From Xico

The Myth of Consumer Choice « The Baseline Scenario

I’m such a public radio groupie that David Kestenbaum and Chana Joffe-Walt are minor idols of mine. I get excited on the very occasional occasions when David calls to ask me a question, and Chana . . . well, if I were in my twenties and single, I would probably have a crush on her. So I was disappointed to listen through their recent Planet Money episode on health care, waiting for them to tell the other side of the story, but finally being left to yell at my radio. (No, I don’t actually yell at inanimate objects, but you know what I mean.)

via baselinescenario.com

A good article on the delusion of consumer choice. You have to read the whole thing. Baseline Scenario provides (almost) comprehensible articles on economic issues, including health care reform.

A wonderful blog on cooking and on Molly Izenberg, its author

Here: http://orangette.blogspot.com/

It is called Orangette.  Molly and Brandon have just opened a restaurant.  It is like reading a novel, sort of, and the recipes are fabulous.

IMPORTANT: Bill Moyers Journal . Transcripts | PBS on health care uncivil discourse.

September 4, 2009BILL MOYERS: The editors of THE ECONOMIST magazine say America's health care debate has become a touch delirious, with people accusing each other of being evil-mongers, dealers in death, and un-American. Well, that's charitable. I would say it's more deranged than delirious, and definitely not un-American. Those crackpots on the right praying for Obama to die and be sent to hell — they're the warp and woof of home-grown nuttiness. So is the creature from the Second Amendment who showed up at the President's rally armed to the teeth. He's certainly one of us. Red, white, and blue kooks are as American as apple pie and conspiracy theories. Bill Maher asked me on his show last week if America is still a great nation. I should have said it's the greatest show on earth. Forget what you learned in civics about the Founding Fathers — we're the children of Barnum and Bailey, our founding con men. Their freak show was the forerunner of today's talk radio. Speaking of which: we've posted on our website an essay by the media scholar Henry Giroux. He describes the growing domination of hate radio as one of the crucial elements in a "culture of cruelty" increasingly marked by overt racism, hostility and disdain for others, coupled with a simmering threat of mob violence toward any political figure who believes health care reform is the most vital of safety nets, especially now that the central issue of life and politics is no longer about working to get ahead, but struggling simply to survive. So here we are, wallowing in our dysfunction. Governed — if you listen to the rabble rousers — by a black nationalist from Kenya smuggled into the United States to kill Sarah Palin's baby. And yes, I could almost buy their belief that Saddam Hussein had weapons of mass destruction, only I think he shipped them to Washington, where they've been recycled as lobbyists and trained in the alchemy of money laundering, which turns an old-fashioned bribe into a First Amendment right. Only in a fantasy capital like Washington could Sunday morning talk shows become the high church of conventional wisdom, with partisan shills treated as holy men whose gospel of prosperity always seems to boil down to lower taxes for the rich. Poor Obama. He came to town preaching the religion of nice. But every time he bows politely, the harder the Republicans kick him. No one's ever conquered Washington politics by constantly saying "pretty please" to the guys trying to cut your throat. Let's get on with it, Mr. President. We're up the proverbial creek with spaghetti as our paddle. This health care thing could have been the crossing of the Delaware, the turning point in the next American Revolution — the moment we put the mercenaries to rout, as General Washington did the Hessians at Trenton. We could have stamped our victory "Made in the USA." We could have said to the world, "Look what we did!" And we could have turned to each other and said, "Thank you." As it is, we're about to get health care reform that measures human beings only in corporate terms of a cost-benefit analysis. I mean this is topsy-turvy — we should be treating health as a condition, not a commodity. As we speak, Pfizer, the world's largest drug maker, has been fined a record $2.3 billion dollars as a civil and criminal — yes, that's criminal, as in fraud — penalty for promoting prescription drugs with the subtlety of the Russian mafia. It's the fourth time in a decade Pfizer's been called on the carpet. And these are the people into whose tender mercies Congress and the White House would deliver us? Come on, Mr. President. Show us America is more than a circus or a market. Remind us of our greatness as a democracy. When you speak to Congress next week, just come out and say it. We thought we heard you say during the campaign last year that you want a government run insurance plan alongside private insurance — mostly premium-based, with subsidies for low-and-moderate income people. Open to all individuals and employees who want to join and with everyone free to choose the doctors we want. We thought you said Uncle Sam would sign on as our tough, cost-minded negotiator standing up to the cartel of drug and insurance companies and Wall Street investors whose only interest is a company's share price and profits. Here's a suggestion, Mr. President: ask Josh Marshall to draft your speech. Josh is the founder of the website talkingpointsmemo.com. He's a journalist and historian, not a politician. He doesn't split things down the middle and call it a victory for the masses. He's offered the simplest and most accurate description yet of a public insurance plan — one that essentially asks people: would you like the option — the voluntary option — of buying into Medicare before you're 65? Check it out, Mr. President. This health care thing is make or break for your leadership, but for us, it's life and death. No more Mr. Nice Guy, Mr. President. We need a fighter. That's it for the Journal. I'm Bill Moyers. See you next time.

via www.pbs.org

Read this from the normally very civil Bill Moyers. It is shocking but I agree with him.

Health Care Reform and Tort Reform

In the previous post, I mentioned tort reform.  I should clarify I don't mean TORT reform, I mean the reform of how doctors and hospitals deal with careless errors and malpractice that harm patients.  Continuing the current system of addressing errors and malpractice is not a great idea, to say the least.  Caps on awards certainly wouldn't stop our problems. Here Dean Baker gives a broad-brush picture of why:

Doctors are rarely sanctioned by medical boards for negligence. (Doctors usually control the licensing boards.) If they don't face serious civil penalties for negligence, then we are likely to see more incompetent doctors remaining in practice.

 What is needed is a new system for addressing medical errors and malpractice problem, including a willingness to survey records for mistakes so that technical and educational improvements could be made and some kind of arbitration system that neither lawyers nor doctors nor insurance have undue influence over.  This is another example of an issue which the market certainly doesn't address properly.

And while you go after the lawyers, please also remember that insurance companies make a lot of money off liability insurance.

Health Care Reform, YES -- A critical look

The page in the left  side bar of this blog has some graphs which indicate expense problems with current health care.  Some points to bear in mind:

 1.  When people hear the trillion dollar bill mentioned as the cost of health care reform

    a. This is not THAT much more than the Republicans blithely removed from the federal budget when they removed the estate tax which affected only the richest among us.

    b.  It will be spread over ten years.

    c. PERHAPS, just perhaps, if it works, this money will really be redirected money that people are currently paying to private insurance companies.  

I have qualms with health insurance reform.  But we can't address our qualms effectively until we've moved from our current screaming match and are addressing questions from within the issue. 

Qualms include:

    a. Yes, bureaucracy.  I'd like to see an outline of how this compares to current systems which contro medical practice and hospitalization, etc.  My biggest annoyances were inspections of facilities and records that caused all of us to clean up stuff with some artifice just before inspectors showed up and that, yes, did interfere with treatment for various reasons.  BUT THE INSPECTORS CAME FROM PRIVATE ORGANIZATIONS!

    b. Lower prices for coverage and payments to providers should not be TOO low as Medicaid currently are.  Medicaid was no great shakes when I was in the field, either, let me tell you.  At times patients were victims; at times they couldn't find care.

    c. Are there any efforts to deal meaningfully with law suits?  As I understand it, law suits per se are not that much of a contribution to high costs, but the following surely are: doctor's liability insurance premiums, especially in some fields; the fear of suits leading to excessive and sometimes harmful tests and treatments.

    d. Are there any efforts to have the government pay for medical school so that students don't think of medical school as an entrance to a high paying job as much as (or at least any more than) as a public service?  Payment of fees should entail some obligatory medical service after training, as is done in Mexico.

    e. Are there any plans to do something about the nurse and primary provider shortage?  Primary providers would be key to efforts to lower costs. A primary provider also gains much better knowledge of his patients as people with a complex of issues than any specialist possibly can. They should be the lifeblood of medicine. This is what I think people are referring to when they talk about choosing their own doctor.  Nurses actually could do with more equality with doctors.  They are not diagnosticians, but in hospitals where they see patients more than doctors do, when they are good, they have the best insights into the patients and they also are key to patients' treatment and recovery. 

    d. There should be use of measures of treatment effectiveness and outcomes, but will those reviewing and writing standards of practice remember that statistics provide group answers, not individual answers, so that while 85% of people may respond to such and such a treatment, 15% won't so other treatments need to be available?

 These qualms characterize the CURRENT system.  I would hope that reform would CORRECT them.

Old Stuff All Over the Place -- It Must Have Been Crowded in Mexico in the Old Days

Right now there is (among many others) archaeological project at a place called Calixtahualca, north of Toluca, the capital city of the state of Mexico. It is under the direction of Michael E. Smith of Arizona State University.  Smith's interests are in both studies of ancient cities and of pre-Hispanic Mexico.  He's a very good and readable writer.  You should check out his book, The Aztecs, which is available on Kindle (yay!).  Smith is one of a number of contemporary scholars who have a passion for trying to figure out who people really were, how they might have thought, what their lives were like and how they planned their cities.

 Anyway, he has a blog on this project, and for those of you with an interest in the workings of an archaeological project in Mexico, here's the link.   You can also find out more on the project's web page here.  Many more links are available at these sites.

The Instituto Nacional de Antropología e Historia (INAH) of Mexico presents a really nifty and impressive web page on a related site called Malinalco.  You should check it out: don't get dizzy, though, investigating it.  I found this linked to on Smith's blog.

Here's a picture from the INAH site of Malinalco:

Here in Mexico, too, we live in interesting times....

A link to Richard Grabman's Mex Files: http://mexfiles.net/2009/09/05/what-she-said-about-the-informe/

Richard has translated a post by the famous Denise Dresser on the current problems of Mexico and the need for citizens to speak up.  The only thing I'd disagree with is that I don't think Denise Dresser is all THAT establishment.  She has spoken passionately and boldly about Mexico's current state before. Two examples here in English and here in her open letter to Carlos Slim (in spanish).

Veracruz in September

This month marks the 99th anniversary of the beginning of Mexico's struggle for independence.  NEXT year we will see HUGE parties, but this year enough is no small potatoes.  There is a lot going on in our beautiful state of Veracrz.  

Here is a link to the official site of the State of Veracruz:  

http://portal.veracruz.gob.mx/portal/page?_pageid=153,1&_dad=portal&_schema=PORTAL

Much information in English to follow.

 

Government Reform and Health Insurance: Will it Really Save You Money?

There is plenty of stuff we should be discussing when it comes to government reform of health care coverage which we are not because of all the Republican sound and fury.  For me, in addition to the concern about the lack of a cap on costs of Emergency Room visits for the uninsured we should be worried  that without a public option there will be nothing really to keep prices affordable for anyone but those who fall into the enlarged Medicaid pool  and those on Medicare and the rich.  The numbers in the article below, from Kaiser Health News are dismaying. Following the article is a comment by Don McCanne for Physicians for Single Payer Health Care. Having a public option is the only way I can see that costs will really lessen for ordinary people.  If we don't have that, political oponents will probably (rightly) be able to charge that reform failed to provide for middle class citizens.  For you who don't understand the public option idea, as I understand it at least, it will be a government insurance program that will be able to keep prices lower by eliminating the costs/salaries/stock profits/bonuses of health insurance companies; by setting fees for doctors; by establishing some quality control measures to evaluate treatment outcomes; and by forcing pharmaceutical companies to lower their prices through a bidding system as the VA (I think) now does.

Kaiser Health News

September 4, 2009

KHN Exclusive: Congressional Documents Show Health Cost

These documents, prepared by the House Committee on Ways and Means and obtained by KHN, show the maximum premiums and out-of-pocket costs low- and moderate-income people might face under the House health overhaul plan, called America's Affordable Health Choices Act (HR 3200).

One example selected from the tables:

Family of four with an income of 400% of the federal poverty level ($88,200):

Maximum monthly premium: $809 ($9708 per year)

Out-of-pocket cap (in addition to premium): $10,000

http://www.kaiserhealthnews.org/Stories/2009/September/04/House-Bill-Premiums.aspx

Comment: By Don McCann Under the House bill for reform (HR 3200), a family of four with an income of $88,200 that had health care needs could be responsible for $19,708 of their health care costs, which is 22% of their income (23% under the Energy and Commerce amendments). That would leave them with an income of $68,492 for all of their other needs and wants (and some of that could be burnt up in out-of-network costs and non-covered services that do not apply to the cap).

When people want to know what reform is going to cost them, it is usually the numbers in these tables that they want to see. Because of concerns about federal budget deficits, it is likely that the financial responsibility for individuals and families will be even greater than these tentative tables depict.

What is not included here is the amount that we are paying through the tax system for government-financed health care, which is roughly one-half of all health care expenditures (including health plans purchased for government employees, but excluding tax subsidies of employer-sponsored plans which have an uncertain future).

Health care is very expensive, and Congress is selecting the most expensive model that has ever been devised to pay for it.

We're retired and on Medicare, so the numbers above have little meaning for us. But they mean a lot to our children and will mean even more to our grandchildren. Selecting reform using numbers that don't work this year and will be even worse in future years is not a legacy that we want to leave to our children and grandchildren nor anyone else's either.

Let's improve the least expensive model - Medicare - and then share it with all of our future generations. That's an American solution of which we would all be proud, and, to the point, one which we could afford.  [The Medicare model would provide a very good public option. -- Esther]

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Ending Hospital Price Discrimination Against the Uninsured - Economix Blog - NYTimes.com

As President Obama and Congress find themselves constrained by a rapidly growing federal deficit, they may have to be parsimonious in the subsidies granted uninsured families toward the purchase of health insurance. Many solid middle-class, uninsured Americans may not benefit much or at all from such subsidies. Absent a mandate to the contrary, and perhaps even with such a mandate, they may remain uninsured.

via economix.blogs.nytimes.com

The high cost of emergency room treatment for the uninsured is likely to continue even WITH the reforms currently proposed.