Category Archives: Weekly summaries

Each week, a short post that links to the other posts of the week.

Assumed Conditions

September 7, 2009 – 1:18 pm
NO SIFT NEXT WEEK. THE SIFT RETURNS SEPTEMBER 21.

In the practice of American and Canadian life insurance companies, asbestos workers are generally declined on account of the assumed health-injurious conditions of the industry. — Frederick L. Hoffman, chief actuary, Prudential Life Insurance Company, 1918

The fibrosis of this disease is irreversible and permanent so that eventually compensation will be paid to each of these men. But, as long as the man is not disabled it is felt that he should not be told of his condition so that he can live and work in peace and the company can benefit by his many years of experience. — Dr. Kenneth W. Smith, medical director, Johns-Manville Corporation, 1949

They told me that his death was due to industrially incurred disease from asbestos particles in the lungs, but my appeal for burial and medical expenses was turned down due to statutes of limitations. — from a letter by a Johns-Manville widow, published in Outrageous Misconduct by Paul Brodeur, 1985

In this week’s Sift:

  • The Next Time You’re in the Bookstore … look for Doubt Is Their Product by David Michaels. I used to think the tobacco companies were the exception. Now I understand that they’re the model.
  • Can Obama Compromise on Health Care? It sounds simple and obvious to go halfway, but the pieces of health-care reform don’t separate easily.
  • Dick Being Dick. The Cheney Family goes on another Torture Misinformation Tour. Why exactly are we listening to these people?
  • Short Notes. Robbing the low-wage workers. The sad state of economics. Long-running political soap operas. And homeless children in our schools.
The Next Time You’re In the Bookstore …

… look for Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health by David Michaels.

I found this to be a radicalizing book. Each chapter examines a separate example of an industry that knew it was probably killing either its workers or its customers, and how it maneuvered to be allowed to keep on killing them.

What becomes apparent is that this is standard procedure. Sure, nobody creates a product with the idea of killing workers or customers. But if a corporation finds out that either its product or its processes are deadly, there is now an entire industry of firms and consultants that help it “manage” the situation and keep the profits rolling as long as possible — maybe for decades.

The blueprint.The tobacco companies were the trail-blazers, and the path they trod is now well mapped and widely followed:

  1. Hide the data you’ve collected as long as possible. Claim that any internal reports you wrote would reveal your “trade secrets”.
  2. Discourage other people from collecting or publishing data. If you can intimidate or destroy the reputations of the researchers who try, so much the better.
  3. Argue that there is not enough data to justify regulating your product or the process by which you manufacture it.
  4. When independent studies are prove that your product kills people, hire your own scientists to obfuscate the issue. No matter how egregiously they have to abuse scientific method, you can publish their results in “scientific journals” set up by you and other like-minded corporations.
  5. Argue that there is no scientific consensus on the harmfulness of your product. Regulation should be delayed until “conclusive” research is done. Then fight the funding of that research, because there’s not enough evidence to justify an effort to gather evidence.
  6. When regulation becomes inevitable, argue that only the exposure levels that have been proven harmful should be banned. Below that, argue that there might be a “threshold effect”. In fact, no one has ever found a threshold for a carcinogen. If some level of exposure causes cancer in 1 out of every 10 people, a lower level might only cause cancer in 1 out of 100 or 1 out of 10,000. But it still kills people.
  7. Fight every attempt to tighten the initially weak standard you got into the first regulation. Lobby, bribe, threaten — do whatever you have to do to influence Congress and the regulating agency. At every proposed tightening of the standard, start a new round of obfuscation and claim that the science is unclear.
  8. Lobby to diminish or eliminate funding for the agency that enforces the regulations. Uninspected is almost as good as unregulated.
  9. When the jig is up, hide behind the government. You always complied with the regulations — or at least no one can prove you didn’t. And the FDA or EPA (or whoever) could have banned your product, but didn’t. So it’s their fault — you should be immune from liability. The Bush administration actually tried to make this federal policy, in a push known as preemption immunity.

In short, as long as the government can’t assemble (over your constant roadblocks) 100%-conclusive proof that you’re killing people, you shouldn’t be regulated. And as long as no one can prove that you didn’t follow all regulations applicable at the time, you shouldn’t be liable. And if you have trouble carrying out this plan, there are public relations firms that will guide you through it, and other firms that specialize in providing the obfuscating scientific reports you’ll need.

Why they get away with it. The striking thing about this pattern is that the individual steps sound reasonable. And that’s always how you hear them. When some corporate flack on TV claims that his company is being regulated or sued based on flimsy evidence, no one points out that his corporation caused that lack of evidence and has manipulated it to its own advantage.

But when you see the pattern laid out end-to-end, it’s just premeditated murder. Go back and re-read this week’s opening quotes and consider whether Johns-Manville murdered its asbestos workers. They did. Now look at the speech then-Majority Leader Senator Bill Frist gave describing Johns-Manville as a “reputable company” that had been driven into bankruptcy by litigation. (Damn those asbestos-injury lawyers and what President Bush called their “junk lawsuits“.)

Corporations get away with this because the public has been primed to hear their arguments. A very effective propaganda campaign tells us every day that industry is burdened by unreasonable regulations and lawsuits run wild. The discussion you hear in the mainstream media takes for granted that regulation is a drag on our economy.

In fact the opposite is true: American industry is vastly under-regulated, and regulating it effectively would be a huge boon to our economy. Good regulation saves money, because it’s much more cost-effective to stop a Love Canal before it happens than to deal with its effects later.

And what do you think the long-term economic effects of this will be: American children born in the 1990s have higher IQs than children born in the 1970s. Why? Unleaded gasoline. Today’s young people are smarter because they breathed in much less lead while growing up. So if you look into the eyes of your kid or grandkid and see something sparkly looking back, thank government regulation.

Buttered popcorn. For me, the example that brings it all home is in Chapter 10. Most of us know that in the Bad Old Days industries did irresponsible things with heavy metals like lead or mercury or chromium, or with chemicals like dioxin or PCBs. But did you know that until just a couple years ago workers were dying to put the artificial butter flavor into microwave popcorn?

It’s true. The flavoring chemical was diacetyl, and while the FDA had approved it for eating, no one had ever tested what happens when people inhale it. Turns out they get the disease now known as popcorn lung. It was discovered, as most of these things are, by what Michaels calls “the body-in-the-morgue method”: Workers at a popcorn plant in Missouri started getting the same previously rare lung disease. At least one frequent popcorn-eater got it.

The government’s National Institute for Occupational Safety and Health recommended setting exposure standards for diacetyl in 2003, but (due either to step-8 underfunding or Bush-administration foot-dragging) OSHA couldn’t get around to it. By 2007 Rep. Lynn Woolsey introduced a bill to force OSHA’s hand. So naturally, the Bush administration and Republicans in Congress rose to protest this bill, using the step-5 “inconclusive research” dodge. During Congressional debate, Rep. Buck McKeon said:

More research currently is underway to determine a connection between diacetyl and this respiratory condition, and I fully support that research moving forward. Until the agency draws any conclusions, however, it is an open question as to whether diacetyl alone is to blame or whether the chemical, in combination with other agents, places workers at risk. … In short, without proper scientific research into this question, I do not see how we can effectively legislate on it.

You see, butter-flavored microwave popcorn is so essential to the American way of life that workers should continue dying until we’re absolutely sure what’s killing them. (The workers would have been much better off if terrorists had been poisoning them rather than their employers. Then the one-percent doctrine would have come into play, and even a small likelihood would have demanded a drastic response.)

Eventually, the popcorn lung story got enough exposure that the major microwave popcorn companies stopped using diacetyl. The impact on the economy seems to have been minimal. (And of course we know the new flavoring is perfectly safe.) But it’s still not illegal, and if you get an obscure popcorn brand, diacetyl might still be in there. Don’t inhale the steam when you open the bag.

Now, in some ways the popcorn workers were lucky. Because the disease that threatened them was so rare and showed up so quickly, not that many of them had to die before people started catching on. But chemicals that just increase the rates of more common diseases are much harder to recognize as dangerous. Probably there are factories whose long-term workers suffer an uncommon number of heart attacks or prostate cancers, and nobody notices.

Or maybe just the company notices.

Can Obama Compromise on Health Care?

On Wednesday, President Obama will give a nationally televised address to Congress about health-care reform. He’s expected to lay out what he wants, and to make a case for it to the nation. Everyone is trying to guess to what extent he’ll accept half a loaf, and if so, where he’ll compromise.

Words like compromise and bipartisan sound good, and suggest that if we only do half the job, it should only cost half as much. But the problem with designing half-way measures is that a lot of health-care reform ideas interlock. So if you just pick a few of them, it’s possible to make things worse, or to create a system that will be so unpopular that the public will never support finishing the job. Let’s go through the major reform ideas and see how they depend on each other.

The main idea.Sick people should get care, and paying for it shouldn’t drive them bankrupt. I wish every Democrat who spoke in public about health-care reform started with that statement. It frames health care in terms of people, and makes it a moral issue.

No pre-existing conditions.If you’re insured for everything but the illness you actually have, you’re not insured. No-pre-existing-conditions is the most popular reform idea. Even Republicans say they’re for it. So if you don’t get this, you don’t have reform at all.

No caps. Another very popular idea, for good reasons. If your insurance policy has a lifetime or annual cap, you’re covered unless you really get sick — then you’re not covered. That’s not insurance.

Mandates. Mandates say that people have to be insured, or somebody — either an employer or the individual — pays a penalty. Nobody likes being told what to do, so this is one of the least popular reforms. But it’s linked to no-pre-existing-conditions like this: If you’re healthy and the law says insurance companies can’t turn you down for being sick, the clever thing to do is to stay uninsured until you get sick. You get most of the benefits of insurance without paying the premiums. If a lot of people do that, then everybody else has to pay whopping premiums to make up for them.

Insurance companies love mandates. (What business wouldn’t love to have the government force people to buy its product?) Hospitals also love mandates, because their administrative costs go down if they can assume that everybody who comes in the door is covered.

Minimum coverage standards.If the law is going to mandate coverage, then it has to define what coverage means. Otherwise bogus insurance companies will sell worthless policies to individuals and employers who are just trying to avoid the mandate penalty. But defining coverage raises a bunch of hot-button issues like abortion.

Cost.Lowering coverage standards is one way to limit costs. A policy can be a lot cheaper if it has a high deductible, high co-pays, and covers broken legs and heart attacks but not mental health or plastic surgery.

Low cost is particularly important if you have a mandate, because you don’t want to force people to buy something they can’t afford. But there’s a trade-off, because a policy with a $2,000 deductible is useless if you don’t have $2,000. If you can’t go to the doctor because the co-pays and deductibles would bankrupt you, you’re not really insured.

Subsidies.No matter how far you lower the cost of coverage, there will be people who can’t pay it. So the government will have to pick up the full cost of insuring the poor, with a sliding subsidy that pays at least part of the cost of insurance for the working class. Otherwise a mandate is too onerous and the program will be wildly unpopular. Or, without a mandate, people will spend their premium-money on something else and gamble that they can stay healthy for the next few months.

Public option. In many parts of the country, health insurance companies are like Coke and Pepsi: There only a handful of them, and they compete on advertising rather than on anything that matters, like price or quality. Now imagine that people are forced to buy their product and government money flows in to pay for it. What a gold mine! They can continue to raise premiums 10-15% a year without improving anything. So costs get out of hand unless there’s real competition, not Coke/Pepsi competition.

Democrats want competition to come from a government-run public option. I never (OK, rarely) hear anybody make this analogy, but the logic is similar to FDR starting the TVA and the rural electric co-ops: Non-profit power companies provided a point of comparison that kept the profit-making power companies honest.

Republicans want to increase competition by tearing down the barriers to interstate competition between private insurance companies. The Republican plan could work, but only under conditions they undoubtedly would not support. Their plan eliminates any protection you get from state regulators, so there would have to be federal regulation at least as strict as the strictest state. And without serious anti-trust enforcement, a merger binge would replace the current local insurance oligopolies with a national oligopoly. Competition, in other words, would be temporary.

Taxes and deficits. Now that the Democrats are in power, deficits matter again. People who didn’t blink at spending a trillion borrowed dollars to take over Iraq are horrified that caring for the sick might cost money. (It’s all in the New Testament you know: “Curse you to hell, for I was hungry and you didn’t feed me. I was naked and you didn’t clothe me. I was an oil-rich Middle Eastern country and you didn’t invade me.”)

Some moderate Democrats have pledged not to vote for a bill that increases the deficit. (Republicans aren’t going to vote for any bill, no matter what’s in it.) In the campaign, Obama talked about reversing the Bush tax cuts for people who make more than $250,000 a year, but any tax increases beyond that would be a huge loss of face for him.

So what can Obama give up to get more support? Not much that I can see. The danger, if you start compromising, is that you wind up forcing people to buy over-priced policies that don’t really cover them, the extra money flows to the insurance companies, and middle-class folks end up paying for it either in high premiums or increased taxes.

That’s not half a loaf, and it would be so unpopular that you’d never be able to go back and get the rest of the loaf. Obama would do better to push through a good bill on a one-vote margin, and trust the results to speak for themselves.

Let me hit the deficit point a little harder: About 3,000 people died in the 9-11 attacks, and that was a reason to spend literally trillions invading Afghanistan and Iraq, not to mention homeland security spending. No one asked how we would pay for it; it just had to be done.

Do you know how many American lives we could save if our death-from-treatable-conditions rate got down the level of France? More than 100,000 a year. That’s like preventing a 9-11 disaster every 11 days. What’s that worth to you?

Dick Being Dick

If a recent liberal administration had been as across-the-board disastrous as Bush-Cheney, I doubt we’d be hearing much from its leading players. But for some reason Dick Cheney can get on TV any time he wants to spout new lies and nonsense. And his daughter can too, which is even crazier.

The Cheney family’s latest grand tour concerned the classified memos Dick said would prove that torture worked. Redacted versions of the memos were released, and they did no such thing. So he altered his phrasing:

The documents released Monday, clearly demonstrate that the individuals subjected to Enhanced Interrogation Techniques provided the bulk of intelligence we gained about al Qaeda.

Ummm, yeah. But the documents pointedly don’t say — and you have to think they would if it were true — that enhanced interrogation got that information out of those individuals. Former FBI interrogator Ali Soufan says that it didn’t. He also brings up the piece of the puzzle everyone else leaves out: What intelligence did torture cost us?

It is surprising, as the eighth anniversary of 9/11 approaches, that none of Al Qaeda’s top leadership is in our custody. One damaging consequence of the harsh interrogation program was that the expert interrogators whose skills were deemed unnecessary to the new methods were forced out.

Defenders always say something like “they kept us safe” (except for that one time) to excuse all the other Bush-Cheney failures: not catching Bin Laden, not winning the wars they started, wrecking our economy, selling out our moral principles, etc. But President Clinton kept us just as safe, if not safer. Maybe Chelsea Clinton should be on all the Sunday talk shows to tell us how he did it.

Short Notes

Happy Labor Day. A new study surveyed thousands of low-wage workers our three biggest cities. They found that underpaid wages, late paychecks, unpaid overtime, and various other abuses were common. “We estimate that 1.1 million workers across the three cities are robbed of $56.4 million every week because of employment and labor law violations.”

Paul Krugman sums up the current state of economics.

Not even a Death Panel can pull the plug on bad political soap operas: Sarah Palin and Rod Blagojevich.

What are the public schools supposed to do with one million homeless pupils? “We see 8-year-olds telling Mom not to worry, don’t cry.”

By weeklysift | Also posted in The Sifted Bookshelf | Comments (7)

Dual Citizenship

July 6, 2009 – 2:32 pm
Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ~Susan Sontag, Illness as Metaphor, 1977

In this week’s Sift:

  • A Logical Guide to Healthcare Reform. Three factors will shape any healthcare bill: What makes sense, what can be made to sound good, and what lobbyists are willing to pay money for. A public option makes sense — but will that be enough?
  • Que Sera, Sarah. Don’t look at me. I wasn’t expecting her to resign either.
  • Short Notes. New Zealand Air has nothing to hide. Antidisestablishmentarianism in Illinois. The glory days are over at the Washington Post. But the revolution in Iran may not be over for a long time.
A Logical Guide to Healthcare Reform

Almost all the debate about Obama’s healthcare plan centers on three issues:

  • How close will it come to covering everybody?
  • Will there be a public option?
  • How much will it cost?

Let’s take them one-by-one.

Coverage. The Census Bureau has estimated that 47 million Americans lacked health insurance in 2006. That number was trending upward at the time, so it was probably higher than 47 million even before last September when the economy began collapsing. Of course, that isn’t the same 47 million people from one month to the next; Families USA estimated that 86.7 million Americans were uninsured at least temporarily between the beginning of 2007 and the end of 2008.

Even that number doesn’t capture the full extent of the problem, because many people who have some kind of health insurance aren’t insured for their most serious illness, which their insurance company considers a “pre-existing condition”. In March, Time magazine writer Karen Tumulty told the story of her brother Patrick, who had been insured continuously by the same company for six years. When Patrick developed an expensive kidney condition, the company refused to pay. Why? His policy renewed every six months, and at each renewal he was considered a new customer. Since it took his doctors eight months to diagnose his problem, it was already pre-existing by the time his treatment started. Tumulty estimates that 25 million apparently insured Americans would be in a similar position if they happened to get sick.

Of all possible health plans, only single-payer (the government covers everybody) completely solves the problems of uninsurance and under-insurance. But that is off the table, because Congress is afraid that single-payer would turn us into a totalitarian state like Canada.

A second-best approach to coverage is mandate-and-subsidize: The government forces people to buy health insurance, and helps out people who can’t afford it. Massachusetts currently does this; you pay a penalty on your state income tax if you can’t prove you have health insurance. It’s not perfect, but their rate of uninsured people has dropped from 6-10% to about 2.6%. Mandate-and-subsidize, however, is considered too heavy-handed for a federal plan. (After all, the Massachusetts plan is left over from the socialist regime of Governor Mitt Romney.)

So we seem to be stuck with a third-best approach: subsidize and hope people are smart enough to recognize a good deal. Subsidize-and-hope only sort of works: The first Kennedy-Dodd proposal would have left 37 million people uninsured by 2019. And it has been revised because it was too expensive.

Public option. The most heated debate has been about whether there will be a public option. In other words, will the plan only include private health insurance or will one choice be some sort of Medicare-for-everybody? This is the most naked special-interest vs. public-interest issue, so it has the most confusing rhetoric. Your representatives can’t just say: “I’m against a public option because I need money from drug companies and insurance companies to get re-elected” or “I’m counting on making a bundle as a lobbyist after I leave Congress, so I need to keep the corporations happy.” So they need to come up with other explanations.

The basic problem is that a public option would be too good. Medicare

  • has low administrative costs;
  • doesn’t spend any money on advertising, multi-million-dollar executive salaries, or stockholder dividends;
  • is big enough to demand that healthcare providers accept reasonable prices;
  • doesn’t cancel anybody’s policy.

So if Medicare were an option for everybody, everybody might do the smart thing and choose it. And that would be a sneaky, back-door path to a single-payer system, which (as I already pointed out) would end America-as-we-know-it and make us just like the Soviet Union or Australia.

The focus-group-tested code phrase for this possibility is “government takeover of health care”. Missouri Congressman Roy Blunt, head of the Republicans’ Health Care Solutions Group, puts it like this:

If there’s a government competitor, in the very short term, you wind up with no competitors. When voters begin to understand that the government takeover of health care is really the end result of a government competitor in the marketplace, they’re not going to like that.

That’s because voters don’t want the option to pay lower rates for more secure coverage — at least not if it means that health insurance companies won’t have profits they can contribute to the campaigns of congressmen like Roy Blunt or many foot-dragging Democrats.

In his June 23 press conference, President Obama pointed out how nonsensical this rhetoric is:

Why would [a public option] drive private insurers out of business? If private insurers say that the marketplace provides the best quality healthcare, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business? That’s not logical.

Yes, he sounds like Mr. Spock when he talks that way. But he’s right.

Cost. Everybody understands that we need to control healthcare costs. Our current system is tremendously wasteful. Already in 2003, we were spending nearly twice as much per person as Canada or France (which is widely believed to have the world’s best healthcare system — see this comparison by the Dallas Morning News or the World Health Organization ratings). A more recent survey didn’t include France, but estimated that we spend $6697 per person each year while Canada spends $3326 — and Canadians on average live more than two years longer than we do. (If only we had their warm, healthy climate.)

Numbers don’t quite match up from one study to the next, because it’s not obvious what to count as “healthcare spending”. (Dental? Eyeglasses? Breast implants?) But just about everybody pegs our total annual cost over $2 trillion. The unimaginable scale of that number creates opportunities for rhetorical sleight-of-hand, because it’s easy to put forward plans that sound convincing and actually would cut costs, but on an insignificant scale.

Malpractice suits, for example, cost billions each year. But that’s actually a trifling part of our healthcare bill. Statistics are hard to lay your hands on for some reason, but Kaiser estimated that there were about 11,500 paid malpractice claims in the United States in 2007, and an average payout of $310,000 in 2006. Blindly multiplying those numbers together gets you an annual cost around $3.5 billion. (I don’t fully trust that calculation, but ten times that number would still be a drop in the bucket.) And on the wider question of “defensive medicine” — unnecessary tests ordered by fearful doctors — the Congressional Budget Office found “no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts.”

Not all costs are equal. Even more important, we need to understand that a lot of very different things get lumped together in that simple word cost. The cost of healthcare is made up of four factors:

  1. The cost of providing the care that people need in the most efficient way.
  2. Inefficiency in providing the care that people need. For example, a late and expensive treatment for a disease that could have been spotted and treated much earlier, or treating something in the emergency room that could have been handled by a general practitioner.
  3. Overtreatment, i.e., providing care that people don’t need and may even be damaged by. Overtesting falls into this category also.
  4. Costs that have nothing to do with treatment: advertising, profit, administration, and so forth.

The best way to cut costs, if you can manage it, is to eliminate 2, 3, and 4, and then do research to come up with even more efficient ways to do 1. The worst way to cut costs is to leave 2, 3, and 4 alone and cut 1 — in other words, you make sick people go without care.

That, in a nutshell, is why I’m a liberal on this issue. If you look at conservative cost-cutting proposals, they inevitably cut 1 and increase 4.

Any proposal that calls for increasing competition in the private sector is a boon to the advertising industry. You know the ad wars between Viagra, Levitra, and Cialis? (If you watch TV at all, I’m sure you do.) Well, imagine if every piece of the medical industry had to establish a brand and compete for individual consumer attention. Do you know the difference between Laboratory Corporation of America and Quest Diagnostic? You would. They’re the duopoly that dominates lab testing. They could advertise like ATT and Verizon.

Liberals and conservatives also have different approaches to decreasing overtreatment, because they have different explanations of how overtreatment happens. In the conservative narrative, overtreatment is your fault: Because insurance is picking up the tab, you go the doctor for every little sniffle.

This is one of those rhetorical sleights-of-hand I talked about. Yes, everybody remembers a time when they took their toddler to the doctor for something that turned out to be nothing. There was an office visit and perhaps an antibiotic, and maybe it cost your insurance company $100. If every single person in America could eliminate one such episode a year, that would save $30 billion annually — which is a round-off error when you’re talking about $2 trillion.

The importance of that Atul Gawande article I linked to a few Sifts ago is that it pointed out the real culprit in overtreatment: the corruption of doctors who are either paid by the procedure or get kickbacks from the testing labs. In short, it’s a capitalist problem, not a socialist problem. Making our system more capitalistic will increase overtreatment, because it will turn doctors into healthcare salesmen.

In the conservative vision, individuals cut costs by being hard negotiators and looking for the best deal. Picture it: A doctor tells you that your daughter will die in a day or two unless he does a liver transplant. And naturally you react the way you would if a mechanic said your car needed a new transmission. You wonder if he’s just trying to make a buck, so you take her to another hospital to make sure, and then you shop around to get the cheapest possible liver transplant. Maybe you even pretend to walk away so that they’ll cut their price.

Is that going to happen? Really?

What about computers? Whenever you challenge the free-market model, somebody is bound to start talking about the computer industry. Yes, they advertise and pay high salaries and make profits, but still competition forces prices down and performance up. Why couldn’t the same thing happen in healthcare?

Now think about the difference between buying a computer and buying health insurance. You and the people you trust are going to buy many computers over the years, and you can start judging them as soon as they come out of the box. Are they fast? Convenient? Reliable? When something goes wrong does the company make it good? Even in the store, the specs are well-defined and meaningful.

Health insurance isn’t like that. Sure, you use your health insurance fairly often. But you don’t really test it. Do you know how well your insurance would perform if you got cancer or some expensive long-term condition like ALS? Or just some mysterious pain the doctors couldn’t quite diagnose? Probably not. That coverage is what you’re really paying for, why you really need insurance, and you have no idea whether you’re getting it or not.

That’s not like a computer at all. Competition in health insurance is not based on performance, because by the time you need performance, it’s too late to change your brand loyalty. (Now you have a pre-existing condition.) So competition is not going to improve performance. It’s just going to improve marketing.

My conclusion. If a single-payer system really is politically impossible (which nobody really knows, because no national leader has ever made a serious case for it) then we have to make sure that we get a real public option, one that isn’t artificially crippled with rules that make it “competitive” with private plans. If that happens, then I expect the public option really will drive the private plans out of business, because a public plan is just a more efficient way to deliver care. If I’m wrong, and the free market really can improve the efficiency of private plans, then so be it.

And I know there will be scary commercials against any plan that includes a mandate, but I think we need to try it. If we’re not willing to let the uninsured suffer and die — and I hope we’re not — then they really are being covered at least to some extent. We need to make that coverage visible rather than hiding it in the inflated costs that the rest of us pay for everything medical. When the true costs of things are visible, we can try to deal with the situation logically.

Isn’t that right, Mr. Spock?

Que Sera, Sarah

There’s still no good explanation for Sarah Palin’s announcement Friday that she’s going to resign as governor of Alaska. What she said in her rambling public statement made no sense even to other conservatives or members of her family, so we’ve been left to read tea leaves. Cenk Uygur takes you through the various possibilities.

The timing is the biggest clue. She made her announcement on a Friday between Michael Jackson’s death and the Fourth of July, so it’s clear she wanted as little coverage as she could get. Also, the absence of stagecraft made the announcement seem hurried. Given time, any good high school journalism student could have written a clearer statement. And the small audience (who look confused in the reaction shots) suggests that she just called a few friends, got a TV crew, set up a podium in her back yard, and went for it. Why so fast?

My best guess: Either she’s getting out in front of a scandal we’ll hear about soon, or her resignation was part of a deal that will keep something secret.

To me, the most puzzling thing about Palin and her fans is their conviction that she was/is persecuted by the media. The working title of a pro-Palin biography is The Persecution of Sarah Palin, for God’s sake.

I hope the book compares Palin’s treatment during the 2008 campaign with that of all the other previously unknown VP candidates whose teen-age daughters turned up pregnant in the middle of a national campaign. Wait — there isn’t anybody else like that, is there? We used to take for granted that a scandal of that magnitude would sink a candidate, but Palin was allowed to ride it out.

From my point of view, Palin has gotten unusually soft treatment. She was never asked any hard questions during the campaign. It just looked that way because she fumbled so many easy questions. I doubt Katie Couric thought she was going in for the kill when she asked what newspapers Palin reads.

When conservative blogs fulminate about satirical articles or images of Palin, the commenters almost always say that if this were done to Obama, no one would stand for it. In truth, worse stuff is done to Obama every day, and he ignores it because (1) he’s got class, and (2) he takes his job seriously, so he’s got no time for this nonsense.

Look at, say, this image. Or this one. Or maybe this or this. I could go on and on. And there are countless videos arguing that Obama is the anti-Christ or satirizing the Obamessiah. Photoshop on, wingnuts. Nobody cares.

BTW, I think this anti-Obama video done to Cake’s song “Comfort Eagle” (“we are building a religion…”) is actually pretty good.

On the other hand, Vanity Fair doesn’t like her very much.

This video of Palin telling Hillary not to “whine” about the media is priceless. And just in case her career really is over, TPM collects their top 10 Palin videos.

Short Notes

New Zealand Air has come up with a novel way to make its safety video interesting: The crew is actually naked; their uniforms are body-painted on. Strategically placed arm rests, safety belts, and life jackets avoid an R rating.

An Illinois minister celebrates Independence Day by writing a newspaper column calling for a Christian Revolutionary War: “We must not relent until our Christian heritage is established again in every aspect of society.” What do you know? A real, live antidisestablishmentarianist.

Truth-teller Dan Froomkin is gone from the Washington Post. More and more the Post opinion pages are becoming a home for neocons in exile: Charles Krauthammer, William Kristol, editor Fred Hiatt, as well as an occasional op-ed by Paul Wolfowitz and various other war criminals. When I looked at the Post ombudsman’s article about Froomkin’s firing, I counted eight approving comments. I added the 557th disapproving one.

I was already thinking I was done with the Post. Commenter mmadd summed it up: “the Post that I loved is gone.” Froomkin was just the last straw; the Watergate glory days have been over for a long time. And then they did this.

The pot continues to boil in Iran, with a major group of clerics declaring the officially re-elected government “illegitimate” and the major presidential contenders continuing to publish reports of election fraud.

Still, no popular nonviolent movement can topple a government that retains both its will to resist and the loyalty of its military. The Shah went down because soldiers and police began tearing off their uniforms and throwing their weapons into the crowd. At Tiananmen Square,
on the other hand, soldiers followed orders and the Chinese government weathered the storm. So far, the Iranian theocracy seems to be weathering the storm.

But it’s way too early to declare a winner, because in Iran these things play out over years. The major anti-Shah demonstrations started in 1977, and his government didn’t fall until 1979.

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