Kevin Drum

Vive La Healthcare

| Fri Aug. 7, 2009 2:01 AM EDT

David Gauthier-Villars has a piece about France's healthcare system in the Wall Street Journal today that's worth a read.  Like everyone, the French have been fighting a rearguard action against financing problems in their system for as long as I've been reading about it, but that means something a little different there than it does here:

Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.

....Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.

Italics mine.  Despite the story's focus on France's "financing woes" — a problem shared by every healthcare system in the world — the chart on the right tells the real story.  The French spend a third less than we do per person and have a growth rate about a third lower than ours.  We should be so lucky as to have woes like that.  Their healthcare costs may be rising, but their tax-funded system reins in costs better than ours and still remains among the best in the world.

No system is perfect, but the French do pretty well.  Service is top notch, costs are reasonable, everyone is covered, administrative costs are low, the private sector is substantial, and supplemental insurance is common for people who want more than the standard level of care.  It is, ironically, a very American approach to universal care.  If we had our heads screwed on straight, we could do a lot worse than to adopt it wholesale.

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Starkman on Taibbi

| Thu Aug. 6, 2009 9:42 PM EDT

Over at CJR today, Dean Starkman has an almost pitch perfect review of Matt Taibbi's famous (or, depending on your point of view, infamous) evisceration of Goldman Sachs in last month's Rolling StoneGo read it.  Both his praise and his criticism match mine nearly perfectly.  There's hardly a word I disagree with.

Hoisted From Comments

| Thu Aug. 6, 2009 7:21 PM EDT

Is the mainstream media giving a lot of attention to the "Democrats want to kill granny" meme?  Commenter majun says, "My impression has been that FOX covers it as the unvarnished truth, MSNBC tends to make fun of it and debunk it a lot and CNN falls in the middle."  Sounds about right.  And then there's this exchange:

g.powell: But the right-wing crazies really believe this stuff about "kill granny". My father is one of them. He moved up the schedule of some elective surgeries at the VA because he is convinced Obama is out to kill him.

Anonymous: Wow g. powell. Now that's what I call irony! Moving up surgery within a govt run health care system (the VA) because govt-run health care is so scary.

g.powell: It's worse than that, my dad hates the idea of socialized medicine — it would be a disaster for the country — but loves the VA. Don't ask me to explain. I have thousand of these stories. The laws of physics and logic behave differently in Crazyland.

That's from the land of the email chain letter.  Just thought I'd share.

Disrupting the Disruptors

| Thu Aug. 6, 2009 6:42 PM EDT

Rotwang says that whining about right-wing mobilization over healthcare reform just makes liberals look weak.  We're bigger and have a better case and we should just make it:

The numbing details of health care reform are important and worth discussing, but the argument against the [teabaggers] is pretty simple. If you hate socialized medicine, do you want to abolish Medicare? Why not? If not, why not have more Medicare, rather than less? Why not have wider access to health insurance that resembles what Members of Congress have? Medicare is their soft underbelly. It's socialized medicine that people already have, are used to, and support. More, not less. Once that is established, you can have a civil discussion about all the details.

That's exactly what my mother was saying to me on the phone last night.  And it's very logical.  I don't think it will work with these folks, but it's very logical.  I'm not sure Rotwang thinks it will work either, considering his ultimate advice:

Anybody who is unwilling to throw people out of their meetings should not be organizing them.

Yeah, but that has to be done very, very carefully indeed.  One small slip and you'll end up on a 24/7 loop on Glenn Beck's show.  Videotape of your goons dragging some 70-year-old grandma out of the room by her hair will not play well at all in the fabled heartland.

I guess I'd propose the following for members of congress speaking at town hall events: (1) Announce beforehand that there have been organized efforts to disrupt constituent meetings and it might happen here too, (2) ask everyone to please stay calm even in the face of provocation, (3) have your own cameras there to record the lunatics, and (4) rely on the fact that organized screaming doesn't wear well with the American public.  And then turn up the volume on your sound system.

Either that or you can get on the stage and announce that some there are some shaggy punks outside burning an American flag and you want some volunteers to go teach them a lesson.  That should get the riff raff out of the room.

Gog, Magog, and George Bush

| Thu Aug. 6, 2009 5:13 PM EDT

I may regret posting this, but here's an account of how George Bush tried to talk French president Jacques Chirac into supporting the invasion of Iraq:

Chirac recounts that the American leader appealed to their “common faith” (Christianity) and told him: “Gog and Magog are at work in the Middle East.... The biblical prophecies are being fulfilled.... This confrontation is willed by God, who wants to use this conflict to erase his people’s enemies before a New Age begins.”

This bizarre episode occurred while the White House was assembling its “coalition of the willing” to unleash the Iraq invasion. Chirac says he was boggled by Bush’s call and “wondered how someone could be so superficial and fanatical in their beliefs.”

After the 2003 call, the puzzled French leader didn’t comply with Bush’s request. Instead, his staff asked Thomas Romer, a theologian at the University of Lausanne, to analyze the weird appeal.

....In 2007, Dr. Romer recounted Bush’s strange behavior in Lausanne University’s review, Allez Savoir....Subsequently, ex-President Chirac confirmed the nutty event in a long interview with French journalist Jean-Claude Maurice, who tells the tale in his new book, Si Vous le Répétez, Je Démentirai (If You Repeat it, I Will Deny), released in March by the publisher Plon.

This isn't brand new: the Toronto Star wrote about it a couple of months ago, though it's gotten very little attention since.  In any case, consider it your weirdness of the day.  Not that we've exactly been lacking for that lately.....

(Via Andrew Sullivan.)

Stimulus Around the World

| Thu Aug. 6, 2009 2:45 PM EDT

Does fiscal stimulus work when the economy is in a deep recession?  There's no way to definitively "prove" that it does, but we can certainly amass evidence for it.  Via Tim Fernholz, here's a chart from a talk CEA chair Christina Romer gave today.  The question she's addressing is whether countries that applied bigger stimulus packages have recovered more quickly:

To get evidence about this, we started with a set of forecasts of growth in the second quarter of this year that were made last November — after the crisis had hit, but before countries had formulated their policy response. We then collected analysts’ recent best guesses for what second-quarter growth will be in those countries. This figure shows the relationship between how countries’ second-quarter growth prospects have changed from what was expected back in November, and the countries’ discretionary fiscal stimulus in 2009.

The fact that the observations lie along an upward-sloping line shows that, on average, things have improved more in countries that adopted bigger stimulus packages. And, the relationship is sizable: on average, a country with stimulus that’s larger by 1% of GDP has expected real GDP growth in the second quarter that’s about 2 percentage points higher relative to the November forecast.

Italics mine. This is, obviously, hardly ironclad proof about how well fiscal stimulus works.  For one thing it's based on estimates, not final data, and if those November forecasts were systematically overoptimistic they might also have been systematically useless.  What's more, eyeballing that line doesn't suggest to me that Romer's correlation is very strong — especially since it mostly seems to rely on three Asian outliers.

Still, it's up and to the right, and that's a data point in favor of using fiscal stimulus during an economic crisis.  There's more evidence in the talk too, all of which is suggestive though not conclusive.

Of course, you wouldn't expect anything conclusive at this point.  Overall, though, I expect data from 2008-2011 to become a rich field for economists to study in the future.  We haven't had a worldwide recession like this since the Great Depression, and it presents a unique opportunity to study what worked and what didn't.  There are enough variables that drawing firm conclusions will always be hard, but it's nonetheless the best chance we've had in decades to get meaningful comparative data on macroeconomic policy responses to an economic crisis.  This paper is a start.

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Restless Pharmaceutical Companies

| Thu Aug. 6, 2009 1:30 PM EDT

Megan McArdle asks:

Why is restless leg syndrome always the poster child for people who hate pharma advertising?  Both my fiance and I clearly have it, and you know what?  It's really not very much fun not being able to sleep, nor are the cramp-like sensations that accompany the uncontrollable urge to kick your legs.

I've wondered about this too.  Is it just because it's kind of funny sounding?  I don't have it myself, but I have a friend with RLS and he tells me he can barely sleep in the same bed with his wife when it's acting up because it's so violent.

Actually, though, the answer doesn't seem to have much to do with whether RLS really exists.  It's more about whether pharmaceutical companies are vastly overestimating its incidence in order to sell more drugs.  In Britain, for example, GlaxoSmithKline got in trouble for promoting an off-label use of one of their products for RLS:

Dr Des Spence, the Glasgow GP who raised the complaint, said the case was an example of the way pharmaceutical companies used patient groups to promote a new condition, and then supplied drugs to treat it.

“The Ekbom Support Group was hijacked by GSK to promote restless legs syndrome and the GSK drug ropinirole,” he said. “I am not saying some people do not experience pain and restless legs but claims on the website that it is a widespread and serious condition are disproportionate.”

The Ekbom Support Group says 5% of the population suffer from the condition. Doctors say fewer than 3% experience symptoms on a regular basis and, of them, only a minority require any treatment.

This is the great gray area of pharmaceutical advertising, of course.  On the one hand, letting people know about a condition and a possible new way to treat it is perfectly fine.  On the other hand, we're all natural hypochondriacs, and it's all too easy to convince millions of people whose legs twitch a bit that they have a serious disease.  In fact, most of them just have legs that twitch a bit.

Anyway, the lesson here seems to be (a) RLS is real but (b) you probably don't have it.  What the policy response to this should be I'm less sure of.

On Accepting Apologies

| Thu Aug. 6, 2009 12:44 PM EDT

In an episode of "Mouthpiece Theater" last week, Dana Milbank and Chris Cillizza of the Washington Post joked about what brands various luminaries might be served at future beer summits.  For Hillary Clinton, they suggested "Mad Bitch."

Ha ha ha!  Well, Mouthpiece Theater has been cancelled and Milbank and Cillizza have apologized.  But Bob Somerby isn't happy:

We’ve long been aware of Milbank’s oddness. But you haven’t seen “corporate media clueless chic” until you read the apology the bosses beat out of Cillizza. Each fellow was required to feign regret; below, you see how Christopher did it. So you’ll know, his blog at the Post is called “The Fix:”

CILLIZZA (8/5/09): I would like to personally apologize for the content in last Friday's video as it was inconsistent not only with the Post brand but, more important and personal to me, the Fix brand which I have worked so hard to cultivate.

Good God, that’s awful! Calling a woman a “bitch” is, at this level, remarkably stupid. Unless you’re a modern, upper-end “journalist,” in which case the practice is inconsistent with a long string of brands! Never mind the denigration of the woman in question! The real harm here was carelessly done to Cillizza’s beloved Fix brand!

This is something that bugs me.  I'm not quite as willing to forgive and forget this episode as MoJo's editor is, but neither do I think it was exactly a hanging offense.  Jokes go awry all the time.  More to the point, though, Cillizza apologized.  But these days, that's never good enough.  Either it's a "non-apology apology" or it's not groveling enough or it's not sincere enough or it came too late or it's an unforgivable crime and no apology can ever erase the stain.

Or something.  Get over it, folks.  Cillizza screwed up, but he groveled plenty for my taste. "I would like to personally apologize" is admirably direct, and there's nothing wrong with also acknowledging that his reputation is going to take a hit from this.

I've mentioned this before, but I sometimes wonder why anybody ever bothers to apologize for anything anymore since it never seems to do any good.  I remember that someone in comments to that post suggested that apologies should be done for their own sake, not in hopes of getting forgiveness.  That's an admirable sentiment, but it's also fabulously innocent of human nature.  Like it or not, public apologies are hard to do, and people hope to get something out them.  If all they get instead is more grief, they'll quit bothering with them.  Learning how to accept an apology is as important as learning how to give one.

Feeding the Beast

| Thu Aug. 6, 2009 11:33 AM EDT

Who's to blame for conservatives gaining traction with ridiculous arguments like Betsy McCaughey's that Democratic healthcare proposals will make it easier for government bureaucrats to kill old people?  Brendan Nyhan says it's not Obama:

Who's to blame for this problem? I largely fault the media. While the Obama administration's message strategy has hardly been perfect, it's absurd to say, as Cynthia Tucker did on This Week, that Obama "allowed the opposition [to health care reform] to scare people" (my emphasis). In a polarized political system, the McCaughey/Taitz approach to concocting and promoting misinformation probably would have worked no matter what the White House did. As Kevin Drum and Matthew Yglesias recently argued, it's extremely difficult to myth-proof a bill or to effectively counter these claims once they are made. Until the media stops giving airtime and column inches to proponents of misinformation, the playbook is going to keep working.

James Ridgeway elaborates:

In recent weeks, variations of this argument have been sprouting up all over the conservative ecosystem. Rush Limbaugh has been laying it on particularly thick for his 22 million listeners. "People at a certain age with certain diseases will be deemed not worth the investment, and they will, just as Obama said, they'd give them some pain pills, and let them loop out till they die and they don't even know what's happened…They're preparing you to die," he said on one show. (A caller who said she was 66 responded, "You know, Rush...they want to get rid of the old people so they can insure the illegal aliens for their voting base.") And it gets even more sinister: Rahm Emanuel’s brother Ezekiel, a physician and White House health care policy adviser is, Limbaugh says, a "central figure" who believes it’s a "waste of money to invest in health care in the elderly. " Plus, he plans to expand hospice care. And we all know what that means!

Fox News host Sean Hannity has also taken up the cause, as has [Randall] Terry, the former head of anti-abortion group Operation Rescue, who has been railing against the President's "death care." Donny Ferguson at the libertarian Small Government Times writes that Obama's plan "sends government employees to your home to monitor your parenting…and forces the sick and elderly to submit to 'end of life counseling.'" According to the Washington Post, Betsy McCaughey, the former New York politician who played a major role in derailing the Clinton health care initiative, told former GOP senator and failed presidential contender Fred Thompson on his radio show that the health care reform bill contained mandatory counseling sessions for seniors "to end their life sooner" by showing them how to "decline nutrition...and cut your life short."

Hmmm.  So this is getting lots of play in the conservative media — places like talk radio and the Wall Street Journal editorial page — but how much play has it been getting in the mainstream media?  I'm not saying it hasn't, but I'm curious abut this since I don't watch much of it.  Outside of Fox, has the "Democrats want to kill granny" meme gotten much play?  Help me out here in comments.

Revenge of the Nerds

| Thu Aug. 6, 2009 2:26 AM EDT

Crunching numbers is the new cool thing:

“I keep saying that the sexy job in the next 10 years will be statisticians,” said Hal Varian, chief economist at Google. “And I’m not kidding.”

The rising stature of statisticians, who can earn $125,000 at top companies in their first year after getting a doctorate, is a byproduct of the recent explosion of digital data. In field after field, computing and the Web are creating new realms of data to explore — sensor signals, surveillance tapes, social network chatter, public records and more. And the digital data surge only promises to accelerate, rising fivefold by 2012, according to a projection by IDC, a research firm.

They want to know what you're doing and what you're likely to buy next.  That's worth a lot of money.  Multivariate correlations and data cluster analysis are the new black.