Monday Mashup (9/21/09)

(And I also posted here.)

The last thing in the world I intend to do here is somehow exonerate the personal conduct of former Dem presidential candidate John Edwards which led to the ruination of his career in public life, but I do want to point out that it says something about the New York Times that, while he was a presidential candidate, he couldn’t buy Page One coverage, but he was granted it yesterday here over the matter dubbed as “Rielle Time” by Bill Maher.

Update 9/27/09" If more stuff like this comes out, then I'll have to start doing those pushups all over again.

Also, for those who think this site is “All President Obama All The Time,” allow me to point out the following from Paul Krugman’s column today (here)…

I was startled last week when Mr. Obama, in an interview with Bloomberg News, questioned the case for limiting financial-sector pay: “Why is it,” he asked, “that we’re going to cap executive compensation for Wall Street bankers but not Silicon Valley entrepreneurs or N.F.L. football players?”

That’s an astonishing remark — and not just because the National Football League does, in fact, have pay caps. Tech firms don’t crash the whole world’s operating system when they go bankrupt; quarterbacks who make too many risky passes don’t have to be rescued with hundred-billion-dollar bailouts. Banking is a special case — and the president is surely smart enough to know that.

All I can think is that this was another example of something we’ve seen before: Mr. Obama’s visceral reluctance to engage in anything that resembles populist rhetoric. And that’s something he needs to get over.

Uh, yeah, I would say so also.

Also, in the Times yesterday, former Bushco economic adviser N. Gregory Mankiw told us the following yesterday about health care…

Despite all the talk about waste and abuse in our health system (which no doubt exists to some degree), the main driver of increasing health care costs is advances in medical technology. The medical profession is always figuring out new ways to prolong and enhance life, and that is a good thing, but those new technologies do not come cheap. For each new treatment, we have to figure out if it is worth the price, and who is going to get it.

As Atul Gawande of The New Yorker tells us here (where he took a visit to Texas for the June article)…

One night, I went to dinner with six McAllen (TX) doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’”

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. “But young doctors don’t think anymore,” the family physician said.

…

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

And as noted here, “stim” funds were included for what is called “comparative effectiveness research,” which is basically learning how to provide the best care at the best cost (leading of course to the typical right wing nuttery, as noted here).

However, as the Times tells us here…

..as the science reporter Ronald Winslow recently reported in The Wall Street Journal, “just 11 percent of more than 2,700 recommendations approved by cardiologists for treating heart patients are supported by high-quality scientific testing, according to new research.”

That circumstance alone justifies spending billions more than we traditionally have on operations research for an industry that now absorbs $2.5 trillion or close to 17 percent of our gross domestic product. Why anyone would oppose that kind of research challenges one’s imagination.

Mankiw continues…

The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it. That soft-hearted aspiration, however, runs into the hardheaded reality that state-of-the-art health care is increasingly expensive. At some point, someone in the system has to say there are some things we will not pay for. The big question is, who? The government? Insurance companies? Or consumers themselves? And should the answer necessarily be the same for everyone?

…

Inequality in economic resources is a natural but not altogether attractive feature of a free society. As health care becomes an ever larger share of the economy, we will have no choice but to struggle with the questions of how far we should allow such inequality to extend and what restrictions on our liberty we should endure in the name of fairness.

Try reading the following from here and see if you become as disgusted with Mankiw’s ignorant pontifications on this subject as I am at this moment…

Nearly 45,000 people die in the United States each year — one every 12 minutes — in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.

“We’re losing more Americans every day because of inaction … than drunk driving and homicide combined,” Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

There is plenty of “inequality” in our system right now, Mankiw. Just ask the nearly 45,000 people per year who have endured “restrictions on (their) liberty,” to put it mildly.

And the “public option” is hardly a “soft-hearted aspiration.”

Please do us a favor and stick to wrong-headed economic “analysis,” as opposed to wrong-headed health care “analysis,” OK Mankiw?

And finally, Matt Bai told us the following in the Times Magazine yesterday (here)…

Why didn’t lawmakers anticipate that “cash for clunkers” would run out of money almost immediately? Why were desperate dealers forced to float rebate checks while waiting for the government to pay the promised money? And if Washington has this much trouble administering what is essentially a $3 billion coupon for car buyers, how do we expect it to handle a nearly $1 trillion overhaul of health care?

(From Malkin/Beck/Drudge’s lips to Bai’s ears, apparently - he considers "Cash for Clunkers" a "managerial fiasco" because it was successful - ???)…

And then, a paragraph later, Bai blames conservatives for coming up with at least one of the talking points that he just parroted so effortlessly – hey, if you don’t think they’re legit, then DON’T SPREAD THEM AROUND, OK???!!

And get a load of this…

…a lot of Washington Democrats embraced the idea that a liberal rebirth was under way, taking as their mandate the expansion of government rather than the rethinking of it.

Do any of these “lot of Washington Democrats” have names, by any chance?

Obama himself has lobbied for hundreds of billions of dollars in new spending to stimulate economic growth, but apart from submitting a modest list of programs he wouldn’t mind cutting (which drew howls of protest inside his own party), he has been reluctant to acknowledge the blatant bureaucratic failures of an earlier era: crumbling housing projects, misguided farm aid, highways plowed thoughtlessly through neighborhoods. Democrats have been resolute in rejecting the tired conservative mantra of limited government, but they’ve shown less interest in confronting the lingering image of liberal activism as invasive and chronically mismanaged.

And Democrats are the only ones who support highway funding and pass bloated farm bills…please (propagating more talking points that he disingenuously blames on Repugs).

Oh, and by the way, speaking of Democrats showing “less interest in confronting the lingering image of liberal activism as invasive and chronically mismanaged,” which president signed welfare reform legislation again?

Try to think real hard, OK?