Saturday, August 15, 2009
The Health Insurers Have Already Won
As the health reform fight shifts this month from a vacationing Washington to congressional districts and local airwaves around the country, much more of the battle than most people realize is already over. The likely victors are insurance giants such as UnitedHealth Group (UNH), Aetna (AET), and WellPoint (WLP). The carriers have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable. Health reform could come with a $1 trillion price tag over the next decade, and it may complicate matters for some large employers. But insurance CEOs ought to be smiling. ...
...The industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business. UnitedHealth has distinguished itself by more deftly and aggressively feeding sophisticated pricing and actuarial data to information-starved congressional staff members. With its rivals, the carrier has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry. ...
...UnitedHealth's relationship with Democratic Senator Mark R. Warner of Virginia illustrates the industry's subtle role. Elected last fall, Warner, a former governor of his state and a wealthy ex-businessman, received a choice assignment as the Senate Democrats' liaison to business. The rookie senator landed in the center of a high-visibility political drama—and in a position to earn the gratitude of a health insurance industry that has donated more than $19 million to federal candidates since 2007, 56% of which has gone to Democrats. ...
...In August 2007, the company hired Sommer, who previously headed global lobbying for Goldman Sachs (GS). He quickly built a new Washington team of former congressional aides and other K Street operatives. One key acquisition: Cory Alexander, former chief of staff for House Majority Leader Steny Hoyer (D-Md.), an influential moderate Democrat. Alexander had been lobbying for the huge mortgage financier Fannie Mae (FNM). Today, Sommer directs a team of nearly 50 people from UnitedHealth's spacious Washington office on Pennsylvania Avenue, equidistant between the Capitol and White House. The company spent more than $3.4 million on in-house and outside lobbying in the first half of 2009.
Sommer has retained such influential outsiders as Tom Daschle, the former Democratic Senate Leader who now works for the large law and lobbying firm Alston & Bird. Daschle, a liberal from South Dakota, dropped out of the running to be Obama's Secretary of Health & Human Services after disclosures that he failed to pay taxes on perks given to him by a private client. He advised UnitedHealth in 2007 and 2008 and resumed that role this year. Daschle personally advocates a government-run competitor to private insurers. But he sells his expertise to UnitedHealth, which opposes any such public insurance plan. Among the services Daschle offers are tips on the personalities and policy proclivities of members of Congress he has known for decades. ...
...What people in Washington tend not to discuss, at least on the record, is the open secret that insurers are minimizing their forecasts of the eventual windfall they will enjoy from expanded coverage for Americans. UnitedHealth has given certain key members of Congress details about its finances and tax liability—both historical numbers and figures projected under various cost-sharing scenarios. But some on Capitol Hill are skeptical. "The bottom line," says an aide to the Senate Finance Committee, "is that health reform would lead to increased revenues and profits [for the insurance industry]. ... There will be [added] costs [to the companies], but we're not sure the revenues and profits will be as low as they say." ...
Civil Rights Commission Criticizes Obama Health-Care Plan’s Racially-Discriminatory Affirmative Action
The U.S. Commission on Civil Rights says Obama’s health-care plan is racially discriminatory. The House health-care bill backed by Obama is filled with “sections that factor in race when awarding billions in contracts, scholarships and grants” and give “preferential treatment to minority students for scholarships.” Taxpayers of all races will end up paying more because of these arbitrary racial preferences. The Civil Rights Commission has concluded that this racial discrimination is unjustified, and that it will neither “reduce health care disparities among racial and ethnic groups,” nor “improve health care in underserved areas.”
Earlier, I wrote about other provisions backed by Obama that would mandate affirmative action in health care to promote “cultural competence” — whatever that means — and fund left-wing community organizers. “ObamaCare” also contains preferences for illegal aliens, who are exempt from its taxes and penalties, but can access its benefits due to lack of eligibility verification safeguards. The safeguards were blocked by liberal lawmakers allied with Obama....
Healthcare Reform That's Hard to Swallow (Los Angeles Times)
...However, the climate for drug development is deteriorating. Research and development investments per new drug introduction approximately doubled between the early 1980s and early 1990s, and only about three in 10 drugs approved by the Food and Drug Administration for marketing recoup their development costs.
President Obama has made it clear that he intends to eke out huge cost savings at drug companies' expense: "You've heard that as a consequence of our efforts at reform, the pharmaceutical industry has already said they're willing to put $80 billion on the table," and he added: "We might be able to get $100 billion out or more."...
...The stimulus bill has already set aside $1.1 billion to figure out how to distinguish the blue pills from the red ones, and reform legislation is expected to pour more money into these attempts to measure "comparative effectiveness."
But this approach ignores the futility of such one-size-fits-all prescribing of medicines. For many classes of drugs -- among them statins, anti-hypertensives, pain-relievers and antipsychotic medicines -- the selection of the appropriate drug among many possibilities requires a delicate balancing of effectiveness and acceptable side effects in each patient. Under Obama-care, you don't want to be one of those people who might really need the more expensive red pill.
Once the cheap blue pill has been anointed as the one eligible for federal reimbursement, there will be little incentive for companies to pour millions of dollars into developing a new generation of drugs that might in fact prove to be better -- but perhaps only for a small subset of patients....
Tuesday, August 11, 2009
Democracy and the Grounds of Distrust
...It requires an amazing kind of selective amnesia to think that there is “no evidence’ that the U.S. government is “capable of madness.” The government of the United States invaded Iraq and its agents have killed many tens of thousands people on the basis of the fact that some Saudis trained in Afganistan flew planes into the World Trade Center, plus some lies. Torture, extraordinary rendition, indefinite detention, etc. I call that madness. Of course, Ezra means the other parts of government concerned with domestic affairs. But not the parts that break into peoples’ houses and destroy their lives for selling contraband herbs, or that subject us constantly to mendacious propaganda about drugs. Our government — and by extension our fellow citizens — is capable of terrible things and proves it every single day. Is it really possible to love government so much, to invest so much hope in its benevolent efficacy, that we grow blind to its evident capacity for evil? Anyway, there must be some parts of the government that are not capable of madness. Ezra invites us to think about those when considering health care reform. Will you accept?
I suspect Ezra thinks that his side of the debate has done nothing to engender distrust. But that would be wrong. The reason I wrote a whole paper about the “noble lies” underpinning the American Social Security system is precisely that our system did and does violate the spirit of transparency and openness needed for good-faith democratic deliberation. And, as I argued last month in my column for The Week, the demonstrated willingness of Democrats, both politician and wonk, to dissemble about whether or not they’re trying to set in motion a chain reaction toward a single-payer system practically demands distrust....
Undue Influence
...Enter Section 1233 of the health-care bill drafted in the Democratic-led House, which would pay doctors to give Medicare patients end-of-life counseling every five years -- or sooner if the patient gets a terminal diagnosis.
On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That's rubbish. Federal law already bars Medicare from paying for services "the purpose of which is to cause, or assist in causing," suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that.
Still, I was not reassured to read in an Aug. 1 Post article that "Democratic strategists" are "hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors."
If Section 1233 is innocuous, why would "strategists" want to tip-toe around the subject?
Perhaps because, at least as I read it, Section 1233 is not totally innocuous. ...
...Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic. ...
Deceptive Obama Health-Care Plan Worsens the Status Quo, Explodes Costs, Say Washington Post Columnists
The Washington Post endorsed Obama — indeed, it hasn’t endorsed a Republican for president since 1952 — but a lot of Washington Post columnists are not enthusiastic about his health-care plan, which is costly, obsolete, deceptive, and harmful.
Obama’s plan would just aggravate the status quo and increase skyrocketing health-care costs, says veteran editorialist Robert J. Samuelson: “One of the bewildering ironies of the health-care debate is that President Obama claims to be attacking the status quo when he’s actually embracing it. . .While denouncing skyrocketing health spending, he would increase it.”
Earlier, Samuelson noted that various aspects of Obama’s health-care plan were “naive, hypocritical” and “simply dishonest.”
Elderly people would be subjected to worrisome undue influence regarding end-of-life decisions, says Charles Lane, a liberal editorialist.
Obama’s plan ignores basic, obvious reforms of the health-care system needed to stem skyrocketing costs and provide health-care security, says Charles Krauthammer — such as a more efficient, less litigious way to decide medical malpractice cases, which wealthy, liberal trial lawyers oppose....
...In the New York Times, economist Tyler Cowan calls Obama’s plan “voodoo economics.”...
The Next Fannie Mae
Much to their dismay, Americans learned last year that they “owned” Fannie Mae and Freddie Mac. Well, meet their cousin, Ginnie Mae or the Government National Mortgage Association, which will soon join them as a trillion-dollar packager of subprime mortgages. Taxpayers own Ginnie too.
Only last week, Ginnie announced that it issued a monthly record of $43 billion in mortgage-backed securities in June. Ginnie Mae President Joseph Murin sounded almost giddy as he cheered this “phenomenal growth.” Ginnie Mae’s mortgage exposure is expected to top $1 trillion by the end of next year—or far more than double the dollar amount of 2007. (See the nearby table.) Earlier this summer, Reuters quoted Anthony Medici of the Housing Department’s Inspector General’s office as saying, “Who would have predicted that Ginnie Mae and Fannie Mae would have swapped positions” in loan volume?
Ginnie’s mission is to bundle, guarantee and then sell mortgages insured by the Federal Housing Administration, which is Uncle Sam’s home mortgage shop. Ginnie’s growth is a by-product of the FHA’s spectacular growth. The FHA now insures $560 billion of mortgages—quadruple the amount in 2006. Among the FHA, Ginnie, Fannie and Freddie, nearly nine of every 10 new mortgages in America now carry a federal taxpayer guarantee.
Herein lies the problem. The FHA’s standard insurance program today is notoriously lax. It backs low downpayment loans, to buyers who often have below-average to poor credit ratings, and with almost no oversight to protect against fraud. Sound familiar? This is called subprime lending—the same financial roulette that busted Fannie, Freddie and large mortgage houses like Countrywide Financial.
On June 18, HUD’s Inspector General issued a scathing report on the FHA’s lax insurance practices. It found that the FHA’s default rate has grown to 7%, which is about double the level considered safe and sound for lenders, and that 13% of these loans are delinquent by more than 30 days. The FHA’s reserve fund was found to have fallen in half, to 3% from 6.4% in 2007—meaning it now has a 33 to 1 leverage ratio, which is into Bear Stearns territory. The IG says the FHA may need a “Congressional appropriation intervention to make up the shortfall.”...
...Then there is the booming refinancing program that Congress has approved to move into the FHA hundreds of thousands of borrowers who can’t pay their mortgage, including many with subprime and other exotic loans. HUD just announced that starting this week the FHA will refinance troubled mortgages by reducing up to 30% of the principal under the Home Affordable Modification Program. This program is intended to reduce foreclosures, but someone has to pick up the multibillion-dollar cost of the 30% loan forgiveness. That will be taxpayers.
In some cases, these owners are so overdue in their payments, and housing prices have fallen so dramatically, that the borrowers have a negative 25% equity in the home and they are still eligible for an FHA refi. We also know from other government and private loan modification programs that a borrower who has defaulted on the mortgage once is at very high risk (25%-50%) of defaulting again. ...
Monday, August 10, 2009
Hate Crime in St. Louis: Obama Backers Beat Up Black Critic of Health-Care “Reform,” Use Racial Slurs
Kenneth Gladney, a black critic of Obama’s health-care plan, was beaten, kicked, and called racist names by members of the SEIU, a corrupt and powerful left-wing union that backs Obama’s plan, leaving him wheelchair-bound and too weak to speak. This hate crime took place at a St. Louis “town hall” meeting. SEIU members are bused in to town hall meetings called by liberal lawmakers in order to create the illusion of grassroots support, and intimidate would-be critics.
To curry favor with the corrupt SEIU, the Obama Administration has betrayed union workers by gutting federal regulations that help uncover corruption by union leaders and their misuse of union members’ dues....
...The Obama Administration has a glaring double standard when it comes to hate crimes. It has turned a blind eye to hate-crimes committed by liberals, such as voter intimidation in Philadelphia by black panthers who included a Democratic official and Obama poll-watcher. Yet it has advocated reprosecuting in federal court other people found innocent of hate crimes in state court, taking advantage of a loophole in constitutional protections against double jeopardy.
Feds’ grip on health care system could strangle biotechs
As lawmakers debate the future of the nation’s health care system, some Maryland biotechnology executives fear federal legislation could cut off the cash supply for startup life sciences companies.
Health reform shaping in Washington could mean that some drug companies would lose their exclusive licenses in less time than it would take to recoup the cost of developing new drugs. Another issue in the health reform debate is whether the government would set prices for some drugs and diagnostic treatments. Venture capitalists would think twice about investing in a new treatment if it can’t be sold at market prices, biotech entrepreneurs say....
Sunday, August 09, 2009
Obama discovers that health reform is a hard sell
...If Obama has his way, his health care plan will be funded by his Treasury chief who did not pay his taxes, overseen by his Surgeon General who is obese, signed by a president who smokes and financed by a country that is just about broke. What possibly could go wrong?...
Trucks win in Cash for Clunkers game
NEW YORK (CNNMoney.com) -- What are people trading their clunkers in for? It depends on who you ask.
The government's results showed small cars as the top choice for shoppers looking for Cash for Clunker deals. But an independent analysis by Edmunds.com disputed those results, and showed that two full-size trucks and a small crossover SUV were actually among the top-ten buys.
The discrepancy is a result of the methods used. Edmunds.com uses traditional sales measurements, tallying sales by make and model. The government uses a more arcane measurement method that subdivides models according to engine and transmission types, counting them as separate models.
For example, the Ford Escape is available in six different versions including two- and four-wheel drive and hybrid versions. The government counts each version as a different vehicle using guidelines from the Environmental Protection Agency. Only the front wheel drive, non-hybrid version made the government's top ten list.
The Ford Escape crossover SUV, instead of being the seventh-most popular vehicle under the program, as the government ranked it, was actually the best seller, according to Edmunds.com. The government pegged the Ford Focus as the top seller. ...
Saturday, August 08, 2009
A French Revelation, or The Burning Bush
Incredibly, President George W. Bush told French President Jacques Chirac in early 2003 that Iraq must be invaded to thwart Gog and Magog, the Bible’s satanic agents of the Apocalypse.
Honest. This isn’t a joke. The president of the United States, in a top-secret phone call to a major European ally, asked for French troops to join American soldiers in attacking Iraq as a mission from God.
Now out of office, Chirac recounts that the American leader appealed to their “common faith” (Christianity) and told him: “Gog and Magog are at work in the Middle East…. The biblical prophecies are being fulfilled…. This confrontation is willed by God, who wants to use this conflict to erase his people’s enemies before a New Age begins.”
This bizarre episode occurred while the White House was assembling its “coalition of the willing” to unleash the Iraq invasion. Chirac says he was boggled by Bush’s call and “wondered how someone could be so superficial and fanatical in their beliefs.”
After the 2003 call, the puzzled French leader didn’t comply with Bush’s request. Instead, his staff asked Thomas Romer, a theologian at the University of Lausanne, to analyze the weird appeal. Dr. Romer explained that the Old Testament book of Ezekiel contains two chapters (38 and 39) in which God rages against Gog and Magog, sinister and mysterious forces menacing Israel. Jehovah vows to smite them savagely, to “turn thee back, and put hooks into thy jaws,” and slaughter them ruthlessly. In the New Testament, the mystical book of Revelation envisions Gog and Magog gathering nations for battle, “and fire came down from God out of heaven, and devoured them.”
In 2007, Dr. Romer recounted Bush’s strange behavior in Lausanne University’s review, Allez Savoir. A French-language Swiss newspaper, Le Matin Dimanche, printed a sarcastic account titled: “When President George W. Bush Saw the Prophesies of the Bible Coming to Pass.” France’s La Liberte likewise spoofed it under the headline “A Small Scoop on Bush, Chirac, God, Gog and Magog.” But other news media missed the amazing report.
Subsequently, ex-President Chirac confirmed the nutty event in a long interview with French journalist Jean-Claude Maurice, who tells the tale in his new book, Si Vous le Répétez, Je Démentirai (If You Repeat it, I Will Deny), released in March by the publisher Plon....
The Market Doesn’t Ration Health Care
...To see that the market does not ration one need only see that “the market” doesn’t do anything. To talk as if it does things is to reify the market — worse, it is to anthropomorphize the market, ascribing to it attributes — purposes, plans, and actions — that only human beings possess. We may also see this as another instance of literalizing a metaphor, which, as Thomas Szasz has so often warned, is fraught with peril.
I’m not saying that economists don’t realize this diction is a metaphor. Of course they do, and there’s no harm in using this shorthand among those who understand it as such. The problem, as I see it, is that the general public doesn’t fully grasp the metaphorical nature of these statements. For the sake of public understanding, free-market advocates should not welcome a debate in which they begin by saying, “Our method of rationing is better than your method of rationing.”
Better to respond to the interventionists this way: The market does not ration or allocate. The market does not do anything. It has no purposes or objectives. It is simply a legal framework in which people do things with their justly acquired property and their time in order to pursue their own purposes....
...It is true that as a result of market exchanges, goods and resources change hands and (except for land) locations. But in no sense is this rationing or allocation. The resulting arrangement of resources is simply a product of many transactions. Of course, people’s choices of what and what not to buy and sell at which prices create an arrangement of goods and resources that tends to be intelligible in terms of consumers’ subjective priorities. But that does not warrant calling the process rationing or allocation....
France Fights Universal Care's High Cost
...France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.
And service cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.
The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul....
...Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.
France faces a major obstacle to its reforms: French people consider access to health care a societal right, and any effort to cut coverage can lead to a big fight.
For instance, in France, people with long-term diseases get 100% coverage (similar to, say, Medicare for patients with end-stage kidney diseases). The government proposed trimming coverage not directly related to a patient's primary illness -- a sore throat for someone with diabetes, for example. The proposal created such public outcry that French Health Minister Roselyne Bachelot later said the 100% coverage rule was "set in stone."...
...Since the 1970s, almost all successive French health ministers have tried to reduce expenses, but mostly managed to push through only minor cost cuts....
...In the U.S., hospitals are paid for each individual procedure. This system, called fee-for-service, is suspected of contributing to runaway costs because it doesn't give hospitals an incentive to limit the number of tests or procedures.
Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment....
...Yet even the smallest budget moves are proving controversial. Local residents are up in arms over a cost-cutting measure that makes patients pay €1.10 an hour to park at the hospital. "It's a scandal," says retired local Communist politician Gérard Eude. "It goes against the very idea of universal health care."
‘You Are Terrifying Us’
We have entered uncharted territory in the fight over national health care. There’s a new tone in the debate, and it’s ugly. At the moment the Democrats are looking like something they haven’t looked like in years, and that is: desperate.
They must know at this point they should not have pushed a national health-care plan. A Democratic operative the other day called it “Hillary’s revenge.” When Mrs. Clinton started losing to Barack Obama in the primaries 18 months ago, she began to give new and sharper emphasis to her health-care plan. Mr. Obama responded by talking about his health-care vision. He won. Now he would push what he had been forced to highlight: Health care would be a priority initiative. The net result is falling support for his leadership on the issue, falling personal polls, and the angry town-hall meetings that have electrified YouTube.
In his first five months in office, Mr. Obama had racked up big wins—the stimulus, children’s health insurance, House approval of cap-and-trade. But he stayed too long at the hot table. All the Democrats in Washington did. They overinterpreted the meaning of the 2008 election, and didn’t fully take into account how the great recession changed the national mood and atmosphere.
And so the shock on the faces of Congressmen who’ve faced the grillings back home. And really, their shock is the first thing you see in the videos. They had no idea how people were feeling. Their 2008 win left them thinking an election that had been shaped by anti-Bush, anti-Republican, and pro-change feeling was really a mandate without context; they thought that in the middle of a historic recession featuring horrific deficits, they could assume support for the invention of a huge new entitlement carrying huge new costs.
The passions of the protesters, on the other hand, are not a surprise. They hired a man to represent them in Washington. They give him a big office, a huge staff and the power to tell people what to do. They give him a car and a driver, sometimes a security detail, and a special pin showing he’s a congressman. And all they ask in return is that he see to their interests and not terrify them too much. Really, that’s all people ask. Expectations are very low. What the protesters are saying is, “You are terrifying us.” ...
Ken McIntyre: Associated Press outsourcing to Leftist nonprofits is a bad idea
...Earlier this month, the 163-year-old news cooperative announced it would distribute "watchdog and investigative journalismÓ penned not by its own staff or that of member papers, but by four outside groups: the Center for Investigative Reporting in Barkeley, Calif.; New York-based ProPublica; and two D.C. outfits, the Center for Public Integrity (CPI) and the Investigative Reporting Workshop at American University.
AP, itself a not-for-profit enterprise, identified the four organizations as "civic-minded nonprofits. They also all have decidedly liberal sponsors. A cursory glance at the "independentÓ news shops reveals their reliance on left-tilting patrons such as the Knight Foundation and leftist donors such as financier Herbert Sandler and currency speculator George Soros.
Sandler and his wife, Marion, founders of ProPublica, are generous givers to Democratic candidates and left-wing causes including the Center for American Progress and ACORN, the ethically-challenged radical action group. Soros, an early backer of CPI as well as the radical MoveOn.org, poured tens of millions into attacks on President George W. Bush...
Inventor Dean Kamen Says Healthcare Debate "Backward Looking"
...Well, I mean the whole supposition that "We have a crisis in healthcare." Our healthcare system has seen some of the greatest achievements of the human intellect since we started recording history: We're developing incredible devices and implantables to improve the quantity and quality of people's lives. We're developing pharmaceuticals that alleviate the need for surgery and eliminate the volatile effects of diseases. We're making the surgeries that are necessary ever less invasive. You can get a stent through your femoral artery all the way up into your heart and fix a blockage without surgery. I'd say, if we have a crisis, it's the embarrassment of riches. Nobody wants to deal with the fact that we're no longer in a world where you can simply give everybody all the healthcare that is available.
Each side of this debate has created the boogieman and monsters, like "We don't want let this program to come into existence because that will mean rationing." Well, I hate to tell you the news but as soon as medicine started being able to do incredible things that are very expensive, we started rationing. The reason 100 years ago everyone could afford their healthcare is because healthcare was a doctor giving you some elixir and telling you you'll be fine. And if it was a cold you would be fine. And if it turns out it was consumption; it was tuberculosis; it was lung cancer—you could still sit there. He'd give you some sympathy, and you'd die. Either way, it's pretty cheap.
We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it's enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won't be reimbursed, according to the common standards. We're not only rationing today; we're rationing our future. ...
...Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free.
Whatever the marketplace, if talented people are given resources they're going to keep driving us to having better, simpler, cheaper solutions to problems. And, by the way, if they come up with a better solution but it can't be cheaper—which, in the beginning, most things aren't—nobody says you have to buy it. If you think this new drug is too expensive, it's not a good deal, we have a crisis, buy the old one. It's a generic now. It's cheap.
You can't look at the problem and say, "I want them to do more, better, faster miracles—and not invest in research, not invest in development, and have those miracles delivered to me free." It's unrealistic. And people know that about most things. They do. Nobody expects that just because they've made computers better they're going to give them to you free. ...
...
Last year what did we spend in the United States on soft drinks? $121 billion. Nearly half of what we spend on all of our pharmaceuticals, on soft drinks. I'm not against soft drinks—I think you ought to buy all the soft drinks you want.
Last year what did we spend supporting professional sports? $409 billion.
Now if somebody in this country wants to explain to me that we ought to be spending about twice as much supporting sports as on all of our pharmaceuticals, then stop spending. You don't like that drug? You don't want to cure this disease? Don't buy it. But don't make villains out of people so that we can turn what is a real social responsibility issue into a political debate. ...
...Well, it would kill us if we look at the 30-year actuarial data based on our 19th century confidence in technology. But I'm sure in 1920 if you asked actuaries to say what percentage of our GDP are we going to spend taking care of people with polio, they'd say: "They get polio, it goes to their lungs, they sit in iron lung machines, they could live a whole lifetime with three people watching over them. We can't support them all."
But what did it cost to deal with everybody with polio? Oh, $2 apiece. We gave them the Salk vaccine. But in the 1920s Salk wasn't around yet. ...
THE NATIONALIZATION OF YOUR BODY
Health care is a game-changer. The permanent game-changer. The pendulum will swing, and one day, despite their best efforts, the Republicans will return to power, and, in the right circumstances, the bailouts and cap-&-trade and Government Motors and much of the rest can be reversed. But the government annexation of health care will prove impossible to roll back. It alters the relationship between the citizen and the state and, once that transformation is effected, you can click your ruby slippers all you want but you’ll never get back to Kansas....
...But it will make a lot of other things worse. Government-directed health care is a profound assault on the concept of citizenship. It deforms national politics very quickly, and ensures that henceforth elections are always fought on the left’s terms. I find it hard to believe President Obama and his chums haven’t looked at Canada and Europe and concluded that health care is the fastest way to a permanent left-of-center political culture. He doesn’t say that, of course. He says his objective is to “control costs”. Which is the one thing that won’t happen. Even now, health care costs rise far faster under Medicare than in the private sector. ...
...So elections dwindle down to a sterile argument over how to “improve” the system: The left-of-center party usually pledges to throw money at it. The right-of-center party is less enthusiastic about that, which generally makes it suspect on the issue, so it settles on some formulation to the effect that it can “deliver” better “services” more “efficiently”. In other words, the only viable rationale for the right becomes its claim to be able to run the leftist state more smoothly than the left. Every footling reform with any whiff of the private sector about it has the ranks of the great and the good lining up on TV to drone the indestructible cliché that “the NHS is the envy of the world.” Years ago, in The Daily Telegraph, I wrote that I’d seen a fair bit of the world and had never met anybody who envied the NHS, although presumably there must be a Bhutanese yak farmer up country somewhere who’d be impressed by it. A couple of days later, Mr Sonam Chhoki, a Bhutanese gentleman, wrote to the paper to say that, while not a yak farmer himself, he came from good yak farming stock and, after a bit of grumbling about my outmoded ethnic stereotyping, declared that he certainly didn’t envy the NHS. His British parents-in-law “have had to wait more than two years for operations, after being turned away several times for lack of hospital beds. However basic the Bhutanese health service is, it has not yet come to this sorry state.”...
...In a nanny state, big government becomes a kind of religion: the church as state. Tommy Douglas, the driving force between Canadian health care, tops polls of all-time greatest Canadians. In Britain, after the Tube bombings, Gordon Brown began mulling over the creation of what he called a “British equivalent of the US Fourth of July”, a new national holiday to bolster British identity. The Labour Party think-tank, the Fabian Society, and proposed that the new “British Day” should be July 5th, the day the National Health Service was created. Because the essence of contemporary British identity is waiting two years for a hip operation....
To Lower Costs, Mass. May Restructure Doctor Pay
Massachusetts is proud of its landmark 3-year-old health insurance law. It has brought the state's proportion of uninsured down from around 10 percent in 2005 to only 2.6 percent — the lowest in the nation.
But the achievement is in jeopardy. Massachusetts has the highest health costs in the country.
"The critical point is whether or not we can begin to do something about cost control," says Dolores Mitchell, who heads a state commission that buys coverage for 310,000 government workers and their families. "We've just got to do it."...
...But some worry "global payment" sounds suspiciously like the managed care "capitated" HMO plans of the 1990s. Those plans were also based on paying health care providers a fixed amount per patient....
Geithner Vents at Regulators as Overhaul Stumbles
WASHINGTON -- Treasury Secretary Timothy Geithner blasted top U.S. financial regulators in an expletive-laced critique last Friday as frustration grows over the Obama administration's faltering plan to overhaul U.S. financial regulation, according to people familiar with the meeting.
The proposed regulatory revamp is one of President Barack Obama's top domestic priorities. But since it was unveiled in June, the plan has been criticized by the financial-services industry, as well as by financial regulators wary of encroachment on their turf....
Government Employment Up or Down?
The New York Times editorialized today about the supposed “brutalizing” effects of state and local government spending cuts. They claim that “most states also have cut their public workforces.”
Yet USA Today reporter Dennis Cauchon takes a look at the actual data, and he finds that state and local governments added 12,000 workers in the latest quarter, while the private sector cut 1.3 million jobs.
Thus, it appears that “brutal” restructuring is going on in the private sector, but not in the government sector. ...
Morning Bell: The People Spreading “Disinformation” About Obamacare
...The President has explicitly said that the public option will not eliminate private insurance. He told the American Medical Association on June 15th: “What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system…So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this - they are not telling the truth.” So the President SAYS the public option will not lead to single payer health care … but a number of prominent people are saying the exact opposite:
* Rep. Jan Schakowsky (D-IL) at a Health Care for America Now rally: “And next to me was a guy from the insurance company who argued against the public health insurance option, saying it wouldn’t let private insurance compete. That a public option will put the private insurance industry out of business and lead to single-payer. My single-payer friends, he was right. The man was right.”
* Rep. Barney Frank (D-MA) told Single Payer Action: “I think that if we get a good public option it could lead to single-payer and that is the best way to reach single-payer. Saying you’ll do nothing till you get single-payer is a sure way never to get it. … I think the best way we’re going to get single-payer, the only way, is to have a public option and demonstrate the strength of its power.”
* Washington Post blogger Ezra Klein at the Democratic National Convention last year: “They have a sneaky strategy, the point of which is to put in place something that over time the natural incentives within its own market will move it to single-payer.”
* Noble Prize winning New York Times columnist Paul Krugman: “[T]he only reason not to do [single-payer] is that politically it’s hard to do in one step…You’d have to convince people completely give up the insurance they have, whereas something that lets people keep the insurance they have but then offers the option of a public plan, that may evolve into single-payer.”...
Obamacare Is Called a Trojan Horse for a Reason
...Schakowsky tells her Health Care for America Now audience: “And next to me was a guy from the insurance company who argued against the public health insurance option, saying it wouldn’t let private insurance compete. That a public option will put the private insurance industry out of business and lead to single-payer. My single-payer friends, he was right. The man was right.”...
...Frank tells a member of Single Payer Action: “I think that if we get a good public option it could lead to single-payer and that is the best way to reach single-payer. Saying you’ll do nothing till you get single-payer is a sure way never to get it. … I think the best way we’re going to get single-payer, the only way, is to have a public option and demonstrate the strength of its power.”...
...Klein tells his netroots audience: “They have a sneaky strategy, the point of which is to put in place something that over time the natural incentives within its own market will move it to single-payer.”...
...Krugman tells his audience: “[T]he only reason not to do [single-payer] is that politically it’s hard to do in one step…You’d have to convince people to completely give up the insurance they have, whereas something that lets people keep the insurance they have but then offers the option of a public plan, that may evolve into single-payer, but you can do it politically…”...
‘Cash for Clunkers,’ By the Numbers
...He added that the average annual income of those who bought cars with their rebates was $57,700, just under the $61,000 for all new car buyers these days. That suggests that consumers with the lowest incomes who, in theory, need the rebates most, are not benefiting from the program.
One of the problems, Mr. Spinella said, is that even a $4,500 rebate may not be enough to persuade consumers to turn in their cars, particularly if they are unable to borrow from cautious auto dealers.
“Some of the folks who drive a beater all the time are unlikely to get a new car loan,” he said. “That’s one of the problems with the program.”
The WTO Subsidies Rules and “Cash for Clunkers”
The government’s new “cash for clunkers” program has been wildly successful. Under the program, consumers may receive up to $4,500 towards the purchase of a new, more fuel-efficient vehicle. What is surprising is the impact this it is having on consumer spending patterns regarding domestic vs. imported vehicles. According to press reports, more than 70% of the clunkers that were traded-in were domestic. Moreover, as reported here, consumers are showing a preference for imported cars when they purchase under the program, with Toyota (17%) and Honda (14%) leading the way. The top ten sellers under the program are Ford Focus, Honda Civic, Toyota Corolla, Toyota Prius, Ford Escape, Toyota Camry, Dodge Caliber, Hyundai Elantra, Honda Fit, and Chevy Cobalt. In other words, six of the top ten sellers are foreign cars (although the Camry is built at home and abroad).
Cash for Clunkers is one of the few government subsidy programs that I am aware of that clearly has the de facto effect of promoting imported over domestic goods. ...
Cash for Clunkers Falls Flat
Only in Washington could a program that is spending money 13 times faster than was planned be labeled a "success." The "cash-for-clunkers" program ground to a halt last week because in less than a week, a program that was supposed to last until November 1, had spent the entire $1 billion allocated to it. Let's just hope that the government takeover of the rest of the health care industry doesn't result in similar "success."...
...The Obama administration also got the program's costs all wrong. The money was spent so quickly that it lasted less than a week-- just 8 percent of the time that it was supposed to last. If the government gets the health care numbers this wrong, one can only imagine the damage to the deficit....
Sahara Desert Greening Due to Climate Change?
Desertification, drought, and despair—that's what global warming has in store for much of Africa. Or so we hear.
Emerging evidence is painting a very different scenario, one in which rising temperatures could benefit millions of Africans in the driest parts of the continent.
Scientists are now seeing signals that the Sahara desert and surrounding regions are greening due to increasing rainfall.
If sustained, these rains could revitalize drought-ravaged regions, reclaiming them for farming communities.
This desert-shrinking trend is supported by climate models, which predict a return to conditions that turned the Sahara into a lush savanna some 12,000 years ago. ...
New Detainee Site In U.S. Considered
The administration is considering whether to transfer some detainees at the military prison at Guantanamo Bay, Cuba, to a facility in the United States that would contain courtrooms to hold federal criminal trials and military commissions to prosecute terrorism suspects, administration officials said Sunday.
The maximum-security facility would be jointly run by the departments of Defense, Justice and Homeland Security, with each assuming responsibility for different sets of inmates. Officials said such a facility could also house prisoners held in indefinite detention and those cleared for release but who have no country willing to accept them. Those convicted in federal court or military commissions could serve their terms there. ...
...The administration has signaled that some Guantanamo Bay detainees will be tried in federal court and some in military commissions. It also said that there may be a third category of prisoners who are deemed too dangerous to release but who cannot be tried because of a lack of evidence or the need to protect intelligence material. ...
California's Reckoning -- and Ours
...Here's the national lesson. There's a collision between high and rising demands for government services and the capacity of the economy to produce the income and tax revenue to pay for those demands. That's true of California, where poor immigrants and their children have increased pressures for more government services. It's also true of the nation, where an aging population raises Social Security and Medicare spending. California is leading the transformation of politics into a form of collective torture: pay more (higher taxes), get less (lower services).
Make no mistake: The spending cuts and tax increases the state enacted to bridge its budget deficits are not cosmetic. In February, the Legislature agreed to a penny increase in the state sales tax, bringing the total -- including local sales taxes -- to about nine cents or more. Top income tax rates, already among the highest in the country, were raised. So were motor vehicle registration fees. Spending cuts approved in February and July are deep. Together, the cuts equal almost 30 percent of the general revenue fund and will affect schools, prisons, colleges and welfare.
The state's liberal establishment is in mourning. "Reversing 40 years of progress" is how Jean Ross of the California Budget Project, a liberal research and advocacy group, put it in one blog. Some welfare benefits will be cut by half. California's student-teacher ratio, now about a third above the national average, will probably go even higher. The University of California system lost 20 percent of its state payments. It's raising tuition and student fees 9.3 percent, imposing salary reductions of 4 to 10 percent on more than 100,000 workers, and delaying faculty hires.
National parallels again seem apparent. Federal budget deficits -- reflecting the urge to spend and not tax -- predate the recession and, as baby boomers retire, will survive any recovery. Amazingly, the Obama administration would worsen the long-term outlook by expanding federal health insurance coverage. There's much mushy thinking about how we'll muddle through. ...
Why Most Journalists Are Democrats: A View from the Soviet Socialist Trenches
... What I found was so much propaganda about the wonders of Soviet Socialist Mankind and the horrors of Western Democracy that the people exposed to it might as well have had electrodes implanted to control their thoughts. There were no governmental checks and balances and nothing even close to a free press—so positions of power were filled by nasty sorts who kept good people in fear for their lives if they didn’t think the right thoughts. Soviet Socialism, as it turned out, was a perverse system that killed motivation even as it made fear as natural as breathing.
Why wasn’t this widely reported in the Western press?
As it turns out, the preponderance of journalists are Democrats. And socialism, with its idyllic, “progressive” programs, has formed an increasingly important role in Democratic policies. Who wants to investigate a possible dark side of your own party’s plank?
We’ll get to that. First—why are most journalists Democrats?...
...Most journalists take a number of psychology, sociology, political science, and humanities courses during their early years in college. Unfortunately, these courses have long served as ideological training programs—ignoring biological sources of self-serving, corrupt, and criminal behavior for a number of reasons, including lack of scientific training; postmodern, antiscience bias; and well-intentioned, facts-be-damned desire to have their students view the world from an egalitarian perspective. Instead, these disciplines ram home the idea that troubled behavior can be fixed through expensive socialist programs that, coincidentally, provide employment opportunities for graduates of the social sciences. Modern neuroscience is showing how flawed many of these policies have been—structural differences in the brains of psychopaths, for example, help explain why remedial programs simply helped them become better at conning people.
Academics in the social sciences tend to give short shrift to the dramatic failures and corruption within US educational system or unions. (Think here of the Detroit Public School system, or the National Education Association, whose former officers have written: “The NEA has been the single biggest obstacle to education reform in this country. We know because we worked for the NEA.”) Instead, because of their ideological biases, professors often emphasize that corporations are the bad guys, while unions and the government—at least the type of government that supports higher paychecks for social science professors and jobs for their students—are good. This type of teaching makes the Democratic Party and its increasingly socialist ideals seem naturally desirable, and criticism about how those ideals will supposedly be met less likely. (How many social scientists predicted that the billions spent on busing and the Projects would worsen the situations they were meant to solve, as ultimately happened?) It’s no wonder that journalists enter the profession as Democrats, then keep their beliefs intact through all-too-common tendencies to conform. ...
...This also ignores journalism’s own issues with greed and corruption—most despicably with Walter Duranty, who covered the Soviet Union for the New York Times and won the Pulitzer Prize in 1932 for a series of stories that uncritically backed Stalinist propaganda, denied the Ukrainian famine, and defended Stalin's infamous trials. Duranty lived lavishly in Stalin’s good graces. (Meanwhile, the Times has never returned the Pulitzer.) More recently, the New York Times’ fraudulent reporter Jayson Blair received a mid-six figure advance for his memoirs—even the most egregious reporters can make big bucks and become media darlings....
...If you’re a journalist, want to help people and want to tell the truth, what truth are you going to tell? Why, the truth you think helps people, of course! ...
Leave Swiss Banks Alone
...But for us here in Switzerland, our financial privacy laws are a foundation for individual dignity and basic property rights.
Unfortunately, the confidentiality that is the hallmark of Swiss banking is coming under increasing pressure. The global economic crisis has led some governments to intensify efforts to seek tax revenue abroad — and Switzerland, which accounts for nearly 30 percent of all offshore private wealth, is a natural target. ...
...Until recently, the Swiss government had steadfastly insisted on Swiss sovereignty and refused to provide assistance to other governments in cases of tax evasion — that is, cases in which a taxpayer failed to declare income, either intentionally or unintentionally. While tax fraud is considered a crime here, tax evasion is not (though it can be subject to fines).
This Swiss peculiarity of considering tax evasion as a mere administrative offense has a long history. We think government exists to serve us, not the other way around. We understand that we have to pay taxes — and we do, with numerous studies showing that the Swiss are extraordinarily honest about paying what we owe — but we do not think it is the government’s role to intrude on our privacy and wrench them from us.
This attitude goes back to Switzerland’s founding in the 13th century. The original Swiss communities’ resentment of what they saw as the Hapsburgs’ oppressive taxes helped push them to claim their independence in 1291.
Today, Swiss citizens continue to vote on any tax increases in referendums (and sometimes even accept them). These healthy curbs on government contrast with the Orwellian concept of the “transparent citizen” whose every act is known to government. We see our system as a social pact between citizens and the state.
Swiss privacy laws help preserve basic property rights. Bank secrecy was introduced in 1934, most notably to protect the identities and assets of Jews in Nazi Germany. ...
Why Default on U.S. Treasuries is Likely
Almost everyone is aware that federal government spending in the United States is scheduled to skyrocket, primarily because of Social Security, Medicare, and Medicaid. Recent "stimulus" packages have accelerated the process. Only the naively optimistic actually believe that politicians will fully resolve this looming fiscal crisis with some judicious combination of tax hikes and program cuts. Many predict that, instead, the government will inflate its way out of this future bind, using Federal Reserve monetary expansion to fill the shortfall between outlays and receipts. But I believe, in contrast, that it is far more likely that the United States will be driven to an outright default on Treasury securities, openly reneging on the interest due on its formal debt and probably repudiating part of the principal. ...
...What about increasing the proceeds from explicit taxes? Examine Graph 1, which depicts both federal outlays and receipts as a percent of GDP from 1940 to 2008. Two things stand out. First is the striking behavior of federal tax revenue since the Korean War. Displaying less volatility than expenditures, it has bumped up against 20 percent of GDP for well over half a century. That is quite an astonishing statistic when you think about all the changes in the tax code over the intervening years. Tax rates go up, tax rates go down, and the total bite out of the economy remains relatively constant. This suggests that 20 percent is some kind of structural-political limit for federal taxes in the United States. It also means that variations in the deficit resulted mainly from changes in spending rather than from changes in taxes. The second fact that stands out in the graph is that federal tax revenue at the height of World War II never quite reached 24 percent of GDP. That represents the all-time high in U.S. history, should even the 20-percent-of-GDP post-war barrier prove breachable.
Compare these percentages with that of President Barack Obama's first budget, which is slated to come in at above 28 percent of GDP. Although this spending surge is supposed to be significantly reversed when the recession is over, the administration's own estimates have federal outlays never falling below 22 percent of GDP. And that is before the Social Security and Medicare increases really kick in. In its latest long-term budget scenarios, the Congressional Budget Office (CBO), not known for undue pessimism, projects that total federal spending will rise over the next 75 years to as much as 35 percent of GDP, not counting any interest on the accumulating debt, which critically varies with how fast tax revenues rise. However, the CBO's highest projection for tax revenue over the same span reaches a mere 26 percent of GDP. ...
Monday, August 03, 2009
Sweden's Public Downsizing
Think the answer to America's problems is bigger government? Swedish Finance Minister Anders Borg has seen the result up close and says it's not pretty for the economy or investors.
Anders Borg has a message for those who look to government to take over health care, rescue the financial system and run troubled corporations: I have seen the future--and it doesn't work.
As the finance minister of Sweden, Borg is the chief financial officer of a country long known as a walking billboard for a social welfare state. In Borg's view, the 1970s and 1980s were lost decades for Sweden. Left-leaning politicians pushed government spending, excluding investment outlays, from 22% of gross domestic product in 1970 to 30% in 1980. Real growth fell from an average of 4.4% annually in the 1960s to 2.4% in the 1970s and remained low for the next two decades....
...Borg, 41, doesn't look like a finance minister or fiscal conservative. The Stockholm native wears a long ponytail and gold loop earring. His hippie appearance hides a dyed-in-the-wool free marketeer who champions the idea of "making work pay." That is a revolutionary concept in a country where the penalty for working has historically been high taxes and the reward for staying home a comfortable welfare or unemployment check....
...Since sweeping to power in 2006, Reinfeldt's center-right Alliance has been shrinking Sweden's welfare state. The government is resisting calls to rescue its struggling auto industry. To hear Borg tell it, his government isn't inspired by coldhearted Darwinism but by cold, hard evidence that the easier the state makes life for people, the easier they take it....
...Among other tax cuts: Reinfeldt has done away with a wealth tax and cut corporate and property taxes. Those are on top of the Social Democrats' elimination of inheritance taxes before Borg came to power, as well as investment of a portion of the state's pension assets in the stock market--something reminiscent of George W. Bush's failed attempt to reform Social Security.
As the U.S. takes over some corporations outright, and offers others financial lifelines, Sweden is unloading scores of industries. It is selling state-owned pharmacies and plans to put its remaining 37% stake in telecom incumbent TeliaSonera ( TLSNF.PK - news - people ) on the block when market prices improve. Last spring it unloaded Absolut Vodka. A distillery, Borg notes drily, is not a core function for either a welfare state or a night watchman's state.
Swedish health care is getting a whiff of free marketeering, too. The government's abolition of the "Stop Law" is expected to give a green light to hospital privatization, and starting next year local authorities will have to offer private primary care options....
Sunday, August 02, 2009
Publicly available data being purged at UK’s Hadley Climate Centre
...It appears that the “mole” has caused a Centre-wide panic and they are purging publicly available climate data.
If their climate science is so solid, so unassailable, why would they need to do this? Why hide the climate data gathered from public domain sources worldwide such as NOAA and NCDC? Steve McIntyre tells the story and wonders also. I’m sure all of those who complained in my case will do the same about Hadley, since it will affect the climate community worldwide. I suppose we now have a new term: “Climate Data Deniers” – Anthony...
...On July 31, 2009, the purge of public data at CRU reached levels “unprecedented” in its recorded history. Climate Audit reader Super-Grover said that the data purge was “worse” than we expected....
Here’s a Second Opinion
...7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”
8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.
10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States....
Billions 'wasted' in health system: report
KEVIN Rudd's hand-picked health reform adviser has warned that Australia is wasting much of the $94 billion it spends each year on health services and will not be able to afford even the current, flawed system without major reforms.
The Prime Minister's National Health and Hospital Reform Commission will publicly release more than 120 recommendations in Canberra today, handing the government a blueprint for change, but allowing for "long-term" implementation that pushes the most politically sensitive reforms beyond the next election. Among its recommendations will be taking responsibility for some health services away from the states and giving it to the commonwealth.
The commission, set up early last year to help redesign Australia's health system, will warn that healthcare services, already under strain, will be swamped by the rising tide of chronic illness, an ageing population and costly new health technologies.
Saturday, August 01, 2009
How House Bill Runs Over Grandma
...This administration, pledging to cut medical costs and for which "cost-effectiveness" is a new mantra, knows that a quarter of Medicare spending is made in a patient's final year of life. Certainly the British were aware when they nationalized their medical system.
The controlling of medical costs in countries such as Britain through rationing, and the health consequences thereof are legendary. The stories of people dying on a waiting list or being denied altogether read like a horror movie script.
The U.K.'s National Institute for Health and Clinical Excellence (NICE) basically figures out who deserves treatment by using a cost-utility analysis based on the "quality adjusted life year."
One year in perfect health gets you one point. Deductions are taken for blindness, for being in a wheelchair and so on....
...Can't happen here, you say? "One troubling provision of the House bill," writes Betsy McCaughey in the New York Post, "compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, Pages 425-430)."
One of the Obama administration's top medical care advisers is Oxford- and Harvard-educated bioethicist Ezekiel Emanuel. Yes, he's the brother of White House Chief of Staff Rahm Emanuel and has the ear of his brother and the president.
"Calls for changing physician training and culture are perennial and usually ignored," he wrote last June in the Journal of the American Medical Association. "However, the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible."
Emanuel sees a problem in the Hippocratic Oath doctors take to first do no harm, compelling them "as an imperative to do everything for the patient regardless of cost or effect on others," thereby avoiding the inevitable move toward "socially sustainable, cost-effective care."...
Obama threatens to limit U.S. intel with Brits
The Obama administration says it may curtail Anglo-American intelligence sharing if the British High Court discloses new details of the treatment of a former Guantanamo detainee.
A court filing from the British Foreign Office released recently includes a letter from the U.S. government, identified as the "Obama administration's communication." Other information identifying the U.S. agency and author of the letter appears to have been redacted.
The letter says:
"If it is determined that [her majesty's government] is unable to protect information we provide to it, even if that inability is caused by your judicial system, we will necessarily have to review with the greatest care the sensitivity of information we can provide in the future." ...
Clinton moved to halt disclosure of CIA torture evidence, court told
Hillary Clinton, the US secretary of state, personally intervened to suppress evidence of CIA collusion in the torture of a British resident, the high court heard today.
The dramatic turn emerged as lawyers for Binyam Mohamed, the UK resident abused in Pakistan, Afghanistan, Morocco and Guantánamo Bay, joined by lawyers for the Guardian and other media groups, asked the court to order the disclosure of CIA material.
It consists of a seven-paragraph summary of what the CIA knew, and what it told MI5 and MI6, about the treatment of Mohamed. Lord Justice Thomas and Mr Justice Lloyd Jones, the judges hearing the case, have said that the summary contains nothing that could possibly be described as "highly sensitive classified US intelligence".
However, David Miliband, the foreign secretary, has repeatedly told the court that the US would stop sharing intelligence with the UK if the CIA material was published. ...
Top US lawyer warns of deaths at Guantánamo
...But first, Bradley, a US military attorney for 20 years, will reveal that Mohamed, 31, is dying in his Guantánamo cell and that conditions inside the Cuban prison camp have deteriorated badly since Barack Obama took office. Fifty of its 260 detainees are on hunger strike and, say witnesses, are being strapped to chairs and force-fed, with those who resist being beaten. At least 20 are described as being so unhealthy they are on a "critical list", according to Bradley.
Mohamed, who is suffering dramatic weight loss after a month-long hunger strike, has told Bradley, 45, that he is "very scared" of being attacked by guards, after witnessing a savage beating for a detainee who refused to be strapped down and have a feeding tube forced into his mouth. It is the first account Bradley has personally received of a detainee being physically assaulted in Guantánamo....
How Much More Can We Redistribute: IRS Releases New Data
The IRS released data today on the distribution of income taxes. It shows that the highest-earning taxpayers shoulder a considerable burden of the federal income tax.
According to the IRS, the top 1 percent of taxpayers paid over 40 percent of all federal income taxes in 2007. That is a higher share than the bottom 95 percent of taxpayers combined! They paid just over 39 percent....
...In 2000, before the 2001 and 2003 tax cuts that some claim disproportionately benefited the rich, the top 1 percent paid less than 38 percent of income taxes, while the bottom 95 paid almost 44 percent. Since the tax cuts, the top 1 percent’s share increased over 2 percentage points while the bottom 95 percent’s share decreased 5 percentage points. Those that argue the tax cuts solely benefited the rich are mistaken....
...In contrast, the bottom 40% of taxpayers pays no income taxes on average. In fact, they get money from the tax code well above anything they paid in because of refundable credits. ...
American Chemical Society members revolting against their editor for pro AGW views
An outpouring of skeptical scientists who are members of the American Chemical Society (ACS) are revolting against the group’s editor-in-chief — with some demanding he be removed — after an editorial appeared claiming “the science of anthropogenic climate change is becoming increasingly well established.”
The editorial claimed the “consensus” view was growing “increasingly difficult to challenge, despite the efforts of diehard climate-change deniers.” The editor now admits he is “startled” by the negative reaction from the group’s scientific members. The American Chemical Society bills itself as the “world’s largest scientific society.”
The June 22, 2009 editorial in Chemical and Engineering News by editor in chief Rudy Baum, is facing widespread blowback and condemnation from American Chemical Society member scientists. Baum concluded his editorial by stating that “deniers” are attempting to “derail meaningful efforts to respond to global climate change.”
Dozens of letters from ACS members were published on July 27, 2009 castigating Baum, with some scientists calling for his replacement as editor-in-chief.
The editorial was met with a swift, passionate and scientific rebuke from Baum’s colleagues. Virtually all of the letters published on July 27 in castigated Baum’s climate science views. Scientists rebuked Baum’s use of the word “deniers” because of the terms “association with Holocaust deniers.” In addition, the scientists called Baum’s editorial: “disgusting”; “a disgrace”; “filled with misinformation”; “unworthy of a scientific periodical” and “pap.”...
...ACS member scientist Dr. Howard Hayden, a Physics Professor Emeritus from the University of Connecticut: “Baum’s remarks are particularly disquieting because of his hostility toward skepticism, which is part of every scientist’s soul. Let’s cut to the chase with some questions for Baum: Which of the 20-odd major climate models has settled the science, such that all of the rest are now discarded? [...] Do you refer to ‘climate change’ instead of ‘global warming’ because the claim of anthropogenic global warming has become increasingly contrary to fact?”...
...William E. Keller wrote: “However bitter you (Baum) personally may feel about CCDs (climate change deniers), it is not your place as editor to accuse them—falsely—of nonscientific behavior by using insultingly inappropriate language. [...] The growing body of scientists, whom you abuse as sowing doubt, making up statistics, and claiming to be ignored by the media, are, in the main, highly competent professionals, experts in their fields, completely honorable, and highly versed in the scientific method—characteristics that apparently do not apply to you.”...
...On May 1 2009, the American Physical Society (APS) Council decided to review its current climate statement via a high-level subcommittee of respected senior scientists. The decision was prompted after a group of 54 prominent physicists petitioned the APS revise its global warming position. The 54 physicists wrote to APS governing board: “Measured or reconstructed temperature records indicate that 20th – 21st century changes are neither exceptional nor persistent, and the historical and geological records show many periods warmer than today.”
The petition signed by the prominent physicists, led by Princeton University’s Dr. Will Happer, who has conducted 200 peer-reviewed scientific studies. The peer-reviewed journal Nature published a July 22, 2009 letter by the physicists persuading the APS to review its statement. In 2008, an American Physical Society editor conceded that a “considerable presence” of scientific skeptics exists....
5 freedoms you'd lose in health care reform
1. Freedom to choose what's in your plan
2. Freedom to be rewarded for healthy living, or pay your real costs
3. Freedom to choose high-deductible coverage
4. Freedom to keep your existing plan
5. Freedom to choose your doctors
Obama's Misleading Medicine
...The health-care conundrum involves a contradiction that the administration steadfastly obscures: In the short run -- meaning four to eight years -- government cannot both insure the uninsured and rein in health spending. Here's why. The notion that the uninsured get little or no care is a myth: They now receive about 50 to 70 percent as much health care as the insured. If they become insured, they would use more health care, possibly as much as today's insured. That would increase both government and private health spending, depending on how the insurance is provided. ...
...Evaluations of proposals reflect this reality. The Congressional Budget Office judges that the legislation in the House would, through expanded Medicaid and subsidies for private insurance, reduce the uninsured from 46 million in 2007 to 17 million in 2019. But the cost would be $1 trillion over a decade; of that, $239 billion would add to the budget deficit. Worse, the costs would rise faster than the sources of financing, including a tax on the wealthy. In 2019, the projection's last year, the deficit would be $65 billion. Assuming that the deficit rises 4 percent a year, the cumulative shortfall in the second decade would total about $800 billion.
But Obama sees all blue sky. "Here's what reform will mean for you," he said at a recent rally. "It will mean lower costs and more choices and coverage you can count on. Health insurance reform will save you and your family money," he said. (Note: Except for subsidies, it's doubtful families will experience savings anytime soon.) ...
Falling out of love with market myths
...In 2003, the Organisation for Economic Co-operation and Development published The Sources of Economic Growth in OECD Countries, reporting on a comprehensive regression analysis of the factors that might explain the different growth rates of the world's 21 leading economies between 1971 and 1998. This indicated that only privately funded R&D led to economic growth, and that publicly funded R&D did not. Worse, the public funding of R&D crowded out private funding, and thus slowed economic growth.
This is because, as scholars such as the late Edwin Mansfield of the University of Pennsylvania tried to show, the assumptions of the "perfect market" are false when it comes to the spread of knowledge about innovations. The copying of innovations is actually very expensive because it requires the acquisition of the relevant tacit knowledge - the sort of knowledge that cannot be transferred as a neat unit. The direct costs of copying an innovation are, on average, some two-thirds of the cost of creating it from scratch. Add to that the cost to the copying companies of employing their own scientists and their own infrastructure, and the average costs of copying a new product match those creating it originally.
In research, new knowledge spreads. Researchers read papers and patents, talk at conferences, and analyse their competitors' products. But this spreading of knowledge is actually a sharing of knowledge, and on average the amount of knowledge a company or scientist disseminates freely is balanced by the knowledge it or they import freely. Indeed, scientists - even from competing companies - meet at conferences and other venues to exchange ideas for mutual advantage. This is why sociologists say science is organised in "invisible colleges". The idea of market failure in knowledge and science is therefore wrong - though it persists universally in research-based enterprises. Just recall the numerous appeals by British multimillionaire biotech entrepreneur Christopher Evans for government cash for start-ups.
Unfortunately, entrepreneurs today love the theory of market failure. Once, like Bill Gates, they rejoiced in the free market, but today, banker-like, they want to nationalise the costs of their R&D but to privatise their profits. Indeed, when I ran a biotechnology start-up in the 1990s, I too claimed every government grant going, even though I secretly knew that there is no market failure.
But because the idea prevails, scientists lose out: as the OECD showed, government funding of research crowds out more money than it supplies, thus driving down research budgets, researchers' salaries and the self-worth of researchers....
A Long, Long Post About My Reasons For Opposing National Health Care
...Basically, for me, it all boils down to public choice theory. Once we've got a comprehensive national health care plan, what are the government's incentives? I think they're bad, for the same reason the TSA is bad. I'm afraid that instead of Security Theater, we'll get Health Care Theater, where the government goes to elaborate lengths to convince us that we're getting the best possible health care, without actually providing it.
That's not just verbal theatrics. Agencies like Britain's NICE are a case in point. As long as people don't know that there are cancer treatments they're not getting, they're happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.
So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure. Innovation benefits future constituents who aren't voting now. Producing it is very expensive. On the other hand, cutting costs pleases voters this instant. This is, fundamentally, what cries to "use the government's negotiating power" with drug companies is about. Advocates of such a policy spend a lot of time arguing about whether pharmaceutical companies do, or do not, spend too much on marketing. This is besides the point. The government is not going to price to some unknowable socially optimal amount of pharma market power. It is going to price to what the voters want, which is to spend as little as possible right now....
...At this juncture in the conversation, someone almost always breaks in and says, "Why don't you tell that to an uninsured person?" I have. Specifically, I told it to me. I was uninsured for more than two years after grad school, with an autoimmune disease and asthma. I was, if anything, even more militant than I am now about government takeover of insurance.
But you can also turn this around: why don't you tell some person who has a terminal condition that sorry, we can't afford to find a cure for their disease? There are no particularly happy choices here. The way I look at it, one hundred percent of the population is going to die of something that we can't currently cure, but might in the future . . . plus the population of the rest of the world, plus every future generation. If you worry about global warming, you should worry at least as hard about medical innovation.
The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone's life. Look at the uptick in stories on obesity in the context of health care reform. Fat people are a problem! They're killing themselves, and our budget! We must stop them! And what if people won't do it voluntarily? Because let's face it, so far, they won't. Making information, or fresh vegetables, available, hasn't worked--every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools. Americans are getting fat because they're eating fattening foods, and not exercising. How far are we willing to go beyond calorie labelling on menus to get people to slim down?
These aren't just a way to save on health care; they're a way to extend and expand the cultural hegemony of wealthy white elites. No, seriously. Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don't have any programs to promote these "healthy lifestyles"? When you listen to obesity experts, or health wonks, talk, their assertions boil down to the idea that overweight people are either too stupid to understand why they get fat, or have not yet been made sufficiently aware of society's disgust for their condition. Yet this does not describe any of the overweight people I have ever known, including the construction workers and office clerks at Ground Zero. All were very well aware that the burgers and fries they ate made them fat, and hitting the salad bar instead would probably help them lose weight. They either didn't care, or felt powerless to control their hunger. They were also very well aware that society thought they were disgusting, and many of them had internalized this message to the point of open despair. What does another public campaign about overeating have to offer them, other than oozing condescension?
Of course, the obese aren't the only troublesome bunch. The elderly are also wasting a lot of our hard earned money with their stupid "last six months" end-of-life care. Eliminating this waste is almost entirely the concern of men under 45 or 50, and women under 25. On the other hand, that describes a lot of the healthcare bureaucracy, especially in public health....
America's Moral Panic Over Obesity
...It's the classic pattern of moral panics. As public concern about the damage being done to the fabric of society by the folk devils increases, increasingly intense demands are made on public officials to "do something" about the crisis, usually by eliminating the folk devils.
That of course is the strategy for this crisis. If fat people are the problem, then the solution is to get rid of them, by making them thin people. The most amazing aspect of this whole thing, for me, has always been the imperviouusness of policy makers, and even more so people who consider themselves serious academics and scientists, to the overwhelming evidence that there's no way to do this.
I mean, there's no better established empirical proposition in medical science that we don't know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it's about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something.
It's conceivable that through some massive policy interventions you might be able to reduce the population's average BMI from 27 to 25 or something like that. But what would be the point? There aren't any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace's average BMI by a unit or two (and again I will emphasize that we don't actually know if we could do even that) is an incredible waste of public health resources...
...People aren't dumb. They do the experiment, the experiment doesn't work in the vast majority of cases, so they quit until they get desperate again. Or (llke the upper West Side women) they stay on a permanent restricted lifestyle that the vast majority of people don't have the combination of willpower and social privilege to maintain. There's an important class angle here. Thinness is a sign of social status, and is to some extent a product of it, which is one reason -- probably the main reason -- why it's so prized, especially among women....
Tuesday, July 28, 2009
Testimony: Sens. Conrad, Dodd told of VIP loans
WASHINGTON – Two influential Senate committee chairmen were told they were getting special VIP deals when they applied for mortgages, an official who handled their loans told Congress in closed-door testimony. Democratic Sens. Christopher Dodd and Kent Conrad had denied knowing they were getting discounts when they negotiated their loan terms.
Robert Feinberg, who worked in the VIP section of Countrywide Financial Corp., testified about the loan terms before the Senate Ethics Committee, and provided the same information in an interview with Republican investigators of the House Oversight and Government Reform Committee. He could be prosecuted for making false statements.
Both senators have said that at the time the mortgages were being written they didn't know they were getting unique deals from Countrywide, a company that lost billions of dollars on bad loans and since has been purchased by Bank of America.
Dodd, D-Conn., who is chairman of the Senate Banking Committee, still maintains that he got no preferential treatment. Conrad, D-N.D., who leads the Senate Budget Committee, took that position initially, but later acknowledged he did get a special deal....
...The senators were VIP borrowers in the program known as "friends of Angelo." Angelo Mozilo was chief executive of Countrywide, which played a big part in the foreclosure crisis triggered by defaults on subprime loans. The Calabasas, Calif.-based company was bought last July by Bank of America Corp. for about $2.5 billion....
The Henry Louis Gates "Teaching Moment"
...After Oakland police officer Johannes Mehserle shot and killed subway passenger Oscar Grant at point blank range last New Year's Day, police attempted to confiscate cell phone photos and videos of the shooting. Fortunately, not everyone complied. Mehserle will now be tried for murder.
In the last few years we've seen numerous other incidents where cell phone videos and photographs, surveillance video, or handheld video cameras have both exposed police misconduct and shown officers to have falsified police reports. In most of these cases, the police at various points attempted to confiscate, alter, or destroy the photographic evidence.
Still, sentiment like Tucker's is common. Commenting on Gates' arrest, National Review's Jonah Goldberg wrote that he counts himself among those who are "deferential to police," and willing to "give cops the benefit of the doubt for a host of reasons." That's a common position among conservatives. At a Federalist Society luncheon a few years ago, Bush Solicitor General Ted Olson praised the Supreme Court for "putting more trust in our police officers" in recent rulings. Los Angeles Police Department officer Jack Dunphy (a pseudonym) oddly concluded at National Review Online that the lesson from the Gates/Crowley affair is that anyone who asserts his constitutional rights when confronted by a police officer risks getting shot.
This deference to police at the expense of the policed is misplaced. Put a government worker behind a desk and give him the power to regulate, and conservatives will wax at length about public choice theory, bureaucratic pettiness, and the trappings of power. And rightly so. But put a government worker behind a badge, strap a gun to his waist, and give him the power to detain, use force, and kill, and those lessons somehow no longer apply. ..
Sunday, July 26, 2009
Ignoring Science
...Their research, published in the Journal of Geophysical Research, indicates that nature, not man, has been the dominant force in climate change in the late 20th century.
"The surge in global temperatures since 1977 can be attributed to a 1976 climate shift in the Pacific Ocean that made warming El Nino conditions more likely than they were over the previous 30 years and cooling La Nina conditions less likely" says co-author de Freitas.
"We have shown that internal global climate-system variability accounts for at least 80% of the observed global climate variation over the past half-century. It may even be more if the period of influence of major volcanoes can be more clearly identified and the corresponding data excluded from the analysis."
These findings are largely being ignored by the mainstream media. They simply don't fit the worn narrative that man is dangerously warming the Earth through his carbon dioxide emissions and a radical alteration of Western lifestyles mandated by government policy is desperately needed....
...Sharp Americans are starting to understand H.L. Mencken's observation that "The urge to save humanity is always a false front for the urge to rule it." That pretty much sums up the modern environmentalist movement.
Saturday, July 25, 2009
You're (Probably) a Federal Criminal
...Consider small-time inventor and entrepreneur Krister Evertson, who will testify at today's hearing. Krister never had so much as a traffic ticket before he was run off the road near his mother's home in Wasilla, Alaska, by SWAT-armored federal agents in large black SUVs training automatic weapons on him.
Evertson, who had been working on clean-energy fuel cells since he was in high school, had no idea what he'd done wrong. It turned out that when he legally sold some sodium (part of his fuel-cell materials) to raise cash, he forgot to put a federally mandated safety sticker on the UPS package he sent to the lawful purchaser.
Krister's lack of a criminal record did nothing to prevent federal agents from ransacking his mother's home in their search for evidence on this oh-so-dangerous criminal.
The good news is that a federal jury in Alaska acquitted Krister of all charges. The jurors saw through the charges and realized that Krister had done nothing wrong.
The bad news, however, is that the feds apparently had it in for Krister. Federal criminal law is so broad that it gave prosecutors a convenient vehicle to use to get their man.
Two years after arresting him, the feds brought an entirely new criminal prosecution against Krister on entirely new grounds. They used the fact that before Krister moved back to Wasilla to care for his 80-year-old mother, he had safely and securely stored all of his fuel-cell materials in Salmon, Idaho.
According to the government, when Krister was in jail in Alaska due to the first unjust charges, he had "abandoned" his fuel-cell materials in Idaho. Unfortunately for Krister, federal lawmakers had included in the Resource Recovery and Conservation Act a provision making it a crime to abandon "hazardous waste." According to the trial judge, the law didn't require prosecutors to prove that Krister had intended to abandon the materials (he hadn't) or that they were waste at all -- in reality, they were quite valuable and properly stored away for future use.
With such a broad law, the second jury didn't have much of a choice, and it convicted him. He spent almost two years locked up with real criminals in a federal prison. After he testifies today, he will have to return to his halfway house in Idaho and serve another week before he is released....
Union Pension Woes Help Spur Push For Forced Arbitration
...Firms fear that remaining provisions — especially mandatory arbitration — would still harm them.
Among their concerns is that they could be forced to pay into ailing union-run pension funds. Indeed, many business lobbyists believe this is the real agenda behind the legislation.
"The status of underfunded pension funds is a huge part of the motivation to get card check passed," said Ted Phlegar, an attorney with the Chamber of Commerce.
Why pensions? Because many union-managed funds are seriously underfunded.
The average union pension has resources to cover just 66% of what is owed to participants, according to the Pension Benefit Guaranty Corp....
...EFCA's other provisions include mandatory binding arbitration if workers have voted to unionize but the union and the company haven't agreed on a contract. One thing unions could push for in ar bitration is having the firm contribute to a union-run pension fund....
...Businesses fear arbitration could be used to require them to take up the slack in underfunded pension plans. In effect, companies could have to pay the pensions of people who never worked for them.
"We would walk in the door inheriting the unfunded liability that a pension plan already has on the books," said Brett McMahon, a vice president of Miller and Long, a construction company, and a member of Associated Builders and Contractors, which opposes EFCA. "Once you start contributing (under current law) you become liable for the plan's deficiencies before you got there."...
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