Saturday, August 08, 2009

Bird Brains

Intelligence? It's for the birds. (It sure doesn't seem to be for certain people I'm not going to think about this weekend.) It's taken slow human scientists a long time to notice the varieties of intelligent skills in birds, possibly because their brains are embarrasingly small. (The birds I mean.) The latest bird to startle the scientists? No, not starlings. Rooks. It seems Aesop was something of a scientist himself.

Thursday, August 06, 2009

The First

Congratulations to Judge Sonia Sotomayor, confirmed today to be Associate Justice on the U.S. Supreme Court. President Obama's first nominee to the Court, she will be the first Latina to serve on the Court. The Senate confirmed her today with only 8 votes from the Hate, Lies, Violence and White Supremacists Party.

The Dreaming Up Daily Quote

"The great secret of morals is love; or a going out of our nature, and an identification of ourselves with the beautiful which exists in thought, action, or person, not our own. A man, to be greatly good, must imagine intensely and comprehensively; he must put himself in the place of another and of many others; the pains and pleasure of his species must become his own. The great instrument of moral good is the imagination;"
--P.B. Shelley... photo: Northern lights, North Dakota

Wednesday, August 05, 2009

Prescriptions in the Healthcare Debate

John Stewart complained to his guest, Rep Howard Waxman (a Dem leading on healthcare legislation) that Democrats aren't clearly and briefly explaining what they're trying to do with their reform bills--that in fact, Stewart had "fallen asleep for four minutes" during Waxman's last answer. (I don't know how boring it was--I'd zapped over to SportsCenter for a minute myself).

Even given that the clarity of shouting and lying by Republican and insurance funded thugs showing up at town hall meetings is hard to beat, it's a fair point. Waxman is mostly boring, as (it pains me to say it) is Sec. Kathleen Sebelius. The most effective interview I've seen recently was by Sen. Debbie Stabenow of Michigan. She said reform was needed so that your doctor doesn't have to call up your insurance company to see if they'll pay for the treatment you need. She had a few other pithy quotes. I elect her spokesperson for healthcare.

Nevertheless, I have some longwinded notes here from two notable articles. One is in the LA Times, on the Canadian health care system, written by Michael M. Rachlis, a Canadian doctor and health policy analyst. The side-by-side comparisons are so extreme it's enough to make you weep:

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.

He admits there are some problems in delivering good and timely care, but most are problems just as bad in the U.S., while others have nothing to do with the single-payer system. How about choice? "Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors."

So if it's so great, why doesn't everybody admit it? "Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience."

Vested interests? That would be the insurance companies paying out $1.4 million a day to defeat healthcare reform, and that doesn't include all the lobbying and political payoffs. But actually they aren't paying it. The people buying their insurance are. You are. Apart from making some executives very wealthy, that's what the profits are for. That's why you're allowed to pay them their ever-increasing premiums, but risk getting your insurance cancelled if you have the temerity to get sick and actually ask them to insure you.

Okay, next exhibit: an economic analysis by Alexander Hertel-Fernandez on why a public insurance plan is essential to the success of reform. The points track pretty well with what President Obama has been saying: for example, that the public plan introduces competition into a healthcare "market" that pretty much has none anymore:

This lack of competition is a major source of the United States’ uniquely high and rising health costs. A public plan option would force private insurers to compete on efficiency and quality, rather than on their ability to enroll the lowest-cost workers and firms. Furthermore, a public plan would introduce competition to currently monopolistic or oligopolistic insurer and provider markets—three or fewer insurers account for at least 65% of market share in 36 states.

A public plan would reduce costs and foster innovation, the article says, and serve as a benchmark for the insurance market:

Public-private competition is a longstanding feature in the vast majority of advanced postindustrial economies, particularly in health care. Private and public insurers each bring different strengths and weaknesses to the marketplace, complementing one another. One of public insurance’s key strengths is the ability to set a high standard for cost, quality, and access within a national marketplace, to the benefit of private and public insurers, providers, and enrollees alike. If enrollees are unsatisfied with the public plan, they would be able to easily switch back to private insurers."

Not as colorful as big fat idiots screaming big fat idiocies, but a lot more pertinent. Although in the unlikely event that there is a town hall meeting in my neighborhood, I'm seriously considering standing in front of the podium shouting La salute non si paga! Health is not for sale!

Tuesday, August 04, 2009

The Dreaming Up Daily Quote

The social sympathies, or those laws from which, as from its elements, society results, begin to develop themselves from the moment that two human beings coexist; the future is contained within the present, as the plant within the seed; and equality, diversity, unity, contrast, mutual dependence, become the principles alone capable of affording the motives according to which the will of a social being is determined to action, inasmuch as he is social; and constitute pleasure in sensation, virtue in sentiment, beauty in art, truth in reasoning, and love in the intercourse of kind."
P.B. Shelley: A Defense of Poetry

Monday, August 03, 2009

Medicare for All

Congress went on vacation, with all three committees in the House approving a healthcare reform bill, and one of two in the Senate. While headlines emphasize that support for the Obama proposals was weakening, there is also substantial strength of support, and the distinct possibility that the worst is almost over, and the momentum could swing back to a more robust bill with a strong public option.

Congressional Republicans are clearly making it their priority to defeat any plan President Obama would approve. They have allied their political interests with the economic interests of insurance conglomerates and Big Pharma, as have some conservative Democrats. So now there are two sides (at least) and throughout August they will battle for popular support.

So far GOPers have apparently caused public anxiety about healthcare reform mostly through telling shameless lies, especially by saying that Obama wants to kill seniors. So far, Obama and the Democrats have been less than adroit in responding. While Obama's low-key reasoning drives the media crazy, it generally has been effective with the voting public. On this issue however a little righteous indignation might be called for--if not from Barack, then from Michelle. Because that's what the right is saying: if you're old, Obama wants to kill you.

I support the President on health care, and urge others to do so. But I am resigned to reform that will do much less than it should. It is likely to be complex and unwieldy, and morally as well as operationally compromised. It's clear from the experience of other nations, and from the experience of this nation with Medicare, that the method that works is basically a not-for-profit health care system with all medical insurance administered by the national government.

This is known these days as the "single-payer" system, a term so guarded and abstract that it could mean anything. Today I heard another description: Medicare for all. That's a phrase that people would immediately understand, and given that a higher percentage of Medicare recipients are pleased with it than any other kind of medical insurance, it could gain widespread approval.

Medicare is so popular, that people don't even think of it as a government program. I have to admit that I'm surprised that after the past decade and a half of corporate shamelessness and multi-billion dollar bureaucracies devoted to denying care, the spectre of government involvement in healthcare is still an effective scare tactic. Despite the fact, that as Paul Krugman shows, health care in America only works at all because the government is involved.

Medicare looks like it has its frustrations and complexities, too (if I get through the next few years I'll let you know how it works.) But it has very low administrative costs, and already pays for preventive care that most insurance doesn't. But Medicare for all comes closest to, say, that dreaded Canadian system, where (as a recent article about Vancouver puts it) polls suggest Canadians love their health system -- they spend about 55 percent of what Americans spend on comparable health care, and they have longer life expectancy and lower infant mortality rates." GOPers love the urban myth about Canadians coming to the U.S. for medical care--right, all of about 20 of them. Versus more than a million Californians who go to Mexico for treatment they can't afford in the U.S.

Medicare for all is also morally and ethically clear: you don't make money off of the sick and dying, not when you can afford not to. (And again, profit is what corporations get after doctors, nurses, administrators, etc. are paid, as well as the equipment, research, etc. All profit pays for is mansions for CEOs, buying other companies and paying for marketing and lobbying so the profits keep coming.) In other words (you know I'm going to say it), La salute non si paga: health is not for sale!

So why do I support President Obama, the principles he stands for, and the plan that he is likely to support? In the depths of the Great Depression, President Franklin D. Roosevelt had to figure out how to rebuild a shattered economy and society. He and his advisors came up with policies and programs that focused on structural and long-term solutions. They were necessary. But he was reminded of the suffering of the moment by his two closest advisors, his wife Eleanor Roosevelt, and advisor Harry Hopkins who said this: "People don't eat in the long term. They eat every day."

I think of that quote often. To me it means your responsibility includes dealing with the needs and suffering of the moment. Such a philosophy led to most of the New Deal programs we remember, including those that have turned out to have lasting benefits. (Some of the state parks that California may be closing were built by the CCCs during the Depression.)

President Obama seems very mindful of these two responsibilities--to the long term and to the needs of now. His Recovery Act shows this. I also believe that balancing these two responsibilities is of foremost importance to him, over considerations of re-election.

But in any case this is my belief. Applied to health care, it means to me that it's important to fight for the principle of health is not for sale, and for every government program and law that furthers that principle. I would like to see Medicare for all become a clarion call. But if the public gets queasy about the kinds of changes Washington is contemplating, it looks like a long time coming before Medicare for all is politically possible.

The danger is that the kind of mixed private-public system in current Congressional bills (especially one with a very weak or illusory public component) won't succeed in helping people, but Washington will consider the job done and not focus again on health care. Well, it will just as likely be a long time before Washington focuses on it again if no bill is passed at all. And we know the current system is terrible, and is going to get worse, for individuals and the national economy.

The bills before Congress probably will make some important long term and structural changes for the better. But it also becomes about eating every day--or getting the medical attention and care you need today. So if a health insurance reform bill passes Congress that means that more people get the medical care they need--people with "pre-existing conditions" or who change jobs or who can't afford insurance now or who won't even seek care because it will bankrupt their families--then that bill is worth signing into law. Even if I'm not one of those people.

Sunday, August 02, 2009


The latest economic reports and analyses by prominent analysts indicate that the world and the country avoided a catastrophic collapse, and the Great Recession itself may have bottomed out, although it's still pretty bad for the non-wealthy. Though chances seem good that it won't get worse, it may be awhile before it gets noticeably better.

In his weekly address, President Obama noted that the latest data shows that the Recession was "even deeper than we thought" but that over the past few months the economy improved "measurably better than expected" which many economists say is "directly attributable to the Recovery Act."

Yes, the Stimulus the GOPers are complaining about. The immediate job creation portion saved a number of jobs, especially in state and local government (including teachers, fire departments, police, etc.) and by rescuing infrastructure projects about to be deep sixed, saved construction and vendor jobs. But in this day and age, starting new projects takes time, and those projects and jobs are just starting to show up. But the number of jobs created as well as saved for infrastructure projects doubled in June over just a month before. And that growth is expected to continue.

There's more evidence, according to economist Josh Blivens of the Economic Policy Institute. Thanks in large measure to the Economic Recovery and Reinvestment Act: Federal government spending grew at an 11% rate in the quarter, adding roughly 0.8% to overall GDP. State and local government spending grew at a 2.4% annual rate, the fastest growth since the middle of 2007. It is clear that the large amount of state aid contained in the ARRA made this growth possible.

Furthermore, real (inflation-adjusted) disposable personal income rose by 3.2% in the quarter, after rising by only 1% in the previous quarter. A large contribution to this increase was made by the Making Work Pay tax credit passed in conjunction with the ARRA, as this was the first full quarter that the credit was in effect. "

Blivens notes something else that's interesting, that major media doesn't mention. Though disposable income rose, it didn't translate into higher consumer spending. Why not? Because people are saving more (a sensible precaution and long term good thing.) Bliven points out that if more of the stimulus money had gone out as tax cuts or another round of stimulus checks as GOPers wanted, it's likely that money would also have gone into savings, and failed to stimulate the economy right away:

"This slippage between personal incomes and consumption spending caused by a rising savings rate makes plain that, instead of focusing on even more tax cuts, it was wise to make sure that much of the ARRA was devoted to direct public investment spending. The public investment spending in the ARRA, while not having a significant impact in the second quarter, will provide an even stronger boost to the economy in quarters to come."

Some of that spending is designed to strengthen the economy over the long term. It's a balancing act that a responsible Chief Executive must respect: people have immediate needs, and the economy has long term structural needs.

President Obama spoke to both of these concerns. "As far as I’m concerned, we will not have a recovery as long as we keep losing jobs. And I won’t rest until every American who wants a job can find one. But history shows that you need to have economic growth before you have job growth. And the report yesterday on our economy is an important sign that we’re headed in the right direction."

He said again (as USA Today noted) the economy needs a "new foundation" to ward off future crises.. including a better health care system, improved education and development of "a new clean energy economy."

Bliven is among those who believe even more federal economic stimulus would help, or is going to be needed. Certainly there are new challenges. Right now unemployment benefits are running out. States like California face economic as well as social catastrophes and chaos because of huge budget cuts and falling tax revenues. The ripples could send the national economy into another tailspin.