2011 - %3, April

The Republican Wrong Turn on Medicaid

| Tue Apr. 5, 2011 1:42 PM EDT

Although Medicare is getting most of the attention today, Paul Ryan's budget proposal also contains big changes to Medicaid. But Suzy Khimm reports that cuts to Medicaid aren't much more popular than cuts to Medicare:

But new polling from the non-partisan Kaiser Family Foundation also suggests that Medicaid is more popular than Beltway insiders might assume. Though public support for Medicaid lags slightly behind support for Social Security and Medicare, it's still robust: According to the KFF poll, only 13 percent of the public was willing to support major cuts to Medicaid....[Drew] Altman explains that part of the support for Medicaid comes from the services it provides for the elderly and disabled: though the program's usually described as an entitlement for the poor, seniors and the disabled make up two-thirds of Medicaid costs.

For what it's worth, I think Ryan's Medicaid proposal is far worse than his Medicare proposal. Basically, he endorses the Republican party line, which is to turn Medicaid into block grants for states, and then give states the freedom to spend it any way they want. But this is exactly the opposite of what we should be doing.

Here's the problem: states aren't allowed to run budget deficits, so when the economy turns bad they have to cut back on spending. But bad economic times are precisely when more Medicaid spending is needed. So unless Ryan is proposing to automatically increase those block grants whenever individual states or the country as a whole are in a recession — and he's not — this produces the worst possible dynamic you can imagine: a safety net that gets worse at exactly the times when it's needed most.

States have been experimenting with Medicaid for decades, and successes are few and far between. There just aren't any magic bullets here, and giving them more scope for experimentation isn't likely to produce any new miracles. A better bet would be to federalize Medicaid entirely. It's a huge burden to state budgets, and one that's especially burdensome during an economic downturn like the one we're in now. Ryan is right that there's really no good reason for Medicaid funding to be split between states and the federal government, but he's wrong about how to fix that. Medicaid shouldn't be a 100% state program, it should be a 100% federal program, one that's both a true safety net and a useful automatic stabilizer during recessions.

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My Uterus, LLC

| Tue Apr. 5, 2011 1:38 PM EDT

Florida women can now symbolically incorporate their uteruses, in protest of both the onslaught of bills limiting reproductive rights and the ban on the u-word in the state House. 

Incorporatemyuterus.com, where women can file for corporate uterus status, is a project of the American Civil Liberties Union of Florida. (If you really want to take a stab at making it legal, though, you'll need to see the Florida Department of State Division of Corporations.) Here's the idea:

Businesses get special treatment these days. If lawmakers and other politicians see your uterus and your body as a business, maybe they’ll work to get government out of the uterus regulation business as they do for every other company.

This was the point that State Rep. Scott Randolph (D-Orlando) was trying to make last week when the GOP Speaker of the Florida House forbade him from using medically appropriate terminology in the chamber—maybe if a woman's uterus were a private corporation, Republicans would stop trying to make laws about it. Adam has more uterus news over at MoJo blog.

Side benefit of incorporating your uterus: Now it can donate unlimited cash to political action committees! (Hat tips: @jodmentum and @jimhigdon)

This Week in Your Uterus (Video)

| Tue Apr. 5, 2011 1:23 PM EDT

Have you been keeping up with #uterusgate? Last week, Mother Jones told the story of a Florida Democratic state rep who was rebuked by House Republican leaders for suggesting that his wife "incorporate her uterus" to keep conservatives from interfering with her lady business. A progressive meme ensued: See Twitter's #GOPnames4uterus. But this week, the Sunshine State's right-wing lawmakers showed no signs of a U-turn in their war on the U-word. Here's the haps:

My New Incorporated, Offshore Uterus

| Tue Apr. 5, 2011 12:57 PM EDT

Today someone tweeted (I can't remember who, sorry) this new site which encourages women to incorporate their uteruses in order to keep Republican state lawmakers out of them. "Conservatives get elected by promising smaller government and less business regulation," the site says, "but as soon as they get elected, they rush to put big government regulations on the personal freedom and privacy of your body." Maybe, the site suggests, just maybe if you incorporate your uterus, "then your uterus can get the same treatment corporations get—fewer rules, fewer government searches and more personal freedoms."

I'm on board. I would love to have my uterus get more freedoms (and government subsidies) by operating as a business. If I base it offshore, like at the Ugland House in Grand Cayman, I can avoid paying taxes too. What a deal. Goodbye "uterus", hello "Phillips Fund LLC"!

The Future of Healthcare

| Tue Apr. 5, 2011 12:30 PM EDT

Since healthcare is the topic du jour, but Paul Ryan's Medicare plan doesn't really include enough detail to allow more than obvious critiques, here's a short post on an entirely different healthcare topic.

Ryan's budget document contains the chart on the right. Scary! It's based on CBO data, and it's a pretty standard fixture in healthcare debates. Basically, it shows Medicare spending rising at 8% a year forever, which means that eventually it overwhelms everything else and the country is broke. But how likely is that?

I don't mean likely in just the Steinian sense that, eventually, costs will be reined in simply because they have to be. I mean that I wonder if we've been brainwashed by the exploding costs of healthcare over the past 40 years into thinking that exploding costs are somehow inevitable in the healthcare field forever. Are they?

I can think of lots of technological revolutions that were pretty costly at first but eventually reached a point where they leveled out and then became cheaper. In fact, pretty much all of them. But perhaps healthcare is different in some ways from previous technological revolutions? For one, it's fairly labor centric and likely to stay that way. For another, costs really have been going up for a long time and there's not much relief in sight. By now, you'd think we'd be nearer the cusp of the curve where costs start going down, but we sure don't seem to be. New pharmaceuticals are as expensive to develop as ever. Cancer treatments keep getting more costly, as the construction of $100 million proton therapy centers demonstrates. And overall per capita healthcare costs just keep climbing inexorably.

Still: do we really think this is going to keep up forever? If it does, it will be pretty much the first time in history. I'm enough of a technological optimist (and a believer in the power of markets) to guess that someday — 10 years? 20? 30? — things like gene therapies, personalized pharmaceuticals, medical AI, and so forth are finally going to revolutionize medicine. And when that happens, costs will plateau at first and then drop. The curve simply won't keep going up forever.

Now, granted, we can't plan on that. There are no guarantees, after all, and maybe medicine will end up being an exception to the usual rule of technological progress. What's more, folks like Paul Ryan could plausibly claim that this makes voucher plans like his more reasonable: if costs don't come down, then we'll have little choice but to cap them bluntly the way his plan does. And if they do come down, then his caps won't have a serious impact.

I don't really have a position here. I'm just musing out loud about the likely future trajectory of healthcare, and whether we're really looking at it through the right lens. Right now we're tacitly assuming that what's happened in the past will inevitable keep happening into the far future. But there's really not much reason to think that's true. Is there?

Obama's Disappearing Act

| Tue Apr. 5, 2011 11:37 AM EDT

A friend of mine who's fed up with Obama emailed to respond to my suggestion that Obama's real intentions remain fairly enigmatic:

I agree completely that Obama is enigmatic, but at some point, it doesn't really matter whether he gave away something he really believed in or never believed it in the first place. Does it matter in practical terms whether he's pathetically weak or just a bald-faced liar? After this long, I have a really, really, really hard time believing his heart is in what I'd call the right place on any of this stuff since no matter his brave words when he was angling for the nomination, he's basically given it all away, one thing after another.

This critique of Obama I don't really get. Sure, Obama's not the second coming of FDR (though FDR himself wasn't really the first coming of FDR either), but he got a fair amount done in his first two years, and if the healthcare reform bill was a dog's breakfast of concessions to special interests, well, that's the way Washington works. Obama was never going to change that in the space of 18 months. And I just don't see the case for lying. He's failed to get his way on some things, he's compromised other things away, and yes, he's occasionally just plain done an about face. But if I had to judge, I'd say he's done the latter less than most presidents, not more.

But then there's this critique from Ezra Klein, which strikes me as very much on the mark:

The battle over funding the government for the rest of 2011 has gone on for months, but the most involvement we’ve seen from Obama was a few phone calls placed to negotiators over the weekend....With negotiations breaking down, Obama has invited congressional leaders to the White House to hammer out a deal — but at this point, the question is simply how bad the final agreement will be.

But perhaps more disappointing are the times the president has shown up. Last week, Obama laid out his first major energy plan since the campaign....[It] was a terrible disappointment. Forget the ambitious cap-and-trade proposal that candidate Obama pushed in 2008. President Obama’s energy plan undershot the cap-and-trade plan that John McCain and Sarah Palin pushed in 2008.

And the less said about the State of the Union and the subsequent budget, the better. “Winning the future” has come at the expense of a plan for the present....Something has gone wrong in the Obama administration. And the candidate we need to step forward and point it out isn’t whichever Republican manages to limp shamefacedly out of the primaries after agreeing to call Obama a Kenyan anti-colonialist who kowtows to big business and Karl Marx and believes in both radical Islam and dogmatic atheism. It’s the Barack Obama who ran in 2008. The one who believed in “the fierce urgency of now,” rather than “after the election, we hope.”

Obama has long followed a strategy of letting other people fight pitched battles for a while and then parachuting in toward the end to act as peacemaker. And there's a case to be made for that sometimes. He did it with healthcare because Bill Clinton tried it the other way in 1993 and got his hide nailed to the wall, and in the end Obama's strategy worked. Would a more active intervention have worked better? Maybe, but there was a pretty good case to be made for doing it the way he did.

But over the past year this trait has become almost pathological. Maybe the power of the bully pulpit is overrated, but Obama seems unwilling to even try to move public opinion or take a leadership role in his own caucus. At this point, I really have no idea what he thinks of taxes, the deficit, Medicare cuts, or much of anything else on the domestic agenda. I guess he's figuring that if his political opponents insist on digging themselves into a hole, he might as well stand back and let them. But if he keeps this up much longer, there's going to be nothing left of his presidency except "Well, I guess he's better than the wingnuts from the other party." That may win him reelection, but it won't do much more.

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Tribute to a Murdered Jewish-Palestinian Hero

| Tue Apr. 5, 2011 11:00 AM EDT
Juliano Mer Khamis, pictured here in his 2004 documentary film, returns to the Jenin refugee camp to reconnect with his former students.

Jewish-Palestinian peace activist Juliano Mer Khamis was shot to death on Monday in the West Bank refugee camp of Jenin, near the steps of the theater program he helped found. Condolence messages from Palestinians and Israelis are pouring in, and the Palestinian Authority has arrested a suspect. The Jenin mayor saluted Juliano as someone who lived in the camp through "sweet and bitter days" and developed the theater program to reject oppression, injustice, and occupation.

In lieu of a tribute to this hero I've never met, I'd like to encourage readers to watch the 2004 film, Arna’s Children, which Juliano narrated and directed. I've watched many Israeli-Palestinian documentaries. None have haunted and moved me like this one.

The film, shot over almost two decades, is set in the Palestinian refugee camp of Jenin, a place where Israeli bombs and tanks are inescapable realities of childhood. In the first half of the film, we are introduced to Juliano's mother, Arna, a Jewish Israeli who set up the theater group in Jenin in the late 1980s. Arna is bald from chemotherapy, yet devotes her dying days to her playful and talented little actors, helping them express their anger and grief through art and drama.

 

Years pass. Arna succumbs to cancer, the 1994 Oslo peace accords unravel, the theater program shuts down, the Israeli occupation hardens, and the 2000 second intifada erupts. On April 3, 2002, the Israeli army invades Jenin, killing more than 50 Palestinians and destroying hundreds of homes.

And many of "Arna's children" have now become militiamen and suicide fighters.

In the second half of the film, Juliano returns to Jenin to find out how and why this has happened. We see that it's not mainly about anti-Semitic brainwashing—Jenin residents adore Arna and Juliano despite their Jewish background and Israeli nationality. Rather, Arna's children have chosen "martyrdom" because of the searing horrors they've witnessed with their own eyes.

One of the many unforgettable stories is that of Yousef, who had been the "joker" of Juliano's theater group. At age 22, Yousef attempts to rescue a 10-year-old girl who was hit by an Israeli tank shell; the girl dies in his arms on the way to the hospital. One week later, Yousef finds he has nothing left to laugh about. He and another theater group alum open fire on Israeli civilians, killing four women before Israeli police shoot them dead.

Juliano himself is now another tragedy of the conflict. I hope more Israelis, Palestinians, and Americans will watch his film, reflect critically on its message, and work to end this cruel bloodbath once and for all.

Dear Anna: Tips For Viral Video Fame

| Tue Apr. 5, 2011 11:00 AM EDT

If that punk Rebecca Black can get rich by making a crappy song and video, I wanna do it too! How can I make viral videos that win me financial and celebrity acclaim?

~Rebecca CRACK

If I knew the answer to that, do you really think I'd be telling you how to become a millionaire while I sit here in my Target pajamas, drinking Charles Shaw out of a measuring cup?

For the three of you who haven't been on the Internet for the past few weeks, or have simply had better things to do with your time, eff you. I mean, this is what happened with Rebecca Black. She's a 13-year-old whose rich parents gave $2,000 to Ark Music Factory to write two terrible songs and make a video out of the one whose lyrics included the order of the days of the week, and breakfast. Black "sang" it, and Ark made said video into an auto-tuned monstrosity, with kids in braces pretending to drive convertibles and such. The scathing reaction to the song made the video go viral. (As of this week, it's been viewed almost 65 million times). Musician Mike Bauer impersonated Bob Dylan in a hilarious cover of it, which is totally worth watching just to hear him sing, "Gotta have cereal." And bam! Insta-fame.

According to Slate, Black has probably made about $40,000 from the song, and assuming she doesn't use most of it on therapy from the hatefest she inspired, that's a decent sum for a 13-year-old. While there's no magical key for making lots of money that you don't deserve, here are a few suggestions for you to try on your way to Internet infamy, based on YouTube's most-viewed videos of all time.

Read the rest of my social media column at SF Weekly.

Paul Ryan's Non-Proposal

| Tue Apr. 5, 2011 10:58 AM EDT

Just a quick note about Paul Ryan's Medicare plan, since I don't really have enough detail to do the kind of wonky dive that I know everyone is dying for. It's this: Ryan may or may not be the kindest, bravest, warmest, most wonderful congressman on Capitol Hill, but everyone realizes that his Medicare proposal is basically just a PR document, right? It has zero chance of being enacted, and there's pretty much zero chance of anything like it being enacted. It's just a conversation starter, not a serious attempt to produce a workable piece of legislation.

Everyone does understand that, don't they?

So Where's the Medicare Plan?

| Tue Apr. 5, 2011 10:52 AM EDT

So I figured I'd wait until today to get the details of Paul Ryan's Medicare plan, but this is pretty much all that his proposal says about it:

Starting in 2022, new Medicare beneficiaries will be enrolled in the same kind of health care program that members of Congress enjoy. Future Medicare recipients will be able to choose from a list of guaranteed coverage options, and they will be given the ability to choose a plan that works best for them....The Medicare premium-support payment would be adjusted so that wealthier beneficiaries would receive a lower subsidy, the sick would receive a higher payment if their conditions worsened, and lower-income seniors would receive additional assistance to cover out-of-pocket costs.

....Health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage....While there would be no disruptions in the current Medicare fee-for-service program for those currently enrolled or becoming eligible in the next ten years, all seniors would have the choice to opt into the new Medicare program once it begins in 2022.

Is that it? Am I missing something? How is anybody supposed to analyze how this would actually work with no more detail than this?

For now, I'm going to assume that I'm missing something. There must be a more detailed document around somewhere that I haven't found yet. There has to be, right?