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"It is better to be drunk with loss and to beat the ground, than to let the deeper things gradually escape."

- I. Compton-Burnett, letter to Francis King (1969)

"Cynical realism – it is the intelligent man’s best excuse for doing nothing in an intolerable situation."

- Aldous Huxley, "Time Must Have a Stop"

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Friday, 15 April 2005

Topic: The Law

Legal Theory: I love the smell of theocratic McCarthyism in the morning?

In the world of law and considering what Tom DeLay said last week about getting even with judges who make the ?wrong? decisions ? (see last week?s issue here and here) - "The time will come for the men responsible for this to answer for their behavior." ? we have more this week. You do remember more than a week ago Dana Milbank in the Washington Post reported on a conservative conference about out-of-control judges. You remember what those folks said about the current nine on the Supreme Court.
? lawyer-author Edwin Vieira told the gathering that Kennedy should be impeached because his philosophy, evidenced in his opinion striking down an anti-sodomy statute, "upholds Marxist, Leninist, satanic principles drawn from foreign law."

Ominously, Vieira continued by saying his "bottom line" for dealing with the Supreme Court comes from Joseph Stalin. "He had a slogan, and it worked very well for him, whenever he ran into difficulty: 'no man, no problem,' " Vieira said.

The full Stalin quote, for those who don't recognize it, is "Death solves all problems: no man, no problem."
Kill them all? It?s a thought. But not on this side of the fence.

This week? From a transcript of an interview between editors and reporters from The Washington Times and House Majority Leader Tom DeLay, Texas Republican, April 13, at his Capitol office -
I blame Congress over the last 50 to 100 years for not standing up and taking its responsibility given to it by the Constitution. The reason the judiciary has been able to impose a separation of church and state that's nowhere in the Constitution is that Congress didn't stop them. The reason we had judicial review is because Congress didn't stop them. The reason we had a right to privacy is because Congress didn't stop them.
Oh my. The man has a bee in his bonnet.

Some of us are kind of fond of that right to privacy business. The Griswold ruling against the State of Connecticut made sense to us ? that state had no business telling anyone they couldn?t use birth control and what happened in the bedroom really was the state?s concern. Some of us thought that ruling made sense. The idea the government shouldn?t sanction a particular religion and deal harshly with any who don?t subscribe to it? That seems pretty basic ? and a fine idea. Theocracies cause no end of trouble. The idea that the courts can review laws and say hold on, the constitution says you can?t do that is, some of us believe, how things should work.

Tom DeLay ? the Hammer, the Bug-Man ? seems to have other ideas. And this is getting hotter.

Mark Kleiman, that Professor of Policy Studies at the School of Public Policy and Social Research at UCLA, being a bit of a wag, quotes, at length, Alexander Hamilton in the Federalist Papers, Number 78 particularly. Kleiman is here and the link the Hamilton is here.

The complete independence of the courts of justice is peculiarly essential in a limited Constitution. ? Without this, all the reservations of particular rights or privileges would amount to nothing.

? There is no position which depends on clearer principles, than that every act of a delegated authority, contrary to the tenor of the commission under which it is exercised, is void. No legislative act, therefore, contrary to the Constitution, can be valid. To deny this, would be to affirm, that the deputy is greater than his principal; that the servant is above his master; that the representatives of the people are superior to the people themselves; that men acting by virtue of powers, may do not only what their powers do not authorize, but what they forbid.

? The interpretation of the laws is the proper and peculiar province of the courts. A constitution is, in fact, and must be regarded by the judges, as a fundamental law. It therefore belongs to them to ascertain its meaning, as well as the meaning of any particular act proceeding from the legislative body. If there should happen to be an irreconcilable variance between the two, that which has the superior obligation and validity ought, of course, to be preferred; or, in other words, the Constitution ought to be preferred to the statute, the intention of the people to the intention of their agents.

? where the will of the legislature, declared in its statutes, stands in opposition to that of the people, declared in the Constitution, the judges ought to be governed by the latter rather than the former.

? whenever a particular statute contravenes the Constitution, it will be the duty of the judicial tribunals to adhere to the latter and disregard the former.
Ah, what did Hamilton know? He wasn?t born here ? he was a mixed-race illegitimate child born in Saint Kitts in the Caribbean. Uppity fellow. Or so the white Orkin Man from Texas thinks.

Kleiman comments that there was obviously something deficient in the teaching of American history in the public schools Tom DeLay attended. And he points to another fellow suggesting DeLay has an obvious problem with Marbury v. Madison, ?which Defendant DeLay no doubt regards as an exercise in judicial activism.? You can follow the links for that.

What is all this about?

Andrew Sullivan suggests this regarding this and all the ethical problems DeLay is facing ? it?s a personality thing -
I'm not that impressed with the ethical complaints against him. His sleaze doesn't seem to me to be that unusual. Having his wife work for him is almost routine in Congress. The problem with DeLay is that he's a repulsive figure on television and elsewhere. I've never met him and can't believe he's this repellent in person (he wouldn't have done so well in politics if he were). But his religious fanaticism, his seething hatred for his opponents, his natural proclivity for arrogance all reflect a real problem for the GOP. He does indeed represent what the party seems to be becoming. That's why he won't be forced out. And that's why smart Republicans will keep him out of the public eye as much as much as possible. He makes Newt seem likable.
He is what the party is becoming? Yeah, him and John Bolton. The party of hyper-aggressive bullies?

Well, DeLay did apologize this week, sort of -
U.S. House Majority Leader Rep. Tom DeLay, R-Texas, has asked for recommendations on legislation regarding judges' decisions in the Teri Schiavo case.

DeLay became involved with the Schiavo case, in which the husband of a brain-damaged woman received a state judge's order to have the woman's feeding tube removed and the federal courts did not intervene. Schiavo died about two weeks later. DeLay then said the judges responsible for such decisions would be held accountable.

On Wednesday, while saying Schiavo's death may have made him "more passionate" than usual, DeLay told a news conference he told the House Judiciary Committee to recommend legislation regarding the courts. He said, "Of course I believe in an independent judiciary," but added it was congressional duty to rein in the courts, The New York Times reported. He did not outline what kind of legislative action he was seeking.
That is, he really is sorry, and he wants legislation to overturn court rulings. Oh.

Well, what to do about these judges? Get rid of the filibuster so we can get some men of God on the bench. That?s Bill Frist?s idea, as reported widely at the end of the week.
As the Senate heads toward a showdown over the rules governing judicial confirmations, Senator Bill Frist, the majority leader, has agreed to join a handful of prominent Christian conservatives in a telecast portraying Democrats as "against people of faith" for blocking President Bush's nominees. Fliers for the telecast, organized by the Family Research Council and scheduled to originate at a Kentucky megachurch the evening of April 24, call the day "Justice Sunday" and depict a young man holding a Bible in one hand and a gavel in the other. The flier does not name participants, but under the heading "the filibuster against people of faith," it reads: "The filibuster was once abused to protect racial bias, and it is now being used against people of faith."
Reactions? You can find some gathered at the Daily Kos ?

John Cole:
This is so patently offensive that I don't have adequate words to describe how truly wrong this is: [...]

If you don't share our politics, you hate the baby Jesus.

If you don't share our politics, you hate religious people.

If you don't share our politics, you are evil.

Congrats, Republicans. Our leaders have now taken the traditional rhetorical demonization of our opposition and elevated it to heavenly heights. I assume my friends on the right are going to spend the week-end attacking me for being a 'religious bigot' because I rightly point out the inappropriateness of this behavior.
Joe Gandelman:
Senate Majority Leader Bill Frist has reportedly now not only decided on the "nuclear option" on filibusters but he is apparently ready to help instigate a political BIG BOOM that has the potential of enmeshing the GOP in charges that it's ushering in a new, dangerous area of theocratic McCarthyism.

If he does it, it'll be a watershed moment -- a transformational moment for the GOP...marking the political death of a dominant part of its party. [...]

Isn't this ushering in a new LOW in American political demonization? Isn't this akin to labeling those with whom we disagree Communists or Communist stooges? Isn't this throwing out all pretensions of the kind of intellectual, civilized discourse and debate taught in universities, law schools and practiced daily by Americans on the right and left who sit down for drinks or coffee and agree to differ on issues but maintain respect?
Digby at Hullabaloo:
I cannot stress enough how important I think it is to draw the contrasts between the Democrats and Republicans right now. Their ducky president looks lamer and lamer by the day and both GOP leaders of the congress are overreaching badly with this public soul kissing of the extremist religious right. (Giving them any cover for this wacky morals crusade is just dumb. Don't go there, please.)

All we need to do is say we are defending the constitution. Most people may know nothing about civics in this country anymore, but they know damned well that disemboweling one branch of government is not business as usual.
As Kos humself (Markos Moulitsas Zuniga) says - This is going to get ugly. And surreal. But the American Taliban have Frist in their grip, and won't relinquish until they have their Afghanistan-style theocracy.

From the Anti-Defamation League?
Deeply troubled by reports that Senator Bill Frist will appear in a telecast organized by conservative Christian groups that portrays the filibustering of judicial nominees as "against people of faith," the Anti-Defamation League (ADL) today urged Dr. Frist to reconsider his participation in the telecast, stating that: "Whatever one's views may be on this or any other issue, playing the 'religious' card is as unacceptable as playing the race card."

In a strongly worded letter to the Senate majority leader, Abraham H. Foxman, ADL National director, said he was "deeply troubled" by Dr. Frist's decision to appear in the "Justice Sunday" telecast on April 24. The program's message, " deeply flawed and a dangerous affront to fundamental principles of American democracy," Foxman said.

"The heated debate regarding the status of the filibuster in the United States Senate is a quintessentially political contest, not a religious struggle," Foxman said. "Nor should it be portrayed as such. Whatever one's views may be on this or any other issue, playing the 'religious' card is as unacceptable as playing the race card."
The Democratic leadership? Senate leader Reid:
I am disappointed that in an attempt to hide what the debate is really about, Senator Frist would exploit religion like this. Religion to me is a very personal thing. I have been a religious man all my adult life. My wife and I have lived our lives and raised our children according to the morals and values taught by the faith to which we prescribe. No one has the right to judge mine or anyone else?s personal commitment to faith and religion.

God isn?t partisan.

As His children, he does ask us to do our very best and treat each other with kindness. Republicans have crossed a line today. America is better than this and Republicans need to remember that. This is a democracy, not a theocracy. We are people of faith, and in many ways are doing God?s work. But we represent all Americans, regardless of religion. Our founding fathers had the superior vision to separate Church and State in our democracy. It is a fundamental principle that has allowed our great, diverse nation to grow and flourish peacefully. Blurring the line between Church and State erodes our Constitution, and our democracy. It is a blatant abuse of power. Participating in something designed to incite divisiveness and encourage contention is unacceptable. I would hope that Sen. Frist will rise above something so beyond the pale.
Don?t bet on it.

So this is a heads-up. This fight will be amazing. Oppose the Republicans, understand and respect the constitution, expect judges to rule on the laws passed in regard to the constitution? Do so and you are against God.

So it has come to this.

Posted by Alan at 18:56 PDT | Post Comment | Permalink
Updated: Friday, 15 April 2005 18:58 PDT home

Topic: For policy wonks...

Trends: Healthcare in America is the Best?

The specter of "socialized medicine" is the greatest con ever perpetrated on the American public? Over the years we've jury rigged a bizarre system that Rube Goldberg would be ashamed of, but somehow we're convinced that America has the best healthcare in the world? But the plain fact is that we don't?

Monday last I sent my conservative friend an item by Kevin Drum on his site ?Political Animal? over at the Washington Monthly because he and had this exact conversation, almost word for word more a year ago. Here we have Matt Welch and Emmanuelle Richard ? mentioned here before as she?s the French stringer out here for the French daily Liberation and we chatted now once (and she invites me to those press parties and our site crosslink) ? and of interest to me as I used to work in healthcare, first for a chain of hospitals and then for an HMO. Any conversation about healthcare costs and quality catches my attention.

Drum found, via Ted Barlow, a post from Matt Welch from the previous on Friday ? a bunch of libertarians chatting about healthcare about healthcare -
we had some small discussion group about De Tocqueville, and someone (naturally) brought up France's high taxes and thick welfare state. "Well, the thing is," Emmanuelle said (quotes are inexact), "some of the things the French state provides are pretty good. For instance health care."

"Wait a minute wait a minute," one guy said. "If you were sick ? I mean, really sick ? where would you rather be? France or the U.S.?"

"Um, France," we both said.

Various sputtering ensued. What about the terrible waiting lists? (There really aren't any.) The shoddy quality? (It's actually quite good.) Finally, to deflect the conversation away, I said "Look, if we made twice as much money, we'd probably prefer American health care for a severe crisis. But we don't, so we don't."
Drum?s comment?
Hell, I make more money than Matt and if I were really sick I'd rather be in France too. I've read quite a bit about France's healthcare system and it's effin great. To put it in a nutshell, you can pick any doctor you want, the quality of care is high, the doctors themselves seem pretty happy with the way it works, and the overall cost per person is half what the American system costs. Plus it covers everyone in the country, not just 70% of them.

But all you hear about in America is that you might have to wait six months for hip replacement surgery. And indeed you might. But that's because hip replacement surgery is usually pretty low priority stuff. On the other hand, if what you need is either routine medical care or else urgent treatment for something like a heart attack ? that is, the stuff that makes up 99% of actual real life medical care ? France is great.

I've long thought that the specter of "socialized medicine" is the greatest con ever perpetrated on the American public. Think about it. Suppose you were constructing a healthcare system from scratch. Choice #1 is national healthcare along the lines of France or Sweden. (Not Britain. Their system kind of sucks.)

Choice #2 is this: if you're employed, your employer might provide you with healthcare coverage of some kind. Anytime you change employers or your employer changes plans, your coverage and your doctor will change too. If you're unemployed, or you work for Wal-Mart, you get nothing ? though in a pinch you can always show up at an emergency room, which is perhaps the most expensive way of delivering healthcare known to man. If you're poor, there's a shabby government program that will sort of cover your kids, but probably not you. If you're over 65, another government program will cover some but not all of your medical expenses. And all of this will cost us about 14% of GDP, far more than any other industrialized country on the planet.

That's insane. No one would design a healthcare system like that. But that's what we have, thanks mostly to a weird set of coincidences and political compromises made around the time of World War II.

And who benefits from it? Citizens? Probably 95% of us would be better off with France's system than with ours. Businesses? Why should they be saddled with the cost and hassle of providing healthcare? Doctors? Maybe a bit, but an awful lot of them would probably be better off in France too. Insurance carriers and pharmaceutical companies? Bingo.

The whole thing is crazy. Over the years we've jury rigged a bizarre system that Rube Goldberg would be ashamed of, but somehow we're convinced that America has the best healthcare in the world. But the plain fact is that we don't. For a tiny percentage of us, medical care here is better than in France. For the vast, vast majority, France's system is superior to ours in practically every respect.

But ? quelle horror! ? that would be socialized medicine. And you might have to wait six months for hip replacement surgery. Probably best just to stick with what we have. After all, the insurance industry wouldn't lie to us, would they?
And my conservative friend replies -
Interesting. We did have this exact conversation. It's hard to know what is real and what is not.

For example, not long ago in preparing for our upcoming trip to Provence I read Peter Mayle's "Toujours Provence" which, as you probably know and have read, is his wonderfully entertaining slice of life accounts of his experience there. One of the chapters talked about healthcare in Provence and pointed out that it was indeed very bureaucratic and perhaps hit and miss for what you may really have (in terms of diagnosis). Follow up and follow through seemed atrocious and direction from the doctor was fuzzy at best. He didn't directly slam it but his story didn't put it in a glowing light. Ah but that was Mayle's experience.

Mais peut-etre plus de la difference a Paris, n'est-ce pas? Dans la grande ville du pays? C'est meilleur, sans doute.
Well, there is counter eveidence that things are always better in big cities, that Paris is a better play to be sick than, say, Lourmarin.

Here?s one Peter Owen, an expatriate living in France, and his experience -
I live in a rural area around 8km from the nearest village, 12km from a big village and over 20km from the nearest town.

I was cycling home when a dog collided with my bike. The animal was unhurt but I fell off, but only seemed to be in some discomfort at that point. During the night, however, the pain became excruciating so in the morning I phoned my generaliste (GP) in the big village and fixed an appointment for that afternoon when my neighbour could drive me in.

I arrived 15 minutes early and was seen almost immediately. The GP telephoned the X-ray unit 3km away and explained the condition. I was told to come straightaway. I waited about 10 minutes to be x-rayed, then a further 15 minutes while the X-rays were being studied. The radiologist then explained that I had a fracture and a cracked rib. I was told to take the X-rays back to my GP immediately.

The GP studied the X-rays and decided that I should see an orthopaedic specialist. He telephoned the specialist (in the nearest big town) and I was given an appointment for the following morning. In the meantime I was prescribed painkillers, which came from the next-door pharmacy. I would at least sleep that night.

The following day I waited only a few minutes before being seen by the orthopaedic specialist, who decided that my current strapping was insufficient and my wrist and lower arm needed to be put in plaster, which he did. I should return in four weeks' time.
There?s much more detail at the link.

Kevin Drum?s comment?
Total out of pocket cost in this case, which was higher than normal because this guy has an expensive GP, was about a hundred bucks.

That socialized medicine stuff is hell, isn't it?
Well, it IS socialized.

Well, forget France. What about the UK? Everyone knows their National Health System (NHS) is crappy. Right?

Well, Drum points to this from one Avedon Carol, an American who's been in the UK for some years now ?
To me, though, the priceless fact of UK healthcare is this: I pay for it when I can pay, and I get it when I need it. What that means is that, yes, when I'm getting a paycheck, money comes out whether I'm sick or not, but when I'm ill, I get healthcare whether I have money to fork-over or not. I don't feel that money coming out of my paycheck, but believe me, as someone who grew up in the US, I am acutely aware of the fact that when I'm thinking about seeking medical care or advice, I know with a certainty that the price is not an issue.

When I was getting ready for my eye surgery, I didn't forget that even some people I know who have health insurance in the US would have had to write-off their eye if they'd been in my situation because the cost of surgery, two nights in the hospital, and after-care might not all be covered and what they still would have had to produce out-of-pocket would have broken them. Someone with no insurance wouldn't even have been able to consider it. (And that's leaving aside the four weeks I spent house-bound while I kept my head in the necessary position to make sure the procedure works. Would your employer give that to you?)

I get the care I need when I need it, and so far it's been good care. I never have to think about whether I can afford it. Like I say, priceless.
As Drum adds
And keep in mind that this is Britain, which is generally thought to have one of the worst national healthcare systems in Europe.

It's funny, isn't it? Conservatives keep telling us how bad healthcare is in the socialist hells of Europe and Canada, and yet the people who actually live in Europe and Canada mostly like their healthcare just fine. In fact, they like it better than most Americans like American healthcare (see Exhibit 1 in this report). They pay less for it than we do, too (see Figure 1 in this report).

Marc Danziger may think that "If I had a chronic or serious disease, and insurance, I'd rather be here," but I can't figure out why. After all, Europeans seem to get pretty good treatment for chronic and serious diseases, even compared to well insured Americans. I'm afraid the alleged advantages of America's healthcare system continue to evade me.
Well, a lot of folks are wondering about this.

And it finally hit the mainstream press Friday, as Paul Krugman in the The York Times picked up on the conversations of the week.

See The Medical Money Pit, April 15, 2005

Krugman decides he wants to know why we are in this pickle ? spending more and getting less. And he frames the question as why other advanced countries manage to spend so much less than we do, while getting better results.

He too turns to consideration of the NHS in the UK, but ays that may be a bad example -
? let me deal with the usual problem one encounters when trying to draw lessons from foreign experience: somebody is sure to bring up the supposed horrors of Britain's government-run system, which historically had long waiting lists for elective surgery.

In fact, Britain's system isn't as bad as its reputation - especially for lower-paid workers, whose counterparts in the United States often have no health insurance at all. And the waiting lists have gotten shorter.

But in any case, Britain isn't the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.

The countries that have something to teach us are the nations that don't pinch pennies to the same extent - like France, Germany or Canada - but still spend far less than we do. (Yes, Canada also has waiting lists, but they're much shorter than Britain's - and Canadians overwhelmingly prefer their system to ours. France and Germany don't have a waiting list problem.)
Okay, he?s laying the groundwork. Compare systems that spend roughly the same per capita that we do. Don?t consider countries like the UK where they pinch pennies.

So, what do we find? Who is spending what?
In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.

Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.
Well, it looks like we actually are spending double what the other non-penny-pinching countries are per person for healthcare. And everyone knows you get what you pay for. Right?

Not exactly.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
Yes, it is a puzzlement, and Krugman has some ideas why this should be so.
? the United States scores high on high-tech services - we have lots of M.R.I.'s - but on more prosaic measures, like the number of doctors' visits and number of days spent in hospitals, America is only average, or even below average. There's also direct evidence that identical procedures cost far more in the U.S. than in other advanced countries.

? Americans spend far more on health care than their counterparts abroad - but they don't actually receive more care.
So we love our technology, but don?t much care for that human part ? doctor visits and hanging around in the hospital for a leisurely recovery (which no HMO would allow anyway). And we pay doctors too much, and, and?.

But we have the best healthcare system in the world, as my conservative friend protested a year or two ago. Most of us believe that. The evidence is mounting that this is not so.

Ezra Klein points out that the health care debate in America is never going to get very far so long as the conventional wisdom is that health care alternatives in other countries are really awful. Brad Plummer suggests why this is so. It?s the media, but not exactly a matter of simply claiming everything America is obvious the best. Here?s his list of problems ?
1. Reporters just don't know all that much. Let's face it, covering health care issues is awfully hard?it's a complex topic!?and not many reporters do it well, even when they're writing about issues here in the United States. You pretty much have to devote yourself full-time to the subject, as, say, Robert Pear of the New York Times has. And that's just to learn the U.S. system... Not surprisingly, reporters have an especially shallow grasp of health care programs in other countries, so the coverage tends to degenerate, more than usual, into "he said, she said" affairs. In fact, I'd have to do a Nexis search, but I'd wager that it's usually not a paper's resident health expert doing stories on single-payer in, say, France or Canada. It's probably an international reporter who has a million other beats and no time to learn all the gritty details of this or that system.

2. Anecdotes count for more than statistics. This is something of an off-spurt of #1, but also a problem with the media in general, and it's especially detrimental to health care coverage. Reporters lo-o-o-ove covering the poor grandma who waits months for a hip replacement?it's a human interest story! Or those long lines for surgery. Yeesh! But here's the thing: These stories say nothing at all about health care. Everyone has a story: For every grandma waiting for a hip replacement in France, there's an uninsured American who has to pay $95 for a doctor visit to make sure she doesn't have strep throat. Cold, hard, bloodless statistics are all that really matter here, but news coverage of health care in other countries tends either to skimp on statistics or bury them in favor of the attention-grabbing anecdote.

3. Health care professionals in single-payer systems have reasons for drumming up "crisis" rhetoric. This is something that doesn't get noticed very often. For instance, in a national health care system like Canada's, every year the government has to set a budget for hospitals, limit how much doctors can charge, etc. It's a big debate, and to gain leverage, doctors of course love to talk about how there are shortages and people can't get necessary treatments and so on and so forth. Naturally, their complaints get picked up by the Canadian media and trickle on into American papers. But no one stops to think that these health care professionals are all self-interested actors who have their own reasons for playing up the system's faults.
So it?s hard to get the truth of the matter.

And Matt Yglesias adds more reasons we don?t know jack about what is for real, more reasons my conservative friend says it is hard to know what is real and what is not.
The England Problem. For linguistic and other reasons, the European country Americans are most cognizant of is the United Kingdom which happens to have a health care system (the NHS) which goes very far in the opposite direction from the U.S. system in terms of command-and-control health care and which, consequently, offers a very exaggerated version of the downsides of government-run health care.

The France Problem. While the NHS model actually has a certain appeal to me (leave that for another day), it's something that utterly lacks political appeal in the USA and isn't a realistic model for any American reforms. The most likely candidate for something we would want to imitate is France. Unfortunately for the cause of American health care reform, France and the United States have a long-term history of cultural antagonism that makes "we should do it more like they do in France" a public policy kiss of death. Worse, most people are aware that the French economy does not perform in a manner many Americans would want to imitate. People tend not to peer too closely at what it is about the French model that leads to those results, and instead the whole thing gets tarred as bad. But nothing about adopting a French-style health care system would require us to adopt French-style labor rules, French-style housing projects, French-style approaches to cultural diversity, French-style dirigisme, etc., etc., etc. Perhaps most crucially, it wouldn't force us to adopt French-style tax rates.

The Canada Problem. The US-Canada health care dynamic is asymmetrical, because wealthy Canadians can travel to the United States to take advantage of the aspects of our system that work better (for relatively prosperous people) than does their system, while working- and middle-class Americans can't go to Canada to take advantage of the aspects of their system that work better than ours. The result is that you have lots of anecdotal evidence of people fleeing Canadian waiting lists to get their hips fixed in the USA, but no anecdotal evidence of people taking their kids to Canada to get affordable, high-quality preventative care for their kids. In the limited domain of pharmaceuticals, this has changed and Americans now can (and do) go to Canada to get cheap drugs. Not coincidentally, I think, this is the area in which you have the most public support for left-wing solutions.

Cost Underestimation. Apropos of the French-style taxes, it seems natural to assume that governments which provide health care for all their citizens are spending more than are government which provide health care to only some citizens. It's natural to assume, but it isn't true. Reporting on the actual composition of federal spending is always dismal, which leads people to grossly underestimate the extent to which your tax dollars are already going to pay for health care, since Medicare is a universal coverage program for the segment of the population that is by far the most expensive to treat.

Hidden Costs. On the private-sector end, few people understand exactly how much is being spent on health care. This is because the employer side of insurance premiums is hidden from the view of all but payroll people and policy wonks. Additionally, the scale of tax subsidies provided to the health care industry is basically unknown to all beyond the elite.

Bipartisanship as Fairness. Perhaps the biggest problem is simply that since single-payer isn't the official view of the Democratic Party. One problem with "he said, she said" writing is that if he is lying, he gets to get away with it. Perhaps a bigger problem is that if he and she agree that we shouldn't do X, it winds up going without saying that X is, in fact, a terrible idea. If a major political official started insisting that France had a great health care system, you might be able to browbeat the press into acknowledging that he was right. But until someone does it, it will simply continue to be taken for granted that it must not be.

Rich Journalists. Last but by no means least, one must point out the obvious. If you're well-off and seriously ill, the American system probably is the best in the world. Even if you are wealthy, you might never have gotten so seriously ill if you'd been living in a country with proper health care, but once you are seriously ill, the USA is the place to be. Journalism is dominated by relatively prosperous people, and perceptions of the health care system are dominated by people who have a great deal of experience with it, which is to say people who have been seriously ill who who've had close family members fall seriously ill. The things the American system is really, really bad at tend to be hidden from view.
That last point is cool. Prominent reporters have health plans, and funds if any coverage is denied, or one assumes. They are not naturally sensing what it is like for the 40-44 million who have no healthcare insurance at all.

So what is the truth?

You could bop over to the ?National Review? and read this review of Uninsured in America: Life and Death in the Land of Opportunity, where you will find this -
Rotting teeth are a consistent motif among their interviewees, and with a poignancy not often found in policy books, the authors peg tooth decay as a reliable barometer of one's employability and caste status. As one uninsured woman who works part-time in a call center (and therefore out of public view), tells them: "I've gotten toothaches so bad, so that I just literally pull my own teeth. They'll break off after a while, and then you just grab ahold of them, and they work their way out ... The hole closes itself up anyway." As the insured reader guiltily and involuntarily runs his tongue over his teeth upon reading these lines, the authors' caste argument essentially proves itself.

And there's plenty more where that came from, as the authors present through their subjects a laundry list of ominous examples of untreated suffering, ranging from gallbladder disease to diabetes to asthma, addressed alternately by hopeful neglect and homemade cocktails of alcohol and over-the-counter pain medication ? or in the harrowing case of an Idaho man with recurring bone spurs in his feet, a power sander.
Not the stuff for the national news shows.

But? In 1960 Edward R. Murrow for CBS News gave us ?Harvest of Shame? ? first shown on Thanksgiving Day that year - about the conditions of migrant farm workers in America. That kind of put the issue on the table, and no one was thinking much about it before the show. This was, one sees, the prototype for the long-form journalistic documentaries we see now and then.

Did it do any good? In 1962, Congress enacted the Migrant Health Act, which called for the development of health care clinics for farm workers and their families, among other things. Cause and effect? Maybe.

Maybe it is time for another.

But it?s not going to happen. Murrow is long dead, and how can you compete with American Idol and the reality shows? Even CBS?s ?60 Minutes? is in decline. Investigative, hard-hitting television journalism? That?s a dead as Edward R. Murrow ? and if he saw what passes for hard-hitting investigative journalism these days ? from Geraldo Rivera opening Al Capone?s vault a few years ago to this week?s real inside news about Michael Jackson licking the heads of little boys ? he?d be rolling over in his grave, except he was cremated. Ah, imagine the ashes fluffing around in outrage.

No, the mess we have made of healthcare will not be covered. This week?s conversation was an anomaly. I was surprised it moved from the blogs to the New York Times. Other matters will swamp the news cycles. And too, we want to believe we are the best at what we do.

Posted by Alan at 15:17 PDT | Post Comment | Permalink
Updated: Friday, 15 April 2005 15:24 PDT home

Thursday, 14 April 2005

Topic: Photos

Photography: An Old Bird

Political and cultural commentary will resume tomorrow. This week has been visual, not intellectual.

On April 14 the local staff of Just Above Sunset was on a press flight. At ten that morning the editor and Just Above Sunset columnist Bob Patterson flew out of Torrance Airport on a media flight in a restored Boeing B-17G bomber from WWII. This photo album contains a few of the 132 photos we snapped.

And the New York City and Princeton collection has been amended here.

Posted by Alan at 22:11 PDT | Post Comment | View Comments (1) | Permalink

Wednesday, 13 April 2005

Topic: The Economy

The Economy: Better Times for Whom? Paris Hilton.

This article was sitting in the Los Angeles Times on my doorstep Monday as I was thirty-five thousand feet above Kansas, returning from a weekend hanging around Manhattan. No, I?m not rich. I was the guest of a high-powered Wall Street attorney and his family, friends for many decades. (I first met the fellow when he was my student back in the seventies ? when I was an English teacher and he was in the tenth grade.)

And what was waiting for me in my copy of the Times on the doorstep?

Wages Lagging Behind Prices
Nicholas Riccardi, Monday, April 11

Something is up.
For the first time in 14 years, the American workforce has in effect gotten an across-the-board pay cut.

The growth in wages in 2004 and the first two months of this year trailed inflation, compounding the squeeze from higher housing, energy and other costs.
Is this a problem? Well, if folks can only buy less and cheaper, perhaps so. That might slow down the economy even more, as if the price of gasoline weren?t enough alone to do that.

The details?
? This is the first time that salaries have increased more slowly than prices since the 1990-91 recession. Though salary growth has been relatively sluggish since the 2001 downturn, inflation also had stayed relatively subdued until last year, when the consumer price index rose 2.7%. But wages rose only 2.5%.

The effective 0.2-percentage-point erosion in workers' living standards occurred while the economy expanded at a healthy 4%, better than the 3% historical average.

Meanwhile, corporate profits hit record highs as companies got more productivity out of workers while keeping pay increases down.

Some see climbing profits and stagnant wages as not only unfair but also ultimately unsustainable.
Who worries about such stuff? Don?t the people with get-up-and-go and the right attitude just become wealthy, and the others have only themselves to blame? That?s what my conservative friend tells me ? this erosion in workers' living standards is the fault of the workers themselves.

And too, as the economy recovers, as it will, or so we are told, wages will finally rise again. But should they? Unassertive (lazy) non-entrepreneurial folks getting even meager wages is bad for us all, it seems -
? higher wages could hurt the economy by stoking inflation further. Employers might pass the costs on to consumers in higher prices, and that in turn might prompt the Federal Reserve to raise interest rates more aggressively, possibly slowing the recovery or even triggering a recession.
It seems that keeping folks receiving less and less real income saves us from a recession. Odd.

A writer with the pseudonym Quiddity notes another passage from the Times story that seems to indicate things aren?t really that bad -
Despite the failure of their wages to keep pace with inflation, American consumers have kept shopping. Consumer spending has continued to rise. Analysts say that's partly because some shoppers are thinking less about their paychecks and more about their biggest asset: their homes.

Home prices rose 21.1% in Southern California and 9% nationwide from February 2004 to February 2005, sheltering consumers, and the economy, from much of the pinch of higher prices.
Ah, so the pain is not real, so to speak. Refinance, buy, refinance again. And that works out here in California. Home prices have gone up between twenty and twenty-five percent for the last five years or more. Instant money.

But Quiddity points out -
First of all, not everybody has a home, and those people are really losing. Second, when inflation is being "cured" with rapidly rising home prices, you've got a problem. Nothing is being produced. Nothing is being exported. Nothing of value is generated.

But the rise in home prices will work for a while, but only up to a certain point. When that's reached, there will be no way to keep the economy chugging along at a decent rate. Then comes the stall. Then comes the decline.
Really? Cannot home prices go up like this forever? What did Mark Twain say? Buy land. There?s not making any more of it.

Twain has a point. Out here in La-La Land there?s not just a shortage of affordable housing ? only about seventeen percent of working families in Southern California can afford anything for sale in these parts ? there?s a shortage of housing, period. Prices rise and rise, on and on, with no end in sight.

So, will the housing bubble ever really burst and send the economy into the weeds? Who knows? It doesn?t seem you?ll hear any bubble popping out here.

But that doesn?t help some people. For someone like me, who rents, by choice, and is retired, things just get more and more expensive ? with no access to the one remedy that is saving everyone else in the economy. Oh well. One becomes careful.

Of course, the New York Times delivered, a day late, the same story as my local newspaper, to my friend doing securities law in Lower Manhattan, but with more depth. No colorful anecdotes about this gainfully employed Joe Public or that gainfully employed Joe Public eating cat food or dropping health and car insurance to get by. This was in the business section.

Falling Fortunes of Wage Earners
Steven Greenhouse, Published: April 12, 2005

The same sort of opening -
Beginning in the mid-1990's, pay increases for most workers slowly but steadily outpaced the rate of inflation, improving the living standards for nearly all Americans.
But an unexpected reversal last year in those gains has set off a vigorous debate among economists over whether the decline is just a temporary dip or portends a deeper shift that may cause the pay of average Americans to lag for years to come.

Even though the economy added 2.2 million jobs in 2004 and produced strong growth in corporate profits, wages for the average worker fell for the year, after adjusting for inflation - the first such drop in nearly a decade.
Ah! The economists argue.

First, they say problem is not with the jobs themselves ? the problem is not very few and very crappy jobs out there - but perhaps with the now global economy, and with too many workers? benefits -
? Most economists dismiss as overblown the widespread fear that the number of jobs will shrink in the United States because of foreign competition from China, India and other developing nations. But at the same time many of these economists argue that the increasing exposure of the American economy to globalization, along with other forces - including soaring health insurance costs that leave less money for raises - is putting pressure on wages that could leave millions of workers worse off.
Worse off, but as above, keeping inflation in check.

But Greenhouse says there are optimists -
?But some economists are more optimistic, saying that the wage sluggishness is temporary and that real wages have slipped only because a sudden spike in oil prices has briefly left workers behind the curve. These economists assert that wage stagnation will end soon, as normal growth brings a tighter labor market.
Maybe. Let?s blame those middle-easterners with their OPEC nonsense. Everything will get better. No problem.

Some of us aren?t buying that. And we see this too -
? The overall wage figures hide a split, with an elite group getting relatively large gains. In a study of census data, the Economic Policy Institute, a liberal research group, found that for the bottom 95 percent of workers, after-inflation wages were flat or down in 2004, but for the top 5 percent, wages rose by an average of 1 percent, with some gaining much more.

The upper-income group enjoyed strong pay increases largely because of bonuses, stock options and other inducements and because of robust demand in certain fields, like law and investment banking.
Well, my host for the weekend is doing well. He?s an attorney. His wife is an attorney. For those of us in other fields?

Those of us in systems management know the next shift in priorities, or the next merger, or the new off-shore deal, or a change in technologies, means moving on to the next firm, always at a slight net loss. One gets used to it. Ah, there?s always work out there. It is just a bit irritating. Of course that?s the very top of the ?bottom 95 percent of workers? mentioned by Greenhouse. For the bottom 95 percent of workers perhaps it is well beyond irritating. If those folks got beyond being depressed by their slow and steady decline and got, say, angry, there might be a problem.

No, they all voted for Bush because they like is kick-ass style. No revolution this century. It?s a values thing. As long as Lars and Spanky don?t get married and move in down the street, well, that?s just the way it is.

Greenhouse does add more analysis, of course -
J. Bradford DeLong, an economist at the University of California, Berkeley, said that current wage patterns, while perhaps only temporary, did not conform to traditional economic explanations.

? Richard B. Freeman, a Harvard economist, predicted that new competition in the form of millions of skilled Chinese, Indian and other Asian workers entering the global labor market will increasingly pull down American wages.

"Globalization is going to make it harder for American workers to have the wage increases and the benefits that we might have expected," he said.

Facing intense foreign competition, Delphi, the auto parts manufacturer, has decided against any merit raises this year for its salaried workers. And at its air bag and door panel factory in Vandalia, Ohio, it persuaded unionized workers to accept a three-year pay freeze, warning that the plant would be closed otherwise.
Yep, that?s the way it is.

Matthew Yglesias is puzzled by it all and adds this (my emphases) -
Why Low Wages? I'm a little puzzled by Steven Greenhouse's inquiry into the falling wages problem. The bulk of the hypotheses and so forth mooted about seem to suggest that wages are being held down by something or other, with possibilities such as foreign competition, Wal-Mart's low wages, the possibility of substituting technology for labor, etc. being canvassed. That seems to suggest that, in the past, wages went up when productivity went up because bosses were nice and realized that with productivity on the rise they could afford to raise wages. Now thanks to foreign competition, Wal-Mart, and other low wage sources they "can't afford" pay raises. But that's not how the economy works, now or ever. If productivity is growing much faster than wages, then it should be easy to make a lot of money by hiring new workers.

As people do that, wages should start to go up, until it no longer becomes profitable to add new workers, at which point wages will start leveling off. Wages and productivity can't become de-linked because today's businessmen are greedy or because Wal-Mart is cunning, the link between wages and productivity depends on the fact that businessmen are greedy and cunning. You don't raise wages out of altruism, instead you expand your workforce out of greed, and the expanding workforce pushes wages up. So what's going on nowadays? None of the stuff discussed in the article seems relevant to the issue at hand. Professor DeLong is quoted in the article but doesn't have any further comments. I'd be interested to know.
So would we all.

So DeLong replies (again, my emphases) -
Well, there are three hypotheses:

1.) Improvements in firms' ability to squash unions, and thus shift wage bargains toward employers (the Wal-Mart hypothesis).

2.) A slack labor market--much more labor-market slack than the level of the unemployment rate would lead one to expect--in which firms find it easy to hire workers and workers find it hazardous to ask for higher wages.

3.) Changes in the international economy that boost the wages of the skilled and educated (whose products can be sold abroad for more) and put downward pressure on the wages of the less-skilled and less-educated (who now face much stronger competition from abroad).

I believe that (3) is likely to be a very important factor over the next two generations. But this wage-growth slowdown we have seen since 2000 has hit too rapidly and has been too large to be credibly attributed to "offshoring" or other long-run international factors. (1) is surely a factor, but (1) wouldn't work unless (2) were exerting a powerful downward force on wages. (2) has many causes--a relatively high value of the dollar that switches demand from home to abroad is one of them.

I expect things to turn around as employment expands and as (2) loses its force--unless the Federal Reserve decides that it needs to fight inflation now.

Why hasn't (2) lost its force already? Why, with rapid productivity growth and stagnant wages and cheap money that is easy for firms to borrow, isn't firm demand for workers already through the roof? Well, how much would you like to expand capacity if you knew the country had a large budget deficit, and that either big tax increases or a burst of inflation were likely in the future? When Paul Volcker and Bob Rubin say that a serious financial crisis may well be on the horizon? Wages and productivity can't become de-linked because today's businessmen are greedy or because Wal-Mart is cunning, the link between wages and productivity depends on the fact that businessmen are greedy and cunning. You don't raise wages out of altruism, instead you expand your workforce out of greed, and the expanding workforce pushes wages up.
Wait a second here. I know Professor DeLong used to work in the Clinton administration but is he saying the Bush thing of turning a multi-trillion dollar surplus into a multi-trillion dollar deficits through an expensive war and tax breaks for the ultra-rich was a BAD idea?

Yes. Just how are these guys managing the economy?

Well, they have their priorities.

Ah, and that brings us to Paris Hilton.

"Trust fund babies rejoice!"

In the Washington Post we see this is speeding through the House of Representatives ? which one fellow calls legislation designed to keep the Paris Hiltons of the world from ever doing a day of honest work. The house is to permanently repeal the estate tax.

This is class warfare? Perhaps.
Last month, [Michael] Graetz and Yale political scientist Ian Shapiro published "Death By A Thousand Cuts," chronicling the estate tax repeal movement as "a mystery about politics and persuasion."

?For almost a century, the estate tax affected only the richest 1 or 2 percent of citizens, encouraged charity, and placed no burden on the vast majority of Americans," they wrote. "A law that constituted the blandest kind of common sense for most of the twentieth century was transformed, in the space of little more than a decade, into the supposed enemy of hardworking citizens all over this country."

The secret of the repeal movement's success has been its appeal to principle over economics. While repeal opponents bellowed that only the richest of the rich would ever pay the estate tax, proponents appealed to Americans' sense of fairness, that individuals have the natural right to pass on their wealth to their children.

The most recent Internal Revenue Service data back opponents' claims. In 2001, out of 2,363,100 total adult deaths, only 49,911 -- 2.1 percent -- had estates large enough to be hit by the estate tax. That was down from 2.3 percent in 1999. The value of the taxed estates in 2001 averaged nearly $2.7 million.
Hey, that?s a neat trick. Most of us are going to get screwed economically, Social Security must go away, the Veterans get their health benefits cuts, the troops don?t get all their armor ? but Paris Hilton get another Porsche?

Well, that?s fair. Not.

And at the Post E.J. Dionne notes this -
In a little-noticed estimate confirmed by his office yesterday, Stephen Goss, the highly respected Social Security actuary, has studied how much of the Social Security financing gap could be filled by a reformed estate tax. What would happen if, instead of repealing the tax, Congress left it in place at a 45 percent rate, and only on fortunes that exceeded $3.5 million -- which would be $7 million for couples? That, by the way, is well below where the estate tax stood when President Bush took office and would eliminate more than 99 percent of estates from the tax. It reflects the substantial reduction that would take effect in 2009 under Bush's tax plan.

According to Goss, a tax at that level would cover one-quarter of the 75-year Social Security shortfall. The Congressional Budget Office has a more modest estimate of the shortfall. Applying Goss's numbers means that if CBO is right, the reformed estate tax would cover one-half of the Social Security shortfall.

This is big news for the Social Security debate. Michael J. Graetz and Ian Shapiro, authors of a new book on the estate tax, "Death by a Thousand Cuts," have referred to its repeal as the "Paris Hilton Benefit Act." To pick up on the metaphor, why should Congress be more concerned about protecting Paris Hilton's inheritance than grandma's Social Security check? How can a member of Congress even think about raising payroll taxes while throwing away so much other revenue?
How? Assume folks know who their betters are and like good serfs they sacrifice for their lords? No, not that exactly.

It?s more like a principle ? everyone knows you keep and don?t share. It?s related to the conservative mantras about rugged individualism, personal responsibility, and taking care of yourself and not relying on big government. No community. That?s not the American way.

That?s what we all understand is the way things are now. That?s the real Republican revolution.

Posted by Alan at 16:54 PDT | Post Comment | Permalink
Updated: Wednesday, 13 April 2005 16:56 PDT home

Tuesday, 12 April 2005

Topic: Photos

Slow day…

Couldn’t add entries today. The internet service is not good and has been iffy all day. I cannot get to any sites much at all. Comcast says they’re working on it - an area-wide outage. In lieu of commentary, you might want to check out Manhattan, and Princeton, in this photo album from the weekend.

Back to the news tomorrow.

Posted by Alan at 22:41 PDT | Post Comment | Permalink

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