Thursday, December 24, 2009
Tuesday, December 15, 2009
Friday, December 11, 2009
First, let's review the current context. Up to 45,000 people die each year because they don't have health insurance. The U.S. health care system is by far the most expensive in any industrialized nation, and our health outcomes tend to be worse than other industrialized nations. Although we are certainly good at treating certain things, like cancer, we generally get much less bang for our health care bucks. There are also problems with health insurance. Right now, if you have a preexisting condition and don't have insurance, you are headed for financial and medical disaster. Insurance companies also practice shady tactics, like rescission, which involves denying you coverage after you've made a claim on the pretext that they have found some small, unrelated thing in your health history (like some acne treatment) that you did not previously report. Finally, there are problems of runaway costs. If left unchecked, growing health care costs will bankrupt Medicare and the nation within only a few decades.
All of this is unacceptable. Completely and utterly unacceptable. And this bill is the last, best chance we have to do anything real. Now, will the current health care reform bills completely solve these problems? Probably not, particularly with the watered-down reforms that are now being proposed to win over shortsighted, egotistical senators. But here are five reasons why we should still support health reform:
1. New health insurance rules. Health insurance companies will no longer be able to deny people coverage for preexisting conditions or practice rescission. But, you might ask, won't the insurance companies then go bankrupt? How will they afford this? Won't they go out of business? This brings us to number 2.
2. The new individual mandate. Everyone will be required to purchase health insurance. This will increase the insurance pool and give insurance companies thousands of new customers. The mandate will lower costs for everyone and allow the insurance companies to play nice with things like preexisting conditions. But, you might ask, how will people be able to afford health insurance? Isn't it really expensive? This brings us to number 3.
3. New subsidies. Subsidies will be given to poor and middle class families based on a sliding scale. Even the more modest versions of health care reform would help around 29 million people to purchase insurance. This is a huge deal, and it is what we should morally do as a civilized nation. But still, you might ask, will a subsidy really be enough to buy good health insurance? This brings us to number 4.
4. New health insurance exchanges. The exchanges are one of the best ideas of health care reform. Right now, insurance can only operate within states. This limits competition, meaning that most consumers don't have much selection and that insurance companies have little incentive to cut costs. The solution is to let companies sell insurance in an amazon.com sort of way -- a big, national marketplace for people to price shop for their medical insurance. The pools of potential customers will be enormous and insurance companies, seeing this potential, will bid aggressively for the new business, thus reducing costs and increasing efficiency. Alas, the current exchanges in the legislation are smaller, open only to small numbers of people, and won't be open until 2014. Sen. Ron Wyden and (Republican!) Susan Collins are currently pushing an amendment that will open these exchanges to more people. I hope they succeed!
5. New Medicare reform and cost control. Even though Medicare is the most efficient medical coverage system we have, more so even than private insurers, almost everyone agrees that Medicare is not as efficient as it could be. The health care legislation will cut out Medicare Advantage, which basically funnels money to private companies to do what the government could easily do itself. It will also establish a Medicare Advisory Council, a panel composed of doctors and medical providers, which will provide guidelines for Medicare cost-control. In short, doctors will be making recommendations about cost saving and efficiency, not politicians. There is also good stuff about preventing medical errors, about increasing research into what kinds of care actually work, and about formulating programs to reward doctors who work together and provide less expensive care. It may be that this is the largest cost control measure the Congress has ever passed (as I've said before, the CBO projects it will cut billions from the deficit, even with the new spending on subsidies).
The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won't be sent. Parents won't have to fret because they can't take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.
For more information on the exchanges, see Ezra Klein's piece here.
For more about the waste of Medicare Advantage, see here.
Tuesday, December 01, 2009
* In any event, I find it surprising that no one seems to want to acknowledge the cost of war. Wars are very important to people, but even these excellent adventures seem not to be important enough to justify raising taxes. When it was recently proposed that we establish a 1% surtax on everybody's federal tax liability to help pay for the wars, the proposal did not even make it to the House floor for vote. As Yglesias says, "Nobody seems to really think there are national interests at stake that are critical enough to be worth paying slightly higher taxes for. But if a war’s not worth paying for, how can it be worth fighting? And if we don’t pay for the war in the FY 2010 budget, we still need to pay back the loans."
* On the health care reform front, it looks like the public option, a government administered health plan that would compete with private insurance state monopolies, is a goner. I can't say I care that much. The recent public option compromise of compromise of compromise has probably gutted the program of its potential effectiveness, anyway. The Democrats should now use their giving up the public option as a bargaining chip to improve other aspects of the bill.
* The complete CBO analysis of the Senate health care bill have now been released. As I said before, the health care bill is projected to reduce the deficit by $127 billion over 10 years. Not a huge number in the grand scheme of things, but a little saving is better than nothing. The CBO also released a report about what the bill would do to insurance premiums. Premiums would remain steady for people with group coverage, while decreasing for those in the small-group or individual markets (see chart below). Costs would rise for some people, but that is mostly because the government subsidies will allow them to be able to afford more coverage. This is all good news.
* Led by John McCain, the Republicans are presenting themselves as gallant defenders of Medicare. The Democrat's reform bill does indeed include cuts to Medicare Advantage, which is almost universally seen as a program fraught with waste and inefficiency. This is something that Republicans have said they have wanted. So, are they happy now? Nope, they have decided it will help them politically to rile up opposition to these spending cuts. Kevin Drum points out the irony: "Here's a party that opposed Medicare viciously in the first place, routinely spoke out against it in the years that followed, was dedicated to gutting it in the 1990s, voted for major cuts in 1997, and has been using it as a cudgel ever since to get its base riled up over the future bankruptcy of America. McCain himself proposed over a trillion dollars in Medicare cuts just 12 months ago. But now? Well, now it's 2003 all over again and there are elections to think of. So now they're righteously opposed to cutting so much of a nickel out of Medicare spending, even if the cuts are aimed at waste, fraud, inefficient programs, and bad incentives. It's just jaw droppingly mendacious." Amen.
* Some good reporting coming out on Obama's stimulus package. The Wall Street Journal reports on the CBO estimates showing that the stimulus saved up to 1.6 million jobs and added up to 3.2% to GDP. The New York Times surveys private sector economic forecasters (i.e., people who get paid big bucks to give accurate information to companies) who agree that the stimulus is working as predicted and that is was structured properly. While the economy is still struggling, the economists agree, it is doing much better than it would have done without the stimulus: "In interviews, a broad range of economists said the White House and Congress were right to structure the package as a mix of tax cuts and spending, rather than just tax cuts as Republicans prefer or just spending as many Democrats do." See handy charts below.
Wednesday, November 25, 2009
Not One Less. A Chinese film by Zhang Yimou, one of my favorite directors (he did Hero, and House of Flying Daggers). It is about a young, thirteen-year-old girl who is called to substitute teach in a poor, country school. It has interesting things to say about money, the difficulty of social change, the murky nature of our motivations, and the value of dogged persistence. While not as visually interesting as Yimou's other work, the pseudo-documentary style is interesting, too. Some moments, such as when the young teacher meticulously makes by hand sign and after sign in a desperate attempt to find her lost student, are really touching in their powerful simplicity.
Doubt. A film adaptation of a play by John Patrick Shanley. Meryl Streep's performance is absolutely breathtaking. Most interesting, though, is that the theme of doubt is taken up in an interesting way. Does doubt push us apart or pull us together? Is doubt better or worse than absolute certainty? Can we ever be sure we are doing the right thing? The film explores the nature of doubt by immersing the audience in doubt. Who is telling the truth? Who is the bad guy and who is the good guy? How are we supposed to feel about what happened? And what even happened? What did she really mean at the end?
Thirteen Conversations about One Thing. This is one of my old favorites that we just watched again. The "one thing" the film deals with is happiness. The visuals are stunning and the dialogue thoughtful and penetrating, and Alan Arkin plays a very believable scrooge type character. Philosophically rich observations on the machinations in our lives that determine our happiness and on how people respond to such machinations.
Sunday, November 22, 2009
Wednesday, November 18, 2009
Having said that, I still think we are very lucky to have him. The reason I spend so much time defending him is the amount of completely unfair criticism he receives. It seems he can do nothing, from speaking to students about hard work, to bowing (gasp!) to Chinese leaders, that won't provoke outrage. He even gets criticized for things he has absolutely nothing to do with (school kids singing about him after the inauguration). Some people, frankly, seem completely out to destroy him at any cost.
One example of this unwarranted criticism is the federal budget. Two things. First of all, where is the deficit coming from? Here is a helpful chart from the NYT, constructed from data from the Congressional Budget Office. As you can see, much of the deficit comes from 2000 and 2009 recessions and the lack of revenue that comes in during those times. The other big expenditure comes from Republican-era policies (two wars, the prescription drug program, tax cuts for the wealthy, and so forth, that were financed entirely on credit). The bailout (a Bush-era program) and the stimulus (an Obama-era program) amount to about 20% of the deficit. Recent new Obama spending programs and proposals amount to a tiny fraction of the new debt (5%). So, who should we blame for the deficit? Well, it seems that Bush is the culprit here, not Obama.
But what about the health care proposals? So far, the CBO has found the Democratic proposals to be deficit neutral, that is, completely paid for through some cuts to wasteful programs (like Medicare Advantage) and selected tax hikes. You may or may not like the health care reform proposals, but claiming that they add to the deficit is untrue.
Second, now is not the time to worry about deficits. Believe it or not, deficit spending during times of recession and high unemployment is a good thing. I know that when times are tight at your own house, you need to cut back on expenses. This is the correct thing to do, and it is certainly what we do at my house. On the level of "macroeconomics," though, things are different. A recession happens when people stop spending and loaning money. During such times, the only entity that can fill the resulting economic hole is the federal government -- remember, what eventually ended the Great Depression was the massive government deficit spending during WWII. If we cut or freeze spending during this recession, as the Republicans in congress are proposing, the results would be pretty bad. Our state of Ohio, I know, would have been absolutely devastated without the Federal stimulus money. The key will be when we return to low levels of employment and strong, sustained economic growth: If Obama does not address deficit spending at that time, then he deserves criticism. Not now.
Update: The non-partisan Congressional Budget Office just released the deficit projections of the Senate health care reform legislation. It would reduce the deficit by $127 billion over the first 10 years and by a considerable $650 billion over the next ten years. Clearly, it seems if you want to reduce the deficit, you need this sort of health care reform.
Thursday, November 12, 2009
It is possible to be cynical or begrudging in reacting to the LDS Church's unprecedented public decision to support civic protections against discrimination in employment and housing with respect to homosexuals in Salt Lake City. I think that is a temptation to be resisted.
What the LDS church has done in Utah is an immensely important and positive step and places the Mormon church in a far more positive and pro-gay position than any other religious group broadly allied with the Christianist right. They have made a distinction - and it is an admirable, intellectually honest distinction - between respecting the equal rights of other citizens in core civil respects, while insisting - with total justification - on the integrity of one's own religious doctrines, and on a religious institution's right to discriminate in any way with respect to its own rites and traditions.
I believe that there are forces of discrimination and bigotry within the Mormon church - and they have recently been ascendant. But that is true of most churches and most institutions. And what I have long observed among Mormons - unlike some other denominations - is also an American decency that tends to win out in the end. I've never met a nasty Mormon. They put many Christians to shame in their practice of their faith and the civility and sincerity with which they live their lives. And this decision in Salt Lake City - not an easy or inevitable one - to make a clear distinction between civil marriage and other civil protections is one worthy of respect.
I do not agree with it. I see no reason why civil marriage for non-Mormons should be banned because Mormons find it anathema to their doctrines - just as I see no reason why civil divorce should be banned because it violates the Catholic church's doctrines. But I can respect that position because I can respect the sincerity of that religious belief and see in this stance a genuine attempt to reach out and respect the rights of gay citizens in certain basic respects. Gays should and must reciprocate.
Tuesday, November 03, 2009
I believe it is very easy to build God in your own image and very hard to rebuild Him when you crumble. I was born to see and experience the love of God. I saw Him in my father, whose kindness and wisdom led me through a thousand anguishes of youth. I saw Him in my wife–especially in her. I told my father about her when I was nine years old. “We’re going to marry,” I said.
He smiled. “I’m glad you feel like telling me. I hope you’ll always want to tell me things like this.”
For many years I was rich, seeing and loving and touching these children of God. I knew what I believed, because I believed in them and they in me.
They died. First my father. Then my wife. Why do I still arrange my desk-work in neat piles? Why do I straighten a piece of furniture? Why do I try to arrive at appointments a minute early? Why do I lie down to sleep or get up in the morning? Have you ever wandered through an empty house looking for a purpose? You do a lot of little things automatically.
I’d like to talk about my house. It talks to me quietly in the night of the love it still shares, of the garden that still surrounds it, of the laughter of our children and grandchildren and our pride in them. I lie on my bed pulling words around, trying to understand their meaning. Words like “I believe.”
This is know: I believe in the Lord’s Prayer, all of it, but particularly where it says, “Thy will be done.” For me, that’s one clear channel to God. That one belief, “Thy will be done,” carries me through each act of each day. It teaches me to live with all that is given me and to live without what is taken away. It rescues me from the idea that happiness for myself is either important or desirable. But it doesn’t at all destroy happiness as a gift I can give, miraculously, from an empty vessel....
Tuesday, October 27, 2009
Friday, October 23, 2009
We recently drove up to Ithaca, NY, to see the blessing of my new nephew, Alexander. We had a great time seeing family and getting to know Alex a bit better. Sam and Emily were great hosts and showed us the town. Ithaca is a cute little liberal city, filled with natural food stores, surrounded by shale hills, cut deeply every now and then by deep gorges with thundering waterfalls (hence the T-shirts saying "Ithaca is Gorges"), all with a picturesque Ivy-League university gracing the skyline. It was also a beautiful time of year to drive through western New York. The fall colors in the Appalachian Mountains were breathtaking, a kaleidoscope of yellows, oranges, golds, reds, and greens.
I should say that I also dominated the game "Rock Band," flawlessly laying down the lyrics to Billy Idol's "White Wedding."
Monday, September 28, 2009
The very interesting article in the New York Times is here.
Sunday, September 27, 2009
1. The key to good popcorn is to use white popcorn, not yellow popcorn.
2. The keys to being a good teacher are enthusiasm and asking good questions (i.e, questions with an answer that is not immediately obvious).
3. The key ingredient to chocolate chip cookies is sea salt, and more of it than you might think.
4. The key to publishing an academic paper is to relentlessly revise and resubmit, documenting in detail what you have done to please the reviewers.
5. The key to buying a good car is never buying anything but a Toyota.
6. The key to understanding Hegel is to realize he is just warmed-over Aristotle.
7. The key to a good television show is that it is written or produced by Joss Whedon.
8. The key to losing weight is, alas, eating almost nothing -- exercise does not matter at all.
9. The key to a happy marriage is to help out around the house.
10. The key to recognizing Baroque music is to listen for the basso continuo.
11. The key to tying a bow tie is to stick your finger in the knot to widen the hole at the final stage.
12. The key to reading the Book of Revelation is to read it as poetry.
13. The key to success in basketball is the pump fake.
14. The key to a good rock band is the bass player.
15. The key to good pancakes is a good griddle.
16. The key to a good milkshake is that it is thin, not thick, as most people seem to think. You should be able to drink a milkshake from a straw.
17. The key to good cooking in general is this: fresh cilantro.
18. The key to successful fishing is to go where there are fish. (Obvious point, but I've learned it the hard way.)
19. The key to getting anything done is to avoid any place where you can connect to the Internet.
20. The key to using a public restroom is to choose the second-to-last stall near the very end. It is usually the cleanest.
Anybody have anything to add to this list?
Tuesday, September 22, 2009
Still, there is one thing that I think I do understand: The current system is a moral travesty. A recent study by the Cambridge Health Alliance and Harvard Medical School, published in the American Journal of Public Health, found that 45,000 people, on average, die each year because they do not have health insurance, even controlling for all the different variables. This is, admittedly, on the high side of estimates I've read about. An earlier Institute of Medicine study, for example, estimated that 20,000 people a year die because of lack of access. This does not even take into account those who have insurance, but are denied coverage related to necessary treatments.
Let's take the lower number. Suppose terrorists were killing 20,000 people a year in this country. Remember that 3,000 people died on 9/11 and the country went berserk. Yet we are strangely indifferent to a situation in which about 7 times that number die every single year. It seems that if 20,000 people a year were dying from terrorists attacks we would want to try something, anything, to stop it.
Sunday, September 20, 2009
Another Stephen development: Scooting on his tummy across the room. It is fun to watch him go, but hard to get him to do it on film.
Thursday, September 10, 2009
The American Osteopathic Association, American College of Physicians, American Society of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American College of Obstetrics and Gynecology, American Gastroenterological Association, Society of Hospital Medicine, American College of Cardiology, and American Society of Clinical Oncology.The following organizations seem to support the general idea of reform, but have withheld judgment until the bill is more advanced:
American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American College of Radiology, American College of Emergency Physicians.The following groups have opposed the H.R. 3200 until their reimbursement concerns are met:
American Society of AnesthesiologyMeanwhile, the American Nurses Association issued the following comment:
Members of the American Nurses Association (ANA) joined President Obama today to demonstrate their strong support for the President and his speech to the joint session of the U.S. Congress last night urging action on health reform that would provide more security and stability to those with health insurance and guarantee access to affordable health care for those without it....The Mayo Clinic, a leader is efficient and cost-effective medical delivery, issued a strong statement in favor of reform:
ANA President Rebecca M. Patton, MSN, RN, CNOR praised President Obama at his first public appearance on health care reform since addressing Congress for advocating for people who lack access to basic health care services in the nation’s “broken system” and for fighting for consumer protections in the health insurance market. Long ranked as the nation’s most trusted profession by Gallup’s annual survey, nursing has advocated for health system reform for two decades.
Mayo Clinic strongly supports President Obama’s call for health insurance reform and health care delivery reform, and agrees with the President’s position that the status quo is not acceptable.The AMA strongly supports reform:
Today, the American Medical Association sent a letter to House leaders supporting H.R. 3200, "America's Affordable Health Choices Act of 2009." "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform," said J. James Rohack, MD, AMA president. "We urge the House committees of jurisdiction to pass the bill for consideration by the full House."Update:
Actually, doctors are not as divided as I thought. According to a poll in the New England Journal of Medicine, most doctors support a public plan of some sort:
A large majority of doctors say there should be a public option.I had no idea the medical profession was staffed by America-hating communists who want to kill grandmas.
When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.
Most doctors -- 63 percent -- say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.
Sunday, September 06, 2009
Here is my recipe:
8 medium size potatoes (6 peeled, 2 with skins still on)
1 tsp. minced garlic
1/4 cup heavy cream
2 big gobs sour cream
1 big gob plain yogurt
1/3 stick of butter
A bit of milk
Fresh ground pepper
1. Cut potatoes and boil until soft. Drain water.
2. Add garlic, cream, sour cream, yogurt, butter. Whip well with mixer. Add milk and mix some more to achieve a fluffy and creamy consistency.
3. Add salt and pepper to taste.
See you in November, Cougars!
Wednesday, September 02, 2009
Nearly a year after the federal rescue of the nation’s biggest banks, taxpayers have begun seeing profits from the hundreds of billions of dollars in aid that many critics thought might never be seen again. The profits, collected from eight of the biggest banks that have fully repaid their obligations to the government, come to about $4 billion, or the equivalent of about 15 percent annually, according to calculations compiled for The New York Times.At this point, I guess I should, um, give some credit to President Bush who pushed this through over Republican objections. (I think that this a first for this blog!)
Now, remember all the hand-wringing over the $800 billion stimulus package? How is that turning out? The Wall Street Journal reports:
The U.S. economy is beginning to show signs of improvement, with many economists asserting the worst is past and data pointing to stronger-than-expected growth. On Tuesday, data showed manufacturing grew in August for the first time in more than a year....The next time someone says that the government should cut spending in the recession, feel free to snicker.
Much of the stimulus spending is just beginning to trickle through the economy, with spending expected to peak sometime later this year or in early 2010. The government has funneled about $60 billion of the $288 billion in promised tax cuts to U.S. households, while about $84 billion of the $499 billion in spending has been paid...
Economists say the money out the door -- combined with the expectation of additional funds flowing soon -- is fueling growth above where it would have been without any government action.
Many forecasters say stimulus spending is adding two to three percentage points to economic growth in the second and third quarters, when measured at an annual rate. The impact in the second quarter, calculated by analyzing how the extra funds flowing into the economy boost consumption, investment and spending, helped slow the rate of decline and will lay the groundwork for positive growth in the third quarter -- something that seemed almost implausible just a few months ago. Some economists say the 1% contraction in the second quarter would have been far worse, possibly as much as 3.2%, if not for the stimulus.
Saturday, August 29, 2009
Buenos Aires, while a great and beautiful city, is dotted with slum areas, or "villas" ("villas miserias" -- villages of misery) as they were called. These areas were considered open game for missionaries, and it was not uncommon to see us, suits and all, working the alleys of the worst of these villa areas. Hairless, diseased dogs and shoeless children were running everywhere.
I can still remember the smells: sewage mixed with alcohol. I can still remember the sights: a dirty 4-year-old child coughing up a 6-inch worm from her throat. I can still remember the feelings: a punch to my nose as we were being robbed one afternoon in broad daylight. I can still remember the judgments I made: pity and compassion, sometimes, heartless contempt, at other times, and a bit of fear. Sometimes, these places seemed quite ordinary, with children playing, mothers cleaning, milenesa cooking. These friendly but destitute villa dwellers, I came to understand, were not so different from you and me.
One place stands out in my memory, though, an abandoned wine factory filled with indigent squatters, a high-rise slum, basically, surrounded by filth and garbage, with dark and gloomy hallways, hallways that would have echoed with a million tales of woe and suffering. The place was called the the Vino Toro building. It was a "casa tomada" or "taken house," an old building filled with squatters. The police, we whispered, didn't even dare go into the Vino Toro. And yet we did.
The Vino Toro was a strange place. I remember going inside one Friday night, later than we should have. We entered a large room, what once appeared to be a factory floor, a place where people had constructed dozens of shanty homes, almost like cubicles stretching out all around us. The Friday night drinking was just underway, and the air smelled of cheap beer. I could hear bottles smashing, men laughing. It was quite dim inside, but I could feel the eyes of the slum were looking at me, sizing me up, wondering why I had entered their world. For a kid from suburban Utah, this was almost like going to the moon. I had never been anywhere even remotely comparable and I have never been since.
One time, we were visiting a family who had set up their home in what might have been an abandoned office suit. A whole family (maybe 6-8 people) lived in this office. They had a few chairs, a table, and an old mattress spread out in the corner, nothing more. The father who we were speaking with was guarded and somewhat hostile; if I recall, he was involved in some sort of criminal activity. The children were very dirty, and I doubt they had ever seen the inside of a school. I remember hearing what sounded like running water, turning around, and seeing one of the children urinating in the corner of the room. By the smell of things, this was not uncommon.
In such children, I was confronted face-to-face with what I refer to now, in a very sanitized way, as "inequality of opportunity." That kid peeing in the corner of this slum high rise, why did he have so little, while I had so much? As a boy, I was surrounded by toys, he was surrounded by garbage; I went to schools to learn, he went to the streets to beg; I wondered how I would pay for college, he wondered what he would eat for breakfast; I had hope, he had misery; I had everything, he had nothing. The villas of Buenos Aires taught me I have little to boast of, little to feel proud of, and little to feel like I have earned. I had a head start in life that the peeing kid could never overcome. These slums were schools in humility: they changed me forever. I went to Buenos Aires to teach people, and they ended up teaching me.
Thursday, August 27, 2009
The placebo effect is mysterious enough on its own. But there's more. It turns out that placebos work better in some countries than other others. It also turns out that ratings by trial observers vary significantly from one testing site to another. But what's most mysterious is that the placebo effect actually seems to be getting stronger over time. Not only are new drugs having a harder and harder time beating out placebos, but older drugs that have been retested are having problems too:
In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.
It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.
....But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products. Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.
Tuesday, August 25, 2009
The "new consumer protections" it refers to are these:
· No discrimination for pre-existing conditions
· No exorbitant out-of-pocket expenses, deductibles or co-pays
· No cost-sharing for preventive care
· No dropping of coverage if you become seriously ill
· No gender discrimination
· No annual or lifetime caps on coverage
· Extended coverage for young adults
· Guaranteed insurance renewal so long as premiums are paid
Update: A fun video explaining the benefits of a larger government role in health care.
What is interesting is how the emotions that are generated seem to have little to do with the scope of the policies under discussion. The proposals emerging from various congressional committees are, in reality, quite modest. We have proposed some new regulations on health insurance (for example, that insurers can't deny coverage based on preexisting conditions), we have a proposed health insurance exchange to help people find good deals on insurance (which is important in a market otherwise dominated by state monopolies), and we have new subsidies proposed to help poorer people and small businesses buy insurance. We also have various proposals to help cut costs by trimming inefficient aspects of Medicare, by doing more research on effectiveness of treatments, and by creating a not-for-profit health plan to compete with health insurance monopolies.
None of this seems radical. These proposals bend over backward to preserve the existing system (somewhat unfortunately in my mind). Granted they will cost a lot, with the highest CBO estimate I've seen being $1.4 trillion over ten years. To put this in perspective, though, the tax cuts of president Bush cost $1.3 trillion, so this hardly seems radically new or different from a fiscal perspective. Moreover, there are serious proposals out there about paying for the health reform, which (if they are implemented) would actually mark it as much less radical than the Bush-era tax cuts that were not paid for and that led to the skyrocketing budget deficits. So why the outrage now?
Much of it probably has to do with the symbolism of health care. Universal health care has long been the defining aspect of the democratic "welfare state," so its symbolic importance goes beyond the actual reforms themselves, however moderate they might be in this case. It is symbolism over substance.
I think another part, though, is that there is a group Americans who see the country as changing in ways that make them feel out of place. Much of contemporary America doesn't fit the image of what they think America has been or should be, or who Americans are or can be (of course, it never really did). They hear foreign languages spoken on the street, see a man with a funny name as president, watch cities growing and rural life shrinking, observe new technologies -- which they do not use or understand -- come and go in a dizzying whirlwind. It makes them feel like "others" have taken over the country. People "not like me" are in charge, and it is frightening to them. It is this sense of being displaced that motivates the emotions we are seeing rather than anything having to do with health care policy per se.
I think I can understand that. When I'm a little older, I'll probably feel much the same way about certain things. I reserve the right when I reach that point to shout like a crazed madman during a town hall meeting.
One of our senators, Sherrod Brown, held a town hall meeting the other day at OSU. I wasn't there, but from what I've heard, Steven Gabbe, senior VP for health services at OSU, gave a great presentation in favor of reform.
After bashing the media a few posts ago or their lack of interest in "facts," I suppose I should give credit where credit is due.
Thursday, August 20, 2009
Here we are at the Great Circle Earthwork -- you can fit four football fields inside this amazingly perfect circle.
The earthen wall is about 20 feet high in places, with a deep mote on the inside. The pictures don't really do it justice.
The Octagon earthwork: An astronomical device (they think) that is more accurate than Stonehenge.
The Octagon earthwork is now a par three golf course. Ugh! Ohio does not do well preserving its history, and this is another unfortunate example. You can't even look around because you might disturb the country club golfers. From the outside, though, this place looked even more impressive than the Great Circle.
Overall, great trip.
Monday, August 17, 2009
We'll see what happens in the next few months.
The Economic Policy Institute
"A substantial portion of the improvement registered in the second quarter can be attributed to the effects of the American Recovery and Reinvestment Act (ARRA). Both Goldman Sachs and Mark Zandi of Moody’s Economy.com have estimated that ARRA added approximately three percentage points to growth in the second quarter. Both of these estimates are confirmed by the Economic Policy Institute’s own calculations."
"A huge influx of federal stimulus money to state and local governments more than offset a sharp drop in tax collections, helping to put the brakes on the nation's economic decline, new government data show. The stimulus funds helped reverse six months of spending declines, pushing state and local government expenditures up 4.8% in the second quarter, reports the Bureau of Economic Analysis."
Economist Paul Krugman
"A few months ago the possibility of falling into the abyss seemed all too real. The financial panic of late 2008 was as severe, in some ways, as the banking panic of the early 1930s, and for a while key economic indicators — world trade, world industrial production, even stock prices — were falling as fast as or faster than they did in 1929-30....So what saved us from a full replay of the Great Depression? The answer, almost surely, lies in the very different role played by government.
Probably the most important aspect of the government’s role in this crisis isn’t what it has done, but what it hasn’t done: unlike the private sector, the federal government hasn’t slashed spending as its income has fallen. (State and local governments are a different story.) Tax receipts are way down, but Social Security checks are still going out; Medicare is still covering hospital bills; federal employees, from judges to park rangers to soldiers, are still being paid.
All of this has helped support the economy in its time of need, in a way that didn’t happen back in 1930, when federal spending was a much smaller percentage of G.D.P. And yes, this means that budget deficits — which are a bad thing in normal times — are actually a good thing right now....Last and probably least, but by no means trivial, have been the deliberate efforts of the government to pump up the economy. From the beginning, I argued that the American Recovery and Reinvestment Act, a k a the Obama stimulus plan, was too small. Nonetheless, reasonable estimates suggest that around a million more Americans are working now than would have been employed without that plan — a number that will grow over time — and that the stimulus has played a significant role in pulling the economy out of its free fall."
Friday, August 14, 2009
- Before leaving, I remember turning the thermostat up to 85 degrees, not wanting the house (and our pets) to become super hot while we were away. When we returned, though, we found that the thermostat had been turned back down to 75 degrees and the AC had been turned off.
- There were towels placed in our bathroom where we would never have left them (that is, they were hanging neatly inside the shower itself).
- The gate outside had been closed, but we always leave it open.
So, we figure there are four possibilities:
- Our house is haunted.
- We had a very nice home invader who didn't take anything, and who politely closed the gate, turned off the AC, and who hung up the towels neatly.
- Someone is playing tricks on us.
- We are losing our minds, thinking that we had done things before leaving that we hadn't.
Wednesday, August 12, 2009
Upon arrival, we were quickly ushered off to see a premier of the new Harry Potter movie. Here we are with the Merkley clan in matching Harry Potter T-shirts.
The next day, we headed east with Ellie's parents and sister, Emily, to visit Eastern Utah. Here we are in Vernal, Utah, where we stayed in some cute little cabins.
I wanted to go to Vernal to recreate some of the beloved vacations of my youth that were spent in Dinosaurland National Monument. Here we are at the new (to us) Vernal natural history museum.
I think my favorite part of Vernal was the dinosaur garden. Alas, the famous fossil quarry in the monument was closed for renovation, but we did get to see some great scenery within the park, as well as some historical sites. (Although, in a horrifying parental moment, Andrew picked up a rock and hurled it at a window of one of the historical buildings -- luckily, it didn't break.)
About 30 minutes south of Vernal is a breathtaking, undiscovered place called Fantasy Canyon. It is a small area, way out of the way, but it is one of the most unique places in Utah (which is saying something). The delicate rock formations are absolutely wondrous.
After spending a day in Vernal, we headed down to Moab, Utah. To get from Moab to Vernal, you need to go through Colorado, a long drive which I think we were all dreading. But, in the end, we found that the road to Moab takes you through some gorgeous mountain scenery.
The kids, overall, were real troopers. Our little trip consisted in much driving and hiking, which they largely bore without complaint.
When we arrived back in Salt Lake, we spent a few days with my family. We did a lot of fun stuff. Here we are playing in a river (building a dam actually), in Cedar Hills, Utah, where my brother and his family live.
Uncle Ruston took both Nora and Andrew on motorcycles rides. They loved it. Here is Andrew, holding on for dear life.
One of the best parts of the trip was that the kids were able to spend some quality time with cousins. They had an enormous sleep over on Sunday night.
Another highlight was visiting Kennocott Copper mine. Now, to be sure, this place is an environmental travesty. But it sure is impressive (and I guess I use my share of copper, so who am I to complain?). Here is the tire of the massive dump trucks they use there.
Tuesday, August 11, 2009
As I paid for my purchase, an employee leaned over the nearby ice-cream counter and asked, "Excuse me, sir, would you like this free chocolate malt?" Arrgh! Apparently, they had made an extra malt during a training session and wanted to give it away.
I tried to resist, but couldn't. I am a weak and sinful man.
Claim: "The Democrat-backed health care reform plan will require (Americans) to subsidize abortion with their hard-earned tax dollars."
Politifact says: False
Claim: "Page 992 of the health care bill will establish school-based 'health' clinics.Your children will be indoctrinated and your grandchildren may be aborted!"
Politifact says: Pants-on-fire false. (Nothing like that has been proposed)
Claim: "Health care reform legislation is likely to mandate free ‘sex change’ surgeries.”
Politifact says: False. (No such mandate has been proposed)
Claim: "All non-US citizens, illegal or not, will be provided with free health care services"
Politifact says: Pants-on-fire false. (The proposals say exactly the opposite)
Claim: "In the health care bill, the 'Health Choices Commissioner' will decide health benefits for you. You will have no choice. None."
Politifact says: Pants-on-fire false. (The proposed health insurance commissioner has nothing do do with choosing your benefits, only making sure insurance companies stick to the rules)
Claim: "The health care reform bill would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."
Politifact says: Pants-on-fire false. ("The sessions are an option for elderly patients who want to learn more about living wills, health care proxies and other forms of end-of-life planning.")
Claim: "Under a public health care option, 120 million Americans will lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage."
Politifact says: False.
Claim: "Under the Obama plan all the health care in this country is eventually going to be run by the government."
Politifact says: False.
Check it out yourself.
Friday, August 07, 2009
Question: Do the Democratic plans involve a government takeover of health care?
Answer: "There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation. Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals."
Question: So what do the Democratic plans entail?
Answer: "The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy."
Question: Won't health care reform cost a trillion dollars?
"Another lie. First of all, that's not a trillion every year, as most people assume -- it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.
Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year."
Question: But don't the Republicans want to save costs?
Answer: "The Republican lies about the economics of health reform are also heavily laced with hypocrisy. While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.
When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn't, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly. Government negotiation on drug prices? The end of medical innovation as we know it. ... Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing."
Question: Who is being honest in this debate?
Answer: "The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition..."
Question: So, what is at stake in this debate?
Answer: "Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done."