican, made a vigorous ideological defense of ending Medicare as it currently exists, telling seniors at a local town hall that they ought not look to the government to provide health care for the elderly just because their private employer doesn't offer health benefits for retirees.
A Woodall constituent raised a practical obstacle to obtaining coverage in the private market within the confines of an employer-based health insurance system: What happens when you retire?
"The private corporation that I retired from does not give medical benefits to retirees," the woman told the congressman in video captured a local Patch reporter in Dacula, Ga.
"Hear yourself, ma'am. Hear yourself," Woodall told the woman. "You want the government to take care of you, because your employer decided not to take care of you. My question is, 'When do I decide I'm going to take care of me?'"
I’m sure it never occurred to Rep. Woodall that government IS one of the ways we take care of ourselves. We all contribute to the cost of building and maintaining a civilized nation in order that we may all reap the benefits of being citizens of that nation. It’s the first thing in the Constitution. You can look it up and everything.
And that's leaving aside the sad irony that Woodall and his ilk have dedicated their political lives to ensuring that this woman and the majority of all Americans will be denied the wherewithal to "take care of me."
A Kansas state Representative had this to say last week, on the subject of rape:
During the House’s debate, Rep. Pete DeGraaf, a Mulvane Republican who supports the bill, told [state Rep. Barbara Bollier]: “We do need to plan ahead, don’t we, in life?”
Bollier asked him, “And so women need to plan ahead for issues that they have no control over with a pregnancy?”
DeGraaf drew groans of protest from some House members when he responded, “I have spare tire on my car.”
“I also have life insurance,” he added. “I have a lot of things that I plan ahead - for.”
So what Rep. DeGraaf seems to be saying is that women should expect to be raped. Is that what he tells his wife? Or daughters, if he has any? For that matter, how would Rep. DeGraaf feel if anyone so cavalierly treated the rape of his wife or daughter? (Hey, if we can ask Michael Dukakis how he'd react to his wife being raped, I think a similar question may be fairly asked of Rep. DeGraaf.) And just what sort of “planning ahead” does he have in mind? Surely he doesn't mean that women should be saving up for an abortion. If women should expect to be raped, then every man they encounter is a likely rapist, right? Perhaps women should just pre-emptively mace the men they come across in their day-to-day affairs. They might want to start with Pete DeGraaf.
Between this and the unconscionable response of congressional Republicans to the tornado in Joplin, I have to ask myself, Is there any human tragedy dire enough to to register on the Republican psyche as a genuine misfortune?
Available evidence suggests there is not.
There is a documented shortage of primary care physicians in this country, with only token efforts to respond meaningfully. The rewards for being a hard-working primary care physician are far less than for being a specialist or a specialist with a device (an endoscope) or a specialist with a device that beautifies (a laser). We as physicians are effectively reimbursed for 20-minute new-patient visits and eight-minute follow-up visits. Twenty and eight, you ask, how can that be? That is how, in effect, insurance companies calculate their payments — mind you, they are not rationing care, but they are rationing care and have been for a long time, national debates aside.
David Rhode is a paramedic in Middleton, Wis. He works 56 hours a week, mostly in 24-hour shifts, frequently carrying wheezy patients up and down flights of stairs. He said he earns about $43,000 a year.
HuffPost asked Rhode, 36, how it feels to be overpaid. His eyebrows went up.
"I drove my Ford Focus here," he said. "I live in a 950-square-foot condominium!"
Luckily, this question is easily answered: Anyone who makes under $250,000 a year is overpaid. Anyone who make over $250,000 is underpaid.
Please make a note of it. It is, after all, one of the base assumptions of our current national discourse.
WASHINGTON (Reuters) – A third of Americans say they have gone without medical care or skipped filling a prescription because of cost, compared to 5 percent in the Netherlands, according to study released on Thursday…
Healthcare reform was U.S. President Barack Obama's signature policy effort, but not a single Republican voted for the bill that Obama signed into law this year and conservatives in Congress have promised to try to dismantle it…
And this from Columbia University’s Mailman School of Public Health:
Fifteen-year survival rates for men and women ages 45 and 65 in the U.S. have fallen relative to the other 12 countries over the past 30 years. Forty-five year old U.S. white women fared the worst — by 2005 their 15-year survival rates were lower than that of all the other countries. Moreover, the survival rates of this group in 2005 had not even surpassed the 1975 15-year survival rates for Swiss, Swedish, Dutch or Japanese women. The U.S. ranking for 15-year life expectancy for 45-year-old men also declined, falling from 3rd in 1975 to 12th in 2005.
When the researchers compared risk factors among the 13 countries, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all of the other countries. In terms of obesity, researchers found that, while people in the U.S. are more likely to be obese, this was also the case in 1975, when the U.S. was not so far behind in life expectancy…
The researchers say that the failure of the U.S. to make greater gains in survival rates with its greater spending on health care may be attributable to flaws in the overall health care system. Specifically, they point to the role of unregulated fee-for-service payments and our reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.
“It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them,” said lead author Peter Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School of Public Health. “But what really surprised us was that all of the usual suspects — smoking, obesity, traffic accidents, homicides, and racial and ethnic diversity are not the culprits. The U.S. doesn’t stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy.”
Just got this from a reader who, unlike me and probably you, actually knows something about the business of health care:
Watched much of Obama’s really egregious and saddening tail-between-the-legs performance in his press conference. What would be the matter with just quietly and with dignity stating that the lesson of the election is that negativity and obstructionism work, and that Obama is the very embodiment of moderation and bipartisanship?
He is serious about there not being a Red States of America, or a Blue States of America, but rather a United States of America. The proof being that Obama showed substantial skill, leadership and muscle, and invested a huge amount of political capital, in getting the left wing of his party in Congress to hold their noses and agree practically unanimously with the health care plan that was passed — a plan which Obama had selected not because he is a socialist/fascist, but because it was a fairly good Republican plan. Obamacare is a Republican proposal, modeled on the Republican plan passed in Massachusetts, and a Republican proposal from 1993. (Chart here.)
So if people really are looking for reasonable politicians who will take good ideas from the opposition party, and make them their own, then that is in fact Obama — not John Boehner. Over 200 Republicans in both houses of Congress unanimously refused to provide even a single Republican vote for a Republican plan, just because Obama and the Democrats adopted it.
A teaser from Yale political scientist Jacob S. Hacker’s terrific summary of what lies ahead for Obama’s health reforms. Read it all here.
No one who has studied the medical market in recent years can fail to recognize the unhealthy consolidation that has taken place. An ironic coda to the public option’s demise was the release this February of the American Medical Association’s latest report on insurance competition. Its verdict? A “near total collapse of competitive and dynamic health insurance markets,” with more than half of metropolitan areas dominated by a single insurer enjoying at least half the market (up from 40 percent of areas in 2008). Of course, what the AMA neglected to mention is that massive consolidation has also taken place on the provider side, with most metropolitan areas dominated by a single hospital or flagship system.
Comparative-effectiveness research, changes in Medicare payments, encouraging greater competition through exchanges, even taxing high-cost health plans — none of this will seriously restrain costs without the creation of countervailing power to pressure consolidated insurers and provider systems to change their prices and practices. And the only place where this power can ultimately come from is the public sector. For better or worse, the ultimate fate of reform hinges on progressives’ efforts to rehabilitate American government…
Another death panel story, this one from the Fort Worth Star-Telegram:
At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.
Instantly, Doug Tracy knew something was wrong with his son.
“He wasn’t turning pink fast enough,” Tracy said. “When they listened to his chest, they realized he had an issue.”
That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.
Surgery would correct it, but within days of Houston’s birth March 15, Tracy learned that his application for health insurance to cover his son had been denied. The reason: a pre-existing condition…
David Leonardt in The New York Times highlights a key component of Obamacare that you may not have focussed on. I hadn’t, anyway.
Incidentally, if the first person to call the bill “Obamacare” was a Republican, that person will have a lot to answer for in years to come. Johnson wasn’t lucky enough to have Medicare named after him.
For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago…
Meet Texas congressman Randy Neugebauer, the ranking Republican on the Agriculture Committee's Livestock, Dairy, and Poultry Subcommittee. He’s opposed to killing babies, too!
From the Washington Independent:
Kathy Ropte — like Jackson, a member of the Harris County, Ga. Tea Party, had started to move beyond lobbying. As cameras snapped away, she stood in front of the Cannon Building and announced the termination, “to take effect in November,” of pro-health care reform members. One activist chided her for the display, which included a massive sign reading “Waterboard Congress.” Jackson didn’t care. She was in the fight, whether or not health care reform passed.
“One day I turned off American Idol,” Ropte told TWI, “and I turned on Fox News. Before this year I’d never voted in my life.”
Bart Stupak might want to beef up his obstructionism by weighing down the health care bill with the language William Blum suggests below. Go for it, Bart. There are innocent lives to be saved!
About half the states in the US require that a woman seeking an abortion be told certain things before she can obtain the medical procedure. In South Dakota, for example, until a few months ago, staff was required to tell women: “The abortion will terminate the life of a whole, separate, unique, living human being”; the pregnant woman has “an existing relationship with that unborn human being,” a relationship protected by the U.S. Constitution and the laws of South Dakota; and a “known medical risk” of abortion is an “increased risk of suicide ideation and suicide.”
…I'd like to suggest that before a young American man or woman can enlist in the armed forces s/he must be told the following by the staff of the military recruitment office:
“The United States is at war [this statement is always factually correct]. You will likely be sent to a battlefield where you will be expected to do your best to terminate the lives of whole, separate, unique, living human beings you know nothing about and who have never done you or your country any harm. You may in the process lose an arm or a leg. Or your life. If you come home alive and with all your body parts intact there’s a good chance you will be suffering from post-traumatic stress disorder. Do not expect the government to provide you particularly good care for that, or any care at all. In any case, you may wind up physically abusing your spouse and children and/or others, killing various individuals, abusing drugs and/or alcohol, and having an increased risk of suicide ideation and suicide.
“No matter how bad a condition you may be in, the Pentagon may send you back to the battlefield for another tour of duty. They call this ‘stop-loss’. Your only alternative may be to go AWOL. Do you have any friends in Canada? And don’t ever ask any of your officers what we’re fighting for. Even the generals don’t know. In fact, the generals especially don’t know. They would never have reached their high position if they had been able to go beyond the propaganda we’re all fed, the same propaganda that has influenced you to come to this office.”
…Do we want to live in a country in which the fortunate (medically speaking) accept additional insurance costs in order to provide for the unfortunate? Or do we wish to live in a country in which the fortunate are permitted to separate what happens to them from what happens to the unfortunate? Notice that by “fortunate” and “unfortunate” I do not mean “those who do not get sick” and “those who do get sick.” That would be looking at the matter ex post. I mean by fortunate “those less less likely ex ante to get sick,” and by “unfortunate” I mean “those more likely ex ante to get sick.” We are still talking probabilities here, of course. Even the young and healthy sometimes get cancer and have heart attacks. They just do so much less often. And by the same token, even multiple cancer sufferers sometimes go cancer free for the rest of their lives. But that too occurs much less often.
When we clear away all the bafflegab, all the confusion, all the posturing and bickering and procedural wrangling, all the political maneuvering, what we find is that the Democrats want America to be a country in which the fortunate shoulder some of the burdens of the unfortunate. And the Republicans want America to be a country in which they do not. In short, if I may put it this way, the Democrats want America to be a Christian country, and the Republicans want America to be a Godless country…
Here is an economic primer for all your teabagger friends from Fred Clark at slacktivist. It deserves as wide circulation as it can possibly get. Now I’ve done my part. Do yours.
Hey you. You there in the Glenn Beck T-shirt headed off to the Tea Party Patriot rally.
Stop shouting for a moment, please, I want to explain to you why you’re so very angry. You should be angry. You’re getting screwed. I think you know that. But you don’t seem to know that it doesn’t have to be that way. You can stop it. You can stop it easily because the system that’s screwing you over can only keep screwing you over if you keep demanding that it do so.
So stop demanding that. Stop helping the system screw you over.
Look, you can go back to yelling at me in a minute, but just read this first.
1. Get out your pay stub.
Or, if you have direct deposit — you really should get direct deposit, it saves a lot of time and money (I point this out because, honestly, I’m trying to help you here, even though you don’t make that easy Mr. Angry Screamy Guy) — then take out that little paper receipt they give you when your pay gets directly deposited.
2. Notice that your net pay is lower than your gross pay. This is because some of your wages are withheld every pay period.
3. Notice that only some of this money that was withheld went to pay taxes. (I know, I know — yeearrrgh! me hates taxes! — but just try to stick with me for just a second here.)
4. Notice that some of the money that was withheld didn’t go to taxes, but to your health insurance company.
5. Now go get a pay stub from last year around this time, from January of 2009.
6. Notice that the amount of your pay withheld for taxes in your current paycheck is less than the amount that was withheld a year ago.
That’s because of President Barack Obama’s economic stimulus plan, which included more than $200 billion in tax cuts, including the one you’re holding right there in your hand, the tax cut that’s now staring you in the face. Republicans all voted against that tax cut. And then they told you to get angry about the stimulus plan. They didn’t explain, however, why you were supposed to get angry about getting a tax cut. Why would you be? Wouldn’t it make more sense to get angry at the people who voted against that Obama tax cut?
But taxes aren’t the really important thing here. The really important thing starts with the next point…
7. Notice that the amount of your pay withheld to pay for your health insurance is more than it was last year.
8. Notice that the amount of your pay withheld to pay for your health insurance is a lot more than it was last year. I won’t ask you to dig up old paychecks from 2008 and 2007, but this has been going on for a long time. Every year, the amount of your paycheck withheld to pay for your health insurance goes up. A lot.
9. Notice the one figure there on your two pay stubs that hasn’t changed: Your wage. The raise you didn’t get this year went to pay for that big increase in the cost of your health insurance.
10. Here’s where I need you to start doing a better job of putting two and two together. If you didn’t get a raise last year because the cost of your health insurance went up by a lot, and the cost of your health insurance is going to go up by a lot again this year, what do you think that means for any chance you might have of getting a raise this year?
11. Did you figure it out? That’s right. The increasing cost of health insurance means you won’t get a raise this year. Or next year. Or the year after that. The increasing cost of health insurance means you will never get a raise again.
That’s what I meant when I said you really should be angry. That’s what I meant when I said you’re getting screwed.
OK, we’re almost done. Just a few more points, I promise.
12. The only hope you have of ever seeing another pay raise is if Congress passes health care reform. Without health care reform, the increasing cost of your health insurance will swallow this year’s raise. And next year’s raise. And pretty soon it won’t stop with just your raise. Without health care reform, the increasing cost of your health insurance will start making your pay go down.
13. I wish I could tell you that this was just a worst-case scenario, that this was only something that might, maybe happen, but that wouldn’t be true. Without health care reform, this is what will happen. We know this because this is what is happening now. It has been happening for the past 10 years. In 2008, employers spent on average 25 percent more per employee than they did in 2001, but wages on average did not increase during those years. The price of milk went up. The price of gas went up. But wages did not. All of the money that would have gone to higher wages went to pay the higher and higher and higher cost of health insurance. And unless Congress passes health care reform, that will not change.
Well, it will change in the sense that it will keep getting worse, but it won’t get better. Unless the problem gets fixed, the problem won’t be fixed. That’s kind of what “problem” and “fixed” mean.
14. Sadly for any chance you have of ever seeing a raise again, it looks like Congress may not pass health care reform. It looks like they won’t do that because they’re scared of angry voters who are demanding that they oppose health care reform, angry voters who demand that Congress not do anything that would keep the cost of health insurance from going up and up and up. Angry voters like you.
15. Do you see the point here? You are angrily, loudly demanding that Congress make sure that you never, ever get another pay raise as long as you live. Because of you and because of your angry demands, you and your family and your kids are going to have to get by with less this year than last year. And next year you’re going to have to get by with even less. And if you keep angrily demanding that no one must ever fix this problem, then you’re going to have to figure out how to get by on less and less every year for the rest of your life.
16. So please, for your own sake, for your family’s sake and the sake of your children, stop. Stop demanding that problems not get fixed. Stop demanding that you keep getting screwed. Stay angry — you should be angry — but start directing that anger toward the system that’s screwing you over and taking money out of your pocket. Start directing that anger toward fixing problems instead of toward making sure they never get fixed. Instead of demanding that Congress oppose health care reform so that you never, ever, get another pay raise, start demanding that they pass health care reform, as soon as possible. Because until they do, you’re just going to keep on getting screwed.
And it’s going to be that much worse knowing that you brought this on yourself — that you demanded it.
Thanks for your time.
The number of Americans without health insurance to its highest level in more than a decade in the first half of 2009, according to a new survey from the National Center for Health Statistics at the Centers for Disease Control and Prevention. The uninsured went from 14.7 percent of the population in 2008 to 15.1 percent in the first half of 2009. That was a jump of 1.6 million people to 45.4 million.
If you include the number who were uninsured at least part of the yeear, the number jumped by 2.5 million to 58.4 million people. The number without health insurance at some point during the year soared to 19.4 percent from 18.7 percent the previous year.
The problem continues to be concentrated among working age adults. The number of 18-to-64-year-olds without coverage jumped a full percentage point and now is over one in every four adults (25.3 percent). On the other hand, the number of uninsured children fell to 8.2 percent, its lowest level in more than 15 years due to the government expansion of the Children's Health Insurance Program.
Among the insured, just two-thirds of those under 65 received coverage through privage insurance companies, the lowest level since the CDC started keeping the records. About 20 percent got coverage through public plans (Medicaid, sCHIP) while the remainder went uninsured.
Ripley has a terrific post up at Whiskey Fire. Read it all here. Teaser follows:
…Of course, living in Smalltown, USA means kids and families will experience those things that kids and families everywhere experience as children grow up - skinned knees, stubbed toes, stomach cancer, Crohn’s disease, leukemia, brain tumors, massive skin grafting after a fire... you know, those boo-boos that define childhood.
Here’s a slightly gruesome, only slightly off-topic question for you: What’s the best way to market your band in a small town? Answer: Wait for some kid to get sick and play at their benefit! Seriously…
…from today’s Nicholas D. Kristoff column:
Why is it broadly accepted that the elderly should have universal health care, while it’s immensely controversial to seek universal coverage for children? What’s the difference — except that health care for children is far cheaper?…and from Gail Collins:
Has anybody noticed that the people who darkly warn about government bureaucrats forcing insurance companies to cut back our coverage appear to be the same ones who just voted to force insurance companies to stop covering abortions? Where’s the sanctity of the marketplace when we really need it?
Connecticut’s Joe Lieberman, in full smarm mode, has lately been congratulating himself for having the courage to follow his conscience. That poor, wizened little organ has apparently been urging the senator to block passage of the health reform bill by any means possible.
To make it perfectly clear that you can’t blame me for my state’s junior senator, I’m resurrecting this Golden Oldie from last March:
In 2000 a Republican no-hoper named Philip Giordano was running against Lieberman for the senate seat that Holy Joe was clinging to for dear life while simultaneously dragging down the national Democratic ticket as the vice presidential candidate.
I only knew two things about Giordano. One was that he was mayor of Waterbury, which is significant in Connecticut politics. It signifies that you haven’t been indicted yet, but hold your horses. You’ll get there soon enough.
The second thing I knew was that Giordano wasn’t Joe Lieberman, which left me with no option but to cast the first vote of my life for a Republican.
Meanwhile the FBI had already been quietly investigating Giordano for corruption, a process which is more or less automatic when it comes to Waterbury mayors.
During “Operation LandPhil,” as the Bureau called it, the wiretappers snapped to attention one day when they overheard Giordano making arrangements with a local prostitute to bring two girls, aged nine and ten, to his office for oral sex. Now the former Marine is doing 37 years in federal prison.
And still I don’t regret my vote. I’d rather be represented in the Senate by a pedophile than by a whiny, smarmy, sanctimonious warmonger with the blood of innumerable nine- and ten-year-old girls on his hands.
I have a contact in the health insurance industry who tells me that the great under-discussed elephant in the parlor of the current healthcare debate is how much doctors charge for their services. So let’s discuss it. Take a look at the stunning charts in the article from which this is an excerpt, bearing in mind that the other countries deliver better results by practically any measure than our own system does.
Less, it turns out, really is more.
…There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same — the volume of procedures, the days we spend in the hospital, the number of surgeries we need — but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.
In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn’t set those rates for private insurers, which is why the prices paid by Medicare, as you’ll see on some of these graphs, are much lower than those paid by private insurers. You’ll also notice that the bit showing American prices is separated into blue and yellow: That shows the spread between the average price (the top of the blue) and the 90th percentile (the top of the yellow). Other countries don’t have nearly that much variation, again because their pricing is standard…
The flurry of stories about finally putting the health insurance under the antitrust laws like everybody else have left me puzzled. How could such an outrage have been going on since 1945 without anybody noticing? And by anybody, I mean me.
Here’s the answer, taken from an excellent story by Matthew Perrone of the Associated Press:
But industry analysts say courts have long limited the scope of the exemption to allow federal regulators to intervene in instances where competition could be jeopardized. They note the law has never stopped regulators at the Department of Justice and the Federal Trade Commission from intervening in a merger or acquisition.
In practice, the exemption from federal antitrust laws mainly allows insurers to share data on payments and risk ratings — a useful collaboration among life and casualty insurers. But Wall Street analysts point out that giant health insurance companies like Humana, Wellpoint Inc. and UnitedHealth Group have little need to share data, thanks to their national size and scope.
“While the threat to repeal the exemption makes for good headlines, we can’t really see how it alters the business for the established publicly traded players,” wrote JPMorgan analyst John Rex in a note to investors.
With 94 percent of U.S. health insurance markets meeting the Justice Department standards for “highly concentrated” — meaning dominant insurers face little competition — most academics agree reform is needed. But they point out that federal regulators could have prevented much of that concentration under existing law.
Since 1996, the federal government has cleared 400 mergers in the health insurance field, according to the American Medical Association.
The Washington attorney who brought this to my attention was full of admiration. “Terrific politically,” he said. “Scores major PR points without the need to risk any substantive change. Bill Clinton would have loved it.”
Here’s the Word of the Lord from John Hart, who is communications director for famed Christian Senator Tom Coburn of Oklahoma:
Coburn’s opposition to government programs, Hart said, stemmed from his concern for the poor. “His faith informs everything he does,” Hart said. He went on to say that, in the New Testament, Jesus mentions the poor some 300 times. “He doesn’t view the Bible as a think-tank document.,” Hart said. So, Coburn, before he contemplates a policy, Hart said, first asks himself, “How will it impact the people least able to fend for themselves?”
“He has come to the conclusion that large government enterprises harm poor more than help them,” Hart said, offering Medicaid as an example. He conceded that the government health-care program does help some poor people, but he contends that it hurts others, because “40 percent of doctors refuse to accept Medicaid.” (Coburn is an MD himself.)
Hart said that the expansion of Medicaid beyond the ranks of the “truly poor” will only hurt more people.
And, in a not unrelated story, we learn that, “Only one in four Oklahoma public high school students can name the first President of the United States, according to a survey released today.”
From the Washington Post:
— An Oct. 16 Metro article about the funeral of Capt. Mark R. McDowell, who was killed in July while serving in Afghanistan, misstated the name of one of the medals he received. McDowell was awarded the Air Force Commendation Medal, not the Air Force Accommodation Medal.
(The Accommodation Medal went to the Senate Democratic majority for its work on the health reform bill.)
From David Sirota. Sounds about right to me:
So the notion that Snowe’s vote — or any GOP vote — is inherently pivotal to health care reform is a fantasy created by the Beltway media and the Democratic congressional leadership. The former is desperately trying to manufacture headline-grabbing drama; the latter is looking for a Republican excuse to water down the bill and protect corporate interests — all while absolving Democrats of legislative responsibility…
…if you’re a health insurance company. Astonishing. Something else I unaccountably never knew:
As the debate over health care reform rages on, there’s been almost no attention to the fact that health and medical malpractice insurance companies since 1945 have been exempt from the federal antitrust laws aimed at keeping every other private market competitive. The McCarran-Ferguson Act has allowed insurance companies to dominate markets and reap enormous profits, according to several witnesses who testified at a Senate Judiciary Committee hearing this morning.
As Committee Chairman Patrick Leahy (D-Vt.) explained at the hearing, the health insurance industry — unlike any other private industry in the country — is allowed to engage in price fixing, bid rigging and market allocation, all of which would violate the law if any other sort of company did it. Last month Leahy introduced the Health Insurance Industry Antitrust Enforcement Act of 2009, which would repeal the antitrust exemption for health insurance and medical malpractice insurance providers. Sens. Harry Reid (D-Nev.), Dianne Feinstein (D-Calif.), Russell Feingold (D-Wis.), Charles Schumer (D-N.Y.), Richard Durbin (D-Ill.), Arlen Specter (D-Pa.) and Al Franken (D-Minn.) are co-sponsors.
H/T to Hendrik Hertzberg for pointing me to this great musical comment on America’s crippled and corrupt health care system:
From the Associated Press:
WASHINGTON – A Senate committee voted Tuesday night to restore $50 million a year in federal funding for abstinence-only education that President Barack Obama has pushed to eliminate.
The 12-11 vote by the Senate Finance Committee came over objections from its chairman, Democratic Sen. Max Baucus of Montana.
Two Democrats — Kent Conrad of North Dakota and Blanche Lincoln of Arkansas — joined all 10 committee Republicans in voting “yes” on the measure by Republican Sen. Orrin Hatch of Utah.
Let’s hear it for the death panels, Lewis Lapham more or less says:
Like the military industrial complex, the medical industrial complex invites the practice of large-scale fraud, the hospital surcharges for an apple or an artificial limb comparable to the cost-overruns paid by the Pentagon for a cruise missile or a wrench. The “waste” and “inefficiency” in the system is its bone and marrow. Of the $304 billion appropriation levied by the seven richest pharmaceutical companies in 2007, $97 billion was allotted to marketing and sales promotion ($27 billion in the form of free meals and drug samples given to attentive physicians), another $76 billion to payroll (earnings worth $29 million to the Chief Executive of Johnson and Johnson, $25 million to the Chairman of Wyeth), lastly $40 billion (13% of the whole), to Research and Development…
Which isn’t to suggest that our doctors forswear the Hippocratic Oath, or that our politicians abandon hope of squeezing the pus out of the health care system. But where is the blessing to be found in the wish to live forever? A substantial fraction of the annual tithe collected by the medical industrial complex is the invoice ($528 billion) submitted to payees in the last, often wretched, years of their lives.
The corpses in waiting serve as sacrificial offerings placed on the altars of the god in the ATM. Plato thought it “shameful” to provide medical help “not for wounds or some seasonal illnesses” but because one “is filled with gases and phlegm, like a stagnant swamp…” Socrates in the dialogue with Glaucon strengthens the argument with the observation that it is wrong to prolong lives no longer “profitable either to themselves or anyone else.” Medicine, he says, isn’t intended for such people, “not even if they are richer than Midas.”
These variations on a theme are all excerpted from today’s New York Times:
During the transition, the administration created an online “Citizen’s Briefing Book” for people to submit ideas to the president. “The best-rated ones will rise to the top, and after the Inauguration, we’ll print them out and gather them into a binder like the ones the president receives every day from experts and advisors,” Valerie Jarrett, a senior adviser to Mr. Obama, wrote to supporters.
They received 44,000 proposals and 1.4 million votes for those proposals. The results were quietly published, but they were embarrassing — not so much to the administration as to us, the ones we’ve been waiting for.
In the middle of two wars and an economic meltdown, the highest-ranking idea was to legalize marijuana, an idea nearly twice as popular as repealing the Bush tax cuts on the wealthy.
The latest CBS News poll found that 51 percent of those over 64 said health care reform would hurt senior citizens, compared with 36 percent of all adults surveyed. Just 31 percent of respondents over 64 said they approved of Mr. Obama’s handling of health care, compared with 40 percent over all.
What do you get when you combine the worst economic downturn since the Depression with the first black president? A surge of white racial resentment, loosely disguised as a populist revolt. An article on the Fox News Web site has put forth the theory that health reform is a stealth version of reparations for slavery: whites will foot the bill and, by some undisclosed mechanism, blacks will get all the care. President Obama, in such fantasies, is a dictator and, in one image circulated among the anti-tax, anti-health reform “tea parties,” he is depicted as a befeathered African witch doctor with little tusks coming out of his nostrils. When you’re going down, as the white middle class has been doing for several years now, it’s all too easy to imagine that it’s because someone else is climbing up over your back.
Surrounded by middle-aged white guys — a sepia snapshot of the days when such pols ran Washington like their own men’s club — Joe Wilson yelled “You lie!” at a president who didn’t.
But, fair or not, what I heard was an unspoken word in the air: You lie, boy!
As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition…
“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”
By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”
Complex arguments are being batted around in this health care debate, but the central issue isn’t technical but moral. The first question is simply this: Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?
Actually, yes. It really is.
…but he got over it. From a New York Times piece on the man who wants to bring President Obama to his Waterloo by denying health care to uninsured Americans:
Rather, South Carolina voters seem more interested in whether [Senator Jim] DeMint might run for president.
“I wouldn’t get out of my driveway without my wife shooting me in the back,” he said in Greenville. “You’ve got to find somebody who’s smart enough to be a great president but dumb enough to want to be president. Right now, I think I’m still too smart to be president.”
Watch the repulsive physician/senator Tom Coburn as he comforts a grief-stricken Oklahoma constituent with a sick husband. Oklahoma voters (their other senator is James Inhofe) have a lot to answer for.
…”A Nation of Children Roots for the Mafia.” By all means read Joe Bageant’s complete take on healthcare. Excerpts:
There ain’t any healthcare debate going on, Bubba. What is going on are mob negotiations about insurance, and which mob gets the biggest chunk of the dough, be it our taxpayer dough or the geet that isn’t in ole Jim’s impoverished purse. The hoo-ha is about the insurance racket, not the delivery of healthcare to human beings. It’s simply another form of extorting the people regarding a fundamental need — health.
Unfortunately, the people have been mesmerized by our theater state’s purposefully distracting and dramatic media productions for so long they’ve been mutated toward helplessness. Consequently, they are incapable of asking themselves a simple question: If insurance corporation profits are one third of the cost of healthcare, and all insurance corporations do is deliver our money to healthcare providers for us (or actually, do everything in their power to keep the money for themselves), why do we need insurance companies at all?
Answer: Because Wall Street gets a big piece of the action. And nobody messes with the Wall Street Mob (as the bailout extortion money proved). Better (and worse) presidents have tried. Some made a genuine effort to push it through Congress. Others expressed the desire publicly, but after getting privately muscled by the healthcare industry, decided to back off from the idea…
Most of all though, it is testimony that we live under an induced mass hallucination where spectacle replaces fact, information and common sense. In place of actionable information, we are served up screaming red faces — angry mobs manufactured for TV protesting “government interference in the people’s healthcare choices.” One must wonder what inchoate anger is really being tapped by the organizers of these strange “citizen protests.” As usual, the straw boogeyman of socialism is once more invoked. “Oh my god! I’ll have to give up my $1,100 a month insurance bill, which only pays 80% of my insurance costs AFTER I pay the initial $5,000 of those costs! If that ain’t Joe Stalin all over again, I don’t know what is!” We get the false media drama of “death panels.”
And being captives of spectacle and hyperbole, we friggin love it. The idea of death panels plays to our childish attraction to the extreme and entertaining. Killing Grandma is far more entertaining to our imaginations than say, guaranteed access to chest screens and blood pressure medicine. Two generations into this national infantilization, it’s now the only national life we know — the ideological spectacle made real.
Excerpted from The Rude Pundit, who wants us to fight bullshit with bullshit. And he’s right.
The push for health care reform needs to be presented as a civil rights movement.
That’s the bottom line, but let’s put it at the top here: in the arguments about public options and co-ops and whatever, the left, in Congress and elsewhere, has allowed the right to control the language of the debate. And instead of arguing morality and greater good, this has all been about economics.
People don’t understand economics. They don’t get the idea of exchanges. It’s complicated shit written by and for the people who do get it. The people in this country only think that some money they thought they had is being given to people who don’t have it. So it had better be fuckin’ worthwhile. Make it into the difference between being for a right and against a right. And that means taking all the risks that accompany the granting of a civil right…
God, the lies conservatives spout when it comes to the perceived evils of giving people rights. During a good chunk of the 20th century, we were told such convenient myths about desegregation like property values would decline if black people moved into a neighborhood (a lie created by real estate agents looking to artificially deflate and then re-inflate the worth of homes), not to mention the horrors of interracial sex (which one supposes came true for racists with the rise of Barack Obama), rampant black crime in whites’ nice suburbs, and so very much more.
There’s not a nickel’s worth of difference between the mobs of white people shouting at black children walking into a newly-integrated school and the people standing up and shouting at members of Congress at town halls. And they have to be fought in much the same way, which means the government needs to ignore them.
What happens when it leaves the realm of economics is you can start throwing bullshit, emotional rhetorical devices around. Forty-seven million? That’s more than the number of African Americans. It’s over ten times as many Native Americans, like five times the number of Asians. Would you want to deny health care to your IT guys? See, that’s a bullshit argument but it offers perspective. Perfect for this atmosphere.
Republican Tom Coburn is a medical doctor, a church deacon, and the junior U.S. Senator from Oklahoma. Here he is on Meet the Press yesterday:
Look, the, the idea that we ought to talk about our future health and what our family and what we want done is a good idea, it’s legitimate. What is not legitimate is having government even weigh in on it. It is intensely personal; your health care, your plans, your family. There is no role for government in that. And where we’ve seen a role — and, and this happens all the time, which goes to one of the things that never gets talked about in health care — is we have statements, living wills. We have people who have made those very tough decisions. And then, because they’ve made them, but because of the malpractice situation and liability, they’re ignored. And we still intubate and put people onto ventilators that never wanted it because a family member threatens through a situation, even though you have that end of life counseling there.Help me out here. Does Coburn mean, for instance, that government should keep its grubby paws off a woman’s decision to have an abortion? That he would defend Dr. Kerkorian? Would he oppose any effort by “the government” to punish medical malpractice? To regulate or otherwise control drugs and their prescription by doctors? Does all that stuff about ventilators and intubations mean anything, and if so, what? That he wants death panels but only if he’s on them?
Having just posted the previous item, it occurs to me that I have a horror story of my own.
Some years ago a raccoon got into the house through a cat door, and bit me on the hand as I was wrestling it into a trash can. Since any coon abroad in daylight is likely to be sick I shot the animal and put its head in the freezer till the animal control officer could collect it. The day afterward I got a call from the health department to tell me that the coon’s brain had tested positive for rabies.
My primary care physician sent me to the emergency room to begin the three-week course of shots. That was the end of it, I figured. But then I got a bill for close to $3,000. Anthem Blue Cross Blue Shield was refusing to pay on grounds that I should have gone to my primary care physician for the shots.
And the adventure began — the hideous experience that everyone screwed by the private sector is forced to suffer. Cable companies, power companies, phone companies, you name it. The endless phone trees leading nowhere. The stalling. The promises to call you back that are never kept. The repeating each time of the same story to a different agent. The refusal on grounds of “company policy,” presented as something authored by God before which mortals are, alas, powerless.
Logic, as Professor Higgins told Colonel Pickering, was never even tried: “But my primary care physician is the one who sent me to the emergency room.” “I understand, sir, but all shots must by given by your primary care physician.” “But he didn’t even have the shots.” “I’m sorry, sir, it’s company policy.”
I took my problem to the doctor who ran the emergency room, a man I play poker with. “Those sons of bitches,” he said. “This is the kind of shit they always pull.”
He told me that no doctor in our part of the state keeps rabies vaccine in the office. It’s enormously expensive and goes bad quickly, and a doctor may go years without having a call for it. So the emergency room serves as the sole repository for the whole area.
“Blue Cross says they’re rejecting my whole claim because the ER charges more to give shots,” I said. Bullshit said the ER, and got on the phone to my primary care physician. The difference in cost for administering all the shots turned to be something like $25, total.
Back to the phone tree. I offered to pay the $25 difference, but of course this was against company policy. I could, however, take my case to our appeals board. May I have their address, then? Certainly, sir, and thank you for calling Anthem Blue Cross/Blue Shield of Connecticut.
And so I filed the appeal, and weeks passed, then months. At last the appeal was rejected. I then appealed the rejection, more or less as follows:
I do not have $3,000 to send you. I can get it, though, if you’re sure you want me to. The way I get money is by writing stuff and selling it to things like newspapers and magazines. The people who read my stuff may not know much about medicine, but there is one thing that each and every one of them knows.
This is that a human being infected with rabies who is not treated in time will die in one hundred percent of the cases. In fact such a human being just did, that young Connecticut girl who was bitten by a rabid rat while she was sleeping and didn’t realize it until the symptoms showed up.
You will recall, as will everybody in the state, that this girl died a slow and agonizing death, at a cost to her insurance company that must have run to hundreds of thousands of dollars. The exact figure may even be in your own files.
To assist you in considering this matter, I enclose a list of my published articles and books.
Yours sincerely, etc .
This time the logic of my argument proved to be powerful enough for even an insurance company to grasp. The check, eventually, did indeed turn out to be in the mail.
Since I practically never run across anybody without at least one horror story about health insurance (unless they’re on Medicare), I’ve been constantly surprised at the percentage of Americans who tell pollsters they’re satisfied with their private-sector insurance.
I should have guessed:
In addition, data from a Kaiser Family Foundation poll last year, compiled at the request of The Washington Post, suggest that the people who like their health plans the most are the people who use them the least.
Those who described their health as “excellent” — people who presumably had relatively little experience pursuing medical care or submitting claims — were almost twice as likely as those in good, fair or poor health to rate their private health insurance as excellent...
Insurers argue that a government plan could dominate the market, reducing consumers’ options. But in the private market, options are limited by employers who restrict employees’ choice of insurers and by insurers who restrict their choice of doctors.
…pictured here at a town hall meeting in Romulus, Michigan…
On Wednesday our freshman Democratic congressman, the excellent Chris Murphy, held a rally in Simsbury, Connecticut. In the crowd were a number of just plain folks rising up from the grassroots to petition for a redress of their grievances against healthcare reform.
Note particularly the disinterested citizen in the blue polo shirt with the logo of Anthem Blue Cross and Blue Shield on the sleeve. His sign, which he carefully points out is handmade, reads, “We Don’t Want Gov’t Run Healthcare.” (H/T to My Left Nutmeg.)
Watch closely at the very beginning, as the polished debater in the red cap gets his lines from Coach before vomiting them up:
Ignore that tiresome squabbling in Washington about whose health insurance plan is better and get yourself down to Big Bob’s Healthcare Emporium. Big Bob’ll fix you up with some healthcare that will knock your socks off. And for a price even a deadbeat Democrat could smile about.
Let’s start with this week’s special: Bob is offering a deeply discounted starter family plan for an unbelievable $28.50 a month. No deductible, no co-payments, no exclusions, no problems. The plan covers everybody in the family from Granny on down to Baby Snookums — doctors, hospital, medicine, transportation, rehab, home care, prosthetics, dentures, you name it, it’s covered. Covers up to 72 family members including first cousins once removed and second cousins. With a plan like this you can’t afford not to get sick. After the first month, rates may increase slightly, but, hey, there’s no free lunch, right?
And wait’ll you hear about this baby. A nifty plan that’s drawn a lot of attention recently is the Bankers ’n Brokers bonus plan. This one is restricted to members of the financial fraternity/sorority but it’s so good you’ll want to start thinking about switching careers. Here’s how it works.
You give Big Bob a million bucks and he insures your ass six ways to Sunday. Bob invests the million with his pal Bernie the Mad Off and Bernie doubles the million in about a year. Bob keeps the earnings and returns your original million less administrative fees, a small commission, insurance premiums, miscellaneous expenses, and a few other minor costs not worth mentioning.
Your net adjusted gross net still represents a tidy pile of green and you’ve had the security of knowing the costs of your breakdown, your cocaine rehab and your defense counsel would have been fully covered. This is not a plan for the financially skittish.
Another favorite in this politically charged year is the Tell Obama To Go Stuff It Comprehensive Family Healthcare Insurance Plan. This one provides good basic insurance coverage for upscale, discriminating people who would rather not think about things that don’t concern them — like medical insurance for, well, you know, Them. Exclusive, expensive, this is insurance that feels like an Armani jacket and is worth every penny.
The Blue Dog Special. This plan was originally designed for those House Democrats who want to be known as progressive conservatives or conservative progressives. They want the advantages of being part of the Democratic Party along with the freedom to vote like fiscally responsible Republicans. They don’t need medical insurance because as Members of Congress, which you’re not, they have some the best coverage in the world, which you don’t. Bob gives this insurance to the Blue Dogs free for the PR value even though it has no PR value. That’s the kind of guy Bob is.
Then there’s Big Bob’s Own HMO, which offers a wide range of plans to suit just about everybody under the sun. The plans are much too complicated to go into here, but be assured they are as full of clever ideas for helping people through tough times as the plans offered by better known insurance companies. Don’t forget: When the going gets tough, the tough get going.
If it walks and talks like socialized medicine it is socialized medicine. Big Bob knows a thing or two about the practice of medicine in this country and he knows socialized medicine when he sees it. Bob says the plans the Democrats are fighting about are all socialized medicine in one form or another. Get the government into the picture and you can forget about decent health care in this country.
What about Medicare? people ask. Isn’t that the government? Nonsense, says Big Bob. If the government was involved, Medicare couldn’t possibly work as well as it does. The Government only pretends to run Medicare, Big Bob says. It’s actually run by fiscally responsible Republicans and Blue Dog Democrats.
Big Bob’s Healthcare Emporium is open 24/7. Don’t wait. Get down to Big Bob’s now before all the good healthcare insurance policies are gone.
Anthony Piel, a friend and neighbor, was for many years a director and legal counsel of the World Health Organization. This is from a column he wrote for our local weekly, the Lakeville Journal.
…I have sent the Obama administration information about the WHO plan, because, when someone’s got a better mousetrap, why not copy it?
The WHO plan is better even than the health coverage of the U.S. Congress, or of any known HMO or private health insurance plan. For example, in addition to the usual costs of doctors’ visits, prescription drugs, immunizations, hospitalization etc., it covers mental, dental, eyeglasses, prosthetics, etc. It covers those costs anywhere in the world; you can break a leg in the Himalayas, and you’re covered, regardless of provider. WHO has special mechanisms for controlling cost charges in different countries, and drug companies and other providers fear to fight these controls.
For lesser medical costs, the WHO plan covers 80 percent; patient liability is 20 percent. But when there are catastrophic costs due to heart, stroke cancer etc., the WHO plan switches to as high as 100-percent coverage and the patient liability to as low as 0 percent. (That’s the WHO answer to “Sicko.”)
The cost under the WHO plan? Under $300 a month for a family of four. In other words, an affordable, universal health insurance plan is feasible. The WHO plan resembles a standardized, single-payer system, so administrative costs are a fraction of what they are under U.S. private plans. The WHO plan is fully funded, so it is not dependent on future tax revenue, and no one can borrow from it to wage foreign wars. There are enormous savings in the WHO plan, and all income is plowed back into the fund.
That’s the secret of success. All we have to do is copy it. The unique cost problem for the United States, unlike WHO, is that in the United States we’re playing catch-up. We have to prime the pump for all those people who have never yet paid into the plan, but will have immediate health costs. We also have to fund, or help pay the premiums for, the truly poor and unemployed. That could cost a few billion dollars. If we can recover the economy, with full employment, the Obama plan will ultimately pay its own way. We can one day provide truly universal coverage to achieve “Health for All.”
But do we have the political will to do so? The HMO, insurance and pharmaceutical industries are spending multi-millions of dollars in the guise of supporting health-care reform, lobbying Congress to exclude a public option from the mix, on the grounds that (a) it would be inefficient, (b) yet it would out-compete private plans, and (c) anyway it’s “socialized medicine…”
As Congress considers various proposals for overhauling our health care system, it would be well for us to recall the words of former Texas Senator Phil Gramm, who once said, “This is the only country where poor people are fat.”
Ex-senator Gramm, who was known as the bankers’ friend for the many kindnesses he bestowed on the finance industry, brought a brand of “compassionate conservatism” to his politics long before George W. Bush was a gleam in the eye of the Republican Party leaders. Gramm never used the phrase, that we know of, and we don’t hear much about it anymore, but compassionate conservatism is at the heart of the debate over health care reform. What it describes, basically, is a political philosophy that might be summed up thus: We’ve got ours and screw you, Jack.
Congress itself has health care coverage that is better than just about any plan currently available to the public. President Obama has said everybody should have the same coverage as he and all the employees of the federal government, including senators and congressmen, now have. That would be fair, he said.
But “fair” is one of those wishy-washy and fiscally irresponsible notions that liberals are always using to confound their opponents in debate. Phil Gramm had it right: If poor people would take better care of themselves and not go around eating Big Macs with fries and swilling down Pepsi they would be a lot healthier and wouldn’t need health care insurance. Most of the time, when poor people get sick it’s their own fault. If they can’t be bothered to take care of themselves, why should we?
This is a powerful argument and one can only wish that Phil Gramm were still in the Senate to make it. But Phil had to follow his destiny. It wasn’t enough to lead the deregulation charge that made it easier for banks to wheel and deal, Phil secretly yearned to be a banker. And now he is, right there in Washington, D.C., where the best deals have the biggest wheels.
But even without the stalwart leadership of Phil Gramm, Congress seems more than up to the challenge of thwarting the new president’s attempt to foul up a perfectly good national health care system. Since losing so many seats in both houses, the Republicans faced the possibility of being flattened by a unified Democratic Congress. Fortunately, the Democrats are never unified and the party’s dubious leadership in Congress and the Senate seems to be faltering.
Obama, who may be too committed to the idea of bi-partisanship for his own good, has given so much ground to pressure groups from everywhere that the bill, now a thousand pages-long, is all but incomprehensible, much less effective. It is so complicated the Democrats conducted an hours-long seminar in the House basement to make sure its Members understood what the hell the bill provides.
This was a good sign for opponents of the bill. Nothing stops progress like confusion. Meanwhile, help arrived, like the cavalry, with the Blue Dog Democrats of the House. This right-thinking group of fiscally responsible, if sometimes misguided, Democratic Congresspersons has done its obstructionist best to ruin Obama’s reckless plans. With skillful wielding of the monkey wrench and generous deployment of flies to ointment, this estimable band of brothers and sisters is doing its best to discredit the Obama Administration.
With any luck they will so befoul the health care plan that Obama will not recover and his presidency, which some fools believe to have great potential, will be fatally weakened. This would be a kind of justice for a country where the poor people are fat and the head of state is skinny.
Most sentient Americans have heard the bleatings from the medical industry, repeated endlessly for half a century, about the unspeakable horrors of the Canadian medical system.
Those of us who are even marginally skeptical will have dismissed this nonsense long since as the paid propaganda it is. Others may find the list below of interest. Or not, since for most of them anything said loudly enough and often enough must be true.
Anyway, the list:
1. Tommy Douglas
2. Terry Fox
3. Pierre Elliott Trudeau
4. Sir Frederick Banting
5. David Suzuki
6. Lester B. Pearson
7. Don Cherry
8. Sir John A. Macdonald
9. Alexander Graham Bell
10. Wayne Gretzky
Two questions will immediately occur to low-information Americans: Why is Gretzky number 10, and who did the other nine play for?
The list, however, is of the ten Canadians most admired by their countrymen, in a 2004 contest conducted by CBC Television. More than 1.2 million votes were cast. A third question, then. Who the hell is Tommy Douglas?
Oddly enough, considering the horrors he unleashed on his suffering nation, the “Greatest Canadian of All Time” was the father of Canadian Medicare:
For more than 50 years, his staunch devotion to social causes, rousing powers of speech and pugnacious charm made Tommy C. Douglas an unstoppable political force. From his first foray into public office politics in 1934 to his post-retirement years in the 1970s, Canada’s ‘father of Medicare’ stayed true to his socialist beliefs — often at the cost of his own political fortune — and earned himself the respect of millions of Canadians in the process…
Tommy Douglas’s legacy as a social policy innovator lives on. Social welfare, universal Medicare, old age pensions and mothers’ allowances — Douglas helped keep these ideas, and many more, watching as more established political parties eventually came to accept these once-radical ideas as their own.
Well, yeah, but how about all those Canadians, doctors included, heading south to escape the vicious embrace of affordable medical care?
As far as the healthcare seekers heading south, see this. (And for Americans heading south for care — to Mexico — see this. As for Canadian doctors fleeing their homeland, here’s one Canadian’s take on it:
A large number of doctors trained in Canada, with an education hugely subsidized by Canadian taxpayers, immediately head for the United States, where they can make much more money (Canada deals with this by poaching doctors from places like South Africa).
Most stay, but a few come back, giving as a reason the complete lack of focus in the American system on actually caring for patients. In the American system a doctor is not a professional, but a cog in a massive profit-making machine.
The main advantage of single-payer, besides the oodles of money it saves, is that it maintains the doctor-patient relationship as a professional medical relationship, not solely an economic relationship. Patients understand this, if politicians and ‘journalists’ do not.
From Paul Krugman’s blog:
A correspondent writes in, denouncing my latest column, and says that if things go my way we’ll end up with the government providing health care to everyone, which will “destroy the American way of life.”
Hmm. There’s a country this correspondent — and many others who denounce “socialized medicine” — should look at. It’s a country where there is, indeed, a substantial private health insurance industry, which pays 35 percent of medical bills. But the government pays a larger share — 46 percent. (Most of the rest is out-of-pocket spending.)
The country is called the United States of America.
It has recently come to my attention that the entire population of the world except for China is being poisoned by chemtrails. These are the apparently innocent contrails from commercial and military jets — secretly modified by the Power Structure to suppress evolution so that the New World Order (NWO) can be imposed on mankind.
Why and how? This is complicated stuff, so pay attention:
The NWO will fail if citizens become genetically empowered to wake up and fight with superhuman powers against tyranny. This is already occurring, and chemtrails are ultimately ineffectual at preventing the inevitable.
Few know the chemtrail program’s true purpose, and most of those implementing it have been told lies. They believe the “mass vaccination” scenario, that what they are doing is beneficial to citizens. Unfortunately this illusion, like all others created by the power structure, shall fall away in due time.
The point (more fully explained here) is that we are evolving into organisms with 12 helixes in our DNA rather than the standard two. Dr. Berrenda Fox is currently working with children who only have three helixes, but are already telepathic and can fill glasses of water just by looking at them. Plainly if this kind of thing continues, mankind will become too intelligent to fall for the Power Structure’s tricks.
But it will not continue, because many ordinary people such as yourself have already armed themselves with orgone generators capable of neutralizing the evolution-halting power of those chemtrails that fill our skies.
These generators may be had at the website linked above for $95 plus shipping and handling for the natural finish model and only fifteen dollars more for a copper patina finish.
If I were you I’d go for the copper patina option despite its higher price. Why? Here’s why:
While many people are fascinated by the natural look of orgone generators, other people might prefer a more finished, art-like appearance with less need to answers questions like: “What’s it’s for?”
The Weathered Copper Patina finish gives these orgone generators the look of an esoteric art object either dug up from a ancient Minoan archeological site or something Mr. Spock brought aboard The Enterprise. Either way, it looks nice sitting on a shelf, on top of the TV, or on a desk — without raising suspicions about its true function.
Here’s the money shot from an Associated Press story that the New York Times ran in today’s business section instead of on the front page where it belonged.
You have to admire the evil ingenuity and ravening greed of these people. Well, no, actually you don’t.
WASHINGTON (AP) — Congressional investigators said Wednesday that two-thirds of the nation’s health insurance industry used a faulty database that overcharged patients for seeing doctors outside their insurance network, costing them billions of dollars in inflated bills…
More than 100 million Americans have plans that allow them to see doctors who are not part of their insurance network. For more than a decade, insurers submitted data to Ingenix to determine the typical cost for care received in such visits.
But Congressional investigators say companies would deliberately skew data to underestimate the costs of medical services, leaving patients to pay more in out-of-pocket expenses.
“The result of this practice is that American consumers have paid billions of dollars for health care services that their insurance companies should have paid,” according to the report of the Senate Commerce Committee’s investigative staff.
From Paul Krugman’s blog:
Really bad news on the health care front. After making the case for a public option, and doing it very well, Obama said this:
“We have not drawn lines in the sand other than that reform has to control costs and that it has to provide relief to people who don’t have health insurance or are underinsured,” Mr. Obama said. “Those are the broad parameters that we’ve discussed.”
There he goes again, gratuitously making a big gift to the other side.
My big fear about Obama has always been not that he doesn’t understand the issues, but that his urge to compromise — his vision of himself as a politician who transcends the old partisan divisions — will lead him to negotiate with himself, and give away far too much. He did that on the stimulus bill, where he offered an inadequate plan in order to win bipartisan support, then got nothing in return — and was forced to reduce the plan further so that Susan Collins could claim her pound of flesh.
This doesn’t surprise me, but I hadn’t seen these figures before. They’re in a letter to the New York Times from David A. Balto, of the Center for American Progress.
I was disturbed to see your editorial suggest that the blame for “ever rising premiums” falls primarily on physicians. Let’s give credit where credit is due.
Between 2000 and 2007, the 10 largest publicly traded insurance companies increased their profits 428 percent, from $2.4 billion to $12.9 billion, according to Securities and Exchange Commission filings.
During the same period, the number of insurers fell by nearly 20 percent, largely because of a huge wave of mergers that led to stunning consolidation. And premiums increased by more than 87 percent, rising four times faster than the average American’s wages.
Today, 95 percent of American insurance markets qualify as tight oligopolies. As in so many industries, blind reliance on free-market forces has failed the American public.
Clearly, doctors bear a responsibility to curb costs. But the real culprits are the middlemen who, after years of lax regulation, now have such a tight grip on the market that they can — and do — charge whatever they want.
Factoid found in a New York Times story about free breast implants as a recruiting bonus for Czech nurses:
Dana Juraskova, the Czech minister of health and a former nurse … said there were other ways to motivate nurses: for example, the recent introduction of a fee of one euro, or about $1.40, for visiting a doctor — which spawned a national outcry in a country accustomed to free health care — had resulted in cost savings that were now being passed on to nurses, she said.
Father knows best, except, just maybe, when he’s sold us out to his campaign contributors in the insurance industry. Robert Parry at Consortium News:
As the health insurance industry and its defenders in Congress lay out their case against permitting a public option in a reform bill, perhaps their most curious argument is that some 119 million Americans are ready to dump their private plans and jump to something more like Medicare – and that’s why the choice can’t be permitted.
In other words, the industry and its backers are acknowledging that more than one-third of the American people are so dissatisfied with their private health insurance that they trust the U.S. government to give them a fairer shake on health care. The industry says its allies in Congress must prevent that.
The peculiar argument that 119 million Americans must be denied the public option that they prefer has been made most notably by Sen. Chuck Grassley of Iowa, ranking Republican on the Senate Finance Committee, which is one of two panels that has jurisdiction over the health insurance bill…
Facts have trouble making themselves heard over the orchestrated noise from offstage, right. But here are a couple anyway, from Paul Krugman’s blog:
Everyone knows that lots of Canadians come to America in search of medical care. But what everyone knows is wrong: a careful study concluded,The numbers of true medical refugees—Canadians coming south with their own money to purchase U.S. health care—appear to be handfuls rather than hordes.Driven by rising health care costs at home, nearly 1 million Californians cross the border each year to seek medical care in Mexico, according a new paper by UCLA researchers and colleagues published today in the journal Medical Care.
Don’t reject Charles Hugh Smith’s assessment of Medicare before you’ve read his whole argument. Unless you’re a better person than I am, he has thought harder about the matter than we have.
Given the choice between government ownership (Veterans Administration) and a “please loot and overmedicate us” Medicare system, I’d go with the VA model. The bastardized socialism of Medicare (no ownership, no accountability to anyone) is the worst possible system; at least the pure socialism of the VA eliminates the stupendous incentives for looting (bill for services) and the malpractice nightmare in which providers’ attempts to ward off lawsuits via endless tests and specialists end up costing more than the lawsuits (go ahead and sue the VA; good luck with that).
Given a choice between government care and a completely free market, I’d choose the free market — as “unfair” as it is. If people had to pay all their medical care in cash, an astonishingly rapid transformation would take place: virtually no provider could collect the bills Medicare routinely pays. The single greatest driver of Federal insolvency (Medicare) would disappear.
In terms of social welfare, the government could then fund modest programs in support of wellness and not getting ill in the first place, instead of funding programs which encourage illness because it’s so darned profitable, while keeping people well is insane because there is literally no profit in that at all…
I am particularly sickened by stories like this because one of my sons is a physician who has spent the last 20 years of his life preparing for a career in the management of pain.
That he could be jailed by some cruel and ambitious prosecutor is appalling. That his equally innocent patients could be sentenced to a life of pain by a cruel system of criminal “justice” gone mad is even worse.
Presently, I face going to a Federal penitentiary for the next 24 years and eight months without possibility of parole for a CRIME THAT NEVER HAPPENED. My family is devastated, not only because I’m facing a prison term, but they witnessed what my wife of 23 years and I went through during the grueling years of my medical training, at such an advanced age (I graduated medical school at age 42). It makes no sense that I, as a 53 year old physician, would suddenly get involved in the drug trade when I’ve spent years lecturing to students about the abuse of drugs, alcohol and cigarettes. I also spoke about teenage pregnancy, getting an advanced education (doesn’t have to be college). As an aside…imagine a product of the ghetto, becoming a board certified physician, Chief of Staff of a hospital, and Chairman of the Alabama Army National Guard Medical Board! Yet, the DEA and the U.S. Justice Department would have the general public believe that I was a common street-level drug dealer. What “profile” were they using?
For more of The Agitator’s coverage of pain treatment miscarriages of justice, go here and scroll around. Frightening stuff. A sample:
One red flag the government uses, for example, is to look for physicians who simply prescribe a raw number of pills that investigators say is too high, a practice pain advocates say has made doctors afraid of engaging in the high-dose opiate therapy course of chronic pain treatment that’s been so effective. Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis, a problem pain advocates say has become increasingly common not because more doctors are selling scripts to addicts and drug dealers, but because the few doctors who do still treat chronic pain are overwhelmed with patients whose former doctors have been arrested, stripped of their licenses, or run out of business by investigations.
More lifted from Matt Steinglass at Accumulating Peripherals. When I was his age I was easily half as smart as him, but there’s been considerable slippage since. As an extra bonus, the next-to-last paragraph contains an excellent example of an infinitive that had to be split in the interest of clarity.
One of the things that chess grand masters encounter when they play machines like Deep Blue that can’t be beaten by humans is that the machine sometimes makes moves that don’t appear to make any sense. Humans play chess by “clustering” classes of moves that tend to work well according to higher-level strategic insights built up over long experience in playing the game.
Machines play chess by calculating, with brute force computation, which moves lead to the best possible outcomes over the next hundred-odd rounds of play. So machine moves occasionally look weird, from a human point of view; humans simply can’t calculate far enough out to see why they work.
When Obama was running against Clinton and Edwards in the primaries and adopted the position that mandates were a bad idea, many health policy wonks were baffled. At the time (January 2008), a theory occurred to me, which I proposed to a journalist friend over dinner.
Everyone knows that the problem with instituting community rating (i.e. everyone pays the same price for health insurance) without mandates is that healthy young people will opt out of buying health insurance. This in turn makes health insurance more expensive, leading yet more healthy people to opt out, creating a gradual death spiral for insurance companies.
Meanwhile, if, as in Obama’s plan, a government-funded insurance plan has been set up that offers taxpayer-subsidized affordable coverage, private insurers will soon be unable to compete. So, if you institute community rating and a public plan without mandates, who will start pressing you to institute mandates? The private insurance companies.
You shift the political landscape so that your enemies start to use their strength in the service of your goals. Jujitsu! And meanwhile, since the public mostly opposes “mandates” because they sound mean, you can use your anti-mandate stance to beat your primary opponents. Double jujitsu!
Of course, this seemed too conspiratorial and deep to be an actual explanation for what Obama was doing … But I think we are starting to get a lot of evidence of how Obama views politics, and one thing he does religiously is to not get out ahead of his constituency. Another thing he does is to try to rearrange conflicts so that interests are aligned with each other, not freezing each other into gridlock — so that his side can win without having to beat anyone.
Anyway, Obama is now saying mandates are going to be a part of the health care solution proposed in the upcoming budget bill. Apparently he now thinks he has the political strength to do the whole reform at once, universal care, mandates, and all. Maybe he’s wrong, but he hasn’t been wrong yet.
You might be interested in how socialized medicine is working out for one American unfortunate enough to have it. Whole article here. Sample:
Even better is the speed, integration and comprehensiveness of the care. I can walk in unannounced any day and go to the walk-in clinic. I’ll wait a while, but get to see a doctor about my complaint relatively quickly.
I have a regular GP doctor there who calls me in every six months for another check up. They take the initiative to make the appointment and call me – and send me reminder letters – informing me of the time. The supportive lab work is done there too. Many specialists are in house. I now regularly see a rheumatologist there.
When any doctor or nurse working there needs to refer to my complete medical history, they just make a few key strokes and it appears on their computer screen. If they want me to have a blood test or an x-ray (or a sonogram or an EKG) they just hit a few more key strokes and send me down the hall for the procedure. Typically, I’m back in 30 minutes with the results already in their computer. If they want to order a medication, a few more key strokes and it’s ready for me down the hall at the pharmacy. They even have masseurs and nutrition counselors…
We are talking here about the non-Swiftian style of modest proposals, but Andrew Lahbe has decided to call it quits from the hedge fund industry and retire on what he says in his business is a modest sum. If you read the Financial Times, you will quite often find in it many insane proposals that their creators regard as groundbreaking proposals,
Andrew Lahbe offers up a modest proposal that seems to me to be entirely sensible, or mostly so. Since I don’t smoke pot and don’t find any benefit in it personally from a medical perspective - although I understand that others vehemently disagree, I am thus an agnostic and libertarian on this part of his article. Although I am suffering from chronic back pain right now and haven’t tried it for that purpose. In the past the weed just tended to make me dull and lazy.
By all means go read the whole thing. I only post a few interesting tidbits that I have edited modestly to whet your appetite for an article that appears in a place that for many who read this blog, no reasonable man dares to go. Some appetite whetters appear below. The whole thing appears here. I invite others to critique the proposal and find any flaws they find in it. I’ve done my part by critiquing the marijuana portion of the proposal.
I was in this game for the money. The low hanging fruit, i.e. idiots whose parents paid for prep school, Yale, and then the Harvard MBA, was there for the taking. These people who were (often) truly not worthy of the education they received (or supposedly received) rose to the top of companies such as AIG, Bear Stearns and Lehman Brothers and all levels of our government. All of this behavior supporting the Aristocracy only ended up making it easier for me to find people stupid enough to take the other side of my trades. God bless America.
Some people, who think they have arrived at a reasonable estimate of my net worth, might be surprised that I would call it quits with such a small war chest. That is fine; I am content with my rewards. Moreover, I will let others try to amass nine, ten or eleven figure net worths. Meanwhile, their lives suck. Appointments back to back, booked solid for the next three months, they look forward to their two week vacation in January during which they will likely be glued to their Blackberries or other such devices. What is the point? They will all be forgotten in fifty years anyway. Steve Balmer, Steven Cohen, and Larry Ellison will all be forgotten. I do not understand the legacy thing. Nearly everyone will be forgotten. Give up on leaving your mark. Throw the Blackberry away and enjoy life.
On the issue of the U.S. Government, I would like to make a modest proposal. First, I point out the obvious flaws, whereby legislation was repeatedly brought forth to Congress over the past eight years, which would have reigned in the predatory lending practices of now mostly defunct institutions. These institutions regularly filled the coffers of both parties in return for voting down all of this legislation designed to protect the common citizen. This is an outrage, yet no one seems to know or care about it. Since Thomas Jefferson and Adam Smith passed, I would argue that there has been a dearth of worthy philosophers in this country, at least ones focused on improving government.
Capitalism worked for two hundred years, but times change, and systems become corrupt. George Soros, a man of staggering wealth, has stated that he would like to be remembered as a philosopher. My suggestion is that this great man start and sponsor a forum for great minds to come together to create a new system of government that truly represents the common man’s interest, while at the same time creating rewards great enough to attract the best and brightest minds to serve in government roles without having to rely on corruption to further their interests or lifestyles. This forum could be similar to the one used to create the operating system, Linux, which competes with Microsoft’s near monopoly. I believe there is an answer, but for now the system is clearly broken.
Hemp has been used for at least 5,000 years for cloth and food, as well as just about everything that is produced from petroleum products. Hemp is not marijuana and vice versa. Hemp is the male plant and it grows like a weed, hence the slang term. The original American flag was made of hemp fiber and our Constitution was printed on paper made of hemp. It was used as recently as World War II by the U.S. Government, and then promptly made illegal after the war was won. At a time when rhetoric is flying about becoming more self-sufficient in terms of energy, why is it illegal to grow this plant in this country? Ah, the female.
The evil female plant — marijuana. It gets you high, it makes you laugh, it does not produce a hangover. Unlike alcohol, it does not result in bar fights or wife beating. So, why is this innocuous plant illegal? Is it a gateway drug? No, that would be alcohol, which is so heavily advertised in this country. My only conclusion as to why it is illegal, is that Corporate America, which owns Congress, would rather sell you Paxil, Zoloft, Xanax and other addictive drugs, than allow you to grow a plant in your home without some of the profits going into their coffers. This policy is ludicrous.
My George W. Bush Countdown Calendar for today reads:
In his memoir, The Audacity of Hope, Barack Obama, the African-American Senator from Illinois, tells of an encounter with George W. Bush at a meet-and-greet at the White House. The president shook his hand warmly, then “turned to an aide nearby, who squirted a bit dollop of hand sanitizer in the president’s hand.”
Can this possibly be true? Is it out of context? Anybody read the book?
What’s needed here is a vaccine for stupidity. From Reuters:
WASHINGTON (Reuters) — Parents refusing to have their children vaccinated against measles have helped drive cases of the illness to their worst levels in a dozen years in the United States, health officials reported on Thursday…
“Of the 95 patients eligible for vaccination, 63 were unvaccinated because of their or their parents’ philosophical or religious beliefs,” the CDC said…
Outbreaks of measles are being reported now in Israel, Switzerland, Austria, Italy and Britain among people who are declining the vaccine.
British health officials said in June that measles had again become endemic for the first time since the mid-1990s due to parents declining to get their children vaccinated.
One of my sons is a bankruptcy lawyer. What brings most clients to him are medical bills. His experience is not unusual but typical. Harvard Law School professor Elizabeth Warren collected the statistics and learned that health emergencies cause half of all personal bankruptcies. (H/T to Avedon at The Sideshow.)
What, me worry? We’re covered. We’ve got health insurance. Oh, yeah? Good luck with that, buddy. Professor Warren’s got those numbers too. Seventy-five percent — three out of four — of Americans driven into bankruptcy by medical bills were just like you. Which is to say, insured.
Professor Warren’s conclusion::
“Anyone shy of the multimillionaires is just. not. safe.”
Can’t think why this isn’t all over the traditional media here in the US. The Guardian’s got it, and the Beeb, but a Google search didn’t find a mention in any large American outlet. Perhaps it’ll make the evening news…
Or perhaps our esteemed newspaper editors don’t think it’s newsworthy that the US, still the world’s number one economy, has fallen to number twelve in livability, according to the American Human Development Report. Presumably those who aren’t resigning in protest over cuts in newsroom staff are either struggling to stay above water and have no political capital to spend on such stories, or are living high enough off the wages of collaboration not to care.
The report, funded by Oxfam America, the Conrad Hilton Foundation, and the Rockefeller Foundation, lists the eleven countries ahead of us; all have lower per-capita incomes.
Those countries score better on the health and knowledge indices that make up the overall human development index (HDI), which is calculated each year by the United Nations Development Programme.
And each has achieved better outcomes in areas such as infant mortality and longevity, with less spending per head.
Japanese, for example, can expect to outlive Americans, on average, by more than four years. In fact, citizens of Israel, Greece, Singapore, Costa Rica, South Korea and every western European and Nordic country save one can expect to live longer than Americans.
Unsurprisingly, the lack of health care for 47 million Americans is a big part of our deficit. As a result, we’re 42nd in life expectancy and 34th in infant mortality. If we were to match Sweden, about 20,000 more American babies would make it to their first birthday every year. Culture of life, my ass.
For the Stephen Colberts among us, there are still some opportunities to wave the flag. We remain first among the world’s richest countries in child poverty; 15% of American children live in families with incomes of $1,500 a month or less.
The US also ranks first among the 30 rich countries of the Organisation of Economic Cooperation and Development in terms of the number of people in prison, both in absolute terms and as a percentage of the total population.
It has 5% of the world’s people but 24% of its prisoners.
On those rare occasions when Bush is moved to do the right thing, he gets knee-capped by his best friends. If it weren’t so horrible it would be amusing. Consider this unusually ripe specimen:
WASHINGTON — President Bush’s efforts to broaden a widely respected, bipartisan program to fight the spread of AIDS in Africa have faced roadblocks by seven Republican senators.
Bush had hoped that Congress would pass legislation to spend $50 billion to fight AIDS, malaria and tuberculosis primarily in Africa in time for the Group of Eight summit in Japan next month. However, the seven socially conservative senators, led by Sen. Tom Coburn, R-Okla., refuse to support the legislation unless spending focuses more heavily on treatment than on prevention.
In a letter to Senate Minority Leader Mitch McConnell, R-Ky., the seven senators — Coburn, Jim DeMint of South Carolina, Richard Burr of North Carolina, Jim Bunning of Kentucky, Saxby Chambliss of Georgia, Jeff Sessions of Alabama and David Vitter of Louisiana — criticized the bills’ increased spending over the next five years from $15 billion to $50 billion, the expansion of AIDS funding to countries such as China and India and the inclusion of funding for agricultural-assistance and poverty-alleviation programs.
“The bills’ support would allow morally questionable activities, including advocating with host governments to change gender norms and policies and promoting activities that could include needle distribution to drug users,” the senators wrote.
Vitter, Vitter. Haven’t I heard that name somewhere? Isn’t he some kind of an expert on morally questionable activities? Oh, yes, now it all comes back:
After Vitter’s telephone number was discovered this summer among the records of the so-called “D.C. Madam,” the rumors about his sexual proclivities really started flying. Wonkette and a variety of liberal blogs ran with rumors that he had a diaper fetish and liked to make in his nappy during sexual acts. No one seems to be sure where that rumor originated, so we did our best to get to the bottom of it.
Wendy Cortez (Ellis), a New Orleans-based reformed hooker, said during a press conference yesterday that Vitter stopped seeing her after he learned her real first name was the same as his wife’s. Cortez tells Radar that Vitter never wore any diapers during their sexual transgressions, which she says occurred two to three times a week over a four-month period in 1999.
“That story referred to another client of [mine] and was later misconstrued by reporters and bloggers,” Cortez explained. She also added that Vitter was always “very clean” during intercourse.
From today’s Times:
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified…
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified…
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
“My understanding is that once you’re denied it’s hard to get other insurance,” Ms. Robertson said. “Man, is that a scary thing.”
Apparently it’s polygamy.
Something struck me last night, looking at TV footage of the wives and children of the Fundamentalist Church of Jesus Christ of Latter-Day Saints who were taken from their home in what’s starting to look like another bonehead play by the Great State of Texas
Every single one of them seemed vigorous, healthy — and slim. There were perhaps 20 or 25 women and children altogether in the cllps I saw. What are the odds, in a random group of that size anywhere else in America, of not seeing a single wide load?
What I know of history seems to fit the proposition that power hierarchies thrive on secrecy and information management, while populist reforms tend to wither and petrify without the sunshine of open exchange.
First, the existence of a site that posts documents that governments and corporations would prefer to hide has in a sense been affirmed as within the law. But it wasn’t just a victory for the First Amendment; the judge was impressed by the argument that the information was already being mirrored in a variety of countries around the world, so publication could no longer be enjoined. The geekosphere is crowing about the impotence of government as against our beloved and all-providing internet. And people in government and corporate bureaucracies who occasionally find opportunities to inform the public have an outlet to help them do that, one that’s survived its first court test.
Second, the whole legal contretemps brought a lot of attention to Wikileaks, a relatively new site happy for the news coverage, whose mission statement begins:
Wikileaks is developing an uncensorable Wikipedia for untraceable mass document leaking and analysis. Our primary interest is in exposing oppressive regimes in Asia, the former Soviet bloc, Sub-Saharan Africa and the Middle East, but we also expect to be of assistance to people of all regions who wish to reveal unethical behavior in their governments and corporations. We aim for maximum political impact. Our interface is identical to Wikipedia and usable by all types of people. We have received over 1.2 million documents so far from dissident communities and anonymous sources.
We believe that transparency in government activities leads to reduced corruption, better government and stronger democracies. All governments can benefit from increased scrutiny by the world community, as well as their own people. We believe this scrutiny requires information. Historically that information has been costly — in terms of human life and human rights. But with technological advances — the internet, and cryptography — the risks of conveying important information can be lowered.
Wikileaks opens leaked documents up to stronger scrutiny than any media organization or intelligence agency can provide.
That will help. If we read the documents.
It doesn’t require an extensive search to find an example of power heirarchies and information management: we don’t have single-payer health care like all the other so-called grown-up countries because private industry is making huge profits by failing to keep us as healthy as citizens of other countries who pay a lot less. And even with all that money we pay, our health-care system makes more errors than other countries experience, our record-keeping and coördination is worse, and more of us go without health care for economic reasons. Long story short: our health-care system is so far from being the best in the world that the opposing position can only be maintained for ideological reasons. I expect our system’s the best advertised, though.
Certainly there are other influences pushing the debate away from government-managed health care. The philosophical position that the federal government shouldn’t manage things has a lot of supporters, and it’s a philosophy with some sense. I too prefer to minimize government activity, and to keep as much of what must be done local as is reasonable.
Still, there’s more that needs to be done at the federal level than defense and air traffic control. The overall superiority of federal single-payer health care in the real world has been demonstrated in other countries; the study I just cited considered Australia, Canada, New Zealand, the UK, the Netherlands, and Germany, plus the US, the only country without government-run health care. We’ve seen it work here in the proto-socialist Medicare program as well, which everyone nowadays knows is more efficient than the private health-care industry.
Universal single-payer averages the risks and costs across the greatest number and the most accurate cross-section, namely everyone. Expenses can be spread out over larger bases, and reduced by high-volume shopping techniques. Results include a higher level of care overall and somewhat more controllable costs, but perhaps most importantly a system focused on getting and keeping people healthy, rather than on maximizing profit for parent corporations.
If the goal of single-payer is obvious, the path toward that goal is less obvious; the opposition will be fierce, and extremely well funded. I kind of like the two-pronged attack on the problem, prong one creating a single-payer Medicare-like system, and prong two providing a framework for private industry to compete against the government through private hospitals, HMOs, insurance, and all the familiar tools. Citizens can choose either system. Let the market decide, and may the best system win.
The realization that government could have a positive impact on our health care seems to have sunk into the American consciousness quite broadly. Despite the nearly complete absence of reporting on successes of single-payer systems from major US media outlets, Americans have heard of this, and they understand that Medicare works. They know you can’t count on the government, but how much less can you count on the insurance company? Which one has an inherent direct interest in screwing you?
It kinda depends on what we want. If keeping the population healthy is the goal, universal single-payer is the method. If insurance companies are built into whatever health plan this country designs, then the point of the plan will be to profit them.
But even more it depends on what we’re willing to fight for.
Whoever we vote for in the primary or the general election, we should pressure all our elected representatives to create a decent health care system like everyone else has. They won’t be able to do it against entrenched opposition without an overwhelming push from below.
If you’re suffering from nostalgia about the Clinton years, take a look at Vincente Navarro’s article. He’s a professor of health and public policy at Johns Hopkins, among other things, and he remembers what really happened.
It’ll cure you.
People in this nation die due to lack of health care. The estimates vary from 18,000 to 100,000 a year, depending on how you measure preventable deaths. But even based on the most conservative number of 18,000 (from the conservative Institute of Medicine), this is six times the number of people killed on September 11, 2001, by Al Qaeda. And these deaths continue year after year. The deaths on 9/11 are rightly seen as the result of enemy action. But why do the 18,000 deaths each year go unnoticed? Why aren’t they seen as the outcome of hostile forces, whose love for their country is clearly nil?
At least we’re still ahead of Liberia.
The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.
The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.
To no one’s surprise, babies born to black mothers die two and a half times as frequently as those born to white mothers, a stark indication of the continuing influence of racism, and probably even more of disparities in income.
…finding out that you’re covered by Medicaid when you show up at an emergency room isn’t at all the same thing as receiving regular medical care.
Beyond that, a large fraction of the population — about one in four nonelderly Americans, according to a Consumer Reports survey — is underinsured, with “coverage so meager they often postponed medical care because of costs.”
So, yes, lack of insurance is a very big problem, a problem that reaches deep into the middle class.
Here’s the part I keep missing, somehow. Why are people so excited about insurance? I can’t remember the last time I needed health insurance. What I need is health care, and I don’t want any damn insurance company making money off that need. In fact I think they should have to pay me for putting up with their existence.
Public subsidy, private profit, that’s the American system. Or put another way, we’re all about socialism, but it only applies to the costs. Those we’re happy to socialize. The benefits must be privatized, or we’d have the unhappy situation of, say, Cuba, where any random person off the street could get health care.
This morning I came across the Photoshopped image below, which seems timely as Bush has just now, for only the fourth time in his presidency, wielded his poison pen to veto health insurance for millions of American children.
Here’s what I’m hoping for, accurate presentation of the candidates’ actual policies.
All three plans would leave the existing private system in place. Edwards would create Health Care Markets — state and regional non-profit insurance-purchasing pools — to offer consumers a choice of competing insurance plans. At least one of those plans would be a public program based on Medicare. If more people choose that public plan, it could lead to a single-payer approach like in Canada, where government administers health care, collecting fees and paying out costs.
Obama proposes a National Health Insurance Exchange to help individuals and employers buy health insurance. But he doesn’t talk of a single-payer system. Clinton said Monday she wouldn’t build any new bureaucracy.
What, people say, do you want the government running your health care? Well, between guaranteed inefficiency and an overt disincentive to treat me, I’ll take the inefficiency every time. As opposed to an insurance company, in other words, yes, I do want government running my health care.
It must be weird to live in a country that can, perhaps legitimately, complain about poor news service, and yet have as its mainstay the BBC. The Beeb sucks, perhaps, but watch this eleven-minute clip on the decision of the Thai government to manufacture cheap copies of drugs the government says its citizens need.
Lehrer wouldn’t allow such things to be said on his show. Olbermann would, if he had the eleven minutes to spend on one subject. But drug patents aren’t as sexy as, say, sex scandals with DC madams handing pounds of telephone records to ABC, so they don’t rate much time on the nightly news; and I suspect producers would draw a lot of heat from Big Pharma if they made such a forthright case against certain intellectual-property constraints in a Frontline or documentary context.
The recent coup in Thailand continues to have interesting repercussions. Dr. Mongkol na Songkhla, the country’s new health minister, has decided to issue “compulsory licenses” for the manufacture of three drugs he thinks Thai citizens need.
Thailand’s growing world connections are making conditions like diabetes and heart disease more common, and the government health care system is overwhelmed. Bangkok’s main chest hospital spends nearly a fifth of its total budget on Plavix, a heart drug. So Thailand issued a compulsory license for Plavix.
Such licenses are allowed by the WTO under an agreement that gives governments the right to compel manufacture of cheap drugs in a health crisis. The thing is, the agreement grants the governments a lot of discretion.
The language of the agreement is vague. It recommends that governments consult the drug companies first, and requires them to pay a small royalty. But crucially, the government itself can decide what constitutes a health crisis.
The drug companies have always assumed that the Trips exception would only be used for a dire emergency, like HIV/Aids or avian flu.
Issuing a compulsory licence for a heart drug, they say, breaks the spirit of the agreement.
Abbott has now withdrawn all its future products from the Thai market — including a new heat-resistant form of Kaletra which is desperately needed by HIV patients.
This is the kind of action that makes Big Pharma more despicable than any other industry except for weapons manufacturers, whose money comes even more directly from death.
Explain to me, beloved capitalist, how capitalism solves such problems. Or at least how it justfies inaction resulting in deaths because the profit motive was removed.
It’s interesting that the country and the companies had hammered together some working arrangements on Aids drugs. But when it came to heart problems, I mean, really, you gotta feel the drug companies on this one.
After all, R&D is so expensive (the companies say), and drug development takes a long time, and lots of it doesn’t prove to be usable or can’t get approved by the government. In other words, research and development in the area of drugs is a particularly risky business.
Which is true. That’s why we long ago socialized a lot of the cost. Paul Cawthorne from Medicins Sans Frontiers, who supports the Thai government’s decision, argues that much of the research into new drugs is done in government-funded universities, and that the drug companies spend more on advertising than on R&D.
He is calling for a radical shake-up in the pricing of a whole range of essential drugs, to make them affordable in every country — and he believes Thailand has set an example other governments should follow.
Opponents argue that governments cannot feel free to break the patents on any drugs they choose, just to fund cheap healthcare for their citizens.
That, they say, destroys the incentive to develop new drugs.
Violate the Principle of Profit just to provide cheap healthcare? Horrors! Death and disease? They’re not really an incentive to develop new drugs; there’s only one kind of incentive that matters, and it’s the kind that people mean when they say “incentivize”.
It’s interesting to note that neither the US government nor the World Health Organization has criticized Thailand’s action.
Chomsky calls it public subsidy, private profit: universities do the research, corporations market and sell. And that’s my fundamental problem with capitalism as an organizing philosophy: it’s basically amoral, but its amoral judgements often lead to immoral actions, and for the basest of purposes.
Certainly the marketplace can be an efficient method of supplying certain kinds of needs. Everyone needs groceries, so distributing them is big business, hypercompetitive with very low profit margins. But this system works because it’s so heavily regulated. I’ll go into a store I don’t know and trust what I buy because I saw their health-inspection certificate on the wall. I expect that the food I’m buying has been inspected along its path to me, and that I’m not depending purely on companies with lawyers and insurance for the safety of my food, because government is enforcing certain standards.
In other areas, too, like energy and transportation, we act more effectively as a community rather than a pile of individuals. And, I would claim, in medicine we should as well. Call it socialized medicine if you will. What I want, and what I believe Americans should demand from their government as soon as we get ourselves extracted from Iraq, is universal health CARE. I don’t want a law that requires me to buy insurance and helps me pay for it. Insurance buys me nothing; health care is what I need, and what everyone will need at some point.
And by the same token I want drug technology to be controlled in ways that are designed to benefit society, to save lives rather than make profit. The current grotesque concentration of wealth is not advancing humanity or making the world a better place. So how do we justify allowing it to happen?
As usual, Fred Clark hits the nail on the head:
If [President Bush] truly believed that such [stem-cell] research involved “the taking of innocent human life,” then he would be obligated to stop it using every means at his disposal. “I won’t fund it, but it’s fine if others do,” doesn’t cut it. All such funding, all such research, would have to be outlawed — with severe criminal penalties for the mass-murdering Mengeles who violated this ban. The fertility clinics, also, would have to be shut down. The innocent human lives imprisoned in their liquid-nitrogen charnel houses would have to be made wards of the state until such time as they could all — in their many thousands — be placed into snowflake foster care.
I am not suggesting that this is what President Bush’s position implies taken to its logical extreme. This is what it demands as a bare minimum response. It is not possible, in any meaningful way, to believe that embryonic stem cell research is “the taking of innocent human life” unless you also advocate all of these steps.
President Bush does not advocate any of these steps. If he is not a liar then he is a fool or a monster. There is no fourth option.
Here’s a disconcerting statistic: emergency rooms are turning away an average of one person a minute in the US because they’re too full. This according to USA Today, which has somehow morphed into a news outlet.
These numbers are scary enough; after all, if (!) there’s another terrorist attack, or the bird flu hits, where will people be heading? The article quotes
Arthur Kellermann, director of the Center for Injury Control at Emory University School of Medicine in Atlanta. “We cannot let the most time-sensitive portal in the hospital get gridlocked.”
Two additional suboptimal truths, according, again, to USA Today. First, with ERs overflowing, your survival chances vary drastically from one location to another. The paper claims to have found a ten-fold difference between major cities in survival rates of cardiac-arrest patients. Second, the article doesn’t tell you which cities are good and which are bad.
First, news out of India that shows that a number of people have died from complications of bird flu:
Nine poultry farmers from across India have killed themselves and many more face a grim future after the scare of bird flu wipes out demand for chicken in the country.
India has culled hundreds of thousands of chickens to contain several outbreaks of the H5N1 avian flu virus among poultry since February 2006. But the disease continues to resurface, mostly in the state of Maharashtra.
The bird flu scare has decimated the country’s US$ 7.8 billion poultry industry, which claims that losses in the past two months have reached US$ 2.2 billion, or Rs 8,000 crore. “Nine farmers have committed suicide after their businesses suffered huge losses,” says O P Singh, member of the National Egg Coordination Committee (NECC).
In the last 15 days, suicides have been reported from West Bengal, Tamil Nadu, Assam, Andhra Pradesh and Maharashtra, the last state being the epicentre of the bird flu outbreak in India. “These are cases reported from areas close to cities and towns. One does not know how many more such cases in remote villages have gone unreported,” the NECC says in a press release.
But wait! There’s more. Here in the US it’s going to be deadly too, perhaps not just to chickens, but to some of our own farmer’s businesses. At least American farmers will be compensated for the value of the dead chickens, although it might hard to compete with corporate poultry farms thereafter. I suspect when this business is over that a good many small farmers will be out of the chicken business forever.
Free-ranging chickens and small, backyard flocks will be at greatest risk if deadly bird flu reaches the United States, officials said yesterday. They also said they would begin killing off flocks large or small if they are suspected of having the virus — even before tests are completed.