Kevin Drum

Quote of the Day

| Mon Nov. 2, 2009 2:38 PM EST

From Sen. Orrin Hatch (R–Utah), explaining why conservatives should worry about the Democratic goal of eventually implmenting a national healthcare system:

If they get there, of course, you're going to have a very rough time having a two-party system in this country, because almost everybody's going to say, 'All we ever were, all we ever are, all we ever hope to be depends on the Democratic Party.'  That's their goal. That's what keeps Democrats in power.

Weird.  I understand that conservatives don't like the idea of a national healthcare system, but guess what? Germany has one. Britain has one.  France has one.  Canada has one.  And the conservative parties in those countries have done just fine.  Republicans would do fine too if we had one.

Via Atrios.  And I promise to do some non-healthcare posts soon.

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The Cost of Technology Revisited

| Mon Nov. 2, 2009 2:03 PM EST

A few days ago Ezra Klein quoted the CEO of Kaiser Permanente, George Halvorson, telling us that CT scans cost "a few hundred dollars in Europe and over $15,000 here."  This didn't seem quite right to me, and today Ezra gets the goods straight from Halvorson in lovely chart form.  Turns out the "few hundred dollars in Europe" part is right, but there was some kind of mistake about the U.S. pricing.1  As you can see from the chart, a head CT scan costs about $950 in the U.S. vs. an average of $276 in six other countries.  That's a difference of about 3.5x.

Which is still a very big difference.  As I've mentioned before, here in the U.S. we pay higher fees to our doctors, we pay higher prices for drugs, we pay higher prices for diagnostic tests, and we pay higher administrative costs to our insurance companies.  If we want to reduce healthcare costs, we have to do something about all that, but both Obama and the Democratic leadership in Congress have (quite accurately) decided that doing so right now would earn the undying wrath of doctors, Big Pharma, insurance companies, hospitals, and device manufacturers, and together they could easily kill any chance of passing healthcare reform at all.  So instead we'll pass reform now without addressing prices and then hope that maybe we can do something about it later.

And maybe we can.  But don't bet on it: interest groups fight like crazed weasels to keep what they have, and they usually win.  We might be able to freeze cost increases a bit if we put some serious muscle into it, but that's probably about all we can reasonably hope for.  Or maybe technology will save us.  You never know.

More charts here.  I'm sure everyone will have their own favorite.

1Apparently it was a mistranscription.  Halvorson actually said $1,500, not $15,000.  Ezra has since corrected the original post.

A "Gang of Six" Tick-Tock, Please

| Mon Nov. 2, 2009 1:25 PM EST

In the New York Times today, Lamar Alexander claims that the White House was never really interested in a bipartisan healthcare bill.  Matt Yglesias isn't buying it:

Chuck Grassley is not just some guy, he’s the top Republican on health care issues. And the Grassley courtship process took a long time. And Grassley abandoned it in a blaze of hypocrisy, eventually slamming Democrats for embracing an individual mandate to purchase health insurance that he had long supported.

The larger context is that the president laid out some goals for health reform. He wants a bill that expands coverage in a way that’s deficit neutral in the medium-term, doesn’t disrupt people’s existing health insurance in the short-term, and bends the long-term cost curve. A lot of different ideas were put forward in Congress about how to do this. None of them were put forward by Republicans.

You know what this country needs — aside from strict rules limiting the volume of commercials on TV?  A really good tick-tock about the seemingly endless healthcare negotiations this summer among the "Gang of Six" on the Senate Finance Committee.  Did Republicans put forward any good ideas?  Were they truly trying to find a bipartisan compromise?  Was the president deeply involved in any of this?

There's no question that Republicans had some ideas about healthcare.  But that's not the correct measure of whether they were working in good faith to fashion a bipartisan bill.  Given that Democrats control both Congress and the presidency by wide margins, it was always going to be the case that the fundamental structure of healthcare reform would be a liberal one.  So the real measure of Republican good faith is whether they provided suggestions and compromises that worked within that structure but would have made it more acceptable to conservative sensibilities.

That was never my impression, at least in the more public arenas.  Republican contributions, such as they were, essentially boiled down to tossing out the liberal framework entirely and pretending that conservatives had won the 2008 election.  These ideas were transparently DOA, designed primarily to rally the base, not to produce a serious conversation on healthcare.

But is that what happened in the Finance Committee negotiations?  Or did Enzi, Snowe, and Grassley really, sincerely try to figure out a way to take a liberal superstructure and modify it in ways that might make it genuinely acceptable to at least some Republicans in the Senate?  Inquiring minds want to know.  Is there anyone out there with the sources to take a serious crack at writing this story?

The Frakt Curve

| Mon Nov. 2, 2009 12:24 PM EST

You've heard of the Laffer Curve?  Today we get the Frakt Curve, courtesy of Austin Frakt, who suggests that trying to increase competition in the healthcare insurance market might reduce costs, but it might not.  It all depends on where we are on the curve:

[When insurer concentration is high] premiums are above the minimum possible level. Insurers are charging above the competitive premium level because they have excessive market power. In this region, higher premiums stem from higher insurer profits and/or lack of administrative efficiency....

[When insurer concentration is low] premiums are again above the minimum because insurers can’t negotiate down to the lowest possible price with providers. Providers have too much power relative to insurers and are charging prices above the competitive minimum. Insurers pass those high prices onto consumers through higher premiums. In this case, higher premiums stem from higher medical costs.

Austin's point is that to a large extent the healthcare battle is waged between insurers and providers.  Since the American healthcare system relies primarily on both private providers and private insurers (and this will be true even if a public option passes), we don't necessarily get the lowest costs when one side or the other is weakened, but when the two sides are fairly equally matched.  Thus, removing antitrust protection for insurers might lower costs or it might not.  It all depends on where we are on the curve right now.

Alternatively, we can try to move the entire curve downward.  Or we could ditch the whole thing and ask the Swedes to please design us a new healthcare system.  But in the absence of either of those things, where you are on the curve dictates whether and how much you need to rein in one half of the healthcare market vs. the other.

UPDATE: Michael Hiltzik makes the case for more insurance industry competition here.

The Power of Couch Potato-ism

| Mon Nov. 2, 2009 1:28 AM EST

Guess what? Apparently DVRs aren't the commercial killers everyone was afraid they'd be.  Even though DVRs let you skip past ads, it turns out that lots of DVR users are too lazy to bother:

Against almost every expectation, nearly half of all people watching delayed shows are still slouching on their couches watching messages about movies, cars and beer. According to Nielsen, 46 percent of viewers 18 to 49 years old for all four networks taken together are watching the commercials during playback, up slightly from last year. Why would people pass on the opportunity to skip through to the next chunk of program content?

The most basic reason, according to Brad Adgate, the senior vice president for research at Horizon Media, a media buying firm, is that the behavior that has underpinned television since its invention still persists to a larger degree than expected.

“It’s still a passive activity,” he said.

Hard to believe.  Maybe lots of people actually like commercials?  I can't tolerate them, myself. Whenever a commercial break comes on, I start manically flipping through the channels looking for something else.  Maybe a few minutes of a ballgame.  A little bit of CNN.  Anything.  Having to sit through commercials is like having to eat breakfast without something to read in front of me: completely intolerable.

Which really means I should get a DVR and join the 54% of viewers who do skip ads.  Instead I watch shows at their regularly scheduled times and then immediately start channel surfing whenever commercials come on.  Sometimes I get back before the show starts back up, sometimes I don't.  Pretty dumb, I suppose.

Rick Santorum's Crystal Ball

| Sun Nov. 1, 2009 5:41 PM EST

Rick Santorum, yesterday:

When Assemblywomen Dede Scozzafava suspended her campaign because it appeared that her Conservative-party opponent, a Republican, stood a better chance to win on Tuesday she noted that she was a proud Republican....Her announcement today is a lesson to all of us — that even those in our party who may not agree with us on many of our core principles and positions not only still want to be on our team, but want us to win.

Dede Scozzafava today:

State Assemblywoman Dede Scozzafava (R), who dropped from the special election in Upstate New York yesterday, has now thrown her support to Democrat Bill Owens.

"It's not in the cards for me to be your representative, but I strongly believe Bill is the only candidate who can build upon John McHugh's lasting legacy in the U.S. Congress," said Scozzafava in a statement released moments ago.

Italics mine.  Apparently Santorum's version of the Republican Party is not quite so popular as he thought.

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Poll Flippery Explained!

| Sun Nov. 1, 2009 3:20 PM EST

Suppose you conduct an opinion poll and get answer X on a particular question.  If you follow up with a question like "But what if....." then X is likely to change.  But how much?  Is there some minimum amount of change you'll get no matter what followup question you ask?

I asked that question a couple of weeks ago, and Dave Munger of Cognitive Daily decided to investigate.  The result was a cheap-and-cheerful nonscientific online poll that gauged whether some people would change their minds no matter what the followup question was.  I've been sworn to secrecy until now, but here are the results:

While it is true that someone changed their answer for each question, in some cases, very few people did. Consider the responses to the question "Should the United States withdraw all troops from Afghanistan?"....While 35 percent of respondents said they'd change their answer if the US kept one base in Afghanistan to address only the terrorist threat, only 4 percent said they'd change their answer to the original question if the US also closed the prison at Guantanamo Bay.

Aside from one genuinely out-of-the-blue question, that seems to have been the baseline: you can get 4% of your respondents to change their minds no matter what the followup is.  That's actually pretty low.

But there's more!  Who changes their minds more, liberals or conservatives?  Click to link to find out.

Media Trend Watch

| Sat Oct. 31, 2009 5:00 PM EDT

Old CW: Drudge rules their world.  New CW: Breitbart rules their world.  Jim DeMint gets it: "We don't need The Washington Post to cover things anymore.  Something can get on a conservative blog, then on Fox News, then it's everywhere."

Pundit Watch

| Sat Oct. 31, 2009 3:17 PM EDT

Good news!  The Washington Post has picked the ten finalists in its "America's Next Great Pundit" contest.  I know you don't have time to read them all, so I'll summarize:

Richter: Bring back the Office of Technology Assessment.
Haber: Where I come from, five plus one equals eight.  What's more, Nevada will both lose and gain a congressional seat after the 2010 census.
Martin: These days, everybody wants it all.  Also: my dad is driving my mother crazy.
Jackson: Barack Obama needs to stop whining.  Bush 43 wasn't so bad.
Gyamfi: Cable news is stupid.
Huffman: I want to be the next Dave Barry.
Esper: Healthcare is an important issue.
Khalil: Surprise! Arab-Americans watch Fox News.
Khan: Women like to yak, and Obama should capitalize on this.

I know what you're thinking: this is only nine columnists.  What's the deal?  Answer: there's a tenth, but for some reason her column isn't up yet.  Not sure why.

By the way, the ten winners include a Nobel Prize winner, a Bush 43 assistant secretary of commerce (guess which one), a senior correspondent for the American Prospect, an analyst at the Council on Foreign Relations, a former researcher at the Kennedy School of Government, an Atlantic Media fellow, and a small-town newspaper editor.  Not exactly a crowd of just plain folks.  It might have been more fun to read the other 4,790 entries.

Apocalypse Soon

| Sat Oct. 31, 2009 1:55 PM EDT

Via the mysterious Will, io9 has a guest post this week from Chanda Phelan, a graduate of Pomona College who recently completed a thesis on post-apocalyptic literature.  Basically, she looked at 423 books, poems, and short stories about the apocalypse (full list here) in order to try and divine trends on just what the fictional causes of fictional apocalypses are.  Fun!

Anyway, the result is a gigantic chart, partly excerpted below.  And some discussion:

I wanted to see if there were patterns in how writers saw the monster. As it turned out, the patterns were clearer than I imagined. Nuclear holocaust was really popular after 1945; that's to be expected. But the precipitous and permanent drop in nuclear war's popularity after the dissolution of the U.S.S.R. in 1991 (see chart)? That surprised me.

....The easily spotted trends make the patterns' total collapse in the mid-1990s even weirder. Human-created apocalypses shrink dramatically, and there's a sudden spike of unexplained apocalypse scenarios at the turn of the century. What happened? One possibility is that every End started to feel clichéd. The terror of a possible nuclear war faded, and no new extravagant ways to kill ourselves appeared to replace it.

My theory: most the explained apocalypses hightailed it to the movie theater, where practically the whole point of apocalyptic storytelling is to show you exactly how the planet is destroyed in loving IMAX/Technicolor/Dolby CGI detail.  This wouldn't really be on my mind except that I've now seen the trailer for 2012 about a hundred times — it feels like a hundred times, anyway — and apparently the purpose of the movie is to make the entire genre obsolete by rolling up every disaster movie trope ever invented into one ultimate 2-hour extravaganza never to be surpassed.  Everything will be destroyed.  Every manner of destroying things will be used.  Every cliche will be exploited.  When you're done, you will never need to see another disaster movie ever again!

Which is fine with me.  I'm just wondering if they'll even pretend to tell a story while all this mayhem is going on.  Or is that too old school these days?

POSTSCRIPT: I also have a question about the chart: what happened in 2000?  Not a single work of planet-ending fiction in the entire year?  Really?