Kevin Drum

Here's Yet Another Rage-Inducing Scam in the American Health Care System

| Mon Sep. 29, 2014 1:03 PM EDT

Here is your statistic of the day:

The average salary of an emergency room physician was $311,000 in 2014, rising from $247,000 since 2010 — a period when many other types of doctors experienced declines in salaries, according to Merritt Hawkins, a physician staffing firm.

Why is this? A shortage of ER physicians? More emergencies? Higher standards for ER work?

Nope. Elisabeth Rosenthal's latest rage-inducing piece about America's health care system1 suggests the reason is far more corrupt. Apparently one of the great trends in American health care2 is to outsource ER staffing. This means that even if you're careful—possibly while in great pain or barely even coherent—to show up at an in-network ER covered by your insurance plan, there's a pretty good chance that the actual doctors who attend you aren't in your network. Naturally, this being American health care,3 you have no choice in this matter even if you're savvy enough to know about the whole in-network and out-of-network distinction. And as we all know, out-of-network docs in the American health care system4 are basically allowed to charge any prices they want. And they do.

This is a great scam for everyone. Presumably hospitals save money because freelance ER docs cost them less. And the ER docs cost less because they know they'll be able to run the ol' out-of-network scam on lots of patients, thus raking in the bucks. It's a win-win.

As a result, during a period of economic stagnation that produced zero wage growth for everyone else, ER docs are now making $64,000 more than they did four years ago. And they're doing this by preying on the most vulnerable, most easily scammable members of society: folks who are flat on their backs and almost by definition unable to understand what's going on around them. Not that it would matter if they did, of course. The law provides no recourse even if you don't like this system. That's the way things roll in the American health care system.5

If this kind of stuff doesn't make you pop a vein, I'm not sure what would. It's right on a par with the telemarketing ghouls who prey on senior citizens with dementia. Except that these guys wear white coats and are welcomed into all the best country clubs.

1Best in the World, Baby.™

2Best in the World, Baby.™

3Best in the World, Baby.™

4Best in the World, Baby.™

5Best in the World, Baby.™

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Republicans Once Again Favored to Take Control of the Senate

| Mon Sep. 29, 2014 12:00 PM EDT

Remember my post a couple of weeks ago saying that Republicans were no longer favored to take control of the Senate? Well, recent polls have not been kind to the Ds, and now everyone—including Sam Wang—agrees that Republicans are once again favored. Here's the Vox aggregation of aggregators:

You may now either celebrate or else sharpen up your seppuku knives, depending on your partisan leanings. But keep one thing in mind: two weeks ago, only one pollster out of six thought Republicans were favored. Today six out of six think Republicans are favored. Things can change mighty fast, and there's still more than a month to go before Election Day. Your guess is as good as mine whether Joni Ernst can go five consecutive weeks without letting the crazy show.

Obama Needs to Learn How to Admit Error on National TV

| Mon Sep. 29, 2014 11:10 AM EDT

So President Obama was on 60 Minutes last night. Steve Kroft asked about the meteoric rise of ISIS in northern Iraq:

Steve Kroft: How did they end up where they are in control of so much territory? Was that a complete surprise to you?

President Obama: Well I think, our head of the intelligence community, Jim Clapper, has acknowledged that I think they underestimated what had been taking place in Syria.

I can't find a full transcript to verify that this was the complete context surrounding Obama's remark, but I wonder what possesses him to do stuff like this? It's Management 101 that you don't throw folks under the bus (on national TV!) unless you have pretty convincing reasons for doing so. I mean, all he had to do was say that "we underestimated" what was happening in Syria.

This is really tone deaf. Even if the whole debacle really was Clapper's fault, it would still sound terrible to say so. Was this just a real-time flub? Or, after six years, does Obama still not understand how petty it sounds to try to deflect blame this way?

Obama Threatened Far More Often Than Any Previous President

| Sat Sep. 27, 2014 8:35 PM EDT

Carol Leonnig has a piece in the Washington Post today about a botched Secret Service response to a 2011 shooting at the White House:

The suspect was able to park his car on a public street, take several shots and then speed off without being detected. It was sheer luck that the shooter was identified, the result of Ortega, a troubled and jobless 21-year-old, wrecking his car seven blocks away and leaving his gun inside.

The response infuriated the president and the first lady, according to people with direct knowledge of their reaction. Michelle Obama has spoken publicly about fearing for her family’s safety since her husband became the nation’s first black president.

Her concerns are well founded — President Obama has faced three times as many threats as his predecessors, according to people briefed on the Secret Service’s threat assessment.

Gee, I wonder why?

A Very Special Friday Cat Blogging - 26 September 2014

| Fri Sep. 26, 2014 2:35 PM EDT

So. Marian and I paid a visit to our local shelter on Monday. We figured on adopting an adult cat. Maybe a calico, if one was available. So naturally we walked out with two kittens, one gray and white and the other black and white. They're brother and sister, 10 months old. For the moment, their code names are Miss Flopsy (on the left) and Mr. Mopsy (on the right). Soon they'll get permanent names, but we haven't decided yet what they'll be. Vickie and Bertie? Luke and Leia? Frankie and Ellie?

In any case, life is more exciting around here these days. There is much chasing and pouncing. So far they've both fallen off just about everything that's possible to fall off. My bookcases are a shambles. And eight hours of sleep at night is not really on the agenda.

But I know you all want to reward me for this act of catblogging heroism, don't you? And you can! If you haven't done it already, how about contributing a few bucks to the MoJo investigative fund? Please think of the kittens, won't you?

It only takes a minute to make your tax-deductible contribution, and you can give using your smartphone, tablet, or computer.

Flopsy and Mopsy thank you!

Chart of the Day: The Death of Print

| Fri Sep. 26, 2014 1:29 PM EDT

Here's a BLS chart that shows how much we spend on reading-related materials. But what does it mean? It's true that young folks spend less on reading material than anyone else, but that's mostly because of their complete non-interest in dead-tree magazines and newspapers. Also, presumably, because young folks spend less on everything than prosperous older folks.

But if you add up the books + e-readers category, young folks are spending nearly as much as anyone else. It's just not clear what they're reading. E-books? Longform articles? Blogs? TMZ? Hard to say. Then again, it's not clear what the older folks are reading either. It may be on paper, but it's probably not Shakespeare for the most part.

In any case, this shows fairly dramatically that print is dying. As we all know by now, young folks mostly prefer digital. And so do plenty of non-young folks like me. I occasionally have to read a print book, but I'm annoyed whenever it happens.

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Republicans Already Planning Big Fight Over Nominee They Don't Even Know Yet

| Fri Sep. 26, 2014 10:32 AM EDT

Attorney General Eric Holder announced his resignation yesterday. The tea party show horses are already in full war cry mode:

Sen. Ted Cruz (R-Tex.) issued a political call to arms for conservatives, saying that outgoing senators should not vote on the nominee during the post-election lame-duck session. “Allowing Democratic senators, many of whom will likely have just been defeated at the polls, to confirm Holder’s successor would be an abuse of power that should not be countenanced,” Cruz said in a statement.

This is pretty plainly part of Cruz's ongoing effort to be king of the tea party wing of the GOP, since it obviously makes no sense otherwise. Unless Cruz is suggesting that they should be banned completely, then of course business should be conducted during lame duck sessions. What else is Congress supposed to do during those few weeks?

In any case, since Congress has no intention of doing anything worthwhile for the next two years, this means they'll have plenty of free time for dumb fights that allow them to one-up each other for the tea party vote. The rules of the contest are simple: the dumber and more outrageous your rhetorical firebombs aimed at President Obama, the better you do. It's sort of like a video game for cretins. I'm sure it's going to be a barrel of fun.

South Carolina Cop Unloads on Unarmed Driver Reaching for His License

| Thu Sep. 25, 2014 9:01 PM EDT

This video of a traffic stop in South Carolina earlier this month was published yesterday, and it's been making the rounds today. You really need to watch it to get a sense for just how appalling it is, but in a nutshell, here's what happened. At about the 00:35 mark, a police officer stops a black guy at a gas station for a seat belt violation. Guy gets out of his car. Cop asks for his license. Guy reaches into his car to get it, and the cop instantly starts screaming at him and unloads several shots at point blank range.

Luckily, this cop was apparently a lousy shot, and the motorist is recuperating. But the most heartrending part of the whole thing is how apologetic the motorist was after getting shot for no reason. "I just got my license," he pleads. "I've got my license right here." Then: "What did I do, sir? Why did you shoot me?"

"You dove headfirst back into your car," the cop says. "I'm sorry," he apologizes abjectly. "I'm sorry."

Thank God this police car had a dash camera. If not for that, probably no one would have believed the motorist's story. As it is, Julian Sanchez says this video might finally be having a real effect on people:

Seeing an unexpected number of comments on conservative boards to the effect of: "Holy shit, I'm white and this would never happen to me."....My anecdotal gestalt impression is this SC shooting is actually a Road to Damascus moment for a nontrivial number of conservatives.

We can hope so. If neither Ferguson nor the Ohio Walmart shooting did it, maybe this finally will.

The Wild West Days of Pharmaceutical Sales Are Coming To an End

| Thu Sep. 25, 2014 2:55 PM EDT

Pharmaceutical sales reps used to spend all their time inviting doctors to Hawaii for "conferences" and giving out lots of free samples. But the times, they are a changing:

Kendall French used to pitch drugs to doctors who could prescribe them.

But many of those doctors now work for hospitals that don't give them final say over what is on the menu of medicines they can pick. So when the GlaxoSmithKline PLC saleswoman began plugging two new lung-disease drugs to a big San Diego hospital system this spring, it was to an administrator who doesn't see patients but helps write the menu, also called a "formulary," of approved medications.

....Ms. French's sales calls are part of a shift that is rewriting the drug-marketing playbook. As hospital systems get bigger, they are putting distance between their doctors and drug sellers, making it harder for pharmaceutical companies to get quick acceptance of newly approved medicines and putting pressure on profits.

Today, 42% of doctors practice as salaried employees of hospital systems, up from 24% in 2004, according to Cegedim Relationship Management, a marketing consultant.

This is yet another example of how the health care market should be viewed as a competition between buyers and sellers. In some cases, this means that a region with a small number of powerful insurers might have lower overall costs because the insurers (buyers) have a lot of bargaining power with doctors and hospitals (sellers). In the case above, it means that hospital consolidation can reduce costs because it gives hospitals (buyers) a lot of leverage with pharmaceutical companies (sellers).

In other words, it's complicated. Hospitals are responsible for some of the most egregious billing practices in the entire health care industry, but at the same time, they can also be responsible for helping to contain costs. This is because powerful hospitals are both sellers (when they're dealing with insurance companies) and buyers (when they're dealing with pharmaceutical companies). Sometimes they're the good guys and sometimes they're the bad guys. It might not be the greatest way of running a health care system, but it's what we've got.

Republicans Still Having a Hard Time Believing In Racism

| Thu Sep. 25, 2014 12:15 PM EDT

The chart below, from a recent PRRI survey, has gotten a fair amount of attention on the intertubes over the past couple of days:

Adam Serwer thinks the change between 2013 and 2014 is due to backlash from the Ferguson shooting, but I suspect that's only part of the story. The poll was done over the course of four weeks, and only the final week overlapped with the shooting of Michael Brown and its aftermath. Those folks in the final week would have had to change their opinions massively to produce the 5-10 point difference we see in the survey population as a whole.

So there's probably more to it, and that's a good thing. It suggests the shift in opinion might be more durable than one motivated by a single incident.

But I want to play partisan hack today and just focus on the far left bar, which shows that Republicans are far less likely than Democrats to think that blacks don't get a fair shake from the criminal justice system. At first glance, you might figure that's just demographics at work. Republicans are heavily white and old, and those two groups are the ones least likely to think blacks are treated unfairly.

But take another look. The mere fact of being Republican makes you less likely than even whites and seniors to believe blacks don't get fair treatment. Why? Call it the Fox News effect. If you're exposed day after day to Fox and Drudge and Limbaugh, it means you're being overwhelmed with the message that blacks are dangerous, blacks are thuggish, and blacks are forever whining about wanting special treatment. This message is so overwhelming that even after Ferguson, Republicans are far less likely than any other group to acknowledge the simple fact that blacks might occasionally get treated a little roughly by cops and DAs.

That's changed by ten points in the past year, so maybe there's hope. Perhaps Fox and the others have toned down their obsession with racial hot buttons over the past year. Perhaps.