August 30, 2009

Taking a Short Break

Things have been pretty hectic here in recent weeks, and continue to be so. As a result, while I have been able to update Sensen No Sen regularly, that has come at the expense of other things, which also need doing.

To correct that imbalance, I'll be taking a short blog-cation, but only for a few days. Be back soon!

August 25, 2009

The Public Welfare Is Not a Commodity

Last week, Congressman Anthony Wiener of New York - who is rapidly claiming a role for himself as one of the more eloquent and forceful progressives in the House of Representatives - asked Morning Joe's Joe Scarborough a question that literally left the host in stunned silence, and then fumbling for a substantive response: What value, exactly, is it that health insurance companies provide? [At roughly the 5:20 mark.]

It was an interesting exchange in that Scarborough, a vocal advocate of privatizing government services during his own tenure in the House, appeared open to conversing politely with the congressman, but flat out couldn't get past the idea that capitalist enterprise isn't always the right course of action; that it might not be something for which we should always strive in every situation. It was clear that Mr. Scarborough simply took for granted the inherent "goodness" of profit-driven solutions to problems affecting the public welfare.

As I have said in the past, in almost all cases, a robust private marketplace will, in fact, eventually produce a solution to most problems. Unfortunately, the time line for such a solution - as well as the inherent instability of such a market - can inflict, or at least permit, tremendous human costs. That is the case with the current state of health care coverage in the United States.

Today we have almost 46 million uninsured Americans, and for the richest country in the world, pathetic - and worsening - performance along measures of life expectancy at birth, infant mortality and amenable deaths when compared to other industrialized nations.

Simply put, if our goal is to ensure a healthy citizenry - which, by the way, will help drive economic growth - we cannot afford to regard the public welfare as a commodity which is required to produce a profit. The baseline from which we should be operating is that medical coverage for all comes first; private profits a very distant second.

Funny or Die takes a look at the logical end state of an approach that worries more about political ideologies than health care or the public good. (Click here to view if embedded video isn't functioning.)

August 20, 2009

The Truth, From an Intellectually Honest Conservative

Bruce Bartlett, a conservative Republican who served in both the Reagan and George H.W. Bush administrations, has a column over at The Daily Beast that is required reading. In The GOP's Misplaced Rage [h/t Paul Allen], he writes that Obama-hating town-hall protesters are angry at the wrong person; their ire should be directed at the man who left the White House last January, George W. Bush:
Conservative protesters should remember that the recession, which led to so many of the policies they oppose, is almost entirely the result of Bush’s policies. According to the National Bureau of Economic Research, the recession began in December 2007 - long before Obama was even nominated. And the previous recession ended in November 2001, so the current recession cannot be blamed on cyclical forces that Bush inherited.
The entire article is worth reading, filled as it is with all sorts of facts that those who are convinced President Obama is trying to destroy the economy and the country will find terrifically inconvenient:
But the truth was always that the economy performed very, very badly under Bush, and the best efforts of his cheerleaders cannot change that fact because the data don’t lie. Consider these comparisons between Bush and Clinton:
  • Between the fourth quarter of 1992 and the fourth quarter of 2000, real GDP grew 34.7 percent. Between the fourth quarter of 2000 and the fourth quarter of 2008, it grew 15.9 percent, less than half as much.

  • Between the fourth quarter of 1992 and the fourth quarter of 2000, real gross private domestic investment almost doubled. By the fourth quarter of 2008, real investment was 6.5 percent lower than it was when Bush was elected.

  • Between December 1992 and December 2000, payroll employment increased by more than 23 million jobs, an increase of 21.1 percent. Between December 2000 and December 2008, it rose by a little more than 2.5 million, an increase of 1.9 percent. In short, about 10 percent as many jobs were created on Bush’s watch as were created on Clinton’s.

  • During the Bush years, conservative economists often dismissed the dismal performance of the economy by pointing to a rising stock market. But the stock market was lackluster during the Bush years, especially compared to the previous eight. Between December 1992 and December 2000, the S&P 500 Index more than doubled. Between December 2000 and December 2008, it fell 34 percent. People would have been better off putting all their investments into cash under a mattress the day Bush took office.

  • Finally, conservatives have an absurdly unjustified view that Republicans have a better record on federal finances. It is well-known that Clinton left office with a budget surplus and Bush left with the largest deficit in history. Less well-known is Clinton’s cutting of spending on his watch, reducing federal outlays from 22.1 percent of GDP to 18.4 percent of GDP. Bush, by contrast, increased spending to 20.9 percent of GDP. Clinton abolished a federal entitlement program, Welfare, for the first time in American history, while Bush established a new one for prescription drugs.
Beyond the economy, Mr. Bartlett also notes that it was President Bush who not only set the stage for the health care reform debate currently underway, but left his party bereft of any sort of plan of their own, their only option to simply oppose Democratic initiatives at all costs:
But there is yet another dimension to Bush’s failures - the things he didn’t do. In this category I would put a health-care overhaul. Budget experts have known for years that Medicare was on an unsustainable financial path. It is impossible to pay all the benefits that have been promised because spending has been rising faster than GDP.

In 2003, the Bush administration repeatedly lied about the cost of the drug benefit to get it passed, and Bush himself heavily pressured reluctant conservatives to vote for the program.

Because reforming Medicare is an important part of getting health costs under control generally, Bush could have used the opportunity to develop a comprehensive health-reform plan. By not doing so, he left his party with nothing to offer as an alternative to the Obama plan. Instead, Republicans have opposed Obama's initiative while proposing nothing themselves.
Mr. Bartlett conclusion is one with which I agree completely:
In my opinion, conservative activists, who seem to believe that the louder they shout the more correct their beliefs must be, are less angry about Obama’s policies than they are about having lost the White House in 2008. They are primarily Republican Party hacks trying to overturn the election results, not representatives of a true grassroots revolt against liberal policies. If that were the case they would have been out demonstrating against the Medicare drug benefit, the Sarbanes-Oxley bill, and all the pork-barrel spending that Bush refused to veto.

Until conservatives once again hold Republicans to the same standard they hold Democrats, they will have no credibility and deserve no respect. They can start building some by admitting to themselves that Bush caused many of the problems they are protesting.
Go check out the article. It's a worthwhile read from an intellectually honest conservative.

August 15, 2009

Amenable Deaths and Political Power

Within the confines of the debate over health care reform, one of the most important justifications for moving to a public option is routinely obscured by anecdotes of long waits for treatment in Canada or England or (horrors!) France. Namely, just how poorly the health care system of the United States stacks up against those of other industrialized nations. As I noted in a previous post:
The United States spends far more per capita on health care than any other industrialized nation. Yet for all of that expenditure, the U.S. is just 37th in the most recent World Health Organization (WHO) rankings of the world's health care systems, slightly ahead of Slovenia and Cuba, but behind such dynamos as Costa Rica, Dominica, Chile, Colombia, Morocco and Greece. Further, the United States ranks 47th in life expectancy at birth; 29th in infant mortality (down from 12th in 1960); and 14th out of 26 developed nations surveyed for deaths from heart disease. Americans also wait as long or longer for care as people in countries with national health insurance.
Even some of these facts, however, have been tested in conversations I have had on the topic, with questions about how one can possibly compare health care across national boundaries when the lifestyles and dietary habits of Americans, French and Japanese, for instance, are so clearly different. As it turns out, a methodology for doing just that was devised by U.S. researchers in the 1970's; it's called amenable mortality, and it's been used worldwide for the past thirty-odd years.

Amenable mortality captures factors such as children who die younger than age 14 from vaccine-preventable or easily-treatable illnesses like coughs, asthma and measles; adult deaths from breast or colon cancer before age 75 (symptomatic of a lack of timely screens and/or care); deaths from infections or hypertension before age 75 (indicating a dearth of preventative and appropriate care); and the death of diabetics prior to age 50 from complications that can be prevented with proper medical management. These and other indicators are then compiled to create a measure comparable across nations.

So, how does the United States stack up? In the late nineties, two British researchers found that, of the 19 countries they surveyed, the U.S. ranked 15th, behind all but Finland, Portugal, the U.K. and Ireland:

The same researchers followed up five years later, and what they found was even more disturbing. The rates of amenable deaths in all countries had improved, but where all other nations had seen strong gains, the United States had gotten only slightly better. The result? The U.S. now ranks dead last in preventing deaths through accessible, quality health care:

Surely, given this, Americans can't be satisfied with the health care that is available to us as a nation, so what is behind the deep-seated and increasingly fanatic opposition to President Obama's efforts to bring reform? To be sure, there are undoubtedly people who strongly - and in good faith - believe that a single payer or public option system is undesirable. (I have not seen much evidence for that stance, personally, but for the purposes of discussion, let's grant that position, nonetheless.)

What then, to make of the wild and demonstrably untrue claims from Republican political leaders that - among other things - Democratic health care reform will create bureaucratic "death panels" to evaluate the desirability of continuing treatment for the elderly when they fall ill? These assertions - made not only by people of notably dubious intellect like former Alaska Governor Sarah Palin, but respected individuals such as former Republican Speaker of the House Newt Gingrich and allegedly moderate GOP Senator Chuck Grassley - have become part of mainstream discussion, when even cursory examination of the legislation in question indicates that they are wholly and completely... well... lies.

The answer, as Paul Krugman notes in a recent editorial, is political power:
This opposition cannot be appeased. Some pundits claim that Mr. Obama has polarized the country by following too liberal an agenda. But the truth is that the attacks on the president have no relationship to anything he is actually doing or proposing.
And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread...
Last week, Mr. Grassley claimed that his colleague Ted Kennedy’s brain tumor wouldn’t have been treated properly in other countries because they prefer to “spend money on people who can contribute more to the economy.” This week, he told an audience that “you have every right to fear,” that we “should not have a government-run plan to decide when to pull the plug on grandma."
So much, then, for Mr. Obama’s dream of moving beyond divisive politics. The truth is that the factors that made politics so ugly in the Clinton years — the paranoia of a significant minority of Americans and the cynical willingness of leading Republicans to cater to that paranoia — are as strong as ever. In fact, the situation may be even worse than it was in the 1990s because the collapse of the Bush administration has left the GOP with no real leaders other than Rush Limbaugh.
I believe Mr. Krugman is correct, and that the only solution to enacting true health care reform is to abandon the spurious priority of bipartisanship. It is not needed to pass legislation in either the House or the Senate, and Republicans have made it clear that they are more interested in demonizing Democrats and working against the president using any means available than they are in actually solving this problem. A loyal opposition is important to our system of government; unfortunately, at this point in history - as amply demonstrated by the tactics they have employed - on this issue, we simply don't have one.

For a stark example of just how bad things have gotten in terms of both actual health care in America and the extremism of opposition to reform, be sure to check out this report from Dana Gould on behalf of HBO's Real Time with Bill Maher. [Note: Contains profanity.]

When the only way to bring affordable health care to Inglewood, California is through a Remote Area Medical clinic - something originally devised to serve Third World countries and poor, rural outposts in America like Appalachia - it is clearly time to shut the crazies out.

August 11, 2009

Disagreeing Over Things That Aren't Real

[Click image to enlarge.]

In what is - to date, anyway - the peak of increasingly deranged rhetoric coming from opponents of health care reform, former GOP candidate for Vice President, Sarah Palin posted the following note on her Facebook page:
The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
Such a system IS - very definitely - evil. It is also complete fantasy.

When ABC News queried the former Alaska governor about her comments, Mrs. Palin's spokesperson, responded by eMail: "From HR 3200 p. 425 see 'Advance Care Planning Consultation'." An examination of that part of the House bill (Section 1233), however, yields the following:
Advance Care Planning Consultation
(1) Subject to paragraphs (3) and (4), the 7 term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years...
The language that follows includes further detail, and it is very clearly about patients making their own end-of-life and living will arrangements so their families don't have to. It's about putting more control in the hands of patients themselves, not placing the lives of the elderly in the hands of faceless government drones.

In fact, no one was more shocked by Governor Palin's freely associative reading of Section 1233 than the author of an amendment to include similar language in the Senate version of the bill, pro-life Georgia Republican Senator Johnny Isakson. Here's what he had to say in a telephone interview with the Washington Post's Ezra Klein:

KLEIN: How did this become a question of euthanasia?

ISAKSON: I have no idea. I understand - and you have to check this out - I just had a phone call where someone said Sarah Palin's web site had talked about the House bill having death panels on it where people would be euthanized. How someone could take an end of life directive or a living will as that is nuts. You're putting the authority in the individual rather than the government. I don't know how that got so mixed up.

KLEIN: You're saying that this is not a question of government. It's for individuals.

ISAKSON: It empowers you to be able to make decisions at a difficult time rather than having the government making them for you.

KLEIN: The policy here as I understand it is that Medicare would cover a counseling session with your doctor on end-of-life options.

ISAKSON: Correct. And it's a voluntary deal.

Given that Senator Isakson is a conservative member of Governor Palin's own party, I think it is fair to say - if it wasn't already before - that she is either a liar or an idiot. There really are no other choices, and Post columnist Steve Pearlstein certainly seems to agree, as his column from last Friday amply illustrated:
As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don't agree. Today, I'm going to step over that line.

The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.
President Obama, speaking at town hall forum in New Hampshire, had this to say:
This is not about putting the government in charge of your health insurance. I don't believe anyone should be in charge of your health insurance decisions but you and your doctor. I don't think government bureaucrats should be meddling, but I also don't think insurance company bureaucrats should be meddling. That's the health care system I believe in.
And I have to say, this is personal for Lori but it's also personal for me. I talked about this when I was campaigning up here in New Hampshire. I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance would refuse to pay for her treatment. And by the way, this was because the insurance company was arguing that somehow she should have known that she had cancer when she took her new job - even though it hadn't been diagnosed yet. So if it could happen to her, it could happen to any one of us.
Under the reform we're proposing, insurance companies will be prohibited from denying coverage because of a person's medical history. Period. They will not be able to drop your coverage if you get sick. They will not be able to water down your coverage when you need it. Your health insurance should be there for you when it counts - not just when you're paying premiums, but when you actually get sick. And it will be when we pass this plan.

Now, when we pass health insurance reform, insurance companies will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses, because no one in America should go broke because they get sick.

And finally - this is important - we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and prostate cancer on the front end. That makes sense, it saves lives; it also saves money - and we need to save money in this health care system.

So this is what reform is about. For all the chatter and the yelling and the shouting and the noise, what you need to know is this: If you don't have health insurance, you will finally have quality, affordable options once we pass reform. If you do have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care that you need. And we will do this without adding to our deficit over the next decade, largely by cutting out the waste and insurance company giveaways in Medicare that aren't making any of our seniors healthier.
...There's been a long and vigorous debate about this, and that's how it should be. That's what America is about, is we have a vigorous debate. That's why we have a democracy. But I do hope that we will talk with each other and not over each other - because one of the objectives of democracy and debate is, is that we start refining our own views because maybe other people have different perspectives, things we didn't think of.

Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed. Because the way politics works sometimes is that people who want to keep things the way they are will try to scare the heck out of folks and they'll create boogeymen out there that just aren't real.
That sounds about right to me. We've got enough problems to solve without arguing the imaginary.

August 5, 2009

Not Elected to Create a Democratic Majority

In a most recent special comment that should be required viewing for anyone dismayed by the current state of health insurance reform on Capitol Hill, Keith Olbermann names the names of legislators from both parties who are in the pocket of the health care and insurance industries. More importantly, he reminds centrist Democrats that they were not elected to create a Democratic majority, but to restore the country after eight years of disastrous Republican rule.