Kevin Drum - March 2010

Skin in the Game

| Thu Mar. 4, 2010 1:25 PM PST

Time's Barbara Kiviat is on a new healthcare plan:

I used to be charged co-pays. About $25 a pop for office visits. Now I am under a system of co-insurance. After my yearly deductible, I pay 10% of all my health care costs, up to an annual out-of-pocket maximum.

This has immediately changed my behavior. I hurt my ankle a while back, but how I did that and what is ultimately causing the pain is a mystery. My first foot doctor was stumped. I went to see another one a few weeks ago and [...] one of the technicians fetched me for an X-ray. I asked how much the X-ray would cost. He said he didn't know, but he could try to find out... or would I just like to wait and see the doctor first? I said I'd wait.

The doctor came in and asked me a few questions. I explained that I'd been to another doctor. I repeated what that doctor had told me about the X-ray I'd had at his office. My new doctor examined me and told me that another X-ray wouldn't tell him what he needed to know. And that was how I prevented my very first unnecessary medical test.

Kiviat is a fan even though the new plan costs her more than the old one. Just knowing how much everything costs — and being responsible for a chunk of it — makes her a better healthcare consumer.

Now, before the HMO/PPO revolution, this sort of plan was pretty standard and healthcare costs skyrocketed anyway. What's more, since a big part of healthcare spending is for emergency services that nobody shops around for and big ticket items that exceed the out-of-pocket caps on these plans, it's not clear how much this kind of "skin in the game" would really save. Still, with some caveats that I won't go into right now, I think this is a good idea. Even if the effect on healthcare inflation were modest, that's better than nothing. And taming healthcare costs isn't going to be done with one big idea; it's going to be done by implementing a whole bunch of little ideas that each have a small effect.

Still, as Kiviat notes, a minimum requirement for making this work is knowing how much healthcare costs you in the first place. And this is something that really does, in theory, have bipartisan support: Democrats and Republicans both say that doctors and hospitals should be transparent about the cost of all the various procedures they offer. And Rep. Steve Kagen (D–Wisconsin) has introduced a bill that would require just that. It says that healthcare providers shall:

publicly disclose, on a continuous basis, all prices for such items, products, services, or procedures in accordance with this section....The disclosure required under subsection (a) shall be made in an open and conspicuous manner; be made available at the point of purchase, in print, and on the Internet; and include all wholesale, retail, subsidized, discounted, or other such prices.

And there's the rub. There is no "price" for an ankle X-ray. There are only prices. If Kagen's bill were law, Kiviat would have been confronted with something like this:

X-Ray, Ankle, Single View

Medicare: $145
Medicaid: $98
Aetna: $156
   • With bundling discount: $141
Anthem Blue Cross: $157
   • After March 18, 2010: $203
Cigna: $168
Uninsured: $578
   • Discounted price if you complain hard enough: $275
   • Discounted price if you complain even harder: $198
Etc.

Actually, it would be way more complex than that. But you get the idea: it's not as simple as it sounds. However, this might be a feature, not a bug. Not only might healthcare consumption be improved by making prices transparent, but it might be improved by showing everyone just how arbitrarily different people are treated depending on what kind of insurance they have. It's worth a try.

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The Right's Latest Derangement

| Thu Mar. 4, 2010 12:16 PM PST

One of the things that I'm simultaneously impressed and repelled by is the right's ability to invent bizarre new smears where ordinary people would see no potential at all. How do they do it? The latest example comes from John McCormack at the Weekly Standard, whose headline blares:

Obama Now Selling Judgeships for Health Care Votes?

Where does this come from? It turns out that Obama has nominated University of Utah law professor Scott Matheson to a judgeship on the Tenth Circuit Court of Appeals, and Matheson is the brother of a congressman, Jim Matheson, who will be voting on healthcare reform in a couple of weeks. "The timing of this nomination looks suspicious," McCormack says darkly. The acerbic Jon Chait, after noting Scott's stellar qualifications, comments:

McCormack, before proceeding to speculate that the nomination is intended to pay off his brother, does concede, "Matheson appears to have the credentials to be a judge." Come on, let's not be so naive here. Sure, he's a Stanford alum, Rhodes scholar, Yale Law School graduate, Harvard profesor, U.S. Attorney, and law school dean. Maybe that makes him "qualified" by the rock-bottom standards of this administration, even if he's no Harriet Miers.

The real problem here, I think, is that McCormack isn't really cut out for this kind of thing. This is Glenn Beck material, as he demonstrates so eloquently in his response to the news about Matheson: "Can I tell you something. How many times does someone from Utah need to be the linchpin that almost destroys the Republic?"

Now that's the ticket! Forget about healthcare and pivot immediately into some grand conspiracy theory about the role of Utah in the destruction of the Republic. Beck is even a Mormon, but he doesn't let that stop him. That's what we all admire about the guy.

Anyway, terrific stuff. Enjoy it while you can, because tomorrow it will be something new.

Grammar, Commas, and You

| Thu Mar. 4, 2010 11:29 AM PST

Today is, apparently, National Grammar Day. James Joyner, in the course of musing on changes over his lifetime, says:

I never know where to put a comma anymore. We’ve certainly become much stingier in their use in recent years. The trailing comma in lists, for example, is gone.

Not on this blog, pal! I'll use the Oxford comma til the day I die. Never let The Man take away your commas.

Gossip Alert

| Thu Mar. 4, 2010 11:04 AM PST

Via Drudge via Twitter, here's the latest from gossip site Radar.com:

EXCLUSIVE: John Roberts, Chief Justice of the United States Supreme Court, is seriously considering stepping down from the nation’s highest court for personal reasons, RadarOnline.com has learned exclusively.... RadarOnline.com has been told that Roberts, 55, could announce his decision at any time.

This is, obviously, not true.1 But what I'm curious about is where something like this comes from. When it's celebrity gossip, you figure it comes from one of the thousands of sycophants and hangers-on that infest Hollywood and the celebrity world in general. But the Supreme Court? Who the hell peddles phony gossip about the Supreme Court?

1Yes, yes, maybe it is true. Then I'll eat my words. But come on.

UPDATE: Question answered! It came from a Georgetown law professor who was playing a trick on his class. Apparently all it took was a quick text message from a student for this to hit the big time.

Allow a Vote!

| Thu Mar. 4, 2010 10:17 AM PST

Yesterday at the big White House healthcare rollout, we got this:

President Obama, beginning his final push for a health care overhaul, called Wednesday for Congress to allow an “up or down vote” on the measure, and sketched out an ambitious — and, some Democrats said, unrealistic — timetable for his party to pass a bill on its own within weeks.

Why have we all adopted this "up or down vote" language? Doesn't it obscure the real point, mainly that what we want is just a vote, period? The whole point of a filibuster, after all, is to extend debate so that the Senate never gets to vote on the bill in question. Shouldn't Obama simply be saying that "we deserve a vote" or some such thing? Wouldn't that make more sense to the average viewer?

Google Wins Again

| Thu Mar. 4, 2010 9:17 AM PST

Guess what? This is my first blog post written on Chrome. Looks pretty much the same, doesn't it?

We'll see how it goes. Firefox generally works fine, but I finally got tired of the performance problems. Too many sites these days seem to have scripts or code that freewheel forever, sucking up so many CPU cycles that they bring the entire browser to a screeching halt. The Wall Street Journal is especially bad on this front, but plenty of other sites do it too. Chrome seems to be a bit better on this score, so I'm giving it a try.

Sadly, AdBlock doesn't seem to work as well as it does on Firefox, so I have to put up with more ads than I used to. But maybe that will improve.

Got any advice for me? Leave it in comments. I'm thinking about getting a new email client too that has a better search capability than Thunderbird. Feel free to offer recommendations.

UPDATE: Well, that was a short-lived experiment. Turns out that our blogging software doesn't play well with Chrome, and I don't feel like keeping two browsers open all the time, so it's back to Firefox. Sic transit etc.

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Pay No Attention to the PowerPoint Behind the Curtain

| Wed Mar. 3, 2010 4:55 PM PST

You know, when liberals claim that conservatives are rabid reactionaries motivated by fear, hatred, and greed, they say we're a bunch of coastal elitists who are out of touch with the feelings of real Americans living in the heartland. But guess what? In the privacy of their own fundraising PowerPoint presentations, it turns out that Republican Party honchos describe their base pretty much the same way:

The small donors who are the targets of direct marketing are described under the heading “Visceral Giving.” Their motivations are listed as “fear;” “Extreme negative feelings toward existing Administration;” and “Reactionary.”

Major donors, by contrast, are treated in a column headed “Calculated Giving.” Their motivations include: “Peer to Peer Pressure”; “access”; and “Ego-Driven.”

So who do you think should be more offended by this: small donors or major donors? I say major donors. The small givers are characterized as fearful and reactionary, and who knows? They might actually glory in that description. ("Reactionary? Hell yeah.") But the major donors who are supposedly motivated by peer pressure, access, ego, and greed? It's possible that their egos are so big they'll just assume this applies only to other major donors, not them, but probably not. If I were them, I'd be pretty pissed.

In any case, pay no attention to all this. "Chairman Steele did not attend" the presentation an RNC flack assures us. "Obviously, the Chairman disagrees with the language and finds the use of such imagery to be unacceptable. It will not be used by the Republican National Committee — in any capacity — in the future," he said. Click the link to see just what "imagery" he's talking about.

Healthcare and Hard Votes

| Wed Mar. 3, 2010 4:11 PM PST

One of the great tensions in the politics of healthcare reform is between what's good for the Democratic Party and what's good for individual members of Congress. On the former, I think you can make a pretty strong case that passing reform is a net benefit for the party as a whole: Dems are going to suffer the downsides of supporting healthcare reform no matter what happens, but if it passes at least they have an accomplishment to their credit that they can try to sell. Without that, they just look completely hapless.

Now, I think this is a pretty strong argument, but it's obviously a debatable one. In the case of individual members of Congress, however, there's just no question about it: there are certain Democrats in conservative districts who are going to suffer if they vote for reform. Maybe even lose a seat they might otherwise have won. That's what happened to Marjorie Margolies-Mezvinsky when she provided the 218th vote for Bill Clinton's tax-raising budget in 2003. Karen Tumulty catches up with her today:

Margolies insists that she did the right thing. What was wrong was with politics itself, she says. The bill was at least 80% grounded in Republican-backed ideas, and had been endorsed by Fed Chairman Alan Greenspan. The fighting over that last 20% was "heartbreakingly partisan to me, and I'm very much a centrist," she recalls. "It just infuriated me."

She thinks it has only gotten worse since she left Congress. "What has happened is the minority has taken over," Margolies insisted. "Democrats don't frame as well as Republicans do. [And for Democrats,] this is the vote that is going to get a tremendous amount of play in their districts."

Margolies thought that she could make her constituents understand why she had made the choice she did. But she underestimated the power of the sound bite. "I was really good at the four-minute explanation when I went back back to the district," she says. "But it's the Frank Luntz 30 seconds that kills you." She notes ruefully that her name has become shorthand in Washington for committing political suicide. "I was a terrible politician. It was a drive-by," she says. "I never thought I'd become a verb."

Now, you can take two lessons from this. The first is that Margolies did indeed commit political suicide with her vote. The other is that 1994 was a Republican tidal wave and she would have lost her seat regardless. But make no mistake: Margolies is the example that haunts a lot of fence-sitting Democratic congressmen today. In the end, I think healthcare reform will probably pass, but it's going to come down to a handful of individuals making very difficult, hardheaded decisions about their own personal futures. It won't be easy.

Tom Friedman: Good or Evil?

| Wed Mar. 3, 2010 2:57 PM PST

Tom Friedman devotes today's column to a "public service": bringing Intel CEO Paul Otellini's concerns about the federal tax code to the broader public:

“The things that are not conducive to investments here are [corporate] taxes and capital equipment credits,” he said....If the government just boosted the research and development tax credit by 5 percent and lowered corporate taxes, argued Otellini, and we “started one or two more projects in companies around the country that made them more productive and more competitive, the government’s tax revenues are going to grow.” With the generous research and development tax credits and lower corporate taxes they receive, Intel’s chief competitors in South Korea basically have “zero cost of money,” said Otellini.

Matt Yglesias is gobsmacked: "Read today’s Tom Friedman piece and watch in amazement as he doesn’t even consider the possibility that Paul Otellini’s ideas might be motivated by anything other than a disinterested concern for the welfare of the American people." In other words, it's Friedman being Friedman. Here's an exasperated excerpt from my review of The World is Flat a few years ago:

He reprints entire PR messages from eager CEOs without any apparent sense that of course these guys think their companies are doing world-shaking things. I spent the decade of the 90s as a marketing executive at a software company, and these kinds of breathless paeans are sadly familiar to me.

But Friedman remains resolutely credulous in the face of these gales of corporate spin, and in the end, his corporate triumphalism becomes an idée fixe....Every CEO he talks to is brilliant, insightful, and far seeing. Raising his own everyday experiences to the level of epiphany is yet another. He figures out one day that Southwest Airlines allows you to print a boarding pass on your computer, and it immediately becomes a strained metaphor for a global convergence of technology and human psychology. The chairman of Starbucks tells him they offer soy milk because their customers asked for it, and he presents this mundane act of satisfying customer demand as something new and visionary.

This is what makes Friedman so infuriating. His basic thesis, as it often is, is fine in today's column: Education is important, innovation and entrepreneurship are important, and American competitiveness is important. Even his tin-earred penchant for oversimplification is understandable. It might drive me nuts, but he's writing for a wider audience than just people like me. So that's fine. But then there's his actual narrative, which is so interwoven with almost childlike reverence toward the banal sayings of the rich and powerful that it's enough to make you throw his books across the room and swear off reading forever. If I want to immerse myself in breathless corporate spin, after all, I can always turn on CNBC.

But here's the question that always gnaws at me: on balance, does Friedman do more good than harm? I genuinely don't know. He really does have a huge audience, he really does explain things in a way that probably appeals to a lot of them, and for the most part his hobbyhorses are basically decent ones: clean energy, climate change, dealing with globalization, improving education, etc. He's mostly given up his cheerleading for endless war, too. So does that make up for his corporate shilldom and other assorted sins? I'm not sure.

Tying a Rock to the Economy

| Wed Mar. 3, 2010 12:01 PM PST

Jim Bunning's ostensible reason for blocking the extension of unemployment benefits was one of fiscal rectitude: he wanted the benefits paid for instead of added to the deficit. For some reason I haven't noticed anyone pointing out how dumb this is, but CBPP does the job today:

The widespread and significant decline in economic activity that defines a recession ended sometime this past summer, and the economy is in the early stages of recovery. That is good news, but it does not mean that the economy no longer needs stimulus. The economy is just beginning to climb out of the longest and most severe recession since the Great Depression. Without additional stimulus, and soon, many economists fear that the pace of recovery will be particularly sluggish — and the economy could even fall back into recession.

....At a time when many people want to work but cannot find jobs and the demand for goods and services falls well short of what businesses are capable of supplying, the key to boosting economic activity and strengthening the fragile recovery is to create additional demand....For Congress to require contemporaneous cuts in federal spending or tax increases so that measures to boost the economy do not increase short-term deficits would be unwise and counter-productive — it would reduce the overall demand for goods and services and thereby partially or fully cancel out the economic boost that the recovery measures were designed to provide.

This is a little bloodless, as befits a policy shop full of economist wonks. So let's translate into bloggish: Bunning is a moron. The goal of stimulus spending is to increase the federal deficit. Paying for it misses the whole point. It's like putting high-test fuel in your car and then tying a lead weight to your bumper so you can't accelerate too fast.1

This is especially noteworthy in light of a recent research note from Joshua Aizenman and Gurnain Kaur Pasricha suggesting that "the aggregate fiscal expenditure stimulus in the United States, properly adjusted for the declining fiscal expenditure of the fifty states, was close to zero in 2009." That is, federal spending went up but state and local spending went down, for a net stimulus of zero. (Via Tyler Cowen.)

To sumarize, then: not only is Jim Bunning a cranky old man who held the entire Senate hostage just because he could, he's a cranky old man whose grasp of economics is nonexistent. And even at that, there were at least half a dozen Republicans who actively supported his cranky tirade and virtually none who did anything to actively fight it. Quite a party they have there.

1As CBPP points out, we should be doing something credible to rein in our long-term deficits. But that has very little to do with running short-term deficits to fund emergency stimulus during a recession.