April 29, 2005
A Private Obsession
The next in Paul Krugman's healthcare series ran today and you can read it below. Check out this excerpt:
"You see, America is ruled by conservatives, and they have a private obsession: they believe that more privatization, not less, is always the answer. And their faith persists even when the evidence clearly points to a private sector gone bad."
A Private Obsession
By PAUL KRUGMAN
The New York Times
Published: April 29, 2005
American health care is unique among advanced countries in its heavy reliance on the private sector. It's also uniquely inefficient. We spend far more per person on health care than any other country, yet many Americans lack health insurance and don't receive essential care.
This week yet another report emphasized just how bad a job the American system does at providing basic health care. A study by the Robert Wood Johnson Foundation estimates that 20 million working Americans are uninsured; in Texas, which has the worst record, more than 30 percent of the adults under 65 have no insurance.
And lack of insurance leads to inadequate medical attention. Over a 12-month period, 41 percent of the uninsured were unable to see a doctor when needed because of cost; 56 percent had no personal doctor or health care provider.
Our system is desperately in need of reform. Yet it will be very hard to get useful reform, for two reasons: vested interests and ideology.
I'll have a lot more to say about vested interests and health care in future columns, but let me emphasize one key point: a lot of big companies are essentially in the business of wasting health care resources.
The most striking inefficiency of our health system is our huge medical bureaucracy, which is mainly occupied in trying to get someone else to pay the bills. A good guess is that two million to three million Americans are employed by insurers and health care providers not to deliver health care, but to pass the buck to other people.
Yet any effort to reduce this waste would hurt powerful, well-organized interests, which have already demonstrated their power to block reform. Remember the "Harry and Louise" ads that doomed the Clinton health plan? The actors may have seemed like regular folks, but the ads were paid for by the Health Insurance Association of America, an industry lobbying group that liked the health care system just the way it was.
But vested interests aren't the only obstacle to fixing our health care system. We also have a big problem with ideology.
You see, America is ruled by conservatives, and they have a private obsession: they believe that more privatization, not less, is always the answer. And their faith persists even when the evidence clearly points to a private sector gone bad.
I could cite many examples of this obsession at work. But a particularly good illustration of ideology-induced obliviousness is the 2004 Economic Report of the President, which devotes a whole chapter to health care that can be read as a sort of conservative manifesto on the subject.
The main message of that report is that U.S. health care is doing just fine. Never mind the huge expense, the low life expectancy, the high infant mortality; it's a market-based system, so it must be good.
The report even takes a Panglossian view of uninsured Americans - one that is completely at odds with the grim statistics I cited above - suggesting that "many of them may remain uninsured as a matter of choice," perhaps because "they are young and healthy and do not see the need for insurance."
The president's economists had only one criticism of the system: insurance is too comprehensive, which encourages people to consume too much health care. As they see it, insurance covers too large a percentage of medical costs. The answer to this problem is the creation of, you guessed it, private accounts, which have now superseded tax cuts as the answer to all problems.
Indeed, a new paper by Martin Feldstein of Harvard, which clearly reflects the administration's views, suggests that Social Security privatization and health savings accounts - tax shelters designed to encourage people to pay medical costs out of their own pockets - are only the beginning. "Investment-based personal accounts," he says, are the way to go for unemployment insurance and Medicare, too.
O.K., let's not turn this into a Bush-bashing session. President Bush didn't cause the crisis in American health care. His health care policies have made things only a little bit worse.
The point, instead, is that even though all the evidence suggests that we would be much better off under a system of universal coverage, any such move will be fiercely opposed, on principle, by conservatives who want us to move in the opposite direction.
And reform will also be opposed by powerful vested interests - my next subject in this series.
April 26, 2005
Does anyone still think it was a good idea?
Does anyone still think that invading Iraq was a good idea? The active search for WMD's was called off a couple of months ago, and now they say they've looked everywhere and found nothing.
I am certainly sympathetic to those who gave the benefit of the doubt to President Bush initially, I myself did. While I didn't particularly want anyone going to war, I was naive enough to not recognize the mistruths. Looking back on it, I see that (even if he actually did have WMD's) we should always exhaust the alternatives to war.
Are you glad we invaded?
April 22, 2005
Nailed it
Without really meaning to, I see that I've done alot of bloggin' this morning. However, I can't resist posting today's Krugman editorial, as it really nails what we've been talking about lately.
Passing the Buck
by Paul Krugman
The United States spends far more on health care than other advanced countries. Yet we don't appear to receive more medical services. And we have lower life-expectancy and higher infant-mortality rates than countries that spend less than half as much per person. How do we do it?
An important part of the answer is that much of our health care spending is devoted to passing the buck: trying to get someone else to pay the bills.
According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.
According to the health organization, the higher costs of private insurers are "mainly due to the extensive bureaucracy required to assess risk, rate premiums, design benefit packages and review, pay or refuse claims." Public insurance plans have far less bureaucracy because they don't try to screen out high-risk clients or charge them higher fees.
And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money. ... It's a war with insurance, every step of the way."
Isn't competition supposed to make the private sector more efficient than the public sector? Well, as the World Health Organization put it in a discussion of Western Europe, private insurers generally don't compete by delivering care at lower cost. Instead, they "compete on the basis of risk selection" - that is, by turning away people who are likely to have high medical bills and by refusing or delaying any payment they can.
Yet the cost of providing medical care to those denied private insurance doesn't go away. If individuals are poor, or if medical expenses impoverish them, they are covered by Medicaid. Otherwise, they pay out of pocket or rely on the charity of public hospitals.
So we've created a vast and hugely expensive insurance bureaucracy that accomplishes nothing. The resources spent by private insurers don't reduce overall costs; they simply shift those costs to other people and institutions. It's perverse but true that this system, which insures only 85 percent of the population, costs much more than we would pay for a system that covered everyone.
And the costs go beyond wasted money.
First, in the U.S. system, medical costs act as a tax on employment. For example, General Motors is losing money on every car it makes because of the burden of health care costs. As a result, it may be forced to lay off thousands of workers, or may even go out of business. Yet the insurance premiums saved by firing workers are no saving at all to society as a whole: somebody still ends up paying the bills.
Second, Americans without insurance eventually receive medical care - but the operative word is "eventually." According to Kaiser Family Foundation data, the uninsured are about three times as likely as the insured to postpone seeking care, fail to get needed care, leave prescriptions unfilled or skip recommended treatment. And many end up disabled - or die - because of these delays.
Think about how crazy all of this is. At a rough guess, between two million and three million Americans are employed by insurers and health care providers not to deliver health care, but to pass the buck for that care to someone else. And the result of all their exertions is to make the nation poorer and sicker.
Why do we put up with such an expensive, counterproductive health care system? Vested interests play an important role. But we also suffer from ideological blinders: decades of indoctrination in the virtues of market competition and the evils of big government have left many Americans unable to comprehend the idea that sometimes competition is the problem, not the solution.
The Pleasant Blog
I've taken Jeff's idea and started a second blog to facilitate non-political banter.
Head on over there and talk to me about...other stuff.
Filibustering people of faith
This is a recent mailing by the founder of Sojourners, whose book God's Politics I'm halfway through.
Filibustering people of faith?
by Jim Wallis
During the 2004 election campaign, Jerry Falwell and Pat Robertson virtually said Christians could only vote for George W. Bush. Many of you, along with other Christians and people of faith, responded with letters to the editor, newspaper ads, and even bumper stickers reminding America that "God is not a Republican...or a Democrat." Then the Republican National Committee circulated lists of "duties" to local churches, which included turning over their congregational membership lists. The RNC also sent postcards to voters in some states with images of a Bible being banned and a man putting a wedding ring on another man - warning that this was what "liberal" politicians planned to do.
Now the Religious Right is saying that supporting the president's judicial nominations is a test of orthodoxy. This is a dramatic new and serious breach in the relationship between faith and politics.
James Dobson of Focus on the Family, Tony Perkins of the Family Research Council, Prison Fellowship's Chuck Colson, and Southern Baptist leader Albert Mohler are hosting "Justice Sunday," a telecast this weekend from a mega-church in Louisville, Kentucky. Their message is that those who don't support President Bush's judicial nominees are hostile to "people of faith."
Senate Majority Leader Bill Frist plans to join them by video to get political support for his effort to end the Senate practice known as the filibuster, which is designed to delay a vote on controversial issues in order to protect strong minorities from being overrun by majorities. The Republican leader's appearance at this event endorses the Religious Right's claim that the Democratic filibuster of a small number of very conservative judges is "a filibuster against people of faith."
Despite the fact that Democrats oppose these judges for their views on a variety of subjects, conservative leaders have singled out abortion and gay marriage as their chief concerns and only want judges who support their agenda. Despite the fact that many Democrats who oppose some of President Bush's nominees are themselves people of faith, Republicans and their religious supporters are questioning the faith and religious integrity of their opponents.
That is an escalation of the religious/political war. And the two together sound like assertions of a Republican theocracy. Behind these activities lies a fundamental assumption by Republican operatives and their conservative religious allies that they own religion in America. They demand that religious people vote only their way. They claim that "values voters" in America belong to them, and they disrespect the faith of those who disagree with their agenda. There are better words for this than just "politically divisive" or "morally irresponsible." For these are not merely political offenses, they are religious ones. And for offenses such as these, theological terms are better - terms such as idolatry and blasphemy.
We should bring our religious convictions about all moral issues to the public square - such as the uplifting of the poor, the protection of the environment, the ethics of war, or the tragic number of abortions in America - without attacking the sincerity of other people's faith, or demanding that we should win because we are religious. We must make moral arguments and mobilize effective movements for social change that can powerfully persuade our fellow citizens, religious or not, on what is best for the common good.
What I hear, from one end of this country to the other, is how tired we are of ideological religion and how hungry we are for prophetic faith. Join me in sending a message to Senator Frist that we are people of faith, and these Religious Right leaders do not speak for us.
April 19, 2005
Thirty Seconds
Have you taken the 'world's smallest political quiz?' It is run by a libertarian group. I did a couple of years ago and was centrist. Hmm.
This is me as of four minutes ago.
Go on, try it. You know you want to. It only takes thirty seconds.
April 18, 2005
Bull Riding School
Gary Leffew is on Fresh Air right now. I haven't heard that name in a long time.
When I was twelve I visited a bull riding school not too far from my grandparents' house in Nipomo, Calif., which is just up the road from Santa Maria, where the Michael Jackson thing is going down. This is about an hour north of Santa Barbara, my hometown.
Upon watching a few dozen guys timidly climb on 2400 pounds of filthy hulking beast only to be hurled off face-first into the filth, I was pretty hooked.
For the next two years I saved up the $300 entry fee until I reached the minimum age for the week-long school.
So I went.
It's a small operation, a few small shacks surrounding a central muddy circle enclosed by very beat up faded red boards and a series of pens, in which are the enormous filthy bulls.
I met Luke Perry. Remember him from 90210? He was there making a movie called 8 Seconds.
Monday morning, twelve cowboys and I sat through an hour or so of lectures on the necessity to not sit on the bull and to keep your free hand up in the air. At least that's all I remember, anyway.
"And now time for ridin'" Gary said.
"What? Now?" I thought. "On the first day? Gulp."
The next hour was spent watching my classmates climb on, strap in, and get comically thrown off.
"You're up" said one of the Gary's sons.
I nervously wandered over to see an enormous white behumped bull in the pen. I had wrongly assumed that they would line up a small bull for me, on account of my being a kid. No such luck.
Until I actually climbed on my bull, I had never thought about the fact that a bull would feel different from a horse. I don't know anything about horses, but I had ridden several growing up. My legs were uncomfortably spread out. The rib cage was absolutely enormous. The bull's sweaty, matted body reached each side of the pen. This was a huge animal. One horn was cut off, the other violently twisted upward.
A short rodeo clown (excuse me, bullfighter) threw open the gate and the bull lunged out in a series of giant leaps, violently shooting up with the front legs, which then slam back onto the ground as the rear legs kicked up and out behind me.
In bull riding, the idea is to last eight seconds for the ride to count. I lasted maybe two. Maybe.
Off I flew, not out away from the bull, but up. Very up. Way up. I have a clear memory of looking down at the ground pretty far down there, and then suddenly rushing towards me. When I landed I was on my back, my arm twisted unnaturally behind me.
I stood up as the rodeo clowns slapped and shouted at the bull, keeping him away from me. I realized that the wind had been knocked out of me as I wheezed and sucked air as hard as I could. I staggered over to the enclosed platform, as instructed, from where Gary video taped our rides. Gary played back my ride and I looked nothing like the guys on the posters. I was leaning way back holding on with both hands. Laying down, really.
"Sitting back like a lazy boy" is how Gary described it.
Not being able to breathe or speak, I grunted something and then crawled out of the ring. Or pen or whatever you call it.
My arm was broken in a spiral along one of those two bones in my forearm.
My dad was there and we bounced along the ruts on the seven-mile dirt road back to Nipomo.
I didn't go back. Maybe I still have a four day credit there.
April 14, 2005
Socialized Healthcare
As long as we're on the topic, see this old TMW from 1994 when the Clinton healthcare reform was shut out.
April 11, 2005
The Great Social Security Distraction
Today's Paul Krugman editorial lays out some brilliant principles.
Among them:
[T]he U.S. health care system is wildly inefficient... We spend far more per person on health care than any other country - 75 percent more than Canada or France - yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.
America's traditional private health insurance system, in which workers get coverage through their employers, is unraveling. The Kaiser Family Foundation estimates that in 2004 there were at least five million fewer jobs with health insurance than in 2001. And health care costs have become a major burden on those businesses that continue to provide insurance coverage: General Motors now spends about $1,500 on health care for every car it produces.
To get effective reform, however, we'll need to shed some preconceptions - in particular, the ideologically driven belief that government is always the problem and market competition is always the solution.
The fact is that in health care, the private sector is often bloated and bureaucratic, while some government agencies - notably the Veterans Administration system - are lean and efficient. In health care, competition and personal choice can and do lead to higher costs and lower quality. The United States has the most privatized, competitive health system in the advanced world; it also has by far the highest costs, and close to the worst results.
April 08, 2005
I'm hiding indoors
TALLAHASSEE, Fla. (Reuters) - People in Florida will be allowed to kill in self-defense on the street without trying to flee under a new law passed by state politicians on Tuesday that critics say will bring a Wild West mentality and innocent deaths.
The Florida House of Representatives, citing the need to allow people to "stand their ground," voted 94-20 to codify and expand court rulings that already allow people to use deadly force to protect themselves in their homes without first trying to escape.
The new bill goes further by allowing citizens to use deadly force in a public place if they have a reasonable belief they are in danger of death or great bodily harm. It applies to all means of force that may result in death, although the legislative debate focused on guns.
April 07, 2005
Photos from Sarah's Costa Rica trip
Here are some of the long-awaited photos from Sarah's Costa Rica trip. I'll add more photos later. They did alot of work and ate alot of rice and beans.
April 06, 2005
2005 Pulitzer Prize Photos
Have you seen them yet?
Amazing.
I can't find a direct link. Select 2005 from the list at top, then 'Breaking News Photography' then the 'works' tab.
April 05, 2005
Brutal Economics
From Language That Unites
Sandra Dufield
Regarding attracting politically conservative Christians to a more progressive view:
Using conservative language, we can point out how some conservative worldviews are ultimately more "secular humanist" than "Christian." For example, a "pull yourself up by your own bootstraps" approach to the poor is unbiblical because it’s rooted in a worldly survival-of-the-fittest mentality. We can show how supply-side economics ignores Christ’s call to place the poor at the forefront of our endeavors.
