Rumbling under the big news of financial distress has been a sense that something in New York is just not working. Other states - notably California, Michigan, I suppose as the big examples - may be struggling with the downturn's most immediate effects... but the sense that New York isn't working one nearly every level is especially hard to escape.
Aside from the general disaster of being, er, ground zero of the financial mess (I hate 9/11 metaphors), there's the zealous dog-catcher antics of Andrew Cuomo, whose heel biting frenzy in going after horses already well out of the barn makes him the near perfect caricature of Elliot Spitzer - who, it should be noted, apparently was onto something about malfeasance in the financial sector. As Gail Collins notes, wouldn't it be nice to have him as, say, our governor... except for that whole thing with prostitutes, and all.
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?
Sure, some of today's stock rally was about home sales ticking up (I'm more heartened that in the new housing start numbers from a couple of weeks ago indicated an increase in apartment construction), but the big reaction was obvious: Geithner's plan may or may not work financially, but it was aces in buying him breathing room.
Honestly, I don't think Geithner's the "massive fail" some have made him out to be; like Hank Paulson,even more than Paulson in some ways, he's just the guy in the wrong job at the wrong moment. Remember the alternative, at first, was Larry Summers. And right now, almost everyone admits that losing Geithner means no one as Treasury Secretary. Also, not an option.
So breathing room... I can't say I'm opposed; taking some of the light and heat off of Geithner might give everyone a chance to reassess where we are and what to do next. The problem of course is... that asset sale plan is lousy. And he may just get away with it.
I've been waiting for Redstar to get back from her vacation and weigh in - from her uniquely connected vantage point - on the AIG bonus mess... and naturally, she does not disappoint: reminding us all, yet again, that underneath the "bonus rage" is a kind of judgment about "who is deserving" that needs better scrutiny.
FWIW, I think when AIG accepted government funds in September 2008,
the Board and leadership should have halted all bonus payments at that
moment for the foreseeable future. But I also believe in progressively
higher tax rates so that we can more equitably provide social service
programs, housing, education and healthcare for every resident of the
U.S. So maybe you personally don't want me making the decisions about
pay schemes at your job or house.
And that's the thing - why I rail against all this "personal
responsibility" rhetoric. Seriously, in principle, who's against it?
Not one of us, from what I can tell. In practice, it can be a
different story. But according to whom? Outraged working families? Joe the Plumber? Who's going to police your behavior??
Maybe, just maybe, if we could get down to the business of governing towards a more just society where we all have
the basics of healthy food, a good education, an affordable place to
live, and the chance to earn a reasonable wage - we'd be far less
likely to face runaway corporate bonuses, shocking homelessness,
widespread job loss and unbearable anger and fear. In other words,
it'd be a lot easier for all of us to fulfill our collective
expectations of personal responsibility. Who knows, we might even
discover a pleasant sense of collective responsibility! Imagine that!
Owned. And awesome. And thanks for the hat tip. :)
I was reminded, this week, of what it was like when my Mom and Dad separated; my Mom had to sit me and my sister down and explain, patiently (and I remember, with some emotion) that things would have to change. We would be fending for ourselves. There would not be as much money. We would have to economize, and adapt, and do unfamiliar things.
What made me think of it - aside from the general nostalgia of birthdays - was the passion and incoherence of so much of the outrage this week. I didn't like the idea of having to give anything up; I didn't understand why any of this was happening... and I was mad. Mad at someone, something... I couldn't quite put my finger on it. For years.
Don't worry about me - I've had therapy and worked out a lot of issues; I love my Mom and Dad, and I know why the things that happened had to happen. But going through it all has helped to understand better when anger is helpful... and when it isn't.
Let's be clear up front: I'm not happy about the AIG bonuses; nor am I happy, more generally, with the way we've "bailed out" AIG, throwing bad money after worse, trying to prop something up that probably can't be saved and isn't worth saving. But I think the anger this week's news unleashed - and the rather shameless way some have tried to capitalize on it - is about much more than bonuses, and indicates a moment of choice for us as a nation, a question of what we can live with... and what we can't.
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