Kevin Drum

Who's Going to Pay For the Latest Iraq War?

| Mon Sep. 22, 2014 2:00 PM EDT

Andrew Sullivan wonders why fiscal conservatives aren't asking some searching questions about the cost of the ISIS campaign:

The ISIS campaign is utterly amorphous and open-ended at this point — exactly the kind of potentially crippling government program Republicans usually want to slash. It could last more than three years (and that’s what they’re saying at the outset); the cost is estimated by some to be around $15 billion a year, but no one really knows. The last phase of the same war cost, when all was said and done, something close to $1.5 trillion – and our current travails prove that this was one government program that clearly failed to achieve its core original objectives, and vastly exceeded its original projected costs.

If this were a massive $1.5 trillion infrastructure project for the homeland, we’d be having hearing after hearing on how ineffective and crony-ridden it is; there would be government reports on its cost-benefit balance; there would be calls to end it tout court. But a massive government program that can be seen as a form of welfare dependency for the actual countries — Turkey, Iran, Jordan, Kurdistan — facing the crisis gets almost no scrutiny at all.

Yep. The only problem with Sullivan's post is the headline: "Does The GOP Really Give A Shit About The Debt?" Surely that's not a serious question? Of course they don't. They care about cutting taxes on the rich and cutting spending on the poor. The deficit is a convenient cudgel for advancing that agenda, but as Sullivan says, "it is hard to resist the conclusion, after the last few weeks, that it’s all a self-serving charade."

Indeed it is. And not just after the last few weeks. After all, if they did care, they'd be demanding that we raise taxes to fund the cost of our latest military adventure. Right?

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It's Time For Kansas to Rejoin the Real World

| Mon Sep. 22, 2014 1:27 PM EDT

The Republican governor of Kansas has pauperized his state in order to fund tax cuts for the rich, while the Republican Secretary of State is busily trying to game the midterm ballot to ensure the reelection of the current Republican senior senator. I'd think this was a parody from the Onion if I didn't know it was for real. I sure hope the good folks of Kansas finally manage to come to their senses this November.

Everyone Please Calm Down About the White House Jumper

| Mon Sep. 22, 2014 12:19 PM EDT

In response to the fence-jumper who got inside the White House before being apprehended, the Secret Service is considering the possibility of creating a larger "buffer zone" around 1600 Pennsylvania Avenue:

One proposal is to keep people off the sidewalks around the White House fence and create several yards of additional barrier around the compound’s perimeter. Another is to screen visitors as far as a block away from the entrance gates.

Petula Dvorak is outraged:

Now the Secret Service — which hasn’t exactly covered itself in glory the past few years — wants us to pay for its mistake, to once again intrude on more public space and make suspects out of millions of visitors, residents and office workers who come near the White House every day. To further encroach on the country’s most important values: our openness and our freedom.

The security gurus think they might want to keep people off the sidewalks around the nation’s most famous residence. Or maybe screen tourists a block away from the White House. They want to Anschluss even more public space to expand The Perimeter around 1600 Pennsylvania, amping up the feeling of hostility, fear and paranoia that already pervades the heart of our nation.

Dvorak speaks for me, and I hope she speaks for plenty of others too. This crap has just got to stop. We simply can't continue this endless series of insane overreactions every time something bad happens. Sometimes an incident is just an incident. In this case, the Secret Service needs to examine its procedures and probably tighten up a thing or two. That's it.

This is a case where no-drama Obama really needs to step in. For God's sake, let's dial down the drama on this whole affair. It's nowhere near as big a deal as it's being played up to be.

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.

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 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.

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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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.

Republicans Really, Really Want to Send Ground Troops Into Iraq

| Fri Sep. 19, 2014 10:44 AM EDT

I missed this NYT/CBS poll when it came out a couple of days ago, but a friend pointed it out to me this morning. I don't think much comment is necessary. It's pretty easy to see how the fight against ISIS is going to turn into a massive game of Munich-mongering and appeasement-baiting in short order. Yikes.