Tag Archives: health care

If Not ObamaCare, What?

June 18, 2012 – 12:36 pm

One way or another — either by decree of an activist Supreme Court or by winning in November and repealing the Affordable Care Act — Republicans are aiming for a post-ObamaCare world. What would they do then?

Despite the rhetoric against it, ObamaCare has never been just an extension of federal power for its own sake. It is an attempt to solve a serious problem: When President Obama took office, something like 50 million Americans did not have health insurance. Millions more had hollow health insurance: Their most likely health problems were labeled “pre-existing conditions” and not covered. Also, yearly or lifetime caps on what the insurance company had to spend meant that people were only covered if they didn’t get too sick. In short, millions of Americans with some kind of insurance still faced bankruptcy if they had major health problems.

The ACA is not a perfect solution. Some people will still fall through its cracks, but ObamaCare imposes federal standards that do away with hollow insurance, and (when it fully takes effect in 2014) it will considerably shrink the pool of uninsured Americans.

Reasonable people can disagree about whether this was the best we could do, or whether the same or better results might have been achieved more efficiently with either more or less government intervention. But reasonable people can’t argue with this: If ObamaCare gets repealed, we’ll then face the same serious health-care problem that President Obama faced when he took office.

What would President Romney do about it?

The Romney campaign web site has a page about that. At first glance, it looks like a serious plan: It has 15 bullet points, each of which looks like a link to some detailed position paper. However, they aren’t links; they’re just bullet points formatted in blue.

That’s all you get.

Blanks, not bullets. A few of the 15 are standard conservative talking points that sound good but are basically empty, like capping malpractice awards. (I’ve explained before why I think this will accomplish very little. Short version: Malpractice awards themselves are a trivial part of the overall healthcare budget, and claims about “defensive medicine” don’t hold up when put to the test. States that cap malpractice awards don’t suddenly see their healthcare costs drop.)

Another empty bullet: “Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage.” Good as that sounds, it just restates what the HIPA Act established in 1996. People who spend their 20s in some Starbucks-barista type job could still be out in the cold when they finally do try to get insurance later on.

And yes, it would be nice to have “IT interoperability”, “non-litigation alternatives to dispute resolution”, and “Consumer Reports-type ratings of alternative insurance plans”, but none of that is going to help you much if you get cancer. And actually guaranteeing such stuff would be too much government intervention anyway, so Romney just pledges to “encourage” and “facilitate” these changes.

States and individuals lose power to corporations. Romney’s website highlights this quote:

I believe the better course is to empower the states to determine their own health care futures.

And yes, the substantive parts of the Romney plan do appear to move responsibility and decision-making from the federal government to states and individuals. However, when you assemble the bigger picture the bullet-points paint, the real story is that power moves to the insurance companies.

Here’s how: The federal government gets out of the standards-making business, apparently returning that power to the states. However, the bullet “Allow consumers to purchase insurance across state lines” undoes all that state power. If consumers can purchase insurance in any state, then states can’t regulate the health insurance sold to their citizens. If Vermont has high consumer-protection standards and New Hampshire low ones, then health insurance companies will only offer Vermonters policies written in New Hampshire.

You could argue that the market will provide whatever consumers demand, but we’ve seen this scenario play out before, when interstate banking was deregulated in 1999. If you have a Citicorp credit card, you send your payments to South Dakota. Bank of America payments go to Texas. That’s because those states have low consumer-protection standards. Would you like to have a Visa protected by the more consumer-friendly laws of, say, Massachusetts? Good luck with that; you won’t find one.

The same thing happened 100 years ago with corporate charters. Half of all U.S. corporations are chartered in Delaware, because Delaware won the race to the bottom.

So we know pretty well what will happen to health insurance if there are no federal standards and insurance companies can sell across state lines: States will race to the bottom until a few states say that health-insurance companies can do whatever they want. Then all policies will be written in those states. There won’t be anything you can do about it, because nobody you can vote for will have any control.

Block grants. Romney’s first bullet reads “Block grant Medicaid and other payments to states”. The cost of Medicaid is currently shared between the states and the federal government. (This article says the feds pay 60% in Texas.) For its contribution, the federal government gets to establish standards.

A block-grant approach would have the federal government say, “Here’s some money for Medicaid; spend it however you want.” By writing that check, the federal government would completely discharge its responsibility for providing health care to poor people.

The assumption behind this approach is that federal standards are inefficient. Left to its own devices, a state might get more out of the money than it does with the feds looking its shoulder. That may or may not be true, and it can work in either a conservative or a liberal direction. (Vermont is hoping for some kind of no-strings arrangement as it moves towards a single-payer system.)

But something else happens when you move the federal government out of the picture: You break the link between poor people’s health care and the Federal Reserve.

As we have seen since 2007, the federal government can borrow money in large quantities even during a financial crisis. And since dollars are created by the Federal Reserve, it is literally impossible for the federal government to go bankrupt as long as it owes dollars.

But states can go bankrupt, and the threat of bankruptcy can force them to do otherwise unthinkable things. Since 2007, states have been canceling projects and laying people off in droves — not because they wanted to destroy jobs and not because they suddenly discovered they didn’t really need teachers or firefighters or highways. But tax receipts were down, needs were up, and something had to give.

If there were no federal standards and federal money involved, Medicaid would be the obvious place to cut during a  crisis. (Texas keeps looking at abandoning the Medicaid system anyway,  even if it means losing the federal money.) Sure, some people would die, but they’re poor and don’t have press agents, so who would notice? (When did you last see a headline like “Sick homeless man dies in alley”? Do you think it never happens?) And if the poor decided to move to a more compassionate state, so much the better. Win/win.

In short, a state Medicaid program can’t provide the same security as the current system. States can promise whatever they want, but in a crisis those benefits would vanish.

And even in good times, states would feel pressure to race to the bottom. Be hard on poor people and maybe they’ll go somewhere else.

Responsibility. Everybody looks with horror at the upward-sloping trend in healthcare spending. But there are two ways to deal that trend: Figure out how to deliver care to everyone more efficiently, as most European countries do. Or push the responsibility off on somebody else, with the ultimate result that federal government won’t be held responsible when there’s no money to take care of people.

Romney wants to go in the second direction. Under President Romney, we could expect more and more people to have hollow insurance policies (written in whichever state allows the hollowest insurance). More and more people will either go bankrupt when they get sick, or will depend on state programs that go unfunded in hard times.

Stacked up against that future, ObamaCare looks pretty good.

By weeklysift | Posted in Articles | Also tagged | Comments (3)

Seven Issues the Election Should Be About

April 9, 2012 – 12:05 pm

You may not have noticed, but the general election campaign started this week. I say that for two reasons:

  • Mitt Romney’s victory in Wisconsin pretty well seals his nomination. Republicans understand now: No white knight is coming to save them. It’s Romney or four more years of Obama.
  • President Obama’s speech Tuesday was essentially a keynote address for the fall campaign.

We can already see what that campaign will be like. Romney won the GOP nomination by raising massive amounts of money and carpet-bombing any prospective rival with negative ads. President Obama is projected to raise just under a billion dollars. In either case, you really can’t spend that kind of money on warm, fuzzy stuff. Constant advertising annoys people, so the best you can hope for is to transfer their annoyance to your opponent.

Given how politics has been going, we can anticipate that major issues will be dodged, misrepresented, and even lied about. The media, which ought to be ferreting out the information voters need to make a wise choice, will instead focus on whatever gaffes or stinging comebacks they can find or manufacture, no matter how irrelevant or trivial.

That’s a shame, because there really is an important debate to be had. I don’t claim to know what Mitt Romney believes in his heart – recently his campaign has suggested that we don’t know his “real views” yet – but I know what his party and the conservative movement stands for. Similarly, I’m never sure exactly how much liberalism President Obama is going to defend, but I have a good idea what liberalism means.

It’s a significant contrast. A honest debate between those two worldviews, resulting in a clear choice by a well-informed electorate, would be a tremendous plus for this country.

OK, it won’t happen. But we shouldn’t just shrug and let the candidates off the hook. Even as we see the waters start to circle around the sewer drain, let’s review what this campaign should be about.

1. Inequality. We’ve been in a vicious cycle for 30 years now: The rich get richer; they use that money to buy more political power; and then they use that political power to lower their taxes, weaken the the regulations they have to follow, and otherwise game the system in their favor – plus make it easier to buy political power.

The Republican Party has been the main (but not the only) vehicle for the rich, so it will be interesting to see whether President Obama succeeds in raising this issue, or if conservatives manage to label it all as envy and class warfare. I thought Obama laid it out pretty well Tuesday:

In this country, broad-based prosperity has never trickled down from the success of a wealthy few. It has always come from the success of a strong and growing middle class. … And yet, for much of the last century, we have been having the same argument with folks who keep peddling some version of trickle-down economics. They keep telling us that if we’d convert more of our investments in education and research and health care into tax cuts — especially for the wealthy — our economy will grow stronger. … Now, the problem for advocates of this theory is that we’ve tried their approach — on a massive scale. The results of their experiment are there for all to see.

2. The National Security State. At a time when government is supposed to be tightening its belt, we continue to spend more on defense than all our potential enemies put together. Is that really necessary? How much money could we save with a less aggressive foreign policy that didn’t inject us into every conflict?

Would the world really be a worse place? We’ll never know how the Arab Spring would have handled Saddam if we hadn’t spent all that blood and treasure in Iraq.

And then there’s the internal effect on our liberty and democracy. Government surveillance gets ever more intrusive, and more and more of the government’s actions are secret. How necessary is that?

The opposing case is that the world is a dangerous place, and would be even more dangerous if the US didn’t police it. Maybe Norway can keep its freedom defended with (and from) a relatively small security force, but the US doesn’t have that option.

It’s President Obama’s fault that we won’t have this discussion. (Ron Paul was the only Republican candidate who wanted to talk about it.) He has largely continued the Bush national security policies rather than challenge them.

3. Climate change. There are lots of legitimate liberal/conservative issues to hash out concerning how to deal with climate change: Should we lower CO2 by market mechanisms (cap and trade), by a carbon tax, or by direct government regulation? Should we bargain hard to get other countries to do their part, or should we take the lead? What CO2 level should we be shooting for and how fast should we try to get there? How do we balance the expense of current CO2 reduction versus investments in future research? Can geo-engineering play a role?

We aren’t having those debates because the fossil fuel corporations have spent enormous amounts of money to make the existence of climate change the issue, when in fact the science is well established. The Republican Party has been acting as a wholely-owned subsidiary of the fossil fuel companies, and some Democrats have also been either bought or intimidated by energy-industry cash.

4. The Deficit. Elsewhere I’ve presented the idea that the deficit is not the doomsday device many would have you believe. But it is a symptom of a broken political process. Congress’ main job is to figure out what we as a people want to buy and how we’re going to pay for it. If it can’t do that, what can it do?

A big chunk of the problem is the misinformed electorate. Survey after survey shows that we grossly overestimate how much money is spent on welfare, foreign aid, and whatever National-Endowment-for-the-Arts-type program we find most offensive. We also grossly underestimate how many government services we use personally, and we’re misinformed about how our taxes compare to Americans of recent decades. (Hint: Our taxes are far lower, especially for corporations and the wealthy.)

About half the country thinks we can eliminate the deficit with spending cuts that don’t touch “programs that benefit people like you”. That wishful thinking allows candidates to get away with proposing big-but-vague spending cuts that exempt defense, Social Security, and Medicare — just about everything we spend big on.

5. Immigration. Both liberals and conservatives are conflicted about immigration. There is no ideologically pure answer to our immigration problem, which is why the conversation never goes anywhere.

The centuries-old dream of American employers is to have a workforce that can’t vote. So their ideal is to have temporary foreign-worker programs: We bring people in for ten years or so, get them to work hard for very little money, and then send them home.

But working-class whites see immigrants-taking-American-jobs as one of the social changes they want the Republican Party to protect them from. Hence the rhetoric about rounding up the millions of undocumented Hispanic workers and sending them home.

The last thing the Republican Party wants is millions of poor, non-white new citizens — who would probably vote for Democrats. Democrats would like that, but the unions that support Democrats probably wouldn’t, for the same reason as conservative working-class whites.

Everybody agrees that we shouldn’t have millions of undocumented people wandering around. It’s a security risk, makes our worker-protection rules unenforcible, and generally undermines the rule of law. But since neither side has a solution it wants to take to the voters, both will posture about the issue rather than try to make progress.

6. Health care. Our health care system is a mess. We spend way more per person than any other country, and we get worse results. This is a great country for someone as rich as Dick Cheney to get a heart transplant, but it’s a terrible country for a poor pregnant woman to get pre-natal care. When you average it out, our life expectancy sucks and we lead the industrialized world in unnecessary deaths.

ObamaCare (like the RomneyCare it’s based on) is an imperfect first step at reform. I think it gives away far too much to health insurance companies and drug companies, but that’s politics. If Congress repeals it or the Supreme Court throws it out, we’re essentially nowhere, because the “replace” part of the Republican “repeal and replace” slogan is just a word; there is no actual plan that addresses any of the substantive issues.

And liberals shouldn’t let Obama say “Done now.” ObamaCare has a lot of holes that need filling.

7. The future of democracy. This issue runs through a lot of the others. Ideally, individual voters would educate themselves about the issues that concern them and elect candidates to represent their views. If they really felt strongly, they’d donate $20 or $50 to a campaign.

We’re far, far away from that ideal, and moving farther all the time. The Supreme Court has ruled that money equals speech, and that more speech is better than less. So elections are dominated by massive spending that produces better propaganda — not better educated voters.

In addition, while voters may wake up in time for an election, the big-money interests never sleep. Defeat some special-interest measure like SOPA, and within a few months it will be back in a different form. The big banks can hire entire staffs of lobbyists to write loopholes into new regulations. Voters don’t have the time to ferret that stuff out, and if they did, they couldn’t organize themselves fast enough to do anything about it.

We aren’t having this discussion because no candidate who took it seriously could raise enough money. Worse, neither party even has an ideal vision of how to handle it. The closest thing to a practical reform vision I’ve seen so far is Lawrence Lessig’s.

Resist. Chances are, this election will be decided by something stupid: a blip in the unemployment numbers, a new Romney gaffe on the Etch-a-Sketch scale, or Obama’s inability to prove that he is not a shape-shifter from the Gamma Quadrant. Heck, we’ve had elections decided on the Pledge of Allegiance.

But we don’t have to give in to that. Collectively, social networking ought to give us Arab-Spring-level power, if we exercise it.  We can refuse to respond to nonsense. We can keep coming back to the real issues. It may not work in this cycle. But eventually, we might be able to drag the candidates back to what’s important.

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Supreme Panic and other short notes

April 2, 2012 – 8:08 am

Should ObamaCare supporters panic? That was the big debate on the legal blogs after the Supreme Court’s five conservative judges asked a bunch of skeptical questions during oral arguments. Jeffrey Toobin says panic, Steve Kornacki says not to.

So far I’m siding with Kornacki. For years legal specialists have been writing that you can’t predict how judges will vote by listening to their questions, so I’m surprised so many of them think they can this time.

Asssuming that the pessimists are right, though, the Court could be headed for a Brown v Board of Education-scale ruling: If they limit the Commerce Clause, all kinds of previous rulings (including ones written by the five conservative judges) come up for review. If they decide that the Medicaid expansion is an illegal coercion of the states by the federal government, the whole federal/state relationship changes.

Two points are worth making here: First, a partisan Supreme Court is a dubious asset politically, and striking down ObamaCare would seal the impression that this Court is Republican. If ObamaCare is struck down, we’re back to worrying about the 50 million uninsured, and Republicans continue to have no plan for covering them.

Second, this is another reminder that institutions are neither good nor bad, liberal or conservative, they’re just institutional. For decades, liberals relied on the Supreme Court to limit the damage done by conservative state legislatures, and many of us got it into our heads that a powerful Supreme Court was good. On the flip side, many of us have it in our heads that global institutions like the WTO are bad because they are dominated by corporate interests. Well, maybe the WTO is also just an institution. We need to figure out how to make it work for us rather than against us, the way conservatives have done with the Court.

While we’re talking about the Court and ObamaCare, a number of liberals are making their usual mistake when they answer what has become known as the Broccoli Argument: If Congress can make us buy health insurance, can it make us buy broccoli?

There are literal legal answers to this question – BTW, the literal answer is “no” – involving the limitations of the Commerce Clause, but they miss the point. Don’t make them unless you’re trying to convince a lawyer. Politically, Akhil Reed Amar has the better answer:

The broccoli argument is like something they said when we were debating the income tax: If they can tax me, they can tax me at 100 percent! And yes, they can. But they won’t. Because you could vote them out of office. They have the power to do all sorts of ridiculous things that they won’t do because you’d vote them out of office.

I think that’s called “democracy”.

About that Santorum “bullshit” incident. I don’t really care what words the guy uses, but imagine the outcry if Obama lost his composure like that. Think of all the lies that have been told about Obama – about his citizenship, his religion, his loyalty to the United States, and a hundred other issues that Rick Santorum never has to worry about. And yet he never snaps.

While we’re on that theme: Imagine the outcry if it’s 2007 and Nancy Pelosi says the Bush generals are lying about what they need. But Paul Ryan apologizes and its all OK now.

In an April Fools’ Day op-ed, David Javerbaum introduces the “quantum theory of Mitt Romney“.

Before Mitt Romney, those seeking the presidency operated under the laws of so-called classical politics, laws still followed by traditional campaigners like Newt Gingrich. Under these Newtonian principles, a candidate’s position on an issue tends to stay at rest until an outside force — the Tea Party, say, or a six-figure credit line at Tiffany — compels him to alter his stance

But Mitt is the first “quantum candidate”, and is governed by different rules.

In much the same way that light is both a particle and a wave, Mitt Romney is both a moderate and a conservative … The act of observing cannot be separated from the outcome of the observation. By asking Mitt Romney how he feels about an issue, you unavoidably affect how he feels about it. More precisely, Mitt Romney will feel every possible way about an issue until the moment he is asked about it, at which point the many feelings decohere into the single answer most likely to please the asker.

There’s more.

Salon’s Michael Lind explains how the rich took over airport security, getting their own faster lines. He then makes this modest proposal:

Why don’t we just make the new class-based discrimination official? Instead of leaving it to airlines and other corporations to construct the new apartheid piecemeal and informally, let the government issue a Premium Elite Citizen Card, valid for multiple purposes. For the right price, a price carefully calculated to be unaffordable by the majority of Americans, those willing and able to pay would be allowed to cut in line, not only at airports, but everywhere: at taxi stands, movie theaters, restaurants. All they would have to do is flash their Premium Elite Citizen Card to force the rabble to step aside and make way.

David Wong of Cracked.com follows up his viral 6 Things Rich People Need to Stop Saying with an almost equally worthy 5 Ways Modern Men are Trained to Hate Women.

It amazes me how misunderstood hate crime laws are, even by people who ought to know better — like NYT editor Bill Keller:

In most cases, hate crime laws take offenses that would carry more modest sentences — assault, vandalism — and ratchet up the penalty two or three times because we know, or think we know, what evil disposition lurked in the offender’s mind. Then we pat ourselves on the back. As if none of us, pure and righteous citizens, ever entertained a racist thought or laughed at a homophobic slur.

Bill: It doesn’t take a genius to understand that painting “Bob loves Mary” on an underpass is a less serious crime than painting swastikas on a Jewish elementary school.

One additional point I left out of my summary of Glenn Greenwald’s With Liberty and Justice for Some: With all the discussion of ways to cut government spending, how come nobody ever proposes that we stop locking up non-violent criminals for long prison terms? Other countries don’t, and it seems to work for them.

By weeklysift | Posted in Short Notes | Also tagged , | Comments (4)

What Abortion Means to Me

February 13, 2012 – 12:52 pm

I’m a guy. So I’ve never been pregnant, never worried about being pregnant, and never had to decide whether I should have an abortion.

But I’ve also been married for … it’ll be 28 years next month. So it annoys me when reproductive rights gets consigned (along with breast cancer, day care, and equal pay) to the special ghetto of “women’s issues”. If you take marriage seriously, you live in the same ghetto your wife does — especially when it comes to reproduction. Because if your wife has a child, you have a child. That’s how it works.

Here’s how it worked for us: In the early years of our marriage, we figured we would become parents eventually, but not yet. In the short run, we wanted to focus on establishing ourselves in the world, so that later, as more mature parents, we could give our children a better life.

Later, as we began to wonder whether eventually would ever be now, we went through a more focused decision process: Were we going to have children or not?

We decided not. (Being a writer, I described that process here and revisited it here when our friends’ kids started graduating from high school.) Children are wonderful and we were glad that so many of our friends were having them, but we liked the lives we were living. We still do.

Even if we had chosen to have a child, we’d have faced another decision about having a second one, or a third, because each child is a new roll of the dice. You can’t predict who this little person is going to turn out to be or how s/he will change your household. (If you think your brilliant parenting will determine the matter, you’re kidding yourself.)

Children arrive with no warranty and no return policy. Downs syndrome is on my wife’s family tree, and autism is something you always have to think about. One of the bridesmaids at our wedding had a perfectly healthy child, who was then killed by a drunk driver. My parents lived next to a family whose teen-age son suffered a brain-damaging accident. They will have to care for him for the rest of their lives, and what happens if he outlives them is unclear.

In short, having a child means risking whatever you thought you were going to do with your life. And each additional child risks not just your own life, but the life you can provide for your other children. That’s why any responsible couple — no matter how satisfying they find parenthood to be — is eventually going to say, “No. It’s time to quit while we’re ahead.”

[I suppose I need to address the people who “trust in the Lord” to decide how many children they will raise. To me, that makes as much sense as snake-handling or strolling through a lion’s den because Daniel got away with it. Look around: People who trust in the Lord get slammed by disaster at the same rate as anybody else who takes similar risks. So I’ll repeat: Any responsible couple …]

Those two reasons — wanting to delay having children until you can provide a better life for them, and wanting to protect the life you have already made — are why almost every couple practices birth control at some point in their marriage. (The only people who can’t see the logic here are priests who can’t get married. I don’t think that’s a coincidence.)

Once you’ve made that decision, you quickly realize that no form of birth control is foolproof. Surgery isn’t an option if you just want to delay parenthood, and is a gamble in general, because your circumstances may change. Even celibacy fails, because you can’t rule out rape.

So we came to this strategy: We practiced birth control faithfully, and planned to get an abortion if it failed. As it happened, we lucked out and never had to get that abortion.

Would we have followed through? I don’t know. I think that’s a situation you can’t fully imagine until you get there. But in any case, the decision would have been ours to make, and not the government’s to make for us. If we had changed our minds and decided to have the baby, our decision would have transformed an “accident” into a wanted child. Having chosen to raise him or her, I believe we would have been better, more loving parents than if we had felt trapped.

Are there moral consequences to choosing abortion? Yes, I believe there are. But I imagine them differently than anti-abortion extremists do. I hold a newly fertilized ovum in very light regard (as Nature — which spontaneously aborts so many of them — seems to). I believe that a fetus’ moral value grows with time, which gives a couple a responsibility to decide about abortion promptly, and steadily raises the decision bar as the pregnancy continues. Eventually, as birth approaches, only the life of the mother is a good enough reason to abort.

These are my own moral intuitions (which my wife largely shares) and yours may be different. But if we had taken action based on them, I would have expected everyone else to mind their own business. I see no justification for any outsider’s morality to have trumped ours.

So that’s what abortion has meant to me as a married man. My wife and I took responsibility for our childbearing. Without the possibility of abortion, we could not have done so.

We are now past the childbearing age. But I hope that those couples who are fertile today will also take responsibility for their childbearing. I believe that collectively they will raise saner, healthier children if they do, and that our society will be better for it. I also want today’s couples to have at least as much control over their lives as we had. And so, for both social and personal reasons, I want abortion to remain legal.

By weeklysift | Posted in Articles | Also tagged | Comments (14)

Religious Corporate Personhood

February 13, 2012 – 12:44 pm

Cable-news shows the last two weeks (especially on Fox) have been dominated by the Catholic bishops’ objection to including contraception in the minimum healthcare plan employers must provide under the Affordable Care Act, and the compromise the Obama administration offered.

In brief: Churches could already claim an exemption to the rule, so the issue centered on other church-run institutions like hospitals or universities. By making a Catholic institution provide contraception to its employees, despite the fact that Catholic doctrine objects to contraception, “the Obama administration has cast aside the First Amendment to the Constitution of the United States, denying to Catholics our Nation’s first and most fundamental freedom, that of religious liberty” — according to one version of the letter which the bishops had read in every Catholic church.

The administration compromised: Church-run institutions also would not have to offer contraception in their healthcare plans, but if they didn’t, the insurance companies providing the plans must offer individual employees a separate, no-fee, no-co-payment contraception policy. (This works financially, because contraception doesn’t cost the insurance company money, it saves money by preventing pregnancies. So the employer is not subsidizing contraception, even indirectly.) But the bishops announced that they would not be satisfied until contraception was withdrawn from the minimum healthcare plan for everyone.

Most of the problems with the bishops’ claims have been dealt with in detail elsewhere:

But one point is not getting nearly the attention it deserves: The bishops are not defending the religious liberty of individual Catholics (who remain free not to use contraceptives). They are claiming “religious liberty” as an institutional right of the Catholic Church.

It’s corporate personhood all over again.

The Founders must be spinning in their graves. The whole point of separating church from state is that we should not have to run our laws past a council of unelected bishops.

The United States has a long history of making room for individual conscience, most notably in allowing conscientious exemption to a military draft. But recognizing the institutional conscience of a church would be something new and strange.

In the American legal tradition, a church’s rights are derived from the right of its members to believe as they will, to worship as they will, and to freely assemble. Any “institutional right” that can’t be so derived is alien to us.

I found this spelled out quite clearly in the 1949 book Cornerstones of Religious Freedom in America by Joseph Blau (which also provided this week’s Sift quote):

Much as business corporations in the United States have battened on their fictitious legal status as corporate persons entitled to individual rights under the “due process” clause, churches — religious corporations — are able to grow overweening and oppressive if their claim to legal status as corporate persons under the First Amendment is granted. “Due process” for corporate persons has produced the legal anomaly of violation of the rights of the very individuals whom the due process clause was intended to protect. Religious freedom for religious corporations, if it is allowed, will end in the trampling of the religious freedom of the individual under the marching feet of a remorseless and self-aggrandizing hierarchy.

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The Return of Death Panels and other short notes

January 30, 2012 – 12:49 pm

Recently this topic showed up on my church’s email discussion list, so I know it’s making the rounds: An anonymous “brain surgeon” called into Mark Levin’s radio show in November, claiming to have seen a unpublished document from HHS describing “what the Obama health care plan would be for advanced neurosurgery for patients over 70.” He said:

Basically what the document stated was that if you were over 70 and you’d come into an emergency room and you’re on government supported health care, that you’d get “comfort care”.

When Levin responds “So Sarah Palin was right. We’re going to have these death panels, aren’t we?” the caller says “Oh, absolutely.”

Tuesday morning, Mariefla on Daily Kos went looking for details after she heard an outraged doctor raise the issue in a hospital staff meeting. She found this letter on the web site of the American Association of Neurological Surgeons. The AANS notes “factual inaccuracies” and says the caller was not a neurosurgeon, they are not aware of any such document, and the AANS conference in which the caller supposedly saw this document never happened. They’ve asked Levin to remove the podcast from his web site, which he hasn’t.

HHS unequivocally told rumor-investigating Snopes.com: “No such document exists and no such presentation took place.”

It’s unsettling to realize how easy this kind of fraud is. Anybody can call into a radio show claiming to be anything and to have seen anything. (“I’m a retired Air Force captain and I used to work at Area 51 with the wrecked alien spaceships.”) If their story supports somebody’s propaganda, a well-oiled machine sends it rocketing around the country.

Alejandrina Cabrera was running for City Council in the Arizona border town of San Luis when her ability to speak English became an issue — not a political issue, a legal issue. The mayor filed a lawsuit remove her from the ballot.

The Enabling Act that set up Arizona’s government in 1910 says:

ability to read, write, speak, and understand the English language sufficiently well to conduct the duties of the office without the aid of an interpreter shall be a necessary qualification for all state officers and members of the state legislature.

And Arizona voters declared English the official language in in 2006. However, 90% of San Luis residents speak mainly Spanish. Cabrera is running to represent them, even though she speaks only “survival level English” according to a linguistics professor appointed by a Yuma county judge to test her. Wednesday, the judge ordered her name removed from the ballot.

Reader comments on the various news stories fall into two camps: Those supporting the lawsuit go on to indict local high schools for allowing her to graduate with such poor command of English, while those opposing it want the voters, not the courts, to judge candidates’ qualifications for office.

Fox News psychologist/consultant Keith Ablow explains to us why Newt Gingrich’s infidelities will make him “a strong president“. Steven Colbert observes: “Somebody without Dr. Ablow’s psychiatric insight might misdiagnose Newt as a sociopathic pussyhound.”

Vodpod videos no longer available.

I can’t predict how practical the Hiriko electric car will be, but it’s got an off-the-scale cute factor. If I were 3 feet tall, I’d really want this half-size prototype.

Until this week, I’ve been having trouble explaining exactly what bugs me about Mitt Romney’s corporate-raider career at Bain Capital. Sure, it looks bad to walk away with a pile of money from deals that leave so many other people unemployed or otherwise holding the bag, but wasn’t he serving the overall cause of efficiency? Doesn’t the profit come from re-purposing assets to more productive uses?

Then a Chris Hayes tweet pointed me to this 1988 paper co-authored by former Treasury Secretary Lawrence Summers. Starting with the idea that a corporation is a “nexus of contracts, some implicit, between shareholders and stakeholders”, the paper argues that hostile corporate takeovers are profitable because the new owners can renege on the corporation’s implicit commitments to workers, suppliers, retirees, and the surrounding community. The process is “wealth redistributing, not wealth creating”.

It goes on to argue that corporations’ ability to make trustworthy implicit commitments has real economic value. But corporate raids destroyed that trust for all corporations, because now all parties know that managers who try to keep such commitments when they become unprofitable are likely to be raided and replaced.

So Romney’s profit at Bain comes not just from efficiency, but also from selling the social capital of the entire corporate system.

Romney bristles whenever anyone mentions the 99% and the 1%. That’s “dividing America,” he says.

Privileged classes always blame social divisions on the people who call attention to them, rather than the people who cause them and benefit from them. The Gandhis and Martin Luther Kings are honored after they are safely dead, but while they are alive they are denounced as troublemakers. King’s “Letter From a Birmingham Jail” is his response to those who accused him of creating “tension” between the races.

So, did dead people really vote in South Carolina? No.

And finally, because I never get tired of listening to Elizabeth Warren:
Vodpod videos no longer available.

By weeklysift | Posted in Short Notes | Also tagged , , | Comments (4)

Will the Court Throw Out Obamacare?

November 21, 2011 – 12:55 pm

Last Monday, the Supreme Court announced something that’s been obvious for a while now: It will rule on the constitutionality of the Patient Protection and Affordable Care Act, nicknamed the ACA or Obamacare. This was inevitable, because four appeals courts have ruled on the Act and disagreed: three said it was constitutional, and one said not. Since a federal law can’t be constitutional in some parts of the country but not others, the Supreme Court needs to straighten this out.

The rulings so far. At the district court level, rulings tended to be political: Judges appointed by Republican presidents invalidated the law while those appointed by Democrats upheld it. (The most polemic invalidation was Reagan appointee Judge Roger Vinson’s in the Pensacola District.) Fortunately, the appellate courts were more, well, judicious in their rulings. In particular, the D. C. appeals court ruling two weeks ago gives a good model of the two most likely ways the Supreme Court might go.

Like the Supremes, the D.C. court had a conservative majority: a Reagan appointee (Laurence Silberman), a Bush II appointee (Brett Kavanaugh), and a Carter appointee (Harry Edwards). Both the majority opinion and the dissent were written by the conservatives.

The majority opinion (by Silberman, supported by Edwards) upheld the constitutionality of the ACA. The dissent (Kavanaugh) didn’t rule on the constitutional issues, saying that the courts could not intervene until the law has fully taken effect in 2014.

Both opinions are well thought out, and I believe the Supreme Court will back one or the other of them.

The issues. The controversial part of the ACA is the individual mandate: It requires people to buy health insurance and penalizes them if they don’t. This notion was proposed by the conservative Heritage Foundation in the 1990s as an alternative to Medicare-like proposals for universal health care, because it keeps the health insurance industry private. Newt Gingrich supported the mandate then, and Mitt Romney made it the center of his Massachusetts healthcare plan.

Now, however, conservatives claim it is unconstitutional for this reason: Article I, Section 8 of the Constitution lists the powers of the federal government, and conservatives hold that none of those powers can be stretched to cover the individual mandate.

Supporters of the law claim that it is authorized by Section 8’s Commerce Clause

Congress shall have Power… To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes

plus the Necessary and Proper Clause

Congress shall have Power … To make all Laws which shall be necessary and proper for carrying into Execution the foregoing powers

In other words, Congress can regulate the interstate market in health care, and in carrying out that mission, Congress has found it necessary and proper to mandate that people buy health insurance.

It’s not a tax. The annoying thing about this whole debate is that Congress could have avoided it by wording the law differently. If it had called the mandate a tax instead of a penalty (in other words, we’re going to tax people who don’t have insurance) it would have fallen under the sweeping power to tax that Section 8 gives Congress:

The Congress shall have Power to lay and collect Taxes

One reason Judge Kavanaugh gives for delaying a ruling until after 2014 is that in the meantime Congress could make the whole issue moot with this minor rewrite of the law.

The who-pays-what-to-whom would be identical. The difference is purely moral: Under the ACA as it stands, an uninsured person is breaking the law, for which s/he is assessed a penalty (collectable by the IRS on the income tax form). If the mandate were a tax, an uninsured person could obey the law by paying the tax (in the same amount on the same form).

The administration has argued that this makes no practical difference, so the courts should rule the ACA constitutional under the taxing power. But judges aren’t buying it. Who’d have suspected: You can’t tell a judge that it makes no difference whether a person obeys or breaks the law.

Or maybe it is a tax. The main reason not to rule on the ACA until 2014 is the Anti-Injunction Act, which says that a judge can’t issue an injunction to prevent a tax from going into effect. If a tax is invalid for some reason, the proper process is for the government to begin collecting the tax and for the courts to get involved only after people to sue to get their money back.

The point, I think, is to keep one or two renegade judges from screwing up the whole government by shutting off its revenue.

I know what you’re thinking: If the mandate is a penalty and not a tax, what does the Anti-Injunction Act have to do with it? Well, apparently there’s a penumbra of some sort, so that if a non-tax is sufficiently tax-like, the Act applies. (You can tell from the D.C. court ruling that Silberman and Kavanaugh had a long argument about this. I confess to skimming this part of their opinions.)

Action vs. inaction. Sooner or later, though, either now or after it takes effect in 2014, the Court is going to have to rule on whether the Commerce Clause authorizes the individual mandate.

Anyone who wants to invalidate the ACA has to deal with the long history of courts interpreting the Commerce Clause loosely and expansively. Under current precedents, Congress can regulate economic activity within a state if that activity is part of a larger interstate market, and it can even regulate non-economic activity (like limiting the quantity of wheat that a farmer can grow for his own use) if some larger scheme of economic regulation depends on it. Commerce-clause justifications have only been rejected when the obvious intention of the law was to regulate local, non-economic activity (like keeping guns away from schools) on the vague justification that the activity has some eventual impact on interstate commerce.

So the basic commerce-clause justification of the ACA goes like this: Healthcare is an interstate market, so Congress has a legitimate interest in regulating it. The scheme implemented in the ACA is a legitimate attempt to regulate that market. That scheme falls apart without the individual mandate, so the mandate is necessary and proper to carry out Congress’ commerce-regulating power.

The counter-argument is that none of the precedents cover the ACA’s individual mandate, because they all concern some kind of activity, while the mandate is regulating inactivity. Simply by existing, the ACA claims, you affect the interstate healthcare market. So upholding the ACA is breaking new ground and substantially expanding the power of the government. If the ACA is upheld, what couldn’t Congress force people to do?

Judge Silberman’s ruling. Silberman agrees with the counter-argument up to a point, but not all the way to its conclusion. The precedents don’t cover inactivity, but the whole activity/inactivity distinction is itself new. It’s not in the Constitution, and it’s not implied by the precedents. So it’s not exactly conservative to toss the law out on these novel grounds.

What’s more, he rejects the basic conservative frame that the mandate is an individual-liberty issue:

Appellants’ view that an individual cannot be subject to Commerce Clause regulation absent voluntary, affirmative acts that enter him or her into, or affect, the interstate market expresses a concern for individual liberty that seems more redolent of Due Process Clause arguments. But it has no foundation in the Commerce Clause.

… it is irrelevant that an indeterminate number of healthy, uninsured persons will never consume health care, and will therefore never affect the interstate market. Broad regulation is an inherent feature of Congress’s constitutional authority in this area; to regulate complex, nationwide economic problems is to necessarily deal in generalities. Congress reasonably determined that as a class, the uninsured create market failures; thus, the lack of harm attributable to any particular uninsured individual, like their lack of overt participation in a market, is of no consequence.

Silberman finds no obvious place to limit Congress’ Commerce Clause power here, but notes that Congress is subject to a “political check”. In other words: This is one of many areas where Congress has the constitutional power to do all kinds of crazy things, and it’s up to the voters to see that they don’t. If Congress only had the power to do wise things, we wouldn’t need to have elections.

What will the Supreme Court do? I think that Silberman and Kavanaugh have blazed the two possible paths that an honest conservative judge can follow: Unless you want to invent some new restriction that isn’t in either the Constitution or the case law, you have to find the ACA constitutional. Your only other option is to punt the ball to 2014 or 2015 by invoking the Anti-Injunction Act.

Now, the Roberts Court has shown itself to be political. Its maneuvering around Citizens United, where it made a ruling more sweeping than either side was asking for, is a case in point. In that vein, I find it disturbing that the Court has chosen to review not just the individual mandate of the ACA, but also its Medicaid expansion, which none of the appellate courts had a problem with. That hints at another activist ruling, where the Court answers a question no one is asking.

Still, Silberman’s reasoning will be hard to reverse, particularly since his opinion quotes both Roberts and Scalia. So I believe the Court will take either the Silberman or the Kavanaugh route.

But the choice between them will be based on politics, not law. The Court’s decision, which may not come out until June, will frame the healthcare issue for the fall election. (Kavanaugh already hints at this by suggesting that a future president could decide not to enforce the mandate if he believes it to be unconstitutional.)

The decision will be determined by the Republicans’ electoral prospects: Will it be better for them to have the issue hanging, or to know that the ACA will take effect unless a new Congress reverses it or a new president refuses to enforce it?

So I’m taking the moderately cynical view of the Roberts Court. I don’t think they’ll throw the ACA out just because they dislike it politically, but which of the valid legal options they’ll take will be determined by politics.

By weeklysift | Posted in Articles | Also tagged | Comments (3)

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.

By weeklysift | Posted in Weekly summaries | Comments (2)