Thursday, March 29, 2012

"Whatever you say Tony"-- Paul Ryan edition

Against my better judgement, I recently commented on a friend’s Facebook political discussion (bear with me, it gets fun eventually) :

JX:  ...I don't like the direction Obama is going one bit. As bad as it sounds I'm holding out for Obama to win but the republicans to take both houses. Then we'll see if Obama can become Clinton. Otherwise I'm fine with gridlock.

Tony:  Just wondering if you dislike Obama so much then why hold out for a win by him? Following the reasoning that it's up to Congress to save us (yikes), wouldn't Etch A Sketch Romney be easier to rehabilitate into Clinton?

JX: Hi Tony! I'm not happy with the republican candidates. Of the clowns I like Romney best (but I don't like Romneycare), don't like Santorum or Gingrich at all. I was hoping that Paul Ryan would run this year. Since I really dislike Obama policy I'll take a neutered Obama and gridlock. I'll hold out hope that Ryan runs next time, I like his fiscal conservativeness. (emphasis mine-Tony)

Tony:  Hi JX. Calling Ryan a fiscal conservative is like calling Hugh Hefner celibate. He voted for Medicare Part D, Tarp and auto bailouts. Trillions of dollars. We are all socialists now; Ryan's the most cognitively dissonant (I wouldn't call him a hypocrite because I think he lacks the awareness to be even that)... because his socialism is only for corporations. When he calls for the repeal of EMTALA then maybe he can speak about free markets in health care.

JX: No matter what someone is going to find the flaw arguments for any candidate, nobody is perfect, that's fine. I would say that I'm a free-market capitalist, I want lower corporate taxes, I want lower capital gains rates, I wasn't smaller government, as much as possible I want government out of my life. To me Obama is the antithesis of this. You may like him, that's fine. I know you're someone that I shouldn't get into a political debate with but I still know where my vote is going.

Tony: You cannot have free markets in health care without repeal of EMTALA* , something Paul Ryan is too squeamish to do, thus his entire thesis is invalidated. There are no free markets, there have never been free markets and there never will be free markets. It's a ruse that corporations are pulling and Paul Ryan is carrying their water. Govt will never be "out of my life", so we are better off making a govt that functions.

(EMTALA: Emergency Medical Transfer and Active Labor Act, requires provision of medical care regardless of ability or willingness to pay.)

(this is where it got fun...)

JX: Whatever you say Tony. Obama was voted into office by people who bought into his rally cries of "Yes We Can!" And what did the knucklehead do during his first two years when he had both houses locked and loaded? Um...nothing (sorry, he did win the Nobel peace prize for doing.....nothing, that's not his fault though). In the thirteenth hour, on a technicality, he passed an unconstitutional health care bill that in their haste nobody in his party actually even read (gotta love Nancy Pelosi) and they are passing out exemptions to the disaster faster than Disney World passes out Mickey Mouse ears. He rode a wave of Bush discontent into office on the backs of the lower class, students, Prius owners and Lilith Fair goers that expected him to bring them to utopia of government handouts, free education, and a USA powered solely by wind and solar energy (as I like to say, the world will NEVER run out of oil) and he sat there scratching his head with idiots surrounding him trying to turn the USA into western Europe (oops, that ain't working out so well for western Europe right now now that the wizard behind the curtain was exposed). And what has he done for his supporters? Let's see, he didn't keep unemployment under the level he promised, the numbers of people on food stamps is the highest in history, he killed Keystone, he kept Solyndra afloat long enough for a photo opp, he passes a bill that will probably be overturned by the Supreme Court...hey let's vote this guy back into office, he's awesome!

Tony: Well played.  I’ve come to learn that whenever a missive starts with the world-weary salutation “Whatever you say Tony...” the next few sentences are going to be an emesis of invective devoid of rational craftsmanship.  And this example doesn’t disappoint-- although I am grateful that no regrettable personal insults were lodged my way (at least I have that). In order not to clutter your Mom’s FB page further, I’ll direct you to the Kalamazoo Post website for my “response”, or not...whatever.

My response:

I’m never sure how the disgorgement of Fox & Friends anti-Obama talking points finds a place in any meaningful discussion, but here we are.  Lilith fair and Prius owners? Really, does Steve Doocy write your stuff? Your frustration about politics might be better directed toward policy.  If we want to invoke the failures of presidential administrations--since it was broached-- why only include the current one? Ten years of tax cuts, increased entitlement obligations (Medicare Part D), corporate welfare (TARP, auto bailouts, farm subsidies), unregulated bubbly housing markets, and funding undeclared wars have certainly played some part in our fiscal woes and an unemployment rate that’s nearly doubled since 2001, no?  And all approved by Rep. Paul Ryan.  Spending? Deficits? Methinks the gentleman doth protest too much.  Not that I’m necessarily enamored with all current policy, but please, the anti-Obama rant will only work on someone who's been asleep for at least a decade.  How soon we forget the world George “This sucker could go down” Bush left us, with a Treasury Secretary on bended knee to Nancy Pelosi.

When the Republicans had control of the presidency and Congress, what did they do? Did they fund Medicare and reform health care to cover the 35 million uninsured? No. Despite inheriting a budget surplus in 2001, we were soon running deficits-- not just deficits, but record deficits-- within a few years, proving once and for all, that trickle down, supply-side tax cuts simply don’t generate enough revenue; with Paul Ryan voting with his party all the way down. And now we have 50 million uninsured.  Enter Paul Ryan for yet another stab at it, only this time we don’t have the luxury of budget surpluses to squander for fun.  

Rep. Paul Ryan has a fiscally conservative budget which supposedly distinguishes him from the Democrats. In addition to lowering taxes further, Ryan’s cost-cutting is predicated largely on revamping Medicare by requiring seniors to purchase health insurance from exchanges, making huge cuts in Medicaid, and pretty much eliminating all other non-defense federal spending, ie, those same programs that he himself has generously voted for over his 14 years in the House.

Since Medicare reform is the linchpin of Ryan’s budget, let’s start there. Ezra Klein from WaPo:

Let’s play a game. I’ll describe a health-care bill to you. Then you tell me if I’m describing President Obama’s Affordable Care Act or the budget released this week by Rep. Paul Ryan (R-Wis.).

The bill works like this: The federal government subsidizes Americans to participate in health insurance markets known as “exchanges.” Inside these exchanges, insurers can’t discriminate based on pre-existing conditions. Individuals can choose to go without insurance, but if they do so, they pay a penalty. To keep premium costs down, the government ties the size of the subsidy to the second-least-expensive plan in the market — a process known as “competitive bidding,” which encourages consumers to choose cheaper plans.

This is, of course, a trick question. That paragraph describes both the Affordable Care Act and Ryan’s proposed Medicare reforms. The insurance markets in both plans are essentially identical.

In other words, Paul Ryan’s Medicare fix is indistinguishable from Obama’s ACA,  yet when the Democrats passed the ACA not one Republican voted for it, nor would they even discuss it, and now they are even challenging the legislation in the Supreme Court. The irony is that if the GOP successfully disallows Obamacare’s provisions, it pretty much scuttles Paul Ryan’s masterful budget which relies on seniors being mandated to buy health insurance with vouchers. Who do you think Ryan will be rooting for this week in the SCOTUS?

As they say on late night TV...but there’s more (Ezra Klein again):

There’s an added complication for Republicans. They have assumed huge savings from applying the exchange-and-subsidies model to Medicare. But they don’t assume — in fact they vehemently deny — that those same savings would result from the identical policy mechanism in the Affordable Care Act. The Democrats haven’t assumed significant savings from the exchange-and-subsidies model in either case.
If the concept works as well as Ryan says it will, then the Affordable Care Act will cost far, far less than is currently projected. There’s no compelling reason to believe competitive bidding will cut costs for seniors but fail among younger, healthier consumers who, if anything, are in a better position to change plans every few years and therefore pressure insurers to cut costs...
[...Republicans are] stuck fighting a war against a plan that they helped to conceive and, on a philosophical level, still believe in. No one has been more confounded by this turn of events than Alice Rivlin, the former White House budget director who supports the Affordable Care Act and helped Ryan design an early version of his Medicare premium-support proposal.
“I could never understand why Ryan didn’t support the exchanges in the Affordable Care Act,” Rivlin says. “In fact, I think he does, and he just doesn’t want to say so.”

Bloomberg Financial says that Paul Ryan’s Medicare fix improves with each new revision.... because it comes closer and closer to looking like Obamacare!

My comment:  The nonpartisan CBO agrees with the Democrats’ conservative estimates of the savings rendered from both the ACA and Ryan’s Medicare plan, which means that Ryan’s estimates without tax increases will not come remotely close to realizing the desired balanced budget.  Personally, I have no confidence at all that market exchanges will work and I think we are merely limping toward the eventual non-employer-based single-payer system that most industrialized nations have implemented. Seniors, especially old and sick ones, will be unable to navigate the insurance markets, thus even more regulation will be needed to ensure workability. Out-of-pocket medical expenses for seniors will increase by Ryan’s own estimate.  If seniors couldn’t afford $30 per month for blood pressure medicine in 2003, which served as the rationale for Ryan voting for the Medicare Part D trillion dollar pharma boondoggle, then how are these same seniors going to pay for cancer surgery?

Very crude, very conservative, back-of-the-envelope calculations for what Obamacare gets us: For $1.3 trillion over 11 years and covering 40 million uninsured: that’s $2900 per person per year. Not bad, and these patients will be placed in the regulated insurance market which Paul Ryan advocates so strongly.  (Granted, this means putting many individuals on Medicaid, but that seems to be the consensus solution from both parties nowadays...unsolicited career advice: forget about medical school as a way to make a living.)  And what did we get for the nearly exact $1 trillion spent over 10 years on the 40 million seniors in Medicare Part D? Answer: certainly not $2500 per patient per year in drug benefits, unless you count 6-figure pharma executives’ bonuses as a benefit.

Bottom line: Obama isn’t as irresponsible as Ryan and the Republicans claim,  Lilith fair-goers notwithstanding, and the Republicans have a storied history of supporting all manner of unfunded mandates (eg, EMTALA) and deficit pork (eg, Medicare Part D), and to think that Ryan will suddenly change seems delusional to me.  Another example: Clearly, Ryan’s cuts to Medicaid are not sustainable and the program will need constant infusions of cash just to keep practitioners in the program.  Paul Ryan says that doctors don’t participate in Medicaid because of its “rules, regulations and mandates” (6:30 mark on this video).  Wrong. Doctors don’t participate in Medicaid because reimbursement is too low. Period.  And Ryan’s Medicaid cuts will need to be remedied by emergency infusions of funds that he has not factored into his budget.  Either he knows this and is lying or he has no real comprehension of the problem; I don’t know which is worse.

Furthermore, Ryan’s budget plan eliminates nearly all non-defense discretionary spending and a large chunk of non-discretionary spending, leaving nothing for roads, airports, infrastructure, national parks, education, research, food, drug and bank regulation, law enforcement, etc.   It might be pleasant to dream of a world without need of such things, but the reality is different.  If we shift all the costs to states, as Ryan proposes, then Mississippi and Alabama will be indistinguishable from Mali and Chad.

Every time someone says they can correct a trillion dollar budget deficit while cutting taxes a puppy dies.

For the record, my gripe with the Democrats is significant: they are cavalier toward protecting the social safety nets on which we all rely from time to time. Going along with Mr Bush and raiding Social Security and borrowing money to pay for ridiculous wars is just one example of Democratic ineptitude, but something Paul Ryan supported as well.  Another: Did you know that Medicare-- MY retirement health insurance plan-- pays the salary, benefits and education expenses of every single doctor-in-training in the USA (nearly $100K per resident per year)?  Why can’t funding come from other sources? Do no other players, ie, business interests and citizen groups, enjoy the benefits of having highly trained physicians?  Why should my Medicare fund it 100%?

Our safety nets have not been nurtured and now they are in jeopardy by political budget hacks. I tend to agree with JX that if Harry Reid and Nancy Pelosi are the best we can do as sentries for our treasured social programs, then maybe we deserve to have them dismantled by Paul Ryan and other water-carriers of the corporatocracy.  But I lay our current budget deficits directly at the feet of Republican policies that spent surpluses and reduced taxes at the behest of lobbyists, and now the only answer Ryan can come up with is to destroy our federal government. Maybe Paul Ryan’s diagnosis and treatment plan are correct, but if so it would be a first for him. His unrealistic tax cuts are boilerplate doggerel written by the wealthy special interests and his budget is not a serious answer to the difficulties we face, needing numerous revisions in order to re-fund all the necessities he's neglected.

One final question: Where is graduate medical education in Paul Ryan’s budget?  You guessed it, it’s not there... he proposes a health care system without doctors!  We can do better.

BTW: now that I'm no longer in Kalamazoo, I've been considering a new name for the blog: "Whatever you Say Tony" is now in the running...


Ezra Klein, Washington Post, Why Ryancare and Obamacare look so similar.

Bruce Bartlett, Reagan’s Treasury Dept economist, Forbes, Republican Budget Hypocrisy.

Jon Walker, Firedoglake, CBO: Ryan’s budget would massively cut Medicaid and Medicare.

Parija Kavilanz, CNN, Kids caught in Medicaid crossfire.

Editorial, Bloomberg Financial, Paul Ryan’s Medicare voucher plan improves with each pass.

Greg Sargent, Washington Post, Tax Expert: Paul Ryan’s budget is all “smoke and mirrors”.

Chris Wallace, Fox News Sunday, Interview: Rep. Paul Ryan defends GOP budget plan.

Jonathan Cohn, The New Republic, The Bush Deficit.

Wednesday, March 28, 2012

Someone understands health care

And it's not George Will.  A Minnesota reader responds to Mr. Will's recent op-ed:

Dear Globe Editor:
George Will declares (Globe, 3/27/2012) that the Obamacare individual mandate problem is simple: compelling people to “buy” insurance violates traditional contract law. If that principle is upheld, he says, then there would be no “stopping point” to Congress’ powers. OK, fair enough. But like his political allies, Will fails to point out an obvious inconsistency. The healthcare system is financially broken because Congress in 1986 forced it by extortion to provide services (through ER’s) to anyone who could not pay for them, the threat being that if it didn’t, Medicare and Medicaid fees would be denied. That law, “EMTALA“, is the reason 41 million people feel that health insurance is not a necessity.
EMTALA is just as much a violation of common law as the individual mandate, and probably more so, and yet no one (of either party) is calling for its repeal. Why is that? I submit that it is because the pols all understand that the electorate is self-indulgent. We love that America has “the best healthcare system in the world”, but we would rather not think about it costing 2 ½ times as much as it should.

The ACA is an improvement, but it is still unaffordable because of EMTALA. The only way out of the financial mess I can see is to make healthcare a tax-supported program like Medicare, the so-called “public option”, but it seems that will have to wait until the present system collapses, something it is now doing in slow motion.

Thursday, March 22, 2012

Rick Santorum apparently wants me to "Get Out!"

...presumably, of my own country. If he wasn't such a self-important little piece of human lint I might take offense at Mr. Rick clapping as Reverend Dungbrain McFlatusBreath pounds the brimstone:

Tell me again how Jeremiah Wright is worse than this.

Wednesday, March 21, 2012

White Sox Prediction for 2012: Pain

The Sporting News today picked the White Sox to finish in the cellar of the AL Central and, not surprisingly, the powerhouse Tigers are slated to win the division (they won't).  Granted, the White Sox' General Manager Kenny Williams has made several awful acquisitions and a few inexplicable moves over the past few years, but I'm more sanguine about their prospects this year: third place.

First, allow me to dump on Mr.Williams. If you are going to re-build, then for chrissakes re-build. This would look something like trading Paul Konerko, John Danks, Gavin Floyd and Matt Thornton and cultivating a White Sox farm system which is among the worst in Major League Baseball.  On the other hand if you are going for a pennant this year, then why allow Mark Buerhrle to escape to free agency? And regardless of rebuild or not, what was the deal with trading Sergio Santos (30 saves last year) to Toronto for Nestor Molina (optioned to Birmingham this week). Duh.

I'll allow that the magnitude of the Adam Dunn debacle was unforeseeable, but acquiring the injured Jake Peavy from San Diego and signing  Alex Rios to a long term deal were a little more visible as evolving disasters. Reinsdorf somehow sees genius in Williams' commandeering of the club to the cellar. 

Enough Williams-bashing, it's just too easy.

This is the line up:

1. Alejandro DeAza, CF, solid defense and has good at-bats. He needs to see lots of pitchers this year and should stay at lead-off.

2. Alexei Ramirez, SS,  will bring his usual OBP of .328, but I'd keep him on a short leash in April and May and would not hesitate to move AJ Pierzynski in the 2-spot if Alexei has his usual poor cold weather performance.  AJ did well batting second during the World Series year.

3. Paul Konerko, 1B, great. 31 HR's, BA 0.300, All-Star.

4. Adam Dunn, DH. Ugh, it is what it is. He's had a good spring with only one strikeout and should improve on his 0.159 BA from last year, but don't expect him to hit AL pitching any better than maybe 0.230 this year with 20 HR's. I don't think he even sees Verlander's fast balls, he just listens for the catcher's mitt.  Barring a surprise recovery, he's broken and should retire after this year--but he won't since Kenny Williams is giving him $14 million/yr through the 2014 season. Ugh.

5. Brent Morel, 3B. If Brett Lillibridge keeps tearing it up like he did last year and has this spring, expect Morel to get challenged.  Lillibridge has intangibles like AJ and the Tigers' Brandon Inge; I'd personally like to see him start.

6. AJ Pierzynski, C. He can't throw runners out (maybe because of the pitchers' poor stretch release), but he should give the young pitching staff the best chance to perform confidently.  AJ is arguably the smartest player in the league and has a respectable OBP because he hardly ever strikes out.

7. Dayan Viciedo, LF. This youngster has the most potential to be a franchise superstar someday. He needs to get innings by playing everyday and learning the pitchers. I'll be watching his matchups against Verlander and other aces this year.  When he gets better he can take the 3 or 4 slot soon.

8. Alex Rios, RF. Nothing to say except it sure would be nice to have a prospect like Jared Mitchell get some at-bats instead. 

9. Gordon Beckham, 2B. Beckham was slated to be a power-hitting shortstop and now he's turning into a defensive second baseman. Disappointing.  I think he could benefit from the sanity of Skipper Robin Ventura, which is sure to be a welcome departure from the Guillen freak show.

The starting pitchers: 

John Danks and Gavin Floyd are solid but need to eat close to 200 innings each just for White Sox to finish the season.

Phil Humber and Chris Sale had strong outings at the end of last year; they are still huge question marks but represent the future of the Sox rotation.

Jake Peavy. I hope I'm wrong but I think anyone who views Peavy as anything but a struggling frustration is delusional.  Personally I feel bad for guy, but geesh is he hard to watch.

The bullpen: 

Trading Santos for 23-year-old Nestor Molina would be a remarkable gaffe on Kenny Williams' part if not for all the other head-scratchers the last few years.  Thornton is solid, but getting from the starter to the closer could be an adventure, and I think Santos is a better closer anyway-- look for him on the NL All-Star team this year.


Fortunately, I've moved to Arizona and have a legitimate team that's fun to watch here, but I bleed Sox Black and White and this year has all the makings of a horror show in Chicago.  To survive, the pale hose need some pleasant surprises and the most likely sources will be the young SS Eduardo Escobar who's had a phenomenal spring, Hector Santiago, LHP who will go deep into the season unless opposing hitters figure out his screwball and Nathan Jones, RHP who has shown promising control.  Beckham, Dunn and maybe even Rios could see dramatic improvements at the plate... and don't forget Lillibridge. If all these stars align, then add breakout years for Sale and Humber, and the Sox have an outside shot at beating even the Tigers who have a fairly mediocre starting staff once you get past Verlander.  I can dream. 

Regardless, I see the Indians besting the Tigers this year, but that's another blog.

Cato Surpises me on the Medical Care Mandate

Not surprisingly, Ilya Shapiro of the Cato Institute does not like the Affordable Care Act's mandate that every American purchase health insurance and has reviewed the sordid history of federal intervention over the last hundred years in his recent opinion Obamacare Premise is Just Wrong.

Indeed, it wasn’t until the New Deal that the Supreme Court allowed Congress to regulate wholly local economic activity. Using the power to make laws that are “necessary and proper” to the enforcement of broader regulations, the court said, the federal government could regulate certain types of local economic activity (wheat-farming, in one particular case) that had, in the national aggregate, a “substantial effect” on interstate commerce. 

But to my surprise he has no problem mandating physicians and hospitals to care for the uninsured for free.

There are plenty of commodities that we all consume: food, shelter, clothing, mortuary services. Many others may lead to large and unexpected costs: a car totaled in an accident, a house destroyed by fire or flood. And the only reason why the impecunious uninsured can slough the costs of their emergency care onto the taxpayer is because the Emergency Medical Treatment and Active Labor Act requires hospitals to provide care regardless of legal status or ability to pay.
I support EMTALA – I wouldn’t want to live in a society that lets people die in the streets – but it cannot justify the individual mandate.
Think about it: if all Congress had to do to get more power was to pass a law creating an economic or other policy problem, then there would be no constitutional limit on federal authority. Instead, Congress could rub Aladdin’s lamp to wish for more wishes whenever a majority of its members thought it wise to do so.
Huh? He supports EMTALA? How can a small-government,  free market think tanker so distrust the free market!? One would think that the mere threat of people dying in the street would propel some free market solution, after all the free market solves everything-- the invisible hand should be able to at least start an IV.  But no, mandating private citizens and private corporations is okay only when they are doctors and hospitals, but mandating private citizens to buy insurance infringes on rights.  Okay.  
To use Cato's analogy, if a supermarket accepts food stamps then they should be required to provide free food to anyone regardless of their ability or willingness to pay.  We wouldn't want to live in a society that lets people die from starvation. If a homebuilder accepts federal financing for home loans then it follows that they should be required to provide housing to anyone, allowing squatters into a new home whenever that person feels the need. We wouldn't want to live in a society that let's people die from exposure.   

EMTALA naturally leads to universal health care, one way or another.  Either it's mandated by government up front or costs rise to the point that every health care entity goes bankrupt and is taken over by government out of necessity.  It's been a long time coming as we've seen health care go from 8% of our GDP to nearly one-fifth. What's the breaking point, 0ne-third, one-half?   Should we finally do something when health costs take up 50% of every dollar our nation produces?
I get that it's squeamish to think of individuals being denied necessary care and I certainly am not advocating EMTALA be repealed (although it would make an interesting thought experiment), but that does also does not mean that we can ignore the ignoble ramifications of requiring the unfunded mandate associated with it.  EMTALA was signed into law by President Reagan when the uninsured represented a fraction of what they do now, but Cato is loathe to admit EMTALA's effect of removing the moral hazard from individuals regarding health care may have had a fundamental role in the burgeoning number of uninsured today. If the the law had not been so lenient toward those irresponsible enough to eschew health insurance maybe we wouldn't now have 40 million uninsured.
In effect, EMTALA is a form of universal health care-- nobody can be denied, nobody will die in the streets-- but it's the worst kind: with no cost controls, no personal responsibility, no oversight.  Shapiro is one of the few commentators these days who even recognize the existence of EMTALA but he still offers no solution.  
Solutions short of the ACA's individual mandate have been offered, such as funding EMTALA care with federal funds, and while this still would not not furnish adequate comprehensive care and preventive services at least we could continue a reasonable dialog.

Thursday, March 08, 2012

The $1,000 test that will destroy health insurance

Ezra Klein in the Washington Post discusses how relatively cheap human genome mapping will destroy the health insurance industry and lead to single-payer Medicare-for-all coverage.  

In 2008, Congress overwhelmingly passed, and President George W. Bush signed, the Genetic Information Nondiscrimination Act. Ron Paul was the lone dissenter. The legislation bars insurers from denying coverage or raising premiums on individuals who show a genetic predisposition toward particular diseases. And in doing, it armed a time bomb beneath the health-care industry.


As we sequence more genomes, mine more data, and conduct more studies, we’ll find a lot more connections [between genes and diseases]. Eventually, genomic testing will be a powerful predictor of future illness. And it raises the potential that young people will get themselves tested and then purchase insurance based off the result. So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance.
The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control.
I would argue further that adverse selection already occurs to some degree with healthy adults often going without insurance or avoiding health maintenance until they qualify for Medicare, which is one reason why Medicare usage is disproportionately high in an individual's first year of use.  Why pay for coverage or a service when that service will be covered by Medicare in a short period of time? 
In one of the quirks of the US system, workers slave away and submit payroll taxes to cover [often wealthy] seniors while they themselves are without insurance. Odd that.  I think Americans just don't understand how screwed up this concept is... and we limp towards single-payer. While I appreciate Klein's argument, private health insurance is already destroyed.

Catholics and the health insurance (ie, birth control) Mandate

The American Catholic has answered the most cited arguments against the Catholic Church's refusal to cover birth control for it's employees in an article called the 10 Most Cited Arguments in Favor of the HHS Mandate I've rebutted their most pertinent "answers" below:

10. Yes the Catholic Bishops have spoken in favor of universal health care, I guess it just depends on what you consider "health" and it would fall back to the usual and customary use of the word.  Is birth control "health" care? Society can debate it and find a consensus (that word again). Why am I paying for knee or shoulder surgery for teens who play football or 50 y/o's who downhill ski?  It's immoral I tell ya!

5. The Jehovah's Witness analogy is actually very close to the point. Jehovah's Witnesses are arguing that blood transfusions are elective just like contraception, and these decisions are respected to the point that Jehovah's who are in dire need die for lack of blood.  Why should they pay for coverage for a benefit they will never use and think immoral? Isn't this the same argument made by Catholics about birth control? The second part of the answer is closer to the mark--- why are employers involved in health  insurance at all? It's an anachronism that should be eliminated; my employer does not pay for my auto insurance, so why my health insurance? (More on this at the end of this post.)
The writer lists the "side" effects of hormonal contraception but does list the health benefits: lower incidence of ovarian cancer, lower incidence of endometrial cancer, higher hemoglobin levels (less anemia), fewer missed work days from menstrual disorders, lower incidence of ectopic pregnancies, greater feeling of well-being and less worry about unwanted pregnancies. If we are going to be complete, let's be complete and not commit lies of omission.  I realize that this a superfluous argument to true believers: if one believes they are sinning by using birth control, then none of this matters compared to an eternity in hell.

The fact is that contraceptive pills are not a singular entity called "birth control", they fall under the broader classification called "hormonal medication" (I'll leave out IUD's and sterilization for the purpose of this discussion), and hormonal manipulation is used to treat a plethora of diagnoses including prostate cancer (depo-provera and luprolide), premenstrual dysphoric disorder (cyclic hormones), and endometriosis (provera, luprolide, cyclic hormones), among others. Should my employer be allowed to refuse to pay for all hormonal medication?

I'm not sure what the ramifications would be if every employer could pick and choose what benefits are covered by their health insurance plan. After I get my gall bladder taken out would I then discover that my employer belongs to a religion that has a special devotion to bile storage organs and thus has chosen not to cover cholecystectomies, leaving me with a $7,000 bill? What if my employer is a Christian Scientist? How responsible should individuals be for reading all the fine print of every policy? A less facetious argument might surround Lipitor, the cholesterol-lowering medication, and it's analogs, which many medical authorities feel are overprescribed and not without side effects every bit as problematic as hormonal medication. Should my employer have a say in whether my Lipitor is covered?  

1. "98% of Catholics use birth control." Yes, that number seems high, just factoring in the 10% of Catholics who are likely lesbian lowers it to 90% (although I would refrain from invoking Glenn Beck for any serious discussion). Does the Catholic Church have a number? My informal sampling of family and friends is above 50%.  (I know of many patients, friends and family members who use or have used birth control to avoid pregnancy due to the teratogenic effects of other medications they were taking. Is this okay with the Church? According to conservative Catholics: No, they are going to hell. This has led some to re-think their faith in the Church altogether, but that's another story.)  Okay, it doesn't matter--- I'll buy that, and it goes back again to the question as to why any employer is buying my health insurance in the first place.

My further comment:  Employer based health insurance is an anachronism left over from the wage freeze of 1943 when employers could not legally raise salaries so they offered other benefits to entice workers. It's unnecessary now and should be fazed out.  Maybe President Obama is playing eleventy-dimensional chess to make the US population realize how divisive the process of universal health will become without government-supplied and regulated health insurance. Obama and the Democrats chose not to include such a public option in the Affordable Care Act, but maybe this was a circuitous master plan to get citizens (finally) screaming for a Medicare-for-all option like other developed nations have-- like a reverse-psychology approach to waken the masses from their slumber. I doubt it, but who knows?

The bottom line: Catholics now pay for birth control all the time by contributing tax support to Medicare and Medicaid. This is the precedent that would argue for birth control in a public option, universal health Medicare-for-all plan, if it were ever instituted.  Why are they complaining now? In addition, insurance regulation historically requires coverage for any therapy that is determined to be safe and effective.  Using the "safe and effective" standard, birth control (hormones, IUD's and sterilization) meet criteria as a reasonable intervention.   

Friday, March 02, 2012

TED talks = "intellectual fraud"

Something I've thought for years but never could verbalize so eloquently. From Kent Sepkowitz at Daily Beast.  Read the whole thing.
An excerpt:
Nowadays, though, TED spells trouble for several reasons. First it doesn’t celebrate a love of smart people really; it celebrates a love of smart-style people. Just as kosher-style food looks and kinda acts like the real thing, but isn’t, so too are the diplomats of TED U kinda full of it. TED provides the Cliff Notes versions of the talks right there on line (TED quotes), little gnomic cyber-samplers (“If we study what is merely average, we will remain merely average” and “I share, therefore I am”) you can sprinkle around without really understanding a drop of the work that stands behind the claim.
As such, TED is a direct descendant of another American favorite: the get-better-quick scheme...
TED and their entire Starship Enterprise world feed directly into many people’s instinctive distrust of the intellectual (and the Santorumians’ absolute contempt). With the provocation, TEDdies are dragging down with them actual American intellectuals (yes they exist). These are the real gym rats who fret their way through daily confusion and panic, hostile never-ending scientific turf wars, and lousy funding to squeeze out a drop of truth – people who scare us not because they are cool but because they are so frantically intense and of a single lumpish piece. Not that the TEDdies care about the trouble, really. They already are getting their slides together for the next big powwow.



Just watch:

In under 4 minutes he succinctly:

1. Points out the absurdity of the Senate

2. Points out the absurdity of employer-based health insurance

3. Pokes fun at his secular Jewish ethnicity

4.  Relishes in his notoriety of being part of the Senatorial record

5. Reprises old jabs at Newt and Trump

6. Mocks infomercials as a staple of our fatuous consumer culture


Taibbi on Breitbart

Matt Taibbi of the Rolling Stone has written an obituary of his ideological antithesis Andrew Breitbart, which he subtitles "Death of a Douche".   Aside from the gratuitous reference to a feminine hygiene product, I guess I don't really understand Taibbi's beef with his buddy Andy. Taibbi praises his style:

For instance, it would be dishonest not to tip a hat to him for that famous scene when [Breitbart] hijacked Anthony Weiner’s own self-immolating "apology" press conference.
....And Taibbi feels that Breitbart has done some decent investigative work:

But there’s no way to watch the raw footage and not grasp how totally nuts some of this ACORN "counseling" was. We have to give Breitbart that.
And Matt goes on to say that while they disagreed about Taibbi's place within the "media-complex", Breitbart's sense of humor was admirable. Really?

This article by Taibbi reinforces one of my previous impressions that he adores the game, being a player, and Taibbi cares less about what side he happens to be on. Like Breitbart had said, you have to pick a side and go to war, and all these guys have a mutual respect for whomever can wheedle themselves into the media spotlight. Taibbi loves the fact that Breitbart paid attention to him, no matter if that attention was negative, no matter that Breitbart appealed to racism and hatred for personal gain.

The legacy of Andrew Breitbart is not completed, and it will be mixed to be sure, but for Taibbi to give such a glowing appraisal of his tactics, his personal attributes and his "career" is disappointing. Even if I agreed ideologically with everything Breitbart presented, his style and demeanor lower the discourse into the gutter and was designed to create discord: obfuscation without clarity, heat without light. Breitbart's mastery of the dog whistle to appeal to the lizard brain is reminiscent of the great propagandists of the modern age-- Lee Atwater, Karl Rove, Dick Morris-- and it is nothing that should be praised. It's akin to praising Jeffrey Dahmer for his dissection skills.

While I enjoyed reading Griftopia, I maintain that Taibbi is not serious about fixing anything or reporting important events as much as he's interested in demonstrating his rhetorical skills for his fans. At least Cesca has the conviction to lay it out truthfully and without pretending that Breitbart was nothing but a self-promoter who would destroy anyone and anything for superficial recognition, even if the fame were infamy.

Andrew Breitbart’s slash-and-burn pursuit of his own career destroyed countless lives and livelihoods. Innocent bystanders in the public debate — noncombatants as I sometimes call them — were crushed by Andrew’s mendacity, his obsessive careerism and his unethical business practices. Workers at ACORN and everyone who that organization sought to help have been crushed. The war against Planned Parenthood was started by Andrew Breitbart and that’s led to its defunding by both Congress and Komen. Who knows how many women will ultimately be hurt by Breitbart’s scams and prank videos. I have nothing positive to say about him.
I Agree.

Thursday, March 01, 2012


I prefer to keep quiet rather than speak ill of the dead.  So let's allow Andrew Breitbart's body of work to speak for him.

On the day Ted Kennedy died, Mr. Breitbart had no problem with his Twitter account. From ThinkProgress on August 26, 2009:

Early this morning, news broke that Sen. Ted Kennedy had passed away after serving in the U.S. Senate for nearly 50 years. Soon after, conservative commentator Andrew Breitbart began a sustained assault on Kennedy’s memory, tweeting “Rest in Chappaquiddick.”

Breitbart unapologetically attacked Kennedy, calling him a “villain,” “a big ass motherf@#$er,” a “duplicitous bastard” and a “prick.” “I’ll shut my mouth for Carter. That’s just politics. Kennedy was a special pile of human excrement,” wrote Breitbart in one tweet.
When Politico’s Michael Calderone highlighted Breitbart’s attacks in an article called, “Not all Kennedy critics hold fire,” a pleased Breitbart tweeted:

Andrew Breitbart tweets about Politico covering his tweets.

Classy guy.  He will be missed.