The Health Care Reform Debate Blog - cmhmd

The Washington Monthly - Ten Miles Square - The Quiet Triumph of Obama Care

2012-01-31T11:38:00.000-08:00

The Washington Monthly - Ten Miles Square - The Quiet Triumph of Obama Care:

We understand why President Obama trumpeted the killing of Osama bin Laden while barely mentioning health reform, his most significant domestic accomplishment in his State of the Union address last week. Ten years after 9/11, the killing of Bin Laden was an indisputable triumph for President Obama, welcomed by almost every American. In contrast, the Patient Protection and Affordable Care Act (ACA), enacted with only Democratic votes by the scarcest of margins in 2010, remains a complex, highly controversial piece of legislation with outcomes and costs that remain to be seen in the years ahead.

Yet surprising even to many advocates of health care reform, evidence is emerging that the ACA is already improving life for millions of average Americans. It is promoting long-overdue fundamental changes in our dysfunctional medical system. Moreover, because those reforms are starting to directly address heightened economic insecurities of average families - the personal financial conditions that will largely determine this year’s election outcomes - President Obama would be wise to more forcefully and more specifically explain how his health care bill is already helping millions of vulnerable families and the country as a whole. Sure, financially-pressured families will celebrate the derring-do of Seal Team Six. They should directly appreciate the immediate impact of improved insurance coverage and reduced medical costs.

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The Facts On Massachusetts Health Reform – Health Affairs Blog

2012-01-30T19:00:00.000-08:00

The Facts On Massachusetts Health Reform – Health Affairs Blog:

Last Thursday’s Republican Presidential Debate in Florida included a lively, but not always accurate, exchange on health reform in Massachusetts. In particular, Senator Santorum reported that one in four Massachusetts residents were going without needed care because of high costs; he also implied that the share of residents choosing to pay the fine for failing to comply with the individual mandate, and the share of residents who were free riders on the system, were serious problems in the state. None of that is true.

My colleagues and I have been tracking health reform in Massachusetts since 2006, with a summary of our most recent findings published in Health Affairs last week. As we report, Massachusetts continues to show strong gains in insurance coverage, access to care, and self-reported health status under reform, all important goals of the state’s 2006 legislation. Currently residents of the Bay State enjoy the highest level of insurance coverage in the nation, with most of that coverage provided through their jobs, as it was before health reform. As Governor Romney noted, a majority of Massachusetts residents continue to support the state’s reform efforts.

Contrary to Senator Santorum’s claims, very few residents of the state are “free riders” on the health care system in Massachusetts, moving in and out of coverage as they need care

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General Surgery News - Spam in a Can

2012-01-27T13:30:00.000-08:00

General Surgery News - Spam in a Can:

For those of you who have been spending your days operating and taking care of patients instead of keeping up with the latest machinations from central planning to separate you from the fruits of your labor and control of your practice, ACOs are bundles of providers who will receive a global payment for a specific patient encounter, like a cholecystectomy. Who will bill, receive and divide the money is uncertain, except that it won’t be you, the surgeon. The only thing certain is that like diagnosis-related groups, the sustainable growth rate, and relative value units, this latest iteration in health care spending discipline will be gamed and ultimately relegated to the alphabet graveyard of designer cost-containment programs invented by health policy wonks who have an aversion to traditional medicine based on the private doctor–patient relationship. I’ll say this much for them: They are undeterred by their unbroken string of failures. Maybe they’re Cubs fans.

An interesting read, if you want to really appreciate the "old school" approach of a lot of our colleagues (this was sent to me by one). My thoughts:

Some interesting phrasing choices in this piece.

"outside secular influence"

"the surgical workforce has been transformed by macroeconomic factors from the ownership class to the labor class."

"Ownership and labor never agree on anything"

"Strip away the thin veneer of status, and the chief of surgery at Johns Hopkins and the junior surgeon at Kaiser both serve at the pleasure of a boss, punch a clock and take fire training and corporate compliance classes."

"you had the common values, aspirations and headaches typical of small-business owners."

"cookbook medicine" (Really? Who still thinks this way?)

Anyway, it all made me think of the Master-Slave morality dichotomy. Since Jesus was the epitome of the 'slave' side of this, I'm comfortable with my position, as is, I expect, is Dr. Russell.

And it also made me think of this great quote:

"A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it"
Max Planck

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Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries - The Commonwealth Fund

2012-01-26T19:05:00.000-08:00

Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries - The Commonwealth Fund:

Key Findings

Public payer fees for an office visit ranged from $34 in Australia to $66 in the United Kingdom; private payer fees ranged from $34 in France to $133 in the United States.
U.S. primary care physicians were paid an average of 27 percent more by public payers for an office visit, and 70 percent more by private payers for an office visit, compared with the average amount paid in other countries.
Public program fees for hip replacements ranged from $652 in Canada to $1,634 in the U.S. In the U.S., private health insurance fees for hip replacements were nearly $4,000—twice as high as the private rates in the five other countries.
U.S. payers paid much higher fees to orthopedic physicians for hip replacements: public payers paid 70 percent more, while private payers paid 120 percent more.
U.S. primary care physicians earned an average $186,582, compared with a range of $92,844 (Australia) to $159,532 (U.K). U.S. orthopedic surgeons earned an average $442,450, compared with a range of $154,380 (France) to $324,138 (U.K.).

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Editor of journal critical of welfare still has DPW job - Philly.com

2012-01-26T15:31:00.000-08:00

Editor of journal critical of welfare still has DPW job - Philly.com:

INQUIRER HARRISBURG BUREAU HARRISBURG - A controversial adviser to Welfare Secretary Gary Alexander is still working for the state and will do so for an indefinite period, despite last week's announcement that he had resigned.

Last week, officials said Robert W. Patterson, a special assistant to Alexander, had quit his $104,470 position as The Inquirer was preparing to publish a story about his outside role as editor of a conservative, faith-based journal.

In announcing Patterson's exit, the Corbett administration distanced itself from views expressed in the journal, which has criticized key welfare programs administered by the Department of Public Welfare and offered opinions that women should be stay-at-home mothers and opposing birth control - as well as musings on how condom use could rob women of reported mood-enhancing benefits of chemicals in semen.

If you haven't read Thomas Frank's "The Wrecking Crew," this could be straight out of it. Hire someone who detests a government agency and especially its constituency, and put them in positions of power within that organization to make it weak and ineffectual, then decry it for being weak and ineffectual.

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Gingrich and Reagan - National Review Online

2012-01-26T15:26:00.000-08:00

Gingrich and Reagan - National Review Online:

Off topic, but too fun to skip...

The best examples come from a famous floor statement Gingrich made on March 21, 1986. This was right in the middle of the fight over funding for the Nicaraguan contras; the money had been cut off by Congress in 1985, though Reagan got $100 million for this cause in 1986. Here is Gingrich: “Measured against the scale and momentum of the Soviet empire’s challenge, the Reagan administration has failed, is failing, and without a dramatic change in strategy will continue to fail. . . . President Reagan is clearly failing.” Why? This was due partly to “his administration’s weak policies, which are inadequate and will ultimately fail”; partly to CIA, State, and Defense, which “have no strategies to defeat the empire.” But of course “the burden of this failure frankly must be placed first on President Reagan.” Our efforts against the Communists in the Third World were “pathetically incompetent,” so those anti-Communist members of Congress who questioned the $100 million Reagan sought for the Nicaraguan “contra” rebels “are fundamentally right.” Such was Gingrich’s faith in President Reagan that in 1985, he called Reagan’s meeting with Soviet leader Mikhail Gorbachev “the most dangerous summit for the West since Adolf Hitler met with Neville Chamberlain in 1938 in Munich.”

Gingrich scorned Reagan’s speeches, which moved a party and then a nation, because “the president of the United States cannot discipline himself to use the correct language.” In Afghanistan, Reagan’s policy was marked by “impotence [and] incompetence.” Thus Gingrich concluded as he surveyed five years of Reagan in power that “we have been losing the struggle with the Soviet empire.” Reagan did not know what he was doing, and “it is precisely at the vision and strategy levels that the Soviet empire today is superior to the free world.”

There are two things to be said about these remarks. The first is that as a visionary, Gingrich does not have a very impressive record. The Soviet Union was beginning to collapse, just as Reagan had believed it must. The expansion of its empire had been thwarted. The policies Gingrich thought so weak and indeed “pathetic” worked, and Ronald Reagan turned out to be a far better student of history and politics than Gingrich.

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Front Group King Rick Berman Gets Blasted by his Son, David Berman | Center for Media and Democracy

2012-01-25T19:49:00.000-08:00

Front Group King Rick Berman Gets Blasted by his Son, David Berman | Center for Media and Democracy:

Rick Berman's son, David Berman, is a 42-year-old singer-songwriter who, since 1989, has been the front singer for a popular New York City indie rock band called the "Silver Jews." Over the years, the Jews have developed a loyal following, but on January 22, 2009 David Berman stunned his fans by posting a note to an online message board announcing that after all these years he was leaving the Silver Jews. The reason? His father, Rick Berman.

In scathing language, David disclosed to his fans who his father is, and how leaving the band related to his father's work. David wrote,

...follow the link. Amazing stuff!

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GPs and healthcare costs | OECD Factblog

2012-01-25T10:37:00.000-08:00

GPs and healthcare costs | OECD Factblog:

It may be common knowledge that doctors’ pay outstrips average wages, with the really high earnings going to medical specialists. But now, more and more doctors are becoming specialised, with implications for costs and healthcare policy more generally. There were some 3.2 million doctors in the OECD area in 2008, which is over 40% more than in 1990 in absolute terms. But looked at on a per head basis, the number of specialists expanded by about 50% over the same 18 year period, compared with a mere 15% rise per capita for GPs.As a result, the number of medical specialists now exceeds generalists in all but four OECD countries–Australia, France, Korea and Portugal. This trend towards specialisation may reflect advancements in medical technologies and the increasing complexity of healthcare. But it also reflects a a widening pay gap.

Indeed, despite the sharp rise in the number of specialists, their pay has grown faster than that of generalists in a diverse group of OECD countries, includingAustralia, Finland, Hungary and the Netherlands . Only in a few European countries, such as Belgium and Luxembourg, has the income of generalists grown faster than that of specialists.

Having more specialists is clearly not bad in itself, but a shift away from GPs can undermine primary care and increase costs pressures.

The UK is one country that has taken deliberate steps to improve the relative attractiveness of general practice . New contracts were introduced in 2004, and since then GP pay has risen sharply. Whether the extra cost incurred in improving the GP contracts has delivered value for money is less clear. But the search for policies to encourage a more effective GP/specialist balance is set to continue.

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Like it or not, Obamacare forces drug company disclosure - News - ReviewJournal.com

2012-01-24T09:38:00.000-08:00

Like it or not, Obamacare forces drug company disclosure - News - ReviewJournal.com:

The New York Times and the Wall Street Journal have taken the lead in writing about potential conflicts of interest between doctors and medical manufacturers. Although philosophically on opposite sides, both newspapers have raised questions in chilling stories about doctors taking money from drug and device manufacturers.

The Times' reported that some doctors practice medicine differently if they take money and are more willing to prescribe drugs in risky and unapproved ways.

In the regulations being finalized, executives at the top would be responsible for the accuracy for that disclosure. The information would be on a searchable website so the public can check it out. About 1,100 companies would have to file reports.

Every transaction may not be dubious, but when more than one out of four doctors are paid for consulting, lectures or enrolling patients in clinical trials, you deserve to know if your doctor might have a financial interest in a particular company.

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Error Correction Physicians organizations on HCR from 2009/2010

2012-01-23T17:05:00.000-08:00

In 2009, I had tracked down the largest medical organizations to determine their position on the then current Health Care Reform Bill, HB 3200. At the time, I reported that 8 of the 10 largest physicians organizations supported HB 3200. I noted at the time:

For completeness, #8, the American Society of Anesthesiology and #10, the American College of Radiology are still against reform until they get reimbursement "fixes."

Then, on Nov. 11, 2009, I wrote:

Now that the American Society of Anesthesiology has voted to support the House Bill, we now have an AMAZING NINE OF of the TEN largest physicians organizations supporting reform.

That, apparently is incorrect, and my colleagues Vivek Murthy and Harold Pollack linked to my post from Feb. 9, 2010, indicating that the ten largest organizations supported health reform with a public option. That last part, I believe, is/was true in that all of those organizations were supportive of the public option (the ASA when reimbursement was delinked from Medicare rates). As my blog post states,

SO, actually, the BIG NEWS is that 10 of the 10 largest physician organizations support health reform with a public option.

I must have inferred or confused the ASA support with the public option with overall support, and I suspect that this was due to the massive focus on the public option issue at that point in time.

As I look back at the other posts I wrote since then, including the one Vivek and Harold cited, I have an exclamation point beside the ASA, as it surprised me so much.

But I have spent over an hour looking, and although I found press releases indicating qualified support by the ASA, I cannot find anything indicating unqualified support. And, as they pointed out to Harold and Vivek, they did issue a formal statement against the FINAL reform bill in March, 2010.

BUT, ASA correction noted, nearly all of the major physicians organizations supported the House Bill (which included the Public Option and the SGR fix), and continued to support the final bill, warts and all.

So, my apologies to the ASA and to Harold Pollack and Vivek Murthy. I will go back and note this correction in the old posts.

Sincerely,

Christopher M. Hughes, MD

25 Best Global Healthcare Rankings

2012-01-21T18:11:00.000-08:00

Interesting web site with all these links on International comparative health care.

25 Best Global Healthcare Rankings: Healthcare Infographics

These interesting infographics help you visualize various healthcare rankings, and can help you see just where your country of residence sits.

Global Health-Care Snapshot: Presents a ranking of countries by how much they spend as a percent of GDP. Includes comparisons of costs in 1980 and in 2006 so that you can see where health care costs have grown the most. Includes helpful information on how people are insured in developed countries, and tabs that illustrate life expectancy and infant mortality.
Health Care Expenditures: An International Comparison: This infographic ranks different expenditures on healthcare by country. Expenditures considered include nursing homes, administration, medications, hospitals and more. An interesting way to break down healthcare costs.
U.S. Healthcare Quality: Get a look at how countries are ranked in terms of health care quality. This infographic looks at different factors related to quality, and ranks different countries.

There are lots more...
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France: 'Best' Health Care?

2012-01-17T18:53:00.000-08:00

I am taking an International Comparative Health Care Course this semester, so will be adding to my US/World Healthcare Comparison tag I'm sure. Here's a piece from CBS Sunday Morning on France. The second half, showing the EMS triage system is pretty impressive.

To Fix Health Care, Help the Poor - NYTimes.com

2012-01-15T12:12:00.000-08:00

To Fix Health Care, Help the Poor - NYTimes.com:

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

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Is Medical Student Choice of a Primary Care Residency Influenced by Debt?

2012-01-12T17:18:00.000-08:00

Is Medical Student Choice of a Primary Care Residency Influenced by Debt?:

Mean total debt for the study population was $89,807 (SD = 54,925). Graduates entering PC did not have significantly less total debt than those entering NPC ($87,206 vs $91,430; P = .09). Further, total debt was not a predictor of a PC residency after adjusting for medical school, year of graduation, and years of training in residency (P = .64).

And another take, similarly suggests medical school costs as independent of specialty choice. I can imagine several reasons for this, and I think the grand experiment could be somewhat as suggested - try major reductions in specialty income and increases in PC income and see what happens. Only half joking here.

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Parsimony & Medicine

2012-01-06T07:26:00.000-08:00

[This is cross-posted on Doctors for America's Progress Notes and DailyKos.]

I wasn't planning on writing about rationing of health care again, since we covered it in my last post prompted by Don Berwick's resignation from CMS.

But two stories came up recently that prompt me to do it again. The American College of Physicians released their revised Ethics Manual this week, and included language regarding the use of cost effectiveness as a criteria for providing care, and even urged parsimony by physicians. In an accompanying editorial, Ezekiel Emanuel, lauds the ACP for this language, noting the physician's obligation to society as a whole, and not just to individual patients. (As we noted last time, the Charter on Medical Professionalism and the AMA Code of Ethics emphasize the physician's duty to social justice in the distribution of finite health care resources.)

All well and good, but NPR did a story on the Manual, and out it came. Scott Gottlieb, MD, of the American Enterprise Institute noted the general acceptance of cost effectiveness data in medical decision making, but then followed up that parsimony "really implies that care should be withheld. There's no definition of parsimonious that I know of that doesn't imply some kind of negative connotation in terms of being stingy about how you allocate something." (The definition I linked to above notes that parsimony can mean simply being careful with money or stingy.)

Daniel Callahan of the Hastings institute also got the vapors: "If you say certain things will not be cost-effective, they're not worth the money, well that's rationing, particularly if some patients might benefit or simply some might desire it whether they benefit or not, whether it benefits them or not. So that's where this all becomes a real viper's pit."

As we noted previously, America rations health care ruthlessly, largely by income and inability to pay (yes, I know that's a link to an NPR story), but also on quality of insurance, most acutely with private health insurance and Medicaid. I won't run through all of this again, please reread the last post for the details, but I cannot help but find it exasperating that supposedly knowledgeable people, like Gottlieb and Callahan, act as if utilizing cost effectiveness strategies necessarily means "withholding care," and, by extension, that all care, effective or not, cost-effective or not, is beneficial.

But more irksome is the implication that we don't ration now, and that this new, threatened "rationing," is somehow anathema to America. Which brings me to the second story that came up this past week, concerning money troubles in the British NHS and a regression in some areas to longer waiting times for certain procedures. The NHS had done quite a bit to repair their reputation and significantly shorten waiting times, but are apparently losing ground due to governmental austerity measures that (surprise!) actually effect people in real life. I noticed that conservative web site Townhall.com covered the story as an indictment of all health care, all over the world (and, of course, missing the irony that conservative austerity measures were the source of the problem). I pointed out over there with a flurry of comments that we're not so hot on this score ourselves, but also noted that Germany and France, in particular, provide health care for all, far more frugally (parsimoniously, even) than we do, and have no waiting times, no significant rationing of services compared to us. We remain the only industrialized nation that thinks nothing of rationing health care - and I mean this more literally than usual - as many of us give no thought to those struggling and suffering and dying for health care.

A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy--a country that switched to Japanese cars the moment they were more reliable, and to Chinese T shirts the moment they were five cents cheaper--has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.

- Malcolm Gladwell, The Moral Hazard Myth

Physicians' Views of the Massachusetts Health Care Reform Law — A Poll — NEJM

2012-01-02T12:00:00.000-08:00

Physicians' Views of the Massachusetts Health Care Reform Law — A Poll — NEJM:

Of 2135 practicing Massachusetts physicians who responded to the poll, 70% said they support the Massachusetts Health Care Reform Law, whereas 13% oppose it.

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NHS or US healthcare? | Poll | Comment is free | guardian.co.uk

2012-01-02T11:26:00.000-08:00

NHS or US healthcare? | Poll | Comment is free | guardian.co.uk:

Which system would you rather be treated under?

89.9% ---- The NHS, every time

10.1% ---- I'd prefer to avoid the waiting lists and go stateside

The website TownHall did a piece on a UK-NHS "horror story" and so I comment bombed them with posts on US anecdotes, international health care, and so on. It is amazing what a bubble these people live in. Read the comments and be prepared to bemoan the US educational system and our media environment. All of their prejudices are clearly pulled right out of Fox, IBD, WSJ, and the rest. Heaven forbid actual research.

I also found this poll from a few years ago that I thought was useful.

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Chart of the Day: Republicans and the Filibuster | Mother Jones

2011-12-21T17:56:00.000-08:00

Chart of the Day: Republicans and the Filibuster | Mother Jones:

This isn't a big surprise or anything, but now you have the color-coded data to show to all your friends and relatives. Republicans are the party of obstruction, and they have been for more than four decades now.

Just wanted a bookmark for this great graphic...

The downward path of upward mobility - The Washington Post

2011-12-21T17:50:00.000-08:00

The downward path of upward mobility - The Washington Post:

This is only a surprise to those on the right, whose favorite policies all favor driving down wages in one way or another because they think it "works."

In fact, over the past decade, growing evidence shows pretty conclusively that social mobility has stalled in this country. Last week, Time magazine’s cover asked, “Can You Still Move Up in America?” The answer, citing a series of academic studies was, no; not as much as you could in the past and — most devastatingly — not as much as you can in Europe.

The most comprehensive comparative study, done last year by the Organization for Economic Cooperation and Development, found that “upward mobility from the bottom” — Daniels’s definition — was significantly lower in the United States than in most major European countries, including Germany, Sweden, the Netherlands and Denmark. Another study, by the Institute for the Study of Labor in Germany in 2006, uses other metrics and concludes that “the U.S. appears to be exceptional in having less rather than more upward mobility.”

A 2010 Economic Mobility Project study found that in almost every respect, the United States has a more rigid socioeconomic class structure than Canada. More than a quarter of U.S. sons of top-earning fathers remain in the top tenth of earners as adults, compared to 18 percent of similarly situated Canadian sons. U.S. sons of fathers in the bottom tenth of earners are more likely to remain in the bottom tenth of earners as adults than are Canadian sons (22 percent vs. 16 percent). And U.S. sons of fathers in the bottom third of earnings distribution are less likely to make it into the top half as adults than are sons of low-earning Canadian fathers.

Surveying all the evidence, Scott Winship, a fellow at the Brookings Institution, concludes in this week’s National Review: “What is clear is that in at least one regard American mobility is exceptional. . . . [W]here we stand out is our limited upward mobility from the bottom.”

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How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet

2011-12-18T20:37:00.000-08:00

How Ayn Rand Seduced Generations of Young Men and Helped Make the U.S. Into a Selfish, Greedy Nation | | AlterNet:

Only rarely in U.S. history do writers transform us to become a more caring or less caring nation. In the 1850s, Harriet Beecher Stowe (1811-1896) was a strong force in making the United States a more humane nation, one that would abolish slavery of African Americans. A century later, Ayn Rand (1905-1982) helped make the United States into one of the most uncaring nations in the industrialized world, a neo-Dickensian society where healthcare is only for those who can afford it, and where young people are coerced into huge student-loan debt that cannot be discharged in bankruptcy.

..............................

Ayn Rand’s personal life was consistent with her philosophy of not giving a shit about anybody but herself. Rand was an ardent two-pack-a-day smoker, and when questioned about the dangers of smoking, she loved to light up with a defiant flourish and then scold her young questioners on the “unscientific and irrational nature of the statistical evidence.” After an x-ray showed that she had lung cancer, Rand quit smoking and had surgery for her cancer. Collective members explained to her that many people still smoked because they respected her and her assessment of the evidence; and that since she no longer smoked, she ought to tell them. They told her that she needn’t mention her lung cancer, that she could simply say she had reconsidered the evidence. Rand refused.

So, I guess that explains why the anti-science crowd is so confident in its ignorance - Ayn Rand has their back!

Rand said, “Capitalism and altruism are incompatible....The choice is clear-cut: either a new morality of rational self-interest, with its consequences of freedom, justice, progress and man’s happiness on earth—or the primordial morality of altruism, with its consequences of slavery, brute force, stagnant terror and sacrificial furnaces.” For many young people, hearing that it is “moral” to care only about oneself can be intoxicating, and some get addicted to this idea for life.

Explains most of the Conservative "thought" on economics, doesn't it? Rand Paul, Paul Ryan, I'm looking at you.

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Koch Brothers funded study:: "ObamaCare Health Insurance Exchanges Get a Grade of ‘F’ "

2011-12-12T10:50:00.000-08:00

» "Independent" Study: ObamaCare Health Insurance Exchanges Get a Grade of ‘F’ - :

The independent Mercatus Center at George Mason University has given a grade of “F” to the ObamaCare Health Insurance Exchanges regulation. The center studies the anticipated results and economic effects of proposed regulations. In other words, their researchers evaluate whether regulations are likely to accomplish what their supporters say they will.

I guess we shouldn't be surprised at what BS will be passed off as legitimate work, given enough money swirling around, but "independent?!?!" In this case, the "Mercatus Center" is a subsidiary of the Koch brothers war on rational discourse. But apparently they are, per the Wall Street Journal, “the most important think tank you’ve never heard of.”

I did review the document, and it has all the intellectual rigor of a teacher who really hates you grading your term paper.

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Doubt is Their Product

2011-12-11T08:09:00.000-08:00

Doubt is Their Product:

"Doubt is our product," a cigarette executive once observed, "since it is the best means of competing with the 'body of fact' that exists in the minds of the general public. It is also the means of establishing a controversy."

In this eye-opening exposé, David Michaels reveals how the tobacco industry's duplicitous tactics spawned a multimillion dollar industry that is dismantling public health safeguards. Product defense consultants, he argues, have increasingly skewed the scientific literature, manufactured and magnified scientific uncertainty, and influenced policy decisions to the advantage of polluters and the manufacturers of dangerous products. To keep the public confused about the hazards posed by global warming, second-hand smoke, asbestos, lead, plastics, and many other toxic materials, industry executives have hired unscrupulous scientists and lobbyists to dispute scientific evidence about health risks. In doing so, they have not only delayed action on specific hazards, but they have constructed barriers to make it harder for lawmakers, government agencies, and courts to respond to future threats.

Just bookmarking this for future reference...

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To Fix Health Care, Help the Poor - NYTimes.com

2011-12-11T08:07:00.000-08:00

To Fix Health Care, Help the Poor - NYTimes.com:

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

What’s more, America is one of only three industrialized countries to spend the majority of its health and social services budget on health care itself. For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries, for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care.

Our study found that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending. While the stagnating life expectancy in the United States remains at 78 years, in many European countries it has leapt to well over 80 years, and several countries boast infant mortality rates approximately half of ours. In a national survey conducted by the Robert Wood Johnson Foundation, four out of five physicians agreed that unmet social needs led directly to worse health.

It is also well understood in the public health communities that health has far more to do with overall poverty than access to health care, per se. But we have this hard headed approach in America to "punish" the "undeserving" poor. Therefore we shoot ourselves in the foot economically in order to feel better about our "values."
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The few, the proud, the very rich « The Berkeley Blog

2011-12-11T08:05:00.001-08:00

The few, the proud, the very rich « The Berkeley Blog:

"Upon closer inspection, the Forbes list reveals that six Waltons—all children (one daughter-in-law) of Sam or James “Bud” Walton the founders of Wal-Mart—were on the list. The combined worth of the Walton six was $69.7 billion in 2007—which equated to the total wealth of the entire bottom thirty percent!"

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George Lakoff: Words That Don't Work

2011-12-11T08:04:00.000-08:00

George Lakoff: Words That Don't Work:

Unfortunately, Luntz is still ahead of most progressives responding to him. Progressives need to learn how framing works. Bashing Luntz, bashing Fox News, bashing the right-wing pundits and leaders using their frames and arguing against their positions just keeps their frames in play.

Progressives have a basic morality, which is largely unspoken. It has to be spoken, over and over, in every corner of our country. Progressives need to be both thinking and talking about their view of a moral democracy, about how a robust pubic is necessary for private success, about all that the public gives us, about the benefits of health, about a Market for All not a Greed Market, about regulation as protection, about revenue and investment, about corporations that keep wages low when profits are high, about how most of the rich earn a lot of their money without making anything or serving anyone, about how corporations govern your life for their profit not yours, about real food, about corporate and military waste, about the moral and social role of unions, about how global warming causes the increasingly monstrous effects of weather disasters, about how to save and preserve nature.

Progressives have magnificent stories of their own to tell. They need to be telling them nonstop.

Let's lure the right into using OUR frames in public discourse.

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The Bomb Buried In Obamacare Explodes Today-Hallelujah! - Forbes

2011-12-11T08:03:00.000-08:00

The Bomb Buried In Obamacare Explodes Today-Hallelujah! - Forbes:

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

Today, that bomb goes off.

Today, the Department of Health & Human Services issues the rules of what insurer expenditures will—and will not—qualify as a medical expense for purposes of meeting the requirement.

As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.

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Parting Shot at ‘Waste’ By Key Obama Health Official - NYTimes.com

2011-12-04T18:07:00.000-08:00

Parting Shot at ‘Waste’ By Key Obama Health Official - NYTimes.com: Republicans called him evasive. For political reasons, the administration did not want him to defend past statements in which he had extolled the virtues of the British health care system and had suggested a need to cap total health spending and limit the supply of costly high-technology medical care in the United States.

Dr. Berwick said most of the criticism by Republicans, who warn of a government takeover of health care, was “purely political, a world of sound bites.” In the interview, he lashed out at Republicans who depict him as an advocate of rationing health care.

In 2009, he told a biotechnology journal, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

Dr. Berwick said Republicans had “completed distorted” his meaning. “My point,” he said, “is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

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School Lunches and the Food Industry - NYTimes.com

2011-12-04T18:06:00.000-08:00

School Lunches and the Food Industry - NYTimes.com: An increasingly cozy alliance between companies that manufacture processed foods and companies that serve the meals is making students — a captive market — fat and sick while pulling in hundreds of millions of dollars in profits. At a time of fiscal austerity, these companies are seducing school administrators with promises to cut costs through privatization. Parents who want healthier meals, meanwhile, are outgunned.

Each day, 32 million children in the United States get lunch at schools that participate in the National School Lunch Program, which uses agricultural surplus to feed children. About 21 million of these students eat free or reduced-price meals, a number that has surged since the recession. The program, which also provides breakfast, costs $13.3 billion a year.

Sadly, it is being mismanaged and exploited. About a quarter of the school nutrition program has been privatized, much of it outsourced to food service management giants like Aramark, based in Philadelphia; Sodexo, based in France; and the Chartwells division of the Compass Group, based in Britain. They work in tandem with food manufacturers like the chicken producers Tyson and Pilgrim’s, all of which profit when good food is turned to bad.

Here’s one way it works. The Agriculture Department pays about $1 billion a year for commodities like fresh apples and sweet potatoes, chickens and turkeys. Schools get the food free; some cook it on site, but more and more pay processors to turn these healthy ingredients into fried chicken nuggets, fruit pastries, pizza and the like. Some $445 million worth of commodities are sent for processing each year, a nearly 50 percent increase since 2006.

The Agriculture Department doesn’t track spending to process the food, but school authorities do. The Michigan Department of Education, for example, gets free raw chicken worth $11.40 a case and sends it for processing into nuggets at $33.45 a case. The schools in San Bernardino, Calif., spend $14.75 to make French fries out of $5.95 worth of potatoes.

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Eagle Forum Contradicts Thomas Jefferson On Constitution's "Christianized" Roots | Right Wing Watch

2011-12-04T18:05:00.000-08:00

Eagle Forum Contradicts Thomas Jefferson On Constitution's "Christianized" Roots | Right Wing Watch: In fact, Jefferson skewers those in England who tried to implement biblical law, much like many on the Religious Right attempt to do today, arguing that the gospel was “intended by their benevolent author as obligatory only in foro concientiae” (obligations of conscience, not law), and that the Ten Commandments were never incorporated into common law:

In truth, the alliance between Church and State in England has ever made their judges accomplices in the frauds of the clergy; and even bolder than they are. For instead of being contented with these four surreptitious chapters of Exodus, they have taken the whole leap, and declared at once that the whole Bible and Testament in a lump, make a part of the common law; ante 873: the first judicial declaration of which was by this same Sir Matthew Hale. And thus they incorporate into the English code laws made for the Jews alone, and the precepts of the gospel, intended by their benevolent author as obligatory only in foro concientiae; and they arm the whole with the coercions of municipal law. In doing this, too, they have not even used the Connecticut caution of declaring, as is done in their blue laws, that the laws of God shall be the laws of their land, except where their own contradict them; but they swallow the yea and nay together. Finally, in answer to Fortescue Aland’s question why the ten commandments should not now be a part of the common law of England? we may say they are not because they never were made so by legislative authority, the document which has imposed that doubt on him being a manifest forgery.

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The American-Western European Values Gap | Pew Global Attitudes Project

2011-11-30T20:49:00.001-08:00

The American-Western European Values Gap | Pew Global Attitudes Project:

As has long been the case, American values differ from those of Western Europeans in many important ways. Most notably, Americans are more individualistic and are less supportive of a strong safety net than are the publics of Britain, France, Germany and Spain. Americans are also considerably more religious than Western Europeans, and are more socially conservative with respect to homosexuality.

Americans are somewhat more inclined than Western Europeans to say that it is sometimes necessary to use military force to maintain order in the world. Moreover, Americans more often than their Western European allies believe that obtaining UN approval before their country uses military force would make it too difficult to deal with an international threat. And Americans are less inclined than the Western Europeans, with the exception of the French, to help other nations.

These differences between Americans and Western Europeans echo findings from previous surveys conducted by the Pew Research Center. However, the current polling shows the American public is coming closer to Europeans in not seeing their culture as superior to that of other nations. Today, only about half of Americans believe their culture is superior to others, compared with six-in-ten in 2002. And the polling finds younger Americans less apt than their elders to hold American exceptionalist attitudes.

This is a fascinating read. If I had to give it a subtitle, I'd say, "More Americans removing heads from butts - finally!" It is difficult to stay small minded in this increasingly globalized world, though many manage to do so, and do so with amazing arrogance.

Insiders Sound an Alarm Amid a Natural Gas Rush - NYTimes.com

2011-11-30T20:48:00.000-08:00

Insiders Sound an Alarm Amid a Natural Gas Rush - NYTimes.com: “Money is pouring in” from investors even though shale gas is “inherently unprofitable,” an analyst from PNC Wealth Management, an investment company, wrote to a contractor in a February e-mail. “Reminds you of dot-coms.”

“The word in the world of independents is that the shale plays are just giant Ponzi schemes and the economics just do not work,” an analyst from IHS Drilling Data, an energy research company, wrote in an e-mail on Aug. 28, 2009.

Company data for more than 10,000 wells in three major shale gas formations raise further questions about the industry’s prospects. There is undoubtedly a vast amount of gas in the formations. The question remains how affordably it can be extracted.

The data show that while there are some very active wells, they are often surrounded by vast zones of less-productive wells that in some cases cost more to drill and operate than the gas they produce is worth. Also, the amount of gas produced by many of the successful wells is falling much faster than initially predicted by energy companies, making it more difficult for them to turn a profit over the long run.

Amgen’s New Enbrel Patent May Undercut Health Care Plan - NYTimes.com

2011-11-23T18:04:00.000-08:00

Amgen’s New Enbrel Patent May Undercut Health Care Plan - NYTimes.com:

Something to really dislike about the PPACA!

Enbrel, which is used to treat rheumatoid arthritis and psoriasis, was one of several biotechnology drugs that were expected to face competition in the next few years from copycat versions, eventually saving the health care system billions of dollars a year.

The 2010 health care law established a way for such biologic drugs, which can cost tens of thousands of dollars a year, to face competition from near generic versions, which are often called biosimilars. A new law was needed because biologic drugs, which are made in living cells, were not covered by the 1984 law governing most pharmaceutical competition.

The main patent on Enbrel was to expire in October of next year. But the new patent could stave off such biosimilar competition until Nov. 22, 2028. By that time, Enbrel will have been on the market 30 years, far longer than the 20 years of protection expected in patent law.

Enbrel had sales of $3.5 billion in the United States and Canada in 2010, accounting for nearly one-quarter of Amgen’s revenue. The drug costs more than $20,000 a year. Pfizer sells Enbrel abroad.

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N.Y. Malpractice Program May Offer Model For Medical Liability Cases - Kaiser Health News

2011-11-23T17:13:00.000-08:00

N.Y. Malpractice Program May Offer Model For Medical Liability Cases - Kaiser Health News:

At its core, the New York program, called judge-directed negotiation, is simple: When a medical malpractice lawsuit is filed, a judge with expertise in medical matters becomes the point person for that case. He or she supervises the entire process and brings the parties together as often as necessary to discuss the case and help broker a settlement.

This is very different from what typically happens now: The pre-trial discovery phase, in which depositions are taken and other evidence is gathered, sometimes drags on for months or even years. A number of judges may be involved over that period, and with no one person pushing the parties toward resolution, serious settlement discussions generally don't happen until late in the process, often after a court date has been set.

A judge overseeing the entire case can make sure the parties don't dawdle over such things as procedural meetings to set up discovery dates. From the beginning, that designated jurist can delve into the case with an eye toward settlement, says Judge Douglas E. McKeon, an administrative judge in the Supreme Court of Bronx County, who pioneered this approach in 2002. He discovered that "if you created a process that people knew had the potential to get a case settled sooner rather than later for significant sums of money, they came in and they were ready to talk," he says.

Sorry that a lot of these posts are just snippets, but I keep them for my own future reference, and it's either this or EverNote...

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Using new health law, HHS challenges Pa. insurer's rate increases - latimes.com

2011-11-23T08:20:00.000-08:00

Using new health law, HHS challenges Pa. insurer's rate increases - latimes.com:

Insurance premiums have historically been regulated by state governments. But oversight has varied substantially from state to state, with some doing almost no review and some actively blocking rates they deem excessive.

The Obama administration this year announced it would review any rate increase above 10% in states that do not have the capacity to do reviews themselves.

The Department of Health and Human Services is reviewing 35 such increases. And administration officials have completed two, including the Everence rate hike in Pennsylvania.

They have already determined that an 11% increase that Everence is imposing on customers in Montana is reasonable.

Another 77 rate hikes of more than 10% are being reviewed by state regulators around the country, according to the Department of Health and Human Services.

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To save pennies on food and fuel, we let industries poison our children

2011-11-23T07:24:00.000-08:00

To save pennies on food and fuel, we let industries poison our children:

In 2005, researchers at Mt. Sinai Medical Center in New York released their finding that mercury air pollution was costing the U.S. economy $8.7 billion a year in lost earnings due to diminished IQs of children exposed to mercury in the womb.

Mercury is well known and well understood as poison -- to both children and adults -- but it also is a developmental toxin. It affects developing fetuses and children in a way that it doesn't affect adults, and its effects are permanent and irreversible.

Lowered IQ. Lessened ability to learn. Reduced capacity for life. Why?

Because we like cheap electricity, and in today's market coal-fired electricity is the cheapest. When coal is burned, mercury is released into the air. Then it makes its way into the nostrils, lungs and brains of our children.

The solution is simple: Require all coal-fired power plants to install equipment that captures mercury before it escapes into the air.

Try that idea out on the power and coal companies. You won't have long to wait for the denials, evasions, knee-jerk rejections of data, lobbying and the charming PR that is churned out by the industry resistance machine.

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The Fracturing of Pennsylvania - NYTimes.com

2011-11-23T07:20:00.000-08:00

The Fracturing of Pennsylvania - NYTimes.com:

This is less than 20 miles away from my home...

That same day, when Voyles told Range Resources she had developed blisters in her nose, it offered to put her up in a hotel, as it does for all nuisance complaints, but she didn’t want to leave her dogs and horses behind. (Range later said that it had no record of the complaint.) Next door on McAdams Road, Haney and her kids began to have intense periods of dizziness and nosebleeds. Of the three, Harley was the worst off. Haney took him to their family physician, Craig Fox, in the nearby town of Washington. Like most local doctors, Dr. Fox had never seen such symptoms before.

Haney says that Dr. Fox’s advice to her was unequivocal: “Get Harley out of that house right away. I don’t want him anywhere near there, even driving by, for 30 days.” So Haney took Harley to a friend’s house in Eighty-Four, a town named for the lumber company. She took her daughter to her parents’ house in Amity. Each day, she spent about four hours in the car shuttling the kids from school, to and from friends’ homes and driving to the farm to feed the animals, which were O.K. some days and vomiting or collapsing on others. Haney found a cousin willing to take her pigs, but she had nowhere to house the other animals, so they remained at the farm. She stayed home for less than an hour at a time, long enough to put a load of laundry into the washer. Every two days, she spent $50 on gas. Their farmhouse stood abandoned. “Our home has become a $300,000 cat mansion,” Haney said when I visited her in July.

Haney is no left-leaning environmentalist; she is a self-proclaimed redneck who is proud to trace her roots here back at least 150 years. This is not the kind of fight she usually takes on. “I’m not going to sit back and let them make my kids sick,” she says. “People ask me why I don’t just move out, but where would I go? I can’t afford another mortgage, and if I default on this place, we will lose it. ”

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Why Doesn’t No Mean No? - NYTimes.com

2011-11-22T10:06:00.000-08:00

Why Doesn’t No Mean No? - NYTimes.com:

We talk, as a society, of our need to get health care costs under control. Conservatives, in particular, insist that Medicare must be reformed. Here is an enormously expensive drug that largely doesn’t work, has serious side effects and can no longer be marketed as a breast cancer therapy. Yet insurers, including Medicare, will continue to cover it.

If we’re not willing to say no to a drug like Avastin, then what drug will we say no to?

This is the nub of the argument to control health care costs. We have to say no to things that don't work, whether they have excellent lobbyists or not.

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America's new poor - CBS News

2011-11-21T09:39:00.000-08:00

America's new poor - CBS News:

In Forsyth County's rolling subdivisions near Atlanta, Easy Street seems to run forever. What recession? The average household here earns $88,000 - the highest in Georgia, 13th highest in America.

But for more families here, prosperity is a pretense. The job's lost, the savings are gone, and the big house is either in foreclosure or on its way. And just keeping food on the table is a struggle.

So Forsyth's newly-needy file into local food banks.

Yesterday's GIVERS have become today's TAKERS.

"People lost their jobs and went from great incomes to no incomes," said Sandy Beaver, Sandy Beaver leads The Place, Forsyth County's biggest non-profit center for social services. She calls those who visit The Place "the new poor."

Indeed, the poor you will always have with you. But what if "they" are you?

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Charts: 6 Big Economic Myths, Debunked | Mother Jones

2011-11-20T14:51:00.000-08:00

Charts: 6 Big Economic Myths, Debunked | Mother Jones: #1: The stimulus failed.

Everyone from the nonpartisan Congressional Budget Office (PDF) to private-sector forecasting firms have concluded that the 2009 stimulus package increased economic growth, reduced unemployment, and put millions of people back to work. It just wasn't big enough, or long-lasting enough.
Bust or Boost?

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amednews: [interactive graphic] How much do health plans make? - Revenue falls, but stock buybacks boost per-share earnings. ... American Medical News

2011-11-20T14:26:00.000-08:00

amednews: [interactive graphic] How much do health plans make? - Revenue falls, but stock buybacks boost per-share earnings. ... American Medical News: - Sent using Google Toolbar

Study: Well fees still aren't enough

2011-11-12T09:03:00.000-08:00

Study: Well fees still aren't enough:

Plugging an abandoned Marcellus Shale gas well in Pennsylvania could cost $100,000 or more, and well bonding changes proposed by the Corbett administration could stick taxpayers with almost all of that bill, according to a study from Carnegie Mellon University.

The CMU study found that the new Marcellus gas well bonding fees, recommended by Mr. Corbett's Marcellus Shale Advisory Commission and now under consideration in the Republican-controlled Legislature, would require drilling companies to cover only a fraction of the costs of plugging and decommissioning old, nonproducing and abandoned gas wells.

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Commitment to Development Index : Center for Global Development

2011-11-11T17:21:00.000-08:00

Commitment to Development Index : Center for Global Development:

Just in case you were wondering how the US does in foreign aid.

2011 Commitment to Development Index

Which wealthy nations are helping poor ones most? Rich and poor are linked in many ways. Each year, the CDI scores wealthy governments on helping poor countries via 7 linkages: aid, trade, investment, migration, environment, security, and technology. It averages over the 7 for an overall score.

Here are the graphics for foreign aid, by itself. We in the US are 17th.

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Patients’ Grades to Affect Hospitals’ Medicare Reimbursements - NYTimes.com

2011-11-10T06:42:00.000-08:00

Patients’ Grades to Affect Hospitals’ Medicare Reimbursements - NYTimes.com: Winning praise from patients has become a pressing — and often elusive — obsession for NYU and for hospitals nationwide. In the coming months, Medicare will start taking patient satisfaction into account when reimbursing hospitals. Disgruntled patients will mean reduced revenue, a frightening prospect for hospitals already facing empty beds because of the recession and pressure from insurers to hold down costs.

Medicare’s new rule, mandated in the Affordable Care Act, pits hospitals against one another in a competition to best satisfy patients; those with the best scores will receive more money.

But some hospitals are worried that assessments from patients like Ms. Schwartz can be influenced not just by the quality of their care, but also by amenities like single rooms, renovated units and tasty food. And hospitals in cities and certain regions, like the Northeast and California, tend to get lower ratings, raising concerns that their revenues will be reduced simply because patients in those places are more disposed to grumble about things that a polite Midwesterner or Southerner would forgive.

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Temperatures Rise Over Costs Of Care | Worcester Business Journal

2011-11-06T08:37:00.000-08:00

Temperatures Rise Over Costs Of Care | Worcester Business Journal: Higher Sentiment For ‘Single Payer’?

Presumably, doctors are more familiar than the general public with the pressures driving up health care costs, and an overwhelming majority of them also say there needs to be some government involvement in the health care system. A survey by the Massachusetts Medical Society this fall found that 41 percent of doctors thought the best option for health care reform in the U.S. would be to adopt a single-payer system like Canada’s. That number was up from 34 percent in 2010.

Another 23 percent favor a mix of public and private plans, while 17 percent support reforms along the lines of the 2010 national health care reform act, including an individual mandate like Massachusetts’. Fifteen percent favor a system in which insurers can sell limited-benefit and high-deductible policies and the government gives subsidies to help low-income people buy insurance.

Lynda Young, president of the Massachusetts Medical Society (MMS) and a Worcester pediatrician, said doctors who favor a single-payer system may see it as a way to avoid administrative burdens. She noted that a recent article in the policy journal Health Affairs found that Canadian doctors spend two or three hours a week on administration, compared with about 10 to 15 hours for doctors in the U.S.

Pretty remarkable, especially when you look at the numbers in the graph. 41% plus 23% for 64% favoring either single payer or a 'public option' added to the current mix. 17% OK with the PPACA as it is, and another 15% seeming to favor high deductible plans.

That's a grand total of 81% favoring PPACA at least, the distinct minority, with the significant plurality favoring single payer. Wow.

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Obama’s War Against Americans is Relentless. His Primary Attack Force is the EPA. « Conservatives on Fire

2011-10-25T22:29:00.000-07:00

Obama’s War Against Americans is Relentless. His Primary Attack Force is the EPA. « Conservatives on Fire:

I'm taking an epidemiology/population health this semester, and we were reviewing the topic of environmental and occupational health. I Googled for the war on the EPA, and found the article linked to here, concerning how liberals and other tree huggers were were trying to ruin the economy and take us into a Communist police state through use of the EPA. Of course, this is not new.

But I was stunned by the absolute ignorance of several of the paragraphs, this one in particular:

Dear readers I would appreciate it very much if you would let me know if in fact you do live longer or if you have fewer non-fatal heart attacks or if you experience fewer sick days after this new rule takes effect. I mean we really should keep these records so we can verify if the EPA’s projections were correct or not. So, again, please let me know how it turns out and I will be happy to compile the record and I’ll report back once I have a statistically significant amount of data.

I don't have to explain to anyone with even the slightest amount of education in math or science how profoundly ignorant this is, and if it were just this one blogger, I'd laugh it off. But scroll through some of the comments if you have a strong stomach. Or Google for yourself and see more. Or look here to see Think Progress analysis of Fox News war on the EPA.

I refuse to believe that these people are as stupid as their statements make them sound. But it is deeply saddening to see how profoundly an ideology - Market Fundamentalism - can shut down critical thinking.

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Wallison: Still Wrong About Genesis of Housing Crisis | The Big Picture

2011-10-16T11:39:00.000-07:00

Wallison: Still Wrong About Genesis of Housing Crisis | The Big Picture:

If you’ve been closely following the housing finance reform debate, you may have come across a pair of shrill blog posts penned by Peter Wallison, a senior fellow at the American Enterprise Institute and a Republican appointee to the Financial Crisis Inquiry Commission. He responded to my February 2011 article, “Faulty Conclusions Based on Shoddy Foundations,” which criticized the research underlying Wallison’s dissent from the majority of the members of that commission, and his contention that U.S. affordable housing policies caused the global financial crisis.

In these blog posts on The American Spectator’s blog on May 24 and on AEI’s blog on May 26, Wallison criticizes ”Faulty Conclusions” as “fallacious,” “fraudulent,” and “deceptive”; claims that it contains a “fake” chart; and describes the article as a “political screed.”

As I describe below, these accusations are baseless and distract from the fact that Wallison does not actually address the main arguments of “Faulty Conclusions.” Wallison does not contradict the claim that his FCIC dissent depends critically on the categorization of millions of home mortgage loans as “high risk” that are not actually high risk. Wallison also fails to answer other serious issues with his arguments that were pointed out in “Faulty Conclusions.”

I was watching Bill Maher the other night and John Fund was again blaming Freddie and Fannie (and low income people via the Community Reinvestment Act - the bastards!) for the great recession, and I was disappointed that Thom Hartmann didn't protest more vigorously. I found this article via Brad Delong's economics blog.

Basically, from the viewpoint of a non-economist, the guy flogging these claims was a minority of one, even with other Republicans on the Financial Crisis Commission, and one would think responsible conservatives would recognize the lack of credibility, yet this is the favorite meme among Fund and others who want to minimize the role of deregulation and crony capitalism for this mess.

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How Medicare Fails the Elderly - NYTimes.com

2011-10-16T10:23:00.000-07:00

How Medicare Fails the Elderly - NYTimes.com:

"HERE is the dirty little secret of health care in America for the elderly, the one group we all assume has universal coverage thanks to the 1965 Medicare law: what Medicare paid for then is no longer what recipients need or want today. "

Goes on to delineate some of the problems with the Medicare payment system, that are not news if you've been paying attention, but always good to get it out there for further discussion.

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Is the Fed responsible for health care premium increases? | The Incidental Economist

2011-10-04T06:44:00.000-07:00

Is the Fed responsible for health care premium increases? | The Incidental Economist:

Health spending is obviously relevant to premiums, but many other factors affect premium growth too. What everyone wants to know is why employer-sponsored health insurance premiums jumped up so much this year. Since health care spending growth has been low — at near 1990s levels — we can rule that out as an explanation.

Moving on, let’s consider some other things. For what follows, I’ve been aided by Charles Roehrig and colleagues of the Altarum Institute, with whom I exchanged email on this topic. The title of this post is explained in the final entry of the following list (“The underwriting cycle”).

Besides total health spending, what else affects premiums?

Profits. Insurers have been reporting a big profits lately, which implies premiums growing faster than costs.

If you are interested in understanding why premiums have risen far out of proportion to actual health care costs, please go to the link. There are no certain reasons, but this post offers lots of interesting (and plausible) possibilities, including the one in the title: Insurers are so heavily invested in bonds, that the low returns have "forced" them to turn to out-sized premium increases to keep profits up where they like them.

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Daily Kos: An indecent proposal

2011-10-02T12:01:00.000-07:00

Daily Kos: An indecent proposal:

That cut-up Grover Norquist suggest wealthy Americans like Warren Buffet contribute to the Federal government on an optional basis, and Hunter at DailyKos offers to accept the offer...

My proposal is that we make taxes for wealthy Americans and corporations entirely optional. That's it. If a corporation wants to pay zero percent in taxes, they should be allowed to, and if they want to pay the full tax rate, that is also allowed. The same for wealthy Americans.

The only caveat is that non-contributing corporations and individuals will be barred from taking advantage of any government services. It is the perfect free-market-based opt-out: If you do not want to support the American infrastructure and population to the same extent that your fellow citizens do, you can simply decline to, and live your life as the libertarian god you have always longed to be. You will be free! You will be allowed to go Galt, or not go Galt, to whatever degree you wish; as a special bonus, we shall prevent you from becoming that most dreaded of figures, the parasite, since if you are not contributing to the benefit of society it only stands to reason you should not gain profit from it either.

For starters, companies that do not pay the going tax rate will be barred from shipping their products on American roads. They will be prevented from connecting to the American electric grid, or from using municipal water or sewer systems. Instead, they will have to provide these services on-site. The good news: They can feel free to pollute as much as they like, as long as no pollution crosses the boundaries of their property (above, below or horizontally) into the rest of America. That would be considered an act of war.

Wealthy Americans that opted out of paying the going tax rate would also, of course, be prohibited from using American roads. This would not be a problem for them, as they generally can afford airplanes or helicopters, which would be similarly fine so long as they did not use American airspace (sorry, but the FAA costs money too, you know). But they could certainly fly around the property, which might be a pleasant experience.

Then we must consider the issue of security. Fire and police protection would be right out, so there would be no particular incentive for poorer Americans not to loot their properties (wealthy Americans tend to have nicer things than the rest of us). The American elite might consider the approach taken by wealthy Mexican families, which is to install a high perimeter fence around the property with a heavily armed private guard service. This would be expensive and unsightly, but it would be up to each individual to decide, for themselves, what the appropriate free-market level of protection for their own property might be. My one tip would be to spend a good deal of time on that decision.

It goes without saying that non-contributing Americans, corporate or otherwise, would not have access to the courts. This should be fine with them, since we know that meddlesome lawsuits are the biggest non-tax-related threat to America today. There is the minor issue of no recourse, if armed mercenaries do manage to overpower your guards and make off with your antique commodes or whatever it is you rich people hoard these days: Again, though, think of the tax savings.

This is a nice echo of Elizabeth Warren's comments on the arrogance of the John Galt wannabees.

UPDATE: I posted this to the comments section:

Don't forget the socialism of WWII

Let me add another item to your great piece, Hunter, and to Elizabeth Warren's recent speech: Did the fathers of any of these captains of industry go to college on the GI Bill?
See here:

Within the following 7 years, approximately 8 million veterans received educational benefits. Of that number, approximately 2,300,000 attended colleges and universities, 3,500,000 received school training, and 3,400,000 received on-the-job training. By 1951, this act had cost the government a total cost of approximately $14 billion.
The effects of increased enrollment to higher education were significant. Higher educational opportunities opened enrollment to a varied socioeconomic group than in the years past. Engineers and technicians needed for the technological economy were prepared from the ranks of returning veterans. Also, education served as a social safety valve that eased the traumas and tensions of adjustment from wartime to peace. For the American colleges and universities, the effects were transforming. In almost all institutions, classes were overcrowded. Institutions required more classrooms, laboratories, greater numbers of faculties, and more resources. House facilities became inadequate and new building programs were established. New vocational courses were also added. This new student population called for differential courses in advanced training in education, commerce, agriculture, mining, fisheries, and other vocational fields that were previously taught informally. Teaching staffs enlarged and summer and extension courses thrived. Further, the student population was no longer limited to those between 18-23. The veterans were eager to learn and had a greater sense of maturity, in comparison to the usual student stereotype. Finally, the idea that higher education was the privilege of a well-born elite was finally shattered.

And of course, it was continued after WW II: Continuation of the Bill

The original G.I. Bill of 1944 expired in 1956, but the concept of veteran compensation continued, with all subsequent legislation still referred to as G.I. bills. In 1952 Congress passed the Veterans’ Adjustment Act to compensate veterans of the Korean War (1950-1953). There were some minor differences between the World War II and Korean G.I. Bills, but the outcome was broadly similar. More than two million Korean War veterans used the G.I. Bill to go to college, and 1.5 million financed new homes. The G.I. Bill underwent a significant change in 1966, when Congress passed the Veterans Readjustment Benefits Act (VRBA) as part of President Lyndon B. Johnson’s Great Society slate of social programs. The VRBA removed the requirement of serving in combat to receive government benefits, and instead made G.I. Bill benefits available to anyone who served in the military, whether in wartime or peacetime. Since 1966 the G.I. Bill has undergone a series of modifications and adjustments, but the fundamental benefits subsidizing education and home ownership remain the same. The Montgomery G.I. Bill (MGIB), enacted by Congress in 1985, provides educational stipends to former members of the military who contribute a small portion of their pay during their time in the service. The Post 9/11 Veterans Assistance Act of 2008 (effective date August, 2009) substantially increased the amount of tuition and housing assistance, allows veterans to transfer benefits to their spouses and children, and provides tuition benefits for National Guard and Reserve members.

Medicaid funds allegedly misused: U of L doctors used $4.8 million in Medicaid money for bonuses, Shaughnessy says | The Courier-Journal | courier-journal.com

2011-09-29T12:56:00.000-07:00

Medicaid funds allegedly misused: U of L doctors used $4.8 million in Medicaid money for bonuses, Shaughnessy says | The Courier-Journal | courier-journal.com:

Doctors at the University of Louisville medical school used about $4.8 million in state Medicaid funds to pay themselves “financial bonuses” — money that was supposed to be used for indigent care, state Sen. Tim Shaughnessy says.

And they used another $5.2 million for an electronic records system that would make U of L doctors eligible for additional bonuses from the federal government, according to new details of a controversial transaction that Shaughnessy said he recently obtained from Attorney General Jack Conway’s office.

A spokeswoman for Conway said Wednesday that the office determined only that the $4.8 million was compensation for U of L doctors. But Shaughnessy insisted that Conway’s staff described the money as “bonuses” at a recent meeting.

“I was shocked,’’ said Shaughnessy, a Louisville Democrat who was the first to publicly question a transfer of about $30 million in surplus health funds in 2008 and 2009 from Passport Health Plan to U of L, University Physicians Associates, or UPA, and others represented on Passport’s board.
----------------
Under a settlement Conway announced in July, UPA will repay the state $9 million over five years. Other groups that received funds from Passport’s $30 million transfer agreed to repay the funds according to various schedules. They include U of L, University Medical Center and local hospitals that provided capital to start Passport.
But Shaughnessy said the repayment doesn’t address his basic concern — that U of L’s board wasn’t involved in major financial transactions involving groups with which it is affiliated, including Passport, UPA and the U of L medical center.
“There was no involvement of the U of L Board of Trustees,” Shaughnessy said. “How did these millions of dollars get allocated without any involvement of the board?”

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Heads Of Largest Children's Hospitals Receive Big Salaries And Rich Benefits - Kaiser Health News

2011-09-29T12:44:00.000-07:00

Heads Of Largest Children's Hospitals Receive Big Salaries And Rich Benefits - Kaiser Health News:

The pay packages have continued to climb even as the economy has languished and millions of Americans struggle to pay their health care bills. For some, the generous compensation raises questions about the mission of children’s hospitals, which operate as tax-exempt charities.

"Hospital CEOs, including those at children's hospitals, are among the most lavishly compensated executives in the nonprofit field," said Daniel Borochoff, president of the American Institute of Philanthropy, a charity watchdog group based in Chicago.

"These seven-figure CEO pay packages make it hard for nonprofit hospitals to justify their tax-exempt status," he added. "If hospital CEO compensation were more in line with other large nonprofits then there could be more funding for community benefits such as free or discounted health care or important medical research."

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The Social Contract - NYTimes.com

2011-09-25T18:35:00.000-07:00

The Social Contract - NYTimes.com:

According to new estimates by the nonpartisan Tax Policy Center, one-fourth of those with incomes of more than $1 million a year pay income and payroll tax of 12.6 percent of their income or less, putting their tax burden below that of many in the middle class.

Now, I know how the right will respond to these facts: with misleading statistics and dubious moral claims.

Go read the whole thing!

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A glimpse at the high pay for children's hospital CEOs - Sacramento Living - Sacramento Food and Wine, Home, Health | Sacramento Bee

2011-09-25T08:19:00.001-07:00

A glimpse at the high pay for children's hospital CEOs - Sacramento Living - Sacramento Food and Wine, Home, Health | Sacramento Bee:

"Hospital CEOS, including those at children's hospitals, are among the most lavishly compensated executives in the nonprofit field," said Daniel Borochoff, president of the American Institute of Philanthropy, a charity watchdog group based in Chicago. "If hospital CEO compensation were more in line with other large nonprofits then there could be more funding for community benefits such as free or discounted health care or important medical research."

In 2009, an advocacy group for nonprofit hospitals and other health care groups warned its members that the pay packages were coming under increasing scrutiny. "Boards would be wise to streamline their executive compensation programs to make them less tempting targets," a report prepared for the Alliance for Advancing Nonprofit Health Care stated.

The report pointed to cars, bonuses, generous retirement payouts and country club memberships as likely to attract criticism. "Many nonprofit organizations have been pressing their luck by imitating patterns in the for-profit sector," it noted.

That year, CEO compensation at the 25 largest independent children's hospitals ranged from a high of nearly $6 million to a low of $686,125, records show.

In all, CEOs collected more than $38 million, including deferred income and supplemental retirement awards, for an average of $1.5 million each.

If you are interested in looking up data for your own hospital or for any non-profit, go to Guidestar at http://www2.guidestar.org/Home.aspx and search for the organization. When you have found it, go to the Form 990 section (you will have to register - it's free). Then you will have to look for either page 7, which is where the data may be, or go to an appendix/attachment at the end. Happy hunting.
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How Do You Say ‘Economic Security’? - NYTimes.com

2011-09-25T08:02:00.000-07:00

How Do You Say ‘Economic Security’? - NYTimes.com:

"In 1934, the government was us. We had shared circumstances, shared risks and shared obligations. Today the government is the other — not an institution for the achievement of our common goals, but an alien presence that stands between us and the realization of individual ambitions. Programs of social insurance have become “entitlements,” a word apparently meant to signify not a collectively provided and cherished basis for family-income security, but a sinister threat to our national well-being.

"Over the last 50 years we seem to have lost the words — and with them the ideas — to frame our situation appropriately. "

I firmly believe that one of our major problems today is that conservatives view our government, the one established in our Constitution by the people, for the people, to provide for the General Welfare, is "them," while liberals view it as "us," and thus we must take responsibility for making it better, rather than just tearing it down.

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It’s not ‘class warfare,’ it’s Christianity - - The Washington Post

2011-09-22T16:59:00.000-07:00

It’s not ‘class warfare,’ it’s Christianity - - The Washington Post:

"Let me be clear as I can be. We need to understand the so-called “Christian” underpinnings of the anti-tax, anti-government, anti-the-poor, “let him die” approach to economics and public policy today as completely un-Christian, as well as un-American. What we need to do is re-establish our national values of fairness, equality and opportunity for all, values that I believe are actually the core of the Christian faith, (as well as of other religious traditions and of humanist values)."

A nice summary of how un-Christian the Americanus Christianus really is!

Many of the same points I mad a while back in my "Tea Partiers as Christians - Big Fail" post a while back.

The human face of disability - and one of the doctors assessing it : The Pump Handle

2011-09-21T07:40:00.000-07:00

The human face of disability - and one of the doctors assessing it : The Pump Handle:

"If you hold a job right now, here's something to think about: If you became disabled and were no longer able to work, how would you pay your bills? If your disability were due to an on-the-job injury or an occupational illness, you might be able to get workers' compensation benefits. But what if you were paralyzed after falling down a flight of stairs at home or suffering a stroke? If you're lucky, you'll have disability insurance, which some employers offer as a benefit. But for most people whose ability to work becomes compromised before they're able to retire, disability payments from Social Security become a crucial source of income. "

A sobering look at the Social Security Disability Income program. Our safety net is strung so that most of it lies on the ground.

NJ Spotlight | Filling in the Details of NJ's Health Insurance Exchange

2011-09-19T10:12:00.000-07:00

NJ Spotlight | Filling in the Details of NJ's Health Insurance Exchange:

"In Massachusetts, officials have tailored the requirements for participating insurance companies to ensure a certain high level of benefits; in Utah, the exchange is open to most of the companies that wish to do business in the state. The website for the Massachusetts exchange includes tools to help consumers select the best product, and the signup process takes less than ten minutes, researchers found. Utah’s exchange is more of an online portal, linking customers to existing insurance products, and the state has received a number of complaints about the complexity of the enrollment process.

"According to the Georgetown report, 'you get what you pay for.' Massachusetts’ exchange has a $30 million annual budget and 46 full-time workers, whereas Utah spends $600,000 and employs two staff members. With greater resources and outreach, Massachusetts has reached some 220,000 people, compared with 2,200 now in Utah’s program. According to 2009 data, after a few years with the exchanges in operation, Massachusetts had insured more than 95 percent of its residents and Utah had about 85 percent covered, when including those who obtain insurance through their jobs or the private market.

"The healthcare coalition in New Jersey did not focus on any single state in developing its list of principles, Snedden said, but worked with members to determine what was most critical here. The group also plans to launch a public campaign this summer to help individuals and business owners become more familiar with the concept of the exchange.

"'What we’re doing is getting the conversation started,' Snedden said. 'We want to make 'exchanges' a word that actually rings a bell.'"

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The Independent Payment Advisory Board — Congress’s “Good Deed” | Health Policy and Reform

2011-09-19T10:09:00.000-07:00

The Independent Payment Advisory Board — Congress’s “Good Deed” | Health Policy and Reform:

"Among the most important attributes of legislative statesmanship is self-abnegation — the willingness of legislators to abstain from meddling in matters they are poorly equipped to manage. The law creating the Federal Reserve embodied that virtue. Congress recognized the abiding temptation to use monetary policy for political ends and realized that it would, at times, prove irresistible. To save themselves from themselves, wise legislators created an organization whose funding and operations were largely beyond the reach of normal legislative controls. Short of repealing the law, Congress denied itself the power to do more than kibbitz about monetary policy.

"In establishing the Independent Payment Advisory Board (IPAB) in section 3403 of the Affordable Care Act (ACA), Congress may once again have shown such statesmanship. For several reasons, however, it is too early to be sure. The board must surmount major challenges — first to survive and then to function effectively. Harold Pollack has neatly summarized the problem, the solution, and the problem with that solution: “Every Democratic and Republican policy expert knows that we must reduce congressional micromanagement of Medicare policy. Unfortunately, every Democratic and Republican legislator knows that mechanisms such as IPAB that might do so would thereby constrain their own individual prerogatives.”1

"Medicare’s founding legislation stated that “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine.”2 Duly warned, Medicare administrators have largely forborne from using coverage policy or financial incentives to discourage ineffective or needlessly costly methods of care. Members of the legislative branch have not, however, displayed similar restraint. They have pressured those same administrators on coverage policies and passed laws to impose them.

"In the view of many observers, both executive inactivity and legislative intrusiveness have been unfortunate — the former because the leverage that the country’s largest single buyer of health care could wield to effect reforms has gone largely unused, the latter because few members of Congress are well enough informed to make such decisions wisely, and some are in thrall to campaign contributors and producers and suppliers of medical services."

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Squandering Medicare’s Money - NYTimes.com

2011-09-19T10:08:00.000-07:00

Squandering Medicare’s Money - NYTimes.com:

"MEDICARE has suddenly taken center stage in American politics, with Democrats now trying to score an advantage from the unpopularity of the Republican plan to overhaul the government health insurance program. Apart from the politics, though, Medicare’s financing challenges are worsening: this month, Medicare’s trustees projected that the insurance program would become insolvent by 2024, five years earlier than previously estimated.

"Much has been said about the growing gap between the program’s spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. Examples abound:"

Go to the original piece for the rest!

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What Is a 'Just' Physician's Income? - NYTimes.com

2011-09-19T10:06:00.000-07:00

What Is a 'Just' Physician's Income? - NYTimes.com: "The payment of physician income has been the subject of a lively debate for centuries. In fact, one finds it addressed at length in the famous Code of Hammurabi, chiseled into stone tablets some 4,000 years ago by edict of the Babylonian King Hammurabi along, by the way, with a malpractice system that makes today’s look like a pussycat.

Adam Smith, who generally is regarded as the father of modern economics, mused at length on the compensation of physicians in his celebrated book “An Inquiry Into the Nature and Causes of the Wealth of Nations” (1776).

Chapter 10 of Book 1, titled “Wages and Profit in the different Employments of Labour and Stock,” is a gracefully written treatment of what we now call labor-market theory. It is well worth a read.

“Honour makes a great part of the reward of all honourable professions,” Smith wrote. “In point of pecuniary gain, all things considered, they are generally under-recompensed, as I shall endeavour to show by and by. … Disgrace has the contrary effect. The most detestable of all employments, that of public executioner, is, in proportion to the quantity of work done, better paid than any common trade whatever.” (Italics added.)

Today we teach students that seemingly mysterious differences in the pecuniary income of different occupations can be explained in part by what we call “compensating variations in the psychic income” associated with different occupations.

Remarkably, in his treatise on compensation, Smith then departed sharply from the traditional demand-and-supply framework he popularized and we economists usually employ to explore employment and wages. Instead, for physicians and lawyers he appeared to lean on the medieval doctrine of “just price.” Thus he wrote:

We trust our health to the physician: our fortune and sometimes our life and reputation to the lawyer and attorney. Such confidence could not safely be reposed in people of a very mean or low condition. Their reward must be such, therefore, as may give them that rank in the society which so important a trust requires. The long time and the great expense which must be laid out in their education, when combined with this circumstance, necessarily enhance still further the price of their labour.

Although I’m a card-carrying economist who normally is quite comfortable with our supply-demand framework for virtually anything, I do find Adam Smith’s perspective persuasive.

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Bruce Bartlett: Are Taxes in the U.S. High or Low? - NYTimes.com

2011-09-19T10:04:00.000-07:00

Bruce Bartlett: Are Taxes in the U.S. High or Low? - NYTimes.com:

"The truth of the matter is that federal taxes in the United States are very low. There is no reason to believe that reducing them further will do anything to raise growth or reduce unemployment.

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Myopia

2011-09-19T10:02:00.000-07:00

[Originally posted at Doctors for America's Progress Notes Blog]

Andrew Sullivan's tag line, via George Orwell, is that "It is a constant struggle to see what is past the end of one's nose." One of my favorite lines is from Upton Sinclair, "It is difficult to get a man to understand something if his livelihood depends upon his not understanding it."

When I say "favorite," I mean I like it because it says a lot about the human condition in general, and about our political struggles in particular. Unfortunately, in these times, this myopia in our world views has the potential to lead to human misery, and to continue America on the road to tragedy, as we already have passed farce. I consider myself an optimist, but recent events including our world class embarrassment of a debt ceiling "deal" have left me pessimistic for our short term prospects of reinvigorating our priorities as a nation and consequently our intermediate term prospects of leaving the nation better than we found it.

We have been at our best as a nation when we have had visionary leadership, from Teddy Roosevelt's "Square Deal," to Franklin Roosevelt's "New Deal," to LBJ's "Great Society." Even Eisenhower's more mundane Interstate Highway System and JFK's goal to put a man on the moon represent aspirational goals for America. ("We chose to do these things, and the others, not because they are easy, but precisely because they are hard!") Now, our political will has been demeaned to the lowest common denominator: how will I keep more of my meager income for myself in the short term?

Paul Krugman, Robert Reich, and others have been banging this drum for over a decade now: investing in human capital is the way to grow the economy and keep us a great country. Many wish to continue the defunding of our societal investment in human capital: reducing investments in education and research, reducing money spent on the health of the population, demolishing our social welfare programs like Medicare, Medicaid, SCHIP and Social Security. This is short sighted and a recipe for disaster (with all the ingredients mise en place).

We now have plugged in a small group of Congress Persons in the wildly inappropriately named "Super Congress," with the stated goal of resolving our budget stalemate. I am skeptical, to say the least, and two articles in this week's New England Journal of Medicine reinforce my pessimism.
Jonathon Oberlander points out that "austerity politics" are now in force, and there are real potential dangers that Medicare and Medicaid funding could be cut substantially, including reduced payments to providers, reductions in federal funds for state Medicaid programs, increasing cost-sharing for enrollees, repealing the long term care insurance provisions in the ACA, and - per Paul Ryan's plan - changing Medicare into a voucher plan.

While Oberlander doesn't say it, I will: the "austerity politics" manufactured in Washington by power brokers with lots of money behind them are designed to take an axe to the programs that provide medical care to those who need it and prevent expansion to those who need it even more. We at DFA are all too aware of deficiencies in our current health care system and are not shy at all about pointing them out. But we also know that reforming health care requires a greater intellectual effort than unthinking cuts born out of myopic political calculations.

In the same NEJM issue, Christopher Jennings notes that many stakeholders in health care are coming to realize that there is almost no good that can come out of the work of the Super Committee. Because of the construction of the debt ceiling deal, if the Super Committee reaches no deal and the "automatic cuts" are enacted, Medicaid is exempt from cuts and Medicare would face "only" a two percent cut. As he explains, it is hard to imagine a deal crafted by the twelve that would so good to health care funding:

From the current vantage point of these stakeholders, the choice is therefore not a close call; the automatic cuts are by far the best poison to be forced to take, particularly in comparison to the concoction they fear the super committee could produce. It would meet the requirement of the law, protect against unknown and much larger cuts, and preserve resources and bargaining chips for the next big deal, which will probably take place in 2013 after the presidential election.

So, there is hope, if I ditch my own myopia and hope and pray and work for a new, better Congress in 2013, we may be able to get on the path to becoming a great country again, instead of the "dollar store" nation that so many seem to believe is our destiny!

FactCheck.org : Premium Nonsense On Medicare

2011-09-19T09:56:00.000-07:00

FactCheck.org : Premium Nonsense On Medicare:

My sister-in-law sent me one of those BS right wing chain emails (they try to misinform while staying under the radar of actually informed people by sending it to their fellow in-the-Fox-bubble friends) about rising Medicare premiums because of the Affordable Care Act. Here is the original quote, in the hopes that people Googling for this nonsense will find the correct information, then the FactCheck response (the full response is at the link at the top):

The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; And $247.00 in 2014. These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns. Send this to all seniors that you know, so they will know who's throwing them under the bus.

REMEMBER THIS IN NOVEMBER 2012 & VOTE ACCORDINGLY

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FACTCHECK.ORG

The Real Effect of the Health Care Law

That’s not to say that the health care law won’t have an effect on the premiums paid by some seniors. It will, but not in the way this bogus message claims. The change will affect only a small minority of upper-income Medicare beneficiaries.

Currently, about the top 5 percent of seniors pay an "income-related premium" that was enacted as part of the same 2003 law that created the new Medicare prescription-drug benefit. Upper-income seniors have been paying more than the standard premium since 2007. Currently those earning between $85,000 and $107,000 for individuals (between $170,000 and $214,000 for couples) pay a total of $161.50. The amounts grow larger for higher-income groups, reaching $369.10 per month for seniors making more than $214,000 (or $428,000 for couples).

The new law doesn’t increase those premiums, but does ensure that more high-earning seniors will pay them. It does this by freezing the income brackets at 2010 levels through 2019, rather than allowing them to rise with inflation as originally enacted. The Kaiser Family Foundation released a report in December projecting that in 2019 the top 14 percent of seniors would be paying the income-related premiums — an additional 3.5 million seniors.

The law also established a separate set of income-related premiums for Medicare Part D — the prescription-drug benefit — which previously had charged only a standard premium for all. Taken together, these changes are expected to bring in an additional $36 billion over 10 years, Kaiser’s study said.

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GOP and Obama's jobs plan: Do Republicans oppose the president's economic policies for ideological reasons or political ones? - By Jacob Weisberg - Slate Magazine

2011-09-10T05:59:00.000-07:00

GOP and Obama's jobs plan: Do Republicans oppose the president's economic policies for ideological reasons or political ones? - By Jacob Weisberg - Slate Magazine:

"You can group the conservatives who reject the economic consensus into three rough categories: fundamentalists, cynics, and sheep. The fundamentalists are ideological and come in several varieties. The more primitive prefer Hoover to Keynes, or in some cases God to Hoover. Rick Perry, the Texas governor and presidential candidate, believes that the purpose of the economic crisis is to bring us back to "Biblical principles." Asked on the campaign trail how he would create jobs if he were in office, Perry responded: "You won't have stimulus programs under a Perry presidency. You won't spend all the money." This is a pretty good summation of the Tea Party's know-nothing view that all government spending makes all things worse, always.

"That's not to say that everyone who rejects Obama's stimulus spending is a default-welcoming ignoramus. Libertarians or libertarian-leaners don't necessarily think stimulus won't grow the economy; they just worry that it will grow the government at the same time and that it won't ever shrink back. But they don't mind stimulus tax cuts, which reduce the resources available to government. Rep. Paul Ryan, for instance, the government-slashing chairman of the House budget committee, has argued that stimulus spending is an evanescent sugar high that produces no lasting economic benefit.

"The cynics, by contrast, don't offer any economic analysis at all. They simply reject whatever President Obama proposes. In the now immortal words of Senate Minority Leader Mitch McConnell: "The single most important thing we want to achieve is for President Obama to be a one-term president." McConnell, like Boehner and House Majority Leader Eric Cantor, happily voted for the stimulus bill George W. Bush proposed in 2008, which cost $152 billion. Back then, they felt some responsibility for the economy. Now it's Obama's problem. Mitt Romney knows enough about finance to understand that shrinking spending would raise unemployment. But he also knows that running against Obama with a 9 percent unemployment rate is a better bet than running against Obama with an 8 percent unemployment rate. "

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Trying to understand income inequality, the most profound change in American society in your lifetime. - By Timothy Noah - Slate Magazine

2011-09-05T19:47:00.000-07:00

Trying to understand income inequality, the most profound change in American society in your lifetime. - By Timothy Noah - Slate Magazine: Timothy Noah's 10-part series on inequality, published in Slate last September, has won the 2011 Hillman Prize for magazine journalism, an honor awarded annually by the Sidney Hillman Foundation for reporting that "fosters social and economic justice." It was clear from the moment of publication that "The Great Divergence" struck a chord, treating a profound and complicated issue in an engaging and understandable way, and we're delighted that the Hillman Foundation has recognized Noah's work. You can read the series below, or print a PDF.

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Study compares CEO pay with taxes

2011-08-31T09:57:00.000-07:00

Study compares CEO pay with taxes: Three Pittsburgh companies are among 25 U.S. corporations that paid their CEOs more last year than the company paid in U.S. corporate income taxes, according to a study by the Institute of Policy Studies.

The local companies on the list are Bank of New York Mellon, specialty metals producer Allegheny Technologies and Mylan, which makes generic drugs.

The institute compared CEO pay with the federal tax liabilities companies disclose in their 10-K, an annual report filed with the Securities and Exchange Commission. The institute states the figure is "the best approximation of actual taxes paid to the U.S. Treasury."

The Washington research report examines CEO pay every year. Last year it found the CEOs of companies that announced the largest layoffs earned, on average, 42 percent more in 2009 than the average CEO of an S&P 500 company.

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Cleared of wrongdoing, Penn State climatologist still sees 'smears'

2011-08-31T09:56:00.000-07:00

Cleared of wrongdoing, Penn State climatologist still sees 'smears': Mr. Mann, a doctor of geology and geophysics who serves as director of Penn State's Earth System Science Center, already was a central figure in the controversy over climate-change science before emails were hacked in late 2009 from the University of East Anglia Climatic Research Unit in the United Kingdom.

Now he's an even stronger lightning rod for critics of climate-change science, including Texas Gov. Rick Perry, the Republican presidential candidate who continues to claim data was manipulated to prove climate change.

But on Aug. 15, the NSF and the U.S. inspector general concluded that emails did not reflect flawed or fraudulent science and closed the case. It represents the last of seven investigations of the heisted personal emails that included flippant statements and others that were described as reckless and injudicious.

But three investigations in the United Kingdom and four in the United States including ones by Penn State, the U.S. Environmental Protection Agency, the National Oceanic Atmospheric Administration and now the NSF all have dispelled claims that climate-change research by Mr. Mann and others was manipulated to justify false conclusions.

"It's the seventh investigation that's arisen out of the leak of emails and false allegations by climate-change deniers who were mining for words and phrases out of context," Mr. Mann said. "This should be the final nail in their coffin."

But he said critics of his research continue saying "up is down and black is white in their climate-change denial."

"I'd be lying if I didn't say this was a major distraction for me and my colleagues," he said. "I've been wasting a lot of time responding to allegations. That being said, the scientific community has understood from the start that this was a manufactured scandal and smear campaign against scientists.

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An Insurance Maze for U.S. Doctors - NYTimes.com

2011-08-29T15:13:00.000-07:00

An Insurance Maze for U.S. Doctors - NYTimes.com:

"Researchers asked hundreds of physicians and administrators in private practices across the United States and Canada how much time they spent each day with insurers and other third-party payers, tracking down information for claims that were denied or incorrectly paid, resolving questions about insurance coverage for prescription drugs or diagnostic tests, and filing the different forms required by each and every insurance company.

"Physicians in Canada, where health care is administered mainly by the government, did spend a good deal of time and money communicating with their payers. But American doctors in the study spent far more dealing with multiple health plans: more than $80,000 per year per physician, or roughly four times as much as their northern counterparts. And their offices spent as many as 21 hours per week with payers, nearly 10 times as much as the Canadian offices.

“The amount of time we spend on this is just crazy,” said Dr. Sara L. Star, a partner in a three-physician pediatrics practice in suburban Chicago. “But each insurance company has its own language, its own set of rules and specific contracts with certain laboratories, hospitals, physicians and pharmaceutical companies.”

The Health Affairs article is here.

The rich are different — and not in a good way, studies suggest - Health - Behavior - msnbc.com

2011-08-10T20:51:00.000-07:00

The rich are different — and not in a good way, studies suggest - Health - Behavior - msnbc.com:

"In other words, rich people are more likely to think about themselves. “They think that economic success and political outcomes, and personal outcomes, have to do with individual behavior, a good work ethic,” said Keltner, a professor of psychology at the University of California, Berkeley.

Because the rich gloss over the ways family connections, money and education helped, they come to denigrate the role of government and vigorously oppose taxes to fund it.

“I will quote from the Tea Party hero Ayn Rand: “‘It is the morality of altruism that men have to reject,’” he said.

- Sent using Google Toolbar"

What Republicans get wrong about capitalism - Great Recession | Economic Recession, Economic Crisis - Salon.com

2011-08-08T18:18:00.000-07:00

What Republicans get wrong about capitalism - Great Recession | Economic Recession, Economic Crisis - Salon.com: "Smith would be highly skeptical of such claims. In the final edition of the 'Theory of Moral Sentiments,' written over a decade after 'The Wealth of Nations,' he added a chapter in which he describes the 'disposition to admire, and almost to worship, the rich and the powerful, and to despise, or, at least, to neglect persons of poor and mean condition.' This disposition, Smith says, colors the way we view the world, leading us to conflate wealth and greatness with virtue and poverty and weakness with vice.

It also leads to confusion in thought. Who makes capitalism work? is a very different question from For whom has capitalism worked best? We should guard against presuming the answers are necessarily one and the same.

- Sent using Google Toolbar"

9 Things The Rich Don't Want You To Know About Taxes

2011-08-07T19:01:00.000-07:00

9 Things The Rich Don't Want You To Know About Taxes: "For three decades we have conducted a massive economic experiment, testing a theory known as supply-side economics. The theory goes like this: Lower tax rates will encourage more investment, which in turn will mean more jobs and greater prosperity—so much so that tax revenues will go up, despite lower rates. The late Milton Friedman, the libertarian economist who wanted to shut down public parks because he considered them socialism, promoted this strategy. Ronald Reagan embraced Friedman’s ideas and made them into policy when he was elected president in 1980.

For the past decade, we have doubled down on this theory of supply-side economics with the tax cuts sponsored by President George W. Bush in 2001 and 2003, which President Obama has agreed to continue for two years.

You would think that whether this grand experiment worked would be settled after three decades. You would think the practitioners of the dismal science of economics would look at their demand curves and the data on incomes and taxes and pronounce a verdict, the way Galileo and Copernicus did when they showed that geocentrism was a fantasy because Earth revolves around the sun (known as heliocentrism). But economics is not like that. It is not like physics with its laws and arithmetic with its absolute values.

Tax policy is something the framers left to politics. And in politics, the facts often matter less than who has the biggest bullhorn.

The Mad Men who once ran campaigns featuring doctors extolling the health benefits of smoking are now busy marketing the dogma that tax cuts mean broad prosperity, no matter what the facts show.

- Sent using Google Toolbar"

S&P's credit rating cut: Downgrading our politics | The Economist

2011-08-07T18:49:00.000-07:00

S&P's credit rating cut: Downgrading our politics | The Economist: "Investors largely tuned out the debt-ceiling debate until its final days out of a belief based on long experience that for all the antics and rhetoric of the Tea Party, the people who actually run Capitol Hill would never compromise the country’s credit worthiness. After all, it was Mr Boehner who reminded his freshmen colleagues that on the debt ceiling they’d have to act like “adults.”

That is not what happened. As the fight dragged on, the leadership moved closer to the Tea Party, not the other way around. And they seem happy with the results. Why else would Mitch McConnell have promised on August 1st to do exactly the same the next time the debt ceiling must be raised?

It is striking that the proponents of this strategy seem so oblivious to its impact. Our economy is lubricated by a sophisticated and stable credit market whose most vital component is also the most ephemeral: trust. As the crisis amply demonstrated, when trust erodes, the system freezes up. America has built a reputation for responsible and credible management of its finances over the centuries, and that reputation has been reduced to a political football, like a federal judgeship. Henceforth a foreign pension fund or central bank that once mindlessly ploughed his spare cash into Treasurys will have to think twice.

I never had much sympathy for the view that America’s economy was about to be eclipsed by China’s, and the main reason was our political institutions. Those checks, balances and laws provide an orderly means to change course in response to new challenges. China’s authoritarianism deprives the government of a feedback mechanism to tell it when it is meeting the needs and aspirations of its people. That makes its system intrinsically fragile.

Events of the last few weeks have forced me to reconsider.

- Sent using Google Toolbar"

The Oregon Health Insurance Experiment: Evidence from the First Year

2011-07-07T20:33:00.000-07:00

The Oregon Health Insurance Experiment: Evidence from the First Year: "In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

- Sent using Google Toolbar"

Taking a Side | Crooks and Liars

2011-07-06T17:48:00.000-07:00

Taking a Side | Crooks and Liars:

Just a terrific paragraph:

To me, that question is the most critical one there is when it comes to government policy. I don’t believe that government is inherently good — having lived through Vietnam, Watergate, J. Edgar Hoover’s corruption at the FBI, the massive deficit producing tax-cuts-for-the-rich policies of Reagan and Bush, the S&L crisis, financial deregulation, media consolidation, the Iraq war, Katrina, and the utter economic incompetence of the President George W. Bush economic years. I have no illusions that government as a whole is always on the side of most people. But what I want and believe in is a government of, by, and for the people — most especially for the people. Given the size and power of the financial industry, and other huge multinational corporations, I want a government that is on our side in making sure these massive companies don’t destroy our economy (again), and then demand bailouts (again) because they are too big to fail. I want a government on our side so that big insurance companies don’t tell people they can’t have coverage anymore because they got sick. I want a government on the side of senior citizens who have worked hard their whole lives and now want to live with some modest measure of dignity and economic security through Social Security, Medicare, and Medicaid coverage. I want a government on the side of working class families thrown out of their jobs and homes through no fault of their own. I want a government that is on the side of our kids and helps them get a good education. I want a government that is on the side of small business and start-up entrepreneurs as they work their butts off trying to compete with huge corporations.

This is the converse of the argument I often make about how wonderful people think private business is viz the government: Ever try switching cell phone carriers? Cable companies? Understand your credit card agreement?

To paraphrase Barney Frank. "If you think government is terrible, private businesses aren't so hot, either!"

Old LTE on Jon Stewart

2011-06-20T17:54:00.000-07:00

Given Jon Stewart's recent dust up over on Fox News Sunday, I Googled and old LTE to the Pittsburgh Post Gazette I wrote before the 2004 election. I think it is still pretty spot on, if I do say so myself (and so did the crowd over at Democratic Underground, apparently)!

Pittsburgh Post-Gazette

Friday, September 10, 2004

Mr. Koppel, here's why we watch 'The Daily Show'

I hope this is it. I hope television journalism has hit rock bottom like an alcoholic who wakes up on a downtown sidewalk and understands he must find a 12-step program.

If you stayed up late enough last Wednesday night to see the very end of Ted Koppel's "Nightline," you would have been able to witness just how obtuse television news reporting has become. Ted Koppel tried to teach an elementary lesson in Journalism with a capital J to "The Daily Show's" Jon Stewart, and was repeatedly verbally dope-slapped by the comedian to no apparent effect. Jon Stewart, as he frequently does, was stating the case that journalists were failing miserably at their job. So miserably, in fact, that many people feel they have to watch a basic cable fake news show to find "The Truth."

Mr. Koppel then patronizingly tried to explain to Mr. Stewart the difference between facts and the truth. He suggested that if the president gave a speech calling Mr. Koppel a rapist and pedophile that this assertion would be a fact and newsworthy in that the president called a famous, well-respected journalist a rapist and pedophile, even if the accusation were untrue.

Not being a journalist, I was dumbstruck. Mr. Koppel believes that the correct headline for a journalist to report on this hypothetical event is "President accuses journalist of pedophilia" because it is factually correct. I think the rest of us non-journalists would agree that the headline should be "President falsely accuses journalist of pedophilia." I have been trying to get my head around why journalism has gotten so bad in the past 20 years and Ted Koppel has finally shown me. When Gerald Ford mistakenly argued in a presidential debate with Jimmy Carter that Eastern Europe was not under the influence of the Soviet Union, yes, indeed, it was reported that he said this. But it was never reported without it being noted that he was completely wrong.

If President Bush makes a speech declaring that the moon is made of cheese, the headline is not "President declares moon made of cheese," the headline is "President delusional!" or "White House assures nation that president misspoke."

If you have been paying attention, you have seen this slide to the bottom coming for a long time. Newt Gingrich in the early '90s put the pedal to the metal when he developed his dirty words to call your opponent that won't be challenged. The press, pathetically, and the Democrats, even more pathetically, did nothing to call this slimy tactic by its proper name. This first inroad led us down the path to where we are now: the unchallenged assertion.

On MSNBC's "Hardball" last week, Sen. Rick Santorum finished up his interview with Chris Matthews with some stunning assertions about John Kerry: "Well, I mean, I only have to allude to his testimony before Congress ... And I think that kind of anti-American sentiment, that kind of America can't do it, America isn't good enough anymore, and sort of being critical, as he has been of the president, not supporting our troops, all that coming out in Pennsylvania is just not going to sell."

Well, thank goodness for Chris Matthews and his hard-hitting journalism and integrity. His "hardball" response? "OK. It's great talking to you tonight, Senator Rick Santorum, the junior senator from Pennsylvania."

OK. So for Rick Santorum and the panoply of militarily challenged members of the Bush-Cheney administration, every returning Vietnam veteran, every student, every reporter, every housewife, every member of Congress, and every soldier on a swift boat or in a jungle who opposed the Vietnam War were anti-American? Everyone who believed that Nixon and Kissinger and McNamara were conducting an unnecessary war in a reprehensible manner are anti-American?

Am I incorrect in thinking that our nation's general consensus is that those who opposed the war and literally fought to bring it to an end were courageous, patriotic Americans who fought an unpopular fight but in the end were proven right? "OK."

And thank goodness Sen. Santorum and Sen. Zell Miller are supporting our troops, because apparently if John Kerry were in charge, we'd be fighting "with spitballs." The idea of letting a leader of the majority party of the U.S. Senate say that one of its members from the loyal opposition does not support the troops is repugnant and should not go unchallenged. Why doesn't Chris Matthews (or any journalist for that matter) ask Mr. Santorum: If John Kerry voted for the $87 billion the first time, why didn't it pass? And how did Mr. Santorum and Mr. Miller and Dr. Frist and Mr. McCain vote that time?

And the next time someone says that Mr. Kerry or anyone voted "against body armor" or "against cancer research" or "to poison pregnant women" or any of those outlandishly stupid comments that pass for political discourse these days, shouldn't some high-profile journalist ask them about their obviously ludicrous implication: So you think Mr. Smith is for cancer? So you think Mr. Jones really hates our troops?

I don't care if George W. Bush doesn't do nuance, the rest of us do! We can understand that voting for a bill that includes both $87 billion to fund the Iraq war and tax rollbacks to finance it is different than voting for a bill that doesn't include the tax rollbacks. That second vote wasn't a vote against our troops, it was casting an unpopular vote to make a point that this administration is rolling up massive deficits that will come back to haunt us and our children.

But let's get back to Jon Stewart and Ted Koppel. Koppel has said recently that "a lot of television viewers -- more, quite frankly, than I'm comfortable with -- get their news from ... 'The Daily Show.' " As Stewart points out, that is because "The Daily Show" is willing to point out that what passes for political discourse by well-respected and supposedly well-trained broadcasters when they interact with the pull-string Chatty Cathy dolls spewing forth their disingenuous talking points is what it is, crap.

Mr. Stewart identifies himself as neither a Republican nor a Democrat and believes that the conservative/liberal paradigm no longer works. He is "anti-b.s." Consequently, the current administration, whose ability to make the aforementioned substance smell like reasonable public policy is epic, is a favorite target. And fortunately, Mr. Stewart and his staff apparently have resources not found at virtually any other news organization in the country: collectively, they have half a brain and the writers apparently devote some of their time to research.

Mr. Stewart believes that it is the job of real journalists to adjudicate our national political debate. In a recent segment with "Daily Show" "correspondent" Rob Corddry, Stewart asked about the factual basis of the swift boat vets' charges. "Facts?" said Corddry, "Our job is to parrot what one side says and then parrot back what the other side says!" Apparently this is what politicians can now reliably count on, but I hope the profession of journalism gets into a good 12-step program before the election.

CMHMD

Huge Profits for Health Insurers as Americans Put Off Care - NYTimes.com

2011-05-31T15:59:00.000-07:00

Huge Profits for Health Insurers as Americans Put Off Care - NYTimes.com:

"The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care. "

I know, I'm shocked, too.

Doctors Soften Their Stance on Obama’s Health Overhaul - NYTimes.com

2011-05-30T16:57:00.000-07:00

Doctors Soften Their Stance on Obama’s Health Overhaul - NYTimes.com:

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

As I pointed out here many times over the past couple years, doctors support health reform.

Follow the tags with this to find out more.

How to Lower Cancer Care’s Costs | The Health Care Blog

2011-05-29T11:57:00.000-07:00

How to Lower Cancer Care’s Costs | The Health Care Blog:

In the NEJM last week, two oncology specialists — Thomas Smith and Bruce Hilner of Virginia Commonwealth University — took up the challenge. They created a “top five” list of common oncology practices, which, if limited to situations where they were truly clinically useful, would sharply lower the cost of cancer care. Their lead paragraph noted the need for taking these steps:

Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond. This increase has been driven by a dramatic rise in both the cost of therapy and the extent of care. In the United States, the sales of anticancer drugs are now second only to those of drugs for heart disease, and 70% of these sales come from products introduced in the past 10 years. Most new molecules are priced at $5,000 per month or more, and in many cases the cost-effectiveness ratios far exceed commonly accepted thresholds. This trend is not sustainable.

Look closely at the second to last sentence of that paragraph: “In many cases the cost-effectiveness ratios far exceed commonly accepted thresholds.” It’s worth noting that there are no commonly accepted thresholds for cost of care in the U.S. That’s not true in Great Britain, where the National Health Service, based on recommendations from the National Institute for Clinical Excellence, will refuse to pay for certain drugs when their costs exceed certain levels. But in the U.S., Medicare, which is the primary payer for most cancer care since cancer is primarily a disease of aging, is forbidden by law from taking cost into consideration. If the Food and Drug Administration has approved a specific approach, and the doctor prescribes it, Medicare will pay for it. If the oncologist tries an approach that is not specifically approved by the FDA — either as an “off label” use or combination of approved drugs — the Centers for Medicare and Medicaid Services will still pay for the treatments long as the approach is listed in clinical practice guidelines. And when it comes to most testing and imaging, most insurers including Medicare will pay for whatever the doctor orders, even though the medical literature is loaded with studies suggesting their lack of usefulness in many situations where commonly used.

A good piece exhorting us to begin to address the out of control costs we have built into our care delivery.

Why Medical School Should Be Free - NYTimes.com

2011-05-29T09:48:00.000-07:00

Why Medical School Should Be Free - NYTimes.com:

DOCTORS are among the most richly rewarded professionals in the country. The Bureau of Labor Statistics reports that of the 15 highest-paid professions in the United States, all but two are in medicine or dentistry.

Why, then, are we proposing to make medical school free?

Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.

I've certainly made this point here before, but now a more respectable pair of opinionators.

History of Direct to Consumer Advertising via NPR

2011-05-27T09:49:00.001-07:00

Selling Sickness: How Drug Ads Changed Health Care : NPR:

But then, in 1986, while designing an ad for a new allergy medication called Seldane, Davis hit on a way around the fine print. He checked with the Food and Drug Administration to see if it would be OK.

'We didn't give the drug's name, Seldane,' he says. 'All we said was: 'Your doctor now has treatment which won't make you drowsy. See your doctor.' '

This was one of the very first national direct-to-consumer television ad campaigns. The results were nothing short of astounding. Before the ads, Davis says, Seldane made about $34 million in sales a year, which at the time was considered pretty good.

'Our goal was maybe to get this drug up to $100 million in sales. But we went through $100 million,' Davis says. 'And we said, 'Holy smokes.' And then it went through $300 million. Then $400 million. Then $500 million. $600 [million]! It was unbelievable. We were flabbergasted. And eventually it went to $800 million.'

Thought I'd posted this before, but better late than never.

Critical State of Top Wages at Publicly Financed Hospitals - NYTimes.com

2011-05-26T14:46:00.000-07:00

Critical State of Top Wages at Publicly Financed Hospitals - NYTimes.com:

At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the chief executive was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the chief executive was paid $9.8 million in 2007 and $2.8 million in 2008.

Medicare Costs to Seniors Under House Budget Proposal - U.S. Congress Joint Economic Committee

2011-05-24T17:12:00.000-07:00

Press Releases - Press - U.S. Congress Joint Economic Committee:

A new state-by-state analysis by the U.S. Congress Joint Economic Committee (JEC) finds that in each state in the country, out-of-pocket health care costs will more than double for residents turning 65 in 2022 under the Republican budget plan passed by House Republicans in April.

The non-partisan Congressional Budget Office has estimated that a typical 65-year-old Medicare beneficiary in 2022 would see their out-of-pocket health care costs increase from $6,154 to $12,513 under the Republican budget. Using that data along with cost-sharing data from the Centers for Medicare and Medicaid Services, the JEC has estimated out-of-pocket costs on a state-by-state basis. While the increase varies by state, residents in all states will see their out-of-pocket expenses more than double when they turn 65 in 2022. Residents in Florida face the largest increase –$7,383.

The report also shows that current Medicare beneficiaries will be harmed by the GOP budget, immediately losing preventive services such as mammograms and facing higher prescription drug costs.

“This new JEC analysis helps to fill in the picture on just how disastrous and costly the Republican Medicare plan is for our older Americans,” said Senator Bob Casey (D-PA), Chairman of the JEC. “If Republicans have their way, traditional Medicare will no longer exist in 2022. Instead, our elderly will get a voucher to purchase private insurance, but the voucher won’t keep pace with health care costs. The result would be a staggering increase in out-of-pocket costs beginning in 2022. In my state of Pennsylvania, someone turning 65 in 2022 would face a $6,300 increase in their health care expenses. Our elderly Americans cannot afford to have their health care expenses double, but that’s exactly what the Republican plan delivers.”

The increased out-of-pocket costs result from older Americans bearing a larger share of health care costs under the Republican plan and the increase in total health care costs that results from shifting from traditional Medicare to a less efficient, more expensive voucher program.

“The Republican Medicare plan doesn’t rein in health care costs,” continued Casey. “Instead, it simply shifts the costs onto the backs of our elderly. The Republican ‘solution’ is providing our elderly with dramatically higher costs and less care. Current beneficiaries will suffer and the next generation will face retirement without Medicare and without the peace of mind it offers.”

Wendell Potter: Insurance Industry Flack Screws Up, Points Us to Report We Really Should Read

2011-05-20T11:30:00.000-07:00

Wendell Potter: Insurance Industry Flack Screws Up, Points Us to Report We Really Should Read:

A major point of the Thomson Reuters paper is that up to $700 billion that we spend on health care in the U.S. is wasted and that a big reason for that waste is our multi-payer system of private health insurance companies.

'Health care providers must deal with dozens of health benefit plans to bill successfully for services rendered,' the report said. 'Health plans must support systems for underwriting, claims administration, provider network contracting, and broker network management... Simplifying our health care system's administration could reduce annual health care costs by almost $300 billion.'

Then there were these bullet points that surely will never appear in a health insurance industry presentation:

• The average U.S. hospital spends one quarter of its budget on billing and administration, nearly twice the average in Canada. American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than Canada.

• In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

The white paper is here.

Bible: Caring for and serving the poor

2011-05-16T19:16:00.000-07:00

Bible: Caring for and serving the poor:

"What does the Bible have to say about helping needy people -- the poor, the homeless, the orphans, and the widows? Are there Bible passages which say we are supposed to have compassion and to be giving to the less fortunate? What biblical foundations are there for service to others?

How to care for the poor? How are we to provide for the hungry? Here are instructions from the Bible. Looking for slogan for a promotion about helping the needy or feeding the poor? Use a phrase from one of these Scripture verses as a slogan. "

A nice collection of Biblical quotations about helping the poor.

amednews: Bill seeks outside review of relative values in Medicare services :: April 11, 2011

2011-05-15T13:11:00.000-07:00

amednews: Bill seeks outside review of relative values in Medicare services :: April 11, 2011:

A Democratic lawmaker has proposed changing the way the Medicare program identifies physician services for which it pays too little -- or too much -- by requiring independent contractors to review doctor fees annually.

Since 1992, a panel convened by the American Medical Association and representing a wide range of specialties has recommended thousands of pay changes to the individual services doctors provide to Medicare patients. The bill would add a layer of review on top of the 29-member AMA/Specialty Society Relative Value Scale Update Committee, known as the RUC.

Critics of the committee say it lacks transparency and is responsible for continuing payment discrepancies between primary care physicians and specialists. But supporters, including the AMA, disagree. They say the use of outside contractors would be duplicative and add an unnecessary layer of bureaucracy to the process.

The Centers for Medicare & Medicaid Services is required to consult with health professionals on adjusting relative values for services. Because the process is budget-neutral, any value change that results in Medicare paying more for a service means it will pay less for one or more other services. CMS routinely accepts the majority of the RUC's recommendations, although it is not required to do so.

Rep. Jim McDermott, MD (D, Wash.), introduced the Medicare Physician Payment Transparency and Assessment Act of 2011 on March 30. The bill explicitly would require independent contractors to identify misvalued physician services on an annual basis and recommend adjustments. The national health system reform law already states that the Health and Human Services secretary 'may use analytic contractors,' but the new measure would make this mandatory.

'For two decades now, this panel has been dominated by specialists who undervalue the essential and complex work of primary care providers and cognitive specialists, while often favoring unnecessarily complex, costly and excessive specialty medical services,' Dr. McDermott said. 'The result is clear -- there is a shortage of family doctors, patients don't necessarily get the services they need and medical costs are increasingly driven higher.'

John Kenneth Galbraith understood capitalism as lived – not as theorized / The Christian Science Monitor - CSMonitor.com

2011-05-14T14:33:00.000-07:00

John Kenneth Galbraith understood capitalism as lived – not as theorized / The Christian Science Monitor - CSMonitor.com:

Government's role

While Friedman never really appreciated the limitations of the market, he was a forceful critic of government. Yet history shows that in every successful country, the government had played an important role. Yes, governments sometimes fail, but unfettered markets are a certain prescription for failure. Galbraith made this case better than most.

Galbraith knew, too, that people aren't just rational economic actors, but consumers, contending with advertising, political persuasion, and social pressures. It was because of his close touch with reality that he had such influence on economic policymaking, especially during the Kennedy-Johnson years.

Galbraith's penetrating insights into the nature of capitalism – as it is lived, not as it is theorized in simplistic models – has enhanced our understanding of the market economy. He has left an intellectual legacy for generations to come. And he has left a gap in our intellectual life: Who will stand up against the economics establishment to articulate an economic vision that is both in touch with reality and comprehensible to ordinary citizens?

A nice and too brief overview of Galbraith v Friedman, by Nobel Laureate Joseph Stiglitz.

Uwe E. Reinhardt: How Efficient Is Private Charity? - NYTimes.com

2011-05-10T16:18:00.000-07:00

Uwe E. Reinhardt: How Efficient Is Private Charity? - NYTimes.com: "Although in absolute dollar terms the United States ranks high in that category as well, as a percentage of G.D.P. many European nations outrank us (see Table 1, Annex A, on page 7).

Citizens of other countries may remind us that there is a trade-off between channeling dollars from citizens to charitable or civic activities through the government’s budget and channeling these funds through the budgets of private organizations that we label charitable, whether they truly support charitable or civic activities.

Many charitable or civic activities financed in the United States with private giving are financed elsewhere through government — health care, education and museums among them.

Why do Americans make so different a trade-off between private charity and government than people in most other nations?

One persuasive reason is that through private charitable giving, the donor can direct where his or her funds go. Americans do not trust their government as much as citizens elsewhere seem to. Yet it is not always clear in whose pockets private charitable donations end up.

A second reason is that many Americans have the notion that private charities are more efficient than government can ever be.

My experience is that to many Americans this notion, which is nothing more than a hypothesis, is an axiom, a statement so self-evident that it does not require proof.

The relative efficiency of private “charity” and tax-financed governmental “charity” is an empirical question. The proper criterion is what fraction of our charitable donations actually flows directly to the activities that we seek to support."

I find it strange this article of faith that ALL private operations are inherently more efficient than ALL government ones. When I hear this, I ask the person if they've ever tried to question their cable bill, or, even worse, tried to change providers!

Drug Company Payments to Doctors | Dollars for Docs - ProPublica

2011-05-10T16:11:00.000-07:00

Drug Company Payments to Doctors | Dollars for Docs - ProPublica: "Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But eight companies have begun posting names and compensation on the Web, some as the result of legal settlements. ProPublica compiled these disclosures, totaling $320 million, into a single database that allows patients to search for their doctor. Receiving payments isn’t necessarily wrong, but it does raise ethical issue"

ProPublica has many more articles on the influence of Pharma money on medicine at this link.

Financial Ties Bind Medical Societies to Drug and Device Makers - ProPublica

2011-05-10T15:54:00.000-07:00

Financial Ties Bind Medical Societies to Drug and Device Makers - ProPublica:

"SAN FRANCISCO — From the time they arrived to the moment they laid their heads on hotel pillows, the thousands of cardiologists attending this week’s Heart Rhythm Society conference have been bombarded with pitches for drugs and medical devices.

St. Jude Medical adorns every hotel key card. Medtronic ads are splashed on buses, banners and the stairs underfoot. Logos splay across shuttle bus headrests, carpets and cellphone-charging stations."

Coal Cares: Who needs Global Warming?

2011-05-10T15:52:00.000-07:00

Coal Cares:

"Why Free Inhalers? Because COAL CARES.

Coal Cares™ is a brand-new initiative from Peabody Energy, the world's largest private-sector coal company, to reach out to American youngsters with asthma and to help them keep their heads high in the face of those who would treat them with less than full dignity. For kids who have no choice but to use an inhaler, Coal Cares™ lets them inhale with pride.

Puff-Puff™ inhalers are available free to any family living within 200 miles of a coal plant, and each inhaler comes with a $10 coupon towards the cost of the asthma medication itself.

This reminds me of the advice Jim Carey gave his client in "Liar, Liar," "Stop polluting the air, a******!"

President Lyndon B. Johnson's Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965

2011-04-30T14:01:00.000-07:00

President Lyndon B. Johnson's Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965:

"This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

"Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don't want these people to have anything to do with charity and we don't want them to have any idea of hopeless despair."
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"Many men can make many proposals. Many men can draft many laws. But few have the piercing and humane eye which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.

"But it is just such men who illuminate the life and the history of a nation. And so, President Harry Truman, it is in tribute not to you, but to the America that you represent, that we have come here to pay our love and our respects to you today. For a country can be known by the quality of the men it honors. By praising you, and by carrying forward your dreams, we really reaffirm the greatness of America.

"It was a generation ago that Harry Truman said, and I quote him: "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."

"Well, today, Mr. President, and my fellow Americans, we are taking such action--20 years later."
...............
"And through this new law, Mr. President, every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age."
...............
"I said to Senator Smathers, the whip of the Democrats in the Senate, who worked with us in the Finance Committee on this legislation--I said, the highest traditions of the medical profession are really directed to the ends that we are trying to serve. And it was only yesterday, at the request of some of my friends, I met with the leaders of the American Medical Association to seek their assistance in advancing the cause of one of the greatest professions of all--the medical profession--in helping us to maintain and to improve the health of all Americans.

"And this is not just our tradition--or the tradition of the Democratic Party--or even the tradition of the Nation. It is as old as the day it was first commanded: "Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land."

"And just think, Mr. President, because of this document--and the long years of struggle which so many have put into creating it--in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty--despite their long years of labor and expectation--who will now look up to see the light of hope and realization.

"There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this."

It's the Inequality, Stupid | Mother Jones

2011-04-29T18:43:00.000-07:00

It's the Inequality, Stupid | Mother Jones:

Illustrations by Jason Schneider

Eleven charts that explain everything that's wrong with America.

It is amazing we haven't had a revolt yet.

The Waiting Times Myth

2011-04-24T20:48:00.000-07:00

The Incidental Economist Blog started talking about wait times this past week, and has several interesting posts on the topic here, here, and here. I won't reiterate them, they speak (well) for themselves. The bottom line is that we aren't really any great shakes with our wait times and access to care, we spend way too much time and money and use too much of our work force doing expensive procedures when we should be concentrating on primary care and reducing the need for all of those heroics. The US supply of physicians vs. specialists is inverted from high performing health systems where most doctors provide primary care.

Given this background, here's my take.

When I discuss health care reform with friends, families, colleagues, or in public, the two most pervasive myths about health care outside the US are that in every other country, care is inferior and rationing is accomplished by intolerable waiting times. As I endeavor to dispel these myths, I am invariably told an anecdote about a person who died in Canada or England awaiting some procedure or other.

Dispelling these myths is two-fold: first, pointing out the rationing that occurs in America either by private health insurers or by lack of wherewithal to afford services, and second, by pointing out that there are more health care systems than “ours” and “theirs.”

Given that an estimated 45,000 Americans are estimated to die every year due to lack of access to health care services , rationing in America is particularly troublesome, and oddly overlooked. There are many reasons for this, but mostly it is the lack of drama and, paradoxically, the pervasiveness of this experience, especially to those of us in health care. Anecdotes are powerful things, and so I have to always tell a few of my own to counter the horror stories they’ve heard about other countries. So, a few cases of my own: a man who puts off seeing a doctor (for what he knows is diabetes), ends up in the ICU critically ill, because he is trying to get on a health insurance plan and hopes he won’t be found out; a down-sized engineer with a year long persistent cough and weeks of coughing up blood, who waits until he is near death to come to the hospital because he can’t afford to see a doctor; and finally a young man with a seizure disorder admitted twice to the ICU for unremitting seizures in just a few months because his neurologist won’t see him because he’s been underemployed and couldn’t pay his last bill. Multiply my stories by nearly a million physicians in America and you see the magnitude and pervasiveness of the problem.

Beyond anecdotes, there is actual data, such as the Commonwealth Fund study showing that "U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the ER, see a specialist, and have elective surgery.” Additionally, Americans are less likely to have a regular doctor, less likely to get prescriptions filled, less likely to get follow-up care, less likely to keep a doctor long-term, and have a harder time getting taken care of nights and weekends. In another report, the Commonwealth Fund has shown the US ranks 19th out of 19 countries evaluated on preventing deaths that are amenable to adequate health care, an excellent measure of the overall performance of a country’s health care system.

That there is more than one country outside the US with a unique health system, might surprise some whose rhetoric suggests a vast wasteland of a series of Soviet style medical gulags. OECD data shows (Siciliani, 2003) that waiting times are a problem in some countries, but only about half of those in the OECD. The others are like the United States in lack of significant waiting times, but unlike us they manage to do this with their entire population covered, and at significantly lower costs.

Now, let's do a little thought experiment. Say you are in a country that has relatively high waiting times for elective procedures, say Canada (but not England so much any more!). Take one sixth of your population and deny them access to care because, oh, they don't deserve it. What do your waiting times look like now? Take another sixth or so, and tell them they have to choose among school, dental care, glasses, food OR preventive health care. Or even life saving health care. OK, now how are your queues?

Americans ration, all right. It is unbecoming, to say the least. It is leaving people to slowly die, to be more blunt. It is under the radar for most, but not for us, not for the millions of care givers and social workers and nurses and parents and children who have to bear witness.

Some more on Ayn Rand

2011-04-24T20:42:00.000-07:00

DownWithTyranny!: The Inspiration For Paul Ryan's Profoundly And Explicitly Anti-Christian Budget

An overview of Ayn Rand and the un-Christian worldview she and her followers, like the hard core conservatives in Congress, represent.

That Government Takeover Thing

2011-03-31T10:44:00.000-07:00

[Cross posted from Doctors for America Blog.]

As many of us in DFA know, one of the more fevered arguments against the PPACA, both before and after its passage, was the cri de guerre, "It's a government takeover of health care!"

This argument left me often fumbling for an answer. I know enough about international health care, and enough about our true homegrown versions of government health care (the VA, TriCare, the Indian health Service) to know that PPACA ain't it. Not even close. Trying to explain the difference among single payer systems and true government runs systems and private but universal systems, did not cut the mustard (or get through the neural programming, George Lakoff would say). "Obamacare" was a government takeover, and I was just a dupe if I couldn't see it.

Apparently, the answer was in plain sight, and I just was not aware of it. While researching another topic, Google took me to an interesting, but very public place that I had overlooked before. It is on the GOP.gov web site from over a year ago, and billed as "Courtesy of the Senate Republican Policy Committee": 159 Ways the Senate Bill Is a Government Takeover of Health Care

As you scroll through the list, you might get the feeling that every single line in the bill represents a fundamental alteration in health care as we know it, changing our current "system" into some form of crypto-socialist mockery of the free market system we're all so pleased with. I guess a conservative minded person might indeed scroll through all of these initiatives and gasp in horror, but as I read through it, it seems like a very good list for us to trot out and show all of the good stuff actually in the bill!

The idea that various projects and initiatives to promote administrative simplification on insurance claims, to promote quality of care in the Medicaid program, to promote Patient Centered Medical Homes, grants to support physicians and others entering primary care and geriatrics, to develop quality measures, to figure out how to align payment incentives to promote the best patient care, and on and on, that these somehow represent a sinister plot requires epic, delusional almost, paranoia.

One of our kids' favorite books growing up was "A House is a House For Me." It was a delightful exploration of how, when looked at with the appropriate viewpoint, everything was a house: a sock for a foot, a shell for a hermit crab, or a tree for a monkey.

So, in the minds of the GOP Senate Republican Policy Committee, any law or regulation or initiative, can be a "government takeover." This is not new, of course, Ronald Reagan famously opposed Medicare as the clear path to Soviet style communism, and the John Birchers, now resurgent, thought former Supreme Allied Commander and then President of the United States Dwight Eisenhower was a Soviet agent. The difference now is that this is mainstream political rhetoric, even articles of faith, in many circles.

So, in our new book, "A Regulation is a Government Takeover To Me!" we will explore how there are really no legitimate functions of government, Constitution notwithstanding. Protecting air and water safety is a government takeover of drinking and beathing, food safety rules are takeovers of eating, and promoting homework and hard work in school is a takeover of parenting. See how that works? Although, I understand that all limitations of birth control and sex education are intrinsically appropriate uses of government.

What Would Jefferson Do?...Dissent Magazine

2011-03-16T12:12:00.000-07:00

Dissent Magazine - What Would Jefferson Do? How Limited Government Got Turned Upside Down

Surveying the wreckage of the Great Depression,
Roosevelt simply told his followers that “the average man once more confronts the problem that faced the Minute Man,” because “[a] small group had concentrated into their own hands an almost complete control over other people’s property, other people’s money, other people’s labor—other people’s lives.”

Roosevelt’s analysis of “economic tyranny” shared a critical assumption with Thomas Jefferson and James Madison and other important founders of our country: that limited government is not an end itself, but the instrument of a particular vision of society, an egalitarian vision. It was a social vision in which extremes of wealth and poverty did not exist, and a relatively equal distribution of productive property secured independence and freedom for the whole citizenry.

As historian James L. Huston writes, it was against the “political economy of aristocracy,” government organized by and for a small, wealthy elite, that supporters of the American revolution embraced the “egalitarian promise of the negative state.” The ideal, simply, was a system that restricted the legal and political power of the wealthy, in order to prevent them from combining against independent smallholders and those without property. Limited government, in other words, was a “populist” ideal, a doctrine of the many versus the few. As a group of North Carolina democrats petitioned in 1776, when “fixing the fundamental principles of Government,” the goal should be to “oppose everything that leans to aristocracy or power in the hands of the rich and chief men exercised to the oppression of the poor.”
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Clearly, for Jefferson and Madison (as for Taylor), the republican social objective of securing a relatively equal distribution of productive property was paramount in their thinking about what government should or should not do.
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OK, just go read it already!...........................

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health

2011-03-05T19:48:00.000-08:00

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health:

"Record surpluses amassed by not-for-profit Blue Cross and Blue Shield plans during the first nine months of 2010 could be used to price products more aggressively next year. And that could put pressure on competitors to hold down their rates or risk losing market share, according to one equities analyst. But other industry observers tell HPW that Blues plans are more likely to hold onto their surpluses due to increased regulatory scrutiny over rate hikes and the unknown financial impact of the health reform law."

I mainly put this here to remind me of the Medical Loss Ratio implications of PPACA, specifically the minimum requirements coming into effect this year. The fact that NOT FOR PROFITS don't meet these standards voluntarily, eagerly and easily tells you almost all you need to know about our broken system, but go to the link and scroll down and see the MASSIVE financial reserves these guys are amassing.

In Norway, Start-ups Say Ja to Socialism

2011-03-03T17:11:00.000-08:00

In Norway, Start-ups Say Ja to Socialism

At one point, I asked Wiggo Dalmo why he was still working so hard to expand his company: Why not just have a nice life—especially given that the authorities would take a hefty chunk of whatever additional money he made? "For me personally, building something to change the world is the kick," he says. "The worst thing to me is people who chose the easiest path. We should use our wonderful years to do something on this earth."

When I got back to the United States, I had a beer with Bjørn Holte, the CEO of bMenu, whom I'd first met in Oslo. It was early November—days after the congressional elections—and Holte had just arrived in New York City, where he is opening a new office. We talked about the commercial real estate market, the amazing cultural diversity in a city that has twice as many people as his entire country, and the current debate in the United States about the role of government. Holte was fascinated by this last topic, particularly the angry opposition to President Obama's health care reform package. "It makes me laugh," he says. "Americans don't understand that you can't have a functioning economy if people aren't healthy."

Holte's American subsidiary pays annual health care premiums that make his head spin—more than $23,000 per employee for a family plan—and that make the cost of employing a software developer in the United States substantially higher than it is in Norway, even after taxes. (For a full breakdown, see "Making Payroll.") Holte is no pinko—he finds many aspects of Norwegian socialism problematic, particularly regulations about hiring and firing—but when he looks at the costs and benefits of taxes in each country, he sees no contest. Norway is worth the cost.

This issue of Inc. ended up in my mailbox instead of my subscribing neighbor's. Divine providence, clearly.

You will be shocked, I know, that there are hard working people who are not Americans and that there are other health systems that don't hobble businesses.

JustLists' 30 Significant Medical Achievements and Their Country of Origin

2011-03-03T09:29:00.000-08:00

30 Significant Medical Achievements and Their Country of Origin :

"Much debate occurs today about whether a country’s chosen health system impedes or encourages discovery and invention in the medical field. The fact is… innovation occurs wherever fertile and creative minds are trying to address real human need. Here is a list of a few significant discoveries/inventions:"

This is just too good a list not to share! Have fun showing it to your friends and frenemies!

Mike Huckabee on politics, Christianity, Israel : The New Yorker

2011-02-18T16:34:00.001-08:00

Mike Huckabee on politics, Christianity, Israel : The New Yorker

In defiance of libertarian laissez-faire, Huckabee has extended his Christian vision to include the poor. “If there are a certain number of kids from single-parent homes who aren’t going to school and don’t have health care, you can say that’s not government’s job,” Huckabee told me. “Well, sweet and fine! But you know what? If the kid’s sitting outside the door of the hospital choking with asthma, do I sit there and say, ‘Oh, I’m sorry, I don’t think, philosophically, government should get involved’? I’d much rather the kid get help than I sit around and say I’m so pure in my ideology.”