Kevin Drum

I've Never Gotten an Annual Physical. How About You?

| Fri Jan. 9, 2015 11:17 AM EST

Ezekiel Emanuel passes along the results of research about the value of getting an annual physical exam:

The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.

How can this be? There have been stories and studies in the past few years questioning the value of the physical, but neither patients nor doctors seem to want to hear the message. Part of the reason is psychological; the exam provides an opportunity to talk and reaffirm the physician-patient relationship even if there is no specific complaint. There is also habit. It’s hard to change something that’s been recommended by physicians and medical organizations for more than 100 years. And then there is skepticism about the research. Almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story.

This is a funny thing. I've never had an annual physical. This isn't for any specific reason. It just never occurred to me, and none of my doctors has ever recommended it. I've probably had half a dozen different primary care physicians over my adult life, and not one of them has ever suggested I should be getting an annual physical.

I'm not sure what this means. Is the annual physical something that doctors only do if their patients ask? Or have I just had an unusual bunch of doctors over the years? What's your experience with this?

And as long as I'm noodling about stuff like this, here's a thought that passed through my brain the other day. I was thinking about the fact that one of the indicators of the multiple myeloma that I was diagnosed with comes from blood tests. So why not test routinely for the markers of multiple myeloma? The answer is obvious: you'd be performing millions of blood tests every year with a vanishingly small chance of finding anything. What's more, there are lots of different cancers. Are you going to draw a few pints of blood every year and test for all of them at a cost of tens of thousands of dollars? That makes no sense in otherwise healthy people.

But this got me thinking about that new blood testing technique I wrote about a few months ago. In a nutshell, it requires only a tiny amount of blood, and the tests themselves are super cheap. If this works as advertised—and presumably gets even cheaper with time—does it open up new possibilities for an annual physical that actually makes sense? Would it be possible to draw no more than a standard vial of blood once a year, and then perform a huge variety of tests at a cost of a few hundred dollars? The odds of finding anything would still be small, but it might nonetheless be worth it if the cost both in time and money was also small.

Of course, there are still problems with false positives and so forth, even if the cost of this regimen was small. So maybe it would be a lousy idea regardless of its feasibility. I really have no idea. But it's an intriguing possibility.

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Chart of the Day: Net New Jobs in December

| Fri Jan. 9, 2015 10:12 AM EST

The American economy added 252,000 new jobs last month, 90,000 of which were needed to keep up with population growth. This means that net job growth clocked in at 162,000 jobs, which is not quite as good as last month but still not bad. Virtually all of this growth was in the private sector, yet another sign that the recovery is finally motoring along at a steady if unspectacular rate.

But the news was not all good. The headline unemployment rate fell from 5.8 percent to 5.6 percent, but this was mostly because of people dropping out of the labor force. Wage growth was also disappointing. Last month's wage increases, which I was skeptical about, were entirely washed away. Earnings for nonsupervisory workers actually dropped to slightly below their October levels.

Overall, this jobs report is decent news, but hardly great. Until we start to see steady employment growth and steady wage growth, the labor market still has a lot of slack no matter what the headline unemployment rate is. Given this, in addition to possible headwinds in the rest of the world, the Fed needs to continue to keep interest rates low for quite a while longer. It's not yet time to tighten.

Net Neutrality Might Be a Step Closer to Reality

| Thu Jan. 8, 2015 9:20 PM EST

Net neutrality got some new momentum yesterday from FCC Chairman Tom Wheeler:

Speaking here at the 2015 International CES tech trade show, Wheeler repeatedly hinted he favors reclassification of broadband as a public utility, which would subject Internet providers to some of the same rules that govern old phone companies. The approach is already drawing heavy fire from Republicans and telecom giants who warn it will lead to burdensome regulation.

....Back in Washington, Sen. Dean Heller (R-Nev.) quickly slammed Wheeler’s comments, urging him to defer to Congress. And Senate Commerce Committee Chairman John Thune (R-S.D.) separately on Wednesday said he’s pushed the FCC to delay its new rules until lawmakers have a chance to come up with their own solution. He expressed early interest in legislation that would specify new consumer protections without going as far as reclassifying broadband

We think a legislative route is a better way to go, and we’ve developed some language that we think addresses a lot of the concerns that Democrats have raised — but does it without that heavy regulatory approach,” the senator said.

The best solution to the problem of net neutrality would be the introduction of genuine competition among ISPs. Your local cable company might still want to discriminate against rivals in the video business—or maybe team up with one of them and degrade the others—but they'd have a hard time doing that if Google was providing great quality for every web-based video service and customers could easily switch if they got tired of poor Netflix streaming. More generally, competition would put a ceiling on all sorts of bad behavior. If your prices are high, or your service is poor, or you have a habit of playing favorites with certain sites, then you're going to lose customers unless you get your act together. True competition would make heavy regulation of broadband mostly unnecessary.

But we don't have true competition and we're not likely to get it anytime soon. So we do what we always need to do when corporations enjoy monopoly positions: we regulate them. And given the noises that ISPs and other broadband suppliers have occasionally made in candid moments, strict regulation requiring equal treatment for everyone is probably in order.

This means that Wheeler's announcement is good news. In theory, so is John Thune's. That's because I agree with him: the best net neutrality solution would be a legislative one. It would allow more flexibility than the FCC has under its existing Title II telephone regulations, and it would almost certainly be less vulnerable to court challenges.

But is Thune really serious about addressing "a lot of the concerns that Democrats have raised"? I guess I'm skeptical. Part of the reason is that I've never really understood exactly why Republicans are so dead set against net neutrality regulations. This isn't something that would stifle competition, after all, nor is it a simple matter of siding with corporate interests that Republicans are traditionally sympathetic to. Rather, net neutrality is basically a battle between corporate behemoths: in general, content providers are for it and ISPs are against it. I've never quite figured out why the GOP has so steadfastly taken the side of the broadband providers in this battle.

This makes me wonder what forces are driving Thune, and whether he's really able and willing to make substantive compromises on net neutrality. Without something to prod him, my guess is that he'd prefer doing nothing, so if Wheeler's actions provide that prod, then three cheers for Title II regulation. It might not be ideal, but it might be just the incentive Republicans need to get serious about introducing legislation good enough to get support from both President Obama and enough Democrats to pass the Senate. We'll see.

Free Speech Doesn't Require You to Offend People Just to Prove You Can

| Thu Jan. 8, 2015 1:50 PM EST

Andrew Sullivan points to the following postscript in a Washington Post story about the Charlie Hebdo killings:

Editor's note: An earlier version of this article included images offensive to various religious groups that did not meet the Post's standards, and should not have been published. They have been removed.

Sullivan calls this a "capitulation," and says, "If any reader knows exactly what images they removed, let us know and we’ll post them here."

Hmmm. Something is off kilter here. I don't normally publish things that are gratuitously offensive to Catholics or Muslims or other religious groups. That's just me, of course, and obviously there's a ton of judgment involved in how I personally choose to conduct myself as a public writer. But Sullivan goes further: He's suggesting that even if I wouldn't normally publish something because it's offensive, I should actively do so now just to prove that I can. And so should the Post.

I don't buy that. If there's news value in reprinting some of the Charlie Hebdo cartoons so that their readers have some idea of what motivated the attacks, the Post should print them. But that's all they should do. If they normally try to avoid gratuitous offense, there's no reason to change that policy. That's free speech.

UPDATE: I suppose this was inevitable, but my point is being widely misunderstood. Let me try again. Anyone who wishes to publish offensive cartoons should be free to do so. Likewise, anyone who wants to reprint the Charlie Hebdo cartoons as a demonstration of solidarity is free to do so. I hardly need to belabor the fact that there are excellent arguments in favor of doing this as a way of showing that we won't allow terrorists to intimidate us.

But that works in the other direction too. If you normally wouldn't publish cartoons like these because you consider them needlessly offensive, you shouldn't be intimidated into doing so just because there's been a terrorist attack. Maintaining your normal policies even in the face of a terrorist attack is not "capitulation." It's just the opposite.

Pharma Marketing: Pretty Much the Same As Every Other Kind of Marketing

| Thu Jan. 8, 2015 1:16 PM EST

Charles Ornstein and Ryann Grochowski Jones published a story yesterday that's gotten a lot of attention. It's an examination of where pharmaceutical companies spend most of their marketing budgets:

The drugs most aggressively promoted to doctors typically aren't cures or even big medical breakthroughs. Some are top sellers, but most are not. Instead, they are newer drugs that manufacturers hope will gain a foothold, sometimes after failing to meet Wall Street's early expectations.

"They may have some unique niche in the market, but they are fairly redundant with other therapies that are already available," said Dr. Joseph Ross, an associate professor of medicine and public health at Yale University School of Medicine. "Many of these, you could call me-too drugs."

Maybe this is just my marketing background blinding me to an obvious outrage, but....what else would you expect? This is what every company does. If you're in marketing, you spend a lot of money on new product launches and you spend a lot of money where you most need to differentiate yourself. This is nothing unique to pharma. It's just the common-sense way that marketing works.

There's a lot that's wrong with pharmaceutical R&D priorities, and there's also a lot that's wrong with pharmaceutical marketing strategies. But spending a lot of money on new products that have entrenched competitors? If that's wrong, then every consumer products company on the planet is doing something wrong. I'm a bit at a loss to figure out what the story is supposed to be here.

Here's the Story on Party ID: There's Not Really Much of a Story

| Thu Jan. 8, 2015 12:17 PM EST

Several people have already commented on a new Gallup poll showing that Democrats and Republicans are continuing to lose ground to self-identified independents. And it's true: the percentage of independents has risen steadily since 2008 from 35 percent to 43 percent.

But my advice is to ignore the noise. As Gallup itself says, "Although independents claim no outright allegiance to either major party, it is well-known that they are not necessarily neutral when it comes to politics." Quite so. In fact, "leaners" tend to vote the party line just about as loyally as folks still willing to explicitly call themselves Democrats and Republicans. For most people, identifying as an independent isn't so much a genuine political commitment as it is a lifestyle statement.

So here's the chart to look at: Party ID plus the leaners. And the story it tells is fairly unremarkable. You can see spikes up and down as elections are held and the public gets tired of the party in power, but there's not much of a long-term trend. I eyeballed the average party ID for both Democrats and Republicans in the Gallup chart, and it shows very little movement over the past few years: Democrats are down slightly from their long-term average—probably not surprising in the sixth year of a presidency—and Republicans have gained slightly.

If there's a story to tell here, I don't really see it. Perhaps pundits with sharper eyes and more column inches to fill will find something.

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The GOP's First Priority for 2015: Paying Off Wall Street

| Thu Jan. 8, 2015 10:48 AM EST

So how did House Republicans kick things off when they came back into session this week? Answer: They quickly passed a few noncontroversial bills (the Hire More Heroes Act, etc.), but then came the real top priorities. Something about abortion? Or gun rights? Maybe an immigration bill? Some other tea party hot button?

Nope. First up was a new rule that would speed the bankruptcy of the Social Security disability fund. It passed. Next they tried to sneak through a massive omnibus bill full of goodies for Wall Street. David Dayen describes what happened now that Elizabeth Warren has wakened the populist strain of the Democratic Party:

Democrats rushed in to squash the Republican Frankenbill. H.R. 37 came up for a vote Wednesday under a suspension of the rules, meaning that it needed a two-thirds vote. So Democrats would have to supply several dozen votes for the bill to pass....“It has not yet been 24 hours since members of Congress have been sworn in,” said Democrat Dan Kildee (D-MI) on the House floor, “When Main Street had its needs we couldn’t get a hearing. When Wall Street asks, we suspend the rules without taking a breath.”

House Democratic leader Nancy Pelosi termed it a “brazen attempt” to “sneak through a New Year’s present to big banks.” Ultimately, enough Democrats shied away from the bill for it to fail by a vote of 276 to 146. Only 35 Democrats voted with all but 1 Republican in favor. The lack of two-thirds support means that the bill would not survive a Presidential veto either.

There you have it. All the tea-party stuff will come eventually, but the very first actions of the Republican House were ones to hurt disabled workers and give a huge gift to Wall Street. Actions speak louder than words, and these were their first actions. Welcome to 2015.

Obama Is the Most Liberal President Since LBJ—But That Doesn't Really Mean Much

| Wed Jan. 7, 2015 2:40 PM EST

Michael Gerson thinks that Democrats have regressed to the bad old days of 70s liberal excess, when the American public rebelled against lefty craziness and finally installed Ronald Reagan as president to get the country back on track. Bill Clinton and the New Democrats eventually got their party back in power by moving toward the center, but over the past six years that's all been thrown overboard. "President Obama has now effectively undone everything that Clinton and the New Democrats did in the 1980s and ’90s," he warns.

Ed Kilgore, who was there, throws up his hands in irritation:

Since Gerson appears to assume that Clinton was strictly about appropriating conservative themes, I guess he cannot come to grips with the fact that the Affordable Care Act was based on the "managed competition" model that a lot of New Democrats preferred to Clinton's own health care proposal, or that Obama's "cap-and-trade" proposal was relentlessly and redundantly promoted by the New Democratic think tank the Progressive Policy Institute. Just about everything Obama has proposed on tax policy, education policy, infrastructure policy, trade policy and even national security policy has been right out of the Clintonian playbook. Has Gerson noticed that Obama's not real popular with people on the left wing of the Democratic Party?

There's a weirdly schizoid nature to Obama's presidency. If you were to call him the most liberal president since LBJ, you'd be right. There's really not much question about it.

But that's not because he's some kind of wild-eyed lefty. It's because there have only been two other Democratic presidents in the meantime, and both of them were relatively conservative. It's easy to forget now, but Jimmy Carter's strength in the 1976 Democratic primaries was largely based on his appeal to evangelical Christians. This spawned the ABC movement—Anybody But Carter—midway through the primaries, but it was motivated not by Carter's liberalism, but specifically by a fear among liberal Democrats that Carter was too conservative for the party. And he was. In office, Carter governed mostly from the center left, infamously opening himself up to a crippling primary challenge in 1980 from Ted Kennedy.

Ditto for Bill Clinton, who explicitly ran and governed as a centrist liberal. So is it fair to say that Obama is the most liberal president of the past half century? Sure, in the same way that it's fair to say that a Honda Civic is faster than a Toyota Corolla or a Chevy Cruze. But that hardly makes the Civic a speed demon.

Still, even with all that said, Obama is, in fact, more liberal than previous Democratic presidents of the past half century. He's rhetorically more liberal than Clinton, for example, and he's rarely felt the need to do any Sister Souljah-ing. What's more, while he may have made occasional noises about entitlements and budget deficits, he's got nothing like either welfare reform or bank deregulation on his record. Everything he's done has been pretty much in the mainstream liberal tradition.

Plus there's one more thing: Obama has been far more effective than either Carter or Clinton. That obviously makes him seem more effectively liberal than his predecessors. But this isn't really due to either a fervent commitment to radical populism or to shrewd management of the lefty agenda. It's because Obama enjoyed a huge Democratic majority in Congress for his first two years. When that went away in 2010, so did much of his success.

So two things are true: Obama is the most liberal president since LBJ and he's also a fairly standard-issue mainstream Democrat. Obamacare, in particular, doesn't make him a radical. It just makes him lucky to have had a Congress willing to pass it.

After 30 years of ascendant Reaganism, it's probably normal for conservatives to feel that any kind of liberal agenda is extremist almost by definition. But that's little more than an unwillingness to accept the normal pendulum swings of American politics. As Kilgore points out, Obama's tax policy, education policy, infrastructure policy, trade policy and national security policy have been to the left of George Bush, but not really much different from anything Bill Clinton would have done if he'd been able to. In the end, Obama is a Honda Civic to Clinton's Toyota Corolla. A little faster, but still not exactly a thunderbolt.

Republicans Take Aim at Obama, Shoot Workers in the Foot

| Wed Jan. 7, 2015 12:10 PM EST

President Obama announced yesterday that, yes, he would veto a bill to approve the Keystone XL pipeline. This is hardly news, since he's already said this before, but it was nonetheless reported as yet another shot across the bow of congressional Republicans. The GOP wants to be reasonable and bipartisan—honest!—but it's tough when Obama keeps deliberately baiting them like this.

So what's the GOP doing as a show of good faith? Trying to blow a hole in Obamacare, of course. But that's not all! They've actually picked a specific plan that's something of a trifecta. Here's what it does:

  • Cripples a part of Obamacare.
  • Costs the federal government money.
  • Increases corporate profits.

Don't you love the smell of napalm in the morning? The proposal in question would change the definition of full-time worker from 30 hours to 40 hours. As a result, employers would be required to offer health insurance only to employees working 40 hours or more, not those working 30 hours or more. It's hard to truly capture the cynicism motivating this proposal, but Matt Yglesias does a pretty good job this morning. I'll turn over the mike to him:

It turns out that the authors of the ACA weren't idiots....Sherry Glied and Claudia Solis-Rosman have shown that while working slightly more than 40 hours is common, working slightly more than 30 hours is rare. In other words, few workers are at risk of having hours slashed from 31 per week to 29, but many could be cut back from 41 to 39.

....While a shift from a 30-hour definition to a 40-hour definition would exacerbate the problem of hour cuts, it would help solve one very serious problem — the problem of rich businessmen who would like to see higher profits rather than lower profits. Lifting the hours threshold would automatically cause millions of workers to fall below the limit, saving their employers money in insurance premiums and fees to the government. And lifting the hours threshold would also make it easier for employers to monkey with workers' schedules to get them redefined as part-time.

At a time when corporate profits as a share of the economy are abnormally high, boosting profits at the expense of workers' health insurance coverage isn't necessarily a great political slogan. But it's still something that business owners and managers care passionately about, and business priorities tend to get a thorough airing on the Hill.

There's always going to be some threshold that defines "full-time" workers. And no matter what that threshold is, there will be employers who game the system by reducing the hours of some employees from barely above to barely below the threshold. There's just no way around that. But you can certainly try to minimize the problem by picking a threshold that's hard to game. One way to do that is to set the threshold at a level that affects very few workers. Democrats did that when they passed Obamacare in 2009, and that was good for employees, good for Obamacare, and good for the budget since it meant fewer workers receiving federal subsidies.

But not so good for anyone who wanted to game the system and toss lots of vulnerable employees onto the federal dime. Apparently that's the GOP's core constituency, though. Are you surprised?

Los Angeles Prepares To Be Played Yet Again By the NFL

| Wed Jan. 7, 2015 10:58 AM EST

Here's your sports factlet of the day:

More than half of the NFL's 32 teams have used moving to L.A. as leverage since the Raiders and Rams pulled up stakes, playing their last games here on Christmas Eve 1994.

It's like Lucy and the football. Los Angeles is Charlie Brown, and we keep thinking that this time she won't pull it away. But she always does. And why not?

The tactic works. Since the last pro game here, 27 NFL stadiums have been built or undergone at least $400 million in renovations. "There's no question that's part of the game," said R.D. Hubbard, who in the mid-1990s fronted an effort to build an NFL stadium at Hollywood Park.

"You always want one guy on the outside and you use him," [said former Fox Sports President Ed Goren]. "It's just good business."

It's happening again, of course, with the recently floated suggestion that the St. Louis Rams might move to a new stadium at Hollywood Park. For the properly pessimistic take on all this, I recommend reading Michael Hiltzik here. I find it comforting that no matter how skeptical I am about the NFL and Los Angeles, there's always at least one person who's even more cynical on the subject than me.