Kevin Drum

Jerry Brown Should Sign California's Assisted-Suicide Bill

| Sat Sep. 12, 2015 2:15 PM EDT
Debbie Ziegler holds a photo of her daughter, Brittany Maynard, after a right-to-die measure was approved by the California Assembly.

Back in June, California Gov. Jerry Brown called a special session of the legislature to deal with highway funding and health care financing. That special session is now over, and no agreement was reached on either of those things. But that's no reason to waste a special session, and legislators did manage to pass bills on drone regulation, medical marijuana, climate change, oil spills, a Los Angeles County transit tax, family leave, racial profiling, and several other things.

They also took advantage of the fact that committee assignments are different during special sessions to resurrect an aid-in-dying bill that had failed earlier in the year:

The End of Life Option Act, which passed in the state Assembly Wednesday, would allow patients to seek aid-in-dying options so long as they are given six months or less to live by two doctors, submit a written request and two oral requests at least 15 days apart and possess the mental capacity to make their own health care decisions.

If you pass these hurdles, you'll get a prescription for a lethal dose of sedatives. You can then decide for yourself if and when you ever use them. The California bill, which is modeled on a similar law in Oregon, sunsets after 10 years and includes a requirement that doctors speak to the patient privately. Will these safeguards be enough to persuade Brown to sign it? No one knows:

"You'd need some kind of séance to figure out what he's going to do," says Jack Citrin, director of the Institute of Government Studies at UC Berkeley. "He plays his cards very close to the vest."

....Brown is Catholic, even at one point considering becoming a priest...."He's in an interesting dance with the Catholic Church," says Gar Culbert, a California State University-Los Angeles political science professor. "He wants the church to participate in advocating for policies that are environmentally friendly, so he wants to stay on good terms."

Brown might also feel that the bill's safeguards against abuse still aren't sufficient:

In spite of the bill's provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.

He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for "physician aid in dying."

"As soon as this is introduced, it immediately becomes the cheapest and most expedient way to deal with complicated end-of-life situations," Dr. Kheriaty said. "You're seeing the push for assisted suicide from generally white, upper-middle-class people, who are least likely to be pressured. You're not seeing support from the underinsured and economically marginalized. Those people want access to better health care."

There isn't much to say to people who object to assisted suicide on religious grounds. If the Catholic Church says it's a sin, then it's a sin.

For Catholics, anyway. But that shouldn't affect the rest of us. We should be allowed to decide this on secular grounds. And with the obvious caveat that nothing is ever perfect, the safeguards in this bill are pretty good. Here are a few bullet points:

  • Assisted suicide just isn't very popular, law or no law. In Oregon, prescriptions for lethal drugs have been written for 1,327 people over the past two decades and 859 people have ended up using them. In 2013, lethal drugs were used by only 105 people out of a total of 34,000 who died that year.
  • The Barbara Wagner case cited above is misleading. Yes, her insurance company covered assisted suicide. And yes, it also refused to cover a particularly expensive cancer therapy. But those are simply two separate and unrelated parts of her coverage. The way the sentence is written makes it sound as if someone specifically made a decision to deny the cancer treatment and offer her some lethal drugs instead. That's not at all what happened.
  • There is endless speculation that people will be pressured into dying by greedy heirs who either want to inherit right now or who don't want to see their inheritance drained away on expensive end-of-life treatments. Coercion is a legitimate issue, but California's law goes to considerable lengths to address it. You need two doctors. You have to be within six months of dying. You're required to meet with the doctors in private. And you have to submit multiple requests at least 15 days apart. That said, improper coercion almost certainly happens on occasion. But outside of the movies, there's just no evidence that it happens other than very rarely. It's usually just the opposite, with family members urging further treatment until there's literally nothing left to try.

I want to add an additional, more personal argument. A few years ago a friend's father was dying of cancer. He was a physician himself, and had decided long before to take his own life before he lost the ability to make decisions. But because it was illegal, he had to make sure that his kids couldn't be held even remotely responsible. So he decided not to tell anyone when the time came.

Luckily, a friend talked him out of this at the last minute. He called his kids, and they came out to say goodbye one last time. But it was a close-run thing. If that hadn't happened, his family would never have seen him before he died. They would have heard about it via a phone call from the coroner's office.

That's not how this should have to happen. It's common knowledge that sometimes people who are close to death take their own lives, legal or not. But they shouldn't have to do it earlier than necessary, just because they're afraid they might lose the physical ability to act if they wait a little longer. Nor should they be afraid to have their family around because they want to make sure nobody is held legally responsible for assisting them.

California's bill won't affect very many people. Assisted suicide just isn't a very popular option. But for those who choose that path, a safe and legal alternative is more humane both for them and for their families. Just having the option available makes it more likely that they'll wait until they truly want to die, and that they'll do it surrounded by their loved ones, rather than alone in a bedroom somewhere. I hope Jerry Brown thinks about this while he's deciding whether to sign this bill.

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Friday Cat Blogging - 11 September 2015

| Fri Sep. 11, 2015 2:58 PM EDT

Like all cats, Hilbert and Hopper love staring out the window. So much cool stuff: birds, squirrels, rabbits, bugs, butterflies, and invisible pixies. I don't know what had them entranced in this picture, but it was probably a butterfly. We've had several monarchs hatch lately, and they are very attention-grabbing critters. Especially if you're a cat.

The iPad Pro Is Lacking One Thing If It Wants to Play in the Business World

| Fri Sep. 11, 2015 2:52 PM EDT

Apple has been playing catch-up for a while now. The large-screen iPhone 6 was catching up with Samsung (and pretty much every other smartphone maker). The new Apple TV box is catching up with Roku, Chromecast, and others. The Apple watch is catching up with Android watches.1 And now, as Will Oremus points out, the iPad is catching up with Microsoft's Surface Pro:

The iPad Pro’s screen measures 12.9 inches diagonally, making it far bigger than any tablet Apple has made before—but comparable in size as the 12-inch Microsoft Surface Pro 3. It features a split-screen mode for multitasking and is optimized for productivity apps like Microsoft Office. And its two most notable accessories are—what else?—a keyboard cover and a stylus.

Close, but no cigar! Everything Oremus says is true, but if you're going after the business market I'd say that a high-quality docking station is probably the key accessory. Microsoft has a very nice one for the Surface Pro. Apple doesn't.

Maybe it's coming soon, but Apple didn't want to delay the iPad Pro just for that. Or maybe Apple still doesn't really get the business market.

But I'll give Apple this: they sure do know how to make a lightweight device. I assume this is because their ARM processors are more power stingy than even the newest Intel processors, which allows Apple to use smaller batteries. But whatever it is, I'm jealous. It's not like my Surface (non-Pro) is a brick or anything, but shaving another eight ounces off it would sure be nice.

But light or not, the lack of a docking station would prevent me from using the iPad pro as a serious business device. In most homes and offices, you're going to want to connect a keyboard/mouse, network cable, a local printer, and maybe an external hard drive. Plus a bigger monitor if you decide to go that route. Someday all this stuff will be effortlessly wireless, but that day is not today. For now, the only way to make this work conveniently is with a docking station.

1None of this is to say that Apple can't make good money playing catch-up. They can. And stealing features from the competition is practically the definition of the tech industry. Still, they've been going after low-hanging fruit for the past few years. I'm not seeing an awful lot of visionary thinking anymore.

Eat Any Kind of Sugar You Want, Just Don't Eat Too Much of It

| Fri Sep. 11, 2015 1:29 PM EDT

From Susan Raatz, a research nutritionist at the USDA who recently conducted a test of cane sugar, honey, and high-fructose corn syrup:

The marketers “made a big mistake when they called it ‘high-fructose corn syrup,’” said Raatz.

Now, now. Let's not blame the marketers. They had no hand in this debacle. And they did try to rename it "corn sugar" a few years ago, but the FDA turned them down.

Anyway, Raatz concluded that HFCS, honey, and cane sugar all had similar effects on the human body. This should not come as a big surprise, since all three are basically 50-50 mixes of fructose and glucose.

So why is HFCS high fructose? Because it has more fructose than ordinary corn syrup, not because it has more than most other sweeteners. But the damage has been done, and now concerned parents everywhere are making sure to feed their kids only cane sugar or honey, in the misguided belief that they're somehow healthier and more natural.

Sorry. Sugar is sugar. Eat any kind you like. Just don't eat too much of it.

Let's Have More God Talk in This Campaign

| Fri Sep. 11, 2015 1:07 PM EDT

"Liberal Jewish atheist" Paul Waldman thinks we should talk about God more:

The United States has far and away the highest levels of religiosity of any industrialized democracy, and all presidential candidates are expected, at least at some point, to be photographed going to church and testify to their deep and abiding faith in God. As long as that’s the case, we have not just a right but an obligation to ask them specific questions about what they believe and how it would affect their actions in office.

....But journalists are extremely squeamish about getting into those details, no doubt because they’re worried that it will come off sounding like criticism of the candidates’ beliefs instead of a worthwhile exploration of them....We spend a ridiculous amount of time trying to get inside the heads of those who would be president, but when the topic of religion comes up, we take a tentative step forward, then rush back lest we give offense.

This is quite a change from 1960, isn't it?

In any case, I'll toss out an alternative explanation: most mainstream reporters aren't very religious themselves and don't think they can keep up their end of an interview about faith. When the Rev. Jeremiah Wright says "God damn America," that's catnip for the press: it's not really about religion, it's about somebody saying something outrageous and then tallying up the responses. Easy peasy. But a serious discussion about the ins and outs of various faith traditions and how different candidates ended up where they did? It's sort of like talking about the details of handgun design. There's a serious chance of a liberal journalist embarrassing himself badly.

The reason I don't think that mainstream journalists are genuinely worried about religious questions coming off as criticism is because plenty of journalists do ask questions about religious faith. And presidential candidates talk to them. The thing is, these are mostly journalists for religious publications, who have the background to talk about this stuff without sounding ignorant. Mainstream reporters are well aware of this, and well aware that most presidential candidates are happy to talk about it. They're just uneasy about their ability to do the job right.

Scientists Say "Trust Us" on Blood Pressure Study

| Fri Sep. 11, 2015 11:58 AM EDT

The New York Times reports on a big U-turn in the study of low blood pressure:

Declaring they had “potentially lifesaving information,” federal health officials said on Friday that they were ending a major study more than a year early because it has already conclusively answered a question cardiologists have puzzled over for decades: how low should blood pressure go? The answer: way lower than the current guidelines.

....Less than two years ago, a National Heart, Lung and Blood Institute panel went the opposite direction. People had been told to aim for a systolic blood pressure of 140. But the panel recommended a goal of 150 for people ages 60 and older, arguing that there were no convincing data showing lower is better.

Given the fact that this represents a major change to a recommendation from two years ago, it would be nice to see the data. And yet, apparently it hasn't been released. Austin Frakt is annoyed:

I have high blood pressure, so this is of more than academic interest to me. I've also heard plenty of horror stories of people being massively overmedicated in an effort to get their blood pressure below some magical target. So if you want me to get my systolic blood pressure down to 110 or so, you'd better have some mighty convincing data.

But of course, this is not about me me me. Frakt is right: this is just bad science, and it's especially bad in the areas of health and nutrition, which are overrun with both crankery and constantly changing recommendations. If you have big news, release it in a reputable journal and let other experts take a look at it. Don't announce blockbuster findings and then promise that "a paper with the data would be published within a few months." This is not the way to do things.

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A Unified Theory of Conservative Crankery Isn't So Hard

| Fri Sep. 11, 2015 11:23 AM EDT

Paul Krugman is musing about conservative crankdom:

Notice that the ludicrous claim that most of the revenue effects of huge tax cuts would be offset by higher growth comes from economists who, like Jeb!, are very much establishment figures — but who evidently find that the partisan requirement that they support voodoo outweighs any fear of damage to their professional reputations.

While the intellectual implosion of the GOP is obvious, however, it’s less obvious what is driving it....The thing is, there isn’t anything comparable on the other side. You can find cranky individuals on the left, but mainstream Democratic politicians don’t feel the need to support, say, extreme anti-GMO positions. There are interest groups with a lot of influence on Democratic politics, like teachers’ unions, but supporting bad economic theories that serve their interests isn’t a litmus test for establishment politicians.

All of this leads to a further question, which is why the GOP is the party of apparatchiks and cranks. I don’t yet have a deep answer.

I don't know that I'd overthink this. Krugman points to two varieties of economic crankery—tax-cut fever and inflation paranoia—but I don't think there's any big mystery there. As Krugman points out, supply-side tax nonsense is obviously driven by the desires of rich people. And I think inflation paranoia comes from the same place. It's a bit of a mystery why rich people are so worried about inflation, but they are.

Other subjects are similar. The claim that global warming is a hoax is obviously driven by the desire not to address global warming, which would require offending the interests of lots of rich business donors. Anti-evolution crankery is a little different, but it's basically harmless and it doesn't offend powerful interests, so there's no reason not to play along with it.

There are other bits of crankery here and there that are driven by base politics, but in the end, the versions of conservative crankery that really matter nearly always come down to pandering to the rich at all costs—or, at the very least, doing nothing to offend them. Whatever else you can say about the Republican Party, it knows who's in charge and it always has. This is starting to create some seismic faults that are likely to cause them a lot of angst in the near future, but for now, it's the wealthy uber alles.

Parents Sure Are Keen on Their Kids Becoming Pro Athletes

| Thu Sep. 10, 2015 6:20 PM EDT

Here's a curiosity. According to a new poll, 26 percent of parents of high school athletes hope their kids will turn pro someday. This rises to 39 percent among parents who earn less than $50,000 per year. As Christopher Ingraham points out, this is pretty ridiculous. Fewer than 1 percent of high school athletes—way fewer than 1 percent—ever make it to the show.

And it's actually even more ridiculous than that. If your kid isn't already a star athlete by high school, the chances of going pro drop to basically zero. There's no way that 39 percent of these folks are the parents of star athletes.

This makes me curious about what this poll really means. Do parents "hope" their kids become pro athletes the same way they hope to win the lottery someday? As in, it's nice to dream about, but it's probably not going to happen. Or do they hope in the same way they hope to buy a new car next year? As in, with a little luck and some hard work our dream could come true. These are two very different things.

If it's mostly the former, no harm done. I'd like to win the lottery too. But if it's mostly the latter, America must be chock full of really disappointed parents. Maybe that explains something.

Scott Walker No Longer Understands His Own Base

| Thu Sep. 10, 2015 3:00 PM EDT

A few days ago Scott Walker refused to answer a question about Syrian refugees because "I'm not president today, and I can't be president today." This was a novel take on presidential campaign questions, which are—for obvious reasons—all about what you'd do as president. But apparently Walker decided it was unfair to ask him about that before he actually became president. He left unclear what kinds of questions would be left for reporters to ask him.

Today, unsurprisingly, Walker changed his tune. He decided to "clarify" his answer, which turned out to be simple: he doesn't want the US to take in any more Syrian refugees. We take in plenty already. Instead, he wants to increase our bombing campaign against ISIS. This would probably make the refugee crisis worse, but whatever.

I say that Walker's clarification was unsurprising because he's really made a habit of this. Steve Benen provides the blow-by-blow:

Walker’s pattern of stumbling only reinforces doubts about his strength as a national candidate. TPM’s Caitlin MacNeal noted a series of issues and controversies — Kentucky’s Kim Davis, whether sexual orientation is a choice, evolutionary biology, President Obama’s patriotism and religion — on which Walker couldn’t or wouldn’t share his position publicly.

There are a variety of other issues — birthright citizenship, Boy Scouts, building a Canadian border wall — on which Walker managed to state an opinion, but soon after, that position proved untenable, forcing him to “clarify” his actual beliefs. Asked about Walker last week, an Iowa Republican told Politico, in advance of this week’s incident, “For the last two months [Walker] hasn’t made a single policy pronouncement that he or his staff hasn’t had to clarify or clear up within two hours.”

When the campaign began, I was pretty bullish on Walker. He seemed to have the right combination of respectability and pit-bull snarl to appeal to a wide variety of voters. And since he's had a long political career, including four years as Wisconsin governor, he'd have a pretty good handle on campaigning.

But no. It turns out he barely has a clue about campaigning. Has this always been the case, or has the rise of Donald Trump completely flummoxed him? Maybe a bit of both, but I think he's really let Trump get inside his head. He planned to campaign pretty far to the right, and when Trump took that away from him he didn't seem to know what to do. Agree with Trump? Then he's just a follower. Disagree with Trump? But that could be dangerous if the base is really enthralled with the guy. What to do?

The answer, apparently, is to make it clear that he has no considered views of anything and merely wants to say whatever will make the tea partiers happy. But he no longer knows what that is. So he tap dances desperately, but does it so bumblingly that he just embarrasses himself. At this point, it's not clear if he'll ever get his act together.

Even Conservatives Agree That Jeb Bush's Tax Plan Is a Huge Boon for the Rich.

| Thu Sep. 10, 2015 2:05 PM EDT

The Tax Foundation is a conservative outfit that's predisposed to like Jeb Bush's tax plan. They believe it will increase GDP by 10 percent over the long term, which will pay for more than half of the plan's cost. Jeb's tax cuts, they conclude, "would greatly increase the U.S. economy’s size in the long run, leading to higher incomes for taxpayers at all income levels."

All income levels? Well, yes. But there are incomes and there are incomes, and some do better than others under Jeb's plan. Can you guess which ones? Huh? Can you?

It turns out that even the Tax Foundation can't make Jeb's plan look anything close to fair. Under a normal (i.e., "static") estimate, here are the effects on income:

  • Poor: +1.8 percent
  • Middle class: +2.8 percent
  • Rich: +11.6 percent

Yowza! That looks pretty bad. Something has to be done about this, so let's do a "dynamic" estimate that assumes these tax cuts will hypercharge the economy. That helps, but not enough:

  • Poor: +10 percent
  • Middle class: +12.7 percent
  • Rich: +16.4 percent

The Tax Foundation has a very rosy view of dynamic effects, which are almost certainly far less than they estimate. But even if you take their analysis at face value, Jeb's tax plan is still tilted heavily toward the rich. They don't just get a bigger cut in absolute dollars, they get a bigger percentage cut.

That's not surprising. When credulous reporters are around, Jeb's team highlights the plan's cap on deductions and its elimination of the carried interest loophole. But that's small potatoes compared to the huge rate cut at the top, the elimination of estate taxes, and the cut in the corporate tax rate. The end result is the usual one for Republicans: the rich get a big tax cut while the poor are bought off with beads and trinkets.