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.
…and we’re here to help. From The New Yorker:
Because West Virginia has a population of only 1.8 million — less than the city of Houston — an investment in influence goes far. The conservative fossil-fuel magnates Charles and David Koch, through their charitable foundations, have devoted particular attention to the state. The Investigative Reporting Workshop, at American University, found that, between 2007 and 2011, the Kochs gave $30.5 million to two hundred and twenty-one universities; West Virginia University received nine hundred and sixty-five thousand dollars, the third-highest amount, behind George Mason and Florida State. In February, the university announced that it was creating a five-million-dollar Center for Free Enterprise, funded in part by the Charles G. Koch Foundation.
The Kochs also helped fund research at the Public Policy Foundation of West Virginia, a think tank that, in 2007, published “Unleashing Capitalism: Why Prosperity Stops at the West Virginia Border and How to Fix It,” edited by a West Virginia University economics professor named Russell Sobel. The book argued against mine-safety regulations, on the ground that “improved safety conditions result in lower money wages for workers,” and asked, “Are workers really better off being safer but making less income?” It also called for relaxing rules on water usage. “Although they are intended to benefit citizens, water use regulations will only hamper prosperity by impeding the state’s ability to retain and attract businesses and to generate new employment opportunities.”
Governor Manchin invited Sobel to brief his cabinet, as well as a joint session of the Senate and the House Finance Committees. The state Republican Party chairman said, “Unleashing capitalism will be our party platform.” In February, Americans for Prosperity, the political-advocacy group funded heavily by the Koch brothers, established a chapter in West Virginia. A state Republican consultant told me, “You can do things here incredibly, incredibly cheaply. For instance, A.F.P., the Koch brothers, went and did North Carolina last time. Well, a legislative seat here is about one-fourth the size of a legislative seat in North Carolina. So there’s bang for your buck.” In any given district, he said, “You can go in for twenty grand, and probably fix a problem.” He also noted, “People are just showing up with pockets full of money, saying, ‘We want to help you out.’ ”
WASHINGTON (Reuters) — The U.S. oil sector is not sharing important information about oil-by-rail shipments sought by regulators seeking to prevent the kinds of fiery derailments that have occurred in recent months, according to the Department of Transportation.
“Despite the energy industry making assurances to DOT more than two months ago, we still lack data we requested and that energy stakeholders agreed to produce,” a spokeswoman said.
“The overall and ongoing lack of cooperation is disappointing, slows progress, and certainly raises concerns.”
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.
…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.)
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.
From the New York Times:
Much of the deal came down to dollars and cents. Mr. Dimon, the people said, signaled during that Sept. 24 call that he was willing to increase JPMorgan’s offer to settle an array of state and federal investigations into the bank’s sale of troubled mortgage securities before the financial crisis. The government, these people said, had already balked at the bank’s two initial offers: $1 billion and $3 billion.
And so that same week, Mr. Dimon traveled to the Justice Department in Washington for a meeting with Mr. Holder that underscored how expensive the healing process had become. At the meeting, the people briefed on the talks said, JPMorgan executives raised the offer to $11 billion, $4 billion of which would serve as relief to struggling homeowners.
But Mr. Holder wanted more money to resolve the civil cases, the people said. And despite the bank’s requests, he refused to provide JPMorgan a so-called nonprosecution agreement that would halt an investigation from prosecutors in California, who were scrutinizing the bank’s mortgage securities. Instead, the people said, he informed Mr. Dimon that the Justice Department wanted JPMorgan to plead guilty to a criminal charge in that case, an unusual show of force against a Wall Street bank.
I’m beginning to like the Attorney General, just a little bit. Now if he could only remember where he mislaid the First Amendment…
From the New York Times:
The company that operated a fertilizer plant in the city of West, where an April explosion killed 15 people, faces $118,300 in federal fines for two dozen serious safety violations, including a failure to have an emergency response plan, officials said Thursday. The Occupational Safety and Health Administration, which had not inspected the facility since 1982, said the West Fertilizer Company committed violations that included unsafe handling and storage of two fertilizers, anhydrous ammonia and ammonium nitrate, a chemical that investigators believe contributed to the huge blast…
Alice Rivlin ran the Office of Management and Budget in 1995 when the Republicans forced one of their earlier government shutdowns. Here is a memory from that childish GOP tantrum of yesteryear:
AR: The questions you get are “Let me tell you about this activity; is it essential.” So you have to make a call on that.
My two favorite stories of that period are these. One was [the National Institutes of Health]. The clinical facilities where they had patients, that was clearly essential. But most of NIH is research and research management. We decided that was not essential. And so we sent the researchers home. But then you have laboratory animals. You can’t leave the laboratory animals to starve. So the technicians that take care of the laboratory animals are essential and the researchers are not.
My neighbor Tony Piel, a former director and legal counsel of the World Health Organization, started out with Citibank. One of his assignments from its chairman, George Moore, was to set up a public/private development bank for Morocco.
Here Tony wonders if what was good enough for Morocco might not be good enough — better, actually — for the United States than leaving the economy in the hands of Wall Street’s sociopaths:
Now, some forty years later, back in the USA, we find the world’s most powerful nation in crisis and in desperate need of economic development and jobs. In my day in Citibank, we would have opened the valves of business and personal lending to solve the crisis. That’s what commercial banks are for. But today the five largest US banks (BofA, Citi, Morgan-Chase, Wells Fargo and PNC) having received tens of billions of dollars in bailouts for those “too big to fail,” and holding some 40 percent of all deposits and 48 percent of all bank assets, have cut back on small business lending by a full 53 percent. (Where are the George Moores of banking now?) Here’s the question: Should state-owned banks come to the rescue of Main Street?
We have a home-grown model to guide on, and to build on: the state-owned Bank of North Dakota (BND), established in 1919 to promote agriculture, commerce, industry and infrastructure development in North Dakota. The BND takes placements of North Dakota state and state agency funds, and acts as an economic development agency and “banker’s bank,” lending to and covering risks of private banks and businesses. It arranges low cost loans to farmers, students, and local enterprise. BND also makes a market in municipal bonds to promote and finance community development.
The BND has almost $ 4 billion in assets, a $ 2.67 billion loan portfolio, and over $ 50 million in profits for six straight years. Over the last ten years, the bank has funneled almost $ 300 million in profits to North Dakota’s state treasury. During the recent national credit crunch, when private banks ratcheted down their lending, BND’s business lending actually grew by 35 percent, and private sector jobs were increased throughout the state, outpacing the rest of the nation.
What’s the development bank secret? The answer: Regulated government service salaries. No fat cat bonuses. No kick-backs. No self-dealing. No double dipping. No excessive risk taking. No gambling with other people’s money. No bundled mortgages, no derivatives, no credit default swaps, and no currency speculation. No short-selling. Transparent accounting. Profits are returned to equity. The point of the enterprise is not self-interest. The point is economic development. That’s what a democratic state development bank is all about. That’s why Morocco succeeded. That’s why North Dakota succeeded. It’s difficult to argue with success.
The question is, could something like this work in Connecticut and other states? The answer, perhaps, is Why Not? The principal objection to such a state bank may be based on the false ideological premise that government and private enterprise are necessarily and irrevocably hostile opponents. The Moroccan experience suggests otherwise.
More pointedly, private banks may fear that they may lose some of their deposits and be forced to compete more actively with each other and with the state bank for lending opportunities. But perhaps competition is a good thing? Furthermore, when the economy recovers and further develops, the opportunity increases for all. There are more and bigger slices of a larger pie. It’s win-win for everyone.
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 have no idea how link to a tweet, or even what a tweet is, and so I’ll just put up this screen grab from The Maddow Blog.
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...
How often do I agree wholeheartedly with Fox News. Not often, but not never:
Another myth central to Obama’s campaign is that Mitt Romney wants to go back to the “policies that got us into trouble in the first place.”
What are those injurious Republican policies?
Presumably the president refers to the deregulation of financial institutions that liberals blame for the recession. But, it was Bill Clinton who repealed Glass-Steagall. The Gramm-Leach-Bliley bill, which undid that long-standing law, passed the Senate 90-8, with Vice President Biden among the many Democrats supporting the measure. By contrast, George Bush was a regulation nut. It was during his administration that the country adopted the oppressive Sarbanes-Oxley legislation.
George Packer has a piece in this week’s New Yorker that tells you more about how Washington (and the human species for that matter) actually fits together than anything I’ve read in years. It’s sad and terrifying at the same time.
The full text is behind a pay wall, but a summary is here. Don’t be satisfied with this, though, because the devil is in the details. Get hold of the magazine if you’re not a subscriber. It contains another wonderful piece, this one by Jane Mayer and available on line. It’s called “The Voter Fraud Myth.” The cunning little Bushie behind that myth is pictured below.
—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.
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…
Willard Romney, eBay’s current top bidder for the GOP presidential nomination, is the proud owner of no less than six homes.
Romney’s personal real estate includes six homes: one in La Jolla, two in the Boston area, a ski lodge in Utah and two lakeside residences in New Hampshire.
No word on whether any of those homes have a dog strapped to the roof.
Here are some assumptions that I think it is safe to make from the above list:
1) Willard’s houses will all abut nicely paved roads. After all, he wouldn’t want to risk gravel dings on any of his wife’s Cadillacs. Who paved those roads? That’d be “the government.” Who paid for that roadwork? That’d be “the taxpayers.”
2) Willard’s houses will all be hooked up to a sewer line. Said line will feed into a municipal system and ultimately a treatment plant. Who runs those? That’d be “the government.”
3) Willard undoubtedly sits placidly in each of his six houses, untroubled by the prospect that any of them are likely to collapse about his head. How can he do this? Because those houses will have been built to code. Whence cometh this code? That’d be “the government.” This same code also means that our Willard doesn’t have to spend any of his valuable time worrying that faulty electrical wiring will reduce his home to a pile of ashes. (Of course, if he turns out to be wrong about that, the help will promptly call the socialist Fire Department.)
4) I know nothing of the geography of Boston. But it’s safe to say that Willard’s two houses in Boston will be in the nicest parts of town. What makes them so nice? One thing would be well-maintained roads, which we’ve already covered. Another would be a solid police presence, in the form of either regular patrols or prompter response times should there be trouble. Government and taxes at work, once again.
5) La Jolla I’m more familiar with. Let’s say that Willard’s home there has a lovely ocean view. What makes that ocean view so lovely? One of those things would be government protection of coastal areas. And I’d be willing to bet there are some very nifty zoning laws that help to keep the ocean view unobstructed.
6) We can make similar assumptions about the lakeside residences in New Hampshire. Willard simply would not live next to a lake that was a fetid pool of waste and pollution. What keeps those waterways so pristine? One way or another, that will be overseen by that terrible horrible no-good very bad government.
The evidence is clear — Mitt Romney is a lousy stinking socialist! You don’t hear him denouncing any of these benefits he receives from the Government, do you? Nope. Not a peep. That means he must approve of them.
That, of course, is always how it is: It’s only “socialism” when it benefits someone else. (Especially if that someone else’s skin tone is darker than beige.)
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.”
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.
Years ago an elderly relative of mine, sick and near death, told me the only thing that kept him going was opening the paper one more morning to see what stupid shit the bastards were up to now.
He’d be alive yet if he had known that Oklahoma State Senator Ralph Shortey would surface one day, introducing a bill to ban the sale of food made from the kidneys of aborted human fetuses.
The senator believes that cells from these innocent pre-born Americans are already being used, or could be used, or might be used, or something, to enhance the flavor of soft drinks and potato chips. Or something. But let Senator Shortey tell you about it himself. Here’s the audio.
…to secure for our children the right to stay fat. From the Associated Press:
In an effort many 9-year-olds will cheer, Congress wants pizza and french fries to stay on school lunch lines and is fighting the Obama administration’s efforts to take unhealthy foods out of schools.
The final version of a spending bill released late Monday would unravel school lunch standards the Agriculture Department proposed earlier this year. These include limiting the use of potatoes on the lunch line, putting new restrictions on sodium and boosting the use of whole grains. The legislation would block or delay all of those efforts.
The bill also would allow tomato paste on pizzas to be counted as a vegetable, as it is now. USDA had wanted to only count a half-cup of tomato paste or more as a vegetable, and a serving of pizza has less than that.
Nutritionists say the whole effort is reminiscent of the Reagan administration’s much-ridiculed attempt 30 years ago to classify ketchup as a vegetable to cut costs. This time around, food companies that produce frozen pizzas for schools, the salt industry and potato growers requested the changes and lobbied Congress.
The point, which Teddy Roosevelt was the last Republican president to grasp, is that the natural and inevitable result of “free market” competition is not efficiency, invention, a level playing field, personal freedom, or the greatest good for the greatest number. It is monopoly.
This is what the Republican small government types would fear if they had a clue. Not government regulation. Ask anyone for his or her worst experiences with unresponsive, uncaring, indifferent, and rapacious bureaucracies. The answer will seldom be the Post Office or the Social Security Administration or even the Department of Motor Vehicles.
Nine times out of ten it will be a bank, an insurance company, a giant utililty, a cable provider. You can’t vote the rascals out. There is no congressman to complain to. You haven’t got a hope of successfully suing them. Corporate decisions are unappealable, mercilessly and mindlessly enforced by courts and bill collectors.
You can’t even get past the phone tree to speak to anybody in actual authority. Such people must exist, but they are faceless and unaccountable. You are in Kafka country. Just ask any of the poor bastards defrauded and evicted in the great mortgage swindle that blew up the economy for everyone but the bankers responsible.
This is the “big government” the useful idiots of the Tea Party ought to fear. Instead they are speeding its arrival. Perhaps it has already arrived. Look at the chart.
The only thing capable of standing in its way is the regulatory authority of the “big government” that the boobies have been taught to fear. Indeed it may already be too late. The Citizens United decision and the corporate-owned Congress and Obama’s economic team may have seen to that.
In which case God bless us all, and Tiny Tim Geithner.
The Justice Department got the headline, but the spadework for this giant bust was done by a new unit in the Centers for Medicare & Medicaid Services called the Center for Program Integrity — created by President Obama’s health care legislation to fight the Medicare fraud that costs the taxpayers billions of dollars a year. And a highly-placed source (one of my sons, who works there) says this is just the beginning:
The Justice Department on Wednesday announced charges against 91 people including doctors, nurses and other medical professionals allegedly involved in a nationwide Medicare fraud scheme in eight cities totaling $295 million in false billing.
“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” Attorney General Eric Holder said in a press release. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”
According to the Justice Department those charged are accused of a variety of fraud-related crimes including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering. The scheme involved home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment services, the Justice Department said…
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.
From the New York Times:
In Texas, which now has about 93,000 natural-gas wells, up from around 58,000 a dozen years ago, a hospital system in six counties with some of the heaviest drilling said in 2010 that it found a 25 percent asthma rate for young children, more than three times the state rate of about 7 percent.
“It’s ruining us,” said Kelly Gant, whose 14-year-old daughter and 11-year-old son have experienced severe asthma attacks, dizzy spells and headaches since a compressor station and a gas well were set up about two years ago near her house in Bartonville, Tex. The industry and state regulators have said it is not clear what role the gas industry has played in causing such problems, since the area has had high air pollution for a while.
“I’m not an activist, an alarmist, a Democrat, environmentalist or anything like that,” Ms. Gant said. “I’m just a person who isn’t able to manage the health of my family because of all this drilling.”
If we all carried guns, the argument goes, there would be less gun violence. It is the mutually assured destruction argument.
Now we have a good example of how open-carry law has worked. In Arizona it is legal and common to carry sidearms openly so that in any gathering of normal size plenty of people are likely to be carrying sidearms for protection. Yet when the Tucson slaughter commenced, not one self-defensive weapon was drawn or used.
Why has this tragic occurrence disproved once again the gun lobby theory that an armed populace is safer than an unarmed one? Because, as the Tucson case demonstrates, events move too quickly for almost anyone to draw on the shooter.
Yes, you might say, but trained shooters would be able to react fast enough to prevent a murder. However the facts disprove that theory as well. Not once in all of the recent assassinations and attempted assassinations have the Secret Service guards, or anyone else, gotten a shot off at the perpetrator. In most the assassin, as in Tucson, is wrestled to the ground by guards or bystanders. Generally the assailants are taken prisoner immediately after firing their weapons.
Guns in schools, guns on the streets, guns everywhere. History has shown there is not much chance the proliferation of guns will stop murder and assassination.
The excerpt below is from Upton Sinclair’s The Goose-Step: a Study of American Education. This quaint and curious volume of forgotten lore was published in 1923, even before Roe v. Wade. A thousand dollars then would be worth $12,795.50 today.
Or maybe it is medicine the young man has studied. He has heard about the nobleness of the healing art, but he has to keep an automobile and his wife wants to get into society, and competition is keen. There is one way a physician can make a thousand dollars by a few minutes’ work, and any physician who is in touch with the leisure class has women on their knees to him every week, begging him to take their money. Dr. William J. Robinson estimates that there are a million abortions performed in the United States every year, so you see that our medical schools have not steeled all their graduates against this temptation.
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.
Hey, gang, Team USA is Number 15! Here’s yet another infrastructure outrage for you:
Since 1991, the telecom companies have pocketed an estimated $320 billion — that’s about $3,000 per household.
This is a conservative estimate of the wide-scale plunder that includes monies garnered from hidden rate hikes, depreciation allowances, write-offs and other schemes. Ironically, in 2009, the FCC’s National Broadband plan claimed it will cost about $350 billion to fully upgrade America’s infrastructure.
The principal consequence of the great broadband con is not only that Americans are stuck with an inferior and overpriced communications system, but the nation’s global economic competitiveness has been undermined.
In a June 2010 report, Organization for Economic Co-operation and Development (OECD) ranked the U.S. 15th on broadband subscribers with 24.6 percent penetration; the consulting group, Strategy Analytics, is even more pessimistic, ranking the U.S. 20th with a “broadband” penetration rate of 67 percent compared to South Korea (95 percent), Netherlands (85 percent) and Canada (76 percent). Making matters worse, Strategy Analytics projects the U.S. ranking falling to 23rd by year-end 2010…
I know as much about broadband as I do about the Emperor Hadrian, but I have a mole planted deep within a giant telecom company. She reports as follows:
Well, the news that we are way behind much of the world in connect speeds is right, but I don’t understand many of the other claims. The telcos definitely grab whatever they can get from deals with the PUCs, but from what I can see, that usually does not amount to that much.
What a lot of confusion and inefficiency arises from is that the PUCs will require the telco (in exchange for some rate break or something) to build out their infrastructure such that some number of folks are *able* to order a broadband connection. There is never a requirement to actually *sell* the service.
The telco will then plow in fiber, deploy equipment, etc., to fulfill their obligation to offer service to some god-forsaken county in the middle of New Mexico with 10,000 people in it. Then, 83 of them actually sign up for service. So, assuming that the rate break or other incentive actually did result in more telco revenue, a lot of it has to be spent on the buildout to service those 83 people.
Nobody walks away a winner. The PUC is mad that the hicks are still not online, the telco is shaking their heads saying “I told you nobody would buy it! We’re gonna have to keep that crap running for years!”, the 9,917 folks that still have no broadband still can’t see their YouTube, and everyone is sad that we are another step behind in the race to connect everyone.
So, it really is not some gift to the telcos. Neither is it money well spent in connecting folks to broadband. It is the worst of both worlds — little extra broadband penetration, no telco windfall, and only a bunch of aging equipment deployed with little chance of ever being used. It is really just an inefficient regulatory effort to accomplish something with not enough information or control.
Probably the only way to fully connect the boonies is to re-regulate and force the issue that way. It is just too expensive to do it otherwise.
…and have been since that night early in the millenium when I first heard Professor Warren on late night radio as I drove through Virginia on I-95. Thrillingly, she was talking about a trick employed by insurance companies to extort fake “late fees” out of customers. The companies, it seemed, would require East Coast customers to mail their payments to a West Coast address, and vice versa. That way a sucker could pay on the dot but still incur a late fee because of the extra day or so in the mail. A few million pennies here, a few million pennies there… It all added up.
Here, I knew at once, was a woman who really, truly understood me to the depths of my socialist soul. We two could find true happiness together, I said hopelessly to myself as I drove forlorn and lonely through the gathering dark of Bush’s America.
It takes only a little investigation to learn how bad things have been inside those buildings. The list of offenses for which the DeCosters and their farms have been fined in Iowa and Maine only begins with hiring children and illegal immigrants.
In 2000, Jack DeCoster, the operations’ founder, was named a “habitual violator” of Iowa’s environmental laws. His egg factories have been cited by OSHA for deplorable working conditions. In 2003, Mr. DeCoster paid more than $1.5 million to settle an employment discrimination suit charging that 11 women working in the Clarion plants had been subject to sexual harassment, including rape and threats of retaliation. There have been nearly 1,500 illnesses as a result of the salmonella outbreak. Every one of the billions of eggs produced this way has been tainted.
The recall, which began Aug. 13, involves more than half a billion eggs from the Iowa operations of two leading egg producers, Wright County Egg and Hillandale Farms. About 1,500 reported cases of Salmonella enteritidis have been linked to tainted eggs since the spring — the largest known outbreak associated with that strain of salmonella.
The F.D.A. inspection reports portray areas of filth and poor sanitation at both operations, including many instances of rodents, wild birds or hens escaped from cages — all of which can carry salmonella — appearing to have had free run of the facilities.
Wright County Egg is owned by Jack DeCoster, who has a long history of environmental, labor and immigration violations at egg operations in Maine, Iowa and elsewhere. The inspection report identified Mr. DeCoster’s son, Peter DeCoster, as the chief operating officer of the Iowa operation.
A reliable source in the Maine legal community tells me that over the years two law firms in the state have dropped Mr. DeCoster as a client. Basically, my source says, because the guy was such a flaming asshole.
Think about that for a minute. How flaming an asshole would a millionaire client have to be for a law firm to fire him? Remember that O.J. Simpson had a lawyer and Tom DeLay had a lawyer. Bernie Madoff had a lawyer. Even Leona Helmsley had a lawyer.
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…
From the McClatchy Newspapers:
WASHINGTON — The number of naturally occurring microbes that eat methane grew surprisingly fast inside a plume spreading from BP’s ruptured oil well, an oceanographer who was one of the first to detect the plumes said Tuesday…
On the other hand…
However, the microbes also use oxygen in the water, and Joye said the repercussions of the resulting oxygen depletion aren’t yet known… They’re also looking to see if the microbes will draw down oxygen to levels that would make the waters unsuitable for life. The Gulf of Mexico already has dead zones created by nutrients from fertilizer carried from the Midwest by the Mississippi River.
Couldn’t have said it better myself, and therefore won’t. Here’s The Economist.
Maureen Dowd doinked Mr Obama Saturday with her silly-straw-like wit, faulting his “inability to encapsulate Americans’ feelings.” Yeah, you know who would’ve killed as the president facing a deep-sea oil blowout? Philip Seymour Hoffman. Or maybe Meryl Streep. Did you see them in “Doubt?”
Ms Dowd’s involvement is fitting, as this may be the sorriest spectacle of content-free public hyperventilation since Al Gore’s earth tones. The difference is that in this case the issue is deadly serious; it’s the public discourse that is puerile. There is plenty of room for substantive critique of the flaws in governance and policy uncovered by the Deepwater Horizon blowout. You could talk about regulatory failure. You could talk about corporate impunity. You could talk about blithely ignoring the tail-end risk of going ahead with deepwater drilling without any capacity to cope with catastrophic blowouts. Precisely none of these subjects are evident in the arguments our pundit class is having. Instead we have empty-headed squawking over what the catastrophe is doing to Barack Obama's image…
At last a motive appears, glimpsed dimly through the mists. Look, it appears to be green, like BP’s logo. Perhaps it is concern for the environment, leading to some protective procedure gone horribly wrong? Nah, that doesn’t seem to be it. Whatever it is, though, it’s certainly green.
From the New York Times:
Evidence began emerging Wednesday that BP officials may have had an incentive to proceed quickly.
A member of the federal panel investigating the cause of the blast said that before the explosion, the company had hoped to use the Deepwater Horizon to drill another well by early March, but was behind schedule.
BP applied to use the Deepwater rig to drill in another oil field by March 8, said Jason Mathews, a petroleum engineer for the Minerals Management Service.
Based on an estimate of $500,000 per day to drill on the site, the delay of 43 days had cost BP more than $21 million by the day of the explosion on April 20, Mr. Mathews estimated.
A Transocean official — Adrian Rose, the company’s health, safety and environmental manager — confirmed that BP leased the rig for $533,000 per day. He could not confirm where the Deepwater Horizon was planning to go next, but he said it was going to undertake another drill, probably for BP.
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…
It used to be the practice at the old Washington Daily News to write things like, “Police identified the murder suspect as Howard Ignoto, of the 1700 block of Maple Street.” If a more precise address turned out to be even a single digit off, a bedridden 90-year-old bishop’s widow would inevitably be living at that number. Our lofty journalistic principle was therefore, “It is better to be vague than wrong.”
The Epicurean Dealmaker suggests following the same principle when it comes to resolution authority to discipline Wall Street houses judged too big to fail, and his reasons are equally practical:
I like the fact that the proposed resolution authority is currently vague and undefined. I think it should be written into law in as vague and undefined a manner as possible. That would make it much more effective in combating the next (inevitable) financial crisis…
For another thing, vagueness will offer regulators discretion.
This will have two salutary effects. It is well known that financial institutions — like sophisticated businesses everywhere — are expert at structuring their business practices to satisfy the letter of the law, while evading its spirit and intent with maximal effect. The more specific laws and regulations become, the easier it is for these institutions and their in-house and outside counsel to find their way around them.
Should legislation authorizing resolution authority be too specific — in the tools, techniques, and processes regulators are allowed to use in identifying and winding down financial institutions in distress — then you can bet your bottom dollar those firms will exploit this fact to skew the game in their favor. In contrast, purposely vague and undefined resolution authority will not offer its potential objects as many preemptive opportunities to evade its intended jurisdiction or consequences.
In addition, regulatory discretion would foster what I would view as a healthy increase in uncertainty among financial institutions and their stakeholders. Should, for example, a regulator have the authority to unilaterally abrogate, modify, or suspend any and all prior contracts or securities arrangements entered into by a financial institution undergoing resolution — as some might suggest — you can just imagine how much more cautious investors, lenders, and counterparties would become in their dealings with any financial institution potentially subject to such a regime in the future.
The cost of funding financial institutions would undoubtedly rise, as investors become sensitized to increased contractual risk. Firms in obvious distress would see their cost of financing skyrocket and their counterparty business dry up, as no-one with a contractual claim could rest assured it would receive exactly what it was otherwise entitled to in a resolution wind up. But then again, firms in obvious distress see that happen anyway. The point is that regulators charged with cleaning up the mess would not have their hands completely tied by contractual arrangements entered into by others when the failing company was healthy…
The Washington Independent reports:
Speaking to reporters at the Capitol moments ago, Sen. Joe Lieberman (I-Conn.) seemed surprised by his own endorsement three months ago of a Medicare buy-in proposal he now opposes — saying that he finally saw the video “last night,” as if it were someone else who granted the now-infamous interview to The Connecticut Post in September.
Stuck in a corner, he offered two explanations. (1) He first said that it appeared like his September comments referred back to his endorsement of the Medicare buy-in 2000, when he was running as the vice-presidential candidate on the Al Gore ticket.
“I finally got to see that on TV last night,” Lieberman said, “and it looked to me like I was referring back to things I had supported in the past to make that point that, though I was against the public option, I was not against health care reform.”
(Nevermind that the Post interview was conducted clearly in the context of the current health-care debate.)
And (2) he argued that the comments were made before the Senate Finance Committee had introduced its reform bill, which grants generous insurance subsidies to folks aged 55 to 64. (Nevermind that the Senate HELP bill, which passed earlier in the summer, contained similar subsidies and everyone knew that the Finance bill would follow suit.)
He didn’t seem to mind that the explanations were contradictory.
Only two conclusions remain. Either Lieberman is an amnesiac, or he is a posturing, pompous, preening, self-satisfied and self-deluding little popinjay — a sociopathic liar and spotlight-seeker who would shame the United States Senate if such a thing were possible and has certainly shamed the State of Connecticut.
And he is not an amnesiac, although he plays one on TV.
Here he is once more with his soulmate and BFF; I love this picture.
Why the Medicare buy-in is a fine idea — probably better than an anemic “public option” that has been practically strangled pre-birth by the insurance lobby. This from Gooznews.
…The decade before people enter Medicare (55 to 64) is the time of life when many people develop the chronic diseases that will make them the most expensive patients in Medicare once they get there. Diabetes, heart disease and many cancers often emerge in late middle-age. Intervening when the warning signals of these diseases first appear can moderate or even eliminate many of these costly conditions.
Medicare is the ONLY insurer with a long-term interest in engaging in this kind of health care system-delivered secondary prevention. Every other insurer has a self-interest in kicking the can down the road because they know it will be the government and taxpayers that ultimately pick up the tab when those chronic conditions become the most costly…
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…
Looking at the bright side, here’s Maggie Mahar, at Health Beat:
For example, under the House bill, a family of three making $32,000 a year would pay $1,360 in annual premiums for good, comprehensive coverage; under the Senate Finance Committee bill, that family would be asked to lay out $2,013. Today, without reform, if that family tried to buy insurance, it would find that the average plan costs $13,500. For this household, the current legislation makes all the difference.
Too often, the press suggests that such a family would be expected to pay $10,000 out of pocket to cover co-pays and deductibles. That just isn't true.
Even if the entire family were in an auto accident and racked up $200,000 in medical bills, at their income level, the House bill caps out-of-pocket expenses at $2,000 a year. Under the Senate Finance bill, the family would have to pay $4,000.
Moreover, under both bills, there are no co-pays for primary care. Even private insurers cannot put a $25 barrier between a family and preventive care.
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…
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:
When Obama said he planned essentially to fine everybody who wouldn’t buy health insurance, was your first reaction to think “How is that fair?”
Here’s Jay Bookman of the Atlanta Journal, telling you how. Pay particular attention to the fact that an almost identical proposal was advanced by two Georgia Repubican legislators in 2007. And by Senator John McCain in his campaign for president.
All three are naturally against it now, their true aim being not to solve the health care problem, but to drive Obama from office in 2012.
Bookman’s explanation starts this way:
Let’s say you’re a 25-year-old healthy male who doesn’t feel it necessary to spend money on health insurance. You’d rather spend it on other things, such as beer and a hot new car. Suddenly, you blow out your knee in a game of touch football and need surgery you can’t afford…
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?
…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.
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.
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.
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.
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.
Seriously. Doesn’t the Supreme Court of the United States of America have anything better than this to do?
WASHINGTON — The Supreme Court on Monday ordered a federal appeals court to re-examine its ruling in favor of CBS Corp. in a legal fight over entertainer Janet Jackson's wardrobe malfunction.
The high court on Monday directed the 3rd U.S. Circuit Court of Appeals in Philadelphia to consider reinstating the $550,000 fine that the Federal Communications Commission imposed on CBS over Jackson's breast-baring performance at the 2004 Super Bowl.
Everybody else is giving advice to Obama, why not Francis Bacon? And so, from his essay “On Seditions and Troubles”:
A smaller number that spend more and earn less do wear out an estate sooner than a greater number that live lower and gather more. Therefore the multiplying of nobility and other degrees of quality in an over proportion to the common people doth speedily bring a state to necessity; and so doth likewise an overgrown clergy; for they bring nothing to the stock; and in like manner, when more are bred scholars than preferments can take off…
Above all things, good policy is to be used that the treasure and moneys in a state be not gathered into few hands. For otherwise a state may have a great stock, and yet starve. And money is like muck, not good except it be spread. This is done chiefly by suppressing or at least keeping a strait hand upon the devouring trades of usury, ingrossing great pasturages, and the like.
A memo to all hands from White House chief of staff Joshua B. Bolton, dated May 9, 2008:
The President has emphasized that the American people deserve a regulatory system that protects and improves their health, safety and environment … We need to continue this principled approach to regulation as we sprint to the finish, and resist the historical tendency of administrations to increase regulatory activity in their final months…
Except in extraordinary circumstances, regulations to be finalized in this Administration should be proposed no later than June 1, 2008, and final regulations should be issued no later than November 1, 2008…
Agencies should provide adequate time for necessary analysis, interagency consultation, robust public comment, and a careful evaluation of and response to these comments.
How’s that working out for you, Josh?
WASHINGTON — The Labor Department is racing to complete a new rule, strenuously opposed by President-elect Barack Obama, that would make it much harder for the government to regulate toxic substances and hazardous chemicals to which workers are exposed on the job…
With the economy tumbling and American troops fighting in Iraq and Afghanistan, President Bush has promised to cooperate with Mr. Obama to make the transition “as smooth as possible.” But that has not stopped his administration from trying, in its final days, to cement in place a diverse array of new regulations.
The Labor Department proposal is one of about 20 highly contentious rules the Bush administration is planning to issue in its final weeks. The rules deal with issues as diverse as abortion, auto safety and the environment.
One rule would make it easier to build power plants near national parks and wilderness areas. Another would reduce the role of federal wildlife scientists in deciding whether dams, highways and other projects pose a threat to endangered species.
Let’s see you argue with this, from Eye of the Storm:
i’m going to say this one time, and then i’m going to shut up. re: bristol palin. the american liberal is, — seriously, literally — pro-abortion and anti-choice, believes essentially in mandatory abortion. what does the average liberal mom do when her 16-year-old daughter shows up pregnant? drags her immediately to the abortion clinic, whatever the daughter’s (or the babydad’s, of course) misgivings.
the american left thinks that bristol palin having her baby is, actually, morally wrong. and more to the point, it shows something terrible about her mom, who had a moral obligation to make her daughter have an abortion. and one reason for this is that if you have a baby when you’re 16, you will likely slip out of our class. you’ll go live with joey, the kid who wants to be a mechanic. you’ll take classes at the community college instead of heading off to a decent school. you’ll end up in a housecoat with a houseful of wailing babies, listening to faith hill.
what haunts the imagination of the american liberal: my family, in the next generation, will be white trash. maybe it would be more interesting to look at these sorts of motivations than to try to figure out “when human life begins.”
In 1992 Paul H. Rubin of the Heritage Foundation published an article seething with the poisonous snake oil of ideological drivel:
Provisions of proposed legislation could be harmful to consumers. H.R.3642, for example, increases FDA’s powers to issue subpoenas, demand record-keeping and inspections, issue recalls and embargoes, and levy fines. All of these powers would lead to increased costs of doing business for firms regulated by the FDA, which would be passed on to consumers. But even more important, the threat of FDA intervention and the increased risk of loss of trade-secret protection would discourage firms from developing and marketing new products, denying these to American consumers who could be helped by them.
In 2008, a Democratically controlled Congress issued legislation of a nature decried by the likes of the Heritage Foundation so many years ago. Fortunately, this legislation was not vetoed by George Bush (this time). On August 14, 2008, President Bush signed into law the Consumer Product Safety Improvement Act of 2008 (the “Act”). This legislation,sponsored by Senator Mark Pryor (D-AR), comes a year after last summer’s recalls of millions of toys.
And now the CPSC has had a chance to act on that legislation, but unfortunately too late for the parents of one child, who could have been saved had the CPSC taken steps to issue its own recalls earlier.
As reported in the Linglestown Gazette in Central Pennsylvania, the CPSC has issued a recall involving an infant bassinet.
Attention parents of infants – If you are using a “close-sleeper/bedside sleeper” bassinet made by Simplicity, be sure to check out the two links below to see if your model is the one that has caused the death of at least two infants:
* U.S. Consumer Product Safety Commission press release (includes photo), dated Aug. 27, 2008
* Washington Post article, dated Aug. 29, 2008
Hopefully the next step Congress can take is to create a process whereby hedge funds can be prevented from stepping in and buying out companies in an attempt to evade legal and financial responsibility for companies and financial interests that create improperly designed products that kill, injure and maim consumers, particularly the most vulnerable members of our society. And the only chance that it will happen is for a strong Democratic majority to start rebuilding the legislative and regulatory infrastructure that was destroyed by the Republican Congress from 1994 to 2006. And there’s much work to be done to make it happen.
Update: I tend to be ever the optimist because I choose to be, but for a somewhat different analysis, Democracy Lover provides a refreshing (to me anyway) but cynical alternative view to the somewhat cheerful and hopeful view that I present here.