2011 - %3, April

Paying for What We Get

| Fri Apr. 8, 2011 1:40 PM EDT

Andrew Sullivan writes today that healthcare costs are skyrocketing and there are basically two ways to rein them in:

If we want to reduce this giant suck from the rest of the working economy, there are two options: have a government body decide which treatments can be afforded and which cannot; or have patients ration themselves by price....My own view is that central government diktat on these things is more likely to provoke anger and even more heated debates and paralysis than now.

I think half of this is right, but the other half betrays a fundamental (though common) misconception about how politics actually works. First the misconception.

It's true that national healthcare systems usually rely on some kind of expert panel that decides what procedures will be covered and how much doctors will be reimbursed for them. But in a democracy, these panels are merely advisory. The real battles happen in national legislatures, either directly (i.e., overturning the panels on specific issues) or in fights over funding levels, which is what constrains the decisions of the panels in the first place. And those battles in national legislatures are, obviously, mirrors of what the public itself wants. If they want higher funding and more procedures covered, then over time that's what happens. If not, it doesn't.

So it's not really the panels that ultimately decide these things, nor is it central government diktat. It's the voters. But what Andrew is right about is that these decisions are likely to provoke a lot of anger and endlessly heated debates. The problem is that he says this as if it's a bad thing. It's not. This is how healthcare costs get reined in. In a national healthcare system, taxpayers who are footing the bill have to make decisions continuously about how much they're willing to pay for healthcare. They're guided in this by the opinions of experts, but in the end, it's their money and they decide. And unlike in our jury-rigged employer-based healthcare system, where costs are largely invisible, this decision is explicit: tax rates are directly tied to how much healthcare the system provides. The British, for example, are fairly stingy and end up with waiting lists. The French are more generous and don't. That's because the taxpayers of both countries have made their own decisions about how much healthcare they're willing to fund.

The fact that these debates are angry and heated is unsurprising, but it's also healthy. These tradeoffs should be explicit and difficult. The big difference here isn't in whether healthcare is rationed, but in how the rationing is done. Patients are rationing themselves in both systems, but a system that rations via taxes is relatively friendly to the poor while a system that rations on price is friendlier to the wealthy. Knowing that, you can take your pick.

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Map of the Day: High Frequency Trading Locations

| Fri Apr. 8, 2011 12:48 PM EDT

Via Tyler Cowen, A. D. Wissner-Gross and C. E. Freer investigate where you should open a high-frequency trading facility given that light-speed propagation delays are a key factor in arbitraging trades between two exchanges. After much fiddling with partial differential equations, they come up with this map, which shows "Optimal intermediate trading node locations (small circles) for all pairs of 52 major securities exchanges (large circles)....from 2008 data reported by the World Federation of Exchanges." I call dibs on the location just north of Greenland.

The GOP Yanks the Football Away Again

| Fri Apr. 8, 2011 12:33 PM EDT

This is quite a budget showdown we're having, isn't it? The original Republican proposal asked for $32 billion in cuts, and after considerable grumbling Democrats eventually accepted that. But by that time Republicans had moved on, proposing $38 billion in cuts. Democrats are now willing to accept that, but Republicans have upped the ante again: they want $39 billion in cuts plus a bunch of extraneous riders to defund Planned Parenthood and hand out a slew of environmental exemptions to favored industries.

So what's next? Democrats cave in again and Republicans turn down them down unless they accept $50 billion in cuts and Obama goes on national TV to apologize for the New Deal? Yeesh.

Now, tell me again which party is eagerly hoping for a government shutdown and which one just wants to cut a deal?

Taxes, Cost Controls, and Medicare

| Fri Apr. 8, 2011 11:56 AM EDT

Speaking of fiscal reality, Austin Frakt reminds us that the federal budget, including Medicare, is actually in pretty good shape if we follow current law. Here's the CBO's projection of the primary budget (i.e., excluding interest payments):

Are Democrats willing to raise taxes in order to fund Medicare? Austin: "I do recall quite a vociferous debate over just this issue. Did Americans fail to notice that the health reform law spends a lot of money and includes a lot of tax increases? If so, that’s not just a Democratic messaging problem, but a Republican one too, and a general media failure. What more would it take to communicate this?"

Now, this CBO projection is one that assumes we follow current law. That is, we let the Bush tax cuts expire, we stop passing the doc fix, estate taxes revert to their 2009 levels, and we actually allow both the cost control mechanisms and tax increases of PPACA to take effect. As it happens, the estate tax has already been changed to rates slightly below the 2009 levels, but that has a pretty minor effect on things. The only one of these items that's both significant and hard to imagine staying in place is the end of the doc fix. This means the budget isn't quite as balanced as this chart suggests.

Still, even if we modify physician payments, we're in decent shape as long as we have the discipline to let current law take its course, including both its tax increases and its cost controls. Toss in a compromise Social Security fix and we'd be in better long-term shape yet. So what's wrong with this picture?

More detail here from Ezra Klein in word form rather than chart form.

Facing Fiscal Reality

| Fri Apr. 8, 2011 11:16 AM EDT

David Brooks seems to have backed down a bit on his man-crush toward Paul Ryan, but still thinks he's performed a valuable service:

The Democrats are on defense because they are unwilling to ask voters to confront the implications of their choices. Democrats seem to believe that most Americans want to preserve the 20th-century welfare state programs. But they are unwilling to ask voters to pay for them, and they are unwilling to describe the tax increases that would be required to cover their exploding future costs.

Raising taxes on the rich will not do it. There aren’t enough rich people to generate the tens of trillions of dollars required to pay for Medicare, let alone all the other programs. Democrats, thus, face a fundamental choice. They can either reverse President Obama’s no-new-middle-class-taxes pledge, or they can learn to live with Paul Ryan’s version of government.

Until they find a way to pay for the programs they support, they will not be serious players in this game. They will have no credible plans and will be in an angry but permanent retreat.

Look, I won't pretend there's nothing to this. Still, unless I've been living for the past 30 years in that alternate universe where Spock sports a Van Dyke, I'm pretty sure I know which party has been unwilling to raise taxes. And the name of that party doesn't start with a D. What's more, I think Ron Brownstein has the more salient analysis anyway:

The sweeping budget blueprint that House Budget Committee Chairman Paul Ryan, R-Wis., released this week marked the fifth time since 1980 that Republicans have followed an electoral breakthrough by attempting to restructure Medicare or Social Security.

[A bit of history follows]

....From this trail of wreckage, one lesson is clear: Restructuring entitlements without bipartisan support is a high-wire proposition....It’s even tougher to limit entitlements without bipartisan consensus....Ryan, discounting that history, has aimed his plan squarely at Republicans. Even though federal revenue, as a share of the economy, is at its lowest level since 1950, Ryan would attack the debt solely with spending reductions.

After five tries with Ryan's scorched-earth approach, I just don't see the supposedly bracing value of trying it yet again. We already know it won't work, we already know it's purely a base-pandering approach, and we already know that its most likely result isn't to force Democrats to the table, but to make compromise even harder. That strikes me as cowardly and partisan, not brave and farsighted.

So fine: if we want to solve Medicare's long-term problems, we're going to need a combination of smarter policies, reduced spending, and increased taxes. This is the admission that Brooks wants, and I'm happy to own up to it. But the truth is that liberal wonks have been owning up to this for years, and Democratic members of Congress are generally willing to own up to it as well — as long as they have some support from Republicans too. Does anyone really doubt that?

But of course they never get that support. It's Republicans, not Democrats, who tremble like small children before the terrifying gaze of Grover Norquist and are consistently unwilling to face fiscal realities. As soon as a few of them work up the courage to start tearing up those tax jihad pledges that Norquist has bullied them into signing over the years, then maybe we can talk. Until then, it's pretty clear which party is standing in the way of finding real solutions.

What Social Issues "Truce"?

| Fri Apr. 8, 2011 11:16 AM EDT

For the newly empowered Republicans, the budget fight was supposed to be about the numbers: slashing government spending, bringing down the deficit, and restoring the country to fiscal sanity. But a government shutdown now appears to hinge on the GOP's decision to slash subsidies for gynecological exams and local funding for abortions in the District of Columbia, as I reported on Thursday evening. It's a replay of the fight over the Affordable Care Act that happened almost exactly a year ago, when anti-abortion Democrats blocked the bill over abortion funding issues. 

The showdown should put to rest the notion that tea party-backed Republicans simply doesn't care about social issues. Since last year's elections, tea party organizers have tried to insist that the grassroots movement cares most about fiscal issues. "People didn’t come out into the streets to protest gay marriage or abortion," FreedomWorks' Brendan Steinhauser told Politico last month. The Christian Right, likewise, has expressed concern that their issues would be left on the backburner.
"There's a libertarian streak in the tea party movement that concerns me as a cultural conservative," said the American Family Association's Bryan Fischer. "The tea party movement needs to insist that candidates believe in the sanctity of life and the sanctity of marriage."

Well, these social conservatives seem to have little to worry about under the new GOP regime. Even if the tea party activists "in the streets" want the Congress to focus on fiscal issues, they've succeeded in electing the same old Republicans with the same agendas. Tea party heroes like Sen. Jim DeMint (R-S.C.) haven't abandoned their anti-abortion crusades. "Dems to force shutdown & stop troop funding unless taxpayers forced to fund abortions in DC," DeMint tweeted on Thursday night. Now that the tea party has helped put (or keep) them in power, they have full rein to push an agenda that pleases social conservatives and the Christian right—and use these issues to gain leverage over the Democrats. Whether the GOP's tea party supporters—and independent voters—will be happy about this development is another question altogether.

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Oklahoma Birther Bill One Step Closer to Becoming Law

| Fri Apr. 8, 2011 10:22 AM EDT

Big news on the conspiracy theory front: On Wednesday, an Oklahoma House committee approved a bill requiring presidential candidates to present a valid, long-form birth certificate before their names can appear on the ballot in the Sooner State. More than a dozen states have considered "birther" bills since the beginning of 2009, but yesterday's vote puts Oklahoma on track to become the first state to actually enact such a law. The vote means the bill, which has already passed the state Senate, just needs to be approved by the full House before it can go to Republican Governor Mary Fallin's desk.

The bill's sponsor, Republican state Sen. Ralph Shortey, explained to The Oklahoman that under the proposed legislation, President Obama's certificate of live birth would be insufficient—even though not all states provide long-form birth certificates. He also took pains to note that this isn't a birther bill:

"A lot of people are classifying this as a birther bill which I don't think it is," Shortey said. "The concern has stemmed from the questions that have arisen from President Obama."

It's a bill that arises out of concerns that the President of the United States is ineligible for office because he was born in a different country, and therefore requires him to present a valid birth certificate, which he has already done. But it's not a birther bill; where would anyone get that idea?

Eco-News Roundup: Friday April 8

| Fri Apr. 8, 2011 7:54 AM EDT

News on health, the environment, and other green topics from our other blogs.

Right to Sue: Republicans are trying to reduce malpractice suits, just as report shows more medical mistakes.

Flip-Flop: First Republicans hype "death panels", now they want to ration care.

Feeling the Burn: Under Paul Ryan's budget, the elderly and poor would pay more health care costs.

Poll Says: Medicaid might be more popular than some would-be reformers think.

Down South: Florida's not okay with the word "uterus" but they're fine with mandatory ultrasounds.

On Accident: Louisiana oil refineries have 10 accidents, nearly every week.

Show Down: GOP reps say they can't compromise on abortion, even if it means shutting the government down.

Future Health: Is it realistic to think health care costs will continue expanding ad infinitum?

Tennessee House Passes Creationism Bill

| Fri Apr. 8, 2011 6:14 AM EDT

The state that infamously hosted the Scopes Monkey Trial more than 85 years ago is at it again. Yesterday Tennessee's General Assembly overwhelmingly passed a bill that would make it easier for public schools to teach creationism. The bill would require educators to "assist teachers to find effective ways to present the science curriculum as it addresses scientific controversies." It lists four "controversies" ripe for pedagogical tinkering: biological evolution, the chemical origins of life, global warming, and human cloning.

"This is part of a long held creationist strategy," says Steven Newton, policy director for the National Center for Science Education. "By doing everything except mention the Bible, they are attacking evolution without the theology."

Yesterday's floor debate on the bill, though not quite as dramatic as Inherit the Wind, was nonetheless a tour de force in creative polemics. For example, Republican state Rep. Frank Niceley implied that Albert Einstein, who was more or less an agnostic Jew, was actually a Christian and ergo creationism should be taught in schools:

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And then there was state Rep. Sheila Butt's Aqua Net theory:

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Did Butt really learn this in high school? Or is she confusing global warming with ozone layer depletion? Has she seen this piece in Science? Just a few "critical-thought questions" for Butt's colleagues in the state Senate, who'll decide the ultimate fate of the bill in the coming months.

The Uterus Monologues: Limericks From Our Readers

| Fri Apr. 8, 2011 6:01 AM EDT

A week ago, the Florida GOP scolded Rep. Scott Randolph (D-Orlando) when he used the word "uterus" on the statehouse floor. We at Mother Jones couldn't figure out what was wrong with the word, and why it wasn't deemed worthy for public. So Jen Phillips penned a limerick in response, calling on readers to post their own reactions to the Florida GOP's buffoonery. Here are some of our favorites:

 

 

From Active Peacemaker:

A Florida Rep. shouted with rage,
"We can't use those words near a page.
I'm convinced by my work
We were brought by the Stork!"
Now please put that Rep. back in his cage. 

 deanz:

There once was a party so grand
It thought it would give God a hand
By helping her tutor us
on words hardly new to us
but soon She'll be having *them* banned

 To Womb it May Concern:

The word uterus is naughty, you see
Not for use in polite company
They've deprived half the nation
Of sex education
Now it burns whene'er they GO P.

While demagogues Stately and Clerical,
encourage their gals to get spherical
they won't lessen its stature
with crass nomenclature
to use Uterus makes them hysterical.

Amy Sharp

So they think that uterus is offensive...
it is time to get down down off the fences
to hold hands and skip
to the beat of something hip
and get the country back to its sense

Valerie Hope Starr

I'd quiver to think what they'd to us
dare we mention that naughty word uterus
we can pillage, rape, maim but not mention that name
of the place whence we came fore you knew of us

Jim Bazen

Some words are a source of dissension.
They require a thorough preemption.
Now the Reps are all riled
'bout the fetus who filed
A uterine homestead exemption.

Brenda Cummings

The Republicans don't like my uterus.
Revelations like these aren't new to us.
They don't care for humanity,
They've lost their sanity—
We ALL came from one—unum e pluribus?

Thepink Pantsuit

To reject a word such as uterus
I find nothing short of ludicrous
Does not the blessing of birth
Define a woman's self-worth
What more can the GOP to do us?