As of yet, though, he does not act that way, appearing promiscuously on television and granting interviews like the presidential candidate he no longer is. The election has been held, but the campaign goes on and on. The candidate has yet to become commander in chief.
Most tellingly, he gave Congress an August deadline for passage of health-care legislation -- "Now, if there are no deadlines, nothing gets done in this town . . . " -- and then let it pass. It seemed not to occur to Obama that a deadline comes with a consequence -- meet it or else.
Obama lost credibility with his deadline-that-never-was, and now he threatens to lose some more with his posturing toward Iran. He has gotten into a demeaning dialogue with Ahmadinejad, an accomplished liar. (The next day, the Iranian used a news conference to counter Obama and, days later, Iran tested some intermediate-range missiles.) Obama is our version of a Supreme Leader, not given to making idle threats, setting idle deadlines, reversing course on momentous issues, creating a TV crisis where none existed or, unbelievably, pitching Chicago for the 2016 Olympics. Obama's the president. Time he understood that.
Wednesday, September 30, 2009
But in June, Columbia University economist Frank Lichtenberg published a new study that suggests advanced medical technologies are not contributing all that much toward rising U.S. health care expenditures. Lichtenberg begins by looking at how the rate of increase in longevity has varied among U.S. states between 1991 and 2004. He investigates how such factors as the quality of medical care, behavioral risks (obesity, smoking, and AIDS incidence), and education, income, and health insurance coverage affect life expectancy. To measure differences in the quality of medical care, Lichtenberg examines how quickly each state took up advanced medical diagnostics and new drugs. He also calculates what fraction of physicians in a state were trained at top-ranked medical schools.
Lichtenberg's key finding is that life expectancy increased faster in states that more rapidly adopted advanced diagnostic imaging techniques, newer drugs, and attracted an increasing proportion of doctors from top medical schools.
The good news is that between 1991 and 2004 average life expectancy at birth in the U.S. increased 2.37 years. During that time Lichtenberg finds that nationwide the use of advanced imaging procedures nearly doubled from about 10 percent to nearly 20 percent. Lichtenberg calculates that the deployment of advanced diagnostic imaging techniques (e.g., CT scans, MRIs) is responsible for boosting average U.S. life expectancy by 0.62-0.71 years during this period. In addition, he estimates that the adoption of newer drugs increased average U.S. life expectancy by about 1.5 years. On the other hand, the fraction of physicians being trained at top medical schools has declined, which Lichtenberg reckons has reduced overall life expectancy by 0.28-0.47 years.
Interestingly, Lichtenberg found that "growth in life expectancy was uncorrelated across states with health insurance coverage and education, and inversely correlated with per capita income growth." The last finding is a bit puzzling. Lichtenberg calculates that the average 20 percent increase in real per capita income resulted in lowering average life expectancy by 0.34-0.42 years and finds that states with high income growth had smaller longevity increases. He does not speculate on why higher incomes lowered life expectancy but perhaps richer people engaged in riskier behaviors that are unaccounted for in Lichtenberg's model. For example, binge drinking in older men correlates with higher incomes.
It's not too surprising that high-tech medicine and better physician training boost life expectancy, but what about their costs? To answer that question, Lichtenberg looked at per capita medical spending by state. The top six states used advanced imaging diagnostics roughly 30 percent more often than the bottom six, for instance, making them ripe for comparison. He found that the states with larger increases in high-tech diagnostic procedures, newer drugs, and higher quality physicians did not have larger increases in per capita medical spending.
"The absence of a correlation across states between medical innovation and expenditure growth is inconsistent with the view that advances in medical technology have contributed to rising overall US health care spending," he concludes. Lichtenberg further speculates that states that have more quickly adopted high-tech procedures have not seen their health care expenses increase because "while newer diagnostic procedures and drugs are more expensive than their older counterparts, they may reduce the need for costly additional medical treatment." In other words, high-tech medicine may initially cost more, but it reduces spending in the long run, while increasing the life expectancies of patients.
Cost cop Callahan has a solution to the alleged problem of escalating technological costs: Adopt the methods used by European universal government-funded health care systems:"They use—among other tools—price controls, negotiated physician fees, hospital budgets with limits on expenditures, and stringent policies on the adoption and diffusion of new technologies." In other words, stifle innovation.
"Cutting the use of technology will seem wrong—even immoral—to many," Callahan admits. Well, yes. And if Lichtenberg is right, slowing technological progress in medicine wouldn't save money, but it definitely would kill more people.
Monday, September 28, 2009
Let me repeat this. The statistical models used by the High Priests of Global Warming are using a newly identified and specific data set which wrongly produces decades of warming where none exists in the raw temperature data 0r other data sets.
I will let the authors be more reserved, but I find the results damning. To summarize, the infamous Hockey Stick (HS) warming trend that supposedly shows man made CO2 forcing the Earthâ€™s temperature higher is in fact an artifact of one set of bad data.
An impressive list of Muslim achievements at Islam: Making a True Difference in the World
"The spread of Islam was military. There is a tendency to apologize for this and we should not. It is one of the injunctions of the Qur'an that you must fight to spread Islam."
Dr. Ali Issa Othman, Islamic Scholar
The Independence Institute is holding a Real Canadian Health Care Field Trip today in Vancouver, Canada.
Canadian professionals are saying-- "Don't do what we've done. We will lose our escape valve."
For years, I have made the joke about Richard Reid: "Just be glad that he wasn't the underwear bomber." Now, sadly, we have an example of one.
Lewis Page, an "improvised-device disposal operator tasked in support of the UK mainland police from 2001-2004," pointed out that this isn't much of a threat for three reasons: 1) you can't stuff a lot of explosives into a body cavity, 2) detonation is, um, problematic, and 3) the human body can stifle an explosion pretty effectively (think of someone throwing himself on a grenade to save his friends).
But who ever accused the TSA of being rational?
Conservatives are very angry these days. I haven't seen conservatives this angry since the last time a Democrat was president. So the anger is probably because the president is black. While that might not seem so bad, conservative anger could lead to something disastrous: their mobilizing to vote against Democrats.
If that occurs, what happens to the Democrats' dream of spending lots of money on seemingly random things? One day the American people will become enlightened enough to surrender democracy to their betters, who would give them such rewards as free (FREE!) health care, but until then conservative anger has to be dealt with. If not, crazy people like Sarah Palin and Glenn Beck will force absolutely anyone who happens to be an avowed Communist out of public office.
How to make conservatives less angry
Actively ignore them: The most basic strategy to try and keep conservatives from being so angry is to never, ever listen to them. If they try to discuss an issue with you, just cover your ears and scream, "Shut up! Shut up! Shut up!" If they realize there is no chance we'll even listen to them, maybe they'll decide to just give up trying to have their uneducated viewpoints.
Call them racists: If we shout "Racist!" every time they say something, maybe they'll finally reflect on the racism that motivates them against a black president and give up whatever silly cause they think they're pushing.
Point out how much smarter Obama is than they are: Obama is obviously very smart (obviously!), but somehow conservatives are overlooking that simple fact. Maybe they'll be less angry if we keep emphasizing how Obama and his staff are much, much smarter than they are, and in fact they are very stupid compared to Obama and other liberals.
Use sexual slurs: Conservatives are made uncomfortable by sex talk because of their Jesus person, so associating sexual slurs with everything they do might make them uncomfortable and cause them to give up their protests. For example, when conservatives started having "tea parties," we started using the slur "tea baggers" to describe them. Any good liberal should know tons of terms describing lewd sexual acts, so be creative!
Make sure no one in the media addresses their concerns: If conservatives can't get any confirmation of their silly, angry views in the media, maybe they'll give them up.
Disparage their values: Everyone wants to have popular values, so if we ridicule their values maybe they'll discard them and instead have the more popular values of the smart people on TV. So always laugh at them if they bring up the invisible sky fairy they worship so they know that's a dumb belief. Also laugh at any patriotic beliefs they have.
Threaten them with violence: Finally, we can always use physical threats to get them to not be angry. I don't mean we should shoot them like when those anti-choice people were shot recently (though that is understandable since conservatives are so dangerous and violent that they have to be stopped by any means necessary), but we could at least rough them up. Yes, most liberals are kinda, well, too puny to do that, but there are always union thugs who are smart enough to do whatever liberals tell them.
Sunday, September 27, 2009
"Little Green Footballs" isn't the same site it was then, however. Now, there are a new set of foes that take the most prominence in being exposed and denounced. And the damnedest thing is, I agree, basically, with most of those opinions -- but I don't have the same vehemence.
The videos posted by James O'Keefe and Hannah Giles at Big Government exposed ACORN housing officials around the country as eager to lend a hand. They wanted to help O'Keefe and Storm set up brothels in which minors from Central America would be set up as working girls. The New York Times did its damndest to ignore the story, until the political consequences of the videos made it almost impossible.
"Insufficient tuned-in-ness" is a new diagnosis of what's ailing the Times, but now that we've got it, I'm sure we'll find it handy in the future. It explains a lot, and not just at the Times.
JOHN adds: Scott makes the main points that need to be said about Hoyt's column. I would add that Hoyt couldn't resist taking a shot at O'Keefe and Giles, who committed the offense of embarrassing the newspaper he is paid to defend (if at all possible) against all comers. So he came up with this:And the two were sloppy with facts. One Acorn employee who bragged about killing one of her former husbands said she knew she was being scammed and was playing along. The police said they found her ex-husbands alive.But it was the ACORN employee, not O'Keefe and Giles, who was "sloppy with facts." They just recorded what she said, they didn't vouch for it. You can watch the video yourself and judge the claim that the ACORN worker was "playing along;" I think most observers would judge that she was a lunatic--but not one who had any objection to aiding and abetting prostitution, mortgage fraud, tax evasion, etc.
As he has in past columns, Hoyt assures his readers that the Times isn't a shill for liberal causes and politicians. But he confesses that the widespread perception of liberal bias is a problem for the paper, quoting a journalism expert to the effect that "[e]ven the suspicion of a bias is a problem all by itself." To say that the New York Times is suspected of liberal bias is like saying that Ted Bundy was suspected of being an unsuitable prom date.
PAUL adds: As Scott suggests, the "insufficient tuned-in-ness" Jill Abramson cops to is just another name for the liberal bias Hoyt says his paper is suspected of.
Pajamas Media – The Variable Value of Human Life... Somehow, the murder of an abortion supporter is more newsworthy than the murder of an anti-abortion activist.
An elderly, disabled, pro-life activist dependent on an oxygen tank and who wore leg braces was gunned down in Michigan. Had the man been an abortionist or a leftist activist like a Bush-era anti-war protester, the death of Jim Pouillon would have been news all week. Instead, it got buried in the weekend news cycle.
Compared to the media coverage of the murder of George Tiller, which pro-life activists repudiated, the murder of Jim Pouillon has garnered no national coverage. This despite the fact the murderer has admitted he killed Pouillon because of his pro-life activities.
Premature baby 'left to die' by doctors after mother gives birth just two days before 22-week care limit | Mail Online
Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday.
Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early.
They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment.
Miss Capewell, 23, said doctors refused to even see her son Jayden, who lived for almost two hours without any medical support.
She said he was breathing unaided, had a strong heartbeat and was even moving his arms and legs, but medics refused to admit him to a special care baby unit.
She said she was told that because she had not reached 22 weeks, she was not allowed injections to try to stop the labour, or a steroid injection to help to strengthen her baby's lungs.
Instead, doctors told her to treat the labour as a miscarriage, not a birth, and to expect her baby to be born with serious deformities or even to be still-born.
She told how she begged one paediatrician, 'You have got to help', only for the man to respond: 'No we don't.'
One of the things that puzzles me here is this seems to fit the definition of live birth created by the World Health Organization:
A live birth occurs when a fetus, whatever its gestational age, exits the maternal body and subsequently shows any sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact.
I guess the NHS must use a different definition of "live birth". Or else the NHS is willing to withhold medical care from the newly born.
She was shocked to discover that another child, born in the U.S. at 21 weeks and six days into her mother's pregnancy, had survived.
Amillia Taylor was born in Florida in 2006 and celebrated her second birthday last October. She is the youngest premature baby to survive.
Miss Capewell said: 'I could not believe that one little girl, Amillia Taylor, is perfectly healthy after being born in Florida in 2006 at 21 weeks and six days.
However, experts say cases like Amillia Taylor's are rare, and can raise false expectations about survival rates.
Studies show that only 1 per cent of babies born before 23 weeks survive, and many suffer serious disabilities.
It's tempting to ask, "How high must the percentage be to be worth a chance?"
But that's not a question that will be asked under a single-payer plan. In order to save costs, someone has to decide when treatment is "effective", which always means cost-effective.
If the chance of survival is 1%, then every dollar spent saving that one in a hundred represents $99 spent trying to save the ones that don't make it. $10,000 in neonatal intensive care that saves the one represents $1 million spent trying to save all 100.
You may be willing to go for the long shot, but the Single Payer has to pay for all the shots, whether they come in or not.
Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.
But this approach can also mask the signs that their condition is improving, the experts warn.
As a result the scheme is causing a "national crisis" in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke's cancer centre in Guildford, and four others.
"Forecasting death is an inexact science," they say. Patients are being diagnosed as being close to death "without regard to the fact that the diagnosis could be wrong.
"As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."
Isn't that what's known as a "self-fulfilling prophecy?"
An interesting piece from last month's Asia Times Online :: Middle East News, Iraq, Iran current affairs.
"The situation for the Palestinian people is intolerable," declared United Sates President Barack Obama in his June 4 Cairo address. Really? Compared to what? Things are tough all over. The Palestinians are one of many groups displaced by the population exchanges that followed World War II, and the only ones whose great-grandchildren still have the legal status of refugees. Why are they still there? The simplest explanation is that they like it there, because they are much better off than people of similar capacities in other Arab countries.
Adjusting for the Begin-Sadat Center population count and adding in foreign aid, GDP per capita in the West Bank and Gaza comes to $3,380, much higher than in Egypt and significantly higher than in Syria or Jordan. Why should any Palestinian refugee resettle in a neighboring Arab country?
Other data confirm that Palestinians enjoy a higher living standard than their Arab neighbors. A fail-safe gauge is life expectancy. The West Bank and Gaza show better numbers than most of the Muslim world...
Literacy in the Palestinian Authority domain is 92.4%, equal to that of Singapore. That is far better than the 71.4% in Egypt, or 80.8% in Syria.
Without disputing Obama's claim that life for the Palestinians is intolerable, it is fair to ask: where is life not intolerable in the Arab world? When the first UN Arab Development Report appeared in 2002, it elicited comments such as this one from the London Economist: "With barely an exception, its autocratic rulers, whether presidents or kings, give up their authority only when they die; its elections are a sick joke; half its people are treated as lesser legal and economic beings, and more than half its young, burdened by joblessness and stifled by conservative religious tradition, are said to want to get out of the place as soon as they can." Life sounds intolerable for the Arabs generally; their best poet, the Syrian "Adonis" - Ali Ahmad Said Asbar - calls them an "extinct people".
Palestinian Arabs are highly literate, richer and healthier than people in most other Arab countries, thanks to the United Nations Relief and Works Agency and the blackmail payments of Western as well as Arab governments. As refugees, they live longer and better than their counterparts in adjacent Arab countries. It is not surprising that they do not want to be absorbed into other Arab countries and cease to be refugees.
A lot of people make their living from being professional victims. Perhaps it's not surprising such might be true on the scale of populations and nations.
Saturday, September 26, 2009
Like a dog with a bone, the ACLU thinks they have a winning hand with their FOIA releases from the Department of Defense and the Central Intelligence Agency. Along with their "partners", Center for Constitutional Rights, Physicians for Human Rights, Veterans for Common Sense, and Veterans for Peace, they've been scratching through the documentation hoping that they'll find a smoking gun that they can actually call torture.
Just freakin' wonderful. PrairiePundit: Human bombs putting explosives in body
It looks like they have not mastered the art of shaping the charge so the blast goes outward. That suggest the body cavity they used directed the blast downward probably through the anus. If they used metal, the detectors would have read it. Shrapnel buried in body tissue will usually trip the detector so there is no reason it would not detect that in a body cavity. My speculation is that the bomb did not use metal.
This does appear to be part of an increasingly desperate attempt by al Qaeda to stay relevant as the world closes in on them. I think the recent spat of failed attacks are also a reflection of that desperation.
Friday, September 25, 2009
If anyone is having a contest for the silliest argument for ObamaCare, we'd like to nominate yesterday's USA Today op-ed by Patricia Pearson, a Canadian member of the paper's board of contributors. It's titled "The Truth About Canadian Health Care." The subtitle reads: "I've been treated in the American system and have lived with universal care in Canada. Guess which one is freer--and more humane."
If you guessed that this is a brief for Canada's government health-insurance monopoly, you're right! But wait. Here is her U.S. health-care "horror story":The only time in my life that I have ever had to plead my case for health treatment to a bureaucrat was when I lived in New York City.We once got sick on a trip to Toronto--nothing serious, just an upper respiratory infection. We saw a doctor and paid the bill. When we got home, we submitted a claim to our American insurance company, which paid it. So if you have private American insurance and get sick in Canada, you're covered. If you have OttawaCare and get sick in America, you're on your own. Advantage: America!
I had purchased out-of-country medical coverage from a private insurance company in Toronto, where I normally live, for the time I would be spending in the USA.
As luck would have it, I had an attack of appendicitis while I was alone on the fourth-floor of an apartment building. The issue I had to clear on the phone with the insurance company was whether I was allowed to call an ambulance, given that I was in too much pain to walk. That conversation, in turn, evolved into a debate about whether I was experiencing a pre-existing condition, which was difficult for me to articulate or even ponder. (Projectile vomiting will do that.)...
Amazingly enough, this isn't even the most ridiculous aspect of Pearson's argument. Read again her appendicitis horror story. Does she have anything bad to say about the hospital where she was treated? No. About the EMTs who got her there? Nope, they seem to have been fine, once she got the OK to summon them. The postoperative care? Not unless USA Today's editors cut them out for length.
No, her only complaint is about her treatment at the hands of her insurance company. That would be the company from which she bought "out-of-country medical coverage." It was, she relates, "a private insurance company in Toronto." Do USA Today's editors know where Toronto is? We'll give them three hints: It starts with C, it ends with A, and there's an ad in the middle.
Consider these myths and mantras of the current debate:
â€¢â€‰Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not...
The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was supposed to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received.
In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies.
Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."
â€¢â€‰The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate...
The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness." Responsiveness has two components: respect for persons (including dignity, confidentiality and autonomy of individuals and families to make decisions about their own care), and client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). This is what Americans rightly understand as quality care and worry will be lost in the upheaval of reform. Our country's composite score fell to 37 primarily because we lack universal coverage and care is a financial burden for many citizens.
â€¢â€‰We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices.
An analysis from the Ottawa Health Research Institute published in the Annals of Internal Medicine in 2007 reveals how long it takes for conclusions derived from clinical studies about drugs, devices and procedures to become outdated. Within one year, 15 of 100 recommendations based on the "best evidence" had to be significantly reversed; within two years, 23 were reversed, and at 5 1/2 years, half were contradicted. Americans have witnessed these reversals firsthand as firm "expert" recommendations about the benefits of estrogen replacement therapy for postmenopausal women, low fat diets for obesity, and tight control of blood sugar were overturned.
Even when experts examine the same data, they can come to different conclusions. For example, millions of Americans have elevated cholesterol levels and no heart disease. Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. An illuminating publication from researchers in Munich, Germany, published in March 2003 in the Journal of General Internal Medicine showed that of 100 consecutive patients seen in their clinic with high cholesterol, 52% would be treated with a statin drug in the U.S. based on our guidelines while only 26% would be prescribed statins in Germany and 35% in the U.K. So, different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not.
This is how doctors and patients make shared decisionsâ€”by considering expert guidelines, weighing why other experts may disagree with the guidelines, and then customizing the therapy to the individual. With respect to "best practices," prudent doctors think, not just follow, and informed patients consider and then choose, not just comply.
â€¢â€‰No government bureaucrat will come between you and your doctor. The president has repeatedly stated this in town-hall meetings. But his proposal to provide financial incentives to "allow doctors to do the right thing" could undermine this promise. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.
Barbara Oakley looks at how some of the brightest people stop thinking. Kiss my APA! | Psychology Today
The introduction to Westen's session was a real eye-opener. The moderator was so confident everyone in the room was a staunch Democrat that he jokingly interrupted his disclaimer that the APA couldn't be seen as endorsing any particular political party with repeated exhortations of "Barack!" (You might think I'm kidding, but I'm not.) Party unity thus assured, the session began.
A brief video of an embarrassing Jennifer Lopez-inspired slip of the tongue by Fox newscaster Shepard Smith led to Westen's first key point: the general public associates the word liberal with negative connotations that, (he confidently assured us), were untrue – elite, tax and spend, out of touch, big government. The word conservative, on the other hand, had no negative associations.
Hold on a minute. Has Westen studied this? If so, why didn't he present the results so we could judge for ourselves? It would be interesting to analyze Westen's own word linkages. As he spoke, I heard the word conservative disdainfully associated with racist, intolerant, and narrow-minded.
How do bright people get this way?
How can Drew Westen, a remarkably intelligent man, make the kinds of one-sided statements he made, and why did no one in the room question the sheer inanity of what was being presented?
My theory – call it the "Oakley effect" – is that really smart people often don't know how to accept and react constructively to criticism. (A neuroscientist might say they "have underdeveloped neurocircuitry for integrating negatively valenced stimuli.") This is because smart people are whizzes at problems that only need one person to figure out. Indeed, people are evaluated from kindergarten through college prep SATs on the basis of such "single solver" problems. If you are often or nearly always right with these kinds of problems, your increased confidence in your own abilities would be accompanied by an inadvertent decrease in your capacity to deal with criticism. After all, your experience would have shown that your critics were usually wrong.
But most large-scale societal issues are not single solver problems. They are so richly complex that no single person can faultlessly teach him or herself all the key concepts, which are often both contradictory and important. Yes, smart people have an advantage in dealing with such problems, because they've got natural brain-power that allows them to hold many factors in mind at once, bringing formidable problem-solving skills to bear. But smart people have a natural disadvantage, too: they're not used to changing their thinking in response to criticism when they get things wrong.
In fact, natural smarties – the intellectual elite – often don't seem to learn the art of soliciting the criticism necessary to grasp the core issues of a complex problem, and then making vital adaptations as a result. Instead, they fall in naturally with people who admire, rather than are critical, of their thinking. This further strengthens their conviction they are right even as it distances them from people of very different backgrounds who grasp very different, but no less crucial aspects of complex problems. That's why the intellectual elite is often branded by those from other groups as out of touch.
Another important sign of progress hidden in headline numbers is that cancer's victims are dying at older ages. That means more years of life have been preserved, even as people eventually died from the disease. Also, individuals born since 1925 have seen lower cancer mortality rates at every age compared with individuals born before that year.
Wednesday, September 23, 2009
Beldar thinks legislators should be required to read the bill.
Every time I deal with a federal statute in the context of giving legal advice to a client -- which is an utterly basic function of being a lawyer -- I have to actually read and then understand the statute. My failure to do so would be malpractice per se -- something absolutely indefensible, something never excusable under any circumstances. As soon as I admitted or it was otherwise proven that I didn't read and understand the statute, the only question in a malpractice case would be the size of the damage award against me.
But if that's an utterly basic function of being a lawyer who merely advises private clients on how the law may or may not apply, shouldn't it be an even more basic function of a law-maker, a legislator, who creates the laws that apply to an entire country?
By no means am I saying that all legislators therefore must be lawyers. (They certainly already have staff lawyers to help them if they need or want such help.) But if an educated layman, with careful and close study, still canâ€™t parse through the language of a bill and figure out what it does, and how it does what it does, then that says something awful and disqualifying about the legislator, the bill, or both.
I would genuinely support a Constitutional amendment which required every Congressman and Senator, upon casting every vote, to swear under penalty of perjury â€” with existing perjury criminal penalties, PLUS instant disqualification from office â€” that he or she had read every word of everything he or she voted upon. Not just a summary (although they could read summaries too, if they chose) or a recommendation (again, fine as a supplement, but not as a replacement). Enforcement to be by a mechanism where 10% of either chamber's members could indict and prosecute any member of either chamber for an alleged violation, trial to be held within 30 days on national TV, finder of fact to be a jury of 51 randomly selected voters (one from each state plus the District of Columbia), conviction and expulsion (without appeal) to be based on a simple majority vote.
For a bullet-proof practical defense -- and indeed, perhaps even a prophylactic "safe harbor" provision written into the amendment or its enabling legislation to guard against unfair and untrue accusations -- every legislator only needs a video camera to record him or her with an over-the-shoulder view of the text he or she is reading and the pages he or she is turning, perhaps with a side-shot of the notes he or she is taking too. The videos can be posted on C-SPAN or YouTube along with congress.gov.
Not "death panels" per se, but definitely: The "R" Word | John Goodman | NCPA
There are many contentious issues, of course. But towering above all others, THE ISSUE is denying people care. Or, if you like, health care rationing.
At the National Center for Policy Analysis we have brought this issue up frequently – but, I believe, in a responsible way. For that matter, Barack Obama has brought the issue up frequently – also in a responsible way.
Yet what is driving the defenders of Obama Care crazy is that this issue is being discussed at all. For one thing, the President is saying things most Democrats never say when they talk about health care. For another, the opponents have passed up not a single opportunity to distort and exaggerate to the hilt. To get one absurd statement out of the way, let's admit that none of the bills before Congress contain the words "death panel."
Still, is there something here we should be worried about? Answer: Yes. You should be very worried.
How rationing will be done under Obama Care. As I explained in a recent National Review editorial, rationing Obama-style will be done indirectly. It will be the result of administrative decisions – all ostensibly made for the best of reasons: to eliminate futile and unnecessary care. Here's how it will work:
Under Medicare, the Administration is seeking the authority to make decisions on reimbursing providers through an independent commission. The federal government will use the power of the purse to force doctors to change the way they practice medicine. There will be fewer CAT scans, fewer MRI scans, fewer blood tests and fewer operations for the simple reason that Medicare will quit paying for procedures it considers questionable.
But how do we know that the scan or the test not ordered isn't in reality life-saving? We don't. In the very act of trying to change how doctors practice medicine from the payer side of the market, we run the real risk that quality of care will be sacrificed. And remember: the rule makers in Washington – far away from practicing doctors and real patients – will be under constant pressure to keep spending down.
Medicaid (for the poor) could be pressured in the same way as Medicare (for the elderly and disabled). But what about private health plans?
Under Obama Care, everyone who does not get health care from an employer will be required to obtain it in a health insurance exchange. The plans will be free to set their own premiums, but they will have to charge all enrollees the same price – regardless of health status. Because some plans will attract a greater percentage of sick enrollees than others, a government administrator will have the power to "tax" plans with healthier enrollees in order to subsidize plans with sicker enrollees in a process called "risk adjustment." And it is precisely through such adjustments that the government will have enormous power to influence what is done for the sick.
For example, suppose a plan attracts an above-average number of people whose doctors say they need hip replacements and ask the government risk adjustor for an extra payment to cover the cost. The risk adjustor may decide these hip replacements constitute "unnecessary care" or "futile care" and deny the request. In this way, the risk adjustor will have the power to indirectly force health plans to deny people care.
The government risk adjustor will be aided in this effort by a national health board which will be doing "comparative effectiveness" analyses. If the health board decides that a certain type of hip replacement in certain circumstances is "unnecessary" or "futile," this will be prima facie cover for the risk adjustor to deny payments and for the health plan to deny care.
t begins with a paper by Peter Franks et al. published in the Journal of the American Medical Association in 1993, estimating that being uninsured increased the probability of death by 25%. Although the subjects were interviewed only once, for the study's inference to be meaningful, one is forced to make the unverified assumption that the uninsured stayed uninsured for a full 19 years!
Continuing the saga, the Institute of Medicine (IOM) uncritically used the Franks result to claim that 18,000 deaths a year in the U.S. are attributable to a lack of health insurance. The Urban Institute updated the IOM report, and Families USA updated the Urban Institute report.
Not to be outdone, Physicians for a National Health Program (PNHP) has just repeated the exercise (with all its methodological sins) and boosted the tally to a 40% increase in the probability of dying for the uninsured. That produces a whopping 45,000 premature deaths every year – almost as bad as the Vietnam War. And, yes, we get a state-by-state breakdown. There will be 5,302 deaths attributed to uninsurance in California this year. There will be 75 in Wyoming, etc., etc. There is even a minute-by-minute tally: "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance," says David Himmelstein, one of the authors. "Now one dies every 12 minutes."
As in the previous incarnations, the researchers interviewed the uninsured only once – and never saw them again. A decade later, the researchers assumed the participants were still uninsured and, if they died in the interim, lack of insurance was blamed as one of the causes.
Yet, like unemployment, uninsurance happens to many people for short periods of time. Most people who are uninsured regain insurance within one year. The authors of the PNHP study did not track what happened to the insurance status of the subjects over the decade examined, what medical care they received or even the causes of their deaths.
From the Volokh Conspiracy:
UPDATE: A question frequently asked of us "read the bill" types is "Why should legislators have to read the bills when they have staff? Isn't that what staff is for?" Not really. It is certainly appropriate for legislators to rely upon staff to draft legislation, review legislative proposals, and serve as a filter identifying bills that might be worthy of support, and so on.. Indeed, legislators could not do their jobs without such assistance. But this does not relieve legislators of reading those pieces of legislation that seek to enact.
Think of the legislator like a senior partner. It's perfectly appropriate for the senior partner to rely upon associates to conduct research, draft documents, review documents, and so on. But if the partner is going to sign his or her name to a legal brief, he or she better have read it. It is simply inappropriate for the partner to simply sign a document or brief on an associate's say-so. By the same token, when the legislator is prepared to enact legislation, he or she should have read the bill.
I simply don't like cowards who engage in character assassination, lies and innuendo for their own twisted purposes, especially when in every case, they've been the aggressors.
This started a couple of years ago, when Charles got his panties in a knot and started banning 'fascists' - you know, people like my friends Pam Geller at Atlas and Dymphna and the Baron over at Gates of Vienna who haven't got a fascist bone in their bodies but do take the menace of Islamist jihad seriously. Robert Spencer, the brilliant author and proprietor of JihadWatch was next and it continued from there.
Last week though, Charles finally crossed the line and went certifiable .
He started out by attacking Pajamas media for headlining a story by Robert Stacy McCain at The Other McCain, calling him a racist and white supremacist and smearing Jim Hoft at Gateway Pundit as - wait for it - ' a borderline illiterate bigot'.
I don't know either of these gentlemen personally except by repute and by what they've written, but I have a pretty good nose for bigots and if I had any doubts on that score, they wouldn't be on my blogroll. Also, I knew that it was Charles talking, I'd seen how he operated in the past and having looked at his 'evidence' on McCain ( and no, I won't link to it) it's the usual rancid melange of lame, nudge nudge wink wink garbage, guilt by association and 'have you stopped luring children into your gingerbread house' nonsense.Frankly, it's embarrassing that anyone would expect it to be taken seriously.
So why did a once important conservative blog burn all those bridges so gleefully? I have a theory.
Working on the Left side of the street is fairly easy money, especially if you have creds as a past 'conservative' who's Seen The Light. David Brooks,Kathleen Parker, Andrew Sullivan and a number of others come to mind. Blogs like Atrios, Daily Kos and Firedog Lake coordinate their sites with the White House on a daily basis and are essentially paid advertisers.
So I'm pretty much convinced that this was a calculated move by Johnson, although there was certainly a lot of rage and what he perceived as score settling in his mind. He's offended so many people with his anti-Christian rants and vicious behavior that his traffic is down,and his advertising isn't doing as well as it once did. So he's looking for some new sponsors on the Left.
...prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America's health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.....
An American's life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization.
This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.
But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.
As it is, the longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries. The United States is apparently doing something right for its aging population, but what?
One frequent answer has been Medicare. Its universal coverage for people over 65 has often been credited with shrinking the longevity gap between the United States and other developed countries.
But when Dr. Preston and a Penn colleague, Jessica Y. Ho, looked at mortality rates in 1965, before Medicare went into effect, they found an even more pronounced version of today's pattern: middle-aged people died much more often in the United States than in other developed countries, but the longevity gap shrunk with age even faster than today. In that pre-Medicare era, an American who reached 75 could expect to live longer than most people elsewhere.
Besides smoking, there could be lots of other reasons that Americans are especially unhealthy in middle age. But Dr. Preston says he saw no evidence for the much-quoted estimates that poor health care is responsible for more preventable deaths in the United States than in other developed countries. (Go to nytimes.com/tierneylab for details.)
Monday, September 21, 2009
From Number Watch, September 2009, a vision of how today's decisions not to beef up the power grid will kill people.
At the control centre of the national Power Grid there was a nervous quiet, punctuated by short bouts of hushed conversation. They knew the crisis would occur in an hour's time, at about 7 am. They had already made the dreadful decision as to which towns would be made to experience suffering and death by being deprived of power. This was a different world from the last time there were serious power cuts in 1970. It was now totally dependent on computer and related technologies. Owing to decisions made (or, to be more accurate, not made) in the first years of the century, the nation was grossly underpowered for such a circumstance. The domestic demand was already high, as almost everyone had left the heating on over night.
The first to die were among the elderly and infirm. As temperatures plunged they did not know what to do and gradually sank into a hypothermal coma. Next were younger people with disabilities such as breathing difficulties. People with gas and oil central heating suddenly had the realisation forced on them that, without electricity, their control systems did not work. Virtually untouched were people in remote rural areas, who had wood and coal burning stoves and plentiful supplies in store.
So death and disease marched across the land. The economy collapsed and anarchy reigned.
And it was all due to a Government White Paper in 2003 entitled Our energy future – creating a low carbon economy.
Over at the Washington Post blog area, we may read A Skeptical Take on Global Warming - Capital Weather Gang
There are numerous reasons why I question the consensus view on human-induced climate change covered extensively on this blog by Andrew Freedman. But for this entry, I scaled them down to ten:
(10) Hurricanes: One of the strongest value propositions presented for fighting global warming is to slow tropical cyclone intensity increases...
(9) Ice Caps: ....The lack of information and the inconsistencies do not offer confidence.
(8) El NiÃ±o: ...Some climate change researchers predicted that global warming would create more and stronger El NiÃ±o ... But we are now about to complete an entire decade without a strong El NiÃ±o event
(7) Climate Models: To be blunt, the computer models that policy-makers are using to make key decisions failed to collectively inform us of the flat global land-sea temperatures seen in the 2000s...
(6) CO2 (Carbon Dioxide): The argument that the air we currently exhale is a bona fide pollutant due to potential impacts on climate change flummoxes me. CO2 is also plant food... We all agree that it is increasing, but is there a chance that our estimate of its influence on the Greenhouse Effect is overblown given its small atmospheric ratio?
(5) Global Temperatures: ...Three of four major datasets that track global estimates show 1998 as the warmest year on record with temperatures flat or falling since then. Even climate change researchers now admit that global temperature has been flat since that peak. As shown above, the CO2 chart continues upwards unabated. If the relationship is as solid as we are told, then why isn't global temperature responding? I'm told by climate change researchers that the current situation is within the bounds of model expectations. However, when I look at the IPCC 2007 AR4 WG1 report, I can see that without major warming in the next 1-2 years, we will fall outside those bounds....
(4) Solar Issue: ...Our sun is currently becoming very quiet. Not only is the number of sunspots falling dramatically, but the intensity of the sunspots is weakening. ...The second half of the twentieth century (when we saw lots of warming) was during a major solar maximum period- which is now ending.
(3) But what about...? Ultimately after I explain my viewpoint on climate change, I get this question: "But what about all this crazy weather we've been having lately?" As a student of meteorology, we learned about amazing weather events in the past that have not been rivaled in the present. ...we have and will continue to see crazy weather. Very few statistics are available that correctly show an increase in these "crazy" events.
(2) Silencing Dissent: ...several times during debates individuals have told me I should not question the "settled science" due to the moral imperative of "saving the planet". As with a religious debate, I'm told that my disagreement means I do not "care enough" and even if correct, I should not question the science. This frightens me.
(1) Pullback: Does climate change hysteria represent another bubble waiting to burst? From the perspective of the alarmism and the saturation of the message, the answer could be yes. ... I believe that predictions of human-caused climate change will continue to be overdone, and we'll discover that natural factors are equally and sometimes even more important.
For the heart bypass, the most expensive country charges 16.9 times more than the cheapest.
For the knee replacement, it's 7.1 times.
For the face lift, it's 2.5 times.
Heart bypasses are covered by most health insurance plans. Knee replacements by somewhat fewer.
Face lifts are elective surgery, and are not covered. You want one, you pay for it out of pocket.
Notice a trend?
Among other things, a comment about "expensive" emergency room care.
Consider the oft-quoted "statistic" that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment?
Perhaps it's the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals' protected place in law and regulation, it's in hospitals' interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care – the public service that hospitals are providing ‐ will appear to be high.
Two claims are made all the time in the health care debate: 1) that there is little competition among those providing health insurance and 2) that it is important to take the profit motive out of providing health insurance. Both are myths. It turns out that claims about too little competition are based on a misinterpretation of the data and that non-profit insurers are so abundant that the largest insurer in virtually every state is a non-profit.....Several studies point to how concentrated the health care insurance market is. A 2008 study by the American Medical Association shows that one or two health insurance providers dominate the market in most states, implying that the providers could be exploiting a monopoly-like situation to generate "excessive" profits.
But they leave out the fact that for most people it is their employer, not the insurance companies, that pays for any bad health outcomes. The firm does so out of the company's own pocket. The companies do what is called "self-insure" or "self-fund" their plans, and that occurs for around 55 percent of employees according to the Agency for Healthcare Research and Quality with the Department of Health and Human Services.
Take Maine, Senator Snowe's state, as an example. There, the two largest insurance companies appear to control 88 percent of the market. And Well Point Inc. makes up most of that, with 78 percent. But what isn't made clear is that these numbers only deal with privately insured patients who are insured by insurance companies. Slightly over half of the privately insured in Maine (52.1 percent) get their insurance through their employers who "self-insure." These companies merely hire other companies to handle the paper work. Well Point Inc. thus really provides primary or "full" insurance to 78 percent of the market not covered by self-insurers. Doing the math gives 78 percent x (1 - 52.1%) = 37.1 percent of the total market in Maine. The second largest insurance company has only 4.8 percent of the total market.
For Alabama, instead of the "almost 90% is controlled by just one company," as the president claims, the correct number is 36 percent. The second largest company has just 2.1 percent of the market.
Sunday, September 20, 2009
Bernard Chapin interviews John Derbyshire at PahamasMedia: The Politics of Despair: An Interview with John Derbyshire.
...If politicians operationalized your advice, what would our government then look like? Would it mark the beginning of real hope and change?
John Derbyshire: It would be the restoration of self-government and self-support. It would be the end of the nanny state. It would be the end of humongous programs of government expenditure directed mainly to providing indoor relief for otherwise-unemployable graduates in subjects named "[something] studies." It would be the re-beginning of the American experiment, as the Founders envisaged it -- a republic of free citizens.
...In partial defense of the English, though, welfare socialism can be made to work reasonably well in a country that size if immigration is tightly restricted, which alas it hasn't been. I don't believe it can be made to work in the U.S. under any circumstances. We are too big, with too much demographic variety present from our very creation. Even the mild north-European form of socialism is not for us. It would destroy us. Would, will, because that's where we're headed. We are doomed!
BC: Thanks for your time and good cheer, Mr. Derbyshire.
Saturday, September 19, 2009
A quick googling of one of the researchers, Dr. Steffie Woolhandler, shows she's been a passionate advocate of single-payer health coverage for years. Since I haven't read the study yet, I can't say how well she's controlled for a number of possible confounding influences.
Times Watch has a comment:
Reacting to CBS News' equally unquestioning coverage, the Media Research Center's Brent Baker discovered the impressive Harvard imprimatur was misleading: The report was actually produced by the group Physicians for a National Health Program, which describes itself as "the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program." Woolhandler is one of five signers of an "Open Letter to President Obama to Support Single-Payer Health Care." Neither the Times nor CBS noticed.
Cliff May reviews George Gilder's book, The Israel Test
At this juncture, it is probably not just useful but necessary to note that George Gilder is not Jewish. In other words, the case he makes for Israel has no basis in religious or ethnic affiliation. At the same time, not being tethered to Israel or to Jews allows him to be blunt in a way few of Israel's Jewish defenders dare.
For example, he says that people "who obsessively denounce Jews have a name; they are Nazis." He does not hesitate to apply the term to Arab and Iranian leaders who exhibit such behavior. He contends, as well, that the "most dangerous form of Holocaust denial is not rejection of the voluminous evidence of long-ago Nazi crimes but incredulity toward the voluminous evidence of the new Holocaust being planned by Israel's current enemies. Two Iranian presidents have resolved to acquire nuclear weapons for the specific purpose of 'wiping Israel off the map.' "
Gilder has much more to say - more challenging arguments and perplexing questions than I can summarize in a brief column. But his underlying thesis is straightforward: The future of freedom, democracy, capitalism, America, the West and the tiny state of Israel are all tied together in a single knot. Israel is "not only a major source of Western technological supremacy and economic leadership - it is also the most vulnerable source of Western power and intelligence."
Israel is, Gilder contends, "not only the canary in the coal mine - it is also a crucial part of the mine." If Americans will not defend Israel, they will "prove unable to defend anything else. The Israel test is finally our own test of survival as a free nation."
Conservatives are coming for the Democrats on their blind side – the left.
The evidence is everywhere.
At tea parties and town halls, conservative demonstrators oppose health care reform with signs bearing the abortion-rights slogan "Keep your laws off my body" or the line "Obama lies, Grandma dies" – an echo of the "Bush lied, they died" T-shirts worn to protest the Iraq war.
Conservative activists are yelling "Nazi!" and "Big Brother!" where they used to shout "Nanny state!" and "Big Government!"
And the 1971 agitator's handbook "Rules for Radicals" – written by Saul Alinsky, the Chicago community organizer who was the subject of Hillary Clinton's senior thesis, and whose teachings helped shape Barack Obama's work on Chicago's South Side – has been among Amazon's top 100 sellers for the past month, put there in part by people who "also bought" books by Michelle Malkin, Glenn Beck,and South Carolina Republican Sen. Jim DeMint.
Yes, the same folks who brought you Obama the socialist have been appropriating the words and ways of leftists past – and generally letting their freak flags fly.
Many conservative bloggers think these tactics are stupid.
It's not stupid if it works.
The Mayo Clinic managed to get her in and identify the cause of the problem in seven days. But even though it was urgent to get the non-malignant growth removed, or she would go blind, that wasn't enough to get the Canadian health care system to step in and do the surgery. She had to go back to the U.S. for the surgery that saved her sight.
What's really tragic is that the Canadian system, until 2005, actually made it illegal for a health care provider to operate outside their single payer system. Not just "the government's health insurance won't pay for it"--but illegal to provide care. The Canadian Supreme Court in 2005 ruled that "Access to a waiting list is not access to health care," and struck down the Quebec health insurance monopoly. That Calgary Herald piece explains that the doctors at the Mayo Clinic that did the surgery that restored Shona Holmes' vision? They were Canadians, too--who had moved to the U.S. to practice medicine.
So if the crowd that wants Canadian style single payer gets its way--either openly or in a roundabout way, as I pointed out last month that Obama seems to be taking us--where will Americans go to get medical care? Of course, when I say, "Americans," I really mean, "rich Americans." Most Americans, if confronted with a serious problem like Shona Holmes, won't have the resources to pay for medical care in another country, or the cost of traveling there. But the people that Obama represents--George Soros, Nancy Pelosi, and the other obscenely rich--they won't have that problem, will they?
[White House communications director Anita] Dunn played down the role that race could have in fueling the rancor. "I think that is less a part of it than some other people might think," she said.
It may be true, as Allahpundit suggests, that the White House refuses to accuse its opponents of racism directly because "every last halfwit in big media is happily willing to do it for them." But these statements are not mutually exclusive. When Dunn speaks of "some other people," she may well be thinking of the legacy media.
On this topic, the legacy media have turned from investigatory journalism to hallucinatory journalism. To assist those still hearing voices in their heads, let's use a visual aid:
For Carter to be correct, we would have to assume that a large portion of the population was unaware in late 2008 and early 2009 that Barack Obama is a person of color, or that an increasing portion of the public is turning racist. Occam's Razor suggests the correct answer is that Carter is an unhinged, race-baiting demagogue.
And contrary to some White House correspondent, there is not "a national conversation going on about race and the role it has or hasn't played in some of the hostility" toward the president. Only 12% of likely voters hold Carter's view, most of whom are Democrats. Only 20% of registered voters hold Carter's view, 34% of Democrats. Those figures are comparable to the 35% of Democrats who believed in 2007 that George Bush knew in advance about the 9/11 attacks. It is a view held by a minority of a minority. The legacy media's seeming obsession with the notion says far more about them than the president's critics.
At this point, I should take a moment to concede that some of Pres. Obama's critics may well be racists, and may hold extreme views. On the other hand, I can find Hispanics in New Jersey (most of whom are likely not members of Radical Right) who think that Obama is the Anti-Christ, or are "birthers" or "truthers." Indeed, the same poll has half of the African-Americans surveyed as truthers.
Friday, September 18, 2009
Sally Pipes writes at Investors Business Daily:Senate Bill Would Tax Those Who Heal
Baucus' overhaul would be partially funded by new fees on the health care industry. Starting next year, medical device makers would be forced to pony up $4 billion annually to the federal government. Biopharmaceutical firms would be on the hook for $2.3 billion each year. Clinical labs would have to shell out $750 million a year. All this in addition to the taxes they already pay.
Cutting Drug R&D
To put this in perspective, it takes $1.3 billion, on average, to research, develop and bring a new drug to market. So the bill would siphon away money that could otherwise have launched two new medicines.
With less money for research, cutting-edge drugs already in the pipeline undoubtedly will take longer to get to market. And whole lines of research aimed at curing diseases that currently lack treatments could be delayed or even canceled.
The Center for Consumer Freedom features a report on a new farmer's market opening in Washington, DC. It's kind of pricey.
In the mood for a bacon-gouda scone? A $5 pint of raspberries? Some $11-per-pound pork chops? How about the $4 bunch of parsnips? Well, you’re in luck: First Lady Michelle Obama has just cut the organic ribbon on a new farmers market just one block north of the White House. We just returned from the grand gathering of Washington DC’s food cognoscenti, and it had all the charm of wealthy debutantes trying to out-smug one another. A whopping $29 later, we had a pittance of food to take home—plus memorable exchanges with a scientifically challenged reporter or two. Where to begin?
...the White House farmers market doesn’t seem to be targeted at ordinary people. Judging from today’s crowd, it’s more about attracting well-to-do lawyers, gourmet snobs, and fans of the emerging fascination with eating “local.” For our money, though—and we did spend quite a bit of it—a trip to your local supermarket is a better bet. On balance, for one thing, it’s better for the environment. And even though pushing your cart through an ordinary grocery store might not fill you with gleeful self-satisfaction, you just might have enough money left over for dessert.
The Illinois Policy Institute has a piece pointing out that a provision in the Baucus bill will impose severe hardship on the state.
According to a report from the Federal Funds Information for States, the additional “state share” cost to Illinois for immediately expanding Medicaid to uninsured individuals who earn up to 133 percent of poverty level would cost $1.391 billion (FY 2009 numbers, at regular Medicaid reimbursement rates). It would take Illinois’s Medicaid enrollment from 2.4 million enrollees to 3 million enrollees, a 25 percent increase.
Illinois is already having a hard time paying for its current Medicaid obligations – the state’s significant payment backlog is clear proof of this. An expansion – even one partially or temporarily funded by the federal government – would make the outlook for balancing Illinois’s budget and honoring current commitments much more gloomy than it already is. This doesn’t bode well for taxpayers or current Medicaid recipients and providers.
Congress should instead focus on a patient-centered approach to health care reform that empowers the patient and the doctor to make effective and economical health policy choices. Patient-centered reforms include increasing competition among health care insurers by allowing the purchase of health insurance plans across state lines, expanding the adoption of Health Savings Accounts, ending the tax penalization of individually-purchased insurance plans, reducing the number of costly benefit coverage mandates, pursuing tort reform, encouraging medical price transparency, and rethinking licensing laws to encourage greater competition among providers.
Why This Works
Congress should encourage a robust health care market where insurers and providers compete for consumers on the basis of affordability and quality care. Ending regulations that use the tax code to favor employer-provided health insurance and allowing the purchase across state lines will help more families get the coverage they desire. Putting individuals in greater control of their health care dollars through Health Savings Accounts and medical price transparency will help control costs. Empowering individuals and doctors to make the health care decisions that are right for them will provide greater care choices than whatever rationed care the government sees fit to provide.
From the blogs at ABC News: Dem Senator Warns of 'Big, Big Tax' on Middle Class in Baucus Bill - The Note.
Among other nice surprises – a 35% excise tax on "high cost" insurance plans. For an individual plan, the cut-off would be $8000. (I assume that's per year – per-month would meet my standards for "high cost".)
Insurance companies don't have huge bags of money sitting around. 35% of $8000 is $2800, which will have to come from somewhere. It will either be added to the price of the policy, or be reflected in reduced coverage, or some combination of the two.
It is also intended to apply pressure on the costs of policies, keeping them below a cost threshold. It will tend to have that effect, erecting a semipermeable price ceiling. One of the rules of economics which has held up against numerous attempts to break it is that price ceilings result in shortages. If you want a high cost insurance policy, perhaps because you're expecting some high cost medical problems, they'll be a lot harder to come by.
Thursday, September 17, 2009
Well, maybe only close enough for government work.
VIENNA — Experts at the world's top atomic watchdog are in agreement that Tehran has the ability to make a nuclear bomb and is on the way to developing a missile system able to carry an atomic warhead, according to a secret report seen by The Associated Press.
The document drafted by senior officials at the International Atomic Energy Agency is the clearest indication yet that the agency's leaders share Washington's views on Iran's weapon-making capabilities.
It appears to be the so-called "secret annex" on Iran's nuclear program that Washington says is being withheld by the IAEA's chief.
The document says Iran has "sufficient information" to build a bomb. It says Iran is likely to "overcome problems" on developing a delivery system.
Well, maybe they won't use it.
This might be a good time for a pan-Europe plebiscite -- "Shall the US withdraw its forces and leave Europe to show us the right way to handle international politics?"
Sea ice grow.
Grow, ice, grow.
David Friedman looks at figures for the extent of arctic sea ice, and how they compare with claims made about them.
Regular readers of this blog will remember a series of posts (the three links are to three different posts) a few months back dealing with the question of whether NASA/JPL was lying when they claimed on a JPL web page that:
I argued at the time that the latest data actually showed the shrinking to have reversed, although there was no way of knowing if that was more than a temporary deviation. The discussion got me into a correspondence first with someone at NASA who turned to be a publicity person not a scientist, than with a scientist at NSDIC. It also resulted in a lot of comments on this blog.
Out of curiousity, I checked back today on the NSDIC web page, and found:
"The 2009 minimum is the third-lowest recorded since 1979, 580,000 square kilometers (220,000 square miles) above 2008 and 970,000 square kilometers (370,000 square miles) above the record low in 2007."
Or in other words, the extent of arctic sea ice has been increasing for the last two years, contrary to the claim I quoted above.
To avoid irrelevant comments, I am not arguing for or against claims that the greater extent doesn't really count because it is thinner ice or that all the evidence taken together still supports long term shrinking of arctic sea ice. My claim is simply that the quote above, which is still up on the JPL web page, is false. When people lie to me about the evidence for their conclusions, offering other evidence that their conclusions are still true is not an adequate defense.
Rather than making the claim, they should present the evidence.
Wednesday, September 16, 2009
Posted at Americans for Tax Reform
* Individual Mandate Tax. If you don’t sign up for health insurance, you will have to pay a tax in the following range:
* Employer Mandate Tax. $400 per employee if health coverage is not offered. Note: this is a huge incentive to drop coverage, as $400 is much less than the average plan cost of $11,000 for families or $5000 for singles (Source: AHIP)
Single Family 100-300% FPL $750 $1500 300% FPL $900 $3800
* Backdoor Death of HSAs. By requiring that all plans (besides the few that are grandfathered) provided first-dollar coverage for most services, there would be no HSA-qualifying plans available from the Massachusetts-like exchanges
* Excise Tax on High-Cost Health Plans. New 35% excise tax on health insurance plans to the extent they exceed $21000 in cost ($8000 single)
* Report Employer Health Spending on W-2. This is clearly a setup for the easy individual taxation of employer-provided health insurance down the road.
* Cap Flex-Spending Account (FSA) Contributions at $2000. Currently unlimited.
* Eliminate tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D
* Medicine Cabinet Tax. Americans would no longer be able to purchase over-the-counter medicines with their FSA, HSA, or HRA
* Increase Non-Qualified HSA Distribution Penalty from 10% to 20%. This makes HSAs less attractive, and paves the way for HSA pre-verification
* Corporate 1099-MISC Information Reporting. Currently, only non-corporations providing property or services for a business must be issued at 1099-MISC. This would expand the requirement to corporations doing business with other businesses. The amount of reporting needed for an average business would be huge. Paves the way for full information reporting to the IRS.
* Various industry tax grabs based on market share. $2.3 billion PhRMA; $6 billion health insurance providers; $750 million clinical labs; $4 billion medical device manufacturers
This from Dafydd ap Hugh at Big Lizards:
...if we have an unenforced system of health insurance, what happens when somebody without any insurance gets terribly sick or injured -- or worse, his child does. Given that Americans will not stand by and watch someone die from an easily treated disease or injury, the reality is that those free riders will, in fact, be treated. Maybe they'll be billed afterwards, but they can declare bankruptcy and weasel out of even that small bit of personal responsibility.
Similarly, Americans will never countenance senior citizens living on the streets or children growing up illiterate or otherwise uneducated: We have no stomach for willfully forcing people to pay a draconian, perhaps even fatal, price for stupidity... even less for making children pay the price of their parents' stupidity.
Without some solution to the free-rider problem, we cannot move to a system of full liberty.
The problem is in one clause of one sentence above. "Given that Americans will not stand by and watch someone die from an easily treated disease or injury, the reality is that those free riders will, in fact, be treated. Maybe they'll be billed afterwards, but they can declare bankruptcy and weasel out of even that small bit of personal responsibility."
So here's the suggestion:
- Amend the bankruptcy rules so that only a certain dollar value of health-care debt, X dollars, can be eliminated via bankruptcy;
- Set X high enough to cover the deductable of any reasonable insurance;
- But also set X far too low to allow an uninsured patient to shield himself from the consequences of health-care debt by using bankruptcy to wipe it away.
For example, if a typical catastrophic health-care insurance policy had a $5,000 deductable -- normally paid by your health savings account (HSA) -- then X, the dollars of health-care debt you can discharge via bankruptcy, could be set to $5,000. If you have insurance, you're covered; if you only have catastrophic care, but your HSA is depleted (or non-existent), you can declare bankruptcy and discharge $5,000... which is your deductable. That way you won't be socked with life-altering bills, if you're at least somewhat responsible.
But if you've taken no insurance at all -- you're a smart-ass kid who thought he would never need it -- then you may end up with $90,000 of treatment debt, of which only $5,000 can be discharged under bankruptcy. That means you're going to have to agree to some payment plan for the other $85,000, or be taken to court and lose everything you own.
And there are other suggestions as well.
The IBD poll was yesterday. Today, comments by the doctors about why they oppose Obama-Care.
In combing through the responses, we identified no fewer than 21 separate issues doctors felt either weren't addressed or weren't solved by proposed reforms. The issues are many, but boil down to three big categories: costs, controls and courts.
But just to be fair...
Friday: A second opinion — from the doctors who support reform.
These numbers are from an Investor's Business Daily poll of doctors.
Major findings included:
• Two-thirds, or 65%, of doctors say they oppose the proposed government expansion plan. This contradicts the administration's claims that doctors are part of an "unprecedented coalition" supporting a medical overhaul.
It also differs with findings of a poll released Monday by National Public Radio that suggests a "majority of physicians want public and private insurance options," and clashes with media reports such as Tuesday's front-page story in the Los Angeles Times with the headline "Doctors Go For Obama's Reform."
Nowhere in the Times story does it say doctors as a whole back the overhaul. It says only that the AMA — the "association representing the nation's physicians" and what "many still regard as the country's premier lobbying force" — is "lobbying and advertising to win public support for President Obama's sweeping plan."
The AMA, in fact, represents approximately 18% of physicians and has been hit with a number of defections by members opposed to the AMA's support of Democrats' proposed health care overhaul.
• Four of nine doctors, or 45%, said they "would consider leaving their practice or taking an early retirement" if Congress passes the plan the Democratic majority and White House have in mind.
More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll's finding onto that population, 360,000 doctors would consider quitting.
• More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered "no" when asked if they believed "the government can cover 47 million more people and that it will cost less money and the quality of care will be better."
Experiments at the state level show that an overhaul isn't likely to change much.
On Monday came word from the Massachusetts Medical Society — a group representing physicians in a state that has implemented an overhaul similar to that under consideration in Washington — that doctor shortages remain a growing problem.
Its 2009 Physician Workforce Study found that:
• The primary care specialties of family medicine and internal medicine are in short supply for a fourth straight year.
• The percentage of primary care practices closed to new patients is the highest ever recorded.
• Seven of 18 specialties — dermatology, neurology, urology, vascular surgery and (for the first time) obstetrics-gynecology, in addition to family and internal medicine — are in short supply.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and with primary care.
A key reason for the doctor shortages, according to the study, is a "lingering poor practice environment in the state."
In 2006, Massachusetts passed its medical overhaul — minus a public option — similar to what's being proposed on a national scale now. It hasn't worked as expected. Costs are higher, with insurance premiums rising 22% faster than in the U.S. as a whole.
Other states with government-run or mandated health insurance systems, including Maine, Tennessee and Hawaii, have been forced to cut back services and coverage.
This experience has been repeated in other countries where a form of nationalized care is common. In particular, many nationalized health systems seem to have trouble finding enough doctors to meet demand.
In Britain, a lack of practicing physicians means the country has had to import thousands of foreign doctors to care for patients in the National Health Service.
Maybe not. Scott Harrington writes in the Wall Street Journal:
...the president's examples of people "dropped" by their insurance companies involve the rescission of policies based on misrepresentation or concealment of information in applications for coverage. Private health insurance cannot function if people buy insurance only after they become seriously ill, or if they knowingly conceal health conditions that might affect their policy.
To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."
Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."
The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."
The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.
These two cases are presumably among the most egregious identified by Congressional staffers' analysis of 116,000 pages of documents from three large health insurers, which identified a total of about 20,000 rescissions from millions of policies issued by the insurers over a five-year period.
Yes, it's sad when people do, and it's possible the delay in the woman's treatment may have made the difference in her survival. But when you look at the details of these cases, and realize they represent one one-hundredth of a percent of the cases made available for the perusal of Congressional staffers, you have to stop and ask, "That's it???"
Later in his speech, the president used Alabama to buttress his call for a government insurer to enhance competition in health insurance. He asserted that 90% of the Alabama health-insurance market is controlled by one insurer, and that high market concentration "makes it easier for insurance companies to treat their customers badly—by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates."
In fact, the Birmingham News reported immediately following the speech that the state's largest health insurer, the nonprofit Blue Cross and Blue Shield of Alabama, has about a 75% market share. A representative of the company indicated that its "profit" averaged only 0.6% of premiums the past decade, and that its administrative expense ratio is 7% of premiums, the fourth lowest among 39 Blue Cross and Blue Shield plans nationwide.
Similarly, a Dec. 31, 2007, report by the Alabama Department of Insurance indicates that the insurer's ratio of medical-claim costs to premiums for the year was 92%, with an administrative expense ratio (including claims settlement expenses) of 7.5%. Its net income, including investment income, was equivalent to 2% of premiums in that year.
If those rates got jacked up any higher, they might actually leave the bargain basement!