Month: February 2013

Our healthcare system is still insane

by David Atkins

From a lengthy, superb Time Magazine (!) article on the appallingly inefficient and immoral U.S. healthcare system:

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

Be sure to read the whole article, of which this section is but a small excerpt. The essence of the problem is that our nation’s long-term deficit problem is largely a healthcare problem. And the healthcare problem is that insurance companies and providers are bizarrely overcompensated in a seller’s market without the buying power of a national single-payer system.

If the so-called deficit hawks truly cared about our nation’s finances they would work to institute a Medicare-for-all system that brings per capita costs in line with those of other countries. But, of course, we all know that the Very Serious People don’t really care about the deficit. They care about slashing earned benefits for the middle class as a moral crusade against “government dependency.” The nation’s finances and well-being are beside the point.

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Good morning Mr Phelps

by digby

Psychopath Fred Phelps and his band of pathetic loons walked into the belly of the beast today — a few blocks from my house:

You want to protest at Santa Monica High School? Against gay rights? Let’s just say your protest won’t go unanswered. Our kids are protesting before they’re weaned around here.

Via Americablog
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One million (very kinky) moms speak out

by digby

I’d say somebody’s lurid imagination is working overtime:

One Million Moms wants auto insurance firm Geico to pull its latest TV campaign in which a woman appears to be flirting with a pig.

The conservative Christian group that monitors children’s programming issued a statement to condemn the clip.

“The Geico marketing team may have thought this would be humorous, but it is disgusting to see how the company takes lightly the act of bestiality,” One Million Moms said in a statement.

I guess you can’t really blame them. How are kids supposed the know the difference between a pig and the right wing radio hosts their moms listen to every day? You can’t be too careful.

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All the Senate Ladies

by digby

I’ve heard rumblings in certain quarters either condemning Elizabeth Warren for not following the so-called Clinton style “charm offensive” to win over her GOP colleagues or, conversely,  condemning Clinton retroactively for failing to be confrontational in the Elizabeth Warren mode. Both criticisms are wrong because as Joshua Green discusses in this article, the differences are a function of the different legislative environment in which the two women served.

Hillary Clinton established a model for how celebrity senators are expected to comport themselves after she was elected from New York in 2000. When she first arrived on Capitol Hill, Clinton was mobbed by camera crews, which for weeks trailed her TMZ-style through the bowels of the Senate frantically trying to elicit comment. Clinton ignored all but the local reporters and took pains to avoid saying anything controversial. “I’m a workhorse, not a show horse,” was her constant refrain.

In a bastion of ego like the Senate, Clinton’s subordination of her own celebrity was shrewd politics, as was the elaborate deference she showed to her senior colleagues. Clinton stayed quiet for years. In meetings, she poured coffee for male senators. When Clinton was first elected, Republican Senator Trent Lott of Mississippi suggested that it wouldn’t be a terrible thing if she were struck by lightning. But by the end of her term, Clinton had co-sponsored legislation not only with Lott but with 48 other Republicans as well. She was a surprisingly effective senator.
[…]
Today, Clinton’s charm offensive would be less likely to win Republican co-sponsors and far less likely to yield new laws—Congress barely passes any significant ones nowadays.

But new laws aren’t the only way to attack a problem, especially in the realm of financial regulation. One way is, as Warren suggested, to enforce existing laws more aggressively. Another is to stave off banks’ attempts to weaken them. The big fight this session will be over how regulators should apply the Dodd-Frank banking reforms of 2010.

Eventually, though, the Senate will have to legislate. And the next big fight may well be over whether to break up the big banks. An unlikely coalition of politicians and regulators on the left and right who favor this option has lately begun to take shape.

This group so far lacks the critical mass necessary to get a bill through Congress. In the days of yore, a newcomer like Warren could bide her time, gradually win the respect of her colleagues, and then, maybe, after years of diligent effort, put together a coalition large enough to succeed. Today’s Senate doesn’t operate that way. Public pressure, often driven by outrage and anger, is the only force that reliably brings results.

Warren may never achieve Clinton’s popularity among Senate Republicans. But despite the Banking Committee drama—or, actually, because of it—her first hearing gave no reason to think she’ll be any less effective.

There was also the little matter of Clinton being considered to be the bride of satan by the Washington press corps. I think she had to keep her head down for a good long time in order to keep from getting it lopped off. She did amazingly well considering the barriers to her success at the time.

But what Green says is true. The old way of doing business is over, at least for now. Warren instinctively seems to know this as few Democratic politicians do. I’m not sure if it’s instinct or intellect, but whatever it is, I’d put my money on her being able to successfully swim in these turbulent waters.

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A violation of journalistic ethics:: Austerity didn’t work, so we need more austerity.

by David Atkins

This paragraph in the Wall Street Journal‘s story about the Italian election is nothing short of amazing:

Mr. Monti’s government of technocrats took power and passed tax hikes and spending cuts that pulled Italy back from the brink of the euro-zone debt crisis. But the austerity dragged Italy’s already-ailing economy into a further slump, pushing up unemployment and forcing people to rely increasingly on their families for homes and funds. Italy’s debt, meanwhile, continues to be 127% of gross domestic product, meaning that more austerity is likely needed.

First, the obvious: if austerity failed by plunging the economy further into recession and driving up deficits due to the weak economy, how could it follow logically that more austerity is needed? One is reminded of doctors of old who insisted that blood letting was the proper way to treat fever; when the fever failed to subside, it was axiomatic to them that more blood letting was needed. It’s not as if more sensible, Keynesian alternatives have not been frequently presented. The insistence on austerity has become more theology than rational economic policy as this point.

Perhaps more importantly, It’s worth noting that this is a straight reporting piece, not an opinion piece. Yet the notion that “more auserity is likely needed” is presented simply as a matter of fact, not opinion. The language used to describe the need to act on climate change is usually more carefully couched and nuanced than this. It is remarkable that journalists have no qualms about presenting the necessity for austerity as a fact no different from the rising of the sun in the east, when almost no other major issue of the day receives the same treatment. Ezra Klein also noted this a few days ago:

For reasons I’ve never quite understood, the rules of reportorial neutrality don’t apply when it comes to the deficit. On this one issue, reporters are permitted to openly cheer a particular set of highly controversial policy solutions. At Tuesday’s Playbook breakfast, for instance, Mike Allen, as a straightforward and fair a reporter as you’ll find, asked Simpson and Bowles whether they believed Obama would do “the right thing” on entitlements — with “the right thing” clearly meaning “cut entitlements.”

A few days earlier, Ron Fournier, the editor of the National Journal, wrote that President Obama was giving America “the shaft” by taking an increase in the Medicare age off the table. It is difficult to imagine him using similar language for a situation in which Republicans reject universal health care, or Democrats say no to a tax cut. Over the past couple of weeks, MSNBC’s Joe Scarborough has reacted with evident astonishment to Paul Krugman’s argument that the long-term deficit is not a problem we need to solve right this second.

Italian voters have now resoundingly rejected the enforced Austerity program. It didn’t work, isn’t working, and won’t work in the future. Italians may be split between the center-left and center-right, but they do know they don’t want what the IMF snake-oil peddlers are selling. Yet news organizations even in straight reporting stories continue to insist that snake oil and blood letting are the only cures for what ails them. It’s a violation of the ethics and integrity of journalism.

Dancing with the stars it ain’t


by digby

I’m sure most of you saw Michelle Obama’s dancing video with Jimmy Fallon at some point over the past few days. (If not, you can see it here.)

Keeping in mind that Obama and Fallon’s bit was entirely non-political, the right wing has nonetheless answered:

I’m fairly sure it’s supposed to be funny political satire.

h/t to @tbogg

“Judeo-Christian country” means different things to different people

by digby

Here’s Mike Huckabee comparing covering pre-existing conditions to issuing insurance to a house that’s burned down already. Seriously.

“It’s not about being cruel. It’s about using the realities of actuarial science to make an insurance policy work.”

Oh, now he believes in science?

It’s amazing that these people feel so comfortable defending this, dare I say it, un-Christian attitude toward their fellow man. You’ll notice he doesn’t have a clue — or apparently a care — about what’s going to happen to the poor man who has terminal cancer — and his family who would go broke from the bills. Why, if I didn’t know better, I’d think this very religious minister believed that illness is a punishment and the person who gets sick deserves what he or she gets. Certainly he seems to have more concern for the insurance company than he has for the poor patient.

John McCain got himself in a pickle the other day, trying to explain to Republican voters that you can’t tell someone who’s lived in America for 50 years that they have to go “back” to a country they no longer know. People in the audience screamed out “why the hell not?!” and he replied, “because we have a Judeo-Christian ethic in this country.” I guess it’s a function of his age that he believes his voters still think of the Judeo-Christian ethic as meaning any kind of empathy or kindness toward others. (Not that he practices it himself necessarily, but he obviously considers it a common American value.) Someone of McCain’s years probably thinks that most people agree on some fundamental, moral level that it’s wrong to be cruel to others and so that argument is obvious. But I don’t think his voters believe that at all. These people understand the term “Judeo-Christian country” to mean one in which people who don’t look like them, worship like them and think like them are not “real Americans” regardless of their actual citizenship.

They do not believe the Judeo-Christian ethic has anything to do with shared values, but rather shared identity, which isn’t the same thing at all. Witness the great conservative Christian Mike Huckabee, casually talking about “pre-existing conditions” as if the main issue in the discussion is whether or not the “actuarial science” makes sense for the insurance company. No word on what makes sense for the people.

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Why change when you’re already winning?

by digby

Greg Sargent reports that Ted Cruz is doubling down on his McCarthyist smears about Harvard being riddled with revolutionary Communists (with the implication, of course, that Barack Obama was one of them when he attended):

The Cruz spokesperson didn’t elaborate on how precisely these Reds are advocating the overthrow of the government. As Steve Benen notes, you can be a subscriber to “critical legal studies” without wanting to violently bring down the American system and replace it with a communist utopia.
It’s unclear to me that this sort of red-baiting attack on the coastal academic elite will have the resonance it did back in, oh, the last century. But here we are, and if more stuff like this flows from Cruz, it’ll be interesting to see how his fellow Republicans react to it. After all, if Republicans are really going to change their party, they’ll need to create an atmosphere in which moderates are no longer forever in fear of the base.

I’m going to guess we’re not there yet. Here’s Club for Growth president Chris Cocola giving Breitbart News an interview. (That fact alone should be enough to show just how unlikely it is.)

Breitbart News: What are Club for Growth’s key objectives for 2013?

Chris Chocola: We want to continue to grow the pro-growth caucus by supporting strong, fiscally conservative candidates through our PAC. We are hoping that the candidates the PAC has helped elect are helping to drive the agenda within the Republican Party. We’ll be watching closely to see if Republicans stand strong on sequestration and the continuing resolution. We’ll be urging them to cut spending and put us on a path to a balanced budget within 10 years. The whole purpose of the Club for Growth is to encourage policies that lead to a high-growth economy, and we’re very concerned that our growing debt burden and uncertainty about our economic future is holding us back. All we’ve ever wanted from Congress is responsible behavior, and we think that message is beginning to percolate throughout capitol hill. For the first time in a long time, members of Congress are talking about spending less money, not simply slowing the rate of growth of spending. That’s a sea-change, and we’re looking to build on that momentum.

Breitbart News: When you look at specific policy proposals—such as those dealing with the debt ceiling, the deficit, the fiscal cliff, and federal spending in general—do you think the Club is winning the war of war of ideas among the Republicans on Capitol Hill.

Chris Chocola: We take pride in our ability to advocate for free markets and limited government, but it’s really the new members we’ve helped elect through our PAC that are driving policy. It’s because of members of Congress like Jeff Flake and Pat Toomey that earmarks are banned. It’s because of members like Ted Cruz and Rand Paul and Mike Lee that the culture of the Senate is beginning to change. We supported those members and others because of what they believe, and they will stand and fight for their principles. Our goal is to get a majority of the majority. We’re not there yet, but the changes that have happened within the Republican Party on policy over the past decade because of the Club for Growth and its members is undeniably positive.

The changes that have happened within the Republican Party on policy over the past decade because of the Club for Growth and its members is undeniably positive.

They are in this for the long haul. And I’m not sure Democrats are playing the same game. I get the feeling they believe that because they have a demographic advantage it’s going to be smooth sailing. And I suppose if you believe that winning the presidency is the big prize, they are probably looking at a pretty good run. However, on policy, the Club for Growth has every reason to be optimistic. They are doing just fine in that regard, with the national obsession with deficits and low taxes pretty much guaranteeing that they will continue to do quite well regardless of who’s in power.

This goes both ways, of course. Progressives have been very successful at advancing their social and civil rights agenda over the past 30 years despite the dominance of conservative politics. These things work on a number of tracks. But I’m going to guess that the major battles of the coming years are going to be around the fundamental role of government, with labor and social insurance at the top of the list. And on that, I see no signs that the GOP is prepared to moderate. In fact, the Democratic Party isn’t much better on those issues and shows little sign of truly pulling in the opposite direction.

It’s possible that the Republicans will change their style a bit and try to become kinder in tone. (They do that on a regular basis, by the way. Remember Compassionate Conservatism.) But on the fundamental battle over the role of government, they have been winning and they know they’ve been winning. After all, Obamacare, their most hated new government initiative was a GOP plan not even two decades ago.

They aren’t all stupid, especially those who are working to restore our society to a pre-New Deal state. It would be really helpful if Democrats stopped being so cocky and started recognizing how much they have been losing on policy even as they’ve been winning elections. The country is losing either way.

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In search of the honest conservative

by digby

It’s definitely not Rich Lowry:

Ideally, Congress and the president would agree on more targeted and intelligently crafted savings. But the president insists on more tax increases. The other day he said a cuts-only replacement for the sequester would be as absurd as a taxes-only agreement on overall deficit reduction. Yet he exacted a taxes-only agreement from Republicans over the fiscal cliff, with nary a concern about making the deal more “balanced.”

Right:

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Both parties face a dilemma on the carried interest loophole

by David Atkins

Privately, it appears that Republicans may be willing to eliminate one of the most egregious financier loopholes of all time: the carried interest deduction. But only because it would impact big Democratic donors:

Pressed by President Barack Obama to support more revenue increases, congressional Republicans may relent on the carried interest loophole that tends to benefit wealthy Wall Street investors.

Despite the party’s long-standing resistance to tax hikes — particularly after compromising on the fiscal-cliff deal that allowed rates on higher earners to go up — some GOP sources say Republican members might agree to eliminate carried interest deductions because it would primarily affect wealthy Democratic campaign donors. The likely stiff resistance from New York Sen. Charles E. Schumer and other Senate Democrats would be a bonus. Republicans, sources say, are not motivated to protect contributors who have donated millions to their opponents.

Speaker John A. Boehner “can probably offer a carried interest amendment as one tax increase that is warranted,” said a Republican lobbyist with relationships on both ends of Capitol Hill. “If we are forced into a sequester conference that demands taxes, Democrats can screw their big, rich donors.”

A second Republican lobbyist said agreeing to close the carried interest loophole could serve as a GOP concession on taxes in any of the upcoming fiscal negotiations. The loophole allows investors whose earned income is generated mainly from investments to pay taxes according to the capital gains rate, which is significantly lower than the top rate on earned income most of these individuals would otherwise pay.

A golf clap is certainly in order for a Republican Party able to maybe do the the right thing for the country, but only for the most craven and cynical of reasons.

Under normal circumstances it would be well worth watching how certain Democrats vote on the loophole. But sadly we likely won’t get that opportunity, partly as a byproduct of overreach by the pro-austerity crowd. The elimination of the carried interest loophole would almost certainly come packaged with other austerity measures, including chained CPI and other stupid cuts to earned benefits. All any Democrat corrupted by Wall Street would need do is vote against the bill in order to protect hedge fund mangers, while claiming their vote was against cuts to Social Security.

If John Boehner really wanted to put Democrats in a bind, he’d bring the carried interest loophole elimination bill as standalone legislation. But then, Republicans would be on the line with their own base for having raised taxes on heroic job creators.

What a pickle.

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