In a Nutshell

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State of the Blogosphere:

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CIA Director Leon Panetta tells the House Intelligence Committee that the CIA has been hiding significant information from Congress, beginning in 2001 and continuing until last month, presumably when Mr. Panetta found out about it.

In the past, this would have been a significant scandal. However, in post-Bush America the scandalous is normal.

And the Right Blogosphere leaps upon the significant development that the President’s name was misspelled in a White House press release. This is the shiny thing that will keep them distracted from the significance of the first story for a few hours, until someone among them cobbles together a rationalization/excuse they can all get behind.

The third story connects back to the first. President Obama objects to a provision that would require him to inform more than 40 members of Congress — instead of just the so-called “Gang of Eight” — about covert actions taken overseas. Make of that what you will.

Ir-rationing Health Care

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There are a number of treatments for early-stage, slow-growth prostate cancer. These treatments range from “watchful waiting” — not treating the cancer at all, but just keeping an eye on it — to surgical removal of the prostate gland, to high-tech proton radiation therapy using a proton accelerator. The costs for the various treatments range from a few thousand dollars to hundreds of thousands of dollars.

However, there is little evidence that the more expensive treatments are any more effective than the cheap ones, including watchful waiting. Indeed, for an older patient, watchful waiting makes sense, as there is a high probability he will die of other natural causes before the prostate cancer becomes a problem for him. On the other hand, younger patients, meaning men under the age of 65, might benefit from more aggressive treatment. But which more aggressive treatment?

At the New York Times, David Leonhardt interviews some prostate cancer specialists and finds there is widespread skepticism that the new, expensive, state-of-the-art treatments work any better than older, less expensive treatments.

“No therapy has been shown superior to another,” an analysis by the RAND Corporation found. Dr. Michael Rawlins, the chairman of a British medical research institute, told me, “We’re not sure how good any of these treatments are.” When I asked Dr. Daniella Perlroth of Stanford University, who has studied the data, what she would recommend to a family member, she paused. Then she said, “Watchful waiting.”

Naturally, the health care industry is pushing the more expensive treatments.

And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.

Use of I.M.R.T. rose tenfold from 2002 to 2006, according to unpublished RAND data. A new proton treatment center will open Wednesday in Oklahoma City, and others are being planned in Chicago, South Florida and elsewhere. The country is paying at least several billion more dollars for prostate treatment than is medically justified — and the bill is rising rapidly.

This takes us back to the issue of private insurance companies. Or, should I say, the the medical-industrial complex, which includes private insurance companies? I’ve ranted for years that our system is very good at one thing — creating profitable health care products. Medical treatments that make somebody a lot of money somehow get paid for. But any part of the health care system that can’t be made profitable is allowed to rot.

So, there are billion-dollar investments being made to build prostate cancer proton treatment centers that may or may not be any more successful than older radiation therapies that doctors have been using for years. Or, more successful than doing nothing at all, for that matter.

Meanwhile, just as one example, the nation’s emergency rooms are crumbling into decay. Emergency rooms do not make a profit. They have very high overhead because they have to be ready for, well, emergencies. And many people who use emergency rooms can’t pay the bills. So many hospitals are closing or cutting back or downsizing emergency rooms.

(And the practice of using emergency rooms as default “free” clinics for the poor and uninsured not only adds to the burdens on emergency rooms; it is also probably the least cost-effective way anyone could think of to provide last-ditch health services to the poor and uninsured, which is another big reason our nations spends so much on health care.)

Anyway — it appears that if somebody is making money off a particular gizmo or course of treatment, the health insurance industry manages to find room in its heart to pay for it. However, the private insurance companies routinely refuse to cover people who have even minor “preexisting conditions” and drop customers whose ailments are money-losers.

Put another way, if current trends continue, the day will come when the medical-industrial complex will simply refuse to provide treatments that aren’t making a profit for some part of the medical-industrial complex. And consider that conservatives not only want to kill government-led health care reform; they want the private insurance and other parts of the health-care industry to be even more unregulated and unwatched than they are now, and the government “safety nets” to be dismantled, on the theory that the “free market” fairy will solve our problems, even though there is no place on earth in which 21st-century medical care is being delivered by a “free market” system.

Leonhardt’s interviews show us that when it comes to health care, “profitable” and “effective” do not necessarily find their way into the same ball park. Weirdly, “profitable” and “cost-effective” are not necessarily fellow-travelers, either. That’s because the medical-industrial complex does not make a profit from curing you; it makes a profit from what it call sell to you, whether it cures you or not. And if two treatments are shown by studies to be equally effective, the industry will push the one that provides the higher profit.

Let’s go back to our gentlemen with early-stage prostate cancer. “You have cancer” has got to be among the worst pieces of news anyone ever gets. “You have cancer, but let’s not treat it” doesn’t sound much better, and I understand why some patients would push their doctors into providing some kind of treatment. Leonhardt says a Swedish study on treatment effectiveness recommends removal of the prostate gland for men under age 65. Such surgery can result in sexual dysfunction, however, so I understand why men may want another option. So doctors say, well, there is this new proton-therapy treatment …

One of the reasons the medical-industrial complex gets away with scamming us is that doctors themselves often do not know which treatment is most effective. There is remarkably little effectiveness testing going on. “Drug and device makers have no reason to finance such trials, because insurers now pay for expensive treatments even if they aren’t more effective,” Leonhardt writes. So the doctors often have little else to go on but what the sales reps tell them. And some doctors are as keen to boost their revenue streams as anyone else in the complex.

A critical part of President Obama’s health care proposal is called “comparative effectiveness research (CER).” CER is not, as the Right claims, a plan that would allow the government to countermand a doctor’s decisions based on cost-effectiveness studies. The common claim on the Right that CER is about rationing is a lie. The point behind CER is to fund the kind of effectiveness testing that is not being done now and provide that information to doctors and patients, so that doctors and patients can make more informed decisions about what course of treatment to pursue. (See also what Dr. Howard Dean says about CER.)

Of course, if CER becomes government policy, all those billions of dollars being invested to build proton accelerators to treat prostate cancer might not bring much of a return, which brings me to my last point.

Whenever I publish something about health care I get comments claiming that the private, for-profit health care industry is always better than “the government,” all we need is tort reform, blah blah blah, or that government (as opposed to the health insurance industry?) shouldn’t be involved in health care decisions. I agree with the latter; the government shouldn’t be involved in health care decisions, but nobody is saying otherwise.

The mendacious anti-reform talking points repeated ad nauseam by the dittoheads of the Right are generated by a network of right-wing think tanks and other organizations that exist solely to influence public opinion. This network is very good at getting their propaganda uncritically parroted throughout mass media and the Internet, repeated over and over until it becomes “common knowledge.” And in many cases the deep pockets funding those think tanks are also heavily invested in the medical-industrial complex. And round and round it goes …

The White House Department of Law and Other Palinisms

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I wasn’t going to write about Sarah Palin again today. Really, I wasn’t. I was all set to slog into something informative and useful about health care.

Well, maybe later. This is too juicy. ABC News has an absolutely hysterical interview with Palin the Petulant. For example,

Palin conceded many people are still confused about why she made the decision to leave office.

“You know why they’re confused? I guess they cannot take something nowadays at face value,” Palin said.

If we take her at face value, she’s a quitter and a ditz. As I’ve said elsewhere, the speculations on the reasons she left office assume she has a reason, which gives her some credit.

Or maybe the reason is this:

But she said a major factor in the decision was the mounting legal bills she and the state have had to incur to fight ethics charges from her political adversaries. None of the accusations has been proven but, she said, the costs of fighting them have been enormous.

I’m sure Bill Clinton commiserates. But this is the best part:

But as for whether another pursuit of national office, as she did less than a year ago when she joined Sen. John McCain, R-Ariz., in the race for the White House, would result in the same political blood sport, Palin said there is a difference between the White House and what she has experienced in Alaska. If she were in the White House, she said, the “department of law” would protect her from baseless ethical allegations.

“I think on a national level, your department of law there in the White House would look at some of the things that we’ve been charged with and automatically throw them out,” she said.

There is no “Department of Law” at the White House.

Priceless. Of course, the only reason we don’t recognize Gov. Palin’s sparkling intellect and critical thinking skills is that we’re against feminism.

Update: Jonathan Turley is amused.

Eating Their Own

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Or, the little tiny tent is shrinking, fast …

John Cornyn of Texas is reliably one of the most right-wing whackjobs in the Senate. He gets 100 percent approval ratings from National Right to Life, the U.S. Chamber of Commerce and the Christian Coalition, plus he gets an “A” from the National Rifle Association. He gets zeros from NARAL, the Human Rights Campaign, the League of Conservation Voters, and the American Public Health Association.

Yet Sen. Cornyn was booed roundly at a “tea party” held over the weekend in Texas. He wasn’t right-wing enough for the partiers.

Cornyn was booed at the start and close of his remarks, which assailed actions in Washington; there were no boos while he awarded a Purple Heart to a Copperas Cove resident injured in Iraq in 2006.

“You’re the problem,” a crowd member hollered.

Another crowd member yelled that Cornyn voted for the initial federal bailout of Wall Street approved by Congress last year, the Troubled Asset Relief Program.

I take it from the comments to the article linked above that Sen. Cornyn also is involved in a patent reform bill that Phyllis Schlafly has denounced. He has also supported a bill that would allow deported illegal aliens to return to the U.S. as guest workers, or something.

Governor Perry was there, also.

Perry drew scattered boos, notably from crowd members aware of his advocacy of toll roads to relieve traffic congestion.

I don’t know about you, but I had to sit and let that sink in for a while.

The tea parties are something like right-wing jacobins, except they lack a Robespierre to give them philosophical cohesiveness. They want to send everyone who isn’t pure enough for them to la guillotine, just because.

Projections, Hallucinations, and Sarah Palin

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For most of us, everything we see around us is a projection of our inner reality — our beliefs, biases, thoughts, fears, desires, etc. I’m not saying that’s what actually is all around us, mind you, just that that’s what we see. An ability to see things as-they-are is rare and usually takes a lot of work to cultivate. And yes, this is a Buddhist teaching, although I think a lot of psychologists would agree with it.

In the realm of politics, it’s common to put politicians we like on pedestals (eventually to be disappointed when they fail to live up to be the people we projected them to be), while assigning all manner of unsavory characteristics to politicians we don’t like. In fact, I’d say that tendency is more than common. We probably all do it to one extent or another.

They key to developing objectivity is self-awareness. If you have some intimacy with yourself, you can at least recognize your biases as biases and your projections as projections. That doesn’t make the biases and projections go away, exactly, but at least you can learn not to mistake them for reality. Such self-awareness also adds a healthy amount of doubt to your opinions, which keeps the option open that I might be wrong. If you can do that, you are less likely to be utterly fooled.

People who are not self-aware have no idea that they live in a dream world of projections. Further, if the dreamer’s projections are being reinforced by the people around him, this reinforcement can set up a positive feedback loop for the projections that make them even more “real” and impenetrable. This can set up another kind of feedback loop in which everything the dreamer sees is interpreted as reinforcement for the dreams. Such a person becomes more and more delusional, and also appears more and more irrational to other people who aren’t living in the same dream world. (See also “Truth, Lies and Self-Deception: None of us are beyond deceiving ourselves” by Dr. Stephen Diamond at Psychology Today.)

When the dreamer is keenly interested in politics, his projections of political figures become more and more polarized. Politicians are either idealized or demonized. They are either manifestations of all that is noble and good, or they are diabolical agents of evil and destruction. Now, we all do this to some extent. We want to think “our” politicians are doing what’s best, while “their” politicians are stupid, crazy or corrupt. But most of us, I hope, can also appreciate that politicians are all flawed human beings who are neither utterly evil nor utterly good.

I don’t want to set up a dichotomy that says righties are all hallucinating while lefties are not. I see plenty of dreamers on the Left. The “9/11 truthers” are a prime example. During the 2008 Democratic primary, I was startled at the degree of idealization/demonization among progressives of both Barack Obama and Hillary Clinton, and their supporters. And yes, I was caught up in it, too, but at least I could admit it at the time. And don’t get me started on how “identity politics” — which usually involves a lot of ego projection — has held back progressivism.

But now that I’ve said all that — are Sarah Palin supporters out to lunch, or what?

Yes, it’s too easy to make fun of them. But I ran into a post this morning from someone who calls herself a feminist and who appears to lean left but who seems not to see the insanity.

Dr. Violet Socks of Reclusive Leftist correctly notes that some on the Left are projecting all manner of things onto Sarah Palin that may have little to do with Sarah Palin. They ascribe opinions to Palin that Palin may not hold, or at least has not publicly expressed. I honestly don’t know where Palin stands on “abstinence only” sex ed, for example, and if Dr. Socks says Palin is in favor of contraception information in sex ed, I will take the doctor’s word on that.

But here’s a problem:

Which brings me to my first puzzlement: why don’t people bother to find out what Sarah Palin really believes? I don’t mean people as in the usual sexist freaks; I mean feminists.

Sarah Palin is only the second woman in the history of this country to run on a major party’s presidential ticket. That alone makes her, to me, a fascinating figure worthy of serious investigation. When McCain announced Palin as his choice for VP, I immediately tried to find out as much about her as I could. I wanted to know who she was, what she believed, what her politics were. It never occurred to me that this interest would make me in any way unusual among feminists, but apparently it did. Apparently most feminists — at least the ones online — are content to just take the word of the frat boys at DailyKos or the psycho-sexists at Huffington Post. That amazes me. Aren’t you even interested in who she really is? I want to ask. She’s only the second woman on a presidential ticket in our whole fricking history!

But even weirder is what happens when you try to replace the myths with the truth. If you explain, “no, she didn’t charge rape victims,” your feminist interlocutor will come back with something else: “she’s abstinence-only!” No, you say, she’s not; and then the person comes back with, “she’s a creationist!” and so on. “She’s an uneducated moron!” Actually, Sarah Palin is not dumb at all, and based on her interviews and comments, I’d say she has a greater knowledge of evolution, global warming, and the Wisconsin glaciation in Alaska than the average citizen.

Where to begin: First, I have listened to and read Palin speeches and interviews, and I do not think Sarah Palin knows what Sarah Palin believes. She doesn’t seem to have any cohesive political ideology beyond what plays well to the crowd. And when the crowd wants red meat, she throws it with the best of ’em.

Yes, she is only the second woman to appear on a political ticket. And Clarence Thomas was only the second black man to be seated on the Supreme Court, but that doesn’t make Clarence Thomas a beacon of hope for those struggling with oppression, does it?

Yes, a lot of sexism got mixed into criticism of her. Just because she’s a woman doesn’t mean she’s a ditz. However, just because she’s a woman doesn’t mean she isn’t a ditz. And let’s face it — she’s a ditz. I’m sorry, but that’s the truth of it. I cannot see how anyone could have read or heard the speeches and interviews, including the recent “farewell address,” without concluding the woman is a ditz.

Many on the Right took offense at the assumption that she left the governorship because she was about to be hit with criminal charges. Frankly, that assumption gave her credit. It ascribed a solid, grown-up (if not pretty) reason for bailing out on the governorship. If she is not leaving for any reason other than what she gave in her speech — good luck finding a reason in that incoherent mess of a speech — then she’s a ditz. With sprinkles, whipped cream and a cherry on top.

Whether she’s “dumb” I cannot say. She probably does have considerable native intelligence or she wouldn’t have gotten as far as she got. However, she shares with our recent president George W. Bush a pathological incuriousity about the world. During the 2008 presidential campaign she revealed more than once that her knowledge of how the federal government works, including what a vice president does, barely rose to the level of “superficial.”

As for

Actually, Sarah Palin is not dumb at all, and based on her interviews and comments, I’d say she has a greater knowledge of evolution, global warming, and the Wisconsin glaciation in Alaska than the average citizen.

One of us is living in Bizarro World, and I don’t think it’s me.

I assume that Dr. Socks is projecting qualities and virtues onto Palin because Palin is a woman. But Palin in this case is a walking Rorschach inkblot test. Dr. Socks looks at Palin and sees what she wants to see.

As for the real Sarah Palin, she may be neither stupid nor corrupt. My suspicions are that the adulation of the extremist Right has unhinged her, and brought out the worst in her, and had she not come to the nation’s attention she would simply have been a reasonably average governor of Alaska. If I’m right, the best thing she could do for herself is to drop out of public life and try to remember who she is.

However, I’m afraid she won’t do that. And if she continues to grow into the persona the extremist Right projects onto her, she’s going to become more and more monstrous as time goes on.

Sarah Palin Is AWESOME!

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Something is awesome, anyway. I don’t know which is more awesome; Palin or her True Believers. Truly, there’s a lot of awesomeness there to spread around.

That, and it’s a slow news day.

Let us think of more awesome things. The sinking of the Titanic must have been awesome, for example. Pickett’s Charge. The 1883 eruption of Krakatoa. Great white sharks. Awesome.

How the Wind Blows

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Via Tom Friedman’s New York Times column, here’s a draft memo from the President’s Economic Recovery Advisory Board on Energy, the Environment and Technology:

We have already described the importance of the environmental impact of climate policy. It has an important competitive impact as well. If the U.S. fails to adopt an economy-wide carbon abatement program, we will continue to cede leadership in energy technology to other nations. The U.S. is now home to only two of the ten largest solar Photo-Voltaic producers in the world, two of the top ten wind turbine producers and one of the top ten advanced battery manufacturers. That is, only one-sixth of the top renewable energy manufacturers are based in the United States. To lose our advantage in technologies that were pioneered in the U.S. may cost us dearly if not reversed.

Sustainable technologies in solar, wind, electric vehicles, nuclear and other innovations will, in the view of many on our board, drive the future global economy. We can either invest in policies to build U.S. leadership in these new industries and jobs today, or we can continue with business as usual and buy windmills from Europe, batteries from Japan and solar panels from Asia.

The new green economy could be transformational for our country. Compare it to the internet. Fifteen years ago there was no web browser. There was no internet at your fingertips, no ecommerce, no search engines. Now, the internet has transformed our lives: how we learn and inform, how we entertain and communicate, how we buy and sell goods. Today, the internet economy is estimated at $1 trillion with 1.5 billion internet users worldwide—and growing.

The new green economy has greater potential. Energy is a large and growing global market with 4 billion users of electricity—and usage doubling in 25 years. It is perhaps the largest economic opportunity of the 21st century. With the right policies driving innovation and investment, America can retake the lead in energy technology and create millions of new green jobs and industries, preserve millions of indirect jobs and repower our economy.

Unfortunately, that’s a lot harder to chant than “drill, baby, drill,” and it won’t fit on a bumper sticker.

In recent years China has been moving ahead of us in green technology. James Fallows has written some articles for The Atlantic on this; see especially “China’s Silver Lining” from the June 2008 issue. Yes, China has been a horrific polluter. But in his column Friedman quotes Hal Harvey, the chief executive of ClimateWorks:

“They want to be leaders in green technology. China has already adopted the most aggressive energy efficiency program in the world. It is committed to reducing the energy intensity of its economy — energy used per dollar of goods produced — by 20 percent in five years. They are doing this by implementing fuel efficiency standards for cars that far exceed our own and by going after their top thousand industries with very aggressive efficiency targets. And they have the most aggressive renewable energy deployment in the world, for wind, solar and nuclear, and are already beating their targets.”

Although Friedman is not clear in exactly what we are lagging behind, we are apparently lagging behind Japan, Europe, and China (in that order) in something related to new energy technology.

Why is it so hard for us to commit to even keeping up with green technology? Oh, yes. We have to fight the Right about it.

Remember when that great meathead Reagan — excuse me, Saint Ronald of Blessed Memory — ripped the solar panels off the White House? That signaled to the Right that to be pro-environment is to be a wuss, and possibly a liberal-socialist wuss. I might argue that this works for manufacturers too, but … what manufacturers? Do we still have any?

Anyway, I think 99 percent of the Right’s pathological refusal to back anything with the prefixes “enviro-” or “eco-” attached to them dates to that. Their lips would curl up and fall off their faces if they had to admit maybe, about something, Jimmy Carter was right and Reagan was wrong. They’ll pawn the whole bleeping country to China first.

Happy Independence Day

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july4whitebackground

Update: A consensus is forming on the Right that Sarah Palin quit because liberals kept saying nasty things about Trig. (I do think HuffPo went too far yesterday with the “retardation” post, but I see the author removed it.)

Update: At Comment Is Free — Mark Sanford and Me.

Update: Put this in the “what I said” department. I wrote after the first round of “tea parties” last April:

There are plans for a bigger event on July 4, but I wouldn’t be surprised if the powers behind yesterday’s tea parties quietly drop plans for follow-up events.


David Weigel reports for the Washington Independent that the local organizers of the April “parties” have organized more events for today. But unlike the April events, this time the GOP and right-wing media are not hyping them.

But the collaboration between the official Republican establishment and the Tea Parties has not lasted into June. The RNC has no plans to get involved with any Tea Parties. A spokesman for Rep. John Boehner (R-Ohio), who jaunted around northern California to attend several Tea Parties, said that his holiday plans were private but would probably not include Tea Parties. Gingrich will not attend any of the Tea Parties, although he recorded video messages for events in Birmingham and Nashville “at the request of the respective organizers,” according to spokesman Dan Kotman.

Media coverage has also gotten a little bit more scarce. Coverage on Fox News has largely been limited to interviews with Tea Party organizers on the network’s morning shows. While sources at Fox would not discuss their plans for covering the weekend events, they confirmed that no anchors would be attending and that the attendance and news value of the events looked to be lower than that of the April rallies. Tea Party organizers are counting, instead, on local news coverage and on distributed reporting such as the conservative news site PajamasTV, which hosts an “American Tea Party” show and has asked readers to submit their own videos from their rallies.

Excuses are being made for lack of media coverage — “it’s not a novelty any more” is one — and one of the local organizers says she likes having a smaller event so she can meet more of the people who show up. We can all enjoy reflecting on the logic of that, I think.

However, I think the real reason the Powers That Be in rightie politics and media are drawing back from supporting the “tea parties” is that they were genuinely embarrassed by the April events. The April parties may have involved only as many as 300,000 people nationwide, which was pathetic enough. But more than that, the parties turned into freak shows. Many of the participants who got the attention of television crews were genuinely demented, and frightening. Not to mention confused.

I’m saying the financial backers of “The Movement” decided to keep some distance between themselves and the “teabaggers.” As I predicted.

The Drama Queen Exits, Stage Right

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melodrama2Speculative reasons why Sarah Palin is resigning as governor of Alaska:

Mark Halperin has ten possible reasons she might have resigned, most of them focusing on a possible presidential bid.

Brad Friedman thinks some major scandal might be about to break that could involve indictments.

Update: Once again, some things snark themselves.