Health care Politics The Opinionsphere

Shame on You, Mr. Hentoff

[digg-reddit-me]Mr. Hentoff,

I have been following you for years – ever since my father suggested I read your column because you were honest and independent-minded and liberal. I have admired your steadfast positions, including on abortion and right to life issues. But your last column was truly shameful.

Given your career and the reputation you have built and maintained, you should be embarrassed to have such poorly sourced journalism attributed to your name. It reads like something an overeager Cato intern might have thrown together – with the sloppy reference to Pelosi condemning the “furor” as “un-American” and the casual defamation of Ezekial Emanuel. It’s hard to tell if you made these points out of laziness – not taking the time to investigate the standard right wing talking points on health care – or if you chose to use your stature to lie.

If you had chosen to read the op-ed published by Speaker Pelosi and Representative Steny Hoyer (conveniently linked to here) you would have noticed that they never called the protestors or the furor “un-American” as many right wingers have claimed. Instead, they made a statement which you doubtless agree with:

Drowning out opposing views is simply un-American.

Which means your statement – misidentifying the co-author of the piece as Senate Majority Leader Harry Reid – calling them “blind to truly participatory democracy” began with a faulty premise.

Regarding your next point: If you had chosen to read the article you quote by Dr. Ezekial Emanuel (among others) instead of simply quoting the Washington Times editorial quoting the article – or if you had even done some sort of search beyond that single right wing editorial – you would have found that Dr. Emanual was not describing how he believes medical resources should be allocated – but considering what should be done in times or situations of extreme scarcity, such as during a pandemic or with extremely scarce resources such as organs to be donated. The article describes 8 systems for distributing extremely scare resources/services – and recommends 6 of them be incorporated into any decision-making process. The quote you push here is cribbed from the description of one system. It is a blatant falsehood to claim it represents Dr. Emanuel’s overall thought on the subject. And I know you are an old man, but would you seriously put forward the moral proposition that if your kidney is failing – and so is a 12-year old girl’s – you should get priority to that kidney?

To state that this quote means that Dr. Emanuel is in favor of medical rationing is a lie. To state that it means Dr. Emanuel is in favor of euthanasia is a lie. (In fact, one of the articles you link to clearly states that Dr. Emanual is and has been opposed to euthanasia.). To  insinuate that the plans currently under consideration are pushing such rationing or euthanasia or death panels is finally a lie too far.

You clearly know little about the bills under consideration – as you conflate the subsidies for voluntary end of life counseling and the Independent Medicare Advisory Board – as Sarah Palin in her ignorance did – into a “life-decider” panel that decides whether you merit “government-controlled funds to keep you alive.” You also make this ominous point:

The members of that ultimate federal board will themselves not have examined or seen the patient in question.

Of course, it is unclear what panel it is you are trying to describe here. As mentioned above, it seems a conflation of one panel in the proposed legislation – and a provision to subsidize end of life counseling – with both fearfully conflated and confused into one panel that has a quite different purpose. The closest thing to what you’re describing in the bill would be the Independent Medicare Advisory Board – which is an amended version of the current MedPAC which sets Medicare reimbursement rates. It would be checked by Congress and the President – either of whom would be able to reject any untoward recommendations by the board. In addition, either the IMAC or another advisory board would collect and distribute research on “best practices” in medicine – comparing the comparative effectiveness of different treatments for the same or similar diseases.

Of course, none of these boards would be making decision about individual patients – as you claim. But clearly, you didn’t take the time to look into any of this.

Shame on you, Nat Hentoff. This was a poor piece of journalism that only succeeds in spreading lies about health reform even further.

If you value your journalistic integrity, you should issue a retraction and apologize to Dr. Emanuel – or double down and explain what primary sources you have for your rather frightening conclusions. Until then, your opinion must clearly be dismissed as the shoddy piece of right wing talking points that it has become.

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The Web and Technology

Brief Thoughts for the Week of 2009-08-21

  • Whoa. just discovered @jwcampbe and Direct Messages aren't the same thing. so many message i've missed. I will be getting back to y'all now. #
  • who – just discovered @jwcampbe…so many message i've missed. I will be getting back to y'all now… #
  • A very long day. #
  • Quoting @ezraklein "It would be neither decent nor democratic to doom hc because bill's greatest advocate contracted incurable brain cancer" #
  • "You can only find truth with logic if you have already found truth without it." G. K. Chesterton #
  • Try following this flow chart: #
  • "Man, I would do unspeakable things to that chick…" (SFW) #
  • Bizarre things afoot. #
  • Obama’s Promise Was To Break the Hold the Idiocrats Have On Our Society; so far, he's failing #
  • My horoscope today: "In an effort to lose a few lbs, walk at least part of the way no matter where you go." #
  • YouTube Story of a trip to Europe: "My girlfriend, although great in many respects, was not the greatest listener…" #
  • 1001 Rules for My Unborn Son: No. 384. All drinking challenges must be accepted. #
  • "Love is what we call it when our neuroses are compatible. Happy Monday." #
  • So frustrating watching MTP. David Gregory isn't a moderator of debate; every time a debate starts, he stops it to say its time to "Move on" #
  • Does anyone have a recommendation of a good web host? I think I need to switch. #

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Barack Obama Economics Financial Crisis Health care Life Morality Politics Reflections The Opinionsphere The Web and Technology

Weekly Must-Reads: Disappearing, the Super-Rich, Harry Potter, the Public Option, Craziness, and Abortion

[digg-reddit-me]A low-key blogging day today. Further events complicated my normal week-night blog writing, as my brother was hospitalized yesterday. He’s doing fine. But to some extent, it impressed upon me the reality of some small portion of this health care debate. To get to my brother’s room, I had to walk through the hospital – through security measures in the pediatric section, and then further security measures in the Intensive Care Unit of the pediatric section – and then to his room where I saw him, looking wan, but apparently much better than in the morning, with maybe a half-dozen tubes giving him drugs and liquid and food and another half-dozen wires monitoring his oxygen levels and heart beat and who knows what else. The nurses had to do tests on him every hour. And as I visited in the evening, I didn’t see the doctors who are figuring out what’s wrong and directing the treatment. The whole set-up must be outrageously expensive. And with my brother lying there, getting better, every cent is worth it. As a society, we have made a choice to spend some large portion of our wealth on protecting our families, ourselves – on following our natural human instinct to care for those who are not well. We have made a choice to maximize life at the expense of wealth.

But we must acknowledge that our system has limits. If my father didn’t have a generous health insurance plan, he could never have afforded for my brother to be treated this way. The hospital would treat him anyway – and then they would go after my father for everything he had. About a third of all Americans would be in this position – on the verge of bankruptcy – if an emergency required serious medical attention. And while hospitals have an ethical obligation to treat anyone who needs treatment, studies have shown that those without sufficient insurance get significantly worse treatment. When people argue that health care is not a right, they must do so in the face of those who need treatment. And if you consider health care to be a right, then health insurance must be a necessary responsibility for each citizen.

We do need to reign in increasing health care costs; we also need to preserve our system’s willingness to spend. But what we need most of all is a reasoned debate about what type of system we have and what type of system we want – and it doesn’t seem that America is capable of that. To that, I don’t know the solution.

Without further ado, here are the must-reads of the week:

1. Disappearing. Evan Ratcliff explains in Wired the difficulty of disappearing in our modern world – and how even the smallest slip-up can bring the authorities to your door. It’s an interesting look at the desire to start over – and how technology today makes it both easier and harder.

2. The Super-Rich. David Leonhardt and Geraldine Fabrikant examine the implications of the current recession on the super-rich – including John McAfee of McAfee Anti-Virus fame, whose net worth went from $100 million to $4 million in the downturn. Not that anyone should feel bad for the guy. The piece looks at the historical implications of our recent massive inequality and what this downturn’s implications are for such inequality in the long-term. The prognosis: the super-rich will stay richer than they were in the 1950s and 1960s, but their relative wealth will decline a bit.

3. Harry Potter and theological libraries. Michael Paulson in the Boston Globe explains how Harry Potter is becoming a serious subject of theological debate:

[S]cholars of religion have begun developing a more nuanced take on the Potter phenomenon, with some arguing that the wildly popular series of books and films contains positive ethical messages and a narrative arc that is worthy of serious scholarly examination and even theological reflection. The scholars are primarily interested in what the books have to say about the two big issues that always preoccupy people of faith – morality and mortality – but some are also interested in what the series has to say about tolerance (Harry and friends are notably open to people and creatures who differ from them) and bullying, the nature and presence of evil in society, and the existence of the supernatural.

Scholarly interest in the Harry Potter books began long before the series was finished, and shows no signs of slowing. There have been several academic books, with titles such as “The Ivory Tower and Harry Potter: Perspectives on a Literary Phenomenon” and “Harry Potter’s World: Multidisciplinary Critical Perspectives.” The American Academy of Religion last fall offered a panel at its annual convention titled “The Potterian Way of Death: J. K. Rowling’s Conception of Mortality.” And there is a raft of articles in religion journals with titles including “Looking for God in Harry Potter” and “Engaging with the spirituality of Harry Potter,” as well as the more complex, “Harry Potter and the baptism of the imagination,” “Harry Potter and the problem of evil,” and the crowd-pleasing “Harry Potter and theological libraries.”

4. Fighting for the Public Option. Ezra Klein makes a persuasive argument against simply giving up on the public option, but he still comes down on the side of those willing to give it up:

For all that, it’s one thing to fight for an uncertain, but promising, policy experiment. It’s another thing to sacrifice health-care reform on its altar. In July, Families USA released a paper explaining “10 Reasons to Support Heath-Care Reform.” The public plan is one of the reasons. But only one of them. And it’s not even the most convincing.

5. Crazy is a Preexisting Condition. Rick Perlstein, author of Nixonland, has an editorial in the Washington Post examining the “crazy” that he sees as an essentially American part of the political process. Read the whole piece:

So the birthers, the anti-tax tea-partiers, the town hall hecklers — these are “either” the genuine grass roots or evil conspirators staging scenes for YouTube? The quiver on the lips of the man pushing the wheelchair, the crazed risk of carrying a pistol around a president — too heartfelt to be an act. The lockstep strangeness of the mad lies on the protesters’ signs — too uniform to be spontaneous. They are both. If you don’t understand that any moment of genuine political change always produces both, you can’t understand America, where the crazy tree blooms in every moment of liberal ascendancy, and where elites exploit the crazy for their own narrow interests.

6. Watching an Abortion. Sarah Kliff for Newsweek, who is pro-choice, watched her first abortion and reported on her feelings. Rather moving and honest. A welcome inclusion into our fraught debate.

[Image by me.]

Health care Politics

Quote of the Day

From the daily bit of news for the “thinking man,” a profound point about the health care reform debate:

Old folks haven’t been this impassioned since Matlock went off the air and Sizzler posted “No sharing” signs on their salad bar.

On a side note: Sorry for the light posting today. I was out late last night and didn’t get to put together my usual queue of posts. But on a related note, you should see In the Loop, and if you’re going to sit down for an extended period of time, this isn’t the best location.

National Security Politics The Bush Legacy The War on Terrorism

The CIA Hired Blackwater to Help with Covert Killings

Mark Mazzetti gleans another detail in the “executive assassination ring” that Leon Panetta finally found out about earlier this summer and promptly informed Congress of: the always upstanding, peace-loving organization Blackwater was involved, having been hired by the CIA to help in some unclear capacity. As Mazzetti points out, hiring a private organization to participate in a covert killing program adds yet another layer of bureacracy and legal protections that makes accountability all the harder. This is especially true of Blackwater, given its byzantine structure and secretive leader, Erik Prince.

Barack Obama Health care Politics

Tricking Us Into Real Health Care Reform

Matt Yglesias posits a legislative maneuver to split the health care legislation into two parts: one with various insurance industry reforms, creating the health insurance exchange, an employer mandate, and a weak and underfunded co-op that would get 60 votes. And a second bill passed through the reconciliation process which would only need 50 votes which would strengthen and tweak the co-op to make it stronger – and get it closer to what progressives want.

To a great degree, those with power can often just push and get away with anything. Look at George W. Bush’s behavior on tax cuts, on the Medicare prescription drug benefit, on the Iraq war – or Bill Clinton on Bosnia. But in this climate, this type of trick isn’t what we need. A show of force whereby Obama pushes the Democrats to forthrightly endorse a bill would be – and play – much better in my opinion. Shenanigans – while legal – can be forgotten in time if the legislation proves popular; but a show of force would be more effective on almost every other level.

Barack Obama Health care

The Selfishness of Reform’s Opponents

[digg-reddit-me]It’s not good politics to attack “Grandma,”* but…

Everyone has noticed that many of the opponents of health care reform are the elderly and near-elderly (especially the older batch of Baby Boomers). They rail against “government-run health care” – but of course, that’s exactly what they enjoy – and enjoy it they do, professing higher levels of satisfaction with their insurance than any other group.

So why are they so anxious about health care reform then? It’s simple: Their rants about “tyranny” are just a cover for the fact that they realize their health insurance could barely get better – and so they have little incentive to support any changes, except to benefit their children.

The system we have now works well for only a few groups of people; it works poorly for many people (who lack choice and security while paying large sums) and not at all for about 47 million. It is estimated that 18,000 Americans die each year because they lack health insurance. Insurance premiums are rising exponentially and are forcing companies to forgo giving their employees raises. Millions more each year enter the rolls of the uninsured as fewer and fewer can afford it. Those who have health insurance often fear what would happen if they lose it and have little choice in picking their plan. Our current system is self-evidently unsustainable.

Yet those who benefit under our current system – especially those with government-provided Medicare coverage – are adamantly opposed to any changes, even should they benefit the rest of us. This is the classic Baby Boomer mentality: Put off every difficult decision and wearying task to the next generation; sacrifice nothing yourself, take everything. It is this attitude that George W. Bush with his massive tax cuts and massive spending increases signified; and it is this attitude that leads men and women enjoying government health care financed by the rest of us to adamantly refuse to even consider changes to our unsustainable health care system that would benefit their children based on the fear that any change might hurt them (even if it is designed to avoid any such thing).

There are other reasons to oppose health care reform – ideological reasons to oppose any government involvement and pragmatic ones to oppose these particular reforms – but the “movement” has clearly been dominated by these selfish Baby Boomers concerned, as always, only for themselves.

Here’s my message to those selfish opponents of health care reform: Shame on you. You’re not even being asked to sacrifice anything. You only oppose this out of the fear that you someday might be so asked. Your parents sacrificed for you – and left you with a better world. They paid 90% tax rates, went to war, worked hard and made America the most powerful nation in the world. Now, you won’t even support simple reforms. Shame on you…

*And mine is great, so y’all better leave her out of this.
[Image by The One True b!x licensed under Creative Commons.]

Barack Obama Health care Politics

Health Care Lie #492*: A Government Takeover of 16% of the Economy

*I’ve stopped counting, so that number is made up.

[digg-reddit-me]We’ve all heard this claim – that Obama’s health care reform – specifically the public option – is really a stealth attempt to socialize America and have the government take over a significant portion of our economy.

This claim isn’t true. However, unlike the fearmongering that is the invocation of “death panels,” there is a bit more substance to this accusation. But like so much of this debate, it has little to do with the bills currently under consideration which have rather weak public options. What this claim is based on are the hopes of progressives that the public option could prove to the country how great and effective government health care is and thus lead to a single-payer, Medicare For All type system.

According to Mark Schmitt of The American Prospect, the public option was latched onto by progressives early on as a potential “stealth” tool to gradually move America into a Medicare-for-all type system – as they assumed that given the choice, most citizens would prefer government-run health care. As Ezra Klein summarized Schmitt’s piece:

The reason the idea managed to catch the liberal establishment’s imagination was that it was sold as a way of achieving single-payer, or something close to it, within the current constraints of the political system.

Those on the right wing saw the fervor that accompanied discussions of the public option and soon identified it as a potential target. But the public option wasn’t designed to work as a stealth tool. Its main designer and earliest promoter, Jacob Hacker saw his policy “as an alternative to single payer” and “as a competitive alternative to private insurance” – in other words, as a way to maintain some of the advantages of the system a large number of Americans currently have while offering a different model of competition to keep insurance companies honest. The initial design of the public option – which remains intact today – would create a self-sustaining, non-profit agency that competes with private plans on a Health Insurance Exchange. Perhaps the best explanation of why this would work comes from Michael F. Cannon of the Cato Institute who – while trying to attack the possibility of a public option – made this observation:

Any payment system creates perverse incentives…which is why we need competition between different payment systems to temper the excesses of each. So if Kaiser Permanente is skimping on care, which is the perverse incentive its payment system creates, there are fee-for-service insurers on a level playing field that can lure patients away from Kaiser. That tempers the rate at which Kaiser succumbs to those perverse incentives…

This understanding of how markets work – and how a competing payment system could improve health care for all – is exactly the reason so many people were in favor of a choice between a public option and private ones before the current fear-mongering campaign.

Hacker’s policy is what President Obama has decided he wants in a public option, as he explained Time‘s Karen Tumulty:

It shouldn’t be something that’s simply a taxpayer-subsidized system that wasn’t accountable, but rather had to be self-sustaining through premiums and that had to compete with private insurers.

Tumulty later described Obama’s position on the public option:

Obama has never presented the public option as anything other than a means to an end — one that he would be perfectly willing to achieve through other avenues if necessary. His goal is twofold: to provide a low-cost alternative to the private system that already exists and to assure competition in a health-care market where it is generally lacking.

Further demonstrating that the goal of Obama’s health care reform is not to stealthily push America into a Medicare For All program, he has signalled he would be willing to accept a co-op in place of the public option. However, while Republicans had promoted the idea of co-ops as an alternative to the public option, they now are quickly moving away from this position. Ezra Klein explains:

This is a dynamic we saw in 1994. A compromise is offered, and after great anguish and infighting, Democrats grudgingly move toward it. Then the compromise is yanked away. The famous example of this is Bob Dole voting against two bills that had the name “Dole” in the title.

Someone here is acting in bad faith and has a secret agenda. It doesn’t seem to be the Democrats.

Conclusion: The public option could become a stealth path to single-payer. Just like Medicare could. Or Medicaid. Or S-Chip. Or any other legislation that has ever dealt with the serious problems in our market for health insurance. But what we’re seeing now isn’t a stealth option – as much as both progressives and right wingers may want to pretend it is. If our nation is moving towards a single-payer Medicare-for-all-system, this legislation isn’t what will get us there. That fight will come later.

And for what it’s worth: the public option isn’t the most important part of health care reform. The Health Insurance Exchange (on which the co-op or public option would sit along with private companies) is more important – as are the various reforms of the health insurance industry.

(Some other resources on the public option are this Slate magazine piece from 2006 and this report by Jacob Hacker on the advantages of allowing the public to choose a public option.)

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Criticism Politics The Media

David Bauder Passes On Bernard Goldberg’s Dubious Claim

I wonder how an inane comment like this can get reprinted in a news story (written by David Bauder of the Associated Press):

Since Fox is already the network of choice for conservatives, the ratings indicate it must be drawing in more moderates and even liberals, said Bernard Goldberg…

The claim being made here is ridiculous – that because ratings arae increasing, it must mean Fox News is attracting “moderatates and even liberals.” Fox News’s audience number in the millions; the number of conservatives and right wingers in America number in the tens of millions at least. I can see why a propagandist list Goldberg would want to make every disingenuous claim he can get away with – but why would David Bauder of the Associated Press pass on such a clearly dubious claim?

[Image by arellis49 licensed under Creative Commons.]

Barack Obama Politics The Opinionsphere

The Caricature of Rahm Emanuel

I thought it was pretty amusing that Zeke Emanuel didn’t seem ready to play along with Ezra Klein’s last farcical questions about his brother, Rahm:

What is your brother Rahm’s favorite food?

Good question. I don’t know, actually.

I’ve heard it’s the still-beating hearts of his enemies.

Oh, my brother is a lovely person. He doesn’t do any of that.

Perhaps this has something to do with the fact that Ezekial is still smarting from the ongoing campaign to paint him as a “Dr. Death” who wants to euthanize those who aren’t productive enough. (This despite the fact that he has been on record as opposing euthanasia since at least a decade ago.)

Of course, this Times piece over the weekend by Peter Baker and Jeff Zeleny profiling Rahm Emanuel has a much lighter take on the most powerful chief of staff in memory:

The caricature of Mr. Emanuel as a profanity-spewing operative has given way to a more nuanced view: as a profanity-spewing operative with a keen understanding of how to employ power…

[Image not subject to copyright.]