Category Archives: Health Care

Bushies Are Trying to Kill You

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What else can one conclude from this, except that the Bushies have a dastardly plan to kill us, especially the poorer among us? Arian Campo-Flores writes at Newsweek.com that the Bush Administration is “reforming” Medicaid in a way that will cause emergency rooms and even hospitals themselves to close.

The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more.

Nearly a year ago the Institute of Medicine issued three reports (key findings here) saying the nation’s emergency rooms are inadequate and getting worse. Among other things, it found:

  • Demand for emergency care has been growing fast—emergency department (ED) visits grew by 26 percent between 1993 and 2003.
  • But over the same period, the number of EDs declined by 425, and the number of hospital beds declined by 198,000.
  • ED crowding is a hospital-wide problem—patients back up in the ED because they can not get admitted to inpatient beds.
  • As a result, patients are often “boarded”—held in the ED until an inpatient bed becomes available—for 48 hours or more.
  • Also, ambulances are frequently diverted from overcrowded EDs to other hospitals that may be farther away and may not have the optimal services.
  • In 2003, ambulances were diverted 501,000 times—an average of once every minute.

    • After these reports came out, David Brown wrote in the Washington Post:

    The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

    This is related to the ongoing controversy over disaster response (quoting the key findings from the National Institute of Medicine linked above):

    The emergency care system is ill-prepared to handle a major disaster. [Drawn from all three reports]

  • With many EDs at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack.
  • EMS received only 4 percent of Department of Homeland Security first responder funding in 2002 and 2003.
  • Emergency Medical Technicians in non-fire based services have received an average of less than one hour of training in disaster response.
  • Both hospital and EMS personnel lack personal protective equipment needed to effectively respond to chemical, biological, or nuclear threats.

    • That going on six years after 9/11 there has been no coherent effort to prepare the nation for biochemical or nuclear attacks goes way beyond the parameters of incompetence, IMO. The ridiculous Department of Homeland Security tosses money at pork projects and “contractors” (with ties to Republicans in Washington, one suspects) who don’t deliver. Yet to fund tax cuts for the rich and Bush’s pointless Iraq War — which is supposed to be about keeping America safer somehow — Bush’s government lets our ability to respond to disasters go to rot.

    On 9/11 New York City actually had surplus medical emergency response. That day the city’s wealth of world-class medical personnel and state-of-the-art facilities mustered a triage army around the Financial District. (I understand this was done on the initiative of New York City’s medical community; Rudy Giuliani didn’t have to ask.) But the nature of the disaster was such that people either got out, or they didn’t. The crack medical teams had little else to do but wipe bloody noses and wash dust out of eyes.

    But poor New Orleans after Katrina was a different story. Kerry Sanders reported for NBC News on September 2, 2005, that the sick, injured and dead alike were being stacked up at the New Orleans airport:

    The stench of death reeks inside portions of the airport here. Other parts of the airport just smell as any hospital would if there was no way to clean up. It is human misery as people are lying in pain, ailing and wailing.

    The pained screams from patients is like fingers on a chalkboard because there is nothing you can do to reach out and help these people. They have limited medical supplies. They do have aircraft coming in. The C-17s, Storm-30s are moving people out of here as fast as they can. …

    … A reporter is supposed to remain detached and just report what’s going on. But, when there is a man lying on the ground, and he’s yelling out to anyone walking by, “Help me! I need some water! Help me!” and there is no one to help this man.

    The moral is, if you’re ever a victim of a natural disaster or terrorist attack, be sure you’re someplace with really expensive real estate. Increasingly, America’s alleged “best health care in the world” is reserved for the well-to-do. Last year Jane Bryant Quinn wrote,

    America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

    To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

    But now, in true Bush style, the Bush Administration is going to take a grim situation and make it worse. Let’s go back to Arian Campo-Flores at Newsweek.com:

    The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

    Let’s see; the Bushies have run the National Guard into the ground and now they’re fixin’ to close hospitals. This at the very time that disaster and terrorist attack response is supposed to be a critical priority. Does it get dumber, or what?

    See also: The Mahablog, “Je m’amuse” (June 15, 2006).

    Assigning Blame

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    Following up yesterday’s post on the “causes” of the Virginia Tech massacre — I was disappointed to see that Arianna Huffington wrote this:

    Reports that Cho had been taking antidepressants once again turn the spotlight on the uneasy question of what role these powerful medications might have played in yet another campus massacre.

    It’s the same bloody-morning-after question I’ve been asking since 1998, when we learned 15-year old Oregon school shooter Kip Kinkel, who opened fire in his school cafeteria, had been on Prozac. Nearly ten years — and numerous school-shooters-on-prescription-meds — later, we’re still waiting for answers….

    … Eli Lilly, the maker of Prozac, has vehemently denied numerous claims that the drug causes violent or suicidal reactions. But the company’s own documents admit that “nervousness, anxiety, insomnia, inner restlessness (akathisia), suicidal thoughts, self mutilation, manic behavior” are among the “usual adverse effects” of the medication. And a clinical trial found that Prozac caused mania in 6 percent of the children studied.

    Can there be any doubt that Cho was exhibiting many of these adverse effects during his reign of terror in Blacksburg? His rambling, multi-media diatribe seems like a textbook example of manic behavior. The question is, was his manic behavior purely the result of a sick mind or was drug-induced psychosis part of the toxic psychological mix?

    We don’t know. But we do know that one school shooter after another was on prescription drugs. Kip Kinkel was taking Prozac. Columbine killer Eric Harris was taking Luvox. Red Lake Indian Reservation shooter Jeff Weise was taking Prozac. James Wilson, who shot 2 elementary school kids in Greenwood, South Carolina, was taking anti-depressants. Conyers, Georgia school shooter T.J. Solomon was on ritalin. Is this just a coincidence?

    A “coincidence” that people with behavioral problems are prescribed drugs? Huffington seems to think that these were perfectly well-adjusted children until some pharmaceutical salesman got hold of them. I doubt that’s the case. It’s more likely that these kids were given drugs after they developed some behavioral pathologies, in hopes that the drugs would help. Apparently, they didn’t. It is unfortunately the case that Prozac doesn’t do squat for, say, attachment disorder or other personality disorders, which might well have been behind all of the atrocities Arianna cites. It is also unfortunately the case that the only treatment for some problems is long and intensive (and expensive) work with a therapist. It’s easier to hand out pills

    We can only speculate what was going on with Seung-Hui Cho, but schizophrenia certainly would account for all of his actions and behaviors. It’s typical for schizophrenics to be perfectly bright and normal children until they hit late adolescence or early adulthood — college years, in other words — when the symptoms begin to manifest. In rare cases symptoms are not apparent until the late 20s or early 30s. John Nash (the subject of “A Beautiful Mind“) fell apart during his graduate school years. The “Unibomber,” Ted Kaczynski, also began to struggle with his symptoms while in graduate school. At the moment it’s thought that schizophrenia is caused by a combination of genetic and environmental causes; it appears some people are born with some brain miswiring that makes them susceptible to developing the disease.

    Instead of incessantly looking for scapegoats like Prozac, what we need is a massive overhaul in the way our nation, society, and health system deals with psychiatric disease.

    I agree with Joan Walsh that we humans tend to look for patterns or causes in order to reassure ourselves that episodes like the Virginia Tech massacre are not completely random. Well, in a sense, it wasn’t completely random; it happened because a young man with a serious psychiatric disorder wasn’t getting proper treatment and supervision. It just didn’t happen because of cultural rot or video games or even Bill Clinton. Walsh also wrote,

    Several of the “lessons” people tried to draw were particularly heinous and bogus, of course. No matter what Michelle Malkin says, the answer to gun violence isn’t more guns. I already wrote about right-wing crackpots’ efforts to blame the victims for not fighting back, and I still can’t believe such cruelty didn’t get more coverage. Instead, on Sunday we got more noxious garbage on ABC’s “This Week,” as Newt Gingrich blamed liberalism for the massacre.

    On one level, this wasn’t a surprise. In 1994 the then-House speaker blamed liberalism when Susan Smith murdered her two children in North Carolina, and said the only way to prevent such tragedies was to “vote Republican.” He blamed liberals, again, for the 1999 Columbine killings. What surprises me is not what Gingrich says, but the very fact that the serial adulterer from Georgia is still on Sunday news shows lecturing the nation on morality. Aren’t there enough interesting, respectable, credible Republican leaders to make the rounds?

    And can you imagine if a major Democratic Party figure, who was once third in line for the White House and who might run for president again, was saying such idiotic and hateful things about Republicans? Can you imagine if, say, Al Gore blamed the Bush administration, or the conservative movement generally, for the Virginia Tech massacre? He would be howled into political exile by braying right-wingers, but it’s an acceptable part of mainstream discourse to blame liberalism for the nation’s most jarring tragedies. And mainstream media elites wonder why they’re losing their audience. (Tangent, or not: Was there a better symbol of the media elite’s growing irrelevance than the choice of Rich Little to entertain them — and mirror their obsolescence — at the White House Correspondents Association dinner Saturday night, after Stephen Colbert’s brave, bracing, hilarious performance last year?)

    (Aside: I actually feel sorry for Rich Little. He’s an elderly fellow who was a big star in the 1970s. Now he probably feels publicly humiliated, and he’s going to be remembered as the old guy who bombed at the press dinner.)

    Update: Cho’s commitment papers.

    Edwards on Health Care

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    Marie Cocco and Paul Krugman have columns out today panning and praising, respectively, John Edwards’s national health care proposal. As much as I respect Professor Krugman, at first glance I have to side with Cocco on this one. The Edwards plan is a lot better than what we’ve got now, but I don’t think it’s where we want to go.

    As explained on Edwards’s campaign web site, the proposal would achieve universal coverage by:

  • Requiring businesses and other employers to either cover their employees or help finance their health insurance.
  • Making insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs.
  • Creating regional “Health Markets” to let every American share the bargaining power to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance.
  • Once these steps have been taken, requiring all American residents to get insurance.

    • You can read a PDF document explaining the plan in more detail here.

    This sounds a whole lot like a plan being floated by Arnold Schwarzenegger in California, as Krugman acknowledges. I wrote about the California plan here, and quoted Krugman about why the Schwarzenegger plan was bad. So why is the Edwards plan good? Krugman explains,

    People who don’t get insurance from their employers wouldn’t have to deal individually with insurance companies: they’d purchase insurance through “Health Markets”: government-run bodies negotiating with insurance companies on the public’s behalf. People would, in effect, be buying insurance from the government, with only the business of paying medical bills — not the function of granting insurance in the first place — outsourced to private insurers.

    Why is this such a good idea? As the Edwards press release points out, marketing and underwriting — the process of screening out high-risk clients — are responsible for two-thirds of insurance companies’ overhead. With insurers selling to government-run Health Markets, not directly to individuals, most of these expenses should go away, making insurance considerably cheaper.

    Better still, “Health Markets,” the press release says, “will offer a choice between private insurers and a public insurance plan modeled after Medicare.” This would offer a crucial degree of competition. The public insurance plan would almost certainly be cheaper than anything the private sector offers right now — after all, Medicare has very low overhead. Private insurers would either have to match the public plan’s low premiums, or lose the competition.

    Again, this is way better than what we’ve got now. But Marie Cocco says,

    John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

    Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

    Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business.

    He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

    The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

    So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

    I think that we need to get private insurers out of the picture except, maybe, for people who want to purchase supplemental policies like many folks on Medicare do. In practice, pure single-payer systems don’t seem to deliver as well as a system that covers everyone publicly but permits private insurance and providers to stay in business also.

    Since Edwards’s big draw is that he’s strong on domestic policy, to be a candidate I would support he’s going to have to be amazing on domestic policy. I think the health care proposal falls short of amazing.

    Health Care and Poison Pills

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    Awhile back Harold Meyerson wrote a column called “Master of the Poison Pill” in which he outlined the Karl Rove method of taking an issue away from the opposition. For example, in 2002 the Dems were getting traction on their proposal for a cabinet-level Department of Homeland Security, which the White House opposed. When the Bushies decided to flip-flop and create the DHS, they inserted a union-busting poison pill into the bill. Dems balked, and the Bushies promptly claimed the DHS as their own invention, accusing Dems of being opposed to national security.

    Sometimes it’s more than just a pill being used to poison a debate. Wingnuts still equate opposition to the war in Iraq with being “soft” on national security, even though Iraq ain’t doin’ a bleeping thing on behalf of national security except draining resources that could be put to better use elsewhere while causing more people to hate us. The Bushies tried to pull something like this with Bush’s Social Security “reform”; Dems were accused of being unwilling to “fix” Social Security because they didn’t back Bush’s plan. Fortunately the American people realized the “plan” was ridiculous.

    I’m already seeing signs that the Right is going to use Bush’s utterly absurd health care proposals to claim that Democrats aren’t serious about health care reform. There are two columns in the Washington Post today that say Dems are poopyheads for not even listening to Bush’s “ideas.” One is by the already mentioned and cognitively challenged Ruth Marcus, whom Brad DeLong and Ezra Klein skewer a lot better than I did. The other is business columnist Steven Pearlstein:

    … the most surprising and encouraging development is that a president who for six years has only nibbled around the edges of health-care issues has weighed in with some bold ideas to expand coverage, rein in costs and bring some fairness to the tax code. And get this: It actually involves raising taxes on the rich and lavishly insured and giving the money to the working poor and the uninsured.

    Given that, you’d think Democrats would have welcomed a politically courageous proposal to put a cap on one of the biggest and most regressive features of the individual income-tax code. But instead, they’ve shifted reflexively into partisan attack mode, mischaracterizing the impacts of the proposal and shamelessly parroting the propaganda from the labor dinosaurs at the AFL-CIO.

    “Dead on arrival,” declared Rep. Pete Stark (D-Calif.), chairman of a key health subcommittee in the House, hinting at a dark conspiracy to kill off employer-sponsored health insurance.

    In fact, Pete Stark’s web site proudly states:

    I’ve introduced a Constitutional Amendment to establish a right to health care for of equal high quality for every American. If ratified, this would force Congress to make health care coverage available to all Americans. My preferred approach to universal coverage is to build on the success of the Medicare program, which provides universal health care for our nation’s seniors and people with disabilities.

    Sounds to me as if Rep. Stark has already moved beyond the employer-based health insurance model, and that Steven Pearlstein is parroting propaganda from the policy dinosaurs at the Heritage Foundation.

    Pearlstein goes on to sing the praises of Bush’s proposal while accusing Dems of “class warfare.” He also says,

    Almost every health economist agrees that the tax subsidy for employer-paid health insurance is not only unfair but that it also encourages people to buy too much insurance, consume too much health care and pay too much for both. Bush deserves praise for having the political courage to confront the issue.

    Mr. Pearlstein, meet Paul Krugman.

    Some nameless dweeb at Opinion Journal credits Bush for initiating a discussion on health care:

    The U.S. has long needed a debate over health care and tax subsidies, and President Bush got ready to rumble last night with his proposal to make insurance more affordable for most Americans.

    That was bad enough, but in the very next sentence the dweeb actually wrote “Americans have the most advanced health care in the world,” meaning the dweeb plans to rumble with his head firmly planted up his ass. That should be a sight. Although notice he wrote “most advanced” instead of “best,” and it’s possible he could make an argument for “most advanced.” Years of “market forces” have given us a system that is grand at delivering state-of-the-art, boutique health services to the wealthy, even as poor women lack basic prenatal care and emergency rooms close.

    The dweeb puts forth more howlers, such as:

    These new [private health insurance] products are also likely to be policies that put individuals directly in charge of more routine spending. That’s because removing the tax advantage would mean it will make less financial sense to “insure” for predictable expenses like several annual office visits.

    In other words, he thinks insurers should not be covering preventative medicine, meaning people are less likely to indulge in those gold-plated, frivolous office visits to get their cholesterol monitored or their hearts checked or some such. Unfortunately, skimping on preventative care is a sure way to drive up costs overall.

    That in turn could put pressure on health care providers to post–and actually compete on–prices. Such new price awareness might even generate pressure for states that overregulate their insurance markets (New York, Massachusetts) to ease their costly mandates

    The “costly mandates” prevent insurers from refusing insurance to people who have pre-existing health problems. In states without these “costly mandates,” insurers can refuse to insure people with health problems. That reduces the insurers’ costs but doesn’t exactly solve the health care problem.

    It’s true that additional subsidies might be needed for some people with chronic illnesses who might have a harder time finding private insurance in this kind of world. And we’d also like to see a more national insurance market, with companies able to sell policies over the Internet free of the worst state mandates.

    You see the problem. While the dweeb casually acknowledges that a lot of people will need “additional subsidies,” he goes ahead and endorses the very policies that create the pool of people who need “additional subsidies.”

    Insurance works by pooling risk. The premiums paid by people who don’t file claims help pay for the claims that are filed. It’s true that many kinds of insurers charge more for people who have higher risks, such as a teenage driver. But essentially what the private health insurance industry wants is to insure pools of healthy people and force those with chronic health problems onto the mercy of taxpayers. If taxpayers are going to be stuck paying for the high-risk pool anyway, one wonders why we need private insurers at all. One big national system that puts everyone into the same pool would be more cost-effective for taxpayers, obviously.

    The dweeb concludes,

    This status quo won’t hold, and the political race is going to be between those who want to move to a more genuine market and consumer-based health care, and those who want to move toward Canada, Europe and more government control. The Bush plan ought to jump start that debate.

    Many nations have devised national health care plans in which people are free to choose their own doctors, make their own decisions, and keep their medical records private from the government. See Ezra Klein’s Health of Nations series for details on what works and what doesn’t. But what we have here is even worse than government control, because citizens still (although barely) have some say in what government does. Instead we have control by the private insurance industry, meaning people with no medical licenses right now are shuffling papers and deciding who gets treatment and who doesn’t.

    See also: MaxSpeak, The Carpetbagger, Kevin Drum. Brad DeLong thinks the whole proposal is a bluff:

    I believe it is overwhelmingly likely that this is, in fact, a bluff. And it is not clear to me why anybody should be in the business of welcoming things that are not “real solutions.”

    We should certainly welcome real solutions. But otherwise it seems to me that we are still in the standard Bush administration game of Dingbut Kabuki. The administration has made no effort to convince us that this will do more good in terms of redistributing income and increasing access to health insurance than it will do harm in magnifying adverse selection problems.

    Tonight’s the Night!

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    Be sure to drop by tonight for blow-by-blow live blogging of the State of the Union address. You are welcome to watch the SOTU along with me and add your commentary to the comments. Or, you can blow off the SOTU and add your commentary to the comments, anyway. I don’t know that it matters. You know the boy ain’t gonna say shit. I only plan to watch so I can see Nancy Pelosi looming in the background.

    However, there are some things we can watch for, like whether the creature can pull off looking confident, or if he says something that hasn’t already been leaked. Advance word is that the creature plans to focus on domestic policy; stuff that isn’t so much, you know, Iraq.

    The President is expected to announce a major health care initiative, which I discussed earlier this week, here and here. Today we have the exciting news that The Dumbest Health Care Plan Ever!â„¢ has gotten even dumber. Christopher Lee and Lori Montgomery write for the Washington Post,

    The best solutions to the problem of nearly 47 million Americans lacking health insurance are to be found in states across the country, Health and Human Services Secretary Mike Leavitt said Monday.

    President Bush will propose in his State of the Union address tonight, Leavitt said, that the federal government redirect some money from programs such as Medicaid and Medicare into a new grant program to help states devise and implement plans ensuring access to affordable health insurance.

    Leavitt, who did not specify a funding amount, said the new Affordable Choices Initiative would help fuel efforts already underway in states such as Massachusetts and California to guarantee access to basic health coverage for everyone.

    “The aspiration for all Americans to have access to a basic insurance policy at an affordable price is a widely held sentiment,” Leavitt said. “There will be two diverging philosophies on how to solve this problem. One will be to have the federal government ensure everybody, and the other will be, ‘Let the states lead.’ “

    The Massachusetts Plan hit some rocks recently when somebody figured out that the “affordable” insurance the plan promised would cost $380 on average per month for an individual, and “up to $580 per month for a 56-year-old.” The catch is that insurance is mandated, so poor, uninsured folks in Massachusetts are expected to scrape this money together somehow or be in violation of law

    But from a wingnut perspective, the Affordable Choices Initiative would not only slice a few pennies off the cost of health insurance, it would gut Medicare and Medicaid in the bargain! Win/win!

    WaPo’s Lee and Montgomery continue,

    Meanwhile, another Bush health care proposal drew a chilly reception from some Democrats. Bush will urge the creation of new tax breaks for the purchase of health insurance, especially by those who do not get coverage through work. Bush advisers acknowledged Monday that the plan initially would cost the federal government millions of dollars in lost revenue, but said that would be offset by more revenue in later years and the plan would pay for itself within the first decade.

    And you know that whenever a Bushie says a plan will “pay for itself” — we’ll be robbed.

    [Update: Ezra has more details on The Dumbest Health Care Plan Ever!â„¢]

    Here are some links to keep you busy as we anticipate the big event:

    Bush To Face Skeptical Congress

    Diminishing clout presents challenges for Bush

    From Hero to Goat

    How chilly a reception in the House chamber?

    Nearly two-thirds in U.S. have given up on Iraq

    Saving Their Seats, and Maybe the Country

    Stale of the Union

    State of Indifference

    State of the Union: Irate

    [Update:] Trying to Change the Subject

    Let Them Eat Gold-Plated Cake

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    Following up the SOTU preview post on President Bush’s health care plan — Paul Krugman explains the obvious —

    On the radio, Mr. Bush suggested that we should “treat health insurance more like home ownership.” He went on to say that “the current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance.”

    Wow. Those are the words of someone with no sense of what it’s like to be uninsured.

    Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an “incentive” to buy insurance; they need something that makes getting insurance possible.

    Most people without health insurance have low incomes, and just can’t afford the premiums. And making premiums tax-deductible is almost worthless to workers whose income puts them in a low tax bracket.

    Whenever some wingnut proposes to solve X problem by offering tax deductions to make something more “affordable” I want to tear my hair and scream. For people in low tax brackets this really is the same thing as “Let them eat cake.”

    Even if we took Bush’s comparisons to mortgage interest deductions seriously — the mortgage interest deduction doesn’t exactly make it possible for everyone to own his own home, does it? It’s a great benefit for people with average and above incomes, but owning a home is still way out of reach for people with lower incomes.

    Of those uninsured who aren’t low-income, many can’t get coverage because of pre-existing conditions — everything from diabetes to a long-ago case of jock itch. Again, tax deductions won’t solve their problem.

    Indeed. Bush’s plan “is tied to the average cost of family health coverage, which is currently $11,500 a year,” according to this article. I don’t have data handy, but I strongly suspect that if the insurance companies were not allowed to reject “undesirable” (i.e., sick) customers, that cost would be even higher.

    While proposing this high-end tax break, Mr. Bush is also proposing a tax increase — not on the wealthy, but on workers who, he thinks, have too much health insurance. The tax code, he said, “unwisely encourages workers to choose overly expensive, gold-plated plans. The result is that insurance premiums rise, and many Americans cannot afford the coverage they need.”

    Again, wow. No economic analysis I’m aware of says that when Peter chooses a good health plan, he raises Paul’s premiums. And look at the condescension. Will all those who think they have “gold plated” health coverage please raise their hands?

    Krugman writes that what’s behind this nonsense is a theory currently popular in wingnut think tank circles — that too many people have been spoiled by their health insurance, and if they had to pay for more of their health care costs out of their own pockets they’d be more frugal and do without luxury items. (Such as … ?)

    In the real world I ‘spect not a whole lot of people demand medical procedures unless doctors tell them they should have them, and insurance companies can always refuse to pay for procedures they deem unnecessary, anyway. In my experience if you press a wingnut to explain what these luxury procedures are, usually the first item they list is “unnecessary tests.” Doctors are supposed to do a better job of guessing what’s wrong with you and not rely so much on the “luxury” of medical technology, in other words.

    I realize there are people who demand tests for ailments that doctors know they don’t have. These people are called “hypochondriacs,” and most of ’em would benefit from seeing a shrink. But the wingnuts don’t want to pay for that, either.

    What’s really striking about Mr. Bush’s remarks, however, is the tone. The stuff about providing “incentives” to buy insurance, the sneering description of good coverage as “gold plated,” is right-wing think-tank jargon. In the past Mr. Bush’s speechwriters might have found less offensive language; now, they’re not even trying to hide his fundamental indifference to the plight of less-fortunate Americans.

    As I wrote here — once upon a time the British government chose not to provide food aid during the Irish potato famine because (they believed) the Irish were lazy and backward and too accustomed to being impoverished farm laborers, and a little hunger might make them more ambitious. Beside, importing cheap food undercut food prices (bad for business), and if the Irish were given food without working for it they’d become dependent on government handouts.

    So, more than a million Irish starved to death. If only they’d had more of those gold-plated potatoes.

    SOTU Preview!

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    I know you all are eager to hear the State of the Union address, which I will live blog. I’m not promising to live blog it sober, mind you, nor do I promise not to channel surf if it gets too painful. But I will do my bloggerly duty.

    In tomorrow’s New York Times, Sheryl Gay Stolberg and Robert Pear provide us a preview — Bush’s plan for national health care!

    You’ll like this, my lovelies. It’s as good as his Social Security plan.

    President Bush intends to use the State of the Union address on Tuesday to tackle the rising cost of health care with a one-two punch: tax breaks to help low-income people buy health insurance and tax increases for workers whose health plans cost more than the national average.

    “I will propose a tax reform designed to help make basic private insurance more affordable,” Mr. Bush said in his weekly radio address on Saturday, “whether you get it through your job or on your own.” He did not offer specifics, but an administration official provided details of the plan late Friday afternoon. …

    … The basic concept of the president’s plan is that employer-provided health insurance, now treated as a fringe benefit exempt from taxation, would no longer be entirely tax-free. Workers could be taxed if their coverage exceeded limits set by the government. But the government would also offer a new tax deduction for people buying health insurance on their own. …

    … Supporters say the plan would expand coverage to some of the 47 million uninsured. But critics say it would, in effect, tax people with insurance to provide coverage to those without it.

    Now, here is the bestest part.

    In his radio address on Saturday, Mr. Bush described his proposal as a way to “treat health insurance more like home ownership,” giving people tax deductions for their health insurance in much the same way as they get tax deductions for home mortgage interest. He said the current system “unwisely encourages workers to choose overly expensive, gold-plated plans,” driving up the overall cost of coverage and care.

    I’ll pause here to let you read that last paragraph two or three more times. It takes a while for the breathtaking — help me here; I need a noun that means “clueless” and “arrogant” at the same time.

    And isn’t this the same attitude that got Marie Antoinette decapitated?

    More clues about the SOTU:

    White House officials say Mr. Bush has decided to forgo the traditional formula for the State of the Union — a laundry list of ideas, many of them dead on arrival — in favor of a more thematic speech that will concentrate on a few issues, like health care, immigration and energy, on which he hopes to make gains with the new Democrat-controlled Congress.

    Yeah, that health care proposal is going to knock ’em dead.

    As he heads into the address, his first delivered to a Congress controlled entirely by Democrats, Mr. Bush faces intense skepticism from lawmakers over his new strategy in Iraq. But while he will not be able to avoid the subject of Iraq in the speech, White House officials hope to use the address to shift the national conversation away from the war and toward the possibility of bipartisan cooperation in Washington.

    I can’t stand it.

    How Americans Are

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    I’m guest-blogging on Crooks & Liars this week. I am trying to constrain myself over there and not write my usual kitchen-sink-plus posts. Yesterday and today I posted a couple of brief (for me) posts on two of my favorite subjects, post-Katrina reconstruction of New Orleans and the Gulf Coast, and America’s failing health care system.

    Although both posts were triggered by new news stories, there isn’t any information in them I haven’t ranted on about in the past. For the “kitchen sink” details of the “Katrina” post see The Mahablog “Katrina” archive. Past posts on the health care system issue include this, this, and this.

    Yesterday’s New York Times ran a column by Bob Herbert about the New Orleans Ninth Ward that I wish were not behind the subscription firewall. I am too repressed to defy the New York Times copyright and permissions department and post the whole thing here, even though I would probably get away with it. Anyway, Herbert writes that it “boggles the mind” that the U.S. seems to have taken the loss of a major city, New Orleans, in stride. Here’s a portion:

    Much of New Orleans is still a ruin. More than half of its population is gone and an enormous percentage of the people who are still in town are suffering.

    As Mr. [Spike] Lee noted, the public face of the city is to some extent a deceptive feel-good story. The Superdome, a chamber of horrors during the flood, has been made new again. And the city’s football team, the Saints, has turned its fortunes around and is sprinting into the National Football League playoffs. (They beat the Giants in New York yesterday, 30-7.)

    “They spent the money on the Superdome, and you can get drunk in the French Quarter again, and some of the conventions are coming back,” Mr. Lee said, “so people are trying to say that everything’s O.K. But that’s a lie.

    “They need to stop this focus on downtown and the Superdome because it does a disservice to all those people who are still in very deep trouble. They need to get the cameras out of the French Quarter and go to New Orleans East, or the Lower Ninth Ward. Or go to St. Bernard Parish. You’ll see that everything is not O.K. Far from it.”

    Vast acreages of ruined homes and staggering amounts of garbage and filth still burden the city. Scores of thousands of people remain jobless and homeless. The public schools that are open, for the most part, are a scandal. And the mental health situation, for the people in New Orleans and the evacuees scattered across the rest of the U.S., is yet another burgeoning tragedy.

    There’s actually a fifth act, only recently completed, to “When the Levees Broke,” in which a number of people reflect on what has been happening since the storm. Wynton Marsalis, ordinarily the mildest of individuals, looks into the camera with an expression of anger and deep disgust. “What is the government doing?” he asks. “They’re trying to figure out how to hand out contracts. How to lower the minimum wage so the subcontractors can make all the money. Steal money from me and you, man. We’re paying taxes, you understand what I’m saying?”

    For most of America, Katrina is an old story. In Mr. Lee’s words, people are suffering from “Katrina fatigue.” They’re not much interested in how the levees have only been patched up to pre-Katrina levels of safety, or how the insurance companies have ripped off thousands upon thousands of hard-working homeowners who are now destitute, or how, as USA Today reported, “One $7.5 billion Louisiana program to help people rebuild or relocate has put money in the hands of just 87 of the 89,403 homeowners who applied.”

    There are other matters vying for attention. The war in Iraq is going badly. Donald Trump and Rosie O’Donnell are feuding. And, after all, it’s Christmas.

    “You know how Americans are,” Mr. Lee said. “We’re on to the next thing.”

    That may be how Americans are, but what it says to me is that we have no effective national leadership. One of the most important functions of a leader is to keep people focused and working together on what needs to be done. And we just plain don’t have anyone filling that role right now. Dear Leader Bush is floating around in his bubble oblivious even to the basic responsibilities of the job of POTUS. In a nutshell, whatever doesn’t glorify him doesn’t interest him. And he is way disinterested in New Orleans’s Ninth Ward. Meanwhile, the favored federal contractors are profiteering with abandon, getting fat and rich on our tax dollars, while New Orleans stagnates. And while some individuals have worked hard to help New Orleans, without effective national leadership most of us feel helpless to effect any real improvement.

    Shameless

    Posted on by

    I’m not talking about Michael J. Fox’s television ad for Claire McCaskill. I’m talking about rightie reaction to it.

    Apparently embryonic stem cell research is a big issue in the McCaskill-Talent senatorial campaign in Missouri. The Democrat, McCaskill, is fer it, and the Republican, Talent, is agin’ it. Sam Hananel of Forbes describes the ad made by Fox:

    His body visibly wracked by tremors, actor Michael J. Fox speaks out for Missouri Democratic Senate candidate Claire McCaskill in a television ad that promotes her support for embryonic stem cell research.

    “As you might know I care deeply about stem cell research,” says 45-year-old actor, who has struggled with Parkinson’s disease for more than a decade. “In Missouri you can elect Claire McCaskill, who shares my hope for cures.”

    McCaskill has made support for the research a key part of her campaign to unseat Sen. Jim Talent. The Republican incumbent opposes the research as unethical, saying it destroys human embryos.

    The new ad debuted prominently Saturday night during Game 1 of the World Series between the St. Louis Cardinals and the Detroit Tigers and will continue airing statewide this week, a campaign spokeswoman said.

    I bet everybody in the state saw it, then.

    Debate over stem cell research looms large in the state, where voters are considering a ballot measure that would amend the state constitution to protect all federally allowed forms of the research, including embryonic stem cell research.

    “Unfortunately, Senator Jim Talent opposes expanding stem cell research,” Fox says in the 30-second spot. “Senator Talent even wanted to criminalize the science that gives us a chance for hope.”

    Rightie reaction? John Amato has an audio of Rush Limbaugh accusing Fox of faking his symptoms. “He is an actor, after all,” says Rush. (Rush is from a very wealthy and influential southeast Missouri family.)

    Dean Barnett, writing at Hugh Hewitt’s blog, disgusts me just as much. I have annotated the quote with footnotes.

    By way of response, let me first say that I think almost any kind of ad in support of a political campaign is fair game. If a candidate goes too far, the public will punish him or her. So while I find the Michael J. Fox ad crass, tasteless, [1] exploitative and absurd, I fully support Claire McCaskill’s right to shoot herself in the foot. [2]

    The most distasteful aspect of the ad is the way it exploits Michael J. Fox’s physical difficulties. [3] Fox is an actor, and clearly knew what he was doing when he signed up for the spot – no victim points for him for having been manipulated by the McCaskill campaign.[4] The ad’s aim is to make us feel so bad about Fox’s condition that logical debate is therefore precluded. [5] You either agree with Fox, or you sadistically endorse his further suffering as Fox accuses Jim Talent of doing.

    This is demagoguery analogous to the pernicious and pathetic chickenhawk argument. The whole “chickenhawk” logic is that only people who have served in the military are entitled to have an opinion on military matters. Thus, the ideas of non-veterans don’t warrant a hearing and thus don’t need rebutting.[6]

    While Michael J. Fox (like me) has some skin in the stem cell game that most people don’t, that doesn’t give him any special appreciation of the moral issues involved with embryonic stem cell research. Sick people may want cures and treatments more than the healthy population, but that doesn’t make them/us experts on morality. [7]

    My comments:

    [1] I’m sorry that Dean Barnett takes offense at the sight of other peoples’ suffering. I’m sure that in Dean Barnett’s perfect world, sick and handicapped people would be kept hidden away so the sight of them does not upset healthy people.

    [2] On the other hand, crass remarks about Michael J. Fox’s infirmities are certain to rally voters to the Republican cause.

    [3] Not only are physical infirmities tasteless; they also confer an unfair advantage.

    [4] Fox was “manipulated” by McCaskill? Apparently people with disabilities have lost the right to be free agents.

    [5] Ooo, “logical” debate! I wrote about “logical” morality yesterday. I’ll come back to it again in a minute.

    [6] A stirring argument. Too bad that Burnett’s “chickenhawk” is a straw bird.

    [7] Actually, I’d say the Fox ad is less an argument for morality than a test of morality. If you see the ad and feel compassion for Fox, you pass. If you whine about how tasteless, unfair, exploitative, or illogical it is, you flunk.

    Mr. Barnett, for reasons argued here, flunks.

    The Anchoress claims Fox is fighting for “bad science.” I’ve already explained here and here that it’s righties like the Anchoress who lie through their teeth about the science. Sister Toldjah, no lightweight in the idiot department, compares the ad to race baiting. (Go ahead and pause to ponder that one, if you need to.)

    At NRO, Kathryn Jean Lopez ladles the lies on thick and heavy by claiming the issue is about cloning. She links to this anti-science web site that says —

    When you see Amendment 2 at your polling place, you will be asked to decide whether to “ban human cloning or attempted cloning.” Sounds good so far, right? Who’s in favor of human cloning anyway?

    But the 2,100-word Constitutional Amendment—which you won’t see on election day—actually creates legal protection for human cloning. Hard to believe? It’s true. Amendment 2 only outlaws reproductive cloning, which no one in Missouri (or anywhere else on earth) is doing.

    Meanwhile, it protects anyone who wants to clone human beings for science experiments. Amendment 2 glosses over the issue of lab-created human life with complicated phrases like “Somatic Cell Nuclear Transfer.” But cloning is cloning, and Amendment 2 would put this ethically questionable practice beyond the reach of state law.

    And the Big Lie is, of course, that non-reproductive cloning, also called “therapeutic” cloning, does not clone “human beings.” In therapeutic cloning the cloned cells do not develop into an embryo but instead are used only to develop stem cells. A stem cell is no more a “being” than a toenail.

    The fact is that righties are just plain on the wrong side of the embryonic stem cell issue. They’re on the wrong side of it both morally and scientifically. Whine all they like, that’s not going to change. I’m afraid they’ll be whining for a while.

    BTW, McCaskill is my adopted Senate candidate. Please help fight the forces of darkness and donate a buck or two by clicking here.

    Update: See Jonathan Cohn, who interviews William J. Weiner M.D., professor and chairman of the department of neurology at the University of Maryland Medical Center and director of the Parkinson’s clinic there. Dr. Weiner said:

    What you are seeing on the video is side effects of the medication. He has to take that medication to sit there and talk to you like that. … He’s not over-dramatizing. … [Limbaugh] is revealing his ignorance of Parkinson’s disease, because people with Parkinson’s don’t look like that at all when they’re not taking their medication. They look stiff, and frozen, and don’t move at all. … People with Parkinson’s, when they’ve had the disease for awhile, are in this bind, where if they don’t take any medication, they can be stiff and hardly able to talk. And if they do take their medication, so they can talk, they get all of this movement, like what you see in the ad.

    Hat tip John Amato.

    Update update: This is rude.

    This Blog Made Possible by Bupropion

    Posted on by

    Via TPM Reader DK at Josh Marshall’s place — reporter Chris Rose of the New Orleans Times Picayne describes his descent into clinical depression and how he got his life back with medication.

    He starts with an anecdote that perhaps only other depressives can relate to:

    I pulled into the Shell station on Magazine Street, my car running on fumes. I turned off the motor. And then I just sat there.

    There were other people pumping gas at the island I had pulled into and I didn’t want them to see me, didn’t want to see them, didn’t want to nod hello, didn’t want to interact in any fashion.

    Outside the window, they looked like characters in a movie. But not my movie.

    I tried to wait them out, but others would follow, get out of their cars and pump and pay and drive off, always followed by more cars, more people. How can they do this, like everything is normal, I wondered. Where do they go? What do they do?

    It was early August and two minutes in my car with the windows up and the air conditioner off was insufferable. I was trapped, in my car and in my head.

    So I drove off with an empty tank rather than face strangers at a gas station.

    Many years ago I went to a DMV office for some reason; I think I had to change my address. After wandering around a bit in the office I found some forms I needed to fill while waiting in line. But there were no pens or pencils handy. I dug around in my purse for a while and found nothing to write with. So I took the form and went home, because I couldn’t bring myself to ask anyone for a pen.

    And that’s when I was getting better. At least I got to the DMV office.

    Here’s a passage I endorse enthusiastically.

    In his book “Darkness Visible: A Memoir of Madness” — the best literary guide to the disease that I have found — the writer William Styron recounted his own descent into and recovery from depression, and one of the biggest obstacles, he said, was the term itself, what he calls “a true wimp of a word.”

    He traces the medical use of the word “depression” to a Swiss psychiatrist named Adolf Meyer, who, Styron said, “had a tin ear for the finer rhythms of English and therefore was unaware of the damage he had inflicted by offering ‘depression’ as a descriptive noun for such a dreadful and raging disease.

    “Nonetheless, for over 75 years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.”

    He continued: “As one who has suffered from the malady in extremis yet returned to tell the tale, I would lobby for a truly arresting designation. ‘Brainstorm,’ for instance, has unfortunately been preempted to describe, somewhat jocularly, intellectual inspiration. But something along these lines is needed.

    “Told that someone’s mood disorder has evolved into a storm — a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else — even the uninformed layman might display sympathy rather than the standard reaction that ‘depression’ evokes, something akin to ‘So what?’ or ‘You’ll pull out of it’ or ‘We all have bad days.’ “

    Some time before the DMV incident, when I was worse, I abandoned a cart full of food and ran in panic from a grocery store because someone told me to cheer up and smile. (Don’t ever do that to anyone you don’t know.)

    Styron is a helluva writer. His words were my life. I was having one serious brainstorm. Hell, it was a brain hurricane, Category 5. But what happens when your own personal despair starts bleeding over into the lives of those around you?

    What happens when you can’t get out of your car at the gas station even when you’re out of gas? Man, talk about the perfect metaphor.

    Depression don’t get no respect because of the name. The common emotion depression and the disease depression are two entirely different things, but even some doctors and therapists can’t get that.

    … here’s my doctor’s take: The amount of cortisol in my brain increased to dangerous levels. The overproduction, in turn, was blocking the transmission of serotonin and norepinephrine.

    Some definitions: Cortisol is the hormone produced in response to chronic stress. Serotonin and norepinephrine are neurotransmitters — chemical messengers — that mediate messages between nerves in the brain, and this communication system is the basic source of all mood and behavior.

    The chemistry department at the University of Bristol in England has a massive Web database for serotonin, titled, appropriately: “The Molecule of Happiness.”

    And I wasn’t getting enough. My brain was literally shorting out. The cells were not properly communicating. Chemical imbalances, likely caused by increased stress hormones — cortisol, to be precise — were dogging the work of my neurotransmitters, my electrical wiring. A real and true physiological deterioration had begun.

    I had a disease.

    Rose was lucky. His employer realized he was sick and cut him slack, and his wife also recognized he needed help. He got almost immediately relief from a new medication, Cymbalta, instead of going through weeks or months of trial and error — waiting for a new drug to begin working, trying another dosage or another drug if it doesn’t. As Rose’s psychiatrist said, it’s a crapshoot. Many anti-depressants have to be taken for two to four weeks before any effects kick in, and sometimes the effects never kick in.

    Do-gooders trying to get anti-depressive meds banned because of anecdotal evidence they cause suicides need to understand that untreated depressives kill themselves at much higher rates than not-depressed people. If someone who just started to take Paxil commits suicide, that doesn’t mean the Paxil made him do it. If the Paxil was a factor at all, more likely the patient became more despondent because it wasn’t working. Or, it’s possible a patient who is too enervated and mentally disorganized to do much but sit and stare into space might get just better enough to carry out a suicide plan.

    And don’t forget — people get misdiagnosed. When someone taking an antidepressant becomes violent — Eric Harris of Columbine High School fame, for example — before blaming the drug, ask why he was taking it to begin with. He may not have been depressed; he may have been bipolar, which calls for different drugs, or he may have been psycopathic, a condition that doesn’t respond to medication. Also, the drugs may work differently on juvenile brains than on adult brains.

    I hear people who have tried antidepressants say that the drugs suppressed their emotions and made them feel mentally foggy, which suggests to me they didn’t have the disease depression but just the common emotion of depression. If your brain chemistry and neurotransmitters are functioning normally, anti-depressants may make you feel worse. They aren’t “happy pills.” Taking anti-depressants if your brain is healthy is as stupid as taking insulin if you aren’t diabetic. However, if you are depressed, with the right meds your thinking becomes clearer and your emotions are normal. It’s important to understand this, because ignorance may be keeping some people from taking meds who could genuinely benefit from them.

    Too many people still have medieval attitudes about psychiatric disorders. Many of them are caused by real physical and chemical changes in the brain, and these should be treated with the same respect as any other disease in any other organ.