Monthly Archives: June 2009

What We’re Not Talking About

Posted on by

This morning there’s endless speculation on the disappearance and alleged reappearance of Gov. Mark Sanford of South Carolina. I say “alleged” because I’m not sure he has actually reappeared yet, but aides insist they will be able to conjure him up today. The most recent report I found says the governor took a quickie, unannounced vacation to Buenos Aires to “unwind.” His wife didn’t know where he was. I say the governor has some ‘splainin’ to do.

So far there’s much less chatter about civilians killed by U.S. drones in Pakistan. A drone fired missiles into a funeral of a Taliban militant, killing at least 45 Taliban militants, reports say, but also a number of civilians. The New York Times reports that the attack may have been conducted by the Pakistani Air Force, but “local news reports uniformly attributed it to a United States drone.” This will have been the 23rd drone attack carried out in Pakistan this year.

Pierre Tristam says that most of the casualties of the 23 drones have been civilians. Tristam’s commentary is very much worth reading. I don’t criticize using force to stop the Taliban; it has to be done, and it’s probably true that there’s no other way to do it.

But what does it say about us that we go into a several-day mourning frenzy over one young woman killed in Tehran, but shrug our shoulders over civilians killed in Pakistan? And do we really want the people of Pakistan to associate the U.S. with robot killing machines? Whatever happened to sending CARE packages?

Regarding the protests in Tehran, Juan Cole makes a good point —

The kind of unlicensed, city-wide demonstrations being held in Tehran last week would not be allowed to be held in the United States. Senator John McCain led the charge against Obama for not having sufficiently intervened in Iran. At the Republican National Committee convention in St. Paul, 250 protesters were arrested shortly before John McCain took the podium. Most were innocent activists and even journalists. Amy Goodman and her staff were assaulted. In New York in 2004, ‘protest zones’ were assigned, and 1800 protesters were arrested, who have now been awarded civil damages by the courts. Spontaneous, city-wide demonstrations outside designated ‘protest zones’ would be illegal in New York City, apparently.

Meanwhile, the New York Times reports,

Documents gathered by lawyers for the families of Sept. 11 victims provide new evidence of extensive financial support for Al Qaeda and other extremist groups by members of the Saudi royal family, but the material may never find its way into court because of legal and diplomatic obstacles.

Back in 2002 and 2003 when the Bushies were stampeding us into the Iraq war, one heard over and over again that Saddam Hussein had to be taken out because he “supported terrorism.” And I don’t doubt he did, although not al Qaeda, and his support was minuscule compared to that of the Saudis. But back then, whenever one brought this up, one was shouted down. We weren’t allowed to talk about it.

What else are we not talking about?

Update: Oh, what the hell — via Betsy Phillips at Nashville Scene, here’s a tribute to Mark Sanford. Enjoy.

Pathological Narcissism and the American Way

Posted on by

“He should point out this is not just an Iranian issue. This is an American issue.” This is John McCain, from the Rachel Maddow clip below. To me, this encapsulates the entire problem with the Right’s approach to foreign policy.

Visit msnbc.com for Breaking News, World News, and News about the Economy

On the clip Chris Hayes of The Nation said,

“In the long mythology of neoconservatism there’s a notion that Reagan single-handedly brought down the entire Soviet Empire because he said ‘tear down this wall,’ and somehow if you are, like, really willful and chest thumping that the world will sort of bend to your will. … There’s a tremendous pathological narcissism on behalf of people like McCain and [Lindsey] Graham, that everything revolves around the U.S. and revolves around our own, kind of, preening moral self-satisfaction, and it’s actually, it’s really destructive. I mean, if the president were doing what they wanted him to do, we would see things get worse in Iran, worse for the dissidents and protesters. It’s very hard to excuse.”

Of course, in a sense what’s going on in Iran is not just an Iranian issue; it’s the world’s issue. On the other hand, this is very much an issue the Iranian people need to work out for themselves, without outside interference.

And all manner of people keep saying that bellicose rhetoric from America is exactly what Mahmoud Ahmadinejad and Ayatollah Ali Khamenei want, just as an American invasion of a Muslim country was exactly what Osama bin Laden wanted. The chuckleheads on the American Right are so easily manipulated it isn’t funny.

Today there is much self-righteous chest-thumping on the Right about bloodshed in the streets of Tehran. The chest-thumpers are, for the most part, the same crew who has been calling for bombing of Iran for years. They wail about the martyred Neda Agha-Soltan, but if Ms. Agha-Soltan had been killed by an American bomb or drone she would have been, to them, collateral damage and not given a moment’s thought.

A rightie reading this might accuse me of “blaming” America. No, I’m saying America needs to not do things that are blameworthy. It’s my country, right or wrong, but as a patriot I feel it’s my duty to nudge it toward the right and away from the wrong.

Lies and the Lying Liars, Etc.

Posted on by

Last week in “Restating the Obvious” I quoted Erick Erickson of RedState:

Jay Rockefeller, Ted Kennedy, Barack Obama, and a host of liberal writers admit that the government will determine whether or not to treat you based on whether the government thinks the cost/benefit analysis makes sense.

And I asked if anyone knew were Erickson got such an off-the-wall idea. Well, I stumbled across the “source” yesterday. Harold P of Democracy for America says the righties are scrambling what’s called “comparative effectiveness research (CER).”

What is CER? Dr. Howard Dean explains:

At issue is something called “Comparative Effectiveness Research” which basically means giving your doctor access to the latest research on what treatments and therapies work and which don’t. This also helps doctors know which treatments are more expensive than others, and helps both patients and doctors decide if there is a cheaper treatment that is just as effective. As a doctor and the husband of a doctor, I know how important it is to have solid scientific research to make critical decisions for my patients.

This research will help doctors choose the best treatment for their patients’ situation and help them make more informed choices rather than risk prescribing less effective or even potentially harmful treatments.

Essentially, in order to control costs and provide patients with better care as we reform health care, the Federal Government will fund and disseminate research that evaluates the effectiveness of different treatments and medicines. This research will give doctors and patients better choices, and most importantly better health care for their money.

This is a common sense idea that should have been put in place a long ago.

Naturally, the Right is against it. Igor Volsky wrote for Think Progress on June 19:

During yesterday’s mark-up of the HELP Committee’s ‘Affordable Health Choices Act,’ Sens. Tom Coburn (R-OK), Pat Roberts (R-KS), Mike Enzi (R-WY) and Orrin Hatch (R-UT) introduced multiple amendments preventing the government from using the results of comparative effectiveness research (CER).

Of course they did. What else would you expect?

Responding to the Republican charges, Sen. Barbara Mikulski (D-MD) pointed out that existing language already prevented the new comparative effectiveness council from using the research to make coverage decisions. …

…The government isn’t mandating that doctors adopt the results of CER and it is not rationing care. Each patient has his or her unique needs and the ultimate decision for how to proceed should be left to the doctor and the patient. Currently, approximately one-third of all treatments have never been proven to produce better outcomes; CER would provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care.

(It seems to me that one of the results of CER might be that doctors do less over-treating and over-prescribing, which the Right has complained about for years. The Right’s complaints are in the context of scare stories about out-of-control malpractice litigation, charging that fear of lawsuits causes doctors to over-treat and over-test, thus running up the cost of medicine. However, this is a charge I’ve been looking into lately, and the “defensive medicine” claim appears to be mostly myth, albeit a myth many doctors believe. Over the past couple of decades several states have passed stringent “tort reform” laws that have drastically reduced the number of lawsuits filed in those states. And guess what? Doctors continue to order as many tests and as many treatments as they did before. But that’s another post.)

So how did the fevered imaginations of righties turn CER into rationing? You can trace that back to a column written in February by Betsy McCaughey. As Harold P at Democracy for America explains, McCaughey’s article is grossly inaccurate. But it established the conflation of CER with rationing, and the Right won’t let go of it.

Paul Krugman:

How bad is it? Let me count the ways.

  1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.
  2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.
  3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.
  4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.

See also Ezra Klein

Reform Theater

Posted on by

The New York Times reports that a whopping large majority of Americans want the government, not the private insurance industry, to take charge and address the health care crisis. The New York Times/CBS News poll found that most Americans —

  • Think the health care system needs to be fundamentally changed or completely rebuilt (85 percent).
  • Would be willing to pay higher taxes so everyone could have health insurance (57 percent).
  • Want a government-administered insurance plan that would compete for customers with private insurers (72 percent).
  • Think government could do a better job of holding down health-care costs than the private sector (59 percent).

Given these poll results, I believe that in nearly any other industrialized democracy in the world politicians would be tripping over themselves in the rush to provide universal health care coverage for citizens.

But not in the United States. In the U.S., politicians pat us on the head and tell us we’re confused. What we really want, we’re told, is to keep the private for-profit system that allows increasing numbers of Americans to fall through the cracks.

In the United States, the will of the people means nothing any more. What was once a vibrant democracy has been riddled with parasites sucking democratic values, not to mention wealth, out of it. These are special interest groups, big corporations and a small but well-funded — thus overrepresented in government and media — extremist Right.

In Washington today, just one lobbyist can cancel out the will of hundreds of thousands of voters.

For years the only point of view on health care presented in electronic media has been that of the parasites. The private interest, right-wing perspective has been preached at us incessantly on radio and television for years. I cannot recall ever seeing a balanced, substantive discussion on health care on American television, ever, and I gave up on radio years ago. Print media may sometimes present more substance, but it is usually in the form of showcasing “both sides,” that of the medical-industrial complex and that of an advocate for universal care side by side, with no attempt at editorial refereeing to sort the facts from the propaganda.

At this point, most of us fully expect that President Obama’s health care proposals — which were moderate and centrist to begin with, not nearly the total overhaul most of us wanted — will be watered down and compromised away to nothing but a collection of minor tweaks. And when the health care “reform” bill is signed into law there will be a great ballyhoo about it, but the American public will see no real difference. And the struggle will continue, and the Right will argue that we tried a progressive option and it didn’t work.

So we’ll continue to see charities established to deliver health care to third-world nations coming to the U.S. to provide health care to Americans. We line up for makeshift free medical clinics set up in old animal pens. Our young working adults set their own broken bones. More than one-fifth of Americans now are struggling, or failing — to pay for the health care they need. After a big hoopla about reform, these things will continue.

Years of government that cannot be made to respond to the will of Americans has resulted in political enervation. We’ve become resigned to an ever-encroaching shabbiness, an increasingly instability. None of the promises of reform made to us by the politicians we elect are ever kept to any meaningful extent, and we no longer expect them to be kept. Instead, we get reform theater, and nothing changes. That’s just how it is.

That wasn’t always the case. I am old enough to remember the attitudes of my Greatest Generation parents and their friends, who grew up with the New Deal and fought World War II. They came out of that era believing the American people, through their government, could accomplish anything. Now we’re grateful if our lights come on and our bridges don’t collapse.

Sorry if I’m feeling bleak today, but a number of news stories say the Democrats are going to be forced to compromise away the public insurance option — you know, the option that 72 percent of Americans support — to get a health care bill passed. And as far as I’m concerned that’s the only part of the package that really matters. It’s not a perfect solution, but it would make a real difference to millions of Americans and put us on the road to more genuine reform in the future.

And of course we may ask, with such broad public support for the public option, who is forcing the Dems to compromise? And the answer is, well-funded interest groups, the over-represented Right, and Big Money generally. We won’t get the reform we need, because it would cause a few well-connected people to lose money.

We’re told as if it were holy writ that health care reform would be bad for small business; I understand small business says otherwise. But the Powers That Be don’t listen to small business, either.

We can write letters and make phone calls and even hold massive rallies until we all grow feathers and fly. It won’t matter. We know that, because we’ve tried these things in the past, with this and other issues, and were ignored. That’s why so many of us have given up.

Some of us slog on, of course, because we have no alternative. As long as there is even a remote chance that the people’s will might be respected, we keep trying. What else can we do?

In the early 19th century, Alexis de Tocqueville wrote of Democracy in America: “The people reign over the American political world as God rules over the universe. It is the cause and the end of all things; everything rises out of it and is absorbed back into it.” Not any more.

Today in Iran

Posted on by

There are fresh reports that Iranian police are cracking down on protesters in Tehran. I’m thinking of Prague Spring, 1968; Tiananmen Square 1989; Saffron Revolution, Burma, 2007. I hope we won’t be adding Tehran, 2009, to that sad list, and the result this time will be more democracy in Iran, not more brutality.

Juan Cole’s backgrounder on what’s been going on the past couple of days is a recommended read. Also, h/t Talking Dog, keep up with the latest at Al’s Place.

Zombies of the Twilight Zone

Posted on by

On the same day we learn that Dan Froomkin was fired from the WashingtonPost.com, WaPo runs separate op eds by Paul Wolfowitz — Paul Wolfowitz, mind you — and Charles Krauthammer. They both argue that President Obama doesn’t know what he’s doing and should more forcefully and directly come out in support of the demonstrating Iranians.

Jonathan Chait:

President Obama has taken a cautious tone toward the demonstrators in Iran, with his stated reason being that more open support would discredit their cause. This strikes me as a sensible position. The revealed preferences of both sides suggest a mutual belief that an American embrace would hurt the protestors. The regime is trying (so far, without much success) to tie the demonstrators to the U.S., and the demonstrators are embracing the symbolism of the Iranian revolution (the color green, chants of “Alluah Akbar,” and so on) in order to demonstrate their patriotism and mainstream cultural status.

… What’s remarkable to me is that those on the other side refuses to rebut it. Today’s Washington Post op-ed page has two more columns lambasting Obama for failing to embrace the demonstrators. Today’s offerings are by Charles Krauthammer and Paul Wolfowitz. Neither one of them even mentions, let alone answers, Obama’s argument for why embracing the demonstrators would be counterproductive.

What’s remarkable to me is that Wolfowitz and Krauthammer have the chutzpah to be seen in public, never mind offer opinions on foreign policy, never mind actually get those opinions published in a major newspaper. Taking foreign policy advice from the likes of these two is like hiring Napoleon as a consultant for your Russian land invasion. Worse, actually, since I suspect Napoleon was smart enough to learn from mistakes and might have had some useful ideas.

Gary Kamiya wrote this week,

Like Rasputin, the unhinged “Mad Monk” whom they sometimes seem to have adopted as an intellectual role model, the neoconservatives who brought us the Iraq war refuse to die. Although they have been figuratively stabbed, poisoned, shot, garroted and drowned, they somehow keep standing, still insisting that history will vindicate George W. Bush’s glorious crusade. In a world governed by the Victorian moral code conservatives claim to uphold, they would be shunned, shamed and forbidden to appear on television or write Op-Ed columns. But because Beltway decorum apparently requires that disgraced pundits be given a permanent platform to bray their discredited theories, the rest of us are condemned to listen to their ravings.

I would argue that they haven’t been “figuratively stabbed, poisoned, shot, garroted and drowned,” or at least, not nearly enough. Major media (e.g., the Washington Post) still treats these zombies with respect, as if their opinions had credibility. Amazing.

I also want to point out, as others have, that the same neocons and their followers who are cheering for the demonstrators now (and may I say I am cheering for them, also; they are a genuine inspiration) have been urging us to bomb the smithereens out of Iran lo these many years. Do they not now see that they were wrong? That sometimes it’s wiser to stand back and let events take their course than to force an outcome with death and destruction?

Probably not. In 2005 the neocons couldn’t say enough about the glorious Cedar Revolution and the brave people of Lebanon. In 2006 the Cedar Revolution was quickly forgotten when Israel decided to initiate a military adventure into Lebanon, an action that by some miracle killed only Hezbollah Supporters, according to the Right Blogosphere at the time.

Of course, as Kamiya suggests, the real purpose of neocon bleatings now is not to offer any real advice on foreign policy. It is to undermine the Obama Administration. Period.

Restating the Obvious

Posted on by

There’s more commentary today on health insurance rescissions. Many are angry, but I’m not seeing anyone else state the obvious — the CEO’s insistence that they can’t stop recissions and make a profit; the implicit acknowledgment that they can’t insure people with preexisting conditions and make a profit; amounts to a confession that the private health insurance industry cannot solve the health care crisis. The “free market” is inadequate to the task of paying for modern health care.

And see Digby — the CEOs of the 23 top health insurance companies received $14.9 billion in compensation over a five year-period. You can provide a lot of health care for $14.9 billion.

What are the righties saying? So far the only reaction I’ve seen is from Erick Erickson of RedState. Taking his comments in reverse —

More damning, the White House cannot think of a single example of a single-payer system in the world that works.

Apparently White House spokesman Robert Gibbs was caught inexcusably flat-footed on a question about which single-payer system in the world “works.” I can answer that, but first let’s turn the question around — name a single nation in which 21st-century health care is being delivered by a “free market” system, at all.

{Cricket Chirps}

The United States is the only industrialized democracy that pretends to have a “free market” system, although in fact a large part of our health care costs are being paid by government, anyway. And the World Health Organization says ranks the U.S. at #37, behind Costa Rica, in terms of quality and fairness of our system.

In other words, there are 36 nations with some form of government-paid national health care system, several of which are single-payer, that are doing a better job than we’re doing in delivering health care.

Erickson also says,

Jay Rockefeller, Ted Kennedy, Barack Obama, and a host of liberal writers admit that the government will determine whether or not to treat you based on whether the government thinks the cost/benefit analysis makes sense.

Does anyone have any idea where Erickson got that idea? I’ve seen no such admission, and of course Erickson doesn’t provide a link.

Life as a Preexisting Condition

Posted on by

The must-read new story today is by Lisa Girion of the Los Angeles Times. In “Health insurers refuse to limit rescission of coverage,” we find the clearest case yet why the private health care industry will never, ever, not in a million years, come even close to solving the health care crisis.

In a nutshell — yesterday three big insurance company executives — WellPoint Inc., UnitedHealth Group and Assurant Inc. — told the House Subcommittee on Oversight and Investigations that their business models depended on being able to cancel the health insurance policies of customers who cost them too much money. An investigation by the Committee had found that over a five-year period, these companies had canceled the coverage of more than 20,000 people in order to avoid paying more than $300 million in medical claims.

One of the execs claimed the rescissions — industry jargon for canceling coverage — were necessary to protect the companies from fraud. People lie about preexisting conditions on their applications, he said, and this drove up the cost of insurance for everyone else. I’ll come back to this point in a moment.

In practice, this means insurers target people with high-cost conditions such as breast cancer and lymphoma and direct employees to examine patients’ paperwork for any pretense to cancel coverage. People with innocent mistakes and inadvertent omissions; people who were unaware of a preexisting condition at the time they filled out the application because the symptoms hadn’t developed yet; people whose preexisting conditions were minor and had nothing whatsoever to do with the disease costing the insurer money — such people found themselves dumped out of the health care system at their time of greatest need.

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

Karen Tumulty at Time presents several other heart-breaking, and outrageous, examples.

Of course, you might remember that Michael Moore documented this practice quite nicely in Sicko. We all knew this was going on. Members of the House Committee feigned surprise.

But I want to go back to the part about rejecting people with preexisting conditions. Who above the age of 40 does not have a preexisting condition? For that matter, what percentage of young adults freshly cut loose from their parents’ policies find they cannot obtain insurance because they failed to get through childhood without a preexisting condition?

The insurance companies are saying they can’t make a profit unless they deny coverage to people with preexisting conditions. How is this not an admission the private health insurance industry is a big, fat FAIL?

Righties just love to tell us that the reason health insurance is so expensive in some states, like New York, is that those states have (Cue: “Fortuna, Imperatrix Mundi (O Fortuna)”) regulations. And what are those regulations? Chief among them are provisions that limit the insurers’ abilities to deny coverage to people with preexisting condtions.

So, in many states, a middle-aged person with no serious health problems who was once prescribed Lipitor for high cholesterol would be unable to obtain health insurance at any price. In New York, this person can get insurance. Yes, it’s so expensive most people can’t afford it, but it’s obtainable for those who can pay for it.

What this says to me is that relying on a private insurance industry to pay for health care costs is unworkable. A private insurance industry simply cannot do the job of paying for health care, because the only way a private company can make a profit is to deny coverage to people who are actually sick so that they don’t have to pay those bills.

My next question is, how obvious does this have to get before people see it?

I’m sure some people do lie on their insurance applications in order to obtain coverage. But in most industrialized democracies, this wouldn’t even be an issue. You’re a citizen, you get health care. Whether you once had acne treatments or took Lipitor or had a gallstone or even had a life-threatening disease, you get health care. Because the purpose of the health care system in most countries is delivering health care, not making a profit.

And for those worried about the cost to government of providing health care to sick people, let me present this handy chart:

healthcarecostsbycountry

This chart was adapted from a Canadian site calling for health care reform in Canada. The Canadian system has its problems, but I suspect seeing the mess we’re in persuades many Canadians to leave well enough alone. At least Canadians can get health care.

I believe the only way we’ve got a shot at lowering per-capita cost while delivering health care to everyone is to kick the insurance companies out of the picture altogether and going to a purely public system. At least a public health insurance plan would be a step in that direction.

Regarding the recently released CBO estimate of $100 trillion over ten years — see Extra Klein for why the CBO estimate is deeply flawed. See also “The Bright Side of the CBO Snafu.”