I haven't written a lot of healthcare related posts lately, mainly because I think we're in a holding pattern until someone, whether it's Congress or the President, actually steps forward with more than the "outlines" of healthcare reform, but an actual reform proposal with specifics. It's not far off - of all the committees, Max Baucus and his Finance Committee in the Senate have been the most transparent in their process - but we're still not down to any of the hard choices that need to be made, or how anyone plans to pay for, what appears to be, a very expensive set of ideas.
In the meantime, there's been little substantive discussion of the healthcare crisis in public, or in the media... a mistaken approach, I think, on the part of reformers, because the public still really doesn't fully appreciate the scope of our healthcare problems. Karen Tumulty's recent piece in Time illustrates some of the problems, and a piece today that Susie mentions in Philly also does... but both also show how much more needs to be done.
This week's New Yorker, too, features a piece by Atul Gawande, which goes a long way towards expanding understanding of just how broad and deep our healthcare issues go; unfortunately, like other recent pieces, by narrowly focusing on a specific aspect of our crisis (in Gawande's case, looking at excessive charges and care in McAllen, Texas from the viewpoint of doctors and hospital executives), larger pieces of the puzzle, which also need fixing, are missed. And with Washington focused mainly on expanding insurance coverage, I think the mismatch between our problems and our idea of "solutions" has never been quite so clear.
Because I can't write another post about another shooting...
What happened in Binghamton was awful... the question is, was it preventable? We won't know that until someone, yet again, wakes up to the real common thread here: episodes of mass violence stem, usually, from a failure to deal with mental illness. If we could start there... and do something about it... we might finally make a dent in stopping them.
I finally bit the bullet this week and registered over at Change.org; I encourage you to do the same (though a certain regular reader/writer got there well before me). As a result, I've been, er, exposed to a lot of new ideas, people, and discussions, now that I can comment to my little heart's content (plus, I need a new conversation place... Ezra's just not doing it like he used to).
One of Red's fellow guest posters, Greg Plotkin, has been taking up the topic of food and poverty. In a fairly provocative post, he recently suggested that, despite serious misgivings, it might be worth considering that Wal Mart's foray into the Chicago city market might not be a bad thing, given the problem with "food deserts" in an urban area like Chicago, where access to fresh groceries is very limited.
This has led to an interesting discussion of the various ways to look at Wal Mart... but it got me wondering... just what are we dealing with in this notion of food deserts? I said as much to Greg:
I also have to be honest: I'm skeptical of the "food desert" issue;
while I've seen some indication of challenges finding groceries in some
neighborhoods, when I lived in New York, I also find it overstated -
Manhattan lacks large grocery stores all over, because of space
limitations; only in the past 15 years or so did I see new building
construction really adapt to the need for groceries anywhere. In
Harlem, much as anywhere, there are places to get groceries. They're
not all great, they're not all great on price... but they are there.
And they were there.
Over at Change.org, I'm back with a guest post (and I'm a noisy, difficult guest, I promise you) on Red's Poverty blog, talking about the latest development, in discussions at least, on the healthcare front: the need for a "public plan" as part of a "universal mandate" for health insurance, which appears to be the general direction of talks in Congress.
Over there, I go on - at some length, though less than I intended - about the general overview of how we got here, and why such a plan may be beneficial to workers at or near the poverty line; over here, I'd like to get a little more into the problems of our "healthcare debate," such as it is, and why a "public plan" is simply the latest in a series of non-newsy tidbits that don't, really, tell us much of anything about solving the broader healthcare crisis we face... and why our current financial crisis may make much of what we're discussing moot, anyway.
Much of the problem with the healthcare is, simply... we're not having one. Still. A lot of the problem, I think, is that the problem is complicated, and a lot of what passes for "debate" is little more than part of the current fashion for a kind of anger that complains about what we have, without necessarily offering a lot of solutions. In healthcare, that means a lot of raging about the bad acts of big health insurers... but not discussing the complexities of, say, reimbursements for services, where insurers are not necessarily the main culprit.
Thanks to Twitter, I am getting more exposure to the Media Matters blog, and its rolling criticism of right wing media outlets. Maybe it's going to my head... but it at least got me re-started on blogging about healthcare issues.
I haven't said much, lately, because there's not much to say; we are all waiting for actual details of an actual plan that Congress may or may not be able to see through to a vote, and many discussions, which seem to be about parts of such a proposal... are really mostly speculative, based on conjecture, rumors, and extrapolations. I'd rather we admit we don't know what we don't know.
Or better, I wish we were using this moment to better educate the public on health care issues. I've been trying, in my limited way, to do some of this, guest posting over at Red's Poverty blog at Change.org on issues around Medicaid. It's a small contribution, but I'm amazed about how little else there (still) is - outside of a recent piece by Karen Tumulty in Time on her brother's medical insurance issues (which was also somewhat problematic in terms of clearly expressing what "cost shifting" means in a way people can understand), few pieces of real journalism on healthcare tend to show up.
Into that breach steps... Sean Hannity, joining a chorus of conservative media types railing against a plan for "socialized" medicine which doesn't exist. Media Matters clipped an exchange between Hannity and a British expert (though who he is and why he's expert... I'm not clear), making the point that Hannity is attacking a straw man: whatever system we plan to enact this year... it can't remotely be like the British system of National Health.
Hannity, however, raises another issue that deserves some explaining, scaring people yet again with the idea of "government beaurocrats" who will determine which drugs and procedures you, ordinary consumer, will have access to. This bogeyman has been a running theme of right wing opposition, fueled in part by a provision in the Stimulus Bill to establish a Federal Advisory Board on healthcare that would help to evaluate good practice and idnetify areas for savings and reducing costs. This, as I mentioned a while back, was part of Tom Dachle's ideas about trying to institute some federal pressure on insurers to control costs of healhcare. I also have said, repeatedly, that I think the idea is problematic... not for Hannity's reasoning, but because the problems we have with controlling costs aren't solved by a panel, however well meaning; and that a panel composed primarily of doctors will probably pick practice enhancements that are helpful to their colleagues, and not really challenge the status quo in healthcare.
But that's not why Hannity's so wrong about these "faceless beaurocrats"; what Hannity, and other conservatives, seem to either not know or simply igore is that these decisions - about who gets a procedure, or a drug, or other service - are being made now, every day, by insurance companies and hospitals. That, ironically, is one thing Michael Moore got right in Sicko - that Managed Care is deciding, often painfully and to the detriment of individuals, whether to pay for certain types of care. This is, though, a necessary function - it's called "rationing," and it is the practical outgrowth of supply and demand. We can't do everything we'd like, help everyone who needs help... we have to make decisions; we have to draw lines.
Rationing of care, which is how healthcare operates, means we don't do an experimental cancer treatment with only single digit percentages of success on a terminal patient with metastastizing tumors. We don't, sometimes, do a hip replacement on an elderly patient who is unlikely to leave the hospital ever again. These are the hard choices. They involve things like facing death, or disability or a life less comfortable. We don't like them; and Hannity benefits from our discomfort by suggesting that it's shocking that somehow, someday, we might have to make these "horrible choices"... when, in fact, we already do.
The reason you want healthcare reform, when it comes to rationing, is that we ration care now, in the US, in the worst way imaginable: we don't deny services in a way that has to do with best care for the right people... too often we do it based on economics, based on who can pay, and who can afford it. This means, yes, we deny necessary care to people who need it but can't pay for it... but it also means we allow wasteful, needless services to people who can. Both contribute to the problem of our out of control healthcare costs. Hannity may be concerned about a system like NICE in the UK, and certainly, it has flaws... all systems of rationing do. And probably, yes, what we want is an independent board of review that makes science and research a priority, not dollars and cents (or at least, not dollars over science, caring, and good sense); but we need to ask these questions. We need to try. And we need to do more to explain these choices to people... or we are surely letting a scaremonger/puppetmaster like Hannity pull the strings without any opposite pull.
Today, a few things that aren't entirely what they seem at first glance:
The Republicans offered an "alternative budget" yesterday and the hoots of derision started before the presentation was even finished; one key measure of just how badly it fared: conservative blogs didn't even try to present it seriously. And while I don't love Rachel Maddow (smart, yes... but oy the sarcasm), her acid take on the presentation is especially well done (and just below it, Contessa Brewer, my favorite MSNBC anchor goddess, losing it)
via Greg Mankiw, one of the best assessments I've seen on the "Geithner plan for troubled assets" in the Financial Times. Also Time Magazine (via Ezra) has a nice breakdown of the different parts of the plan... and explains why none of them is large enough, probably, to fix things.
And in the Hollywood Minute... you may be shocked to discover that, say, Britney Spears doesn't write her own Twitter feed. But, as 50 Cent's Ghostwriter explains “He doesn’t actually use Twitter,” Mr. Romero said of 50 Cent, whose
real name is Curtis Jackson III, “but the energy of it is all him.”
And the "energy" of those fruity nut bars is mostly sugar... but who's counting? My tweets though... are all me. :)
MIDDAY UPDATE: one that I missed over my birthday week is this interesting discussion about the claims and actual measurement of the audience for Rush Limbaugh. It's one of those "the closer you look, the fuzzier it gets," but it's a good pointed reminder to take notions of the "power of right wing radio" with some serious grains of salt. (PS, this is also a nice moment to plug the twitter feed from Media Matters, which helped lead me to the first article.)
And then (via one of my new Twitter feeds, Karl in Austin, TX) there's the headsmacking shock - and seriously screwed up implications - of the (Republican) member of the Texas House (and on the Health Committee!) saying... "What's Medicaid?"
A less screaming - but just as pointed - wake up call comes (via Ezra) from the Washington Monthly in this interesting article: when conservatives get cultural criticism wrong, how can they expect anyone to listen to them criticize the culture?
And in the Hollywood minute - you do realize that "Right Round" is about getting head, right? And that "If You Seek Amy" is really dirty too... right?
I'd love to say I have a strong feeling about anything Barack Obama said last night... but frankly, I don't think he said all that much: most of the ideas were vague, and mostly boilerplate rehashing of points he's made already, which, in the abstract, are basically left-wing notions about governing that we all pretty much agree on. Who doesn't want smarter, more efficiently run government (well, aside from Bobby Jindal... but let's get to that in a moment)? Who doesn't want major improvements to our health care systems? Better schools? What kept jumping out at me last night was... all the jumping up for standing ovations, the race to see who could applaud soonest, loudest, and longest. Yes, Republicans deliberately sat on their hands at moments... but those seemed fleeting compared to the times that everyone seemed to be enthusiastically supportive of the big ideas... like people need jobs. Or we need better schools and better healthcare. Or the military is great, and honorable. Anyone opposed?
I didn't think so.
Much of the speech was simply content-free; Ezra's been kind of spear-heading the "theater of healthcare nonspecifics as if they were substantive details" type of posting, but even Tim Foley over at Change.org fell into similar mode today, arguing that lack of substance and details was, you know, reassuring. I don't know what it is... I'd kind of have to have, you know, details or something, to make that out.
In general, it seems that Obama is likely to propose a universal insurance mandate, presumably on the Massachusetts model of a gradual imposition of fees (tied to tax returns) for people without coverage. That, in theory, means that some new form of individual insurance would be made available to people without coverage, probably the "Federal worker" option of allowing average citizens to buy into the same set of options offered to federal employees, in some form. There's almost no other way to achieve any kind of reasonable goal of universality otherwise.
When I started my idea of an "Awesome Award", it was kind of a lark (and a way to celebrate a pal)... but I've actually kept an eye out for additional posts that meet my own, personalized, criteria for awesome posts that really sum up a particular issue. And I found one! Via Ezra (and a reminder that he tries to be one of the good guys), this, well, awesome post from Jessica at Feministing, taking on the whole idea of a "hookup culture" and pointing out that it's really just more "dirty girl" propaganda from the far right:
And these books are just the latest in a long line of
publications and reports - almost all put out by conservative
organizations (and I'll explain why that's important in a minute)
saying that hooking up is the most dire issue facing young American
women today.
A short publication - a little booklet meant for college women -
put out by the Clare Booth Luce Policy Institute, for example, says
that the more sexual partners women have, the more depressed they are
and that young women who have sex are just going to end up sad, lonely
dropouts with HPV.
(I'm paraphrasing obviously, but this is in fact what was written in the publication.)
The booklet hinges so much on scare tactics that it goes as far as to wish STDs on fictional characters.
"It's easy to forget, but the characters on Grey's Anatomy and
Sex in the City are not real. In real life, Meredith and Carrie would
have warts or herpes. They'd likely be on Prozac or Zoloft."
Just as an aside, I think it's really telling that a lot of
anti-hook up books rely on anecdotes from TV or the movies - characters
that are totally fictional - because they often can't find real life
examples for their scare tactics.
Since I gave into discussing the Phelps story, I suppose its worth mentioning two recent developments.
First, angry potheads have launched a boycott of Kellogg's, for dropping Phelps, the only company to do so. That seems fair, after all, since Kellogg's is calling pot smoking incompatible with representing wholesome cereals (part of a complete breakfast... if you eat a lot of other actually nutritional stuff). Still, I'm not quite sure eliminating the munchie market for late night gobbling of Froot Loops or Apple Jacks constitutes an impactful boycott... and, well, have you ever seen potheads follow through on this sort of thing? Okay, have you ever seen potheads follow through on... hey, are those brownies? In fact, have you really seen a lot of angry potheads? ("You're bringing me down, man.") I'm trying to take it seriously, honest... but I can't stop giggling. Or maybe that's the weed.
Second, the South Carolina sheriff who threatened to prosecute Phelps has followed through, sort of; so far, there have been eight arrests, many for possession and one for intent to distribute, and the guy who was the owner of the bong had it confiscated and was arrested, even though wasn't at the party (but apparently tried to sell the thing on e-Bay). Many of the "live free or die" legalization folks hope this sideshow will underscore the needless prosecution of drug possession... I'm not so sure; though I think we waste a lot of time and money and resources chasing down drug offenses, I think the pro-legalization arguments are simply shot through with flaws that can't be surmounted (and pot legalization types struggle to separate their case from heroin and cocaine, which are much dicier arguments). Better, I think, if the Phelps sideshow can reinvigorate the larger discussion of drug use and abuse in America, and get us to focus more seriously on treatment rather than prosecution for people caught using. I'm not sure some college dude caught with pounds of pot is going to evoke a lot of sympathy for legalization. Unfortunately, I think a lot of partying college students also don't create the right frame for looking at people with drug problems who desperately need help, either.
In sum I think all we've got is an entertaining evening of bong hits, froot loops, and Court TV. And so it goes.
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