2009 - %3, October

Sucking You Dry

| Tue Oct. 6, 2009 2:06 PM EDT

I've written a bit lately about how banks make a lot of money by exploiting complexity and confusion.  This works all the way from the small (overdraft fees) to the huge (weird credit derivatives that no one really understands).  Apparently the healthcare industry, which was never exactly a model of straight talk and plain speaking in the first place, is taking lessons.  No longer content to simply bill for procedures, they've started including a separate "facility fee" for every visit:

One billing consultant has estimated that the fees could generate an additional $30,000 annually per physician for hospitals.

Critics [...] regard the fees as disguised price increases that ratchet up the cost of care at a time consumers can least afford it. Many say that facility fees underscore the urgent need for transparency in pricing for medical services and exemplify the relentless cost-shifting that is driving more Americans into medical debt and bankruptcy. It is common for facility fees to be applied to an insurance plan's hospital deductible, which can be thousands of dollars higher than a physician deductible.

...."It's like a barber saying, 'That'll be $20 for a haircut and $10 for sitting in my chair,' " said Wisconsin state Rep. Chuck Benedict, a Democrat and retired neurologist from Beloit. Benedict's bill to require hospitals to post notices about the fees and furnish upfront cost estimates was defeated in 2007; he has introduced a similar bill this year. Legislation has also been proposed in New Hampshire.

How do they get away with this? You'll be unsurprised to learn that it's all due to a weird loophole inserted in federal legislation a few years back:

[Facility fees are] the result of an obscure change in Medicare rules that occurred nearly a decade ago. Called "provider-based billing," it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors' offices owned by physicians and freestanding clinics are not permitted to charge them.

And how do you find out if the the clinic you're going to is allowed to assess the fee?  Good luck!  The short answer is that you probably can't.

Anyway, you all know what I'm going to say next, don't you?  So I'll say it: the American public is flat out nuts to put up with this.  It's not as if France and Sweden have solved all the world's healthcare problems or anything, but at least they've solved this one.  If you need medical care in those countries, you just go to your doctor and get it.  No games, no tricks, no hidden fees.  Why anyone would prefer our fantastically expensive, jury-rigged, insecure, and maddeningly complex system to theirs is beyond me.

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Boing Boing Raises Its Middle Finger to Ralph Lauren

| Tue Oct. 6, 2009 1:47 PM EDT

Our friends at the wonderful (and newly redesigned) Boing Boing are raising a collective middle finger to Ralph Lauren after the clothier took issue with their display of an ad that a staffer had singled out for criticism.

On September 29, Xeni Jardin re-posted the disputed ad, which she'd seen at a site called Photoshop Disasters, along with her own reaction: "Dude, her head's bigger than her pelvis." The implication, perhaps, was that the company's marketing people had tweaked the image to give the model, in the words of Jardin's colleague Cory Doctorow, "an impossibly skinny body."

Calling out such an ad for criticism or comment, Doctorow concludes in his followup post, is "classic fair use." But in their cease-and-desist letter, lawyers for Ralph Lauren claimed it was an "infringing image." The lawyers brought their complaint to Boing Boing's Internet service provider, which, rather than caving to Smartly Dressed Big Brother, passed it along so that BB staffers could discuss it. And they did. And the lawyers' complaint didn't pass their "giggle test."

"So, instead of responding to their legal threat by suppressing our criticism of their marketing images, we're gonna mock them," Doctorow promises. He then issues a scolding counter-threat: That any time the fashion house attempts such a weak legal maneuver, Boing Boing will again reproduce the original criticism, publish and mock the threat to ensure it is spread far and wide, and, my favorite: "Offer nourishing soup and sandwiches to your models."

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Capitalism: A Love Story

| Tue Oct. 6, 2009 1:22 PM EDT

Yesterday I saw Michael Moore's Capitalism: A Love Story.  It was kind of discouraging.

But not for the obvious reason.  Right now I'm working on a piece for the magazine that has a different focus than Moore's film but basically the same theme: the outrageous conduct of the financial industry over the past decade or so.  But it turns out this is really hard to document.  Surprisingly hard.  There's plenty of outrageousness to choose from, but most of it is either too dry (numbers, numbers, numbers), too complex to hit you in the gut (derivatives, Fed policy, etc.), too distant from the real center of action, or too hidden to really get at effectively.  Moore, it turns out, had the same problem.

For example, there's a segment early in the film about the Wilkes-Barre "Kids for Cash" case, where a local judge cozied up with a private juvenile detention facility and sent lots of kids there who hadn't really done anything to merit being locked up.  That's outrageous!  But it's also garden variety fraud, not a serious slam against capitalism.

Likewise, the segment on Detroit is heart wrenching, but frankly, not really a condemnation of either capitalism or Wall Street's recent escapades.  And when, toward the end of the film, Moore does turn his lens on Wall Street, he never really lands a killing blow.  There's a mishmash of public stunts (the "citizen's arrest" gag), criticism of TARP and Goldman Sachs, some hits on the cult of deregulation, and a few other things, but they never quite add up.  He's obviously trying to make the point that the finance industry (and, more broadly, the rich) basically own Congress and everything else, but at least for me, it never quite came together.  It was just too scattershot.

And I really wanted it to come together.  Because, as I said, that's pretty much the theme of the piece I'm writing right now, and I'm having a helluva hard time with it.  Like a lot of people, I believe pretty strongly that if the public really understood everything that had happened over the past decade, it would be torches and pitchforks time.  But making the case is a lot harder than it sounds.  Even Michael Moore, it turns out, had a pretty hard time with it.

Why'd Goldman Get an Earmark?

| Tue Oct. 6, 2009 1:08 PM EDT

Here's a nominee for one of the 111th Congress' most dubious earmarks: $3 million to subsidize a mining concern owned primarily by Goldman Sachs, recipient of a $10 billion bailout (since repaid), and two hedge funds. Politico reports that the measure was slipped into the House defense appropriations bill by Rep. Jerry Lewis (R-Calif.), the top Republican on the House appropriations committee who's regularly featured on Citizens for Responsibility and Ethics' annual list of the most corrupt members of Congress. How'd he earn a spot on the list? For allegedly trading earmarks for campaign contributions—a matter for which he's presently under federal investigation.

Lewis and his supporters say this particular earmark is a matter of national security. The mining project in question, run by a company called Molycorp Minerals, is harvesting rare elements that are an ingredient in the magnets used in precision-guided missiles and smart bombs. (Among Lewis' top contributors are defense and aerospace firms that produce such munitions.) China, as Politico notes, is the world's primary producer of these hard-to-come-by minerals, but the country has threatened to stop exports, prompting a search for other sources.

Copen-bloggin': Bike Jam

| Tue Oct. 6, 2009 12:50 PM EDT

Back home in Washington, DC, I like to consider myself somewhat of a rebel, a risk-taker perhaps, because I commute by bike. DC doesn't have the greatest bike lanes (and in many parts of town, no bike lanes at all), and we have more than our fair share of aggressive drivers. Biking to work in the city does tend to offer some insight into one's personality—or at least their political and environmental inclinations. As Matthew Yglesias, who is also on this trip this week, points out, bikers back home identify with a bike culture and feel a common bond to others who bike to work. We're rogues in the District, totaling just 2.3 percent of commuters.

But here in Copenhagen, it seems these bike identity politics are somewhat provincial. And, after spending the afternoon with Lise Bjørg Pedersen, the political director of the Danish Cyclists Federation, I no longer feel quite as hardcore for biking. Seven years ago, Pederson traveled by bike to the hospital to give birth to her son. She wasn't peddling—that task fell to her boyfriend, she said – but she was riding in a giant bike cart padded with pillows. It was only three kilometers to the hospital, she said—not worth calling a cab.

The Nobel Prize for Catblogging

| Tue Oct. 6, 2009 12:21 PM EDT

You think I'm joking, don't you?  Au contraire:

Half of the $1.4 million prize went to Charles K. Kao for insights in the mid-1960s about how to get light to travel long distances through glass strands, leading to a revolution in fiber optic cables. The other half of the prize was shared by two researchers at Bell Labs, Willard S. Boyle and George E. Smith, for inventing the semiconductor sensor known as a charge-coupled device, or CCD for short. CCDs now fill digital cameras by the millions.

Without CCDs to take the pictures and fiber optics to carry them from my house to the server that broadcasts them to the world, there would be no Friday Catblogging.  So congratulations to Drs. Kao, Boyle, and Smith.  The catbloggers of the world salute you.  The cats of the world would salute you too if their appreciation of light went beyond coveting sunny patches on the floor.

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Letter to the Editor

| Tue Oct. 6, 2009 12:12 PM EDT

This letter to the editor in Saturday's Washington Post was pretty amusing:

George F. Will used his Oct. 1 column to deride government officials and scientists warning of the consequences of global warming, and he suggested that these climate-change "Cassandras" slow down and not cater to "alarmists" 

Mr. Will has perhaps forgotten his classics. Cassandra, prophetess of Troy, was always right when she sounded the alarm but was never believed by those with power to avert disaster.

JIM McELFISH

Senior Attorney

Environmental Law Institute

Washington

The man with the oddly appropriate name is right. (Via)

The Long, Hard Slog of Change

| Tue Oct. 6, 2009 10:51 AM EDT

Brendan Nyhan takes a look at support for Barack Obama's healthcare plan following his big speech a couple of weeks ago and comes away unimpressed:

There was a small bounce in support for health care reform after the speech, but part of the effect dissipated. Meanwhile, estimated opposition to reform, which dipped in the wake of the speech, quickly rebounded toward previous levels and is now greater than it was before the speech.

....I'm emphasizing this point because there's a misperception among journalists that the president can easily move public opinion. As we've seen again and again over the years, it's simply not true, but the lack of followup by the press means that the lesson is never learned.

I agree on the narrow question here: a single speech by a president probably has very little impact except in the very short term.   But I'm not sure that's the same thing as saying the presidents don't have much effect on public opinion.  It's obviously harder to measure presidential impact the more broadly you look at it, but my guess is that presidents can have a fair amount of impact if they pick one or two subjects and hit on them early and often.

This was one of my criticisms of Obama from the very beginning: his campaign was very good at inspiring people to vote for "change," but that message was only good enough to win the election.  By November 4th, the only specific change in most people's minds when they entered the voting booth was that they didn't want four more years of George W. Bush.

Now, Job 1 in a campaign is to get elected.  And "change" is one of the two classic messages for any winning campaign.  (The other is "experience counts.")  But there's not much point in getting elected unless you can accomplish something once you're in the Oval Office, and that requires a public that's solidly behind your legislative program.  Unfortunately, that's something Obama never really got, because he didn't want to take the chance of muddying his message and risking the election.  Maybe that was the right decision, but the end result is that he doesn't really have a lot of genuinely fervent public support (the kind of support that generates townhall protests in every state, lights up the congressional swithcboard like a Christmas tree, and makes politicians fear for their reelection) for his specific healthcare agenda.

It could be that there's no way to square this circle.  I don't know.  But I believe two things: (a) public opinion is the key to almost everything and (b) it's hard for a president to move public opinion.  One lesson you can take from that is that presidents are stuck.  The other is that they should treat public opinion the way Eisenhower treated World War II and mount a long, hard campaign to win it from their earliest days on the campaign trail.  I choose door #2.

Semi-Republicans Show Semi-Support for Healthcare

| Tue Oct. 6, 2009 10:10 AM EDT

Several semi-employed Republicans have recently said they support Barack Obama's healthcare reform plan, but today brings news that a couple of employed semi-Republicans do too: Arnold Schwarzenegger (technically an R but pretty much disowned by most of his party) and Michael Bloomberg (currently pretending to be an independent).  There's still not much in the way of support from anyone who's both employed and a red-blooded Republican, but it's a start.

Obama and Afghanistan: You Can't Handle the Truth?

| Tue Oct. 6, 2009 8:20 AM EDT

The Obama White House keeps running smack into fundamental and inconvenient contradictions concerning its tough slog in Afghanistan. Most recently, on Monday, White House press secretary Robert Gibbs declared that pulling out of Afghanistan is "not a decision that's on the table" for President Obama. Yet a few days earlier, he had said that the Obama administration can only succeed in Afghanistan if it has a partner there that "is free of corruption and transparent." That description certainly does not fit the Kabul government—not even close. So how can the Obama administration hold on to both of these notions: that it will stick with this war and that it cannot triumph if the Afghan government and its security forces are not effective, competent and honest?

Looking for an answer to this critical question, I asked Gibbs about the apparent conflict between these two ideas at Monday's press briefing. Here's the exchange: