Mojo - December 2009

Why Mammograms—and Other Tests—Should Be Rationed

| Wed Dec. 16, 2009 7:30 AM EST

Predictably, the GOP has capitalized on the recent uproar over revised mammogram recommendations as proof that the federal government is trying to ration your health care. And while the US Preventive Services Task Force (the panel doing the recommending) consists of 16 doctors who review the research and conduct risk-benefit analysis—the GOP is more or less correct. The government is trying to ration health care. And it should, according to Princeton University bioethicist Peter Singer.

I’m with Singer. In seeking the status quo, do these pols really imagine that health care isn’t now rationed by private insurers? Of course not. They’re just grandstanding. Fact is, no medical rationing is more extreme than kicking someone out of your health plan. Costs do need to be controlled, for sure, but the costs are just a symptom of bad decisions and perverse incentives that have made America's health care system No. 37 in the world—even though we're No. 1 in per-capita spending. A lot of those bad decisions involve unnecessary testing, followed by treatment for conditions that are not, in the end, life-threatening. I’m not talking about withholding a lifesaving treatment from your 75-year-old mother here, but rather about approaching health—and mortality—with rational medicine rather than emotional politics.

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Need To Read: December 16, 2009

Wed Dec. 16, 2009 7:30 AM EST

Today's must reads:

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A Good Week For Gays

| Tue Dec. 15, 2009 8:23 PM EST

Last week, three openly gay people rose to positions of public prominence. A quick rundown:

1. Houston (yes, the one in Texas) became the largest city in the US to elect an openly gay mayor. Annise Parker defeated Gene Locke with 53 percent of the vote. I wrote a blog about their runoff, which featured a bit of anti-gay fuss from pastors and social conservatives.

2.  In Los Angeles, Rev. Mary Glasspool became the second openly gay bishop in the Episcopal Church and the world Anglican fellowship. Her ascendancy follows Episcopal leaders' decision to lift a de facto ban on the ordination of gay bishops in July. The first openly gay bishop was Gene Robinson, whose 2003 election in New Hampshire caused a rift in the church. More talk of a split has come up around the decision to ordain Glasspool.

3.  Last but not least, the California Assembly picked its first openly gay speaker, John Pérez, on Thursday. Assembly Democrats unanimously backed Pérez, who was elected to the Assembly last year and also happens to be a cousin of Los Angeles Mayor Antonio Villaraigosa.

So what do you think, MoJo readers? Does it matter? Will all of this make any difference next year, when landmark decisions about gay marriage and "Don’t Ask, Don’t Tell" are supposed to be made? While you’re thinking, help yourself to a selection of related video clips below.
 

Bring On the Lieberman Filibuster

| Tue Dec. 15, 2009 4:58 PM EST

Joe Lieberman's latest threat to block the Senate Democrats' "compromise" reform bill is the big health care news this week. As CNN reports:

Lieberman has emerged as the main obstacle to Reid's efforts to get a health care bill through the Senate before Christmas, if ever.

An independent from Connecticut who sits with the Democratic caucus, Lieberman ratcheted up his public opposition to the bill Sunday. On the CBS program "Face the Nation," Lieberman said he would join a Republican filibuster if the bill contained either a government-run public health insurance option or a proposed alternative to the controversial provision—expanding Medicare to people as young as 55.

Lieberman also called for eliminating a provision to provide long-term home health care to the disabled while adding more cost containment measures to the $848 billion Democratic bill.

"We don't need to keep adding on to the back of this horse until the horse breaks down and we get nothing done," Lieberman said.

Lieberman has been making such threats for months. He does it every time something in the legislation fails to please him (and, presumably, his corporate donors in Connecticut, which is insurance industry central). By now it's pretty clear that Lieberman is enjoying his little run of absolute power over the party that abandoned him three years ago. As Ezra Klein puts it, "At this point, Lieberman seems primarily motivated by torturing liberals." And as I wrote earlier, he’ll probably get his wish.

Lieberman's Office Calls Cops on Tea Partiers

| Tue Dec. 15, 2009 4:46 PM EST

Tea party activists were on Capitol Hill today lobbying their senators to vote against the pending health care bill. For the most part it was a pretty peaceful exercise in free speech. But Tea Party Patriots national coordinator Mark Meckler says this afternoon, he and a group of activists were met with some "pretty interesting thuggery" when they paid a visit to Sen. Joe Lieberman's office, the man of the hour in the health care debate. Meckler says they went to Lieberman's office, asked for a meeting, and were told that the senator was unavailable. Meckler told the staffers that the group would wait and they all sat down.

But unlike in Sen. Barbara Boxer's office, where the group spent three hours this morning watching C-Span on nice leather couches while Senate staffers ignored them, Lieberman's staff called the cops, according to Meckler. He says that within five minutes of sitting down, Lieberman staffers threatened "to have us arrested and throw us out. We said we were just going to hang out, but they said 'you won't be meeting with the senator,' and they called the police." He says six capitol police showed up and that it was "very intimidating," so when the cops asked them to leave, "We did leave." Lieberman's office did not respond to an email seeking confirmation and the office phones are completely jammed, presumably with calls from other anti-health care activists. Sgt. Kimberly Schneider, a spokesperson for the U.S. Capitol Police, could not confirm the details of the incident, but said that any calls from Lieberman's office may not have generated a report as long as no one was arrested.

UPDATE: Watch the video of the incident here.

 

 

Obama's Wall Street Window Closes

| Tue Dec. 15, 2009 3:50 PM EST

This week the last of the big banks—Citigroup and Wells Fargo—announced they're repaying their TARP funds, ending a major chapter in the Great Bailout Era. (It's not the end of the Era entirely, as many banks still benefit from the Federal Reserve's guarantees and other means of support.) As the banks exit TARP, they proudly shed the bailout's stigma—namely, needing the federal government as a crutch—and are free from the scrutiny of compensation and governance that came with federal assistance. But from a financial-reform standpoint, the bailout represented a huge, once-in-a-lifetime opportunity for the Obama administration: They had leverage, huge amounts of it, Long-Term Capital Management-sized leverage over Wall Street and its "fat cats." Obama, Geithner, Summers, and their allies in Congress (i.e., Rep. Barney Frank (D-MA)) had a window in which they could enact rigorous, meaningful, lasting reforms in the way our financial markets and institutions do business.

Now's as good a time as ever to ask: How'd they do?

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We're Still at War: Photo of the Day for December 15, 2009

Tue Dec. 15, 2009 7:31 AM EST

CAMP TAJI, Iraq—Under the cover of night, an AH-64D Apache attack helicopter from the 1st Air Cavalry Brigade, 1st Cavalry Division, departs the flight line to conduct operations in support Operation Iraqi Freedom, here, Dec. 2, 2009. (army.mil.)

Need To Read: December 15, 2009

Tue Dec. 15, 2009 7:30 AM EST

Today's must reads:

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Drugging the Poor

| Mon Dec. 14, 2009 9:05 PM EST

Poor children are more likely to occupy prisons and live near hazardous waste facilities than their middle-class peers—and now, The New York Times reports, children covered by Medicaid are prescribed antipsychotics at a rate four times higher than children whose parents have private insurance. Even more troubling: The FDA has approved many of these drugs to treat only schizophrenia and bipolar disorders, but doctors have been prescribing them to poor kids who suffer from more common conditions like attention deficit hyperactivity disorder (ADHD), aggression, and "persistant defiance," which are often diagnosed by family doctors instead of psychiatrists.

The reason for this disparity? Medicaid often pays much less for family counseling and psychotherapy than private insurers do, and families living below the poverty line don't have time to attend counseling and therapy sessions anyway, the article posits. Poverty itself can exacerbate the many problems the kids are receiving medication for:

Experts generally agree that some characteristics of the Medicaid population may contribute to psychological problems or psychiatric disorders. They include the stresses of poverty, single-parent homes, poorer schools, lack of access to preventive care and the fact that the Medicaid rolls include many adults who are themselves mentally ill.

But drugging the poor doesn't come cheap:

Even though the drugs are typically cheaper than long-term therapy, they are the single biggest drug expenditure for Medicaid, costing the program $7.9 billion in 2006, the most recent year for which the data is available.

Since a large portion of state Medicaid spending is financed by grants from the federal government, pharmaceutical companies receiving Medicaid revenues benefit from overmedicating the poor, and so does the government, which receives a portion of the pharmaceutical companies' revenues from sales to Medicaid patients. Something to think about, given the fact that Congress is currently hammering out health care legislation that could increase the amount of people on Medicaid by 15 million.

Dispatch from Foreclosureland

| Mon Dec. 14, 2009 2:47 PM EST

In August, I wrote about the Obama administration's flawed $75 billion homeowner rescue effort, the Home Affordable Modification Program, and therein introduced readers to Florida homeowner Kristina Page. Page's mortgage company, Saxon Mortgage Services, first told her it hadn't heard of HAMP. Then, when Saxon finally admitted Page into the program, it lost her paperwork and told her multiple times to send more copies of the same information even though she knew the name of the employee who'd signed for the originals.

Page eventually made it into HAMP's trial period, a test run during which she had to make to three lower payments on time to qualify for the permanently lower, more affordable payments. After the test run, Page's mortgage company, per HAMP's guidelines, re-examined her financial information and recalculated what her permanent mortgage payments would be. Here's where, like so many other homeowners, Page ran into trouble. "As I feared," she recently wrote me, "the permanent payment is much higher than the trial period estimate payments." On the face of it, her new monthly payment will be $40 less—hardly much help when you consider the mess Page's been through to participate in HAMP.

It gets worse. Here's why, in Page's own words, Saxon gave her higher—and as it turns out, incorrectly calculated—HAMP payments:

I couldn't figure out how they had our income so high, so as I told you I contested the numbers. Saxon called this morning and I explained my problem. [The Saxon employee] checked into it and called me back with this gem. She said, "The extra income is because there is a letter in your file stating your sister Samantha will be contributing $1300 per month toward your household income"...I am an only child...I don't have a sister Samantha or any other sister. She [the employee] apologized profusely and even said, "This is all our fault"...I almost dropped the phone.