Month: August 2009

by Patrick Appel

A reader writes:

I wanted to second the reader who identified the non-transparency of health care costs as a huge part of the problem.  He recited the issues with his wife's pregnancy receiving minimal coverage even though they had private health insurance.

My sister recently had a similar situation, when a needle she used for her insulin injection broke off in her thigh.  She had to have it removed surgically in a brief outpatient procedure.  She has good health insurance through her husband's job, but she wanted to know the cost of the procedure, to determine her copay.  She asked the doctor's office how much the procedure would cost and was told between $5,000 to $6,000.  (Don't have your heart attack yet over the insanity of $5000 for a simple outpatient surgery plus xray or scan to determine the location of the needle.  As Dylan said, "Now ain't the time for your tears".)  She had her uneventful surgery and got the bill for $15,000.  For an uncomplicated outpatient surgery.  After being quoted a price 1/3 that price.

Why did she even ask the price of the procedure if they were going to be off by 250% or more?  If my sister wanted to call around to surgeons to get a better price (and she would, to reduce her copay, if nothing else), what would be the point?  What if my sister had been uninsured – how would she plan to reduce her costs based on such misinformation?  The price of health care procedures is nothing but a dart thrown at numbers on a dart board.  The insurers, the doctors and the hospitals all have blame in this process.   Unfortunately, the uninsured and the poorly insured – and both groups are gaining in numbers daily – pay these outrageous prices.

by Chris Bodenner

HITLER!

by Patrick Appel

Andrew Exum is starting an Afghanistan Strategy Dialogue and asking readers to participate. The question:

Marc Lynch responds:

I have an open mind on these questions, want the U.S. mission to succeed, and have a great deal of confidence in the Obama national security team.  I know that there have been a number of policy reviews at all levels of the government on Afghanistan strategy, and that most of the questions I can raise have already been discussed at one or the other.   But at the same time, I find the strategic rationale for escalating the war in Afghanistan extremely thin, and the mismatch between avowed aims and available resources frighteningly wide.  What are the strategic reasons for expanding the commitment in Afghanistan?  Why should the US be committing to a project of armed state building now, in 2009?    

by Chris Bodenner

A reader writes:

Regarding the last recession story, I couldn't help but be struck by the reader's attitude. It was the same one echoed (if not explicitly) by at least 3 or 4 otherwise decent people I've encountered in the last couple months: The recently laid-off simply feel defeated by the prospect of looking for work when unemployment paychecks will keep them happy enough lounging around the house, watching trashy talk shows, and walking their dogs.

I'm all for government intervention to aid those unable to find work, but I've been utterly dismayed by the effect the recession seems to have had on so many able-bodied young workers in America. I fear that hundreds of thousands of previously comfortable middle-class workers now appear perfectly happy to make the equivalent of $25,000 a year in unemployment, essentially mocking a system that so seldom investigates their claims of looking for work — because damned if they're going to put in a hard day's work in the service industry or work some entry-level position now that their former job disappeared.

The reader doesn't say any of this, because s/he can appease his/her conscience by saying no work equals more time for friends or family, but it appears rather bogus to me. We as Americans have become so devoted to striking it rich that the idea that we might have to do something not quite so satisfying to put food on the table becomes terrifying. Not when government is there to bail us out. What gets lost in the discussion about a recovering economy is that even when jobs come back, they won't be quite as appealing as they once were. And in the meantime, too many laid-off workers — a good many of them who love to decry America's "socialism" — are busy milking the system for all it's worth.

I've grown rather disgusted with those who once had it all now unwilling to do the dirty work the nation's poor would kill to have. This comment isn't very eloquent, I know, but I'm struck by the fact that this reader comment was worthy of posting on its own. It at least deserves a comment from Andrew or one of the other bloggers, because what it truly reveals is the stark reality that cushy jobs often get deservedly slashed, and the outcome is far too many Americans blaming their misfortune on a bad economy and relishing the free money they're about to receive. I've never heard anything like the last few months, and it makes me worry about the future of our workforce.

I'm out of work, without health insurance, filling out applications every day, and I'd kill for 30 grand a year doing what I love. But in the meantime, I'm working my tail off under the table in a warehouse, putting my health at risk with heavy equipment — not visiting the friends and family I love so dearly.

I can relate to a lot of this. Do other readers have good examples of undesirable jobs you took between steady employment?  And not just stories of "look at the crappy job I had to put up with," but rather lessons or personal insights gleaned from a miserable job experience (see Anagnorisis). I'll post any emails that are original, thoughtful, and don't veer into white whines.

Mount Rainier, Washington, 2 pm

by Patrick Appel

One of Ta-Nehisi's readers takes issue with this Dish reader e-mail:

by Patrick Appel

Frum wonders why Republicans are up in arms about medicare reform:

Here is the Post's bullet point description of how the House bill would change medicare. Lots of the savings come from cutting medicare advantage, which costs more than orginal recipe medicare and is considered a boondoggle by many on the left. The anti-reform ad above comes from the 60 Plus Association, a group that TPM calls "right wing." It's surreal to watch Republicans attack Obama from the left –trying to demagogue him for making sensible cuts to a program they have long sought to reform.

by Patrick Appel

It has been making the rounds, but this interview by Ezra Klein with Sen. Johnny Isakson (R-GA) about the "death panels" is worth reading in full. His answer to Ezra's question, "Is this bill going to euthanize my grandmother?":

In the health-care debate mark-up, one of the things I talked about was that the most money spent on anyone is spent usually in the last 60 days of life and that's because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia "durable power of attorney," you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you're unable to make those decisions.

This has been an issue for 35 years. All 50 states now have either durable powers of attorney or end-of-life directives and it's to protect children or a spouse from being put into a situation where they have to make a terrible decision as well as physicians from being put into a position where they have to practice defensive medicine because of the trial lawyers. It's just better for an individual to be able to clearly delineate what they want done in various sets of circumstances at the end of their life.

by Chris Bodenner

The NYT reports that the US military is targeting 50 drug traffickers in Afghanistan. Michael Cohen is gobsmacked:

Ok, just so I have this straight: we’re going to start killing drug traffickers in Afghanistan because drug money from opium sales goes to the Taliban. (Oh and by the way don’t worry this is totally legal because the military said it is). […] And if we don’t target these drug traffickers the Taliban will drive from Kandahar to Kabul where they will take over the country again. Then they will create a safe haven for Al Qaeda, who will set up precisely the same terrorist infrastructure that they had pre-2001 and there’s not a single thing that the US will be able to do about it. And then America will get hit by a terrorist attack again.

You want to know how messed up this idea is: even Andrew Exum agrees with me!

Are we really going to spend our time, money and precious ISR assets going after the Pashtun Pablo Escobar? Again, why are we in Afghanistan? To fight drugs?

Here’s the thing: if we’re out there killing drug dealers in Afghanistan that’s the practical definition of mission creep. What’s next, are we going to start trying to convince farmers to grow something other than opium . . . oh jeez.