Kevin Drum

ba-ROCK and so-toe-my-OR

| Wed May 27, 2009 2:31 PM EDT

Bob Somerby reads two front-page profiles of Sonia Sotomayor and reports back:

In the Times, Sotomayor is a person who is also Hispanic. In the Post’s formal profile, Sotomayor’s ethnicity is the headlined focus. Perhaps unsurprisingly, Goldstein’s focus on ethnicity features a peculiarly trivial, unflattering selection of anecdotes and recollections.

Meanwhile, via Steve Benen, I see that immigration zealot Mark Krikorian is fighting the good fight against pronouncing her name correctly:

So, are we supposed to use the Spanish pronunciation, so-toe-my-OR, or the natural English pronunciation, SO-tuh-my-er, like Niedermeyer? [Following up the next day:] Deferring to people's own pronunciation of their names should obviously be our first inclination, but there ought to be limits. Putting the emphasis on the final syllable of Sotomayor is unnatural in English [...] and insisting on an unnatural pronunciation is something we shouldn't be giving in to.

You know, I'm lousy at pronoucing non-English words.  If you want a nicely rolled R, look elsewhere.  But so-toe-my-OR?  Give me a break.  A five-year-old can do that.  Just like we all got used to pronouncing the president's name ba-ROCK.

This is going to be a long couple of months.

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Can the Mayo Clinic Save Healthcare?

| Wed May 27, 2009 1:28 PM EDT

McAllen and El Paso are very similar places: similar people, similiar diets, similar health profiles, both border towns only a few hundred miles apart from each other.  But healthcare costs in McAllen are almost twice what they are in El Paso.  What could possibly account for that?  Atul Gawande visited McAllen to find out, and ended up getting multiple answers from a group of doctors he went to dinner with one night.  Finally he got to the bottom of it:

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”

....The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period....They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

....“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” [a hospital administrator] said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes — or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said.

....About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

This comes via Ezra Klein, who didn't excerpt anything from the piece because he wanted to encourage everyone to click on the link and read the whole thing.  Obviously I'm not quite so high-minded myself.  Plus there's the fact that I have a dim view of human nature: most of you guys aren't going to click the link no matter how much I tell you to, are you?

But you should!  It really is a good piece.  "Overutilization" is a boring buzzword that Gawande breathes real life into.  If you want to know why American medicine should look more like the Mayo Clinic — and why it would be both better and cheaper if it did — turn off the House reruns and read Gawande instead.  And if you want a different perspective on the same issue, try reading Shannon Brownlee's Overtreated.  It's good too.

(OK, fine, keep watching House.  It's a great show.  Just don't use it as your template for what medical care should look like, OK?)

China and North Korea

| Wed May 27, 2009 12:34 PM EDT

Is there a point at which China will finally tire of the antics of its North Korean neighbor and put its foot down?  Barbara Demick of the LA Times offers up a modest data point today:

North Korea's latest nuclear test raises the question of just how long the bonds forged between old communist allies will endure....Increasingly, China itself is questioning whether the relationship is worth the effort.

Within the Chinese intelligentsia there is a deep divide over how to handle North Korea. The Global Times, a newspaper with close party ties, Tuesday published a survey of 20 of the country's top foreign policy experts. It found them split down the middle — 10 arguing for tough sanctions against North Korea, 10 opposed.

It's not much.  Just a blip.  But I'll bet that even five years ago opinion wouldn't have been split much at all, and if it had it wouldn't have made it into the pages of a newspaper close to the party.  The times may be — slowly, subtly, silently — changing.

Headline of the Day

| Wed May 27, 2009 12:19 PM EDT

From the LA Times:

Protesters found to be a nuisance

Yes, I suppose they are, aren't they?

Do We Need More Think Tanks?

| Wed May 27, 2009 11:43 AM EDT

Douglas Holtz-Eakin, former CBO director and John McCain campaign advisor, wants to start up a new conservative think tank, a "Center for American Progress for the right."  Matt Yglesias, who works for the actual Center for American Progress, isn't impressed:

This seems pretty misguided to me. In particular, DHE needs to think harder about the fact that there are already well-resourced conservative think tanks with plenty of capabilities. Before CAP came on the scene, there really wasn’t a “Heritage of the left.” On the right, Heritage and AEI already exist. The problem they face is that the conservative movement, as presently constituted, is not prepared to accept anything other than “tax cuts” as a solution to anything. Consequently, they’re not really even prepared to accept the premise that other problems exist. Tax cuts can’t solve climate change, so there must be no such thing! Tax cuts can’t curb inequality, so there must not be a problem with growing inequality.

But there's another way to look at this.  After all, a decade ago conservatives would have said that liberals already had think tanks too: Brookings, the Ford Foundation, CFR, etc.  The problem is that they were the wrong kind of think tank: they may have leaned toward the left institutionally, but they weren't overtly partisan.  They weren't dedicated to a cause.

So liberals decided they needed more direct competitors to Heritage and AEI, and CAP was one of the results.  Likewise, although Holtz-Eakin may say his proposed think tank is CAP for the right, my guess is that it's really more a DLC for the right.  That's what the conservative movement needs, after all.  They have plenty of partisan, conservative think tanks at their disposal, but they've ossified so much that they're now as much a part of the problem as the Republican Party's special interest base itself.  What they need is a think tank that tries to move the party back toward the sane center, one that produces ideas beyond bashing gay rights, extolling endless tax cuts, pretending that global warming doesn't exist, and cheerleading the death of ever more people from central Asia.  They need a conservative DLC, and I'll bet that's what Holtz-Eakin really has in mind.

Fundraising Finale

| Wed May 27, 2009 1:50 AM EDT

Two things.  First, I want to thank everyone who contributed to our fundraising drive last week.  These donations really help, and even the small ones add up.  Second, if you didn't contribute last week, how about doing it today instead? 

Your contributions help keep our reporters at work (including me!), but we can only keep doing what we do if our readers deliver the financial support we need to stay on the story.  This is the final week of our fundraising drive, so if you can afford to part with a few dollars, click here to make a donation.  It's a quick credit card donation form, and if you contribute $35 or more you get a subscription to the magazine too.  Thanks!

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Supreme Court Kabuki Watch

| Wed May 27, 2009 1:38 AM EDT

The nomination of Sonia Sotomayor to the Supreme Court is only 12 hours old and I'm already sick of it.  Conservatives, who seem constitutionally incapable of viewing any non-white nominee as anything other than identity politics run wild, have already decided she's just a crass affirmative action hire.  Out of a decade-long appelate court career, the only opinion of hers they seem to have heard of, or care about, is Ricci.  And unlike all the middle class white guys on the court, who are apparently paragons of race-blind rationality, they're convinced that she's just naturally going to be incapable of judging any case before her as anything other than a woman and a Hispanic.

Not that it matters.  We all know how this is going to play out.  First, everyone is going to start looking for some dark secret in her background that will derail her nomination.  That will probably fail.  Then she'll testify before the Senate, and everyone will ask what she thinks of Roe and Casey and Kelo.  She'll dutifully claim that she's never even heard of these cases, and on the off chance that any of them ring a bell, she'll sing the usual song about how it would be improper to say anything about any matter that might come before the court in the future.  Which is everything.  After a few weeks of this, all the Democrats and maybe a dozen or so Republicans will vote to confirm her and she'll join the court in time for the fall term.

It's all so tedious.  So instead of going though with it, why don't we just pretend we did all this, confirm her tomorrow, and then get back to something important, like fighting a couple of wars, trying to rescue the world economy, creating a national healthcare plan, and stopping global warming?

Owning GM

| Wed May 27, 2009 12:50 AM EDT

Here's the latest on America's auto industry:

General Motors Corp. and the United Auto Workers have agreed to a new restructuring plan that would give the union a significantly smaller stake in the company than previously envisioned, and leave the U.S. government owning as much as 70% of the car maker.

....The union — concerned about the GMs prospects — sought the lower stake in exchange for preferred shares that provide annual income as well as a $2.5 billion note from GM, said people familiar with the situation.

I know this is only "temporary."  I know that the followon problems from a collapse of GM might be devastating.  Maybe we have to do this.  Maybe there's no choice.  But I sure don't like it.

Banks are one thing. They're systemically important in a way no other industry is.  When they go broke the government has to either arrange a fire sale or else take them over.  But owning a car company?  Especially one that's in such bad shape that there's a good chance we'll never be able to re-privatize it?  Which means that we'll probably keep it on life support forever because it's politically impossible to shut it down?  Jesus.  This whole deal just keeps getting worse and worse.

Healthcare and Me (And You)

| Tue May 26, 2009 9:20 PM EDT

Over at the Washington Monthly, Jonathan Gruber writes that universal healthcare would create more fluid job markets and spur entrepreneurship:

The main reason for this is a phenomenon known as "job lock," a term coined during the last round of debate over universal health coverage in the early 1990s. Job lock refers to the fact that workers are often unwilling to leave a current job that provides health insurance for another position that might not, even if they would be more productive in that other position. This is because employer-provided insurance is traditionally the only reliable form of fairly priced private insurance coverage available in the U.S.

....[Alison] Wellington estimates that universal health care would therefore likely increase the share of workers who are self-employed (currently about 10 percent of the workforce) by another 2 percent or more. A system that provides universal access to health insurance coverage, then, is far more likely to promote entrepreneurship than one in which would-be innovators remain tied to corporate cubicles for fear of losing their family’s access to affordable health care.

That's true.  Take me.  Suppose I wanted to quit my job and write a book.  The first step would be for me to have a book in mind that I wanted to write — which, unfortunately, I don't.  But say I did.  Would I leave MoJo to do it?

Probably not.  I've never shopped around for an individual healthcare policy, but my guess is that despite my general good health, I'd get turned down simply for being over 50 and having high cholesterol.  And without health insurance, I really couldn't afford the risk of being self-employed.

It's true that this is a moot point until I have a burning desire to spend full time writing a book, but you never know.  Maybe someday I will.  It doesn't matter, though, because that book will probably stay unwritten no matter how good it might be, since I'd have to give up my health coverage to write it.  Pretty stupid system we have, isn't it?

Gay Marriage in California

| Tue May 26, 2009 2:19 PM EDT

The latest on Prop 8 from the LA Times:

The California Supreme Court today upheld Proposition 8's ban on same-sex marriage but also ruled that gay couples who wed before the election will continue to be married under state law.

....Although the court split 6-1 on the constitutionality of Proposition 8, the justices were unanimous in deciding to keep intact the marriages of as many as 18,000 gay couples who exchanged vows before the election. The marriages began last June, after a 4-3 state high court ruling striking down the marriage ban last May.

This doesn't surprise me on either count.  The argument that Prop 8 was a constitutional "revision" requiring a two-thirds vote, not a constitutional amendment requiring a majority vote, never seemed legally defensible.  At the same time, all the marriages performed prior to Prop 8 were as legal as church on Sunday.  I don't know if even an initiative could retroactively annul them, but at the very least it would need to do so specifically and directly, which Prop 8 didn't.

But it might soon be moot anyway.  Prop 8 passed by only a bare majority, and public sentiment is continuing to change.  An initiative to legalize gay marriage might well pass in 2010, and if it doesn't it certainly will by 2012 or 2014 at the latest.  Time is on the side of the good guys.