Monday, August 3, 2009

The Mighty Truth

Truth is mighty and will prevail. There is nothing the matter with this, except that it ain't so.
-- Mark Twain

In this week's Sift:
  • The Healthcare Debate Takes a Turn for the Worse. Before we can even get into a discussion of the legitimate issues in healthcare, we have to beat back the nonsense. And no, we're actually not proposing to kill off all the old people -- no matter how much money it would save.
  • Meanwhile, in Iran. The Iranian regime's show trials are reminding us what torture is really good at: extracting false confessions.
  • Short Notes. Tim Geithner can't sell his house. Louisiana cheapens its diplomas. William Shatner performs Sarah Palin's poetic masterpiece. Most white Southerners aren't convinced that Obama was born in American. Michelle Malkin blames unemployment insurance for unemployment. Coalition casualties in Afghanistan skyrocket. And more.

The Healthcare Debate Takes a Turn for the Worse
The most frustrating thing about the healthcare debate is the way that it hinges on nonsense. In an ideal democracy, the opposition to Obama's proposals would be principled and fact-based. We'd be talking about various ways of designing the program, what they would all do, whether that's what we want, and so on.

Instead, the opposition is taking sections of the proposed House bill, making up bizarre and scary scenarios vaguely related to the subjects of those sections, and dishonestly telling people that's what the proposal would do. So, for example, President Obama had to respond to this comment at his AARP town-hall meeting:
I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly, and I'd like for you to promise me that this is not in this bill.
It's not in the bill, it's never been in the bill, and no Democrat in the adminstration or Congress has ever put forward such an idea. So you have to wonder how this strange notion got into the head of Obama's elderly questioner.

Maybe she's been listening to people like Republican Rep. Virginia Foxx, who has been talking about "seniors in a position of being put to death by their government." Or like House Minority Leader John Boehner, who said that Section 1233 of the Democratic proposal "may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign. This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law." Or maybe she got a misleading chain email like the one ObamaGrandma refutes point-by-point.

It sounds very impressive when Boehner references a numbered section of the bill, like he really must have the goods. Unless you know what Section 1233 actually says: If a Medicare patient wants to have a conversation with his or her doctor about end-of-life care, so that s/he will understand the options and can make sure that the doctor understands what the patient wants and doesn't want -- Section 1233 says Medicare will cover that office visit.

That's it. That's all it says. There's no mandate, no requirement, no government official visiting your home. No euthanasia. No seniors being put to death by their government. It just says: If you want to have that conversation, if you want to tell your doctor that you don't want to spend years living as a vegetable like Terry Schiavo, Medicare will pay for the doctor's time while he listens to you.

That, unfortunately, is typical of the debate we're having.

Even some well-intended parts of our national conversation are based on a misunderstanding of what insurance is and what it's for.

Let's review some history: Insurance as we know it started in the 1600s in a London coffeehouse called Lloyd's, where sea captains liked to hang out between voyages. In those days long voyages -- to the Americas, to the South Seas, and so on -- were all-or-nothing propositions. If a ship made it there and back with its cargo, the profit was huge. Otherwise it was a total loss. (That's where we get the phrase waiting for your ship to come in.)

Few people -- particularly not captains trying to make the jump to ship-owner -- were rich enough that they could afford to lose a whole ship, so instead they traded interests in each other's voyages. In today's terms, they were diversifying their investments. When a captain planned a trip, he'd stick an announcement to the wall at Lloyds, telling where he wanted to go and how much money he needed to raise -- and leaving space at the bottom where others could write their names and how much of the voyage they wanted to finance. (That's where we get the term underwriters. They literally wrote under the announcement.) So began the legendary insurance house Lloyds of London.

Here's why I told you that story: The original purpose of insurance is to defend against catastrophic loss, the kind that otherwise would bankrupt you. In more recent times we've confused the issue by insuring against all sorts of lesser losses, like buying service contracts on gadgets we could easily replace or do without. Mostly we do this for superstitious reasons (so that the gadget won't break), and as a result many of us have lost track of what insurance is really for.

A lot of health insurance -- especially individual policies -- depends on that confusion: It insures people against everything but a catastrophic loss. It's like insuring your ship against everything other than sinking. If your insurance has an annual or lifetime cap, for example, it misses the point. A cap means that you're insured unless you need very expensive treatment. If you do, you're on your own; you'll probably have to declare bankruptcy. If your health insurance excludes some potentially expensive pre-existing condition like cancer or diabetes, it misses the point. You're insured against everything but the thing you actually need to worry about.

We throw around a lot of numbers about the uninsured: 45 million people, 50 million, whatever. And whenever we hear those numbers, the rest of us silently congratulate ourselves for having health insurance. But some of that self-congratulation is misplaced, because we don't really have health insurance; we still face the risk of going bankrupt if we get very sick. According to the American Journal of Medicine, 62% of American bankruptcies have medical causes. "Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance."

In the other wealthy countries -- in Japan, Canada, France, and so on -- do you know how many people are at risk of going bankrupt from medical bills? Zero. That's what real health insurance means, and that's what we're now trying to bring to America.

I'm tempted to give the Atlantic's Megan McArdle a pass, because she makes a reasonable argument against government-sponsored healthcare, one that doesn't depend on making stuff up. She claims that government won't have as much incentive to produce innovative new treatments as profit-making industry does.

Anybody who makes that argument, though, needs to explain the defense industry. Somehow we keep coming up with all these whiz-bang new weapons systems, in spite of the fact that the government is the only customer.

McArdle specifically talks about breast cancer treatments, which brings responses from FireDogLake's breast-cancer survivors Jane Hamsher and Marcy Wheeler. Jane points out that in the same study that Republicans are using to denigrate Britain's breast-cancer survival rate, the country with the best rate is ... [wait for it] Cuba.

Marcy goes into a little more detail about the overtreatment/undertreatment question in her case:

You see, I'm no doctor. But based on my fairly sophisticated understanding of the breast cancer diagnosis I had, I understand that instead of the treatment I had here in the US--6 rounds of chemo plus Neulasta, surgery*, radiation, then five years of Tamoxifen--the standard of care in Europe would have been just the Tamoxifen. Or, by my rough calculations, well over $72,000 [less] in costs.

And, at least according to the limited studies they've done on women with breast cancer at my age, the outcomes are exactly the same.

[*Based on my own fairly sophisticated understanding of my wife's breast cancer diagnosis of 1996, I'm guessing Wheeler means only Tamoxifen after surgery. I can't believe the Europeans would leave the tumor in there, or get equivalent results if they did. The $72,000 estimate would still make sense. I heard another chemo patient refer to her treatment -- which makes hair fall out and then come back frizzy -- as a "$100,000 permanent".]

Marcy has no complaints about her husband's insurance, which paid for it all. But in the long run, she wonders whether less treatment might be better:
One of the chemos I had leads to heart problems and has basically turned the veins in my arms into solid tubes. The radiation--particularly in someone with my apparent genetic background--can lead to new cancers. And those known risks are basically short term risks--because so few women are diagnosed as young as I was, they don't know what happens 30 years after this stuff, because most women are diagnosed with just 20 years left in a normal life span. Who knows? Maybe my husband's company paid $72,000 extra for treatments that will eventually kill me.

I've made this point before, but we have to keep repeating it whenever the other side tries to confuse the real issues: People in other countries spend much less on health care, and yet they live longer. Whenever the Right tells some horror story about waiting for treatment in Canada or Britain or someplace, repeat this phrase: But they live longer. If their healthcare is so terrible, how do they live longer than we do?

When asked by a Canadian viewer, Bill O'Reilly had an answer to that question: "Well, that's to be expected Peter, because we have ten times as many people as you do." Yeah, I know, it doesn't make any sense. Were you expecting it to? (This wasn't the kind of brain glitch anybody can have on live TV. O'Reilly was responding to a written comment.)

Jon Stewart takes on the healthcare scare tactics. And this earlier Stewart rant is pretty good too. In response to John Boehner saying: "If you like going to the DMV and think they do a great job or you like going to the post office and think it's the most efficient thing you've run into to then you'll love the government run health care system." Stewart says:
If you like the "military" protecting the "country" or "doctors" helping "veterans" you'll love this new government plan.

By the way, why are you ragging on the post office? For forty-four cents, someone comes to your house, picks up some piece of crap you wrote, and takes it to Wyoming on a plane!

Here's a Canadian doctor's analysis of what Americans should learn from the Canadian healthcare system.

Newsweek's Jon Alter makes the tongue-in-cheek case for why we don't need healthcare reform.

I like the "lifetime limits" that many policies have today. Missed the fine print on that one, did you? It means that after you exceed a certain amount of reimbursement, you don't get anything more from the insurance company. That's fair.

Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.

Tina Dupuy compares healthcare to a private industry that government took over in the 19th century: fire-fighting. Imagine if we were having that debate today, and folks like Senator DeMint were saying: "Do you want a government bureaucrat between you and the safety of your home?

Meanwhile, in Iran
The Iranian government is giving the world a demonstration of what
torture is good for: You can make people say whatever you want.

Currently, Iran is having show trials where repentant opponents of the government confess their sins. Juan Cole quotes from an account of a news conference by two former dissidents, Mohammad Ali Abtahi and Mohammad Atrianfar. Both now completely support the government's claim that there was no fraud in the recent presidential election.
Asked if his current position was under the effect of his imprisonment, Abtahi said the situation in the prison helped him to reach a conclusion about the recent incidents. ... Atrianfar said that the situation in the prison helped him to be courageous enough to confess to his mistakes. He said that many political activists who are being tried today have the same idea, but it may take time before they confess to the same things.
Time and pain, I imagine.

Wouldn't it be nice if the United States could denounce this kind of thing without making the whole world laugh? Iran tortured people to say that their elections were fair; we tortured people to say that Saddam was allied with Al Qaeda. Maybe there's a difference there somewhere, but wouldn't you rather be able to say "They torture and we don't"? Maybe, now that Bush is out of office, we don't torture any more. I hope that's true.

Fortunately, in spite of all the repression, the Iranian people are not giving up. According to a posting on an Iranian email list (quoted by Cole) 150-200,000 people converged on the grave of recent martyr Neda Agha Soltan and chanted anti-government slogans. I don't know of any way to verify accounts like this -- much less the crowd estimate -- but it does seem to indicate that this isn't over.

Short Notes
The Daily Show's John Oliver investigates the plight of an American homeowner who took a job in a new city but (given the current real estate market) can't sell his old house: Federal Reserve Chairman Timothy Geithner.

I don't know exactly what to do to improve American education, but I'm pretty sure this isn't it: Louisiana's Gov. Bobby Jindal just signed legislation creating a second kind of high school diploma with lower standards.
Under the new law, students 15 and older could leave the standard curriculum and instead take a "career track" if they have parental approval. They would face easier requirements for graduation and a curriculum less geared toward college preparation. It would also allow eighth graders to advance to ninth grade without passing the state's high-stakes standardized test.
The idea, I guess, is to do something about Louisiana's low high-school graduation rate. (57.5% in 2006, 5th lowest. The national average is 68.6%.) But it seems like they're defining the problem away rather than solving it. So much for "challenging the soft bigotry of low expectations".

Most observers thought it was incoherent, but they just don't get poetry -- that was Conan O'Brien's reaction to Sarah Palin's good-bye speech. To give the rest of us a chance to appreciate Sarah's poetic brilliance, Conan arranged a dramatic reading of her speech by William Shatner.

Remember last summer when John McCain described his running mate as "the most popular governor in the country"? Well, that was then, this is now: 46.8% positive, 47.5% negative.

And in other Palin news, spokeswoman Meg Stapleton says there's no truth to the rumor that Sarah and Todd are splitting up. For what's its worth, the leading spreader of that rumor only backed off as far as to say that "I just talked to my source again and learned the following. Sarah and Todd will not be making their break up official for some time." (Don't you love anonymous sources?) He added (in response to a denunciation by Stapleton, apparently): "I am going to wear the title of 'so-called journalist' with pride."
The Episcopal Church isn't backing down on gay bishops.

Creationism was just the beginning. Now fundamentalists want to rewrite how we teach American history.

Conservative blogger Michele Malkin knows what really causes unemployment: People's unwillingness to go out and find a job.
If you keep extending these 'temporary' unemployment benefits, you're just going to extend joblessness even more. ... People will just delay getting a job until the three weeks before the benefits run out.
And notice where she said this: As a panelist on ABC's "This Week". How often do liberal bloggers make the jump to be panelists on Sunday talk shows? Approximately never.

Where does this recession rank among post-WW2 recessions? Do you really need to ask?

A few weeks ago I was telling you about the Wolfram Alpha sort-of-a search engine.
InfoWorld's Neil McAllister
wonders how Wolfram's unusual copyright claims for Alpha's output will change our legal relationship to software.

The number of coalition troops who died in Afghanistan in July: 75. The most to die in any other month is only 46. Nine more have died in the first two days of August.

You know those crazy people who think -- in spite of all available evidence -- that President Obama wasn't really born in America? They're close to a majority in the South. 23% of Southerners definitely say he wasn't, while another 30% aren't sure. This compares to 4% no and 3% not sure in the Northeast. Dave Wiegel does some unofficial number-crunching and concludes that as many as 70% of white Southerners either don't believe or aren't sure whether Obama is a native-born American.

CNN's Lou Dobbs claims not to be a "birther" himself, but he continues to fan this made-up controversy on his show. Media Matters has made an anti-Dobbs ad, which they want to run on Dobbs show itself. That's got to be a media-criticism first.

It's flu season in the southern hemisphere. The doomsday scenario is that the swine flu, which wasn't all that deadly at the end of our flu season, may mutate down there and then come back this winter like the Grim Reaper. That's the pattern of the 1918 Great Influenza. But reports from Argentina indicate that so far that isn't happening.

Apparently the O'Reilly-Olbermann feud is over. But it wasn't settled by Bill and Keith, by their staffs, or for any journalistic reason. This was a corporate negotiation between GE and News Corp, which own the respective networks. So much for the idea that the corporate types don't interfere with the news networks.


Anonymous said...

RE: Health Care Reform: Watching the Democrats and Republicans work on health care rerorm is like watching a sporting match where the teams are on the same field but playing entirely different games with different rule books.

RE: MSNBC v. News Corp. Reading Glenn Greenwald's columns about this makes me want to puke all over my keyboard. I used to like Keith and regularly watched his show during the last few years of Bush's administration. Hearing about this gag order from on high makes me sick. I wish he had resigned in protest.

macduff said...

those scare tactics are red-herrings. Our not so very good friends at AARP are in the business of selling health care insurance. Its all about them, the hell with the consumer. We see this over and over and nothing ever changes, where in the heck is the change that was promised? - Cold War reheating, AFPAC expanding, Massive amounts of money drawn from our Treasure to the very people that messed up the economy. Chickens STILL IN THE HENHOUSE. As you can see, I have lost my patience with business as usual. Perhaps because I subjected my self to several weeks of watching congress in action on C-Span. We are in deep trouble folks. Deep doo doo.

xine said...

"How often do liberal bloggers make the jump to be panelists on Sunday talk shows? Approximately never."

Doug, who do we lobby to get you on as a panelist? ;)

Doug Muder said...

A lovely thought, xine. Higher-profile liberal bloggers who deserve a shot at major-network TV are Jane Hamsher, Glenn Greenwald, Markos Moulitsas, and a bunch of people I'm forgetting. One of the best liberal bloggers is Digby from Hullabaloo, but I just know her from her writing, so I don't know how she'd do on TV.

She's not a blogger, but Amy Goodman would make an interesting panelist too.

But it's not going to happen, because major-network panels range from slightly left of center to the extreme right -- like Michele Malkin. People firmly on the left aren't wanted.

kimc said...

What boggles me about the whole "the government is going to kill old people" business, is --- How can anyone just believe that anyone who's anywhere near normal wouldn't be shocked by that idea? It's such an obviously horrible, shocking unconventional idea, what they must think of liberals to think we would think it was an ok idea! the demonization of liberals is so thorough that they think we are monsters. How could they fall for such an obviously outrageous idea? They have to be projecting, and secretly harboring just such an idea.