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Yet More Data Suggests That Health Care Costs Really Are Slowing Down

| Wed Sep. 10, 2014 10:55 AM EDT

Jonathan Cohn points us to the latest Kaiser/HRET survey of employer health plans and passes along some good news:

Its main finding: This year, the average annual price of a single person’s coverage is $6,025 and the average annual price for a family policy is $16,834. (Those are the full prices for coverage, including the portion that employers pay directly.)

That’s a lot of money, obviously. But the cost of the family policy is only 3 percent higher than it was last year, and the cost of the single policy rose by even less....What to think about this? Generally speaking, it’s a positive development when premiums aren’t rising too quickly, since it means that workers have more money in their paychecks.

....Critics of the Affordable Care Act insisted it would cause employers to jack up premiums. There’s no evidence of that happening. And of course this data is consistent with all the other recent data we’ve gotten on health care spending under Obamacare. National health care spending, the amount of money we spend as a country, is rising at historically low rates.

I'd place a fair amount of emphasis on that last point. The chart on the right shows the annual increase in premiums for family coverage since 2000. As you can see, premium increases have been falling pretty steadily during the entire period. In the early aughts, employers were routinely seeing double-digit increases. But in the past few years, that's dropped to around 3-4 percent, which is only slightly higher than the general rate of inflation.

This is all consistent with other data on health care inflation rates, which shows a fluctuating but steady decrease since the early 80s and an even more concrete decrease over the past decade. Obviously this trend has nothing to do with Obamacare, which is benefiting from a bit of a tailwind here.

At the same time, Cohn is right to point out that Obamacare critics all insisted that it would cause premiums to skyrocket. It didn't. Some premiums went up thanks to new minimum requirements for coverage and the start of community rating, which requires insurance companies to cover everyone, even those with preexisting conditions. But that mostly affected the individual market, and even there premium increases have been pretty manageable for the vast majority of people.

How long will this slowdown in health care inflation last? My guess is that it's more or less permanent. It will vary a bit from year to year, and I wouldn't be surprised to see it hit 3-4 points above the general inflation rate in some years. But the downward trend has been in place for three decades now, and that's long enough to suggest that it was the double-digit increases of the 80s and early 90s that were the outliers. Aside from those spikes, the current smaller increases are roughly similar to health care spending increases over the past half century.

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We're Still at War: Photo of the Day for September 10, 2014

Wed Sep. 10, 2014 10:06 AM EDT

US Marines perform a diving exit during pre-deployment training. (US Marine Corps photo by Cpl. Todd F. Michalek)

Video or It Didn’t Happen: What Jihadi John Knows and Ray Rice Found Out

| Tue Sep. 9, 2014 9:44 PM EDT

One of the most famous anecdotes from the Reagan years comes from Lesley Stahl, then a reporter for the CBS Evening News. After airing a long, critical piece during the 1984 campaign, she got a cheerful call from Dick Darman at the White House. "We really loved it," he said. "Five minutes of free media." Dan Schill tells the rest of the story:

Stahl asked, "Why are you so happy? Didn't you hear what I said?" Giving the punch line of the parable, Darman said to Stahl, "You guys in Televisionland haven't figured it out, have you? When the pictures are powerful and emotional, they override if not completely drown out the sound. I mean it, Lesley. Nobody heard you."

Stahl said she examined her piece again, this time with the sound off, and found that the Reagan official was right—her story had accepted the Reagan frame and was practically an unpaid political commercial—a brilliant montage of Reagan surrounded with flags, children, balloons, and cheering supporters.

Asked if this experience changed the way she produces her stories, Stahl said, "Not really. I'm still trapped, because my pieces are written to the pictures we have."

I was reminded of this story once again yesterday when TMZ released elevator video of Ray Rice slugging his then fiancée and knocking her unconscious. It was a brutal attack and reaction was swift and uncompromising. Rice was released by the Baltimore Ravens, the NFL suspended him indefinitely, and his sponsors began abandoning him almost immediately.

And yet, that video told us nothing. We already knew what had happened. Based on previous video, we knew that Rice had punched Janay Palmer hard enough to knock her out. We just didn't have it on tape.

And it's not only the NFL that reacted differently after the new video was released. Even the folks who criticized the league's anemic response back in February are now far more outraged. The video affected everyone's reaction.

Why? Is it the visceral effect of images? Does it have something to do with an instinct to avoid drawing the most damning conclusions until an image makes it impossible to evade the truth any longer? Or is it all a charade, and lots of people are just pretending to be more outraged because they know it's now expected of them?

I don't know. But the internet is now the domain of LOLcats, BuzzFeed listicles, and charts of the day—the latter for those of us who like images but also like to believe we're too smart to be manipulated by them. The fastest growing social media sites are Instagram, Snapchat, Pinterest, and others like it. Blogs are often so stuffed with YouTube videos that you can refill your coffee cup while you wait for them to load. Millions of formerly peaceable people—people who already knew perfectly well that ISIS was a barbarous bunch of thugs—suddenly want to go to war because we now have pictures of that barbarism. Images rule everywhere. It's not just Lesley Stahl who's trapped in Lesley Stahl's world anymore. We all are.

Pentagon and Other Agencies Slammed for Police Militarization at Senate Hearing

| Tue Sep. 9, 2014 5:07 PM EDT
Sen. Claire McCaskill (D-Mo) at the Senate hearing.

In a Senate Homeland Security Committee hearing Tuesday, Democratic and Republican lawmakers slammed officials from the Department of Defense, Homeland Security, and the Department of Justice for their handling of federal programs that help provide military grade vehicles, equipment, and weapons to local police departments across the country. The hearing was called in response to the events that took place in Ferguson, Missouri, after an unarmed black teenager, Michael Brown, was shot and killed by a white police officer, and peaceful protests were met by a heavily militarized police force. "Aggressive police actions [were] being used under the umbrella of 'crowd control,'" noted Sen. Claire McCaskill (D-Mo.).

The panel grilled Alan Estevez, a Department of Defense agent dealing with logistics and acquisition of military equipment; Brian Kamoie, a federal grant regulator at the Department of Homeland Security; and Karol Mason, an attorney from the Department of Justice.

Senators questioned why certain military equipment was on the Pentagon's list of acceptable items for local police departments. Senator Tom Coburn (R-Okla.) declared that police militarization gives him "real heartburn" and wondered "how did we get to the point where we think states needs MRAPS"—that is, mine-resistant ambush protected vehicles, which have been acquired by a large number of small police departments across the country. In Texas, McCaskill noted, police departments have more than 70 MRAPS, while the state National Guard has just six.

Sen. Rand Paul (R-Ky.) questioned what police departments could possibly do with the 1,200 bayonets that have been issued in recent years. The Pentagon's Alan Estevez replied that he was unsure. Throughout the hearing, members of the panel underscored the point that police officers are often not adequately trained in how (and when) to use the military-grade equipment their departments acquire. The Pentagon doesn't require police departments to undergo any training before supplying them MRAPS and other military equipment.

Estevez testified that the Pentagon would reevaluate its list of acceptable equipment for police departments. But Brian Kamoie, the Homeland Security official, and the Justice Department's Karol Mason, both acknowledged that their agencies don't do much to regulate how police departments use the grant money they dole out to local law enforcement.

McCaskill condemned the Department of Defense and the other agencies for their lack of oversight over the use of military equipment by local police. "None of them know how it's being utilized," McCaskill said. She pointed out that a police department in Lake Angelus, Michigan, which employs only one police officer, has received 13 military grade assault weapons since 2011. "I think we need to get to the bottom of that," McCaskill said.

Watch the hearing here:

Ebola Is Getting So Bad That Even House Republicans Will Back New Funds to Fight It

| Tue Sep. 9, 2014 4:00 PM EDT
Medical staffers tend to patients infected with the Ebola virus in the Liberian capital, Monrovia.

Despite some worries last week that spending-averse Republicans might not support additional funding to fight Ebola, Rep. Hal Rogers (R-Ky.), the chair of the House appropriations committee, said late Monday that House GOPers will back new money to combat the spread of the disease.

Lawmakers are currently negotiating a temporary spending bill that would fund the government's operations through December. Late Friday, the White House asked Congress to add $30 million to this stopgap spending measure to pay Centers for Disease Control and Prevention staff in the United States and Africa. That came on top of $58 million the administration already requested to accelerate the production and testing of new drugs and maintain the development of two experimental Ebola vaccines, bringing the total White House request for Ebola-related funds to $88 million. Rogers wouldn't say whether Republicans would agree to fund the full amount.

The House is due to vote on the bill on Thursday.

If approved, the new money will add to a slow but growing American relief effort, as government agencies steer their budgets to fight Ebola, following calls from the World Health Organization and Doctors Without Borders to dramatically step up their involvement. On Monday, the Pentagon announced it would deploy one $22 million, 25-person field hospital to Liberia, the current epicenter of the epidemic. The hospital—part of a wider effort coordinated by the US Agency for International Development (USAID)—will be turned over to the Liberian government as soon as it's built and will not be staffed by American government employees.

But with Liberia's medical staff stretched thin, finding the right people to staff the hospital may prove difficult. Liberia's health care system—already strained before the outbreak with one doctor for every 100,000 people—has been hit hard by Ebola. Since the outbreak began, 152 medical workers have contracted the disease in Liberia, the WHO said on Monday, about 7 percent of all suspected and confirmed patients. Seventy-nine of these medical workers have died from the disease.

A single 70-bed facility needs 200 to 250 medical personnel to staff it, according to WHO, and Liberia "urgently needs" 1,000 more beds to treat the currently infected patients.

While there's no cure or approved treatment for Ebola, hospitals and treatment centers are needed to quarantine infected patients. In its statement, the WHO said that sick people in Liberia's capital, Monrovia, were traversing town in taxis looking for a hospital bed, bringing the disease—which is spread through bodily fluids such as blood and saliva—into the city's public transit system.

In a statement to Mother Jones, a spokesman for Doctors Without Borders (MSF), one of the few medical groups which has been actively fighting the disease since the outbreak, said that organization had also dramatically increased its budget for the effort to almost $39 million today. Still, he said, this would not be enough to stave off the disease. 

"Much more help is needed from actors other than MSF," he said.

The most recent figures released by the WHO reported more than 2,000 people either known or believed to have been infected with Ebola, and more than 1,200 known or believed to have been killed in Liberia since the outbreak was first detected in March. More than 2,000 are believed to have been infected and more than 1,000 killed elsewhere in West Africa since the outbreak began, almost all of them in Guinea and Sierra Leone. About 49 percent of the infections in these three countries occurred in the last three weeks. 

On Monday, the WHO said infections in Liberia were increasing "exponentially." On Tuesday, the country's defense minister, Brownie Samukai, called Ebola the worst threat to the country since its last civil war ended in 2003. "Liberia is facing a serious threat to its national existence," he said of the epidemic.

Almost All the Books People Say Influenced Them Were Written for Children

| Tue Sep. 9, 2014 3:40 PM EDT

Recently, a status update ran around Facebook asking people to "List 10 books that have stayed with you in some way. Don't take more than a few minutes, and don't think too hard. They do not have to be the 'right' books or great works of literature, just ones that have affected you in some way." Facebook's data scientists went though 130,000 responses and came up with a list of the 100 most common entries.

It should be noted that though the books may not have had to be the "right books" or "great works of literature," human nature being what it is, most of the titles on the list are, in fact, the 'right books,' by which i mean, books you can proudly define yourself as a reader of. ("I am the type of person who was affected by To Kill A Mocking Bird." "I am the type of person whose political opinions were formed by 1984.")  No one is listing Fifty Shades of Gray. They are listing books that they think say something complimentary about who they are as a person.

Almost all of these books are YA. They may not be in the YA section at Barnes & Noble, but children and adolescents are their primary audience. On the one hand, duh: People are most open to being affected by books when they're young. Also, duh duh: Most people probably stop reading much fiction when they leave high school and are no longer required to. On the other hand, one of the books that probably affected me when I was growing up was the forgettable crime novel Silent Witness by Richard North Patterson. I read it when I was about 10 because my father was reading it and I wanted him to like me and for us to have something to talk about. That's not to say you too were influenced by Silent Witness, but that, I think, that phenomenon—reading books aspirationally for social reasons—is pretty common and I'm surprised there aren't more straightforward adult titles on this list.

One other fun fact: There are no Ayn Rand books on this list.

Without further ado, here are the top 20 along with what percent of responses included the title:
1. Harry Potter series - J.K. Rowling - 21.08%
2. To Kill a Mockingbird - Harper Lee - 14.48%
3. The Lord of the Rings - JRR Tolkien - 13.86%
4. The Hobbit - JRR Tolkien - 7.48%
5. Pride and Prejudice - Jane Austen - 7.28%
6. The Holy Bible - 7.21%
7. The Hitchhiker's Guide to the Galaxy - Douglas Adams 5.97%
8. The Hunger Games trilogy by Suzanne Collins - 5.82%
9. The Catcher in the Rye by J.D. Salinger - 5.70%
10. The Great Gatsby by F. Scott Fitzgerald - 5.61%
11. 1984 by George Orwell - 5.37%
12. Little Women by Louisa May Alcott - 5.26%
13. Jane Eyre by Charlotte Bronte - 5.23%
14. The Stand by Stephen King - 5.11%
15. Gone with the Wind by Margaret Mitchell - 4.95%
16. A Wrinkle in Time by Madeleine L'Engle - 4.38%
17. The Handmaid's Tale by Margaret Atwood - 4.27%
18. The Lion, the Witch, and the Wardrobe by C.S. Lewis - 4.05%
19. The Alchemist by Paulo Coelho - 4.01%
20. Anne of Green Gables by L.M. Montgomery - 3.95%

Head on over to Facebook for the full 100 titles and some neat data visualizations.

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Climate Change News Just Keeps Getting Worse and Worse

| Tue Sep. 9, 2014 3:08 PM EDT

The World Meteorological Organization announced today that global levels of carbon dioxide reached their highest point ever in 2013. No surprise there. They also announced that the growth rate of CO2 reached its highest point ever. Brad Plumer provides the details:

There are two possible reasons why the amount of carbon-dioxide in the atmosphere is growing so rapidly. One is obvious: Humans  continue to emit more and more carbon-dioxide from power plants, cars, and factories each year.

But the other reason is a bit more surprising: According to the WMO, early data suggests that the world's oceans and forests are now absorbing less of our extra carbon-dioxide than they used to — which means that more of it ends up in the atmosphere, where it traps heat and warms up the planet.

The amount of CO2 absorbed by the oceans is cyclical in the medium term, which probably helps explain why global temperatures periodically stabilize for a decade or so before resuming their usual upward march. But there's also a long-term trend. Oceans can't absorb CO2 indefinitely, and eventually they'll reach their limit. As that happens, more and more CO2 will be trapped in the atmosphere, where it contributes to global warming. And unless we do something to rein in CO2 emissions, this will happen at the same time that humans are pumping ever more CO2 into the sky. More here.

Quote of the Day: Why Republicans Don't Want to Vote on Airstrikes in Iraq

| Tue Sep. 9, 2014 12:48 PM EDT

From Republican congressman Jack Kingston, explaining why no one wants to hold a vote to approve military action in Iraq:

A lot of people would like to stay on the sideline and say, ‘Just bomb the place and tell us about it later.’ It’s an election year. A lot of Democrats don’t know how it would play in their party, and Republicans don’t want to change anything. We like the path we’re on now. We can denounce it if it goes bad, and praise it if it goes well and ask what took him so long.

I guess that's refreshingly honest. Or something.

Should Liberals Support OTC Access to Oral Contraceptives?

| Tue Sep. 9, 2014 12:35 PM EDT

There's been a mini-boomlet lately in Republican candidates supporting over-the-counter access to birth control pills. This is great! There's very little medical reason to require a prescription for oral contraceptives, and OTC pills are far more likely to be used regularly than prescription pills. It's nice to see Republicans on the side of good science. But Rebecca Leber warns that not all is as it seems:

There’s a catch. Doctors aren’t the only hurdle between women and contraceptive access. For low-income women, cost can be what’s most prohibitive. Under the Affordable Care Act, the pill and other forms of contraception count as preventative care, which means insurance covers them completely—without any out-of-pocket expenses. This is not a position the Republicans have endorsed. On the contrary, none of the candidates have changed their position on the law more broadly, including their opposition to the mandate covering preventative care like birth control, writes Paul Waldman at the Washington Post. They still want to transfer the costs for other forms of contraceptives, like IUDs and the morning-after-pill, to women directly.

This is all true. But Republican opposition to Obamacare isn't going to change no matter what, so that hardly matters. What matters is whether Obamacare covers the cost of contraceptives, and that's what's causing liberal angst over a cause that we've all supported in the past. We're afraid that if oral contraceptives become available OTC, Obamacare will no longer pay for them.

But is it necessarily true that Obamacare wouldn't cover the cost of OTC contraceptives? After all, this isn't an issue that will be resolved by Congress, so there's no chance of some terrible bill passing that trades OTC contraceptive availability for an end to the Obamacare mandate. The FDA makes the call about whether contraceptives can be sold OTC, and HHS regulations specify which contraceptives are covered by Obamacare. Those regs currently cover "FDA-approved" contraceptive methods, and if the FDA approves OTC contraceptives then HHS will have to modify its regs to make it clear whether those are covered too. There's no reason they couldn't choose to mandate coverage of OTC pills that are FDA-approved. Alternatively, they could simply require insurers to continue paying for prescriptions for OTC oral contraceptives, as they do currently for OTC products like spermicides and sponges that are prescribed by a doctor. This would be a good deal for insurance companies since OTC contraceptives would almost certainly be cheaper than prescription versions of the same pills.

So let's join the Republican cause on OTC oral contraceptives. It's good science and good policy. And let's continue to oppose any efforts in Congress to weaken the contraceptive mandate. That's also good policy.

Or am I missing something here?

Is It Time For Yet Another War?

| Tue Sep. 9, 2014 10:33 AM EDT

Dave Weigel sums up the recent American reaction to ISIS:

On August 18, the airstrikes helped Iraqi forces take back the Mosul dam from ISIS. The next day, ISIS released a video of captured journalist James Foley being beheaded by one of their men.

The video, surely meant to sow fear and breed over-reaction, succeeded magnificently. The panic showing up in polls, in which the number of Americans favoring airstrikes in Iraq and Syria has surged, has been matched by a return of panic-first politics....The long Democratic dream, from Kerry to Obama, of reducing terrorism from an existential threat to a managable nuisance, is just not an election-winner.

This is, sadly, not surprising at all. For years, the conventional wisdom has been that Americans are weary of war, and the conventional wisdom is largely correct. At the same time, it's always been obvious that Americans remain easily susceptible to the same kind of bloody-shirt waving that got us into the Iraq war in the first place. The only thing that's saved us is the fact that President Obama isn't a bloody-shirt waver. Even when he's initiated military action, his public persona has been quiet and reluctant.

But now we're seeing just how easy it is to whip Americans into a war frenzy yet again. Even with Obama striking his usual no-drama pose, the public is becoming increasingly belligerent. All it took was a carefully stagecrafted beheading video and the usual gang of conservative jingoists to exploit it. For now, the lack of presidential blood lust is holding back the tide—barely—but that's a thin reed. If Obama wanted to go to war, it would be the work of a moment to whip up a war frenzy in a solid majority of the country.

And just think about how tempting it must be. A full-blown military assault on a loathsome enemy like ISIS would almost certainly be a big campaign winner for Democrats this fall.

War weary? Sure, as long as the president keeps a low profile. But if he decides to change his mind, the American public will back him up. After all, Americans have historically gotten a little restless if they don't have a new war every four or five years, and it's been about that long since we pulled out of Iraq. Maybe we're due.