Tuesday, August 06, 2013

Nobody pays $384 for a physical therapy visit

The headline from a WaPo op-ed reads:

For a stiff neck, nearly $6,000 in physical therapy seemed too much

The author is a patient who had physical therapy prescribed for a simple musculoskeletal problem.

My insurance company sent me notification it was “seeking additional information about these charges,” which would mean a “delay in payment” for my PT treatments. My insurer had been billed $412 for my first appointment and $384 for the second. I can hardly blame the company for wanting to know the justification of such costs.
Now I understand why the front desk seemed so eager to have me use my maximum of 12 visits before the end of June: I was leaving nearly $5,000 worth of payments on the table. [bold mine-- Tony]
Notice the confusion of bills, payments and cost.
The author assumes that the insurance company gets no discount and will pay the full $384 billed for the physical therapy appointment and the thousands of dollars of visits. It's satisfying I suppose for health care consumers to read these bills and feel that they have found the real reason, the Holy Grail, of the health care cost crisis, -- $6,000 !!!! OMG!!!--so they fire off an op-ed finally enlightening all of us on the true nut of the issue.
Of course, it's way more complicated than $6,000 in bills. Every insurance company and payer, even cash payer, negotiates a discount to the amount billed. In fact, the amount billed, the $6,000 is a compete fiction. Stop talking about it. 
There's a discount. It might be $100 or $300 or $50.
For a nation ostensibly built on the notion of capitalism and finance I continue to be astounded at the lack of sophistication of the arguments regarding health care finance.
If the Washington Post can publish such an inane op-ed then there is no hope. We should be way beyond the griping about the $384 charged for a physical therapy visit. Nobody ever pays $384 for a physical therapy visit. The insurance company gets a discount. Medicare gets a discounts. Medicaid gets a BIG discount (if it's covered at all). Even cash customers negotiate a discount.

Maybe it's a problem that we really don't know how much is reimbursed for that visit. Fine. But nobody PAYS $384 for a physical therapy visit.

Let me say it again, nobody pays $384 for a physical therapy visit.

Nobody pays $384 for a physical therapy visit.

$384 was the CHARGE, not the payment, NOT the cost.

Get it?

Nobody pays $384 for a physical therapy visit.

Please, if you are an editor for the Washington Post, the USAToday, the Wall Street Journal, the New York Times, or a producer for any news network do NOT conflate charges with payments with costs. Don't embarrass yourselves by publishing op-eds and letters like this without explanation. You are morons.

Nobody pays $384 for a physical therapy visit.

Monday, July 08, 2013

The Cost of Prenatal Care

The New York Times has a lengthy article concerning the lack of price transparency in prenatal care and the apparent price gouging that occurs. This follows the theme of other news items covering the crisis is health care economics.

Like many reports on this topic, the NYT fails to differentiate adequately between costs and charges. The comments typically devolve into hand-wringing about the lack of “price” transparency and a flurry of opinions about how the system should be reformed.

Fine. But let’s define terms. “Charge” is the nominal amount on the price list by the hospital or doctor. This figure has almost no meaning since every insurance company and government entity negotiates a lower price for their members and risk pool. This refers to the upfront, non-discounted fee on the list.

“Cost” is the bottom line bare-bones amount of money needed to provide a service or supply, before profit. “Profit” is the net between what a good or service costs and the actual amount collected by the provider. I have no idea what "price" refers to.

The table shows the “amount paid” for prenatal care in the US versus other nations, but this is not completely accurate or at least only partially defined in the article. The table has a line below stating “amounts paid are the actual payments agreed to by insurance companies or other payers of services, and are lower than billed charges.” So far so good, but this still leaves out a clarification of how much disparity exists between payers, for example private insurance versus Medicaid. Who pays what amount?  Medicaid typically pays 50% of what private insurance would pay, so the $9775 figure is meaningless because the range might be $3000 to $15,000. And the actual cost, not addressed in this article or this chart, to the hospital/doctor might be $600 or $16,000. Who knows?

Another example of incomplete reporting is the discussion of obstetricians’ charges and collection. The NYT article says “[obstetricians] often charge a flat fee for their nine months of care, no matter how many visits are needed,... That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data.”

Useless reportage. They are referring to a charged fee and not the actual collected amount as negotiated by insurance companies and Medicaid (Medicare provides relatively little prenatal care since older and disabled women are less likely to get pregnant). How much is actually collected? Answer: it depends and varies A LOT. In my experience, our practice in Michigan charged $3600 global fee but then it would be discounted 40-75% with Medicaid paying less than $1000. Nobody ever paid $3600 because even the 1 or 2 cash paying patients every year got a steep discount negotiated upfront.

A “charge” is completely without pertinence. Administrators and bean counters know the bare-bones “cost” of particular services and supplies down to the penny but they are loathe to make that information known.  

The other poorly kept secret is that privately insured patients subsidize Medicaid patients who are receiving steeply discounted prenatal care. As an aside, I always wonder why any young couple bother to get married and pay for benefits. Being frank, from a finance standpoint they’d be better off having their kids out of wedlock while the woman can qualify for Medicaid. The father could make a 5 or 6-figure income, let the state pay for the prenatal care, and pocket more money. Why the hell not? Actually I’m sure some do make that conscious decision...but that's a digression.

The most important figure is not the “price” or the “charge” but the actual “cost”. The supplies, IV bags, gloves, gown, the epidural, 8 hours in a labor room, nurses’ salaries, etc, all have known costs. From there we can determine how much profit can be reasonably tacked on: 2%, 5%, 50%? Let’s get the numbers.  Then they can be extrapolated over a population, knowing that c-section rates are 25% and NICU admissions occur at a certain rate, etc.

To put a table that says “amount paid” is useless and to talk about “charges” is less than useless.

How much this cost disclosure would help individual consumers of health care is debateable. Given all the asymmetric information  I doubt it would help much at all. The value to knowing the cost is for payers-- Medicaid, Medicare and insurers-- to negotiate pricing from a more meaningful vantage point. Like most medical services, prenatal care is not a product that can reasonably be purchased by an individual looking at a line item price list. The costs should be borne by the entire society as a risk pool. I don’t care how much cost disclosure is available, no individual would be able to anticipate all the possible outcomes in labor and pay out of pocket for a complicated hospital course and, say, 12 weeks of neonatal intensive care.

This topic of charges and cost and profit is pertinent to the entire health care debate, but the thought of healthcare as a free market that would benefit from individuals knowing “prices” is wishful thinking. There is no free market in health care. If the ER doctor says your chest pain warrants a cardiac catheterization you don’t shop around for the best price. It might seem like we are empowered if we use our HSA debit card to pay a hospital or doctor’s bill, but it’s all a ruse; the real costs, the big ticket items, cannot be negotiated by a single person with an HSA account.

The kicker is that there is an organization that really does know the costs and uses that information in the real world: Medicare. They have the largest database of costs and Medicare negotiates fees based on this vast knowledge, called the resource-based relative value scale, or RBRVS. This is why Medicare is so damn efficient compared to private payers and state-run Medicaid, but that's another topic for another day.

Thursday, June 27, 2013

Book Review: Body by Science, by Doug McGuff, MD, and John Little

Five Stars out of Five. Highest recommendation.

STOP. Read this book before you do one more exercise routine.

McGuff is an Emergency physician with an avocation for fitness and John Little is a professional fitness trainer. Body by Science is subtitled “A research-based program for strength training, body-building and complete fitness in 12 minutes a week.” The authors cite empirical studies relating workout regimens and formulate a specific routine to most efficiently build muscle while burning fat.

Many of the principles outlined here are in contradistinction to modern convention about exercise. For example, the authors show that prolonged aerobic activity--such as long distance running-- does little to contribute to overall fitness and almost all runners have chronic injuries that limit their long term well-being. Most individuals can achieve their fitness goals more safely in very little time per week; likewise, most faddish regimens-- Tai Bo, Crossfit, P90X-- do little more than waste your time and can lead to serious injury.

While I am usually skeptical of anybody who purports to know a quick and easy way to achieve a difficult goal, I have to say that this book has extremely useful information about metabolism, biochemistry and muscle kinetics. The authors explain the evolutionary rationale for the exercise routine they advocate and also discuss diet, limiting grains and emphasizing whole foods.

On the savannah, prehistoric man evolved to exert himself in short bursts of highly intense activity: avoiding predatory lions or chasing game.  Successful individuals were also able to endure famine and dehydration and certain body habitus were selected. Today, endomorphs who store body fat are often looked upon as less fit than, say, Arnold Schwarzenegger or Sylvester Stallone, who are ectomorphic with more lean mass. Counterintuitively, however, individuals who have adequate fat stores are able to survive seasonal food shortages better than ectomorphs.

In fact, Stallone and Schwarzenegger are genetic mutants who likely would not do well on the prehistoric savannah. Large muscle mass inefficiently burns calories even at rest and these individuals, while looking fit in modern civilization must consume an inordinate amount of resources to maintain their basal metabolic rate.

The purpose of any exercise routine is not to look like Stallone. First of all, it would be impossible for most of us. McGuff and Little explain the genetics of muscle development and review the specific mutations discovered over the last decade, including myosin light chain kinase and myostatin genes among others.

The kernel of the book is the Big Five workout, encompassing slow movements using the largest muscle groups in the body. The authors liken exercise to a medical prescription, looking for the dose that will give the greatest benefit with minimal side effects. The BIg Five includes latissimus pull-downs, chest press, seated row, seated military press and leg press. The safest, most efficient method is to use Nautilus or other progressive cam machines.

Loss of muscle mass-- sarcopenia--  has deleterious implications as we age, limiting our activity and increasing our risk of injury. Building muscle is all-important to overall fitness, and the authors cite studies that show this regimen not only build muscle but also increase aerobic capacity and flexibility. Complex routines, such as Crossfit, on the other hand, are more likely to lead to injury and other practices like stretching actually can lead to muscle weakness.

The key to the Body by Science workout is to continue each exercise in a slow sustained movement until muscle failure. Done properly, you should feel quite uncomfortable at the end of each exercise. Think Neanderthal running from a Lion. The upside is that nothing builds mass and aerobic capacity as quickly as high intensity exercise ending in muscle failure.

The authors recommend 5-7 days rest between workouts. Youtube videos are available to view by googling “Doug McGuff doing the Big Five” or “Body by Science.” The videos make the routine look deceivingly easy, but with heavy weights and slow sustained muscle contraction your heart rate and respiratory rate elevates.

The review of diet is also important. I have always worked out and would consider myself fit-- able to run 5K’s and lift weights--  but chronically overweight. McGuff and Little are quick to implicate the workout industry in giving false expectations that exercise alone can lead to weight loss. Nope. The fact is that I eat too damn much and no amount of exercise will make up for that.

Personally, I found this book an invaluable and readable review of metabolism, genetics and muscle function. It has changed the way I exercise, reducing my risk of injury and increasing the efficiency of each workout. I still do other things, namely an hour-long highly intense full body aerobic regimen with a trainer, but the Body by Science workout has become a weekly added ritual.  I have noticed a significant increase in lean muscle mass, as measured by my trainer, and a generally improved sense of well-being.

Book Review: Lolita, by Vladimir Nabokov

Four stars out of Five.

Set in post-War United States, this story recounts the obsession of a European immigrant with adolescent girls, and Lolita in particular. Nabokov writes in the first person as the protagonist Humbert Humbert is awaiting trial for pederasty and murder. The account is a memoir of Humbert as he pursues the affection of Lolita the daughter of his landlady, taking the girl on a cross-country trip, engaging in illicit behavior and eventually the murder of her paramour.

I read this book because it’s on nearly every list of the best books of the 20th century and I had no idea what to expect.  In order to make a fair judgement since the topic is beyond controversial I purposely read no formal reviews of the book prior to starting. The book is almost beyond description.

On the one hand, the primary theme-- pedophilia-- is a contemptibly bad notion to incorporate as the primary topic of an entire novel, but Nabokov seems to have purposely chosen such a theme for the challenge of constructing a readable full-length novel on a tough subject. He succeeds in spades.

Nabokov exhibits his mastery of language, playing with words and phrases to entertain the reader, which is quite impressive given that Lolita is his first novel written in English, a language he learned as an adult.  Nabokov expounds on the difference between European continental lifestyle versus the United States middle-class style. Darkly comical, Humbert relates his opinion of the fatuity and lack of couth in America, all while engaging in the most vile acts imaginable.

Nabokov uses this novel as a vehicle to mock psychiatry and psychoanalysis. Humbert misleads psychiatrists and, just for fun, consciously confirms their biases toward unproven hypotheses about psychopathology. Another theme is the ease with which Humbert, a good-looking man of means, can easily skirt laws and conventions of behavior by virtue of his appearance.

Much of the book traces the travels of Humbert and Lolita across the United States by car, making this a road story of sorts. He describes the people and places from Connecticut through the Midwest and mountains and out to California.

Lolita, the novel, defies description. Nabokov seems to be attempting to make Humbert a sympathetic character but in the end Humbert becomes self-loathing, recognizing his flaws and the damage he has done to Lolita.

For the writing style and language this is among the best books written.   Recommended.

Wednesday, June 12, 2013

Book Review: Destiny of the Republic, by Candice Millard

Three Stars out of Five. Recommended.

James A. Garfield was an unlikely selection for president in 1880, having won the Republican nomination only after he was drafted at the convention due to an electoral impasse.  Within months of the general election he was shot in a Washington, DC train station and subsequently died.

Millard presents a favorable view of Garfield, the man, Union Civil War General, husband and father, and President. Her glowing depiction recounts his unification of party factions and calm demeanor under duress. Unfortunately, the reluctant Garfield only served as president a few months before being killed by Charles Guitaeu, a mentally disturbed office seeker.

One subplot in the story is the poor surgical care that Garfield received following the shooting. Conjecture is that his wounds were not life-threatening and that he died of fulminant sepsis due to the unsanitary practices of Dr. W. Willard Bliss, his attending physician.  Bliss, the same physician who attended Abraham Lincoln following his shooting 16 years prior, did not ascribe to the latest medical advances about hand washing and sterilization of instruments that was advocated at that time by British physician Sir Joseph Lister.

Millard also describes the frantic efforts made by Alexander Graham Bell, the young teacher and inventor, who tried to devise a method for finding the errant bullet sitting in Garfield’s abdomen. Before xrays (invented 20 years hence by Marie Curie) doctors had no way to image the patient looking for foreign bodies such as shrapnel and ammunition rounds. Bell contrived a prototype metal detector using electric current and capacitors for doctors to identify metal fragments in soft tissue.

Dr. Bliss, while inclined to help Garfield, was reluctant to allow a non-physician like Bell to attend to his patient. The device was implemented incorrectly and therefore failed to detect the bullet. Bliss, the other physicians, Garfield’s family, the nation, and Bell all watched as the President deteriorated and finally died of overwhelming infection two months after the shooting.

Millard’s book is easily read and provides a concise account of the the seminal events of the period. My only misgiving is trivial, i.e., that her characters are simplistic, either paragons of virtue or despicable villains. Oddly, the killer Guiteau is perhaps the most complex persona presented, shown to be conflicted, ambitious and mentally disturbed. Alternatively, Garfield and Bell apparently have no faults and Bliss is seen only with contempt.

Regardless, this is an educational book regarding events in US history about which I was unfamiliar. Her style is similar to Erik Larsen or David McCullough. Recommended.

Friday, May 31, 2013

Book Review: Midnight's Children, by Salman Rushdie

Four stars out of Five.

One Amazon reviewer likens Midnight’s Children to a detailed tapestry with layers of characters and events and symbols. Rushdie’s creation is indeed so complicated yet delicious in it’s imagery and emotion and history.

The book is a novelized history of the nascent Indian republic after it won independence from the United Kingdom in 1947. The new nation is personified in the protagonist Saleem Sinai who was born at the stroke of midnight on August 15th, the moment of the official transfer of power. Rushdie, who was actually born earlier in the year 1947,  writes mostly in first person with the Saleem’s family and life taking on many features of his own.

As in his other fictional works, Rushdie inserts magical realism, combining supernatural powers and phenomena with real events to give a more colorful and effective treatment of history. This is similar to Kurt Vonnegut’s use of time travel and interplanetary travel in his autobiographical novel  Slaughter-House Five. Both authors promote their political opinions regarding real-world events that they had been part of or had observed.

Midnight’s Children is also a saga of war and the transformation of a nation, similar to Margaret Mitchell’s Gone With the Wind. Additionally, both works have a main character who personifies the culture-- Scarlett O’Hara, the Old South; Saleem Sinai, colonial India-- experiencing evolution as a necessary adaptation to change that they encounter in the world.

At times I found Midnight’s Children frustrating in the sheer number of symbols and thematic motifs that must be interpreted. Knowing Indian history beforehand would be helpful as well. I read as a companion text the Reader’s Guide from Continuum Contemporaries written by Norbert Schurer. He adds much value to Midnight’s Children by providing some historical context as well as pointing out much of the symbolism. Also, Sparknotes has some helpful analysis.

Salman Rushdie is a serious writer and Midnight’s Children is an award winning novel that is not for the faint of heart. Not only is it lengthy, but it contains advanced vocabulary, lots of characters, heavy themes and weird literary devices like run-on sentences and giving characters magical powers. Unlike Mitchell’s Gone With the Wind, readers of Midnight’s Children not only have to wade through history and war and a long family saga, but also supernatural symbolism, religion, social ills and enough leitmotifs to drop a pony.  

Annoyed, I had given up reading Midnight’s Children at page 100 a few years ago but finally completed the task this month. A few months ago I read Rushdie’s non-fiction memoir Joseph Anton (reviewed here), and was thus motivated to finish Midnight’s Children now in advance of the recently released movie.  Nobody will absorb all of Midnight’s Children at the first reading, but it is an impressive piece of writing.

Saturday, May 04, 2013

Book Review: The Signal and the Noise, by Nate Silver

Five stars out of five.

I remember watching the TV series Quantum Leap years ago, starring Scott Bakula and Dean Stockwell who traveled through time and lived at the whim of ever-changing Bayesian probabilities. Whatever predicament they encountered has associated chance of solution or death as spit out by Stockwell’s computer named Ziggy. As the conditions changed, say, a bad guy presents himself, Stockwell would translate the changing probabilities: “Ziggy says you have a 85% chance of dying.” With a bad guy vanquished, it would change, “Ziggy now says you have only a 15% chance of dying.”

Nate Silver’s The Signal and the Noise explains the phenomenon of prior probability that subsequently changes with conditions that was first presented as Bayes Theorem three hundred years ago. Silver is a professional poker player who made his “f**k you” money by selling software to analyze baseball statistics. Recently he became a phenomenon of sorts by successfully predicting all 50 state elections in 2012 and currently writes the always informational “five-thirty-eight” blog for the New York Times.

The Signal and the Noise is a more comprehensive discussion of Bayesian probabilities and how they affect almost everything humans do. An engineer friends says that every high school kid should read Silver’s book just to get an idea of how probability works and to hone critical thinking skills. I cannot disagree.

Okay, Silver is concerned with more than the theory of Thomas Bayes, he begins by discussing the huge explosion of data available to humans beginning with the Gutenberg printing press and evolving to the electronic databases today. He also points out that humans are unduly flawed because we too often seek confirmation of our own ideas instead of critically parsing all this information. Political pundits are notorious for
stoking the confirmation biases of their customers, which has been shown by the likes of Dick Morris and Karl Rove claiming to “have the math” only to be embarrassingly wrong on the outcome of recent elections. But they aren’t embarrassed-- they aren’t paid to be correct, only to confirm bias.

Silver also uses the baseball player Dustin Pedroia as an example of the failure of Big Data. On paper, or more accurately, using computer stats, a guy like Pedroia should never have made it into Major League baseball: he’s too small, too slow, not a very powerful hitter and can’t throw very well. Instead of failing, Pedroia is an all-star and a winner. What gives? There are intangibles, data is never able to be completely known. All the stats in the world cannot always be interpreted perfectly.

Separating what’s important (the signal) from confusing interference (the noise) is the key to forecasting any natural event or human phenomenon. We are good at forecasting some things like weather and hurricanes, but poor at predicting other things like earthquakes and terror attacks. Silver is an excellent explainer of how we know things and the limitations of that knowledge. He uses a wide-ranging array of interesting stories: from bird flu and climate to Donald Rumsfeld and poker. Refreshingly, I find no ideological or political preferences in his discussion.

This book is highly recommended.

Friday, April 05, 2013

Saturday, March 23, 2013

Book Review: Joseph Anton, by Salman Rushdie

I've never been a fan of Salman Rushdie's genre of magical realism and I've never been able to finish one of his novels, yet I found his memoir "Joseph Anton" compelling. 

It's a memoir emphasizing Rushdie's plight as an object of a fatwa called by Muslim leaders and supported by the Iranian government because of his alleged disparaging portrayal of the Prophet Muhammad and his wives in the novel The Satanic Verses.

Critics have argued that Rushdie was careless and should have known that fundamentalist Muslims would take issue with his work, The Satanic Verses, or that Rushdie intended to purposely insult Islam for publicity. Rushdie argues against these ideas very convincingly, but more importantly, so what if he "should have known"? Western enlightened society is built on the foundation of personal civil liberties, and paramount is the protection of everyone's right to express ideas, no matter how disagreeable.

Rushdie is an excellent writer but the 600+ pages is lengthy. I frequently thought as I listened--I borrowed the Audiobook from the library-- Does his publisher employ editors? Twenty-two hours of audio! But now, having finished, I can say that the length of the book is necessary to truly understand the complexity of the person Salman Rushdie and the events he endured. He effectively portrays his weaknesses as he honestly admits to heavy alcohol use that damaged his relationships, among other shortcomings.

Another criticism is that Rushdie put publishers, book store clerks and other personnel at risk by insisting that his right to free speech was upheld. Bullshit. Nobody entered into their interactions with Rushdie and The Satanic Verses against their will, and it was Muslim leaders who instigated violence. The publishing industry is the true guardian of such freedom and their professionalism is praised by Rushdie throughout the book. Rushdie mentions the sorrow he felt when translators of The Satanic Verses were attacked, one killed and another injured, by Islamic fundamentalists, but we must all remember who are the criminals in this situation, and it's not the novelist. 

Further critics argue that Rushdie has not shown proper gratitude for the protection and expense put forth on his behalf by the British government and the agents involved. Again, bullshit. Rushdie exhibits gushing praise for the "prot" agents who ensured his safety, although he often voices frustration with the Bureaucracy of Scotland Yard. An example of supreme frustration is that the British government had anti-blasphemy laws on the books until very recently, and these laws, while originally enacted centuries ago to protect Anglicanism, the laws were expanded to prohibit negative opinion of any religion. These laws have been expunged following, and perhaps because of, the Rushdie fatwa.

Like others I found Rushdie's use of the third person confusing at times, but who am I to argue with an accomplished award winning author? Deal with it. Hillary Mantel uses the same literary device in her historical novel Wolf Hall about Thomas Cromwell. 

Rushdie exhibits traits of self-confidence, what others might call narcissism, but there is a distinction between pathology and mere personality traits. I cannot imagine any interesting and successful writer lacking such high opinion of himself or herself; detractors should get over it. Rushdie has lived an interesting life which he has explored with effective introspection. As memoirs go this one is very, very good. He gives a clear impression of his emotions and motivations, his anger and frustration as well as the love and gratitude he feels. Moreover, Rushdie educates the reader on the events of the day and how they are affected by religious ideology and the deadly political and personal ramifications. 

More recently, Salman Rushdie has been interviewed and while he quickly cops to his lack of god-belief, he has a nuanced respectful view of Islam: while he may not agree with the tenets of the faith, he recognizes that it's the leaders of Islam who have made the grievous violent overtures for political purposes. Followers of Islam need to be more vigilant of the true meaning of their religion and not allow it to be co-opted by mullahs for political motives.

Rushdie never apologizes for writing The Satanic Verses, never expresses regret. That is the true message of this story: we have a choice to make as members of a free society, we can stand with the fundamentals of freedom of expression or we can allow assholes to steal our freedoms. The choice is ours. No matter how much or how little we may enjoy a particular writer's work it is our imperative duty to defend his right to express the art.

Joseph Anton is a well-written account of the life of a writer enduring a harrowing assault on his freedom and threats to the life of himself, his family and his colleagues. Rushdie provides an introspective and sometimes humorous (parts are very funny, especially his close encounter with a Playboy Bunny!) rendering of the experience. He addresses detractors (John Le Carre is portrayed as a willful moron) and supporters very effectively and makes the case for the unabridged freedoms of an open society.

Tuesday, March 19, 2013

Warren and the big banks

Let me preface this with the statement that I think Bernanke has done a fine job given his tools and the depth of the crisis. He has called for fiscal solutions to augment his monetary policy and his calls have been met with Congressional gridlock.

Sen Warren voices the frustration that taxpayers should have with the de facto corporate welfare that seems to never end. Meanwhile, Congress is debating how much of Social Security benefits will decrease for workers who have paid in their entire lives and former Sen Scott Brown, whose place Warren has taken, is now employed as a bank lobbyist and paid Fox News commentator.

Monday, March 18, 2013

Dinesh D'Souza: My favorite nut

Dinesh D'Souza is one of my favorite wingnuts for several reasons. First of all, his craziness is entertaining as evidenced by the following CPAC appearance. (Watch the CSPAN video-- not embeddable-- it's great.) Second of all, D'Souza entered Dartmouth in 1979, the same class that turned me down after my application and interview. Essentially, I assume that he took my spot, and it's a clear case (in my mind) of affirmative action, the bane of his brand of boot-straps faux meritocratic conservatism; after all, he's darker than I am and certainly added more diversity that I would have, and I guarantee his ACT scores and academic record were not better than mine. Third of all, he is a hypocrite, having left his wife of two decades for a floozy. He represents the trifecta of the wingnut right: unintentional humor, blindness to the social advantages he has benefited from, and, of course, hypocrisy. 
Here is his latest entry into the canon of jumbled conservative ideology, from Alternet's "10 craziest things heard at CPAC":
8. Dinesh D'Souza, outsted Christian college president, filmmaker and author: One problem with liberalism is the notion that slavery involved the theft of labor from African Americans. Again with the slavery. Sigh.
Riding high on right-wing acceptance of his theory that Barack Obama's worldview is shaped by Kenyan anticolonial sentiment against Great Britain, D'Souza is expanding his theory to include all of liberal America, which, according to him, imported the anticolonial worldview in the 1960s, and thus came to ostensibly regard all wealth as a form of theft. (This is apparently not to be confused with thegood anticolonial worldview of the founding fathers, who decried, in the Declaration of Independence, how King George "plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.")
Given the success on the right-wing conference circuit of his book about Obama's purported Kenyan resentment, and his movie on the same subject, 2016: Obama's America, D'Souza showed a film clip from a forthcoming picture in which he promises to make "a moral case" for what he calls "the free enterprise system," one that is designed to counter all this theft nonsense. (Apparently, slavery was just an entrepreneurial exercise on the part of the slave-traders.) From D'Souza's remarks, delivered on the main stage at CPAC on Saturday:
It isn’t just some Kenyan thing, isn’t just some foreign thing. Anti-colonialism has come to American in the ‘60s. It’s part of American liberalism. And if you listen to the liberal story of America, it is a story of what? Theft. How did we get America? We stole it from the Indians. Slavery is, in a sense, seen as stealing the free labor of African-Americans. And so the whole story of America is a story of oppression. This is the liberal argument in its broad scale, and it needs to be answered. And in our film, we intend to answer it.
Now this is not just, I should say, about the makers and the takers....so the core idea is that free enterprise is a form of theft. We have to make the moral case for free enterprise and for America. A conservatism that did that would be a conservatism that is viable and powerful again.
Watch the C-SPAN video, and you'll also be treated to the metaphor of Barack Obama as a lion-tamer. In that vein, were D'Souza more enchanting, we might view him as a snake-charmer.

Monday, March 11, 2013

Wealth Tax. D'uh.

A while back I saw this video about the wealth inequality in the United States.  It reminded me of the old economic adage that if aliens had come to earth and collected all the wealth and evenly distributed it among humans and left for 50 years, when they came back the wealth would be concentrated into a few individuals. That's just a natural trait among humans: some are better at accumulating assets than others.

But there really is more to the story of wealth distribution. The way wealth is distributed varies depending on what is valued within the society at the current time. I doubt Bill Gates would have been as successful writing software had he been born in Mongolia under Genghis Khan 800 years ago. Charles Manson, on the other hand, might have parlayed his psychopathic conscious-less killing into a lieutenant-ship. Who knows?

Christopher at Christopher's Apologies had an odd take, a head scratcher. He presented the above video and basically shrugged off the epic wealth inequality, saying
"Just so we’re clear: there are no rules, laws, or regulations governing who can have money in this country or how much they can have.  So then what is it that prevents people from moving from one economic stratum to the next? Why is it so many people believe government needs to enter into the fray in order to level the playing field and redistribute wealth on behalf of the lowest income earners?"
Huh? Government redistributes wealth "on behalf of the lowest income earners"?  I have no idea what universe Christopher is observing. Did he even watch the video? Wealth is not being re-distributed to the lowest earners at all. That's the point. Nearly every single penny of efficiency squeezed out by the huge gains in worker productivity has been transferred directly into the bank accounts of the wealthiest 5%. I guess the Wal-Mart heirs deserve it all, Christopher is just sorry we cannot give them more.

We have socialized risks made by banks and oil companies and really every corporation, yet they keep their profits private. When they make money, great, they get to keep it, less of course some nominal income tax which is lower than mine....but when they lose money, oops, they need a bailout.  Nobody goes to jail, nobody even loses a bonus check. The laws are ALL in their favor.

Christopher adds, 
"My second problem with the video (and it’s premise) is that it stokes the fires of greed in people.  I won’t say that it creates greed in people since everyone has that flaw as part of their sinful nature, but media with this type of content pours gasoline on the greedy fire that burns in all of us."
While I'm not 100% sure his point here, I think he is concerned with "stoking" the greed of the less wealthy who are apparently pining for a free giveaway from the wealthy. The video is really just giving a blow-by-blow account of the statistics of the wealth distribution, and I think we can determine who has the greed and who doesn't. 

From the NYT:
A common statistical measure of inequality is the Gini coefficient, a number between 0 and 100 that rises with greater disparities. From the late 1970s through the early 1990s, the Census Bureau recorded Gini coefficients for income in the low 40s. Yet by 1992, the Gini coefficient for wealth had risen into the mid-70s, according to data from the Federal Reserve.
Since then, it has risen steadily, to about 80 as of 2010. In 1992, the top tenth of the population controlled 20 times the wealth controlled by the bottom half. By 2010, it was 65 times. Our graduated income-tax system redistributes a small amount of money every year but does little to slow the polarization of wealth.
These are stunning changes. The global financial crisis did make a dent in the assets of the wealthiest American families, but its effects for the bottom half were utterly destructive; the number of owner-occupied homes has fallen by more than a million since 2007. People in different socioeconomic strata are living ever more different lives, with dangerous results for society: erosion of empathy, widening of rifts and undermining of meritocracy.
History tells us that at some point the fabric of society deteriorates when a few have all the wealth-- think Czarist Russia or France circa 1790. Maybe we're not close to that point but that's the question. How soon until the the aliens come back to see how we've reallocated the wealth? I'm not clear at all on how greedy tendencies of the poor are a problem.
Robert Reich echos the New York Times on this topic, calling for a wealth tax just like property taxes that we all pay. Why not?

Instead we tax income and not wealth. We give a  negative incentive to work and produce, but Paris Hilton gets a pass. I can hear all the Rand-bots predicting that the wealthy will "Go Galt" and move their wealth off-shore and property values will sink and the apocalypse will commence. Really? Where else are the wealthy going to put their assets to be safe and their families protected? Mali? 

I comment not because I see anybody addressing the wealth inequality which is growing in logarithmic fashion-- we know who makes the rules. I just find it interesting that given all the insanity that has occurred with trillions in bailouts and transfers from our Treasury to the connected corporate elite, S&P profits at record levels, stock prices reaching new all-time highs, the wealthy getting wealthier and the poor getting poorer, yet we cannot collect enough to balance our budget...and we can STILL find apologists like Christopher who see nothing wrong here...move along.   

And, oh yeah, the poor are greedy.