I went to Google to see what the earliest occurence was and got nothing at all. Could it be that they have bought the Washington Post Company when I wasn't looking?

Happy days.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

The whole performance is worth study, because up at the WSJ level there is no question that one has to do with dupemasters rather than with dupes.

The snippet quoted cannot, I fear, rank very high, elegancewise: it is too easy for those unaffiliated with the Big Management Party and its AEIdeology to notice that if Ms. Heath-Paling had originally intended to talk about "Medicare spending ... incurred in the last six months of life," she could have done so with impunity.

In fact, the ex-governess wanted to talk about a different subject altogether. One can see why an upmarket Jingo might wish that she had not done so: the "death panels" exuberance is not a thing that can be defended with a straight face before an audience of political grown-ups. S. Heath-Paling is thus in some danger of becomin' an albatross around the neck of her own Party.

On the other hand, the slaves of Murdoch plainly don't want to be rude to or about the Empress of the Arctic -- they may need Her Highness's subjects' votes later on.

Even in the meantime, if Jingos were to say too many discouragin’ words about Her Imperial Highness, a lot of the Party base ’n’ vile would at once start mutterin’ about "country-club Republicans" and ‘R.I.N.O.’s and so on and so forth. As happened when the Jingos got "immigration reform" all wrong -- wrong as viewed from Rio Limbaugh, that is.

Such is the obstacle course that the nameless corporate scribbler had to negotiate. I don't think she did so very well.

Mais que sçay-je?. Take a look at the scribble and decide for yourselves.

Happy days.

Chuckles does not give a hoot whether he scores any points for resemblance to Eleanor Roosevelt and Florence Nightingale.

On the other hand, grossly unwarrantable baloney about "the smartest guy the right has" will probably go straight into the Krauthammerian self-scrapbook.

Happy days.

[T]he NYT ... graduated from considering "death panels" among the "questionable" wackjob charges (Aug. 11) to considering them -- accurately -- "false."

Meanwhile, over at Fox-on-Fifteenth-Street, they've moved on beyond Manichee moralism. The AK governess's fibs are not good fibs or bad fibs, they are, rather, fibs of their time:

"death panels," as former Alaska governor Sarah Palin colorfully put it . . . .

Happy days.

A law isn't a negotiation, but ...

Naturally a loyal donkey like me would never speak of 'doublespeak' in such a context, but let's face it, 'law' is scarcely the only noun that needs to be put between shudder quotes in this weird discussion. 'Negotiation' is just as shudderiferous for anybody who is more interested in how "our country" is generally to be run than in particular power grabs and market cornerings.

Move over Bulwer-Lytton!

"It was a dark and stormy night. In a smoke-filled room at an undisclosed location, the President of the United States had put in many wearisome 'negotiating' an 'agreement' with the drug companies...."

Indeed, maybe that should be "drug companies" while we are at it? Your neighborhood mom-and-pop pharmaceutical developers will not have been invited to attend so select an event any more than journalists and Congresspersons and other irrelevant nuisances, you and me among them.

Now of course it has been established by the Cheney Corollary to the Nixon Doctrine that this sort of thing can go on unchecked (and uncheckable on) as long as its only a matter of bombing and invading and occupying non-voting foreigners, but I was not aware that Mr. Madison's Constitution had been laid aside domestically as well. Do Mr. Reid and Ms. Pelosi know yet that they have been obsoleted?

Picking the general weirdness up by the other end, one might wonder how President Summers and Mr. Obama expect to get through the old-fashioned formal obstacle course without ever letting the Speaker and the Majority Leader (and Televisionland and the electorate) that they (and we) have now been promoted from being a mere 'efficient' part of the Yankee constitution to being a 'dignified' part thereof. [1]

Then there is the SCOTUS caltrop. Once the Administration and the druggies have 'negotiated' an 'agreement' of this Pickwickian sort to their own subjective satisfaction, I fear it will turn out to be a dignified 'contract' rather than one of those tiresome old Contracts that one could usually get courts to resist the Impairment of. (That's article I, section 10, clause 1 of the musty old parchment.) What's to prevent President Summers on the one side or Big Pharma on the other from cheating like crazy?

Larry and Barack dispose of more nukes than Pfitzer and GlaxoSmithKline and Novartis, to be sure, but it is not easy to see exactly how that immense theoretical advantage would be brought to bear in practice.

Still, if it is to be a secret what is in the 'agreement', perhaps one is being unreasonable to wonder how the High Contracting Parties propose to make sure that everybody keeps her word.

No business of yours or mine is that!

Happy days.
McNarrative

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[1] Does anybody still read Bagehot ?

[T]he very conception of the English Constitution, as distinguished from a purely Parliamentary Constitution is, that it contains "dignified" parts--parts, that is, retained, not for intrinsic use, but from their imaginative attraction upon an uncultured and rude population. All such elements tend to diminish simple efficiency. They are like the additional and solely ornamental wheels introduced into the clocks of the Middle Ages, which tell the then age of the moon or the supreme constellation; which make little men or birds come out and in theatrically. All such ornamental work is a source of friction and error; it prevents the time being marked accurately; each new wheel is a new source of imperfection. So if authority is given to a person, not on account of his working fitness, but on account of his imaginative efficiency, he will commonly impair good administration. He may do something better than good work of detail, but will spoil good work of detail

(( "Uncultured and rude population" fits the Teabag Tribe rather well, does it not? Unless, of course, it matters that the Foxcuckooland crew have rather relapsed into barbarism than never arisen from it to begin with. ))

Issuing a memo on a website urging people to demonstrate is neither "planning" nor "paying" for anything.

¡Payin', no, plannin', sí!

Or at any rate, the neocomradely community would call it plannin' in a flash if the good guys were to do it.

Less unseriously, ‘amike’ does, I think, underestimate what we are up against. One great beauty of the secret or private sector is, oddly enough, how easy it is for them to do things privately and secretly.

After sixteen decades of coëxistence with America's Otherparty, liberals and democrats and Democrats would be demented not to possess a moral certainty that there is a whole lot of astroturfin' against health care goin' on at Wingnut City and Rio Limbaugh and Hooverville. But "moral certainty" is not the same thing as proof that will stand up in court -- not even, sigh, in the Court of Public Opinion.

"Life is unfair"!

Happy days.

Meanwhile, back at the ranch, here is the Lewinites' bottom line, given in full, except for figures and cartoons -- for who among us possesses that Harvard Victory School MBA degree that can alone qualify one to cope with an Executive summary?

[p. 38] G. Impact on National Health Spending

National Health Spending will reach $2.77 trillion in 2011. This includes expenditures for health services, prescription drugs and medical equipment. It includes the amounts spent by all payer groups including the federal government, state and local governments, employers and families. To illustrate the impact of the Act on national health spending, we estimated the Act's effect on health expenditures assuming that the program is fully implemented and enrollment is fully mature in 2011.

We estimate the change in national health spending separately for the scenario where all firms are eligible for the exchange and the scenario where only small firms have access. If all firms are eligible for the exchange, and therefore the public plan, national spending would increase by about $1.3 billion. Thus, the Act would reduce the number of uninsured by 32.6 million people without significantly increasing national health spending....

[p. 39] The overall increases in spending for the newly insured would be roughly offset by reductions in provider payments and administrative savings for those covered under the public plan. However, if eligibility for the exchange is limited to only small firms, national health spending under the Act would increase by $48.8 billion. Under either scenario, we estimate an overall increase in utilization of health services of roughly $42 billion for the newly insured and those obtaining improved coverage. In addition, utilization of health services would increase for people who shift from private coverage to the public plan. This reflects that Medicare, which the public plan is modeled on, does not include most of the utilization controls used by private insurers, such as precertification for high cost services. Studies have shown that these utilization controls can save up to 8 percent. (Our analysis is explained in Appendix A). This utilization effect would be $4.2 billion if only small firms have access to the public plan and $20.5 billion if all firms may enroll.

Provider reimbursement for the health services they provide would fall by about $45.0 billion if workers in all firms have access to the public plan. Providers now would be paid for services that under current law would have been provided free as uncompensated care, adding $17.5 [p. 40] billion to provider incomes. The Act also increases reimbursement rates for primary care services under Medicaid to Medicare levels over a three-year period by $8.4 billion.

These increases in reimbursement would be more than offset by reductions in payment for care provided to people enrolled in the new public plan. As discussed above, Medicare hospital payments are about 68 percent of what private insurers pay for comparable services. Physician services are also reimbursed at about 81 percent of private payer levels. By relying upon Medicare reimbursement plus 5 percent, the Act would result in reduced payments to providers for services provided to people who shift from private insurance to the public plan, which we estimate to be $96.4 billion.

If only individuals and workers in small firms are eligible to participate in the public plan, enrollment would be lower resulting in a reduction in provider reimbursement of only about $16.8 billion. In fact, provider reimbursement actually increases by $2.9 billion due to the smaller enrollment in the public plan under this scenario.

A portion of this net reduction in reimbursement will be recovered by providers through increases in charges to those who continue to be covered under private insurance. Studies have documented that about 40 percent of the shortfalls in reimbursement for the uninsured and people covered under government programs are recovered by increasing charges for services provided to privately insured people ..... Based upon these results, we estimate that the program would increase the cost-shift by about $30.0 billion, if all firms are eligible to participate in the public plan through the public plan.

Finally, we estimate an overall reduction in insurer administrative costs for private insurance and public programs of $16.6 billion under the scenario where all firms have access to the exchange. This reflects that there are economies of scale that can be realized by providing coverage through an organized purchasing entity such as the exchange. Also, the public plan would have no allowance for insurer profit and insurance agent and broker commissions, thus reducing the public plan premium.

I incline to doubt that the neocomrades of the Lewin Group originally intended to make this document public. Logically it ought to be classified "TOP SECRET--PARTY EYES ONLY" or the like. Mr. Newman is certainly right to draw attention to it.

What makes it specially worthy of attention is that we lay sheep get to see such a thing before the AEI/GOP/RNC/Heritage/Hoover Agitprop Arm has had a chance to adopt it for vulgar consumption.

That last sentence that I emphasized, for example, is almost shockin'ly spinless! The A. A. specialists would, I daresay, prefer that the question of overhead in the private or secret sector never be raised at all. To admit flat out that profits and commissions exist and that they raise prices is to be tolerated only in the very last ditch. Even then, the Party spinster should emphasize heavily that without such incentives, innovation in insurance products may be gravely retarded.

Or at any rate, that is the orthodox agitprop line about medical innovation. Perhaps when it comes to financial products, the neocomrades should just shut up in public entirely.

Happy days.

Yours,
McRaubfest

Petition to Republicans in Congress
Stop Attacking Reform with Insurance Company-Owned Research

This week, the Washington Post revealed that the Lewin Group - which is commonly cited by Republican lawmakers as an "independent, nonpartisan" think tank - is owned by a health insurance company. Have Republicans heard of a "conflict of interest"? It's time to demand that they come clean about their sources.



Dear Republican Members of Congress:

Republicans must answer to why they repeatedly cite information provided to them by an insurance company-owned firm, and claim it's from a "non-partisan" and "independent" source.

Come clean about your sources – the American people deserve an open, honest debate on the best solution to this crisis.

Sincerely,
[your name]

Happy days.
[his name]

As part of his health care package, President Obama proposed creating an independent commission of medical experts that would determine the medical procedures for which Medicare will pay.

Since it is too hot for me to worry much about being fair to present company, let's rewrite that one a little, shall we:

As part of his depression exit strategy, let President Obama propose creating an independent commission of economic experts that would determine the economic procedures for which Uncle Sam and his neices and nephews will pay.

Happy days.

Happy days.

Happy days.

IDF mulls possible US aid halt effects

By YAAKOV KATZ AND HERB KEINON

Amid growing tension between Jerusalem and Washington, the IDF and Defense Ministry have held brainstorming sessions to discuss the possibility that the United States would cut military aid to Israel, The Jerusalem Post has learned. (( &c. &c. ))

Obama has no choice. If he acquiesces to (sic) Netanyahu, which the Israel Prime Minister is counting on, then the game is over in the region -- and America will slide down a long, slippery slope of nations doubting America's global leverage and competence to accomplish objectives it sets out for itself.

Turnabout may be fair play, but I ask you, is it nice to attempt to embarrass the Hyperzionistical element like that?

Though they have been hollering for centuries (it seems like) about how our Sam must never, ever, anywhere let himself be perceived as the proverbial "pitiful, helpless giant," they certainly were not shopping for this product!

I am not at all sure about the statesmanship of it, but as rhetoric and polemic, it undoubtedly merits an A+.

Happy days.

And what do politics have to do with it? Everyone wants efficient and polite cops.

Sancta simplicitas!

No doubt everybody wants Joe Friday to be nice to herself personally, but does she really want him to extend the same treatment to everybody? ("Be nice even to icky THEM? Say it ain't so!")

Politics has everything to do with it, of course, because whether Officer Friday strikes Ms. Everybody as ‘efficient’ or not must depend on what it is that she expects him to do.

Mr. Gates of H*rv*rd has, I presume, a rather dark theory of what it is that Ms. Everybody wants Joe to be doing for ‘us’. Whether or not Gates is right, he cannot just be swept out of sight under the rug as summarily as this poster evidently hopes.

On the other hand, he (Mr. Poster) is the only peanut in the peanut gallery who, very sensibly, thinks it might matter a little that it happened in Zip Code 02138 and not (say) at Crawford TX or Kennebunkport ME. [1]

Happy days.

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[1] Look at how one of our local wingnutettes picks the story up.

Any account that leaves out hatred of H*rv*rd cannot, I think, be entirely sound.