Kevin Drum

Americans Wildly Overestimate the Impact of Routine Mammographies

| Thu Apr. 17, 2014 9:46 AM PDT

Aaron Carroll passes along the following stunning chart about the actual efficacy of routine breast cancer screening on 50-year-old women:

Obviously, there are circumstances where routine screening is a good idea—perhaps if you have a family history of breast cancer or other specific risk factors. But the best recent evidence suggests that routine screening for all women has a negligible effect. At best, it's very slightly positive. At worst it's literally zero because false positives lead to interventions that themselves carry a risk of death.

The problem is that people don't believe this. They think that routine screening has a far greater impact than it really does. The perception of 50-year-old women is that routine screening saves the lives of about 80 women out of a thousand:

Therein lies the problem. If you think that breast cancer is going to kill 16% of all 50-year-old women in the next 10 years and that mammography makes a huge difference in the mortality rate, then you’re going to demand a universal screening program. Hell, I’d demand it if that were the case. Until we can change the perception of the public to more closely match reality, and make them realize that the harms may outweigh the benefits, we’re going to get nowhere in trying to make changes.

We're all complicit in the level of overdiagnosis in American health care. Over the past few weeks, I've probably gotten something like $20,000 worth of tests and other care—with more to come—in an effort to try and figure out why my breathing suddenly went south. I didn't push back on any of it, and the reason is obvious: when a doctor tells you that your problem might be an embolism or a bad heart or interstitial lung damage, then you damn well want to find out if it is. (It's not. We still don't know what's going on.)

Obviously an acute problem like mine is not the same as routine testing. But I do that too. I've resisted the routine colonoscopy so far because my risk profile is low, but I do get a biannual echocardiogram. Why? Because I have high blood pressure, high cholesterol, and a family history of cardio problems. Routine heart monitoring makes sense in my case.

Routine mammographies make sense too—for some women. But for all of them? The best evidence says it doesn't.

Advertise on MotherJones.com

Latest Gallup Result: 9-10 Million Newly Insured Under Obamacare

| Thu Apr. 17, 2014 8:38 AM PDT

Speaking of the uninsured, I inexplicably failed to blog about the latest Gallup results yesterday. Based on polling that goes through mid-April, Gallup now estimates that about 9-10 million people have gained insurance since Obamacare rolled out last year. If you assume that perhaps a million people lost insurance, that's a net increase of 8-9 million. Of this, about half gained insurance through the exchanges. The rest gained it through Medicaid and increased participation in employer plans.

I'm not going to try to analyze this number any further. It basically represents good news, since it's a higher estimate than we've seen before, and it also jibes with the recent Rand numbers suggesting a large rise in people covered by employer plans. Apparently the individual mandate is having a bigger impact on this than anybody predicted. However, it's one data point in a noisy series, and I suspect we still have to wait another month to get a reliable set of numbers from all the polling outfits. By the end of May, unless the various polls are in wild disagreement, I imagine we'll have a fairly good idea of just how big the impact of Obamacare has been so far.

UPDATE: Sorry, everyone else has been leading with a number of 12 million, so that's what I used. But the Gallup poll estimates that 4 percent of US adults are newly insured, not 4 percent of the entire country. That's in the range of 9-10 million. I've corrected the text.

Note, however, that this ignores children who are newly insured, either via exchanges or Medicaid. So the real number is probably a bit higher. Maybe in the 10-11 million range? It's hard to say. There are a lot of different surveys that are all measuring slightly different things, and they're all working on data that's still incomplete. That's why it's probably wise to wait another month or two before we get too confident in any of these numbers.

Is the Census Recount of the Uninsured a Legitimate Scandal?

| Thu Apr. 17, 2014 8:14 AM PDT

A friend of mine thinks the decision by the Census Bureau to change the way it counts the uninsured—which will make it more difficult to make pre and post-Obamacare comparisons—is sleazier than I give it credit for:

To me this is all about 2016. I think Democrats really want to be able to show a sharp contrast that will demonstrate the dramatic impact of an attempted repeal of the ACA, and stronger numbers on the uninsured would only help the ads that much more. The administration knows that a Republican president will be under terrific pressure to undercut and thwart the law regardless of its popularity (even if with as few fingerprints as possible) and that they will use whatever tools they have to do so. So 2016 is extremely important.

The reason I lost it is because even with independent agencies, there is a certain measure of influence. No, the executive doesn't have a large measure of direct control over independent agencies, but they damn sure know what they are doing — or at least somebody does. They don't operate in a vacuum. (Except, perhaps, some of the security services.) So, this is either:

  1. Something started years ago with a drop date of Spring 2014 that (a) no one picked up on until now and no one can derail the train; or (b) the executive saw coming and was willing to let it happen to help put the best read on the numbers in advance of 2016.
  2. Something that has been out there (sure, everything is "out there") but languishing, which the executive decided to speed up and put in place well before 2016. The goal was to get the most positive read on the numbers, so they indirectly applied pressure to the Census to put it in place — and since the Census wants it anyway there's really no stick here.

Of these, (1)(a) seems most implausible (even if certainly possible) and (2) seems most likely if 2016 is the primary issue. Thus, I am assuming that this is going forward with the executive's blessing on the timing, and a calculation has been made that the blowback — if any — will be among the right's base and they are already energized so this won't change the dynamic much.

And if my assumption is correct, I still think it's a cheap / too-cute-by-half tactic that I would be calling out if the roles were flipped.

I have a hard time buying this for several reasons. First, it is too cute by half. Obama's political shop is not the runaway train that, say, Chris Christie's apparently is. It's implausible to me that anyone there would give this more than a moment's thought before dismissing it. It's just too stupid.

Second, it's not at all clear that the change made by the Census will make Obamacare look better. We're still going to have a clean 2013-14 comparison, after all, just not a longer-term one. Besides, surely any number is better than one with such a big cloud around it that it's open to merciless attack. Especially when it's one that the boffins at the Census Bureau won't defend.

Third, there are loads of other numbers about the uninsured—Gallup, Rand, HRMS, etc. Playing games with the Census numbers won't change any of that.

Bottom line: I continue to think this is most likely something dreamed up by technocrats in the Census Bureau who were oblivious to the political implications. I'll acknowledge that the political implications are obvious enough that this is a little hard to believe, but that's where Occam's Razor takes me. In any case, Darrell Issa is sure to open hearings on this, so I imagine we'll hear from Census officials soon enough.

Putin: Eastern Ukraine is Really "Novorossiya"

| Thu Apr. 17, 2014 7:36 AM PDT

The Guardian reports that Vladimir Putin held a long, "meticulously stagecrafted" press conference today:

Accusing the Kiev authorities of pulling the country into an "abyss", he called on Ukraine to pull back its heavy artillery from the east of the country, asking: "Who are you going to use it against? Have you completely lost your marbles?"

....Putin referred to the region in question by its tsarist name "Novorossiya", or "New Russia", as it was referred to in the 19th century under tsarist rule, and suggested it was a historical mistake to hand it over to Ukraine.

"It's new Russia," he told millions of watchers "Kharkiv, Lugansk, Donetsk, Odessa were not part of Ukraine in Czarist times, they were transferred in 1920. Why? God knows. Then for various reasons these areas were gone, and the people stayed there — we need to encourage them to find a solution."

That does not sound very promising, does it?

Invading Crimea May Have Cost Russia $200 Billion So Far

| Wed Apr. 16, 2014 9:07 PM PDT

Russia's military actions are costing it dearly:

Russia's annexation of Ukraine's Crimea region last month and the instability it created in Russian financial markets were cited by government officials for record capital flight and sharply downgraded growth forecasts for the country. Finance Minister Anton Siluanov said that instead of projected 2.5% growth this year, Russia's economy might show no growth at all.

....U.S. and European sanctions to punish Russia for occupying and annexing Crimea have so far targeted only a few dozen officials and businessmen. But the prospect of broader penalties, such as a Western boycott of Russian oil and gas, have scared investors into cashing out their ruble-denominated assets for hard currency and taking their money abroad. Russia's foreign exchange reserves were drained of a record $63 billion in the first quarter of the year, Economic Development Minister Alexei Ulyukayev said Wednesday in an address to the lower house of the parliament.

....Russian stocks fell 10% last month, wiping out further billions in capital. The ruble has lost 9% of its value since the start of the year, boosting prices for the imported food and manufactured goods on which the Russian consumer market is heavily dependent. "The acute international situation of the past two months" was the cause, Ulyukayev said, referring to the Ukraine unrest.

That's a helluva big drop in economic growth. Just by itself, it represents a cost of $50 billion. Add in the flight of cash and the stock market decline, and you're somewhere in the neighborhood of $200 billion.

Is that enough to make Russia blink? Maybe not. But it hurts, and the prospect of losing even more has got to be enough to give even Vladimir Putin a few second thoughts.

An Update From Our 1 Percent World: Southern California Housing Edition

| Wed Apr. 16, 2014 11:24 AM PDT

The LA Times reports that the Southern California housing market is once again getting frothy:

But a deeper look at the market reveals a recovery divided between the rich and everyone else.

The market for high-dollar homes is hopping, with sales on the rise and buyers launching bidding wars. But sales of low- to medium-priced homes have plummeted during the same period — with many potential buyers priced out....Those declines came even as sales of high-end homes increased. Sales of homes costing $800,000 or more grew 12%, while sales of homes costing less than $500,000 fell at twice that rate.

...."We're getting multiple offers on just about everything," said Barry Sulpor, an agent with Shorewood Realtors in Manhattan Beach, where he said there is a new wave of tear-downs and new construction in prime beachfront locations. "The market is really on fire."

I think partly this is a bit of a statistical artifact: a lot of investors were buying cheap houses a year ago, figuring they could rent them out and make a killing. That didn't work out so well, and now a lot of those houses are back on the market. Long story short, some of the increase in low-end housing prices over the past year or two has been a bit of an investor-fueled mirage, and now reality is catching up to that.

Still, the overall picture is clear: At the lower end of the market, ordinary people have been increasingly locked out for a while, and that's still the case. Nor is it any surprise. After all, median wages have stagnated during the entire period that we so laughingly refer to as a "recovery." As always in our brave new 1 percent era, things are going pretty well for the rich. For the not-so-rich, not so well.

Advertise on MotherJones.com

In Red States, the Uninsured Are Up the Creek

| Wed Apr. 16, 2014 10:03 AM PDT

Gallup has previously reported a drop in the uninsurance rate among Americans following the rollout of Obamacare last year. Today, they broke down these numbers between states that embraced Obamacare by setting up their own exchanges and expanding Medicaid vs. states that have resisted implementing the law.

The results are no surprise. States that embraced Obamacare—which presumably were more committed to public health in the first place—had lower uninsurance rates to start with and saw bigger declines. The states that resisted were the ones with the biggest uninsurance problems to start with and saw only token declines. In fact, the decline in states that embraced Obamacare was more than triple that in the other states, 2.8 percent vs. 0.8 percent.

These numbers will change a bit over the next couple of months as things settle down and signups are complete, but the relative differences will almost certainly remain huge. Republican governors have been almost unanimously dedicated to sabotaging Obamacare and withholding health care from their own residents, and they've been successful. I hope they're proud of themselves.

LBJ Was Great. LBJ Was Horrible. Deal With It.

| Wed Apr. 16, 2014 8:43 AM PDT

David Greenberg and Michael Kazin are arguing about whether LBJ was a great president. Here is Greenberg's wrap-up:

Maybe our differences really come down to this: For Michael, the enormity of the Vietnam debacle is so great that LBJ must remain forever confined to a historical doghouse. In contrast, I would submit that we have to hold both Johnson’s great deeds and his terrible deeds in our minds at the same time. This uneasy position, I think, does more to invite or even demand continued attention to LBJ’s presidency from historians. And it implies a moral verdict on the man that is, in my view, ultimately more unsettling than a tout court denial of any esteem for him whatsoever.

Yes. A thousand times yes. There's no need to rate LBJ or any other president on a scale from 1 to 10. He was a great president in some areas and a terrible one in others. That's it. You can't put those two things in a blender and come to a single, homogenized conclusion, no matter how badly you want to.

This isn't like Mussolini making the trains run on time, or Hitler building the autobahn, trivial achievements that simply don't bear on either man's place in history. LBJ's domestic achievements were gigantic. His foreign policy failures were equally gigantic. That's it. That's what happened, and that's who he is. We just have to live with it.

In War, Truth Is the First Casualty

| Wed Apr. 16, 2014 8:00 AM PDT

David Herszenhorn reports that Tuesday marked yet another day of "bluster and hyperbole, of the misinformation, exaggerations, conspiracy theories, overheated rhetoric and, occasionally, outright lies" that have marked the Russian response to the crisis in Ukraine:

It is an extraordinary propaganda campaign that political analysts say reflects a new brazenness on the part of Russian officials. And in recent days, it has largely succeeded — at least for Russia’s domestic audience — in painting a picture of chaos and danger in eastern Ukraine, although it was pro-Russian forces themselves who created it by seizing public buildings and setting up roadblocks.

....To watch the television news in Russia is to be pulled into a swirling, 24-hour vortex of alarmist proclamations of Western aggression, sinister claims of rising fascism and breathless accounts of imminent hostilities by the “illegal” Ukrainian government in Kiev, which has proved itself in recent days to be largely powerless.

The Rossiya 24 news channel, for instance, has been broadcasting virtually nonstop with a small graphic at the bottom corner of the screen that says “Ukrainian Crisis” above the image of a masked fighter, set against the backdrop of the red-and-black flag of the nationalist, World War II-era Ukrainian Insurgent Army, which inflicted tens of thousands of casualties on Soviet forces.

Over the course of several hours of coverage on Tuesday, Rossiya 24 reported that four to 11 peaceful, pro-Russian “supporters of federalization” in Ukraine were killed near the town of Kramatorsk in eastern Ukraine when a mixed force of right-wing Ukrainians and foreign mercenaries strafed an airfield with automatic gunfire from helicopter gunships before landing and seizing control.

In fact, on the ground, a small crowd of residents surrounded a Ukrainian commander who had landed at the airfield in a helicopter, and while there were reports of stones thrown and shots fired in the air, only a few minor injuries were reported with no signs of fatalities.

Thank God we live in America, where this kind of thing doesn't happen.

Unsportsmanlike Conduct in the NBA Follows an Inverted U-Shaped Curve

| Tue Apr. 15, 2014 10:56 PM PDT

Over at 538, Benjamin Morris asks "Just How Bad Were the Bad Boys?" The bad boys in question are the Detroit Pistons basketball team of the late 80s, who had a reputation for being unusually aggressive on the court. Did they deserve their reputation? To test this, Morris looks at how many technical fouls they racked up, a good measure of unsportsmanlike conduct. In fact, he takes a look at the total number of technical fouls for the entire league, and finds that the number rose steadily until 1995 and then started a long-term decline.

I promise this is just for fun, but I've overlaid another line against Morris's chart. Not a perfect fit, granted, but not too far off, either. I'm sure a few of you can guess what it is, can't you?