Talking health care...  I have not followed the PO issues closely.  What are the components here?  The following are considered as separable features. 


A public agency could administer the "insurance" -- collect premiums, run the money pool, pay providers.

A public agency could closely regulate contractor administrators doing the above.

A public agency could fund the "insurance" via taxes of some kind.

A public agency could supply providers (hire doctors, own/run hospitals, ...).

A public agency could perform coverage triage, set premiums, ration care and attempt to control provider costs.

A public agency could promote or enforce prudent/responsible conduct related to health care.


Other roles?

Nancy Pelosi is cited as having put forth 47M as the number of health-care uninsured in America.  Who are these these people, how many will directly benefit from a given health care reform notion, and how will the "general welfare" be effectively promoted thereby?

Let me first look at a purely economic analysis.  I do this partly because it's easier in principle to quantify economic matters (as opposed to say spiritual or intangible matters), and partly because a main concern is fiscal or financial - who will pay how to whom for what expected benefits?  In addition to ignoring spiritual matters, this review does not deal with plausible Constitutional issues (such as some folks claiming health care as a right while others see it as something outside the proper scope of USA government).

Health care reform advocates promote two kinds of economic benefit:  These people will get health care for diseases or conditions which currently disable them (short term like flu or long term like diabetes).  Reducing disability generally has the effect in principle of increasing effective ability and thus potential productivity, too.  That means they can do better work as workers, assuming they have jobs.  One could then do a cost-benefit analysis to determine a global measure of effectiveness for the proposed specific reform.  If the plan costs $100B/yr then we have a first order decision point -- if the net benefits are less than that, it pays back less in terms of increased output than we invest into it.  That would be an economic failure, whether marginal or worse.  If it instead pays more, we can say that it is at least a marginal plus.  And if it pays back say $200B/yr it should be considered a wild success.  It helps both the individual (at least in the collective sense) and the economy at large (which presumably helps economic leeches such as government employees paid by taxes on economic output).  Of course there could be transition costs in addition to annual costs, but those could be amortized (annualized) rationally in a medium or long term picture.

The second kind of benefit promoted is a negative benefit in this sense:  Reducing the number of uninsureds cuts down on publicly subsidized health care costs mandated by law or conscience.  This presumably then frees up cash flows to be spent otherwise.  That is, the current system has a lost-opportunity cost to it, one which might be significantly reduced by the proposed reform.  That then would be an implicit benefit to those who subsidize things like ER care for indigents.  If we have good data on the status quo we can make reasonable inferences as to how a given reform program would perform on this aspect.

Now, what about the realities?  Is there clear-cut status quo data?

Who are these 47M?  Some quick stats (and these numbers may overlap) --

9.5M are non-citizens
17M have plenty of income to buy basic health care (or are dependents in such a household)
18M are 18-34 and not necessarily in need of significant health care coverage or just choose not to get it.
Of those under 65, 70% who lost insurance regained it within a year, and 50% within 4 months.

How many "indigents" receive what benefits now at a cost to the public (whether via government or NGO charity)? How would that change?

What reasonable projected benefits and costs can we expect, and what is the reality of the status quo?  This of course applies not only to the 47M but to the system as a whole.

If we consider that health care is currently rationed partly by price (one can buy levels of coverage) and partly by access (waiting lines, "preferred providers", denial of coverage), how would the proposed reform ration it?  Would the reform affect quality of care separate from those considerations (competence of providers might go up or down, for instance)?


Previous blogs by me on health care:

Is it too late to reform health care reform?  February 26, 2009, 2:41PM

Rationalizing the Health Care Debate  March 6, 2009, 9:51PM

VA Governor primary, Deeds a clear preference among actual voters but low turnout makes one wonder about democracy in action here.  The polls had Deeds a clear favorite at the end (a dramatic improvement), so there isn't a big question as to whether the vote reflects sentiment in the larger population this week.  It probably does.  But when a candidate wins at just under 50% of those who vote, and about 6% vote, then the candidate is winning with about 3% of the voters supporting him.  Even granted that VA has an open primary and assuming Republicans are about 50% of the voters and did not cast significant votes, that's still only about 6% of non-Republican registered voters who voted for Deeds.

The total vote topped 320,000 or 6.4 percent of registered voters. That was well above the 250,000 that state officials expected, and over double the turnout in the 2006 Senate primary that was the most cited parallel.  --  EK @ 538

The idea that bad weather in No. VA was significant seems contradicted by this which says No. VA was much stronger than the rest of the state anyway --

Most of the state was experiencing turnouts of between 3 percent and 5 percent. In northern Virginia, turnout approached 10 percent while some southwest Virginia localities reported less than 1 percent turnout.

Marc Fisher posted a Q&A session about the VA primary.  Here is one answer he offered on this topic --

Marc Fisher: Many of the voters I spoke to earlier in the campaign talked about being full up on politics, thank you. They just didn't want to hear it anymore.

There are political scientists who have long argued that voter turnout in this country remains low in part because we have it so good here, and general satisfaction with life and government leads to apathy. If that theory were right, though, you might expect turnout to rise in tough times--unless there's also deep cynicism about government's ability to make real change in the economy or the rest of our lives.

Posted 7:10 p.m., 6.9.2009

Have Democrats become an apathocracy or a demo-un-cracy?

It seems timely to remind us of this report from a year ago:

In 2002, as evidence of prisoner mistreatment at Guantánamo Bay began to mount, Federal Bureau of Investigation agents at the base created a "war crimes file" to document accusations against American military personnel, but were eventually ordered to close down the file, a Justice Department report [large pdf file] revealed Tuesday. -- NYT May 2008

The report also covers Iraq and Afghanistan:  See tables of Interrogation Techniques Observed, Tables 8.1, 9.1, and 10.1 (the pdf document is searchable). 
from the report:

One SSA who served two rotations as OSC at GTMO told us that he initially told the agents to write up detainee abuse allegations to a "war crimes" file so the FBI could retrieve the information if it was needed for further investigation.

 

Some agents were told to record such allegations for inclusion in a "war crimes" file; others were told to include the allegations in their regular FD-302 interview summaries; and others told us they were instructed not to record such allegations at all.

    

In general, these reports did not appear to have had a significant impact on military practices at GTMO.

On a related note, Torturing Democracy (link to part 1 of video) provides either a bland indictment or summary judgment of Bush Admin detainee policies, depending on how you watch it.

Petraeus is playing follow the leader.

While it clearly has a troubled history which goes beyond questions of torture or abuse. the US should keep the detention facility at Gitmo and do so in a way which makes Gitmo a positive symbol as far as a detention facility can be a positive symbol.  It can be run as an example of how a detention facility should be run.  It might even be close to that now.  It started out in 2002 under Lehnert in a good light (Lehnert treated all as if Geneva covered them, called in the ICRC, etc.). That early Bush era policies were atrocious does not mean it is irretrievable.

Simply walking away from problem areas, as done at Abu Ghraib, is not a good practice in general.  It's basically an attempt to sweep symbolic dust under the rug.   If Gitmo is too expensive or has other problems as a prison, put those on the table and close it for those reasons.  That it has negative connotations from the past does not mean that it cannot be rehabilitated.  If it's broke, as a symbol or in fact, fix it or recapitalize it.

Do we close the White House after a scandal there taints it?

In a Salon article Michael Lind correctly attacks a right-wing distortion about Social Security.  Tanner's idea of $17.5 trillion unfunded liabilities is hogwash.  But Lind then falls flat on his own face:

Cato's Tanner does concede that the Social Security Trust Fund will pay benefits until 2037. He claims, however, that "that figure is misleading, because the Trust Fund contains no actual assets. Instead, it contains government bonds that are simply IOUs, a measure of how much the government owes the system." So government bonds backed by the full faith and credit of the U.S. government, a government that has never defaulted on its obligations in its entire existence since 1776, are not actual assets? Really?  [bold added]

Lind's feeble attempt at ridicule does not understand that bonds which are assets to an investor are liabilities to the issuer. The SS Trust Fund holdings would show up as BOTH assets and liabilities on an overall government balance sheet. Tanner is correct:  It's like writing an IOU to yourself, holding the IOU doesn't make you any wealthier. Any money going to SS payments from the trust fund will come from general tax revenues or additional future borrowing (deficits), not from some magic treasure chest.

Really, debunking the lies about SS should not require this lack of intelligence at Salon. And worse yet, pretending that the US government is immortal and that the dollar is invincible is probably a really bad idea.

Okay, I'm NOT going to talk about The Flu in this blog and will barely mention guns. :-)   It's just that Diamond's title came to mind as I wondered how to phrase the blog title.

Nate Silver has fun with graphs of polling data around the abortion choice issue. Look at all three graphs (small versions included below).  He concludes, fairly I think, that the issue remains incredibly stable over the long term despite a recent poll from Pew which covered Guns and Abortion.  Silver considers this poll might be "off" ("odds are the Pew result is a mild outlier") but he doesn't look into it much. For one thing, his blog doesn't touch the Gun part of the poll which might serve as a kind of reference check on the abortion issue if the poll is somehow skewed.

On both issues Pew finds a sharp recent trend towards the traditional conservative side.   This is highly marked in the abortion issue by a very large shift among Moderate/Liberal Republicans, -24 change in 8 months in the % saying abortion should be legal.  Such a shift cries out for explanation.  Can it be a Palin effect?  Is it data error?  Unfortunately, Pew doesn't break out the Gun part the same way and the time frame is different too, so no simple comparison can be made from what Pew presents in the article.. 

The data also show that older folks (50+) also changed views to the tune of about -10% against abortion rights (change in % saying it should be legal), as did Protestants and [political] Independents, so it is not just that one slice.

But what I notice which also stood out is that the "no answer" fraction grew a lot.  That is, the "pro + con" don't add up to 100, and the sum consistently is different for the two polls (April and Aug) by about 5%.  For example, in the 65+ category, the poll went from 46/48 in August to 36/48 in April.  The entire -10 shift was on one side of the issue as Seniors who thought abortion should be legal became uncertain in droves while those who thought it should be illegal stayed the same. Perhaps general economic uncertainty is making for a temporary conservative blip as moderates and liberals become uncertain in larger proportion.  Since the trend is clear over all the slices, it doesn't seem to be merely ups and downs due to small sample size (but the Aug sample WAS much larger).

I'm taking the liberty of linking to Silver's graphs here, along with the Pew abortion graph.  In the legal/illegal data (top left) you can see that there has been a lot of polling in the past 5 years, and that there is a lot of extreme scatter on the down side of the blue data but not on the upside (red reversed, ditto).  I wonder how the graph would look if the top six and bottom six data points from 2004-2009 were thrown out as outliers.  Are biased erratic poll results throwing off the trend line?  Is the real trend even more favorable to legal abortions?

   

5 Miami men convicted of Sears Tower attack plot

This is a manufactured crime," Batiste attorney Ana M. Jhones said earlier in the trial.

Also known as entrapment.  On the third trial over three years, convictions result after two jurors excused (one was "booted off") from the secret jury.

A key piece of evidence is an FBI video of the entire group pledging an oath of allegiance, or "bayat," to al-Qaida and Osama bin Laden in a March 16, 2006, ceremony led by an Arabic-speaking FBI informant posing as "Brother Mohammed" from al-Qaida.

The grand jury indictment (pdf) makes it clear that the "informant" was in fact the ring-leader and chief supplier of "material support" of boots and cameras etc. in this tragic farce of Bush era Alberto Gonzalez insanity.

The US Attorney-General, Alberto Gonzales has warned that home-grown terrorists could pose as much danger to the US as foreign al-Qaeda operatives.

Seven men have been charged with plotting to blow up the Sears Tower in Chicago, and attack FBI offices. --BBC June 2006

Other current Miami article about the convictions here. 

Older snippets:

Liberty City 7 trial runs like a B-movie
Someday, the United States will infiltrate, disarm and prosecute a genuine terrorist cell. In the meantime, we have the Liberty City 7. The trial of the Bumbling Jihadists in Miami federal court is a bittersweet farce for our times, a case that offers the illusion of progress in the "War on Terror" without actual war or terror. That such a case even made it to court is testament to our weird, paranoid age. - Nov 18, 2007 Miami Herald about earlier trial

"Nobody knew about it. Like I said, this was imagination," Batiste testified. "I would have been deeply embarrassed if any of the brothers knew I was engaging in that kind of conversation."
Batiste got choked up after his attorney, Ana M. Jhones, asked how the "mission" of the six other defendants differed from the violent attacks he was discussing with the informant, a man he knew as "Brother Mohammed."
"The only mission the brothers had was just walking through the neighborhood and preaching about Jesus," Batiste said. A lunch recess was called after he became emotional and was unable to continue on the witness stand. -- from a blog citing old article by same journalist Curt Anderson re earlier trial

The Pentagon plans to name Lieutenant General Stanley McChrystal, a former commander of special operations forces at Fort Bragg, North Carolina, as McKiernan's replacement, CNN said.

Loose-cannon torturer/assassin or successful patriot?  Surely he's learned some lessons (Camp Nama resulted in numerous wrist-slaps and convictions for abuse by people apparently under his command).  But is his specialty in Iraq, targeted assassination of "suspected terrorists and their supporters", going to play well in Afghanistan when it's iffy in Pakistan border areas?

McChrystal's Zarqawi unit, Task Force 6-26, became notorious for its interrogation methods, particularly at Camp Nama, where it was accused of abusing detainees. - wikipedia

Lt. Gen. Stanley McChrystal, the commander of the Joint Special Operations Command (JSOC) responsible for hunting al-Qaeda in Iraq, employed what he called "collaborative warfare," using every tool available simultaneously, from signal intercepts to human intelligence and other methods, that allowed lightning-quick and sometimes concurrent operations. [...]

[On Saturday, a Washington Post report by Joby Warrick and Robin Wright provided a more detailed look at U.S. counterinsurgency efforts in Iraq. They reported that "fusion cells" of special forces and intelligence officers, using spycraft with sensors and cameras that can track targets, have captured or killed hundreds of suspected terrorists and their supporters in recent months.] -- Woodward WaPo article Sept. 2008

Today TPM offered us a link to another article about the swine flu situation.

The story that this flu targets the 10-50 age range continues to be repeated without critique.  But we do know that the US cases generally were due to travel to Mexico, and that many such travelers were school-aged kids, and that they may have infected their friends and other students.  I have yet to see a news article look into this factor in its effect on the distribution of known USA cases.  Is it too obvious, or just anti-sensationalistic?

As to mortality, USA resident deaths are under 2/2500 at this point.  The 3 USA reported deaths were all of people who had significant pre-existing medical problems.  I wonder how many hospitalization instances also involved pre-existing issues.

If we look at things in terms of ecology, people are organisms in an environment, that is, we are looking at an ecosystem.  In natural ecosystems we easily recognize environmental limitations and constraints on populations.  But when it comes to people, there is an attitude that life is sacred.  This attitude might be anti-ecological if not outright irrational.

From the point of view of ecology we can understand viruses, at least in part, as elements to "thin the herd" (semi-random google hit linked) as is said of wolves and caribou.  If the flu has a high morbidity and mortality rating for the "less than medically fit" should we view it as a terrible threat or a natural function?  Of course individuals don't generally want to die nor to lose close friends and relatives, but looking at it from the larger point of view, is such a culture out of whack with nature at some point?  While culture is necessarily distinct from nature, is a culture which attempts to defy nature at any cost anything more than a collection of metaphysical conceits?


More "herd thinning" links for information or entertainment:

Reverse Darwinism humor

Glen Beck slips it in sotto voce at 2:21

Actual caribou study on confusion

Regulate the regulators

Here are some short reactions to the first three items in TPMDC Saturday Roundup- May 9, 2009, 1:06PM.

Obama Calls For Credit Card Reforms:  "There is no time for delay," said Obama. "We need a durable and successful flow of credit in our economy, but we can't tolerate profits that depend upon misleading working families. Those days are over."

We don't need a durable system, that is what conservatives want -- a lasting status quo in which the powerful retain power. 

Credit does not flow, but debt can be transferable; Obama is misframing.  Credit is the sound basis for debt, it resides in individual honor and in recourse (collateral, whether real or ideal).  (The other basis is faith.)  Non-cyclical debt is unsound and/or dishonorable.

Agreed that profits based on deception are problematic and reforms are past due. However:  Obama is using systematically deceptive language to try to develop profits, and probably not with intentional irony.  It is one thing to study Orwell, another to be a student of Orwell.

GOP YouTube Address Blasts Obama On Gitmo  "Closing our terrorist-detention facility with no backup plan is one campaign promise that can't hold up to national security realities," said Bond. "While the President has made closing Guantanamo Bay a priority, the highest priority must be keeping America safe."

The highest priority, if there is such a thing, must be keeping America sound.  This Republican meme has got to be challenged effectively.  On the one hand they make safety sacred, but then they turn around and do unsafe stuff as well as telling us the Constitution is sacred.  Go figure.  "provide for the common defense" does not mean "ruin America for the illusion of safety", and it's not the highest priority anyway.

I agree that closing Gitmo without a plan would be a mistake.  That said, it's not unreasonable to PLAN NOW  to close Gitmo as a prison soon without having all the details fleshed out.  Not only should this be obvious but look at how Repos supported Bush and his adventurous flagrant abuses of power without an exit strategy or even a plan beyond the simple-minded "Get Saddam" or "Kill bin Laden".

The larger question:  If the US is going to continue to have "detainees" or prisoners who don't fit neatly into the ordinary criminal justice system, why not rehabilitate Gitmo's image and reality?  That Abu Ghraib was closed does not mean Gitmo must close.  Gitmo qua prison started out honorably under Lehnert.  Examine the costs and benefits carefully, don't bow to momentary public aversions.  Or better yet, think big:  Close Gitmo ENTIRELY (that would probably really bug the right wing!).

Obama Attending White House Correspondents' Dinner
President Obama and the First Lady will be attending tonight's annual White House Correspondents' Dinner, essentially a comedy roast with the President himself as the guest of "honor."

There is that word 'honor' again!  Medium-rare, roasted or not.



 

Update:  I'm tempted to make the score 2 to 0 because several articles now have titles or headlines saying the Texas teacher was killed by swine flu, while in the body the article admits otherwise.

Swine flu victim a dedicated teacher
[The Texas teacher] left for maternity leave April 14 and within days was hospitalized. District personnel knew she was sick but as late as May 1 had information from the Hidalgo County Health Department that swine flu tests were negative.

original blog:

CDC "date of onset" data shows both Mexico (upper pic) and USA (lower pic) flu epidemic cases peaked well before Biden's famous April 30 "stay out of confined spaces" remark. Not that the data was necessarily available at that point... but the data now show Biden not only overstated but was about a week or more late.  

Some fear a resurgence in the next official flu season, and in southern hemisphere regions almost totally untouched so far (by today's report).  Maybe some will have learned a lesson for the future.  Nonetheless, score one for the conceptual terrorism cuckoo and note that US resident deaths remain at zero (the death of the teacher in Texas is not being officially attributed to the flu) 

Notice that US non-confirmed cases are "probable" while Mexico's are "suspected".  Also, note April 10 and 18 as turning points.


                                       

[I got a complaint comment from another TPM user (see original thread comments) saying that I was posting abusively by updating a blog entry.  So to honor that complaint (even though it was just one poster and it was not well grounded), I'm changing how I post updates.  Below are the current updates followed by a link to original thread (in its not-original time slot).  The recent updates will generally also appear in the main blog along with the original comments but are posted here as a relatively stand-alone blog entry.]

Recent update [slightly edited]:

update May 5 to include Bloomberg on stress test leaks.  The article says 10 of 19 big banks likely to need capital.  But so far no leaks on the flip side -- are any banks too weak to save?  This is a key reason for stress tests -- to find out which banks should NOT be saved.  While leaking positive info might have good reason, let's hope that the stress tests are not being used as a mere whitewash or PR tool for Treasury.


updated May 4 to include article, Geithner's New Bank Fix Is Bogus, Too, which agrees with my views that the Geithner proposed conversion of TARP preferred stock to common stock is bogus and problematic.  It also supports my position re bondholders:

Unfortunately, the plan also has two major flaws:  First, it's smoke and mirrors. Second, the taxpayers will be even more exposed to losses than they are now. [...] The idea that bondholders should share the bank pain is finally gaining some momentum.  Let's hope that continues in the coming weeks.

As I see it, either the banks' problems are largely smoke and mirrors or Geithner is flailing helplessly.   And if there has been any good news from Warren at COP, I haven't heard it.

As an aside, I read somewhere thanks to a TPMer that Obama had critics Krugman and Stiglitz over for a dinner chat last week.  That strikes me as a hopeful sign.  Would love to have a transcript of that chat...
 
 
Other updates and original blog:
 
Treacle at Treasury - a moral crisis and more [updated]
May 4, 2009, 12:12PM

What's that about?  What does this say about overreaction -- is it an example of overreaction reducing casualties or is it by contrast  just an object lesson in political terrorism of the collective consciousness?

WHO map lists 25 deaths for Mexico and 1 for the US, but the US death was a Mexican kid who had recently arrived in the US.  The map allocates casualties by reporting government.

So actual mortality in Mexico stands at 26/590 or about 4%, down from early estimates around 9%.

Actual mortality for all other official cases is 0/534, per the map's current data (May 5).

The official mortality numbers for Mexico have apparently been falling steadily from early reports around 149 which may have peaked a bit higher a bit later, to an official stat a few days ago of 84, to this current stat of 26.  Is reporting on this "interest rate" headed for a liquidity trap?  That is, could it like interest rates possibly go below zero at some point (see comment 25 in his blog)?


(As an off-topic aside, Krugman's analysis is flawed as comment 25 aka Borrowing Trouble hints.)

update May 5 to include Bloomberg on stress test leaks.  The article says 10/19 banks likely to need capital.  But so far no leaks on the flip side -- are any banks too weak to save?  This is the key reason for stress tests -- to find out which banks should NOT be saved.

updated May 4 to include article, Geithner's New Bank Fix Is Bogus, Too, which agrees with my views that the Geithner proposed conversion of TARP preferred stock to common stock is bogus and problematic.  It also supports my position re bondholders:

Unfortunately, the plan also has two major flaws:  First, it's smoke and mirrors. Second, the taxpayers will be even more exposed to losses than they are now. [...] The idea that bondholders should share the bank pain is finally gaining some momentum.  Let's hope that continues in the coming weeks.

As I see it, either the banks' problems are largely smoke and mirrors or Geithner is flailing helplessly.   And if there has been any good news from Warren at COP, I haven't heard it.

As an aside, I read somewhere thanks to a TPMer that Obama had critics Krugman and Stiglitz over for a dinner chat last week.  That strikes me as a hopeful sign.  Would love to have a transcript of that chat...
 
 
Other updates and original blog after the jump (I hope!)....
 

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