Who matters

Last night at Virtually Speaking, nyceve and emptywheel had an interesting discussion about Afghanistan, the opportunity costs of continued military action in Afghanistan, where every soldier costs $100,000 to maintain. Funding that soldier apparently required not funding teachers in American schools, as the Democrats failed to force through a measure that would have tied funding the war to funding teachers in the US.

You can listen to the entire broadcast either at BlogTalkRadio or Itunes.

One point of discussion near the end involved what the members of the netroots, of the Democratic wing of the Democratic party, can do about what has been a fairly disappointing collection of policy decisions, in the areas of health care, job growth, Afghanistan, Iraq and civil liberties. Some people have been particularly disappointed by the role large corporations are playing, as "partners" in policy making, while others point to the impressive list of accomplishments racked up by Democratic leaders in Washington. (Last week, Ian Welsh discussed how these issues played out at Netroots Nation in some detail.)

Eve asked Marcy where she stood on this question, about whether we should accept that the administration and the Congress have accomplished all that could realistically be expected, or whether we are justified in being disappointed. Some of the ensuing discussion turned on whether the administration would follow through, and appoint Elizabeth Warren as the head of the new banking consumer protection agency, as a real voice representing ordinary Americans. Did Warren's nomination represent a line in the sand? Moreover, should even those who are disappointed suck it up, and work for a President who is unquestionably worlds better than any possible Republican replacement?

In this context, Marcy wanted to make one thing very clear--that we are not talking about firebaggers vs Obamabots. We are really talking about the people who voted, many for the first time, for this President:

Jay, I worked Detroit election day. I worked the polls in Detroit, I was a poll watcher in Detroit. I can tell you that those people haven't gotten much out of voting for the first time. Some of them were 50 some of them were 18. And frankly, again, Michigan probably has gotten the most from this administration, of any state, just because of the auto bail out.

It's not about you and me, it's about the people without jobs. It really is that simple. Until we start making those people a priority; I don't see how Democrats win. It isn't about a guy named Barack Obama or a women named Elizabeth Warren.

Until Democrats begin putting those people at the forefront, until Democrats begin really attending to the needs of those 10% who don't have jobs and the even larger percent who are under employed - part-time workers, what have you. Until they start paying attention to that, we don't win. That's not how Democrats win. We win by taking care of people; of the people who don't have any other help. And that's where we're at right now.

My issue is civil liberties, but that's not what will make or break the next election. It's about whether or not people continue to leave their homes in record numbers, it's about whether people get back to work.

Are the netroots the pragmatists here? Is it, once again, "the economy, stupid."

Thought for the Day

The only people who participate in deciding whether a certain Military action was "worth it" are the people who survived the result. Sort of a skewed dataset if you ask me!

Lying

There is a lot of fuss being made over Veronique de Rugy's "study" claiming that stimulus funds were distributed disproportionately to Democratic Congressional districts. The skinny is that this is an aberration in the data, because funds delivered to state governments are reported as being delivered to the district the capital is in. This means that districts that contain Sacramento, Albany and so forth will appear to have funds they don't, because they will be disbursed by the state government to other districts through the programs funded by the stimulus package.

Nate Silver kicked off the fuss (via the Shrill One):

That de Rugy has testified before Congress on the basis of her evidence, and never paused to consider why the top five congressional districts on her list overlap with Sacramento, Albany, Austin, Tallahassee and Harrisburg, is mind-boggling. The presence of a state capital is the overwhelmingly dominant factor it predicting the dispensation of stimulus funds. This could have been discerned in literally five minutes if she had bothered to look at the apparent outliers in her dataset and considered whether they had anything in common -- a practice that should be among the first things that any researcher does when evaluating any dataset.

No it is not "mind-boggling." She lied to Congress. She worked up a "study" that appeared to support a lie she wanted to tell to Congress. And the reason she wanted to tell this lie to Congress was so that this idea, that Democratic districts had been, corruptly, disproportionately allocated funds, could become a story on Fox news, be repeated by Limbaugh, and, eventually hit the mainstream as a "controversy."

We have seen this before. Betsy McCaughey created the memes that took down the Clinton health care plan, by lying, plain and simple. She worked the same game this time around, only to be taken apart by a late night comedian. McCaughey had no interest in an honest assessment of the plans in either case, no interest in an actual policy debate, but rather wanted to get the "kill granny" meme going.

Nate's characterization of de Rugy's results as a "mind-boggling" error by a researcher is not only too polite, it advances her cause. Instead of a simple lie, this now becomes a conflict between academic researchers on both sides of the issue. And, by writing about it at all, Nate raises the profile of the claim.

There has been much praise of Nate for his devastating takedown. And if this were about a publication by a tenure-seeking professor, it would be so. But this is about someone trying to distort reality. By treating this garbage as worthy of extended analysis is to lend it more credence than it deserves. This deserved a six line dismissal, not a detailed analysis, and those six lines should have included the word "lie." Another possible response is a letter writing campaign to her dean at George Mason. Treating this as fodder for thoughtful analysis helps her attain both the short term goal of getting this meme out, and her personal goal of a permanent place on the wingnut welfare roll.

Ellsberg

This morning at the conference sponsored by the New School, Limiting Knowledge in a Democracy, Daniel Ellsberg (apparently, according to the moderator/New School prof, few of his students knows who he is, or what the Pentagon Papers were) made observations that were new to me. This is all paraphrased, but I think it is accurate.

He recounted a time in 1969 when he explained to Henry Kissinger what happens when you get the dozen clearances above Top Secret*. What happens first is that you feel like a fool. You've published books that you now discover were filled with stuff that was wrong. You have believed you understood how things worked, but you now find out you were completely wrong, that the real world is entirely different from what you have been told your entire life.

But this stage only lasts a few weeks. After you have been reading this material hitherto unavailable to you for a while, you begin to see everybody else as fools. Only with people with these top level clearances know the truth. People whom you previously regarded as experts become ignoramuses, doubly so because they don't realize that they actually know nothing.

Moreover, you have to lie to the fools constantly, because the condition for your getting access to what is really going on is you cannot tell anybody what is really going on. So after a pretty short time period, your conversation with the foolish experts consists of telling them only what you want them to hear.

This lying is essential to the secrecy. Ellsberg recounted a reporter friend calling him, and asking if there was anything to this Pentagon Papers business (which were in Ellsberg's office safe and the safes of a dozen or so others), he said "No. Never heard of this." You end up increasingly living in a bizarre hothouse.

Which is why batshit crazy things like Vietnam, Afghanistan and Iraq come to be. Obama has reasons for continuing the Afghan adventure. But he can't say what they are. Eventually we will find out that they made as much sense as Vietnam, and that there were advisers like Clark Clifford pointing out that the war was batshit crazy.

Oh wait, we already know this about Afghanistan and Obama, that there was much said in dissent with McChrystal's escalation.

Editorial

My note to Clarke Hoyt, NYT Public Editor:

Jackie Calmes' front page story today on deadlock impeding progress on reducing the deficit was not a news story. It was an editorial that focused on Republican talking points about the causes and remedies for the current deficit. Moreover, it is not merely an opinion piece, but it also featured conflations, erroneous statements,and a bizarre neglect of a huge chunk of the federal budget that could easily be cut.

For example, she writes:

But he is hardly alone in sounding an alarm about the long-term budgetary outlook, which has Medicare, Medicaid and Social Security costs growing at unsustainable rates and an inefficient tax system that cannot keep up.

“I used to think it would take a global financial crisis to get both parties to the table, but we just had one,” said G. William Hoagland, who was a fiscal policy adviser to Senate Republican leaders and a witness to past bipartisan budget summits. “These days I wonder if this country is even governable.”

First, she incorporates a false Republican talking point, that there is some difficulty with Social Security. Social Security is solvent out to the mid 2040s with no change to the system whatsoever, and even that is easily solved by raising the ceiling more quickly, or through other minor tweaks. Likewise, Medicaid is not in any difficulty; the program is too small to represent a serious difficulty.

It is true that Medicare is projected to grow at unsustainable rates, but that is not because it is a federally funded program. That is because the entire US health care system is being operated at unsustainably high costs, and rate of cost growth. The Times, of course, has published opinions to the contrary of those expressed by Calmes, articles like this one: Krugman

Then she cites unnamed economists (why were these people granted anonymity?):

The same economists also say a significant deficit-reduction plan is not possible unless Mr. Obama breaks his campaign promise not to raise taxes for households making less than $250,000. Last week, Mr. Obama said he would not impose that condition or any other on a fiscal commission

This is also an opinion unsubstantiated by facts. There are plenty of alternative methods for reducing the deficit that do not involve raising taxes on the bottom 9 deciles. The estate tax could be reestablished at high rates. Marginal tax rates above 250,000 dollars could be substantially raised. Any number of wasteful and counter productive programs could be cut, ranging from agricultural subsidies to elimination of Medicare Advantage to removing private institutions as middlemen to college loans. Most important, the soaring medical costs that afflict everyone, not merely Medicare recipients, could be brought in line with the rest of the OECD.

Moreover, not a word is said about the US involvement in two wars of choice, costing literally trillions of dollars. The only mention of defense spending shows up in the very last sentence.

The poll also found that by a two-to-one ratio Americans oppose cutting health care and education; 51 percent oppose lower military spending.

So, it is inevitable that the US has to reduce spending on programs supported by Americans at a two-to-one ratio, while programs that are not nearly so popular (and that is without any of the innumerable 200 dollar hammer stories that are not being written) are not even worthy of consideration.

This would be barely tolerable on the op-ed page. People do exaggerate and distort facts on those pages (although I would prefer that your editors permit a great deal less of that). But there is no excuse for this kind of biased, opinion reporting being run as straight news.

Terrorists and Their Super-Powers & Kung Fu Grip

Michael Scherer writes at Swampland:

Obama's aides felt stung by the press criticism after Christmas, when Obama initially opted to hold off public comments, work behind the scenes and, to the dismay of several columnists, play golf. So after returning to Washington, by contrast, Obama gave two public addresses, abandoning his uber-cool façade and twice appearing visibly aggravated at the failures in U.S. intelligence that allowed the attack to take place.

Well, thank God "several columnists" were on hand to express "dismay". Lord knows where the nation would be without "press criticism" of the effort politicians need make towards the appearance of "muscular, public and dutiful demonstrations of authority"....probably a whole lot less comforted while our public integrity-bound press-corps maximizes anxieties over a kid with explosives in his underwear, that's where! Where would we get our desperately needed demonstrations of authority to calm and soothe our raging fears over terrorists and their super-powers and kung fu grip?



With a press corps like ours, it's certain that the terrorists will fail miserably...to terrorize...the American people...Yes, that's right. We're just like the British during the battle of Britain...apart from facing the Luftwaffe nightly, and remaining calm, courteous and courageous in the face of huge bombs exploding in all our major cities, and citizens evacuating to subway tunnels year after year, and the literal threat of invasion by a vast army of Nazis. That's just like how we are right now with our superb press corps! How could the terrorists possibly win?

Also, isn't it just super that we have people like the "aides" who "felt stung by the press criticism" in charge of national affairs? Isn't that the most awesome display of strength there is, when the most powerful administration in the world jumps up and down in fearful reaction to the "dismay of several columnists"? What aides were these, Michael Scherer? Who told you about this episode in these terms? Why, surely such honest dealers would put their names to their claims, right Michael Scherer?

All I can say is that having a President who will, at a relative moment's notice, abandon an "uber-cool façade" for the façade of visible aggravation just fills me with total confidence that the focus of this Administration is problem-solving, not posturing. Fan-tastic.
I'm also supremely heartened by a press corps that focuses on real problems to solve, not the political posturing of the new Daddy-Figure-In-Chief to demonstrate his "ability to take charge", and its moment-by-moment effects on public perception.

Thanks for this substantial review and critique of the Administration's security image handling and public relations efforts, and subsequent polling of attitudes, Michael Scherer. I'm sure we're all much safer as a nation for your efforts...at least I feel 2/3rds safer, anyway.

Can We Talk Price?

Over at Swampland, someone helpfully provided a link to National Geographic post in support of my arguments that graphically demonstrates the fact that the US consumer is getting ripped off by her/his profiteering health care system ( link to NatGeo ), but unfortunately, the copy then had to go like this:

The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.” —Michelle Andrews

No, no, no, no.

Thanks Michell Andrews!

Thanks for the graphic, but it's unfortunate that National Geographic had to explain the discrepancy in cost as a function of use, as opposed to a function of price.

It fits a very neat storyline that contains a great deal of truth, but the fact that fee-for-service leads to unnecessary, i.e. wasteful costs doesn't explain the difference between the price of an MRI in Japan and the price of that procedure in Texas.

It isn't just that there is an abundance of inefficiency in delivery, it's that what's being delivered costs more here than anywhere else.

Take, for example, prescription drug pricing ( link to Kaiser Foundation ):

In a comparison of the 20 prescription drugs most commonly prescribed to Medicare beneficiaries, Families USA found that the lowest prices available through the Medicare cards for 10 of the medications were at least 50% higher than prices negotiated by VA, according to Families USA Executive Director Ron Pollack.

The study also found that the lowest drug card price for Lipitor, a cholesterol-lowering medication and the most frequently prescribed drug for seniors, was 59% higher than the price available through VA. According to the study, the Medicare drug card price was 46% higher than the VA price for cholesterol-lowering drug Zocor, 56% higher for acid reflux treatment Prevacid and 65% higher for blood pressure medicine Norvasc. VA discounts also exceeded Medicare drug card prices for the other 10 drugs, although only by 7% in one case (Hartford Courant, 6/3).

Even within the United States, even within Federal entitlement programs there are discrepancies between the prices paid for identical prescription drugs.

Extending the price comparisons internationally, even to our close neighbors, leads to more evidence of inflationary US prices:

One of the most important differences between the two countries is the much higher cost of drugs in the United States. In the U.S., $728 per capita is spent each year on drugs, while in Canada it is $509.[82] At the same time, consumption is higher in Canada, with about 12 prescriptions being filled per person each year in Canada and 10.6 in the United States.[84]

The main difference is that patented drug prices in Canada average between 35% and 45% lower than in the United States, though generic prices are higher.[85] The price differential for brand-name drugs between the two countries has led Americans to purchase upward of $1 billion US in drugs per year from Canadian pharmacies.[86]

But it's not just Canada, and it's not just prescription drugs.

In every other OECD country almost every type of health care consumable, e.g. hospitals, medical procedures, prescription drugs and laboratory tests is less expensive than in the US, while their use is as high or higher than ours.

If we simply over-prescribed, and over-tested, and over-treated because of fee-per-service inefficiencies, then we would probably see exemplary countries like Japan doing far less in comparison, wouldn't we? But that just isn't the case ( link to the Washington Post ):

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Unfortunately, the idea that there are wide price discrepancies between what Americans pay and what everybody else pays seems to be very, very confusing for reporters. It's as if they believe that it's still 1980, and the dollar should buy them vast quantities of quality merchandise in quaint old Europe, and when it doesn't anymore, when even the Canadian Loonie has been worth more than the dollar for almost a decade, they can't get their minds around it.

The problems with the United States' system are many, from an over-abundance of paper-pushing to a wildly uncoordinated supply chain, and yes, fee-for-service is a part of the high cost equation.

But the basic facts of the matter are that a health care apple in one part of Texas can cost $10 compared to a health care apple in Hawaii costing $7, while a health care apple in Japan costs them $3.60. It's not the cost of insurance against the cost of health care apples that's bankrupting Medicare and the private system, just the price of the apples themselves.

Prices are what's wrong with health care in the United States. Prices are what make fee-for-service unsustainable here. Prices are what will ultimately drive all insurance --Medicare and private-- into the ditch.

The question is: why is it so hard for reporters to say the word "price" when talking about health care costs? Why is it so hard for them to comparison shop for MRI's around the wealthy world, and then tell the American people if we're actually getting a good price --or if we're getting ripped off?