In the issue that hits doorsteps this Sunday, the New York Times Magazine has published a two-year investigation by Dr. Sheri Fink, a staff reporter with the nonprofit investigative journalism shop ProPublica, into the claims that Dr. Anna Pou and other medical personnel at New Orleans’ Memorial Hospital, euthanized patients after the hospital was flooded, supplies ran out, and the staff struggled to treat scores of patients who were not evacuated.

The piece is great, and will be (damn them) hard to beat when the American Society of Magazine Editors hands out its annual award for public interest journalism. (And then there's that little thing called a Pulitzer.) Not only because it reveals facts that many other news stories as well as a grand jury investigation failed to unearth, but also because it somehow allows you to feel both sympathy for and horror at the doctors’ actions. It also reveals how various philosophies of triage conflict with each other, and how little training doctors have with any of them. Read it and take a look at all the nifty online extras, too.

So: what does a piece like this cost? In one of those “get to know a Times staffer” Q&As, Gerry Marzorati, the NYTM’s editor said that he and the editors of ProPublica did a back of the napkin calculation. Upshot: $400,000.

Now, that sounds like a lot. It is a lot. Gerry has said before that most NYTM cover stories average out at @ $40K, which is the average per-issue edit buy budget for this magazine. But reading the piece, the price tag didn’t surprise me. And if it surprises you, it’s because most people don’t realize how expensive and laborious investigative journalism can be. So to help folks understand, I asked Gerry to break down the $400,000. He obliged, emailing:

Ok, roughly:
2 years of reporting by a staff writer, full-time: 200k
Editing for that period by 2 ProPublica editors: 30k
Lawyering hours at ProPublica: 20K
Editing hours at the Times magazine over past year (from me to copy editors, 5 editors in all involved): 40k
Times fact-checking: 10k
Photography fees plus expenses: 40k
Times lawyering fees: 20k
Web and Web graphic costs at both the Times and ProPublica: 10k
Cost of adding 6 pages to the feature well to accommodate story: 24k

Total: 394k

Now Sheri got a grant during one of those years from the Kaiser Foundation, meaning some smallish portion of the overall cost was not carried by the NYT or ProPublica. And Sheri did report some other stories for PP during this time. But balance against that what’s not included in this rough calculation: proportional overhead for both organizations including rent, equipment, travel costs, libel insurance (there’s a reason a story like this gets so much attention from lawyers), distribution, servers, etc.

My point? This story—which could result in criminal prosecutions and should result in a national conversation among doctors and hospitals around their triage and emergency procedures—is the kind of work that is in peril now that the financial underpinnings (i.e. advertising) for journalism have collapsed. Bloggers and commenters and citizen journalists can’t take on a project like this. They can add to it, amplify it, criticize it, and generally run with it, but a project like this requires consistent, institutional teams of reporters and editors and factcheckers and lawyers and web dudes. In our most recent editors' note, Monika and I explain what’s going on to the media and the threat that the collapse of institutional reporting poses to a healthy democracy, concluding:

What it's going to take [to turn things around] is for many more Americans to decide that quality reporting—be it on local school boards or Iraq or climate negotiations—is as vital to their lives as box scores and celebrity spats. As media theorist Clay Shirky recently wrote, "Journalism is about more than dissemination of news; it's about the creation of shared awareness," and ultimately the ability to act on that awareness. Because make no mistake: This is a zero-sum equation. Less journalism = less accountability. Corruption, nepotism, cronyism, and propaganda thrive when reporting dies. That's not a price we're prepared to pay.

Read the whole thing here.

Update: Zach Seward of Niemam Jounalism Lab (@NiemanLab and one of my favorite sources on media news out there), also dug into the numbers on Friday—a post I surely would have seen and linked to had we not had a server implosion. Read Zach's post, he poses some interesting questions about measuring cost-benefit analysis, when costs are shared.

Clara Jeffery is Co-Editor of Mother Jones. You can follow more of her stories here and follow her on Twitter here.

Dittoheads and Fox News watchers are understandably wary of any public healthcare option, given the misinformation shoved down their throats on a daily basis. (President Obama tries to dispel some of the myths here.) Part of people's fear, as explained by The New Yorker's James Surowiecki in the latest issue, can be explained by our innate tendency to assign an irrationally high value to something already in our possession—like our often crappy and expensive health insurance plans. But people really need to reflect on this stuff and not let fear and misinformation win out. Consider: What if you have a health problem that's covered through your employer, but you want to switch jobs? Will your new employer's insurance plan accept you? What if you're a freelance or contract worker? Or part-time? Or full-time without bennies? Or you got laid off? That's a lot of what-ifs, especially in the current economy. The bottom line, for anyone with a preexisting condition who isn't insured, is that you're pretty well screwed. Today, Boingboing.net, where you'll always learn something interesting, featured the personal Youtube video below. I think this guy sums up the whole issue pretty articulately—even if the majority of those (nearly) 50 million uninsured don't yet have a preexisting condition. Well, at least that they know of.

Today you get more than boring old catblogging.  You get a cat movie.  Or a short feature, anyway.

OK, fine: it's 26 seconds long.

Its star is Domino as she plonked down the stairs this morning to check out the kibble situation.  You'll notice that she has sort of a weird gait coming down the stairs, not at all like the panther-esque stride that a normal cat would display.  (Like, say, Inkblot.)  (No, really.  When he comes down the stairs you better get out of the way.)  We're not sure why this is, but she's been this way ever since we got her, and it seems to be due to some kind of abnormality in her front legs.  Nothing serious, and she gets around just fine.  She's just not very lithe about it.

Anyway, as the ending shows, this dramatic production is clearly a tragedy: there's no food in the food bowl after Domino makes the long trek downstairs.  But worry not: as soon as the cameraman was done, he filled up the bowl and Domino was there at the head of the line.  Everyone walked away happy from this movie.

Chart of the Day

OK, it's not really a chart.  It's a table.  But it comes from CBPP and it takes a closer look at the recent headlines screaming that deficit projections have risen from $7 trillion to $9 trillion.  Long story short, it's not true.

Here's why.  The lower number is from the CBO and relies on its "baseline" budget calculation.  This is an estimate of what would happen if current law remains unchanged forever, and as such it bears little resemblance to reality.  In reality, the Bush tax cuts aren't going to disappear in 2011, Medicare reimbursements aren't going to be suddenly slashed, and the Alternative Minimum Tax won't be left alone to gobble up ever more income.  As usual, the law will be changed to take care of all these things, just like it is every year.

So if you take a look at what the deficit would be under current real-life policies, and compare it to estimates under Obama's proposed policies, what do you get?  As the table below shows, the real-life deficit isn't $7 trillion, it's more like $11 trillion.  And the Obama deficit isn't $9 trillion, it's about $10.5 trillion once adjustments are made so that it can be compared to CBO estimates on an apples-to-apples basis.  So the bottom line is simple: properly accounted for, the deficit actually goes down when you compare Obama's budget proposals to current policy, not up.

All the grisly details are here.  Warning: not for the faint of heart.

Stephen Colbert could not have done better. The U.S. Chamber of Commerce, the leading opponent of regulating carbon emissions, says it wants a public hearing on the scientific evidence for man-made climate change. A Chamber official told the LA Times that the hearing would be "the Scopes monkey trial of the 21st Century."

The Chamber either forgot that the creationists won that fight--though in the long run, the famous 1925 trial over the teaching of evolution, portrayed in Inherit the Wind, humiliated them--or it's attempting the boldest metaphor in the history of climate spin: creationists = climatologists.

Setting aside the fact that the nation's largest business lobby has supported plenty of dumb ideas, let's assume that this isn't really about science. Because there's no way that a half-competent judge is going to rule that 95 percent of climatologists are wrong. Remember the Supreme Court case? The one that said the EPA has the authority to regulate carbon?

No, what this is really about is false populism. Though it's evoking Scopes, the Chamber is actually calling for a "public hearing," a gathering that would surely be more akin to the recent healthcare town halls that were stacked with anti-government nutjobs. What fearmongering and demagaugery did for health care, it could do for climate change!

Or not. My bet is that 90 percent of the Bubbas who'd show up would also be creationists, the people discredited in the first Monkey Trial. Good luck with that, fellas!

Like everything presidential, the first family's choice for their August vacation is highly politicized. You can typically expect to see the President being as American as humanly possible while pretending to relax. This means playing golf and watching baseball, all while chomping hot dogs and hamburgers wrapped in red white and blue packaging.

"There's been a public significance to presidential vacations going back all the way to Lincoln, who went to the Soldier's Home in Washington during the Civil War," Princeton University history professor Sean Wilentz told the Washington Post. "You have to show the country that you are getting respite from the job, but also that you are still ever at the ready. It's a delicate balance."

And while the Commander in Chief works on his swing in the Vineyard, a more overt political game unfolds each year back in Washington. This year, that has centered on the battle over health care reform and the apparent wrath of teabaggers across the country. But as President Obama's Martha's Vineyard vacation comes to a close, I took a look at what major events have occurred during August vacations in years past. One aspect jumps off the page: Presidents Clinton and Bush II were careful stay out of policy debates. Reagan and Bush I, on the other hand, regularly engaged from their vacation homes.

Quote of the Day

From Steve Benen, responding to Steven Pearlstein's column today about a possible compromise healthcare plan:

If there's "a deal to be had here," who is the deal with?

In theory, a deal should be fairly easy.  Keep the insurance reform stuff and the increased subsidies, dump the public option, add in a few other goodies here and there for both sides, and voila.  Dinner is served.

But who's going to join us at the table?  Are there any Republicans left who will vote for any healthcare plan at all, regardless of what is or isn't in it?  Who are they?  As Michael Kinsley says morosely about a healthcare deal elsewhere in the paper: "I'd like to think that if it goes down this time — when even the insurance companies are on board, promising to eliminate their odious policies about preexisting conditions — Republicans will pay for having killed it, if indeed they do kill it. But they didn't pay the last time."

During the campaign Obama pledged to make the Gulf Coast recovery a paramount goal.
In February, 2008, he declared, "The broken promises did not start when a storm hit, and they did not end there … I promise you that when I’m in the White House I will commit myself every day to keeping up Washington’s end of this trust. This will be a priority of my presidency."

But a new study [PDF] by the Institute of Southern Studies reports that 50 community leaders from areas affected by the hurricane ranked Obama only slightly better than Bush in reconstruction. In a range of different categories, Obama came out with a D+ to Bush’s D.

According to the report, "A diverse group of more than 50 community leaders were asked in August 2009 to grade the Obama administration’s efforts for Gulf Coast recovery in eight key areas. The respondents came from Alabama, Louisiana, Mississippi and Texas, and represented a wide range of constituencies, including faith, community and environmental organizations."

The demographics assembled by the Institute in themselves reflect how little has been done to restore life along the coast:

  • Estimated number of U.S. residents displaced by Hurricane Katrina: 1 million
  • Rank of Katrina’s among all diasporas in U.S. history: 1
  • Estimated number of people displaced by Katrina still living in Houston today: 100,000
  • Percent of New Orleans’ pre-Katrina addresses that are actively receiving mail today: 76.4
  • Percent receiving mail in the largely African-American and working-class Lower 9th Ward: Less than 49
  • Percent of households with children in New Orleans before Katrina: 30
  • Percent shortly after the storm: 18
  • Percent two years later: 20
  • Percent of New Orleans’ pre-Katrina population that was African-American: 67
  • Percent three years later: 61
  • Number of abandoned residential addresses in New Orleans today: 65,888
  • Proportion of all residential addresses in the city that number represents: 1/3
  • Rank of New Orleans among all U.S. cities for the rate of abandoned residences: 1
  • Number of 2010 federal census questionnaires slated to be hand-delivered to homes in south Louisiana in an effort to ensure an accurate count: 300,000
  • Average amount of federal funds states receive over a decade for each person counted in the census: $12,000

The Rationing Canard

Ezra Klein takes a bat to Charles Krauthammer's claim that national healthcare inevitably leads to rationing:

A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent....There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The problem, of course, is that the U.S. rations by denying healthcare to poor people, and the Krauthammers of the world don't really care much about that.  What's more, for all that we like to think of ourselves as nice people, most middle class Americans don't care much about it either.

In any case, Krauthammer also violates two of my standard rules for figuring out when someone is completely full of it when they talk about healthcare.  #1: the old hip replacement canard.  Run for the hills when you hear it.  Krauthammer, as Ezra points out, is implicitly talking about elective surgeries like hip replacements, but there's a reason these procedures are called "elective": it's because these are the procedures that can be most effectively triaged.  We do the same thing in emergency rooms all the time, and we do it every time you have to wait a few weeks for a doctor's appointment because you're not keeling over on the street.  Every system triages something, and in some countries that something is hip replacements that can be easily monitored and scheduled.  In others — like ours — it's things like basic dental care.

#2: Krauthammer is careful to name check only Britain and Canada, which have more problems than most other national healthcare systems — and are conveniently English-speaking, which makes it easy to lazily Google complaints about care.  But he couldn't make his rationing statement at all if he'd chosen France and Germany (or Sweden or Japan) instead.  The plain fact is that universal care doesn't inevitably mean longer waits for care than in the U.S.  As any honest observer knows, plenty of actual, existing countries have proven just that.  We should emulate them.

Af/Pak Dominos

According to Mike Crowley, Bruce Riedel said this at a Brookings event earlier this week:

The triumph of jihadism or the jihadism of Al Qaeda and the Taliban in driving NATO out of Afghanistan would resonate throughout the Islamic World. This would be a victory on par with the destruction of the Soviet Union in the 1990s. And, those moderates in the Islamic World who would say, no, we have to be moderate, we have to engage, would find themselves facing a real example. No, we just need to kill them, and we will drive them out. So I think the stakes are enormous.

Riedel was chair of a White House team that reviewed U.S. policy on Afghanistan and Pakistan earlier this year, so his opinion isn't one you can easily dismiss.

But how reasonable is it?  It's probably true that Pakistani moderates are skeptical about our willingness to stick things out for the long haul, so they often hedge their bets by trying to stay on our good side while they strike deals with the Taliban on the side.  After all, Americans are a wee bit unpopular in Pakistan these days, so why not?  What's more, it's a pretty safe game since these same moderates know perfectly well that we don't have enough leverage to ever really call them out on this tap dancing.

At the same time, neither Pakistani moderates nor, more importantly, the Pakistani army, would ever put up with any serious effort by the Taliban to mount a coup.  The army plays a sometimes dangerous game, trying to use these terrorist groups as useful foot soldiers in its forever war with India, but other than that they've never had any real use for them.  The more important question, then, is what would happen if Islamist elements in the Pakistani army gained more control than they have now and started cooperating with Islamist groups more seriously?  If the U.S. withdrew from the region and radicals claimed victory, would all this stop being a game and start becoming all too real?

Nothing is impossible, but at its core this is just a sophisticated version of the same domino theory that dominated U.S. thinking in Southeast Asia in the 50s and 60s.  That led us into a disastrous war then, and it could do the same now if the Obama administration starts getting too wrapped up in febrile thinking like this.  After all, if you assume enough dominos, you can come to just about any conclusion you want.  I sure hope they're not taking this more seriously than it deserves.

More in the same vein from Michael Cohen here.