Wednesday, July 29, 2009

Either Bill O'Reilly is really stupid, or he thinks his viewers are.

And I don't think he's stupid.

"This guy has a problem"



There have been several clips of the Fox crazies going off in one direction or another lately. Here's some of Glenn Beck's incoherence in just under half a minute...

"This president ... has a deep-seated hatred for white people or the white culture..."

"I'm not saying he doesn't like white people..."

"This guy is, I believe, a racist!"

One of the Fox people point out that many of his closest advisors are white. Not to mention his mom. And his grandparents, who helped raise him.

I've mentioned before the clip I saw where Beck and O'Reilly talk about how Obama supports the Black Panther idealogy. Then one of them says, "I can't prove it, but I believe it." Wow.

I don't know what is wrong with Glenn Beck. But this guy has a problem.

Monday, July 27, 2009

Krugman Nails It, Limbaugh Lies, The Right Weeps for Health Insurers... Health care reform part six

The debate has moved from frenzied to chaotic to oppressive, but nothing to do but put our heads down and soldier on. As I said to someone on Facebook recently, I've been watching health care experts talk about reform for more than ten years. It's past time to actually do something. We can choose to continue to watch this train wreck in slow motion, or we can enact reforms that may be painful and imperfect but at least start addressing the problems.

First up, Paul Krugman boils things down very nicely; Many of those politicians now worried about cost had no problem adding $1.35 trillion to our deficit by voting for GWBs tax cuts. And by opposing things like mandates and the public option, they look like they are not serious about delivering reform and controlling costs at the same time.


Also in the NYT, some good analysis by David Herszenhorn that brings up some CBO numbers that we're not hearing much about (and lately the CBO has not been a friend to reform efforts -- it's been good at pointing out the cost but doesn't seem able to estimate the cost savings from reform). The CBO recently projected that yes, some people would drop their private insurance for the government plan being proposed. About 9 million, by this estimate. But, the CBO says, "12 million people who would not be enrolled in an employment-based plan under current law would be covered by one in 2016, largely because the mandate for individuals to be insured would increase workers’ demand for insurance coverage through their employer.”


So that doesn't sound too bad for the private insurance industry. Which is good, because a lot of folks who oppose reform are really, really worried that the insurance industry is not going to get a fair shake with reforms. Listen, we heard the same arguments about Medicare when it was introduced. It would destroy the insurance industry, etc. Right now, one of the most profitable lines of businesses for private health insurers is the administration of Medicare plans (which is done by companies like Blue Cross, UnitedHealth, etc.). They make more money on these plans than they do on some of their employer-based plans. So Medicare did not destroy the private insurance industry, in fact, it is a profit center for it. Next argument, please.



On a side note, I recently had a discussion with someone who thought Rush Limbaugh and Sean Hannity were truth-tellers and not hate-mongers. Well, as much as I find it hard to believe, I guess you could say such things are in the eye of the beholder. All I know is this latest line of Rush's, that Obama is a tyrant who wants to impose a totalitarian dictatorship on the US so he can torture people and control their lives, well, it sounds like a whoppin' big, hate-filled lie to me.

Thursday, July 23, 2009

Odds and Ends from a Busy Week; Health Care Reform Part Five

(I forgot my subhead on So, Canada. Oops.)

Lots going on, so this will be sort of a grab-bag summary of health reform stuff.

Let’s start with this recent Gallup poll on uninsured Americans (from July 22). Here’s the bottom line finding:

“The Gallup-Healthways Well-Being Index finds that while a large majority of Americans have health insurance, one in six in this country is without coverage. The current percentage of uninsured Americans (16.0%) represents a small, but measurable increase over last year. Hispanic Americans, at a rate approaching triple the national average, are the most likely subset of the population to be uninsured. Those making less than $36,000 per year are the second-most-likely group to be uninsured, with 18- to 29-year-olds following closely behind.”

This lines up with what my other research is showing, that uninsurance is disproportionately a problem for the young, poor, and non-Caucasian. Must be why all those rich old white men in Washington can’t see the need to change things any time soon.

This US News report attempts to give some basic facts about the reform efforts, and while I could quibble about some of the assertions about what the “plan” (there are several) would or wouldn’t do, I think the basic numbers here are helpful.

Here are the numbers that jumped out at me:
*Healthcare spending as a percentage of income, for those earning less than $20,000 per year: 15.5 percent
*For those earning between $55,000 and $70,000: 5.1 percent
*For those earning more than $70,000: 3 percent
*Average increase in employer-based health insurance premiums since 1999: 120 percent
*Average increase in wages since then: 29 percent
*Proportion of personal bankruptcies related to illness or medical bills: 62.1 percent
*Increase since 2001 in the proportion of personal bankruptcies caused by medical problems: 50 percent.

Cheerful stuff, I know.

To make you feel better I recommend two reports from the Commonwealth Fund, one which begins, “The individual health insurance market is not a viable option for the majority of uninsured adults…”

The other says “including both private and public insurance choices in a new insurance exchange would save the United States as much as $265 billion in administrative costs from 2010 to 2020.” One of the conundrums of this debate is reform opponents say that 1) health care reforms proposals will cost too much, and 2) a public plan is a very, very bad idea. Turns out, though, that most analysts (including the CBO) are finding one of the major ways to reduce costs is to have a public plan as part of the reform.

And then there was the IBD editorial the other day that claimed that the House reform bill would end all private insurance plans. I honestly don’t know what these guys were thinking. “Ah ha! If we hadn’t caught this, no one would’ve realized that Obama was wiping out an entire sector of the US economy!” I mean really, guys, does it make sense that they would try to make such a dramatic change and think they could sneak it by everyone?? All I know is, if I were an investor, I’d have to re-think my opinion of the publication’s analytical skills.

What seemed to trip them up was the idea of an insurance exchange, a fairly common industry reform idea that Gov. Tim Pawlenty—a Republican, by the way—has promoted for years. Yes, it would change the regulations a bit but it is not designed to do away with private plans!

OK, on a more positive note, I attended an Organizing for America (formerly Obama for America, so you know where they’re coming from) rally for health care reform. About 500 people showed up, stood in line for hamburgers and chicken sandwiches, and watched a few speakers call for passage of health care reform this year.

It just made me think of all the health care events I’ve covered in the past ten years where physicians and CEOs sit around and talk about how terrible the health care situation is in this country and politely exchange views on what should be done, and then they all go home and repeat the process in three or six or nine months. And nothing really changes. The thing that always strikes me about these industry events is how rarely patients are ever at the table. You know, everyday people who are actually affected by all this stuff.

There were lots of them at this event, and they were tired of being told that the health care system can’t be fixed.

Wednesday, July 22, 2009

So, Canada

One of the most contentious issues of the current health care debate is how our health care system stacks up against Canada’s, or for that matter any nationalized, universal health care system.

I mean there are a lot to pick from. Canada, England, France, Norway, Germany, Sweden, Italy, Spain, Finland, Austria, Japan, Singapore, Australia, New Zealand, Israel, Iceland … well, the list goes on. Makes you wonder why all of those countries can provide universal care and we can’t. Oh, that’s right, socialism. That clears it right up.

Ok, sorry, getting a little snarky. But it is ridiculous, this to-the-death fight we have about which system is better. Take Canada. This is a country that has been one of our closest allies and a valued trading partner. There is probably no society—or economy, for that matter—in the world that more closely resembles ours. And yet this issue of health care has people in the US fuming that Canadians are a bunch of socialists. Come on.

In this country, when Canadian health care comes up, folks on the left and right assail each other with a blizzard of anecdotes, polls, testimonials, and opinions, but despite all the arguing, it seems that few minds are changed. So my collection of google search results may not impress you. But here they are.

One of the enduring claims on the right is that Canadian health care can’t be all that great since so many Canadians come to the US for health care. In “Phantoms in the Snow: Canadians’ use of health care services in the United States,” a report in Health Affairs, researchers looked at this issue. Here’s what they found:

“Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.

“This paper … depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system.”

But Canadians and people in other nationalized systems don’t have the choices that we do here, right? That has to be frustrating. Well, maybe. But in a survey the Gallup company did (it’s a little old, 2003), Gallup found that Canadians and citizens of the UK were generally more satisfied with their access to affordable health care than were US citizens. However, citizens in all three nations rated the quality of care more or less the same.

For access to affordable health care, 57 percent of Canadians gave their system good marks. Sixty three percent of UK citizens gave their system good marks. And 47 percent of US citizens said they were satisfied with access to affordable care in their country.

For overall quality, 52 percent of Canadians were satisfied, 42 percent of UK residents gave a thumbs up, and 48 percent of US residents said they were satisfied. The US had the highest mark of “Very unsatisfied” at 26 percent. (Canada: 22, UK: 23)

As I mentioned, there are a million anecdotal stories about Canadians and how they either can’t wait to have a system like the US or think that our system is crazy. My personal anecdote is a trip to Canada in 2000 where I heard a health care conference by Canadian nurses on the CBC. The nurses were quite passionate about how they would never want to go to a system like the one here in the US. But I can’t claim to know firsthand how the Canadian system works.

One person who can is Rhonda Hackett , a Canadian psychologist who wrote an opinion piece in the Denver Post. The article, Debunking Canadian Healthy Care Myths, goes through the arguments one by one; government control, long wait times, higher taxes, etc. The whole thing is worth reading, but here’s one paragraph that I think is especially interesting:

“Myth: The Canadian system is significantly more expensive than that of the U.S. Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services. “

Who picks up the tab for the much higher costs of health care in the US? Businesses, health plan enrollees, and hospitals through charity care. Of course the highest price of all is paid by the uninsured, though perhaps not always in monetary terms.

Tuesday, July 21, 2009

For the Record: Obama and Taxes so far

Obama's record so far on taxes:

Tax cuts of $400 per worker and $800 per couple annually for two years, phaseouts beginning at $75K for individuals and $150K for joint filers. Various tax credits for education, child tax credit, energy efficiency measures, home and auto owners. Total $237 billion.

Tax credits and refunds to businesses equaling $51 billion, mostly to offset losses from recession, some energy credits.

Tax increases: Increased the federal cigarette tax by 62¢ per pack.

I wouldn't be surprised if there's something I've missed, but this is what I've found so far. Thanks to TPM for giving me the idea.

Monday, July 20, 2009

Socialism is the Least of our Worries; Health Care Reform Part Three

I think this article by Robert Reich is a very good summary of some of the problems with the sausage-making now going on in Congress. Congress and Obama hoped to avoid the industry opposition that the Clinton effort ran into. So they have been making deals with industry players, and some of those deals are obstacles to the goals of real reform. The concessions to the pharma industry particularly bother me. Any reform that doesn’t let Medicare negotiate directly for lower drug prices… well, it would be crazy to exclude that. That’s a Bush-league move, and I mean that literally.

I have been holding out hope that the final bill will resolve some of these issues, but there’s no denying that trying to please all the stakeholders is creating problems.

And then there’s the ongoing debate on how to pay for it. I think Obama’s pledge not to raise taxes on the middle class has always been a problem; there are just too many things to fix in our country to think we’re not all going to have to chip in and pay a little more. But I’d probably make a spectacularly unsuccessful political advisor. One thing to watch is a possible tax on health insurance companies. If I’m not mistaken, that sounds like the “provider tax” we have here in Minnesota. It’s extremely unpopular with physicians, hospitals, and health plans, but it has provided a stable source of funding for MinnesotaCare, one of our best public health programs.

Another issue that we’re hearing a lot about here in Minnesota is Medicare reimbursement. The system currently doesn’t do enough to reward quality over quantity, and it reimburses inefficient regions better than more efficient regions, such as the upper Midwest. Obama was going around talking about these regional differences in early July; I haven’t heard much about it lately, and that’s unfortunate. Without finding efficiencies, without changing the way some docs and regions practice, we will continue to have unsustainable increases in costs.

I’ve always supported the idea of getting the ball rolling on health care reform and refine it as it goes. But I very much want the best legislation possible, and the pressure is on the pro-reform lawmakers to deliver it.

46 Million Losers? Health Care Reform, Part Two

There are 46 million uninsured people in the United States. To me, this is pretty much the beginning and end of the health care debate. When the greatest nation on earth cannot provide adequate health insurance coverage to a huge chunk of its population, something is very wrong. This needs to be addressed, in my view, and the sooner the better.

But not everyone agrees. And one of the most interesting developments of the health care debate is how those opposing reform have tried to rationalize why it’s OK to leave 46 million people out in the cold, so to speak.

The rationalizations are many. The uninsured are lazy; they qualify for public programs but don’t take advantage of them. Or, they’re young and healthy (and selfish) and they don’t think they need health insurance. Or, as one person charmingly put it, they’re “ILLEGALS.”

A recent editorial in the Washington Times entitled “Who Are the Uninsured?” summed up these arguments pretty thoroughly. It concluded that many of the uninsured qualify for Medicaid, some are illegal immigrants, and others are uninsured by choice. “The truly uninsured are, thus, largely young people who can afford insurance but who make the decision to temporarily go without it as they move between jobs.”

This is, to put it kindly, a distortion of the true picture.

Many people who are uninsured are young. “The lack of health insurance has become especially acute for young adults,” says a report on the uninsured by the New England Public Policy Center at the Federal Reserve Bank of Boston. “Over the past 25 years, the likelihood of being uninsured has more than doubled for 25- to 44-year-olds.” But contrary to the Times conclusion, the PPC report concludes that the rising number of uninsured is due in part to the fact that many of the uninsured have either lost or never had access to employer-sponsored health plans. “Between 2000 and 2005, the share of Americans covered by health insurance fell from 64 percent to 60 percent, representing a drop of 3 million people,” the report says. “Over the same period, the share of establishments, both public and private, offering coverage declined from 69 percent to 60 percent.”

I can tell you that the employer surveys I’ve seen since 2005 show that this trend has continued.

Dr. Rani Whitfield, writing for the Urban Thought Collective, puts it this way: “Young adults between the ages of nineteen and twenty-nine with low income and unstable jobs are the fastest growing population of the uninsured in America.”

That low-income part is important. The Kaiser Family Foundation, in its report, “Who are the Uninsured? A Consistent Profile Across National Surveys,” says that surveys consistently show that the majority of the uninsured are in fact employed, but more than half of the uninsured are in low-income families. Poor-paying jobs generally don’t offer health care, or offer plans with high deductibles and copays that may be unaffordable for the workers.

“More than half of the uninsured are in low-income families and about half are ethnic or racial minorities. The majority of uninsured adults are working, but their lack of education makes it more difficult for them to get jobs that offer employer-sponsored coverage.

“Those with low incomes (less than 200% of the poverty level; or $37,620 for a family of four in 2003) are less likely to have jobs that offer employer-sponsored coverage and are also less likely to be able to afford their share of the premium. Roughly a third of the nonelderly population comes from low-income families, but they are disproportionately represented among the uninsured because their chances of being uninsured are over three times greater than those with higher incomes,” the report finds.

And Factcheck.org has a nice summary of the issue, drawing on the KFF data:

“Ever since health coverage became a major issue in the 2008 presidential campaign, we've received periodic questions from readers who wonder whether a large percentage of the uninsured are non-citizens or illegal immigrants. They're not. According to the nonpartisan Kaiser Family Foundation, 79 percent of the uninsured are native or naturalized U.S. citizens. The remaining 21 percent accounts for both legal and illegal immigrants.

“What else can we say about the uninsured? More than 80 percent are from families in which at least one person works (70 percent from families where at least one person works full-time, and an additional 12 percent from families with a part-time worker). Two thirds are near or below the poverty line, making less than 200 percent of the federal poverty level. Only a small number (20 percent) are children, but nearly half are below the age of 30. Non-Hispanic whites make up two thirds of the population but less than half of the uninsured, and they are also more likely than any other race to have private insurance.

So there we have it, young, poor, and often minority people are more likely to be uninsured. Sounds like an important part of Obama’s coalition, no? Maybe that’s one reason he’s pushing health care reform.

Or maybe he just thinks 46 million uninsured in the United States is inexcusable.

Health Care Reform - Part One

This looks to be a very eventful week for the health care reform movement. The plans that Congress and Obama have been promoting are getting some real serious pushback, and Obama’s going to have to work hard to find success in achieving serious reforms.

At the end of the day, Democrats still have a majority in both houses, so it’s likely that something will pass. Worst case scenario, I think, is that we see some serious reforms to health insurance boundaries – for example, no more canceling policies after someone got sick because of a newly-discovered “pre-existing condition.” Just reforms like that will be an improvement, and Obama may be forced to settle for small-scale improvements and declare victory.

But I would hope that the country can do better. I do know that I’m seeing a lot of lively debate among friends, some of whom believe that we’re heading down the road to socialist Armageddon if we follow Obama’s lead.

Some of this debate I’ve ignored, some of it I’ve participated in. But after a while it seems to me that there are quite a few serious issues that keep coming up. So rather than, say, go back and forth on FaceBook with a few people, I’m going to make an effort this week to post some health care reform thoughts here, and provide at least some documentation to back up those views. Feel free to comment.

This could be a historic moment. The more discussion, the better.

And just to start things off on a lighter note:


Study: Most Children Strongly Opposed To Children’s Healthcare

Tuesday, July 07, 2009

Sarah Palin, WTF?

Sorry for the crude title, but really, it's pretty appropriate. Palin has shown herself to be a pretty erratic character, and I cannot see how this helps her if she does indeed have presidential ambitions. Half a term as governor, and then she quits? If it was *anyone* else, people would be saying this is political suicide, but because Palin is seen as the populist face of the Republican party, some are still, amazingly, trying to spin it as a ultra-special-maverick-y move. Come on.

All in all, not a great coupla months for Republicans in the public image department.

Wednesday, July 01, 2009

That's Senator Franken to you.

Is it my imagination or is Al Franken starting to look like the late Sen. Paul Simon from Illinois? All he needs is a bowtie.

Well, so that didn't take long. Congratulations to Tall Guy who predicted the Franken win during the final days of the campaign.

I recommend Chris Cillizza's short but insightful take on the final outcome. Basically, he says, it came down to organization, discipline, and money. Three cornerstones to any winning political campaign.

All I can say is Minnesotans are relieved this thing is over.

And hey, Bill O'Reilly? YOU'RE WELCOME!