Before any more people start going bonkers that I’m accusing Dan Riehl of anything, take a breath. I’m just saying one doesn’t rule anything in or out without some firm answers. After all, Riehl is a man, and most serial rapists are men. All I’m doing is looking at any and all possibilities.

I know nothing about Riehl except what’s in his bio. But who knows if Riehl is telling the truth in his bio? If he’s a serial rapist, wouldn’t he be lying? I’m just saying you can’t leave out any possibilities.

Riehl looks at the apparent murder of Bill Sparkman, who was found hanging in a Kentucky cemetery with the word “fed” written on his chest and his census worker’s tag duct taped to his neck. And the first thing that pops into Riehl’s mind is that the murder has something to do with sex, and that Sparkman might have been a child predator. That tells you something. I don’t know what, but something.

One might speculate that Riehl was involved in Sparkman’s murder and is trying to throw off investigators with the sex angle. I have no evidence that connects Riehl to the murder, but it’s important not to rule anything out.

I suppose there’s even a possibility that Riehl is a disguised bug creature from another galaxy, and the Sparkman homicide was part of the initial assault to take over Earth. Having read Riehl’s blog, this would explain a lot. I have no evidence that Riehl is a bug creature, of course, so don’t go bonkers. I’m just saying you can’t rule anything out.

What’s wrong with conservatism, in a nutshell:

[Video no longer available]

In the video, Sen. Jon Kyl’s (R-AZ) wants to strike language from the Senate Finance Committee’s bill that mandates which which benefits employers are required to cover — for example, maternity care.”I don’t need maternity care,” Kyl said. “So requiring that on my insurance policy is something that I don’t need and will make the policy more expensive.”

Sen. Debbie Stabenow (D-MI) interrupted: “I think your mom probably did.”

Once again, do Republicans not get risk pooling? If the only people who add maternity benefits to their insurance are young couples planning families, their insurance is going to go through the roof. It’s only by spreading the cost out across a big pool that it can possibly be affordable.

These people make me crazy.

One of the most surreal items on the Web today is this interview by Ezra Klein of Sen. Kent Conrad, a Democrat from North Dakota and member of the infamous “gang of six” holding up the Senate health care reform bill in order to chase some phantom of “bipartisanship.”

What comes across all too painfully is that Conrad has no idea what he’s talking about. Conrad recently read T.R. Reid’s The Healing of America, and this is what he took away from it: Conrad thinks the health care system “in France, Germany, Japan, Belgium and Switzerland, is not government-run. That doesn’t mean there’s no government involvement. But it’s not a government-run system. They have largely private insurance, with employers contributing.”

This is, um, not true. Ezra tries to explain: “In France, for instance, the insurance really is government-run. The vast majority of people are on public insurance, and there’s private supplementary insurance atop that. So too with Japan. They’re not confined to simply subsidizing the poor.”

But Conrad comes back and says “But it’s not government-run. The doctors and hospitals are private. You’re right that in France there’s more of a government involvement beyond providing money for those who can’t afford coverage. There’s a regulatory involvement in terms of what’s required by the plans. But the plans themselves, the mutuals, are not government.”

To this last statement Ezra has supplied a footnote: “The French mutuals provide supplementary private insurance. Basic insurance is provided by a program the French call Social Security.” My understanding is that the French have a public insurance system that covers all citizens with the option of purchasing private supplemental insurance if they want to.

Quoting Steve Benen:

Matt Yglesias noted that in Germany, consumers are required to purchase coverage from one of many non-profit “sickness funds” that are regulated by the government. “It’s true that this meets a technical definition of ‘not government-run.'” Matt explained. “But the extent to which the Germany system isn’t government run doesn’t extend to dealing with any of the concerns of private industry. Which is fine by me, but nothing in Conrad’s talk of co-ops and such has suggested that he’s serious trying to put for-profit health insurance out of business, which is exactly what the German model does.”

I see a whole lot of semantic noise around the term “government-run.” On the one hand, Conrad seems to want to define “government-run” health care as a system like Britain’s, in which doctors in the National Health Service are government employees. However, a system in which tax dollars are paying for citizens’ health care via some kind of government administration, but in which government is not actively involved in managing health care, is not government-run. That’s fine, but for Conrad that definition only applies overseas. As you read on, you see that he defines the proposed public insurance option for the U.S. as “government-run health care.”

And what’s even more stunning is that Conrad seems to have only recently noticed that nations other than Canada and the UK have national health care systems.

Meanwhile, there’s a new New York Times poll in which a majority of respondents “were confused about the health care argument and that Mr. Obama had not done a good job in explaining what he was trying to accomplish.” 46 percent said they didn’t know enough about the President’s health care proposals to support or oppose them. Of the remainder, 30 percent mostly support and 23 percent mostly oppose. I assume the remaining 1 percent don’t know what “health care” is.

However, as Josh Marshall points out, the same poll asked:

“Would you favor or oppose the government offering everyone a government administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private health insurance plans?”

Favor 65%
Oppose 26%

Interestingly, according to the poll, support for a public option has jumped 5 points since late August and opposition to it has dropped 8 points.

This suggests to me that a large majority of Americans would favor the President’s proposals if they knew what they were. And yes, President Obama could have been more assertive throughout the summer at pushing back against the insanity spewing from the Right. But I think the larger blame for public confusion has to go to the Right, for its aggressive disinformation campaign, and news media for passively reporting the disinformation.

Whatever the truth turns out to be about the current ACORN scandal, the speed at which Congress moved to de-fund the organization without conducting its own investigation stinks out loud. One strongly expects that an organization catering to wealthy white people that was caught in the same sting would have been treated differently.

John Wellington Ennis writes,

It is vital to assess how this backlash was accepted so quickly in light of videos that were from someone whose films are funded by conservative backers, videos that misrepresented ACORN through editing and not disclosing other failed attempts at their desired response, which may well have been dubbed over, if O’Keefe would dare to release the unedited tapes in their real context to prove otherwise. …

… Is this same adolescent accountability accepted by defense contractors, when Blackwater and its owner Erik Prince are implicated in murder? He just keeps getting contracts.

The Right turned ACORN into the Bogeyman some time back, to the point that the mere mention of the name ACORN sends righties into mouth-foaming, irrational hysteria. I think some of them genuinely believe that ACORN is the only reason their candidates crashed and burned in the last couple of elections.

ACORN is suing the filmmakers and Andrew Breitbart’s Breitbart.com for conducting electronic surveillance without their consent, which is a felony under Maryland law. Ben Smith writes, “I’m not sure of the P.R. value of suing without challenging the substance of the videos, but in the short-term, at least, it’s probably good for Breitbart et al.”

Probably, but perhaps ACORN’s real plan is to subpoena those unedited tapes, if they haven’t already been shredded.

Politicians and pundits keep declaring the public option dead, yet it refuses to be buried. The most recent resuscitation is explained in The Hill by Mike Soraghan, under the headline “Pelosi backs away from deal with Blue Dogs.” The headline is misleading, but here’s the story:

Nancy Pelosi had wanted a public option modeled on Medicare, with providers getting reimbursed on a scale pegged to Medicare rates. The Blue Dogs were opposed to tying the public option to Medicare. So she approved a deal negotiated by Rep. Henry Waxman to remove the link to Medicare to secure the Blue Dogs’ support.

However, Soraghan says, Rep. Mike Ross (D-Ark.), who heads the Blue Dogs’ health care task force, now says he won’t support a public option under any circumstances, “essentially withdrawing his support for the deal.”

The headline, however, implies that Pelosi broke the deal, not the Blue Dogs. Reaction from righties (who, as we know, do not read): “Pelosi leaves Blue Dogs to twist in the wind on health care reform.” Another rightie site says Pelosi “double crossed” the Blue Dogs. I guess in Rightie World, “double crossed” means the opposite of what it means in the normal universe.

As dday says, “Ross, secure with his payoff from a pharmacy chain from a couple years back, has nobody to blame but himself.” Also, it’s about time people started to notice who won the last couple of elections. Hint: not conservatives.

Anyway, the result is that the stronger version of the public option has now been restored to the House bill, which is a bit of good news. And an editorial in today’s New York Times reminds us what’s at stake.

Because they whine that no one takes them seriously, I’ve been trying to learn more about what Republicans really, truly propose to do about health care beyond don’t get sick.

Here’s the official Republican explanation of the official Republican health care reform plan, as explained on GOP.gov, the official congressional Republican website. You can find more details on Congressman Roy Blunt’s site. Here’s the outline — the Republican plan —

• Would allow people who purchase insurance on their own to take an “above the line” deduction equal to the cost of an individual’s or family’s insurance premiums.

I assume this is without an income limit, as if your medical expenses are high enough and/or you are poor enough you can do that already. Notice it’s not helping poor folks buy insurance.

• “Provides immediate substantial financial assistance, through new refundable and advanceable tax credits, to low- and modest-income Americans.”

And this would work, how? I looked at H.R. 3400, the Empowering Patients First Act, which I believe is the GOP’s most recent proposal. Section 101 (beginning on page 4) is on tax credits. I can’t decipher it. If any of you want to give it a shot, be my guest.

In any event, is this a plan to set up a government bureaucracy to which people would apply for credits or refunds? And this is supposed to save the taxpayers’ money?

• “Recognizes that many Americans who have not yet hit retirement age but may be changing jobs or have lost a job often face higher health care costs. To help those aged 55 to 64, the plan increases support for pre- and early-retirees with low- and modest-incomes.”

What does that mean, “increases support”? I dimly remember there was talk of this regarding a McCain proposal, but I don’t remember and cannot find details. If you can offer any clues, let me know.

• “The plan allows states, small businesses, associations, and other organizations to band together and offer health insurance at lower costs.”

That’s fine, but by itself it’s like giving people a pile of rocks and telling them to fill the ocean.

• Implements comprehensive medical liability reform that will reduce costly, unnecessary defensive medicine practiced by doctors trying to protect themselves from overzealous trial lawyers.

Enough of this. I give you Mitchell Schnurman, Dallas-Fort Worth Star-Telegram, on the state of “defensive medicine in Texas six years after their last big “tort reform” act that was supposed to solve their health-care crisis:

Roughly half as many malpractice suits are being filed in Texas these days. Liability premiums, which had doubled before reform, have declined more than 30 percent. …

… Healthcare spending has grown faster in Texas than the rest of the country. Patients are paying more for health insurance and medical bills. Doctors do more tests and scans, an indication that so-called defensive medicine hasn’t declined here.

There also hasn’t been more coverage for the uninsured, a top priority in the Obama push. In Texas, 1 in 4 residents has no health coverage, the highest percentage in the nation and well above the national norm.

See, doctors will self-report that they order X amount of texts and procedures because they are afraid of litigation. Much of the estimates about the astronomical costs of “defensive medicine” are based on those self-reports. But in the real world, in every state that has drastically reduced the number of malpractice suits through tort “reform,” we see no reduction in either costs or in the amount of tests or procedures ordered. Relieving them of much of the jeopardy of litigation does not change physicians’ test- or procedure-ordering habits, in other words.

• Provides Medicare and Medicaid with additional authority and resources to stop waste, fraud, and abuse that costs taxpayers billions of dollars every year.

Everybody, including President Obama, wants to wring savings our of Medicare and Medicaid. How much real waste, fraud, etc. exist in this programs, and how realistic it is to get “billions” of savings out of them, I cannot say, but I think I’ll put that investigation off for another post.

• Creates incentives to save now for future and long-term health care needs by improving health savings accounts and flexible spending arrangements as well as creating new tax benefits to offset the cost of long-term care premiums.

In other words, instead of reforming the current system, we’ll use tax credits to support the current system. And health savings accounts are a joke for anyone except the already wealthy.

• “Gives financial help to caregivers who provide in-home care for a loved one.”

That’s it. According to Rep. Blunt, that’s the plan.

I want to go back to H.R. 3400. I don’t have time to wade through the whole thing line by line, but this one part jumped out at me.

SEC. 201. REQUIRING OPERATION OF HIGH-RISK POOL OR OTHER MECHANISM AS CONDITION FOR AVAILABILITY OF TAX CREDIT.

No credit shall be allowed under section 36B of the Internal Revenue Code of 1986 (relating to health insurance costs of low-income individuals) to the residents of any State unless such State meets the following requirements:

(1) The State must implement a high-risk pool or a reinsurance pool or other risk-adjustment mechanism (as defined in section 211).

(2) Assessments levied by the State for purposes of funding such a pool or mechanism must only be used for funding and administering such pool or mechanism.

(3) Such pool or mechanism must incorporate the application of such tax credit into such pool or mechanism.

Help me out, here — what are the Republicans up to with this? It doesn’t sound good.

I realize that the purpose of HR 3400 was to have a stack of paper to wave at President Obama and call a “Republican health care plan.” I doubt even the Republicans take it seriously as a legislative proposal. But I do think it’s important to underscore the fact that the Republicans, in effect, have no plan.

The Los Angeles Times is running a feature headlined “Conserva-care” in which four conservatives are asked what they would do to fix the nation’s health care crisis. Here is the short version.

First up is former Senator William “hide the cat!” Frist. Frist is an MD whose family fortune rests largely on the medical-industrial complex. I will come back to the Frist family business in a minute, but first let’s hear what Dr. Frist has to say.

The Frist plan for health care reform: Don’t get sick. Seriously. Live a more healthful lifestyle, and especially don’t get fat. It will lower the cost of everyone’s health care if we don’t need it so much.

Really, that’s it. That’s the entire plan.

Next is Mickey Edwards, former Republican congressman from Oklahoma. Edwards suggests a two-step approach:

Step one: Authorize creation of an alternative, non-government source of insurance — a “pool” that would allow the uninsured, self-insured, etc., to join in a private plan that would not be tied to any particular employer or association. This plan already has a great deal of bipartisan support and could easily be brought to life.

In other words, the public option without the “public.” I assume it would be left to the administration of the private insurance industry, which of course is eager to establish a less-expensive alternative that would complete with its own products. (/snark)

The second step is to regulate the insurance industry so that private companies no longer refuse to sell policies to people with pre-existing conditions. That’s a great idea! And it’s in the Obama plan already!

You’ve heard of David Frum. Frum, at least, is willing to admit the idea about selling insurance across state lines is a crock —

New Jersey health policies cost more in large part because New Jersey hospitals and doctors charge more. If I buy a cheaper Kentucky policy that reimburses my providers at Kentucky rates, leaving me to pay the balance, how much good does that do me? And if the Kentucky policy is made to pay New Jersey rates, there vanishes my low Kentucky price.

This has always seemed obvious to me, but I despaired of every seeing anyone on the Right understand this point. Anyway, Frum is thinking boldly. He wants to strip the states of their insurance regulatory policy to create one big national market instead of 50 state markets.

What we need instead is to assert federal regulatory authority over the whole marketplace and get the states out of healthcare altogether. Let the insurers do business as national entities; let the market contract to four or eight major insurers; and then let them do unto their suppliers as Wal-Mart does unto its suppliers: squeeze them.

Hmm, Wal-Mart. This reminds me of something.

You remember Rick Scott, the guy who organized Conservatives for Patients’ Rights and ran a bunch of inane ads against health care reform? Way back when Scott was the CEO of Columbia Hospital Corporation/Hospital Corporation of America (the latter being the old Frist family business, which Columbia purchased in 1994.

Anyway, while he was running Columbia/HCA, Scott preached loudly about the superiority of his efficient, for-profit business model over the sloppy practices of not-for-profit hospitals. His partner, Richard Rainwater (if that name sounds familiar — Rainwater had extensive business ties with George W. Bush) actually called Columbia/HCA “the Wal-Mart of healthcare.” Like Wal-Mart, he said, Columbia/HCA was a big chain that used volume buying and strict cost controls to provide services a low cost.

At the time, many not-for-profit administrators believed Columbia/HCA’s claims were hyperbole. In an article about Columbia/HCA by Joe Flower in Healthcare Forum Journal (March-April 1995), the senior vice-president of a prominent not-for-profit hospital group pointed out that healthcare managers all went to the same business schools, and that volume buying and cost controls were hardly revolutionary. “Price cuts from volume buying will not represent a sustainable competitive advantage for Columbia/HCA,” the senior vice-president predicted.

It turns out that Columbia/HCA’s real competitive advantage was not found in squeezing the suppliers, but in defrauding Medicare. Although he was never indicted, Scott was golden-parachuted out the door of Columbia/HCA in 1997, and the Frists swooped in and began running Columbia/HCA.

Anyway, however much money we might save from obtaining cheap medical equipment from China — slave labor and no quality control will lower costs — the Wal Mart approach already has been tried. Big hospital corporations and major medical centers already have been doing the volume buying thing for some time.

Well, Frum is a wuss, anyway. We finally get to Richard A. Viguerie, a true hairy-chested manly kind of conservative. He’s on Medicare, yes, but conservative nonetheless. Viguerie has a four-part approach.

One. Expect people to pay for much of their own health care out of health savings accounts. “When people spend their own money, they spend it more wisely,” Viguerie said. Patients need to have “skin in the game,” after which they may need to see a dermatologist.

The rightie idea is that Americans are getting too much health care. They demand health care they really don’t need because they aren’t the ones paying for it. If patients had to pay more of the costs themselves, they use better judgment about what health care they try to buy.

One problem I have with this theory is that in all those “socialist” (righties: I’m using the ironic sense) countries in which patients aren’t paying for their own health care, we’re not seeing costs go up as dramatically as in the U.S. Overuse of the system may be a problem in some countries, but other countries seem to be able to control it.

Also, in the real world, we’ve got these creatures called “doctors” who are the ones making the decisions about what tests, procedures, etc. their patients will receive, assuming the insurance companies approve it. And there are some aspects of some physicians’ practices that could use some reforming, Id say. I’m sure there are patients who do demand unnecessary MRIs because people are always getting MRI’d on House, but surely there are ways to control that beside expecting people to pay for their tests so they are not overused.

Also, in the real world, the health savings plan idea would work fairly well for upper-income people with no serious health problems, or for the fabulously wealthy. For everyone else, it would pretty much bite.

Two. Don’t allow government to control health care, Viguerie says. No one is calling for government to “control” health care.

Three. Allow consumers to purchase insurance across state lines, which is a really bad idea.

Four. Don’t discourage profits. I believe that’s from the Ferengi Rules of Acquisition.

Not much of a plan, but Viguerie isn’t done yet. Remember how uninsured patients are driving up everyone’s health care costs? Viguerie’s got the answer to that:

Obama claims that health insurance is a moral imperative. By law, hospitals can’t deny emergency treatment for patients who aren’t insured, leaving an unpaid care gap estimated at more than $50 billion annually, according to the American Enterprise Institute. Conservatives and independents at the tea parties, town halls and beyond believe it is a moral imperative to stop burdening the next generations with trillion-dollar deficits and to stop government’s stealing from the Medicare trust fund, which now has unfunded liabilities of $36.3 trillion, according to the Heritage Foundation.

OK, wait a minute — is he saying we should just not provide health care for people who can’t pay for it, period? Let ’em die in the streets? And this is somehow tied to saving Medicare, which is a single-payer health care system run by the government?

Well, yeah, that’s the end of Viguerie’s little essay. I guess that’s what he’s saying.

So, in a nutshell, the conservative plan is … don’t get sick.