Kevin Drum

Being Uninsured Can Kill You

| Mon Nov. 16, 2009 10:14 PM EST

Today comes news of a new study on emergency medical care:

Patients who lack health insurance are more likely to die from car accidents and other traumatic injuries than people who belong to a health plan — even though emergency rooms are required to care for all comers regardless of ability to pay, according to a study to be published Tuesday.

Well, no surprise there.  But this is a surprise:

Trauma physicians said they were surprised by the findings....Dr. Frank Zwemer Jr., chief of emergency medicine for the McGuire VA Medical Center in Richmond, Va., said he was "kind of shocked. "

"We don't ask people, 'What's your insurance?' before we decide whether to intubate them or put in a chest tube," said Zwemer, who wasn't involved in the research. "That's not on our radar anywhere."

The surprise is that these guys are surprised.  How much evidence do we need about the disproportionate rate of poor outcomes among the uninsured before everyone understands that lousy American healthcare coverage really is killing people?  You'd think that doctors, at least, might be aware of this.

In fairness, part of the result in the trauma study might be due to selection bias.  To some extent, the uninsured are more likely to lead risky lives and more likely to have preexisting conditions of one kind or another.  But mostly it's this:

The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility.

Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses since they don't interact with them as often. All of these factors could influence whether a trauma patient is able to recover from his or her injuries.

A lot of people die unnecessarily every year because we have lousy, expensive healthcare coverage in the United States.  It's about time to start doing something about it.

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Quote of the Day #3 and #4

| Mon Nov. 16, 2009 5:34 PM EST

From Sarah Palin, talking to Oprah about Levi Johnston:

By the way, I don't know if we call him Levi — I hear he goes by the name Ricky Hollywood now, so, if that's the case, we don't want to mess up this gig he's got going.

Ricky Hollywood? And this from a "former McCain campaign aide," on Palin's book:

It is unrecognizable at every instance. There is not one truthful account as it relates to any conversation I ever had with her.

So why is Sarah Palin so endlessly fascinating? The sex appeal that practically oozes out of every pore?  Her perpetual family soap opera? A sense of besiegement and resentment so powerful it practically knocks you over every time she speaks? The fact that she actually seems to take pride in her complete lack of policy expertise? Her seemingly total lack of real self-awareness?  The fact that she lies so casually it seems like she actually believes everything she makes up?

Yeah, I guess that's it.  By the way, Sullivan has been watching her Oprah interview and says "She's clearly hoping to run for president in 2012."  Wouldn't that be great?  And not just for the entertainment value, but to answer some truly nagging questions.  Is it possible to win the Republican nomination while giving interviews to no one except Fox News personalities?  Her fellow Republicans mostly treat her with cautious respect right now, but what will they say about her once they're all on stage together during the primary debates?  Will she develop any actual policy positions?  And who would she choose to be her running mate?  Inquiring minds want to know.

Quote of the Day #2

| Mon Nov. 16, 2009 4:41 PM EST

From Mark Shields, on President Obama's long process of trying to figure out what to do in Afghanistan:

It makes me nostalgic for those days when we had a manly man in the White House who could say, “Let’s kick some tail and ask questions afterwards” you know? That’s what we really need instead of any reflection.

You know, it's not that I don't sympathize at all with Shields here.  It's true that Obama really has drawn out this process for an awfully long time.  And who wouldn't want to just kick some tail if that was all it took to finish things up and bring the troops home?  But it's time to grow up.  Kicking tail is the easy part.  It's figuring out what to do afterwards that's the problem.  That's what Obama is trying to do.

UPDATE: Uncle! I admit it: I just read the quote online.  I didn't watch the video and I didn't read any of the comments at ThinkProgress.  Now that I have, yes, it's pretty obvious that Shields was being sarcastic.  Sorry about that.

Quote of the Day

| Mon Nov. 16, 2009 4:33 PM EST

From Ben Bernanke, in a speech to the Economic Club of New York:

The best thing we can say about the labor market right now is that it may be getting worse more slowly.

Hey, you know what would be great right about now?  Federal aid to states to keep them from going bankrupt and making the labor market even worse.  There must be a branch of the government out there somewhere that could do something along these lines.  Thinking it starts with an L.....

Chart of the Day

| Mon Nov. 16, 2009 1:55 PM EST

Via Kaus, here's a Pew map comparing California's disastrous economic situation to everyone else's.  Congratulations to Rhode Island and Arizona for their close second place finishes!  How's your state doing?

iPhones in China

| Mon Nov. 16, 2009 12:47 PM EST

Have you been sitting around wondering why Apple's launch of the iPhone in China has gone so miserably?  Me neither.  But here's the answer anyway: it hasn't.  Chinese consumers are buying plenty of iPhones, but because the official China Unicom version has WiFi disabled, they're mostly buying them on the gray market instead:

They are for sale at stalls in every cybermall and market in every Chinese city, and come in two varieties: The most expensive ones (at around 6000 RMB in Shanghai for a 16GB 3GS, or 880 USD, depending on your haggling skills) come directly from Hong Kong, where the factory-unlocked model is available from the Apple store for around 4800 RMB....The distribution model is extensive and robust, and in fact most Chinese buy their mobile phones from stalls like this. There are no iPhone shortages, as prices fluctuate to meet demand. The received wisdom is that around 2 million iPhones are in the Chinese wild; I’ve personally seen a good many of them here in Shanghai, where they are much in evidence among the eliterati.

....China Unicom stores all have iPhone banners up; I’ve passed several China Unicom road shows stopping by Shanghai extolling the iPhone. The iPhone is being talked about widely. But so is the fact that the China Unicom iPhone is crippled — the Chinese are sophisticated consumers; forget this at your own peril.

The upshot: anecdotal reports tell of aftermarket prices increasing for Hong Kong iPhones these past few weeks, as demand increased. Clearly, the advertising is working, even if China Unicom’s sales of wifiless iPhones are anaemic.

So: Apple has done an official deal with China Unicom, which isn't producing much in way of official sales but is producing increased marketing and awareness.  Apple's hope, apparently, it that eventually the whole situation will get a little too ridiculous and the Chinese government will cave in to public pressure.  Then they'll start selling unlocked versions through official channels and make a ton of money.  Now you know.

(Via Felix Salmon.)

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Missing the Story

| Mon Nov. 16, 2009 12:08 PM EST

Can a city use its power of eminent domain in order to seize property and then turn it over to a private developer?  In Kelo vs. New London the Supreme Court ruled that it could, but by the time the case was finally decided in 2005 the private development project in question had already started to run out of steam.  Last week, in an ironic coda to the story, Pfizer, which the city of New London had hoped would build a headquarters building on the land, pulled out of New London completely.

Over at CJR, Ryan Chittum says this is a great story that the press completely whiffed on:

The Hartford Courant, fifty miles up the road, wrote a 900-word story the next day on Pfizer’s moves and barely mentioned the whole Supreme Court controversy that roiled the city and country for months. Neither did the Associated Press in a brief. The Wall Street Journal ran with 600-plus words on C3 and didn’t mention Kelo.

....Finally, today, the fourth day of the story, we have major papers covering the Kelo angle. The Daily News hits it, while The New York Times admirably puts its story —and it’s a good effort—on page one.

What took so long and why have other papers been missing on this? Are our institutional memories that short? Are we staffed that thin? Are we that disconnected from our readers?

Believe me, they remember Kelo.

I wonder about that.  Sure, lots of political junkies remember Kelo, but I'll bet that something like 99% of the country couldn't distinguish it from a brand of corn syrup.  Nor do they care about the town of New London, or about Pfizer, or even about the eminent domain issue in question.  The facts of the case make it an interesting topic for a feature story — hubris, irony, hard times, etc. — but in a straight news piece of a few hundred words I'm not really surprised the Supreme Court case didn't get much of a mention.  After all, Suzette Kelo is no Michael Jackson.

CMS Report Revisited

| Mon Nov. 16, 2009 11:17 AM EST

My post last night about the CMS report on healthcare reform may not have been a model of clarity.  For more, see Ezra Klein here and Jon Gruber here.  Combined with my post and this Wonk Room post, you should get a pretty good idea of what's up.

Trade and China

| Mon Nov. 16, 2009 1:35 AM EST

The yawning U.S. trade deficit, which was one of the factors that helped fuel the recent credit bubble, declined sharply in the aftermath of last year's economic meltdown.  But it never came anywhere close to zero, let alone positive, and it was mostly an illusion anyway, the result of a temporary collapse in demand for durable goods.  Paul Krugman:

But with the financial crisis abating, this process is going into reverse. Last week’s U.S. trade report showed a sharp increase in the trade deficit between August and September. And there will be many more reports along those lines.

So picture this: month after month of headlines juxtaposing soaring U.S. trade deficits and Chinese trade surpluses with the suffering of unemployed American workers. If I were the Chinese government, I’d be really worried about that prospect.

Unfortunately, the Chinese don’t seem to get it: rather than face up to the need to change their currency policy, they’ve taken to lecturing the United States, telling us to raise interest rates and curb fiscal deficits — that is, to make our unemployment problem even worse.

And I’m not sure the Obama administration gets it, either. The administration’s statements on Chinese currency policy seem pro forma, lacking any sense of urgency.

I don't know if Obama gets it, but the Chinese sure don't seem to:

Liu Mingkang, chairman of the China Banking Regulatory Commission, said that a weak U.S. dollar and low U.S. interest rates had led to "massive speculation" that was inflating asset bubbles around the world. It has created "unavoidable risks for the recovery of the global economy, especially emerging economies," Mr. Liu said. The situation is "seriously impacting global asset prices and encouraging speculation in stock and property markets."

....Early Monday, a spokesman for China's Ministry of Commerce added further criticism of the Obama administration, targeting recent measures by Washington against Chinese exports. "We've always known the U.S. and the West as free market economies. But now we're seeing a protectionist side," the spokesman, Yao Jian, told a monthly press briefing. Mr. Yao also rejected criticism of China's currency policy, saying the yuan's exchange rate has little to do with trade imbalances with the U.S. and that China should keep the exchange rate stable.

At some point our trade deficit has to turn around.  The Chinese obviously don't want to be the ones to take the hit for this by strengthening their currency and damaging their export-based economy, but they really don't have much choice about it.  The global economy is going to be rebalanced one way or another, and it can either happen gradually or it can happen suddenly. The latter would be no fun for anyone, China included.  Better to take Door #1 instead.

Payback Time

| Mon Nov. 16, 2009 12:55 AM EST

According to "a source familiar with the matter," General Motors is planning to pay off its government loan earlier than expected:

The nation's largest automaker plans to pay $1 billion per quarter until the $6.7 billion loan is repaid, according to a source familiar with the matter.

...."This is a result of the company performing modestly above expectations," said the source, who spoke on the condition of anonymity to discuss the situation. "Obviously, the company has a long way to go and a lot of important things to execute on."

....The $6.7 billion debt is not due to be repaid until July 2015, but the company has exceeded projections, partly by going through bankruptcy more rapidly than it thought it would, and partly by cutting costs.

Am I the only one who thinks this is dumb?  Is GM really that convinced that it's out of the woods and won't be running short of cash anytime in the next few years?  Why?  Has the business cycle suddenly been repealed without anyone telling me?  Are customers suddenly swooning over GM cars?  What's going on?