Month: August 2009

by Chris Bodenner

A blogger takes a stand:

[Bill Clinton] talked about a new progressive era and how America has changed. […] So, at the point that he said, "We need an honest, principled debate", I knew I had to try to stimulate the discussion. So, I stood and said, "Mr. President, will you call for a repeal of DOMA and Don't Ask, Don't Tell? Right now?"

The immediate response shocked me at the time and still does. Those surrounding me yelled at me, booed, and told me to sit down. One elderly lady even told me to leave. While I was among the supposed most progressive audience in the country, they sought to silence someone asking a former President to speak out on behalf of repealing two laws that TOOK AWAY RIGHTS OF A MINORITY. I was shocked. […] I'll let you judge for yourselves the reaction of the audience (I especially LOVE the "I love you Bill!!!" while justifying DADT.)

Bill's complete answer is here. His DOMA response is after the jump:

Let me just say one thing about DOMA, since you — the reason I signed DOMA was — and I said when I signed it — that I thought the question of whether gays should marry should be left up to states and to religious organizations, and if any church or other religious body wanted to recognize gay marriage, they ought to. We were attempting at the time, in a very reactionary Congress, to head off an attempt to send a constitutional amendment banning gay marriage to the states. And if you look at the 11 referenda much later — in 2004, in the election — which the Republicans put on the ballot to try to get the base vote for President Bush up, I think it's obvious that something had to be done to try to keep the Republican Congress from presenting that. The President doesn't even get to veto that. The Congress can refer constitutional amendments to the states.

I didn't like signing DOMA and I certainly didn't like the constraints that were put on benefits, and I've done everything I could — and I am proud to say that the State Department was the first federal department to restore benefits to gay partners in the Obama administration, and I think we are going forward in the right direction now for federal employees.

Andrew had this to say after Clinton got a similar question from a young reporter last year:

The facts are these: under Bill Clinton the rate of discharges of gay people from the military doubled; under Bill Clinton, the Defense Of Marriage Act did not only simply enshrine the pre-existing right of some states not to recognize the civil marriages of other states – as he misleadingly states – but barred all of us gay couples from any rights on a federal level; Bill Clinton cited the Defense of Marriage Act in re-election campaign ads in the South.

Even now, he claims that repealing DOMA would lead to more persecution of gays, because more states would allegedly pass anti-gay constitutional amendments. But there are very very few left that could do more to stigmatize gay couples than currently do. And he still resists any defense of gay equality in substance seeing it entirely, as he did in office, as a matter of partisan positioning. Just as he left any mention of any gay people and any gay appointees out of his interminable autobiography, he still will not stand up for gay equality when confronted by the next generation.

by Patrick Appel

"I don't care how low they drive support for this with misinformation. The minute the president signs this bill, his approval will go up. Within a year, when the good things begin to happen, and the bad things they're saying will happen don't happen, approval will explode," – Bill Clinton.

 

by Chris Bodenner

Laszlo Thoth determines:

It was delicious.

by Chris Bodenner

Marc Heller of Watertown Daily Times points out a nugget of intrigue regarding Brownback's hold on the Army-Secretary-in-waiting, Rep. John McHugh (R-NY):

One of the Republicans who expressed interest in running for Mr. McHugh's seat, but was not selected, is Joshua A. Lynch, a legislative aide to Mr. Brownback.

But a more substantive behind-the-scenes detail is this: McHugh actually co-sponsored the "Keep Terrorists Out Of America Act," a bill that would require the federal government to obtain permission from the governor and legislature before sending detainees to their state. Therefore, McHugh is a natural ally of Brownback and would be a fierce advocate for caution within the Obama administration. So why is Brownback keeping McHugh from his post?  Why is he willing to endure backlash from the White House, the defense secretary, and even the Washington Times for a guy who sees eye-to-eye with him?  Perhaps Brownback is retaliating against McHugh for accepting Obama's offer and thus providing bipartisan cred on Gitmo. If so: politics first, country second.

by Patrick Appel

Turns out it's neurological:

[Washington State University neuroscientist Jaak Panksepp] says that humans can get just as excited about abstract rewards as tangible ones. He says that when we get thrilled about the world of ideas, about making intellectual connections, about divining meaning, it is the seeking circuits that are firing. The juice that fuels the seeking system is the neurotransmitter dopamine.

The dopamine circuits "promote states of eagerness and directed purpose," Panksepp writes. It's a state humans love to be in. So good does it feel that we seek out activities, or substances, that keep this system aroused—cocaine and amphetamines, drugs of stimulation, are particularly effective at stirring it.

Ever find yourself sitting down at the computer just for a second to find out what other movie you saw that actress in, only to look up and realize the search has led to an hour of Googling? Thank dopamine.

by Patrick Appel

Mark Thompson makes several good points. Number one:

The reason why the health care debate has favored liberals and Democrats in recent years has been their ability to appeal to powerful anecdotes of the uninsured and other actual victims of our current health care system.  What the health care protests have done is to put actual people who sincerely (if very, very wrongly) believe they would be victims of Obamacare front and center, providing reform opponents with easily-relatable appeals to emotion that they’ve never had in the past fifteen years.

Number two:

The trouble is that Democrats and liberals have become so closely associated with single-payer and government-run universal health insurance that people can’t comprehend that they’re now pushing for something substantially less than that, particularly when so many Democrats, the President included, have suggested that this is a step on the road to single-payer.  Attempting to explain that the current leading proposals would not, in fact, be a single-payer system or “socialized medicine” is thus either difficult to believe or impossible to do well in a few sentences.  Even where it can be done, there’s not really any way of credibly denying the “slippery slope” argument since so many liberals and Dem politicians have made clear that creating a slippery slope towards nationalized health insurance is precisely what this legislation is supposed to do.

Port Macquarie, Australia, 10 am

by Robert Wright

People continue to ponder whether the reported killing last week of the leader of the Pakistani Taliban will be a big plus for our side. More generally: Does killing terrorist leaders do much good? I’ve seen only one long-term study on the question, and, in the case of religiously-based terrorist groups, its findings weren’t encouraging: “The result that consistently stood out from this research was the propensity of decapitation strikes to cause religious organizations to become substantially more deadly.”

My own assessment is sunnier: Chances that the killing of Baitullah Mehsud will help our cause, hurt our cause, or have no effect are, respectively, 33 percent, 33 percent, and 33 percent. This is based on a rigorous multidecade study of organizations I’ve worked for. Here’s the data: When someone leaves the organization—whether through resignation, getting fired, or even death—the chances that their replacement will be more effective than them, less effective, or about the same are: 33, 33, 33.   

And why should we expect things to be any different when it’s a terrorist leader who is being replaced? 

We know that terrorist organizations aren’t exactly meritocracies. Their leaders don’t answer to a board of trustees or face elections, and few seem ethically opposed to ruthlessly hanging onto power. So their organizations may abound with capable but untested heirs who have been secretly chanting, “Put me in, coach.” Besides, most organizations could use a little shaking up now and then. Sure, the transition may be messy, but, hey, terrorism is a messy business.

An analogy: If you’re trying to put a candy company out of business, killing the occasional top-ranking executive probably won’t get the job done, or have much effect on the company’s fortunes at all. (Unless you kill with such frequency that the pool of aspiring replacements dries up, and in the terrorism business that would require, I think, a much higher rate of killing than we’ve generally mustered.) What you need to do is reduce demand for that brand of candy.

Now, reducing the “demand” for a brand of terrorism is hard to conceptualize. But it would include reducing the amount of grass roots support for the terrorists both in their own habitat and around the world. And one problem with trying to kill terrorist leaders with drone strikes is that the number of civilians you kill in the process can actually increase that support. 

Of course, civilian deaths can have the opposite effect, if enough of the public blames the terrorists for them. Still, I suspect that, on balance, collateral damage helps the terrorists and hurts us. One reason is that, even if civilian deaths cause the local populace to turn on the terrorist organization (a big if), they can still help terrorist recruiters in the wider world. So, come to think of it, my 33 percent estimate of success may be a bit high, all things considered.

by Patrick Appel

This sickbed story received a number of responses. I've rounded up some of the best ones. A reader writes:

I'd be interested to know if your reader has ever actually had to rely on an HSA–I've noticed that those who rave about them are usually doing so from a theoretical perspective, not from personal experience as a consumer. As a freelancer, I've had an HSA for several years, and I hate it.

The policy has a $3500 deductible, so, short of a catastrophic claim, I pay for everything out-of-pocket. It's true that I only pay $113/mth in premiums for my insurance policy, but I never actually use my insurance policy (other than receiving the insurer's negotiated rates for medical services), and it really comes out to $405/mth if you include the deductible that I must pay before getting coverage ($3500/12=$292, although I'm only allowed to deposit $2,900 in the HSA annually).

Yes, the deductible is paid with "pre-tax" dollars (I still pay state and self-employment taxes on any deposits to my HSA), but that doesn't make it any less painful when I'm paying the bills. And it definitely deters me from seeking care on a timely basis. In the past year, I've had two different doctors suggest an MRI (which they seem to do as a matter of form these days–and usually at an affiliated MRI center that shares profits with the doctors). I still haven't gotten an MRI because, with business down significantly, I can't afford at least $1,000 for a test that may well prove inconclusive.

I've found no medical providers willing to negotiate with me for their services. In fact, many of them seem almost totally unfamiliar with HSAs and how they work. And what patient really wants to try to negotiate lower prices with a provider? Talk about uneven bargaining positions. That's just another conservative "let-the-marketplace-decide" pipedream that is totally removed from reality.

I'm also deterred from seeking timely care because I don't want to make myself uninsurable in the future. Last year, I applied for a group policy through my alumni association. After I completed the detailed application and provided additional information over the phone, I received a letter telling me Blue Cross California was "declining" my coverage. Days later, I received another letter listing three reasons:

   * Knee tendonitis and low arches treated with physical therapy (in 2002)
   * Shin splints treated with physical therapy within the past year (which
     cost me $3,000 out of pocket)
   * History of treatment for sciatica (once-in 2004)

My blood pressure, heart rate, and cholesterol are all low, and I weigh less now than I did 20 years ago in college. I take no prescription drugs, have never been seriously ill, and have never received ominous test results. But I couldn't get group coverage because I'd previously sought medical care while insured under COBRA or grad school policies. And a traditional individual policy would be prohibitively expensive. This is how we encourage people to become entrepreneurs?

Our system is clearly in need of reform.

Another reader:

I have been self employed with an HSA for my family for about 4 years.  My experience with finding out even approximately what a procedure would cost was a nightmare.  My son was having one of the most simple procedures done, ear tubes.  Yet no single person could even give a ball park figure for what the procedure would cost.  Individual calls needed to be made to the doctor performing the procedure, the hospital, the anesthesiologist, etc.  Also, the costs for everyone varied on where the procedure was done. 

When it was all said and done, the cost was $6,000 for a 10 minute routine procedure with no complications. This was up from $2,500 just two years earlier. The most touching part of the whole experience was realizing that the people doing the actual procedure, the doctor and the anesthesiologist, were less than 20% of the total cost. 

Of course the ear-tubes were not covered because my son had one ear infection prior to getting our HSA coverage, so it was considered a preexisting condition.  On a related note, my wife's entire back is not covered, not because she had some sort of prior procedure or injury, but because she has been to see a chiropractor.  Also, her lungs are not covered because she has asthma.  Brilliant. 

Another reader

Yes, I successfully negotiate a firm price for eye glasses, teeth cleaning, and even a tooth inlay, paid from my HSA. I suspect the average person's ability to do that drops pretty quickly when they are taken to the ER suffering a heart attack, or when they face cancer surgery. Their choice of secondary providers (hospital, supply vendors, labs) gets determined by their choice of primary provider (surgeon), which reasonably is focused on finding the best treatment to their life threatening problem. I want to meet the mythical patient who, before all the other things they must do prior to their cancer surgery, calls up the lab that will do the biopsy and asks how much that will cost, and what discounts have been negotiated with their particular insurance. And if the patient doesn't like the answer, then decides… what? That they will ask the hospital to use a different lab? Or their surgeon to use a different hospital? Or restart their search for the right surgeon for their medical condition?

Some medical expenses are very much like other consumer purchases. But the ones that cost the most are the most complex and urgent transactions consumers will make, in the face of the greatest information asymmetries.

One more:

This latest poster shows quite a bit of ignorance as well.  The poster repeatedly explains to us that he/she once "worked in medicine," and therefore understands billing codes and the procedures for negotiating prices.  That's great for the poster.

I have a J.D. and a Ph.D. in the humanities; I also have a tenured position as a university professor and good medical insurance (provided, I might point out, by the state government that employs me).  But despite all my years of education, I completely missed the memo explaining to me–as a relatively well-informed patient and consumer–how to negotiate my way through the maze of the medical insurance industry (who to call, what to ask, what to demand, what to offer, etc., etc., etc.).

As your other posters have illustrated so vividly, our current system for medical pricing and billing is utterly impenetrable to anyone on the outside of the medical fraternity, and that's surely the situation the vast majority of American citizens find themselves in.  And as your posters have also pointed out, even if I get that elusive memo, how can I be expected to begin the process of information gathering and negotiation at the very moment I suddenly find myself in unexpected and dire physical distress?

This is a capitalist market that will never work efficiently, because it's a market that thrives on keeping the flow of information a one-way street.