One Death Every Twelve Minutes

John Geyman, Professor Emeritus of Family Medicine at the University of Washington School of Medicine:

Americans are dying at a faster rate — 1 every 12 minutes, 5 an hour, 120 a day, 45,000 a year — not from war or natural disaster, but from lack of health insurance.

That’s the stunning finding of a study published today in the American Journal of Public Health by leading researchers at Harvard Medical School. The report, “Health Insurance and Mortality in U.S. Adults,” reveals that the uninsured have a 40 percent higher risk of death than those with private insurance, resulting in 45,000 preventable deaths annually. …

… The Institute of Medicine estimated in 2002 that more than 18,000 Americans between the ages of 19 and 64 were dying each year as a result of being uninsured. The new number is two and a half times that figure.

The people ginning up terror over “death panels” will deny Americans are dying for lack of health care, of course.

Strangling Ourselves With Selfishness

The headline on Shailagh Murray’s WaPo piece is “Young Adults Likely to Pay Big Share of Reform’s Cost,” and of course righties who have seen the headline are quivering with outrage on the burden that’s about to be put on the young folks.

This is what Murray writes,

A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.

The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.

This is the part that has the libertarians so upset:

Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums — effectively subsidizing coverage for their parents.

One of the relatively milder reactions, from one of the unfree thinkers at Reason:

Despite rhetoric to the contrary, government policies tend to take from the relatively poor and give to the relatively wealthy (see the Medicare prescription drug plan for an example). And so it is with health insurance reform, where it’ll be the kids who pay for the rest of us.

The more I wade around in rightie ideas about health care and insurance, the more I think they just plain don’t understand risk pooling.

I share the concern that young people will be required to buy insurance that is too expensive for their entry-level budgets. That’s one of the reasons a public option is so important. On the other hand, at least some of those young, healthy folks will have catastrophic accidents or unexpected illnesses, and their medical care will be paid for by the premiums of other healthy people. And the rest of the young, healthy folks will eventually grow into older and less healthy folks.

But here’s another piece of the puzzle the righties don’t get — the uninsured drive up health care costs. In fact, the uninsured may be one of the biggest drivers of rising health care costs.

Last week the Los Angeles Times published a letter from Dr. Robert W. Robertson Jr., former director of emergency services at Western Baptist Hospital in Paducah, Kentucky. Dr. Robertson wrote,

In 2005, there were 44.8 million who had no medical insurance. In 2006, that number had grown to 47 million. Presently, it is estimated that there are 50 million who have no coverage, and that number will rise to over 52 million at the end of 2010. …

  1. The uninsured numbers are constantly increasing.
  2. The unreimbursed expenses incurred by hospitals in treating those ever-increasing numbers of the uninsured are constantly increasing.
  3. Hospitals must increase their charges in order to cover the ever-increasing costs of treating the uninsured.
  4. Medical insurance companies must increase the premiums of those they insure in order to pay for the increased hospital charges when their insureds seek treatment.
  5. Each time insurance premiums increase, another portion of the population opts out of carrying insurance. Individuals or companies reach a point, finally, when they can no longer afford insurance, and individual policyholders or employees of companies which drop their benefits enter into the pool of the uninsured.
  6. More uninsured people = increased, unreimbursed hospital costs = increased hospital charges = increased insurance premiums = more uninsured people…. The upward spiral is incessant.

The pressure created by the ever-increasing number of the uninsured is the driving force behind the ever-increasing cost of medical care in the United States. That force is unrelenting. It can only accelerate. It has created a system which is unsustainable.

If you want to fully appreciate how unsustainable it is, take a look at these numbers from the Kaiser Family Foundation. The average cost of a family health insurance policy in 2009 is $13,375. If insurance costs continue to rise at the same rate they’ve risen in recent years, by 2019 the average cost of a family health insurance policy will be $30,803.

It follows that to put an end to the spiral, we must choose one of these three options:

  1. Get everyone insured.
  2. Allow hospitals to turn away people who don’t have insurance. Of course, that could be any one of us if we lose our wallets in an accident and show up at an emergency room with no identification. Instead of death panels, we’ll have a death lottery.
  3. Scrap insurance altogether and go with single payer.

My guess is that libertarians will go with Option 2, figuring they can have their insurance information tattooed on their butts. Or, we can have microchips inserted under our skins so the hospital can scan us and determined we’re covered by Blue Cross, or whomever. Because, you know, everybody could buy insurance if they really wanted it. That’s how Reason sees it, anyway:

To me, Reason‘s video presents a great argument for mandates. I have no way to know what percentage of young people are willfully choosing not to get insurance and what percentage cannot afford insurance, but let’s remember how some of them are coping with not having insurance —

They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.

Enough, I say. We’re strangling ourselves with our own selfishness.

The Power of Myth, 9/12 Randbot Edition

At The New Republic, Jonathan Chait reviews two new books about Ayn RandGoddess of the Market: Ayn Rand and the American Right by Jennifer Burns and Ayn Rand and the World She Made by Anne C. Heller. Via Burns and Heller, Chait’s review nails Randism and the Randbots who still worship at her altar. Just a snip:

When Rand condemned a piece of literature, art, or music (she favored Romantic Russian melodies from her youth and detested Bach, Mozart, Beethoven, and Brahms), her followers adopted the judgment. Since Rand disliked facial hair, her admirers went clean-shaven. When she bought a new dining room table, several of them rushed to find the same model for themselves.

Chait calls Rand’s ideas “inverted Marxism.” He notes the degree to which her novels “oddly mirrored the Socialist Realist style, with two-dimensional characters serving as ideological props.” Like Marxism, Rand’s Objectivism “failed for the same reason that communism failed: it tried to make its people live by the dictates of a totalizing ideology that failed to honor the realities of human existence.”

Yes, Rand hated Marxism, and her ideas were relentlessly reactionary to Marxism. But because Rand’s life and work were shaped entirely by reaction, she was never really free from the things she opposed. Marxism still ruled and defined her, even as she imagined herself liberated from it. Hers was an utter failure to find equanimity.

Anyway, the larger point of both books is the degree to which Rand’s unbalanced ideas still haunt our political discourse. In particular, we are hobbled by the idea “that the United States is divided into two classes–the hard-working productive elite, and the indolent masses leeching off their labor by means of confiscatory taxes and transfer programs.”

(An aside: Culturally, IMO there is something profoundly un-American about Randism. Although we’ve always had our Calvinistic undercurrents, through most of American popular culture since the age of Andrew Jackson our national mythos was about the triumph of common men — yes, usually men — over the inbred, indolent elite. Americans may have admired George Washington, but we identified with Davey Crockett, Daniel Boone, and Huckleberry Finn. Our ur-myth was about the savvy, weather-beaten cowpoke who proves to be a better man than the wealthy, educated city slicker. Now our ur-myth is about winning American Idol.

But notice how the once-admired cowpoke has been replaced by the likes of Joe the Plumber, a man plucked from obscurity not because of his weather-beaten independence but for his usefulness to the elite cause. Wurzelbacher became a pet of the elite because he embodies their sterotypes of a working man while parroting their worldview. In truth, he is close to being a white Step’n Fetchit.)

Chait’s review goes on to demolish most of the assumptions on which Randism is based, particularly the myth of the “self-made man” and the belief that wealthy people are wealthy because they work harder than poor people and therefore are more deserving.

Now, the part that intrigues me is the way so many obviously ordinary, poorly educated and un-affluent Americans have somehow bought into this nonsense. Think of the people presented in the video in the previous post. There is nothing “elite” about this crew. In large part, the rank-and-file of the tea partiers are from the “indolent masses” so devalued by Randbots. IMO what we’re seeing here are two different social-political pathologies finding common ground in opposing progressivism.

The tea-partiers also are locked inside an ideology that says some people are more deserving than others. But in their world “deserving” is not defined by wealth and status, but by race and culture. This is discussed by Michael Lind in “Uninsured Like Me.” See also, Glenn Greenwald’s “Who are the undeserving “others” benefiting from expanded government actions?

What’s beneath wingnut hysteria is not just racial hatred but a sense of racial/nativist entitlement. They are obsessed with the idea that progressivism means taking something away from them and giving it to people who are undeserving (i.e., not white, especially not native-born white).

Having come from a working-class white background myself, I can’t tell you how many people I’ve met in my life who were neither wealthy nor especially industrious, and who were invested with the usual number of faults and moral weaknesses, but who saw themselves as being uncommonly hard-working and virtuous because they were white people with jobs. Such people deny their own vulnerabilities — economic catastrophe couldn’t happen to them — and somehow identify with the self-interests of people who are far more wealthy and insulated than they are. Hence, working people without health insurance somehow are persuaded to oppose health care reform.

(Sign at Saturday’s 9/12 demonstration: “I work hard so Obama voters don’t have to.”)

Odds are that some minority of Saturday’s 9/12 crowd have no health insurance themselves. They are, in effect, choosing to do without decent health care for themselves than to share a benefit with the Other. They are disproportionately and irrationally obsessed with the issue of illegal immigrants getting a taxpayer-funded benefit, and they would rather sacrifice cost-effectiveness than begrudge so much as an aspirin to a migrant worker. As I wrote recently, we Americans are spiting ourselves to death.

So the Randbots and the 9/12ers view the world in different ways, but they’ve come together in lunatic solidarity nonetheless.

This toxic compound is all the more dangerous because it is funded by powerful corporate and media elites. Hendrik Hertzberg writes,

This sort of lunatic paranoia—touched with populism, nativism, racism, and anti-intellectualism—has long been a feature of the fringe, especially during times of economic bewilderment. What is different now is the evolution of a new political organism, with paranoia as its animating principle. The town-meeting shouters may be the organism’s hands and feet, but its heart—also, Heaven help us, its brain—is a “conservative” media alliance built around talk radio and cable television, especially Fox News. The protesters do not look to politicians for leadership. They look to niche media figures like Rush Limbaugh, Sean Hannity, Glenn Beck, Michael Savage, and their scores of clones behind local and national microphones. Because these figures have no responsibilities, they cannot disappoint. Their sneers may be false and hateful—they all routinely liken the President and the “Democrat Party” to murderous totalitarians—but they are employed by large, nominally respectable corporations and supported by national advertisers, lending them a considerable measure of institutional prestige. The dominant wing of the Republican Party is increasingly an appendage of the organism—the tail, you might say, though it seems to wag more often from fear than from happiness. Many Republican officeholders, even some reputed moderates like Senator Chuck Grassley, of Iowa, have obediently echoed the foul nonsense.

Our national forefathers vowed to create “a more perfect Union,” but we have never really overcome the divisions of race and class that have plagued us from the beginning. I’d like to close by pointing out that Canada is at least as racially diverse as the U.S., yet Canadians seem able to govern themselves sanely. In the Washington Post, Jonathan Malloy argues that what makes the difference between the U.S. and Canada is that the two nations are operating under different national myths. “Canadians, who have a highly fragile and internationally ignored national identity, understand instinctively that health care says a lot about a country’s heart and its understanding of itself,” Malloy writes.

I fear our country’s heart is a cold one, and if it’s heart doesn’t warm up soon the U.S. is destined for a long and steep decline.

Maybe Some Want to See the Two-Headed Monkey

Peter Wallsten writes for the Los Angeles Times, “Some fear GOP is being carried to the extreme“:

Some are pressuring the Republican National Committee and other mainstream GOP groups to cut ties with WorldNetDaily.com, which reports some of the allegations. Its articles are cited by websites and pundits on the right. More than any other group, critics say, WorldNetDaily sets the conservative fringe agenda.

And this:

In one symbolic development, organizers of next year’s Conservative Political Action Conference — the country’s biggest annual meeting of activists on the right — said last week that they had rejected a request to schedule a panel on whether Obama was a native-born U.S. citizen.

“It would fill a room,” said event director Lisa De Pasquale. “But so would a two-headed monkey. There really are so many more important issues, and it’s only a three-day conference.”

On the other hand, other “Somes” do not fear being painted as the party of whackjobs.

Michael Goldfarb, a spokesman for John McCain’s GOP presidential candidacy last year, likened the conservative fringe to liberal activists during the Bush years. The antiwar group Code Pink drew headlines, for example, when a protester with fake blood on her hands accosted then-Secretary of State Condoleezza Rice — but Democrats still won elections later.

“Do we look crackpot? Yes,” Goldfarb said. “But that’s how the left looked to me in 2004, and in 2006 they took back Congress. Then they started marginalizing the lunatics.”

However, there are some differences in the way the Dems related to progressive activists during most of the Bush years and the way the GOP is relating to its, um, activists. Democratic politicians always stayed at more than arms’ length –more like football-field length — of Code Pink and other of the more flamboyant elements of the anti-Bush leftie pushback. Indeed, Code Pink targeted Nancy Pelosi for a time, you might remember. The Republican Party, however, is both cultivating and catering to the crazies.

Some are predicting the GOP could gain House seats next year:

Insiders’ criticisms have been dismissed by some conservative leaders, who argue that the party needs an energized base — even if it’s extreme — to gain in future elections. Some analysts think that conservatives’ summer revolt against Obama’s healthcare agenda helped erode public approval of Democratic leadership enough that the GOP could pick up as many as 30 House seats next year.

The 30 House seats may be rightie wishful thinking, but I suspect that once there is a bill, the sky does not fall and jack-booted storm troopers do not appear in the streets, all but the hard-core whackjob fringe will calm down about it all. In particular, once people figure out that the reforms will put an end to the “pre-existing condition” scam, the mushy middle will look upon reform more favorably.

However, the message to Dems in Congress needs to be — don’t let the GOP drag this out. Getting a health care reform bill passed asap is more important to you, politically, than continuing to dawdle in the hopes of getting one or two Republican votes.

MoDo Gets One Right

Via AllSpinZone (’cause I hardly ever read Maureen Dowd any more), today MoDo got to the roots of what’s motivating the tea partiers (emphasis added):

Surrounded by middle-aged white guys — a sepia snapshot of the days when such pols ran Washington like their own men’s club — Joe Wilson yelled “You lie!” at a president who didn’t.

But, fair or not, what I heard was an unspoken word in the air: You lie, boy!

Yesterday70,000 or so right-wingers “demonstrated” in Washington. If you believe their handlers, a segment of people who looked on complacently for eight years while the Bush Administration plundered the treasury suddenly are outraged about government spending. Some of them seemed to have other concerns, however.

Did any of yesterday’s protesters carry signs that had some connection to actual issues — “No Public Option” or “Ixnay on Exchanges” or something? Or was the entire exercise about the hobgoblins who live in their heads?

Like Dowd, I don’t forget that “Democratic presidents typically have provoked a frothing response from paranoids.” But as much as they hated Bill Clinton, the degree of frothing does seem to have been kicked up a notch.

Fuzzy Math

I’ve been in some genuinely massive protests in New York and Washington, DC, where crowd estimates were between 200,000 and 400,000, so I know what a crowd that size looks like and how much space it fills. So I’ve looked at the photographs Malkin has on her website that allegedly shows a crowd of “up to 2 million” in Washington, DC, for the 9/12 rally. No way. It’s hard to tell from photographs, but ABCNews.com reported an approximate figure of 60,000 to 70,000 protesters, attributed to the Washington, D.C., fire department. Official estimates tend to be low, so if the teabaggers claimed 100,000 (which is very respectable, although not spectacular) I wouldn’t argue with them. But 2 million is fantasyland stuff.

See also Josh Marshall.

Update: Eyewitness account from Matt Yglesias.

Spiting Ourselves to Death

Wingnuts don’t seem to realize they’re already paying for the health care of illegal aliens. Every time an uninsured or underinsured person gets treatment in an emergency room and can’t pay the bill, the cost is added to everyone else’s bill, and to insurance premiums. As far as I know, ERs are not turning people away who can’t prove citizenship.

But, shhhh, keep this entre nous. If this gets called to wingnut attention they’ll demand that ERs get proof of citizenship before they treat anyone. None of us will dare leave home without our passports, never mind our insurance cards. Sorry about your Grandma. We couldn’t treat her because we weren’t sure she was a citizen.

After Wednesday night’s heckling the Super Weasel team of Senators Kent Conrad (D-ND) and Max Baucus (D-MT) hustled to do Rep. Joe Wilson’s bidding and close an imaginary loophole in the health care proposal. No one is proposing that any subsidies go to illegal aliens (see “Read the Bill“). But now Baucus and Conrad want to prevent illegal aliens from buying health insurance on the individual market with their own money.

Matt Yglesias:

This will have a direct cost to taxpayers since some verification mechanism will need to be put into place. It will also have an indirect cost to you and me and everyone we know—the vast majority of people, after all, aren’t undocumented immigrants but we’re all going to need to go through a citizenship check hassle before we buy health insurance. It will probably also make average premiums higher, since the exchanges will be left with a smaller risk pool and there’s no real reason to believe that the subset of undocumented immigrants who are capable of affording an unsubsidized insurance policy are below-average health risks. Last, of course, this will make the undocumented immigrant population sicker with negative public health consequences for their coworkers, friends, family, and the customers of the businesses they walk at.

There’s an old saying, “cutting off the nose to spite the face.” It refers to doing something for revenge or spitefulness that is really self-destructive. This describes the Right’s attitudes toward health care reform. Apparently it’s more important to punish illegal aliens than to provide health care for ourselves. Better to let 18,000 Americans die every year for lack of health care than to allow illegal aliens use the proposed exchanges to buy insurance with their own money. And you know if there are subsidies some illegal aliens will be able to scam the system; better to drive tens of thousands of Americans into medical bankruptcy than to let some illegal aliens have a few crumbs of benefits.

And let’s not even think about making sure agricultural and food service workers get flu shots. Epidemics are a small price to pay to be sure people aren’t getting benefits they don’t deserve. It’s a moral thing, see.

There is data showing that the enormous majority of uninsured and underinsured patients are citizens. But if some uninsured citizens really need health care, they can always move to Mexico.

9/11: The Story, The Shrines, The Smell, The Scandal, The Meaning

The Story

When I meet someone who says he was in lower Manhattan on September 11, I apply a little test. Yes, I was watching from an office building on West 17th Street, I say. A high-rise. We had a clear view. Where were you, exactly?

If the answer is vague — standing on a corner or watching out a window — with no specific details offered, I figure the guy is blowing smoke. He wasn’t there. People who were there launch into The Story. The Story varies, of course, but the usual details involve the precise location, such as street name or building, where they stood to watch the towers collapse; where they had just been; where they had planned to go; the people they knew who were, or might have been, in the towers; and if they were close enough, mention of the flaming objects, and people, they saw falling from the sky.

Eight years ago The Story was told urgently. Now the telling is more mechanical, as if reciting a lesson. The details are no longer raw and jumbled, but polished and fixed into place. But The Story still comes out. We still feel a need to tell it.

The Shrines

There were details about life in New York in those days that didn’t come across on television. You had to be in New York to appreciate how the city turned into a shrine, for example. At first there were photocopied pictures of the missing ones afixed to lampposts and scaffolding everywhere. Then came the flowers, cards, notes, candles, flags. Little shrines grew like kudzu all over the city, covering sidewalks and spreading through subway stations.

The Smell

Something else you couldn’t see on television was The Smell. For weeks after, lower Manhattan and Brooklyn were permeated with a sharp, bitter smell of burned plastic, metal, fuel, and we didn’t want to think about what else.

Just a few days after September 11, people who spent large amounts of time where The Smell was strongest began to report skin and respiratory problems. A common condition was being diagnosed by doctors as “World Trade Center cough.” Some people wore surgical masks when out walking.

Still, all the news reports tols us not to be concerned about The Smell. The Environmental Protection Agency issued five press releases within ten days of the attack assuring people that the air was safe to breathe. We would learn later that the truth was being censored.

On September 12, EPA head Christine Todd Whitman issued a memo: “All statements to the media should be cleared through the NSC [National Security Council in the White House] before they are released.” Thus, facts and recommendations from EPA scientists were muzzled in favor of the cheerful, but false, news that there was nothing in the air to worry about.

Recommendations that people with asthma or other breathing problems should take precaution were stricken. Warnings that the dust outside and inside office and apartment buildings was laced with toxins and should be cleaned by professionals never made it to the public.

A few days after 9/11, Congressman Jerrold Nadler set up the Ground Zero Elected Officials task force. The task force decided to conduct its own air quality tests. One September night city council candidate Alan Gerson and Councilwoman Kathryn Freed snuck some scientists with air testing equipment past the barricades. These scientists made the first independent measurements of both air quality in lower Manhattan and asbestos debris within residential apartments. The scientists found levels of asbestos that were more than double what government guidelines say are “safe.”

On September 30, Mayor Rudy Giuliani said,

“There is a lot of questions about the air quality because there are at times in downtown Manhattan and then sometimes even further beyond that, a very strong odor. The odor is really just from the fire and the smoke that continues to go on. It is monitored constantly and is not in any way dangerous. It is well below any level of problems and any number of ways in which you test it.”

On October 26, the New York Daily News published a report by Juan Gonzalez, “A Toxic Nightmare at a Disaster Site.” Gonzalez reported that the EPA had found levels of benzene and dioxin in the air that were several times above the danger zone. Gonzalez wrote more stories revealing that the city’s asbestos-cleanup instructions were dangerously lax.

What I know is that I made my way to the Financial District in mid-October, and after only an hour of walking around my eyes and throat were burning. This didn’t feel “safe.”

The Scandal

Meanwhile, the dedicated firefighters, policemen, and others who worked daily at Ground Zero — the heroes of the hour — breathed toxins all day long without proper safety equipment and instruction. The Occupational Safety and Health Administration (OSHA) refused to enforce worker safety standards even after months had passed and the work was no longer an “emergency.”

A recent study revealed that the a quarter of Ground Zero workers still have persistent lung problems. There doesn’t seem to be an official tally of 9/11 responders who have since died of diseases caused by exposure to toxins, although some news stories put the number at around 100. Keep in mind that some kinds of cancers related to toxin exposure can take decades to develop.

Juan Gonzalez has a recent story in the Daily News about Joe Picurro, an ironworker who volunteered at Ground Zero. Today Picurro is dying, painfully. “The list of ailments ravaging his body is stunning,” Gonzalez writes.

Officially, about 3,017 people died in the terrorist attacks of September 11. Because no one bothered to protect the health of Ground Zero workers, more will die in the years ahead.

The Meaning

There were some things one didn’t see much in New York City. For example, it would be months before I saw the T-shirts with the flaming towers and weeping bald eagle, and I had to go home to Missouri to see them. The imagery seemed as crass as photographing one’s mother’s last moments of life and putting that image on a T-shirt. Or maybe you could celebrate that special moment when a loved one’s vital signs monitor flatlined.

The ideologues pushing the obscene “9/12 Project” want to take us all back “to the place we were on September 12, 2001.” Anyone who really wants to go back there wasn’t in New York. Clearly, the 9/12ers have internalized their own Story, and that Story has very little to do with anything that happened in lower Manhattan and the Pentagon on 9/11.

To me, there’s the Meaning of the day and the Meaning of the Meaning. The first is personal; the second is pathological. The second, to me, illustrates all the ways humans separate themselves from anything real.

It’s much more satisfying to “remember” 9/11 with brash, jingoistic rah rah than to fully acknowledge that day, that moment, with all its heartbreak. It’s more satisfying to enshrine the image of firefighters raising a flag than to see to it they got proper breathing equipment or medical care. It feels better to use 9/11 as a club to bash your enemies with than to fully acknowledge what happened, mistakes and corruption included.

Note the inverse proportion: The further away people were from the events of that day, the more they want to glorify it.

There was glory that day, but not of the sort Glenn Beck wants to fabricate. To me, there was glory in the fact that thousands of people evacuated the towers, walking orderly and calmly down endless flights of stairs. There was no panic or trampling. The infirm were helped by friends and strangers alike.

There was glory in the way New Yorkers reached forward to do what they could. On that day I saw lines of New Yorkers, sometimes several blocks long, winding around hospitals. Sorrowing, they stood in line for hours to give blood, to give whatever they could give. It turns out there was no need for the blood, but the giving was beautiful nonetheless.

This is what I choose to remember, part of my Story. I still feel a need to tell it.