Month: August 2009

What If Hillary Were President Right Now?, Ctd

by Patrick Appel

A reader writes:

Krugman and Drum make some good points, but they leave out the most important point. It's not about how people would react. It's how the President would react to the reactions. This very week, Sec. Clinton lost her cool when she thought a student ignorantly insulted her. She didn't explode or have a meltdown as some of her detractors would describe it. Nor did she strick a blow for women's equality as her fans would tell you. She was placed in an awkward situation by a random questioner and she showed just enough anger/exasperation to make the tone of her answer the issue.

The President, on the other hand, regularly gets compared to Karl Marx and Josef Mengele by far more formidable opponents and deflects it deftly without a bead of sweat.

Does he never misstep? Of course not. I would say his handling of the Gates matter was such an instance. But he still had the self-restraint and perspective to somewhat salvage the situation and to turn it into a learning moment.

We don't know if President Hillary Clinton would have had the stomach to tackle health care right away. If she did, yes we can assume that the attacks would have been just about as ugly. How would she have countered? If we are questioning our choice, that's the question we need to be answering.

Just Barely Worth Staying?

by Patrick Appel

Matt Frost counters Stephen Biddle's careful case for continuing the war in Afghanistan:

If arguing for your war of choice involves all of the following: describing it as “costly, risky and worth waging—but only barely so;” calculating “a net cost-benefit calculus perilously close to a wash;” resigning yourself to “a war whose merits skirt the margin of being worthwhile;” eschewing “clarion calls to great sacrifice for transcendent purpose;” you do not actually have a case for war. You have a policy proposal. I hope that our politicians and our generals alike can tell the difference.

The View From Your Sickbed

by Patrick Appel

A reader writes:

One of the worst problems with the current healthcare system relative to the long-term health of the country is the millions of people, like myself, who are under-insured. I am 62 and retired from full-time employment three years ago.

I still work part time via internet for that same company and have a few other minor clients as a consultant, but, obviously my income is considerably lower than it once was, and prospects are not good for me maintaining even my current level of income over the next few years because of the recession.

My company had decent health insurance and I took full advantage of COBRA, but once that ran out the ONLY insurance I could get is a $5,000 deductible policy at more than double the price of the far, far better COBRA policy. The only reason I could get even that terrible coverage was because the insurance company was legally required to offer me coverage. As a result, I must postpone certain expensive preventive tests, such as the colonoscopy which is overdue. I simply cannot afford it.

I go to my primary care physician only when I feel I absolutely must (luckily my general health is quite good), and often do not go on to specialists that he might recommend for a condition he can't handle if it's something I judge I can live with (getting old is a bitch). I have a history of back and neck problems, minor skin cancers, and occasional Atrial Fibrillation. I can only hope that none of those conditions becomes acute before I qualify for Medicare, because any of them could bankrupt me.

 I've paid my insurance company well over $10k in the 20 months or so since I came off COBRA and have never gotten one cent in coverage payments from them. I hope I never do. Still, I realize that I am luckier than millions of others with no insurance at all…..At least I hope I am.

Eat Your Greens

by Patrick Appel

Ezra Klein strikes the right tone:

[T]he hard evidence of health benefits for organic foods has been mixed at best. There are no long-term studies showing that consumption of organic foods will make people healthier over a long period of time. That's not to say organic foods are bad. They may taste better, or be more environmentally friendly. And we may even eventually find that they are healthier. But I'm much more worried about getting people to eat fruits and vegetables in general than I am about getting fruit and vegetable eaters to switch to organics. And what we do know is that organic produce is more expensive and harder to find.

Follow up here, linking to Tom Philpott's post praising organics. Ezra writes that "the evidence that organics are good for the environment, and the soil in particular, is very compelling." I'm not so sure. Here's a Prospect article from a few years ago about organic crops:

Some opponents of GM crops, who seem to have realised that the argument based on lack of safety has no basis, now focus their opposition on environmental concerns, arguing that GM crops destroy biodiversity. It would be wrong to claim that the planting of GM crops could never have adverse environmental effects. But their impact depends on circumstances, on the particular crop and environment in which it is grown. Such effects occur with all sorts of agriculture. Worldwide experience of GM crops to date provides strong evidence that they actually benefit the environment. They reduce reliance on agrochemical sprays, save energy, use less fossil fuels in their production and reduce the emissions of greenhouse gases. And by improving yields, they make better use of scarce agricultural land.

Organic farming might be better for the environment in some instances but there are plenty of organic fertilizers that can do damage to surrounding ecosystems. Tom Philpott discusses non-organic farming killing microbes in the soil, but I'm generally more worried about how damaging farming is to the surrounding environment and how much it contributes to carbon emissions.

I am open to conflicting evidence.

How Healthcare Killed His Father

by Patrick Appel

David Goldhill tackles the health care system in the September Atlantic.  John Schwenkler calls it "maybe the best thing I’ve read on health care reform." Goldhill lost his father last year to an illness he contracted while in the hospital. A taste:

Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.

From later in the article:

Health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.

Comprehensive health insurance is such an ingrained element of our thinking, we forget that its rise to dominance is relatively recent. Modern group health insurance was introduced in 1929, and employer-based insurance began to blossom during World War II, when wage freezes prompted employers to expand other benefits as a way of attracting workers. Still, as late as 1954, only a minority of Americans had health insurance. That’s when Congress passed a law making employer contributions to employee health plans tax-deductible without making the resulting benefits taxable to employees. This seemingly minor tax benefit not only encouraged the spread of catastrophic insurance, but had the accidental effect of making employer-funded health insurance the most affordable option (after taxes) for financing pretty much any type of health care. There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.

In designing Medicare and Medicaid in 1965, the government essentially adopted this comprehensive-insurance model for its own spending, and by the next year had enrolled nearly 12% of the population. And it is no coinci­dence that the great inflation in health-care costs began soon after. We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense.