2009 - %3, August

"Yes, But"

| Fri Aug. 21, 2009 11:40 AM EDT

Charles Krauthammer writes today that he'd like to hold a reasoned discussion about end-of-life counseling.  "We might start by asking Sarah Palin to leave the room," he says.

That's "close to reasonable," says Joe Klein.  But no, it isn't.

Krauthammer is part of the swelling "Yes, but" crowd, and for my money these guys are infinitely worse than the flat-out nutters themselves.  I mean, at least nutters have the excuse of being nutters, right?  They can be dismissed or mocked or yelled at or whatever.  But everyone outside the nutter base understands that they're crazy.

Then there's the "Yes, but" contingent.  Sober.  Serious.  Looking at all sides of the issue.  Stroking their chins.  Coming to conclusions.

And what are those conclusions?  Well, golly, the nutters might be nuts, but they have a point!  Allowing Medicare to reimburse doctors for advance care counseling might be the first tiny step toward turning them into junior Dr. Mengeles after all.  Krauthammer bases this conclusion primarily on his belief that living wills are pretty much useless:

So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.

It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health-care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.

Subtle pressure indeed.  The only thing that's subtle here is Krauthammer's faux evenhandedness.  Up until two minutes ago, politicians and pundits across the political spectrum universally believed that advance care counseling was an entirely sane and uncontroversial practice, one that any compassionate society would encourage.  Those same politicians and pundits knew perfectly well that it was never about guiding patients in any particular direction and has never been motivated by cost savings in any way.  They knew that other countries reimburse for advance care planning — just like any other use of a doctor's time — and it hasn't led to any pressure, subtle or otherwise, to pull the plug on grandma.

They knew this.  Until two minutes ago.  But now they're pretending — subtly, temperately — that maybe it isn't true after all.  And they're doing this not because they've changed their minds, but because they want to kill healthcare reform for political reasons and they don't care whether innocent bystanders get hurt in the process.  Their "Yes, but" campaign might ensure that patients forevermore mistrust doctors who talk about advance care directives, but they also know that sober, serious, subtle op-eds endorsing this point of view are more likely to derail healthcare reform among the chattering classes than Sarah Palin's Facebook maunderings.  It is intellectual venality of the first order.

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Steele Goes Postal on Health Care Reform

| Fri Aug. 21, 2009 11:39 AM EDT

Since becoming the chair of the Republican National Committee, Michael Steele has not acquired a reputation for the cogency of his arguments. It's hard to pick a favorite from among his many asinine comments, but mine is probably the time he countered Obama's suggestion that empathy is an valuable quality in a federal judge with this sparkling bon mot: "I'll give you empathy. Empathize right on your behind!" (His remark that Perez Hilton is the posterchild of "what an empathetic judge looks like"—he was presumably referring to the beauty pageant judiciary—was also pretty classic.)

But I digress. Today, David Corn takes issue with yet another of Steele's poorly thought-out comparisons—this time, his assertion that government-run health care is "inefficient, limits choices, and hemorrhages taxpayer money like the Post Office." David asks the obvious question: don't most people have an infinitely more positive experience with the Post Office than they do with private insurance companies? 

 

 

Fear in the Heartland

| Fri Aug. 21, 2009 11:20 AM EDT

The health care “debate” has been transformed into a confusing screaming match fueled by wild nativist fears. As Senator Chuck Grassley has found out at town meetings in Iowa, health care really is not the issue that’s on the minds of many. Instead, it’s all about the nation’s economic turmoil: People are hurting, and don’t see the stimulus plan helping them. From there, its a short leap to attacking the Federal Reserve, and what many perceive as a threatening, directionless federal government that is bent on controlling their daily lives.  And Grassley appears to be ready to capitalize on the anger:

Not everyone is coming to the town hall meetings because of health care. It’s kind of the straw that broke the camel’s back,” Grassley said. “They’re seeing the stimulus not working. They’re seeing the Federal Reserve shoving money out of the airplane not working. They’re seeing big increases in the deficit coming. Then they see a trillion-dollar health-care bill, and they think it’s not good for the country.”

These fears remind me of the fears that ran through the Midwest more than 20 years ago, during the 1984 presidential election. Back then Walter Mondale was vainly fighting Ronald Reagan, against a backdrop of farm foreclosures,bank crackdowns, penny auctions, and fight back by rural people in the heartland. Then as now, people showed up in angry knots–not unlike today’s town meetings–at foreclosure s to shout down the auctioneers, trying to save a farm. The gun of choice at that time was the semi-automatic mini 14, which was held by some in the same esteem as the Colt 45 did back in the day. Some turned to the Bible, watched the skies for Soviet bombers, dug themselves into bunkers.

 

Too Much Compassion

| Fri Aug. 21, 2009 10:49 AM EDT

I tend to be pretty squishy and bleeding heart over things like compassionate release for prisoners with terminal diseases.  Usually, though, they're 70 years old and have served 40 years in prison or something.  Releasing a mass murderer after eight years is another thing entirely.  Compassion ought to have its limits, and the Scottish government seems to have lost its mind in the case of Lockerbie bomber Abdel Basset Ali al-Megrahi.  The Libyans aren't exactly helping matters either.  What a mess.

Is Blackwater Too Big to Fail?

| Fri Aug. 21, 2009 10:14 AM EDT

Erik Prince's security enterprise has a division for pretty much everything. Need planes or choppers? See Aviation Worldwide or Presidential Airways. A compliment of Colombian mercs? Greystone at your service. For-hire spooks? Total Intelligence Solutions—emphasis on total—is standing by. And for the super-double-secret covert work—the kind that the CIA keeps even Congress in the dark about—Prince has a division for that too. According to the New York Times, it's called Blackwater Select.

Building on its scoop that the company played a role in the CIA's abandoned program to assassinate Al Qaeda operatives, the Times reports today that this secret division also plays a part in the agency's predator drone program.

The division’s operations are carried out at hidden bases in Pakistan and Afghanistan, where the company’s contractors assemble and load Hellfire missiles and 500-pound laser-guided bombs on remotely piloted Predator aircraft, work previously performed by employees of the Central Intelligence Agency. They also provide security at the covert bases, the officials said.

The role of the company in the Predator program highlights the degree to which the C.I.A. now depends on outside contractors to perform some of the agency’s most important assignments. And it illustrates the resilience of Blackwater, now known as Xe (pronounced Zee) Services, though most people in and outside the company still refer to it as Blackwater. It has grown through government work, even as it attracted criticism and allegations of brutality in Iraq.

Healthcare Ripoffs

| Fri Aug. 21, 2009 10:10 AM EDT

Miller-McCune glosses some recent research about the exorbitant rates the uninsured are forced to pay for medical care:

For example, one doctor billed $4,500 for an office visit when Medicare would have paid just $134. Another doctor billed $14,400 for removal of a gallbladder when Medicare would have paid $656. And a hip replacement cost $40,000 when Medicare would have paid $1,558.

....[Jeffrey] Rice said people should know they have a choice even when their insurance company is paying the bill. "Everyone knows you don't buy a car without knowing what the Blue Book value is. Well the same should be true in health care," he said.

....Previous research published in 2007 in the journal Health Affairs showed the "uninsured and other 'self-pay' patients for hospital services were often charged 2.5 times what most health insurers actually paid and more than three times the hospital's Medicare-allowable costs." The study by Gerard Anderson also found the "gaps between rates charged to self-pay patients and those charged to other payers are much wider than they were in the mid-1980s."

"Blue Book," of course, is a little harder to figure out for triple bypass surgery than it is for a 2003 Honda Civic.

In any case, this practice demonstrates both the pros and cons of going to the mattresses over inclusion of a public option in a healthcare reform bill.  On the one hand, the really important thing is to get the uninsured insured.  With anyone.  They'll get better care and their bill will be way lower, regardless of whether they have a public or private insurer.  On the other hand, private insurance is expensive, and in most of the plans on offer middle income families (above a cutoff of about $50,000) won't get any government subsidies to purchase it.  A public plan would (a) almost certainly be cheaper and (b) put price pressure on private plans to be cheaper too.  Result: more people are insured and fewer people are paying outrageous bills for common procedures.

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Eco-News Roundup: Friday August 21

| Fri Aug. 21, 2009 6:05 AM EDT

News from our other blogs, and around the web, you might have missed.

Sneak Peek: Jim Ridgeway offers a preview of healthcare reform options' effects.

Death And...: Taxes. If the Public Option dies, where will they go?

Trouble Up North: Info shows that Alaskan waters may be particularly vulnerable to effects of global warming. [The Daily Climate]

Sheriff Waxman: He's requesting insurance companies' info, and lots of it.

Smart Chart: This handy chart tells you all you need to know about the GOP's approach to healthcare reform.

Sleeping With the Enemy: Oregon's environmental department is supporting a limits exemption for the state's largest mercury producer. [The Oregonian]

Double-Header: Kevin Drum doubts the Dem's latest two-headed health bill will work.

Money Talks: Blue America has raised a $200,000 incentive for Congress members to vote against any healthcare bill that doesn't contain a public option.

What Gay Marriage Means: Same-sex marriage opponent says it'll lead to more tolerance... and that it's a bad thing.

 

We're Still at War: Photo of the Day for August 21, 2009

Fri Aug. 21, 2009 6:00 AM EDT

Unserviceable captured enemy weapons delivered by Marines with Engineer Ordnance Maintenance Platoon, Maintenance Company, 2nd Supply Battalion Reinforced, 2nd Marine Logistics Group (Forward) to the Taji National Maintenance Depot aboard Camp Taji, Iraq, lay in a pile waiting to be destroyed, July 28, 2009. The depot is responsible for destroying unserviceable weapons and turning over serviceable weapons to the Iraqi government to support the Iraqi Army. (U.S. Marine Corps photograph by Cpl. M. M. Bravo)

Need To Read, August 21, 2009

| Fri Aug. 21, 2009 3:00 AM EDT

Must-reads from around the web:

US General says most of the detainees at Bagram should be released.

About that secret Blackwater assassination program...

Sarah Palin, Facebook queen.

Tom "we don't do politics" Ridge admits he was pressured to raise the DHS color-coded alert in advance of the 2004 election. 

Health care town halls and the LaRouchies.

More fun with interactive maps: this one plots stimulus spending.

Ensign: At least my affair wasn't as bad as Bill Clinton's affair.

Best Twitter feed ever.

David Corn, Mother Jones' DC bureau chief, is on twitter, and so are my colleagues Daniel Schulman, Nick Baumann, and our editors-in-chief, Clara Jeffery and Monika Bauerlein. You can follow me here. (The magazine's main account is @motherjones.)

Chart of the Day

| Thu Aug. 20, 2009 9:24 PM EDT

I haven't had a chart of the day here for weeks.  What the hell is going on around this place?

Well, here's today's: day trips to Canada are down.  Way down.  It's not clear why, either.  The accompanying story blames it mostly on new passport rules, along with "other factors, including the recession and the higher Canadian dollar."  But that doesn't really hold water.  The downward spike from May to June might be due to new passport rules, but the chart makes clear that travel has been steadily decreasing ever since it recovered from 9/11 in early 2002.  Obviously passport rules have nothing to do with this 7-year trend, and neither does the recession or the strength of the Canadian dollar.

So what is it?  Take your guesses in comments.

UPDATE: Actually, maybe the exchange rate explains it after all.