Late Late Night FDL: Fifty Ways To Pull A Trigger

As we enter the final stretch of this battle for the soul of our nations health care, I am constantly reminded just how many triggers there are. Thought I would kick off a list this evening with a few of my least favorite triggers and ask you all to add yours in comments. I will add them to the post throughout the next 24 hours.

As always please do chime in with whatever may be on your mind tonight.

1. Mandates.

2. Join the Third Way.

3. Ask everyone to slow down and read the bill with a trigger in it.

4. Deny any and all working visitors access to care.

5. Hire Rahm Emmanuel as your COS. (more…)

NYT Touts Swiss Insurance System; Ignores It’s Own Expert

The New York Times has produced, often on its Prescriptions or Economix blogs, several useful summaries of health care systems in other countries. However, today’s front page contains an editorial in the guise of news entitled, Swiss Health Care Thrives Without Public Option, which illustrates a point I’ve been making.

The Swiss system, reporter Nelson Schwartz informs us, provides quality, universal coverage, but thankfully avoids being "bureaucratic, socialized medicine." What a relief. The Times then invites us to view the Swiss system as a model for the US:

Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.

That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.

The slam on a public option is both gratuitous and irrelevant, given the Swiss system. As I discussed in this post, When Is a Regulatory Scheme Equivalent to A Government-Run System?, a pervasive regulatory scheme that controls the key elements of an insurance system can become equivalent to an explicit government insurance system.

More important, you have to have at least one or the other (and possibly both?) to succeed. Our Senate isn’t proposing either approach for insurers in exchange markets, but both conditions exist in Medicare. That’s why virtually all Congressional proposals for controlling costs are focused on Medicare (and using Medicare’s leverage to affect provider costs); without a Public Option to push cost reforms, there’s no mechanism to achieve cost reductions in the Exchange, and only a high-end insurance tax to indirectly affect costs in the employer-based market.

And sure enough, the Times article eventually hints at which of these two approaches the Swiss use:

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

There are other important details, but it turns out the Swiss achieve quality and lower costs not through competition between the many non-profit insurers in each Canton, but because there’s a pervasive national system of government regulation with price and quality controls, along with a government-defined framework of basic insurance plans.

The Times’ cites Harvard’s Regina Herzlinger, an expert who attributes the Swiss success to its customer-driven, competitive attributes. These are just the things to appeal to certain Senate Finance Committee members.

“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”

It would have been helpful if the Times had also checked with Princeton’s Uwe Reinhardt, who has also written on the Swiss system and, moreover, reviewed Herzlinger’s study.* Reinhardt writes a weekly post for the Times Economix blog on, among other things, international health care systems. According to Reinhardt,

On the surface, the Swiss health system may give the impression of a price-competitive, consumer-directed health care model. However, the heavy government regulation that pervades the entire system — including the health insurance sector — makes it a far cry from the vigorous, price-competitive health care market envisaged by the advocates of consumer-directed health plans in the United States. Some gestures to competition aside, the Swiss system so far has remained mainly a de facto cartel of insurers and health care practitioners who transact with one another in a tight web of government regulations. . . .

But who brings about the lower prices of health care in the Swiss health system? Herzlinger and Parsa-Parsi[fn] argue that these prices reflect the consumers’ idea of “value for the money.” However, the insured in Switzerland have only indirect and probably weak influence over the prices paid to clinicians, as these prices are negotiated by the cartel-like associations of insurers and clinicians under the watchful eye and heavy hand of government. Since all insurers are bound to the same prices for ambulatory care and prices are negotiated between insurers and individual hospitals for inpatient care, it is not clear how effectively consumer choice among insurers can influence the prices paid to clinicians. It can just as plausibly be argued that these prices reflect government’s idea of value for the money. . . .

Finally, what is most impressive about the Swiss health system is the role tight government regulation plays throughout the entire system. One can plausibly argue that this regulation is chiefly responsible for both the high quality and (relative to the United States) low cost of Swiss health care. Absent that regulation, the Swiss health system probably would metamorphose into something resembling the much less regulated, high-cost US system, which is both more inefficient and more inequitable than the Swiss system, as Herzlinger and Parsa-Parsi take pains to point out.

So the Times headline is not only gratuitous, it misses the point. Once again, we find that where there is no explicit government insurance system as France has, success depends on a pervasive national regulatory scheme, including close rate regulation of drugs, devices, provider services and insurance, which is far beyond anything proposed by Congress.

Our Senate sees only what it wants to see — "It’s not socialism! There’s no PO!" — but they ignore the features that substitute and produce the favored results. The Times editors should be helping them see the whole picture.

*Uwe E. Reinhart, The Swiss Health System, JAMA (2004) See pdf link here.

More
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See wesgpc, comment #1 below for links to WHO descriptions of Swiss system:
http://www.euro.who.int/document/e68670.pdf
http://www.euro.who.int/observatory
More Swiss links from commenter RainaP here.

Video: Marine on vandalized billboard in Tennessee speaks out

The out former U.S. Marine, Tim Smith, who appeared on a billboard in Memphis, TN has come forward to speak about the vandalism that destroyed the sign, which said, “I’m gay and I protected your freedom.” (The Advocate):

The serviceman, who was kicked out of the military under its “don’t ask, don’t tell” policy, says he was shocked when he received news about the vandalism. “It was more or less shock and then it turned to righteous indignation and anger towards whoever had done it and that the act had even been committed,” Smith told WPTY-TV.

(more…)

Do violent death and accidents in the US explain its poor population health performance? Probably not.

Republican Senator John Ensign of Nevada said a couple of days ago that the US would have the best performance in terms of life-expectancy and health outcomes if we subtracted out the higher rate of violent death and accidents in the US compared to European countries.

A news clip I saw said that this claim is based on a study from awhile back, but I cannot find it, whatever it is or whoever did it. But in the mean time, we can look at some vital statistics to find out whether it is a reasonable claim.

First, let’s look at overall mortality rates. This is directly relevant to life-expectancy because the life-expectancy rates that are published by vital statistics agencies are really a way of summarizing mortality rates in a given year. So, let’s look at age and sex standardized mortality rates (per 100,000 population) for 22 high income countries, broken out by all causes, violent death and accidents (traffic accidents, falls, and assault), and non-violent causes (all cause mortality minus assault and accidents).

The countries are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and the United States. The data are for 2002, except 2001 for Canada and New Zealand. Mortality rates for Belgium are not included because it does not have enough recent data.

The average mortality rate in the US is 667, fourth highest among the 21 countries, behind the leader Denmark, and then Ireland and Portugal.

Now let’s look at violent death and falls. The US is second highest in traffic accidents (behind Portugal), twelfth (or middle of pack) in accidental falls, and first in assault. Overall, the US is fourth in violent death and accidents at 26, behind (again) Denmark, Ireland and Portugal.

The US mortality rate from non-violent causes is 640 (one death per 100k population is lost due to rounding). The US is fourth highest behind (you guessed it) Denmark, Ireland and Portugal. Assault, falls and traffic accidents do not seem to make much difference in the standings. The reason is that assault and accidents in high income countries make up only a small fraction of total mortality. The proportion ranges from a low of 1.5% in the UK, to a high of 4.0% in Italy. The difference in mortality rates between the US and leaders in life expectancy such as Japan, Switzerland, and Australia is between 140 and 200 deaths per 100,000 population, which is large compared to the mortality rate due to assault and accidents.

Of course it could be that most of the violence and accidents in the US takes place at very young ages, and if these deaths do occur at unusually young ages in the US compared to other countries, that might lower the life-expectancy at birth due to other causes enough to produce the best performance of all. For that to happen, the effect of very youthful death due to violence and accidents in the US would have to overcome its very high perinatal and infant mortality compared to other countries, and I think that is doubtful.

But there is another way to look at the problem, and that is to look at life-expectancies later in life, say at age 40 and 65. I think that is reasonable. Most assault occurs at younger ages. The US is middle of the pack of high income countries in the rate of mortality due to falls. That leaves traffic accidents, but most of those occur at younger ages.

At age 40, the life expectancy in for women in the US is tied for next to last with Ireland among 22 other high income countries in 2002 with a life expectancy 41.4 years. Only Denmark was worse.

At age 40, the life expectancy in for men in the US was tied for 16 with the Netherlands among 22 other high income countries in 2002 with a life expectancy 37 years

At age 65, the life-expectancy for men in the US is only about average out of 22 other high income countries. For women it is below average, ranked 15 out of 22 other high income countries.

I do not think that the high mortality rate due to traffic accidents, falls, and assault can explain the poor life-expectancies in the US compared to most other high income countries.

If anyone knows what report said that the US healthcare system had the best performance if you took out assaults, falls, and traffic accidents, please let me know in the commments. I would be interested in how they got to that conclusion.

Data from OECD health statistics 2007 and 2009
http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html

Journalist Karen Ocamb launches a blog – LGBT POV

Give a hearty official welcome to the blogmistress-o-sphere to LGBT journalist Karen Ocamb, who has contributed guest posts on the Blend a number of times. She’s launched her own pad, LGBT POV.

It’s up now with a few posts at www.lgbtpov.com. My webmaster and I are still working out some kinks particular to this WordPress site so I hope you’ll be patient with us.

I’ll be focusing primarily on LA and California – but I also plan to continue writing news briefs, political analysis and long form essays.

I’ve also invited some friends to contribute when they have something to say. Right now West Hollywood City Councilmember John Duran has a long piece up (with my photos) on the weeks of protests surrounding the veto of the gay rights bill AB 101 in 1991. We thought it would be interesting, given the Prop 8 protests and the upcoming march on Washington.

And today is John’s 50th birthday.

I’ll be posting at times that don’t conflict with my regular paying gig as news editor of Frontiers in LA. Plus I will continue to post and cross-post at Huffington Post and The Bilerico Project and Pam’s House Blend. But my intention is to have fun “thinking out loud,” as it were.

Karen’s just getting her feet wet in the fast and free-wheeling world of blogs. Her background is in traditional journalism and it’s impressive…

She started her career over 30 years ago at CBS News in New York where she clerked for Walter Cronkite, Dan Rather and Bob Schieffer during the Watergate era and the end of the war in Vietnam.  She eventually became a producer, leaving CBS News after producing coverage of the 1984 Olympics in Los Angeles for CBS affiliates.

As a freelance reporter and independent producer in Los Angeles, Karen produced, hosted and has been a guest on many local public affairs shows. She has contributed to numerous media outlets, including the Los Angeles Times, TV Guide Online, The Advocate, and OutQ News on Sirius/XM Satellite Radio.

But as we all know, the blogosphere is completely different world. More below the fold…

  (more…)

Jay Rock Demands 90%

This is delectable politics. Fresh off a meeting with Ob-Rahma, Jay Rock has come back to the Senate and demanded 90% loss ratio for any coverage the subsidies pay for. "Loss ratio" is insurance-speak for what they actually have to spend providing actual health care. That means the insurance companies can’t steal 20% of our tax dollars to pay for executive salaries. They get 10%.

They’re peeing their pants right now.

But I suspect Jay Rock has offered this as an outcome of his meeting with Ob-Rahma. I’m sure at that meeting they said, "Jello Jay, We’d like you to pitch other ways to save money. We’d like to come up with a way to keep costs down."

And voila!!! 90%!!! Insurance companies have to actually provide health care without gobs of executive subsidies. We’re actually going to demand a certain amount of health care in exchange for the half trillion MaxTax!!!

After Max Tax and Blanche vote it down, it will be crystal clear this is about profits profits profits. 

I don’t know whether Ob-Rahma will pull their head out of Jay Rock’s amendment. 

But I do know this. Jay Rock is intent on fucking with the narrative that MaxTax and Rahm are intent on spinning. If we do our jobs, it’ll be clear why they’re rejecting common sense ways to deliver health care at lower costs and instead are just interested in subsidizing the insurance companies. 

A Tale of Two Baucuses: Why Mere Words Aren’t Enough

As recently as this past April, Max Baucus backed a strong public option — or so he claimed (h/t Steve Benen):

At that point, he and Ted Kennedy co-signed a letter to the president, explaining that they’ve been "working together toward the shared goal of significant reforms to our health care system" for nearly a year, and they planned to "swift" action. Indeed, they saw smooth sailing ahead: "Our intention is for that legislation to be very similar, and to reflect a shared approach to reform, so that the measures that our two committees report can be quickly merged into a single bill for consideration on the Senate floor."

So what happened between April and June, when suddenly Baucus came out as a foe of both the public option and of swift action on health care reform?

Emptywheel figures the change may have been related to the arrival on the scene of health-industry lobbyists bearing bags of money and influence:

On May 11, "stakeholders" including the AMA, PhRMA, the hospitals and the device manufacturers delivered proposals to the White House promising to "voluntarily" reduce cost increases over the next 10 years.  In an effort to keep them "at the table," Baucus’s Chief of Staff  Jon Selib and Finance Committee staffer Russell Sullivan told stakeholders at a May 20 meeting that their participation in the process of crafting a health care bill was contingent on them "holding their fire":

Sources familiar with the lobbyist meeting described it as collegial, but they said Baucus’ aides made clear that any public opposition to the proposed financing of a reform package would be at their clients’ peril. The staffers’ message to K Street was clear: Tell your clients to let the process work and don’t torpedo it with advertisements, press releases and Web sites.

Of course, in the case of Baucus, the health-industry lobbyists have been around for some time: He is the biggest recipient of their dough on all of Capitol Hill. Nearly one of every four dollars that’s gone into his coffers has come from that industry.

This is one reason why mere words of "support" don’t mean an awful lot when it comes to the public option. Unless those words are backed by hardcore action — such as a pledge to vote against any bill without a public option — then they aren’t worth very much.

Late Night: Conservative Bloggers Cower Before Marxo-Fascist Dictator, Are Probably Sissies

If conservative blog-dwellers really and truly believe their stuff about Obama being all evil & Fascist & Commie, why wouldn’t they support a military coup to depose him? Because they’re sissies, obviously. Cowards. Chickens. Bawk-bawk-bawk.

So, earlier, a crazy right-wing person posted something especially crazy and right-wing at NewsMax, which is saying something, because News Max is a site that solely exists so that crazy right-wingers can post crazy right-wing crap on the Internet — crazy right-wing crap like, oh, this (an example chosen more or less at random). But this particular earlier right-wing crap managed to Cross a Line by suggesting the American Military might just take it into their heads to politely and peaceably stage a coup and depose the president on the grounds that he is an evildoer bent on establishing a Marxist Dictatorship in the United States of America.

To be sure, the tone of the column is more sorrow than anger: oh nuts it’s such a drag that we have to get the military involved, but goshdarn it, this Obama fellow is a Marxist Fascist, so whatareyougonnado. Not that this sort of distancing was able to keep the column from getting deep-sixed. Nor was it able to prevent Shocked, Shocked conservative bloggers from talking about how kooky and out-of bounds such a column is, because that’s not how we do it in this country, buster, where we have elections!

Well, fair enough. I guess. But then, well, I rather wonder why exactly they might be taking this sort of reasonable line, that elections have consequences, etc. For instance, the Confederate Yankee goober informs us that "we are a nation of laws, not a nation of mob rule and coups by military strongmen." Good to know. But then, those of us with memories that stretch back all the way to last spring remember that the Confederate Yankee goober was saying stuff like this, about how when the black guy got elected he was gonna take yer gunz:

As severe the rush is now, it would be even worse if more Americans knew of Obama’s attempt to corrupt Constitutional scholarship while at the anti-gun Joyce Foundation. Barack Obama is a gun-banner at heart, and there is every reason for Americans to doubt his campaign’s more moderate rhetoric when compared to his actual record.

Buy guns, America. It’s good for the economy, good for the development of our nation’s moral character, and our last bulwark against tyranny.

So, clearly, for the Goober, an armed uprising against the liar-in-chief is something all good, decent Americans ought to be contemplating. Indeed, the Goober believes all good Americans should be buying guns in order to forcibly resist the policies of the elected president.

Maybe it’s just me, but the peaceable military coup idea sounds less messy, with a lower body count than this "let’s pretend we’re Liberia!" fantasy. Why not go for it?

Because, you know, you have to ask, what’s the problem with this News Max scenario (which is not the first of its genre, by any means), if the general consensus of the online right is, in fact, that Obama is about to impose the dictatorship of the proletariat? That he is, you know, not going to do any such thing, and that these charges are more than a little hypocritical, is not my immediate point.

What I’m saying is that if the right wing really believes that Obama is as dangerous as they say he is… then logic and patriotism ought to dictate that they should be in favor of a peaceable military attempt to depose him. And to be sure, they really have said he’s just that sinister. Shit, News Max just themselves published a detailed explanation of why the Obama presidency is creating a world just as bad as the one we’d be living in if the Nazis won.

So why not a coup, if they really believe their shit? Like I said: they’re sissies.

Either that or they are willing to flirt with destroying representative democracy, but not willing to fuck Mussolini. Or something. Cowards!

Wednesday Hump the Jukebox

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Nothing new this week that I can remember.

You Love It – Peaches (A truly horrid song. Just awful)
47Sunny Day Real Estate
Bad Day – REM
Dark Hand of Contagion – The Minus 5
Gentleman’s Spell – Metal Hearts
Shine On You Crazy Diamond (Parts 1-7) – Pink Floyd
Going Out of My Head – Fatboy Slim
A Small Demand – International Noise Conspiracy
Clementine – The Decemberists (Elliott Smith cover)
Make A Scene – Chris Bell*
and the song that Obama will demand that schoolchildren sing in his honor:
Love In The Shadows – The Magnetic Fields

*This is good news.

Also. I know everybody just looooves her, but Susan Boyle’s cover of Wild Horses is… all wrong. Just terrible. 

This is the standard for the song:

Scahill and Greenwald on the Media’s Wars, the Radical Environmental Movement, and the Public Option at Risk

The absence of a critical fourth estate in the run up to the war in Iraq is widely acknowledged, even by the establishment media that trumpeted the lies and misinformation of the Bush administration. Take the NYT today in an article comparing intelligence on Iran’s nuclear capabilities with Colin Powell’s presentation on Iraq in 2003:

"In many dissections of the blunders before the Iraq war, the news media, including The New York Times, came in for a share of the criticism for repeating Bush administration claims about Iraq without sufficient scrutiny or skepticism."

You say? The question today is whether the media have learned anything at all. From torture to saber rattling over Iran is there enough scrutiny and skepticism? And if not are independent journalists picking up the slack? Glenn Greewald, a columnist at Salon and the author of Great American Hypocrites: Toppling the Big Myths of Republican Politicsir?t=lauraflanders-20&l=as2&o=1&a=0307408663 and Jeremy Scahill, author of Blackwater: The Rise of the World’s Most Powerful Mercenary Armyir?t=lauraflanders-20&l=as2&o=1&a=1560259795 on the battle between the independent press and the mainstream media.

Speaking of fighting from the margins. Mike Roselle, Earth First! co-founder and the author of Tree Spiker: From Earth First! to Lowbagging: My Struggles in Radical Environmental Actionir?t=lauraflanders-20&l=as2&o=1&a=0312556195 discusses the evolution of the radical environmental movement along with environmental journalist Josh Mahan, co-author of Tree Spiker.

Finally, Jacob Hacker, a professor of political science at Yale and the author of Health at Risk: America’s Ailing Health System–and How to Heal It on why the finance committee’s rejection of a public option yesterday does not bode well for healthcare reform of any kind.

Thanks to Frank Lopez for video in tonight’s show.