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Obamacare Isn't Perfect, But That's No Reason to Give Up On It

| Mon Sep. 22, 2014 11:57 AM EDT

A few days ago I noted that health insurance companies were starting to price certain drugs at higher rates. Not just certain brands of drugs, but entire classes of drugs. This is being done in an apparent attempt to discourage patients with certain conditions from applying for insurance. Better to have some other insurance company pick up the cost of their expensive illness.

The reason this is happening is that Obamacare prohibits insurance companies from turning away customers with pre-existing conditions. So instead they need to find cleverer ways of making sure they're someone else's problem. David Henderson comments:

I predict that none of this will cause Kevin Drum to reconsider his pre-existing view that pricing for pre-existing conditions should be illegal.

Quite right. When it comes to Obamacare, there are two kinds of people. Henderson is the first kind. Whenever they hear about a problem, their invariable response is that this proves Obamacare is a hopeless mess and needs to be abandoned.

I'm the second kind. When I hear about a problem, my response is that we need to try to fix it. This is because I believe everyone should have access to decent health care at a reasonable price, and one way or another, we need to figure out how to provide it. We don't give up just because it's hard.

For what it's worth, this particular problem is not something that's taken any of us by surprise. Capitalism has a well-known capacity for motivating people to find clever ways to make money, and Obamacare supporters were all keenly aware that insurance companies would try to game the rules to maximize their profits. It was one of those things that required constant vigilance. Unfortunately, that never happened because it turned out that Republicans in Congress are so uncompromisingly opposed to Obamacare that they've prevented problems of any kind from being addressed, apparently in the hope that someday these problems will grow serious enough that the public will turn against the whole thing.

I guess you can decide for yourself if you consider that a praiseworthy response to a law you don't like. I consider it loathsome myself. As for my pre-existing view about pre-existing conditions, that's easily explained. I supported Obamacare as a good first step, but if I had my way the whole edifice would get torn down and replaced with a sensible national health care plan of the kind used by virtually every other civilized country on the planet. This is because health care of the kind that civilized people desire simply isn't a good that can be efficiently provided by the free market, for reasons that are fairly obvious to anyone familiar with the literature. Nor is this just an academic point. Half a century of experience shows us that national health care works better on nearly every measure than our Rube Goldberg system. It's not perfect, because nothing ever is. But it would be a big step forward.

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The Great "Out-0f-Network" Scam Is Eating Patients Alive. And It's Supposed To.

| Mon Sep. 22, 2014 10:36 AM EDT

Over the weekend, Elizabeth Rosenthal gave us the latest installment in her series of rage-inducing stories about the American health care system. Like all the others in the series, it was all but ignored by the rest of the world. I guess everyone was too busy panicking over the White House fence jumper or figuring out ways to one-up each other in their withering scorn for Roger Goodell.

Or, like me, they've just given up even hoping that anyone will ever do anything about it. Saturday's installment was about a medical practice that infuriates me more than almost any other: the routine practice of creating artificial and insanely high "list prices" for procedures that bear no relation to reality and exist for only one reason: to occasionally take advantage of the people who are most vulnerable to abusive pricing. That includes the uninsured, who can least afford it, and those who are already on the gurney going into surgery, who are barely in any condition to fight back.

Rosenthal's latest piece is about the increasingly common practice of calling in "assistants" during surgical procedures who aren't covered by the patient's insurance and are therefore not subject to rates negotiated with the insurance company. This allows them to charge as much as they feel like, and then to harass patients with bill collectors forever unless they pay up. Here's a graphic that accompanied the article:

The stomach-turning part of this is that it's so obvious what's going on. Clearly, the muscle and skin graft in the first example can be done for about $2,000, which produces a decent income for the doctor. So what's the reason for the list price topping $150,000? There isn't one. It's solely so doctors can scam the occasional patient and make a fast buck. As long as it's not a Medicare or Medicaid procedure, and it's out-of-network, there are no rules. So why not?

Are these assistants pals of the primary surgeon who get called in occasionally as a wink-wink-nudge-nudge buck-raking favor for a friend? Does it happen more randomly than that? Who knows. But there's a limit to what patients can do. They're in prep for surgery, there are tubes in their arms, and they get handed a bunch of papers to sign. Who knows what they say? Are they going to check? Are they going to read all the fine print? No and no, even if they're aware that this kind of stuff can happen. Which most patients aren't. A few weeks later they get the bill and their jaw drops to the floor. It's the same thing that happens to uninsured patients who don't have the benefit of insurer-negotiated rates when they land in the ER.

And there's virtually no way to negotiate anyway. Have you ever tried to mark up a consent form? Have you ever tried to get a hospital to agree to an out-of-pocket max before an operation? Are you laughing hard enough yet? Insurance companies can do this, but ordinary schlubs like you and me can't.

This is a scam, plain and simple. So why does it continue? Let's allow James J. Donelon, the Republican insurance commissioner of Louisiana, to explain:

This has gotten really bad, and it’s wrong. But when you try to address it as a policy maker, you run into a hornet’s nest of financial interests.

And there you have it. It's a great racket that allows doctors to extort loads of money from those in the most pain and with the least ability to fight back. None of them want the gravy train to end, and that's your "financial interests" right there. It's shameless and venal and there's no excuse for it. And that's America's health care system.

In good conscience, I'm not even sure I can recommend that you read the whole piece. It will probably send your blood pressure skyrocketing and possibly send you to the ER, where you'll be pauperized by the very practice the article is about. You have been warned.

Watch John Oliver Explain Just How Mind-Bogglingly Ridiculous Beauty Pageants Are

| Mon Sep. 22, 2014 9:57 AM EDT

Beauty pageants are a pretty insane and demeaning thing for us to still be doing as a society in 2014. I mean, yes, Miss Congeniality was an OK film, but the sequel was awful. Also, the whole thing—beauty pageants, not the Miss Congeniality franchise—sort of stinks of sexism and mores best left to rot in the '50s.

Here's John Oliver taking the Miss America pageant (and its somehow more mockable competitor Miss USA) to task.

Also read: "Are Disney Princesses Evil?"

This Afghan Policewoman Died Fighting the Taliban. Now Right-Wingers Are Desecrating Her Photo.

| Mon Sep. 22, 2014 6:00 AM EDT

Malalai Kakar was a police officer in Afghanistan. She was also a mother of six, a feminist, and a fearsome threat to the Taliban, who gunned her down in 2008. You would know some of Kakar's story if you'd come across Lana Šlezic's captivating photography of women in Afghanistan in Mother Jones and other publications. But the right-wing Britain First party recently co-opted a photo of Kakar—taken in 2005 just before she headed out on a raid to free a kidnap victim—using it as propaganda in the online "ban the burka" campaign. Its August 30 Facebook post using the image has been shared more than 44,000 times. The photo didn't make headlines though until Friday, when Australian senator Jacqui Lambie of the Palmer United Party (created in 2013 by mining magnate Clive Palmer) shared the photo on her Facebook page, prompting news outlets to ask Šlezic whether she was aware how her photograph was being used.

Šlezic's original image as it appeared in the July/August 2007 issue of Mother Jones
 

Šlezic was appalled. "The way her image has been misused for inflammatory purposes has left me, well, somewhat speechless," she says. She immediately contacted both Britain First and Lambie asking them to remove the photo, but neither has complied. Lambie told the Sydney Morning Herald that she "absolutely stands by it" and won't take the photo off her page. On Saturday she posted a "Letter to the Editor" on Facebook calling Šlezic's response a "gross over-reaction," adding that "Malalai Kakar would have been the first to agree with my call to ban the burka."

Šlezic told the Independent, "It's a complete misrepresentation of the truth. It insults everything she stood for, it insults her and her family and suggests a story that is opposite of the truth. It is also an infringement of intellectual property." She has filed a copyright complaint with Facebook.

Šlezic spent two years in Afghanistan documenting the plight of women and girls, and her Mother Jones photo essay including Kakar's image was a National Magazine Award finalist in 2008.

During my two years in Afghanistan, I spent time with Malalai and her family on several trips to Kandahar. I spent time with her in her office while she consoled and helped women who were victims of domestic violence, rape, and forced marriage. I went out on a kidnapping raid with her, witnessed her apprehending a kidnapper and freeing the young teenage girl from his home. She really was a heroine for me, the light at the end of a very dark two year tunnel. Because of her, I believed there was hope for Afghan women and girls. When she was assassinated by the Taliban in September 2008 in front of her home and child, that hope, that light was extinguished.

Šlezic adds a plea to the public:

I'm asking you to lend your voice, your thoughts, your tweets and whatever else you can to send a message back to these people who without consent, without thought, without pause posted such a vulgar misappropriation of Malalai and everything she stood for. She was an extraordinary human being who fought for the rights of Afghan women and girls. Her memory should be respected.

Malalai Kakar
Lt. Colonel Malalai Kakar (left) counseling a woman in her office Lana Šlezic

Stereolab's Laetitia Sadier Delivers a Captivating New Solo Album

| Mon Sep. 22, 2014 6:00 AM EDT

Laetitia Sadier
Something Shines
Drag City

 

Best known as the singer for the long-running British-French band Stereolab—now on an indefinite hiatus—Laetitia Sadier has always been able to address pointedly political and deeply personal concerns with equal eloquence. The debut of Sadier's side project, Monade, was titled Socialisme ou Barbarie, while her first solo outing, The Trip, was her attempt to come to grips with her sister's suicide. On this captivating third solo album, she continues to range far and wide, mixing acoustic sounds with the retro-futurism that made Stereolab's electro-pop so inviting. Whether asking tersely, "Do the rich need the poor to be rich?" on "Oscuridad," or accentuating the positive on the soaring, Beach Boys-inspired "Life Is Winning," her serene, lovely voice is a remarkable oasis of calm that's sure to make you feel better about things to come.

Roger Goodell's Life Just Got a Whole Lot Worse This Weekend

| Sun Sep. 21, 2014 3:40 PM EDT

There's been a mountain of talk about the Ray Rice domestic violence case, but the evidence about exactly what happened and when it happened has remained stubbornly fuzzy. That changed this weekend. ESPN's blockbuster piece, like all stories of this nature, relies a lot on unnamed sources and therefore still isn't quite rock solid. Unnamed sources can have their own agendas, after all. But on the surface, anyway, it seems pretty damn close to rock solid. And it looks very, very bad for Roger Goodell, the Baltimore Ravens, and the NFL. Read it.

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How Can The Atlantic Give Us 5,000 Words on Prison Life Without Interviewing Prisoners?

| Sun Sep. 21, 2014 1:34 PM EDT

As someone who writes about prisons, and who two spent years behind bars, I devour nearly everything written about it, especially the long-form stuff. So I was excited when I saw that The Atlantic’s latest issue had a major story called “How Gangs Took Over Prison.”

Then I read it. Anyone who has ever survived anything traumatic—domestic abuse, rape, torture, war—knows the particular jolt that happens in the body when someone makes light of that thing that you once thought could destroy you. I am a former prisoner—I was held captive in Iran from 2009-2011—and a survivor of solitary confinement. In my experience as a reporter who writes about prisons, it is surprisingly rare that I come across people outside of the prison system who justify long-term solitary confinement. Even within the world of prison administrators many are against it. The last two times I’ve attended the American Correctional Association conferences, there have been large, well attended symposiums on the need to curb the use of isolation.

Graeme Wood, the writer of the Atlantic story, gives a different impression of the practice. He visits Pelican Bay State prison, which probably has more people in solitary confinement for longer periods than any other prison in the world. He goes to the Security Housing Unit, or SHU, where people are kept in solitary confinement or, as he gently puts it, are “living without cellmates.” When he enters, he says it’s “like walking into a sacred space” where the silence is “sepulchral.” The hallways “radiate” and the prisoners are celled in the “branches of (a) snowflake.” Beautiful.

It’s difficult to understand why Wood does not find it worth mentioning that the cells in those snowflakes are each 7x11 feet and windowless. Men literally spend decades in those cells, alone. I’ve been to Pelican Bay, and wrote a story about it in 2012. I met a man there who hadn’t seen a tree in 12 years. Wood tells us categorically that everyone there is a hard-core gang member. This is what the California Department of Corrections consistently claims, but if Wood did a little digging, he would find that number of the prisoners locked away in the SHU are jailhouse lawyers. There are people like Dietrich Pennington who has been in the SHU for six years because, in his cell, he had a cup with a dragon on it, a newspaper article written by another prisoner, and a notebook filled with references to black history, which a gang investigator counted as evidence of gang ideology. People get locked away in the SHU based on all kinds of flimsy evidence that doesn’t involve violence. I won’t say it’s a breeze to get ahold of the documentation of this stuff, but it’s not anything a seasoned reporter like Wood couldn’t handle.

Keep in mind that the UN considers solitary confinement for anything more than 15 days to be torture or cruel and inhumane treatment. University of California-Santa Cruz psychology professor Craig Haney did a review of psychological literature and found that there hasn't been a single study of involuntary solitary confinement that didn't show negative psychiatric symptoms after 10 days. He found that a full 41 percent of SHU inmates reported hallucinations. The corrections department’s own data shows that, from 2007 to 2010, inmates in isolation killed themselves at eight times the rate of the general prison population.

Wood, on the other hand, makes the experience of living in one of those cells sound transcendental. It is as if everyone is “on one of those interstellar journeys that span multiple human lifetimes.”

It’s hard to know where that impression came from because, in his story on prison gangs, Wood doesn’t interview prisoners. Well, that’s not completely true. He does go to the doors of several inmates’ cells—with prison staff—to ask them about prison gangs, then tells us breathlessly that almost no one would talk to him. Wood travels to England to interview a scholar on prison gangs, but there is no indication that he attempted to conduct a single serious interview with a prisoner. Not that California makes this easy—since 1996, the state has given prison authorities full control over which inmates journalists can interview in person. But still, you can write to anyone. Nearly every one of the dozens of people I’ve written in the SHU have eagerly written back.

Wood tells us that no prisoner can talk about gangs because doing so would mean death. Yet there are plenty who do. I’ve had inmates break down gang culture to me in letters, and I didn’t even ask them to. There are whole wards in prisons for gang dropouts, many of which are eager to talk about the life they left behind. There are former prisoners like Andre Norman who used to be in gangs and now make their living by exposing gang culture. These people are primary sources that could have given Wood intimate details and a nuanced understanding. They’d also tell him about what it’s like to live in a place like Pelican Bay, though chances are he wouldn’t find anyone who would describe living in the SHU as “interstellar.”

It’s remarkable that a publication as reputable as The Atlantic would run such a thinly sourced story. Its 5,000 words are based almost entirely on four sources: an academic, the spokesperson of Pelican Bay, the warden, and the gang investigator. Wood prints their claims straight away. At the beginning of the story, for example, Wood is standing with the prison’s spokesperson, Lt. Chris Acosta, and together they are looking out onto the yard, observing prisoners and their behavior. Then he quotes Acosta saying, “There’s like 30 knives out there right now. Hidden up their rectums.”

Well hold on a second. How did Acosta know that? Did Wood verify this? How did his editor let that one slide?

Claims like this make what could be an interesting story hard to trust, and the piece is full of them—the size of the bar of soap on an inmate’s sink indicates what kind of phone he shoved up his ass; requests for halal food are a way to “create work for the staff” rather than a sign of religious conviction. Since when does this pass as acceptable journalism? Prison reporting is tricky, sure. When I reported on Pelican Bay, I had to take pains to verify every claim a prisoner made through extensive documentation or verification by prison officials. No good journalist would print a claim made by an inmate about a guard, for example, without carefully corroborating it. Many prisoners have an agenda. But so do guards and wardens. Prison officials have a long record of trying to stymy public inquiry. I was recently booted from a prison convention—for which I was registered—for my reporting. When you have two sets of people, like inmates and prison administrators, who each have interests in misrepresenting each other, you make every effort to verify their claims about each other. Those are the ground rules of journalism.

One last thing. Jokes about things in prisoners’ asses are not funny. In a presentation for Wood, a gang investigator likens gang leaders to 1980s Chrysler chairman Lee Iacocca. As an aside to us readers, Wood quips, “I have found it impossible to look at a picture of Iacocca without imagining him stuffing his cheeks and rectum with razor blades.” It sickens me that I am meant to laugh at this. 

Friday Cat Blogging - 19 September 2014

| Fri Sep. 19, 2014 2:47 PM EDT

We have a very busy squirrel in our backyard. He is tireless in his quest to find pine cones and bury them in our garden. In fact, every time Marian goes out to do some gardening, she routinely digs up half a dozen pine cones. They're everywhere. But squirrels are squirrely little critters, and it's hard to catch them in the act. Yesterday, however, our local squirrel was zipping across our fence with a pine cone in its mouth, and stopped just long enough for me to acquire hard photographic evidence of his hardworking ways. If I were a squirrel, I'd spend my autumns just keeping an eye on this guy so that I could pilfer his treasure during winter.

In other news, certain of my family members were annoyed with my choice of catblogging photo last week. They wanted the picture of Mozart snoozing on my mother's car with his face reflected in the paint job. Well, patience is a virtue, and this week that's the picture you get. As for next week, who knows? Perhaps by then we'll no longer have a need for guest cats.

Quote of the Day: Nathan Deal Is Tired of Barack Obama's Treachery

| Fri Sep. 19, 2014 1:26 PM EDT

From Georgia Gov. Nathan Deal, apparently upset that his tax-fighting economic policies aren't yet producing a paradise on earth:

It’s ironic that in a year in which Republican governors are leading some of the states that are making the most progress, that they almost, without exception, are classified as having a bump in their unemployment rates. Whereas states that are under Democrat governors’ control, they are all showing that their unemployment rate has dropped. And I don’t know how you account for that. Maybe there is some influence here that we don’t know about.

Maybe! It might be that the Obama administration is cooking the books to make Republicans looks bad. Or maybe Democrats in Georgia are deliberately refusing work in order to spike the unemployment numbers. Or—and this is my suspicion—maybe computers have finally acquired human-level intelligence and they don't like Nathan Deal! If I were a computer, I sure wouldn't.

When I Was 5, I, Um -- What Were We Just Talking About?

| Fri Sep. 19, 2014 1:06 PM EDT

I remember approximately diddly-squat1 about my childhood. But why? Melissa Dahl explains the latest research to me today:

The way parents tend to talk to their sons is different from the way they talk to their daughters. Mothers tend to introduce more snippets of new information in conversations with their young daughters than they do with their young sons, research has shown. And moms tend to ask more questions about girls’ emotions; with boys, on the other hand, they spend more time talking about what they should do with those feelings.

This is at least partially a product of parents acting on gender expectations they may not even realize they have, and the results are potentially long-lasting, explained Azriel Grysman, a psychologist at Hamilton College who studies gender differences and memory. “The message that girls are getting is that talking about your feelings is part of describing an event,” Grysman said....“And it’s quite possible, over time, that those tendencies will help women establish more connections in their brains of different pieces of an event, which will lead to better memory long-term.”

So I can blame my crappy memory on my mother? Cool.

1This is a technical term used by neurologists and memory researchers.