This creek smells funny. How did we get here?

Imagine you were rowing your boat gently down the stream and one of the oars got caught in the hatch. What would happen? Logic suggests that the current would slowly move you downstream as you spun the boat in circles.

O.K. Rowboats don’t have hatches, but Orrin Hatch is a creature and a feature of the ship of state and it is people of his intellectual and moral quality who are spinning the boat in circles when it’s clearly in need of proper direction. In fact, abandoning the first metaphor, they’ve piloted the US up the creek to where it is today. When you’re up this creek, you need a paddle, not an Orrin.

In response to Charles Schumer’s statement, that the Democrats can pass healthcare reform without Republican support:

Sen. Orrin Hatch (R-Utah), who joined Schumer on the show, said Democrats should not try to use reconciliation to force through a bill which could not overcome a filibuster in the Senate.

“If they use that, that would be an abuse of the process,” Hatch said. He also said creating a government health plan open to all would be a grave mistake. “If we do that, we’ll bankrupt the country.”

Earth to Orrin. What do you think you’ve been actively working at for the last 8 years? What do you think lying to the public to make a war in Iraq, and loosely regulating the financial community, have to do with the current economic situation?

The Republican Party set the stage for bankrupting the nation by adopting neo-conservatism as its political philosophy. Neo-conservatism, which is conservatism without moral and intellectual grounding, is bankrupt at the conceptual level, so it’s hardly surprising that Bush’s application of its principles gutted the economy of the nation. It’s also why so many Republicans continue working to bankrupt the nation by applying the principles they say prevent bankruptcy.

Ideologues whose brains can’t get beyond binaries are incapable of accepting the empirical world when it conflicts with their beliefs. One such belief is that public healthcare would bankrupt the economy, when every study ever published in The New England Journal of Medicine on the topic shows that public healthcare is more efficient and cost effective than private healthcare.

With people like Orrin at the helm, there is no reason to wonder why the country is up the creek. I can think of at least two good uses for a paddle.

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The “Racists are now ‘left of the left’ Oxymoron” (emphasis on ‘moron’)

Some of you may be wondering where I disappeared to.  I am sitting on the lanai of a rented condo in Maui, looking at a the clouds.  It’ll pass, I’m sure.  Today, we are taking the road to Hana.  It’s early morning here.  I finally got a decent internet connection.  I’ve been following the news off and on in the past couple of days and was amused to find that someone in the White House is now calling single payer advocates the “left of the left”.

The “left of the left” is not just your typical Birkenstock shod, bamboo sheet sleepin’, compost eating, Berkeley professor type.  No, the “left of the left” ranks right up there with Pol Pot.  Single payer advocates are scheming to force the helpless American citizen into the iron manacles of mandatory CAT scans.  But first, they will implement a regime of preventive medicine.  All of the hypereducated Whole Foods Nation shoppers will be rounded up into exercise and nutrition camps where they will be chained to treadmills and will sweat side-by-side with old, ugly, working class, uneducated women.  They will be made to listen to some perky blonde chic who looks buffer than they will every be as she spouts hour after hour of pseudo scientific drivel on the benefits of taibozumbayogalates- to a disco beat.

But that’s not all.  Any time they want to get emergency services, they will have to sit in a waiting room, decorated in Soviet decor circa 1952, with 500 illegal immigrants and their screaming, feverish children whose noses are pouring rivulets of snot.  No one will get special treatment, not even if they arrive in an ambulance straight from the golf course where they have been struck by lightening.  You wanna know why?  Because we will all be paying such high taxes for those snot nosed brats that there won’t BE any golf courses any more.  No one will be able to afford the greens fees at the private courses and will have to share the tees at public courses with the sweaty, unwashed Tiger Woods wannabees.

(The BFF, who likes getting lei’ed, just filled up my coffee cup.  I could get used to this.  Where was I?  Oh, yeah.)

And let’s not even go there with the choice of doctors.  You will be lucky to get a doctor at all.  The government will actively recruit adolescents who show some talent for applying bandaids and administering drugs to attend to you with their tender mercies.  You’ll have to bribe them with hot new laptops to get anything stronger than tylenol and they will constantly remind you off some psyche shattering slight as they probe you arm with needle, drilling down through subcutaneous adipose tissue to tap into your veins for a routine blood test.

This is what is in store for us if we let the ‘left of the left’ spread its vicious propaganda of the efficiencies of government and economies of scale instead of individualized policies, lovingly customized for the special needs of each and every one of us by the beneficent, bipartisan and uniquely American health insurance industry.  Is this what we want, people?  To be forced into Tricare? Like my mom?  The Fox News watcher who loves her government insurance?  Ahhh, what does she know?  Stupid racist Martin Luther King Jr lover.

How short our memories are.  It was only last year that we long-haired, hippie type, pinko fags were stupid racists.   And now my 70 year old mom is a long haired, hippie type, pinko fag.  It’s kind of late for her to have an identity crisis.  I’m so confused. Of course, we probably *still* are racists and don’t even know it.  The White House has probably never seen the likes of us.  We’re both ignorant bigots and anarchic, civil rights types with a penchant for healthy living.  One thing is for sure: Obama wants nothing to do with us and he’s making a point of telling the whole world how utterly repellent we are.

Well, until he needs our votes, of course.  Then we’ll just be stupid, racist, lefties with no place else to go.  Consistency is not a problem when your goal is “to fool enough of the people most of the time”.   Good thing he doesn’t need our help on health care insurance reform because he’s not gonna get it.

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The Culture of Cannibalism in US Politics: The Cycle of Corruption

Mark Twain, in “Cannibalism in the Cars,” suggested that cannibalism of the body politic is a logical outcome of the practice of the political values of the elected representatives of the United States, in dire circumstances. What would occur, if such dire circumstances did not require a natural disaster, but became a systemic feature of the political landscape?

The current economic crisis and America’s abject failure to provide economically-efficient, affordable healthcare are two examples of dire circumstances that are systemic features of America’s political landscape. Both crises are the results of bad governance. Both circumstances are direct products of the growth of influence of en-corporated political interests (encorps) in the system of governance of the United States. Bad governance, in both cases, involves a betrayal of the public trust that is manifested in not regulating the encorps in a way that protects the public’s interests, especially with respect to not meaningfully regulating the encorps ability to influence government officials.

The United States was born wary of the power of vested interests to influence public policy. Alexander Hamilton’s comments in the Federalist Papers are an example of this concern. .

In republics, persons elevated from the mass of the community, by the suffrages of their fellow-citizens, to stations of great pre-eminence and power, may find compensations for betraying their trust, which, to any but minds animated and guided by superior virtue, may appear to exceed the proportion of interest they have in the common stock, and to overbalance the obligations of duty.

Unfortunately, keeping the vested interests out is not a simple matter. How can it be when parties themselves are collective expressions of a set of weighted interests? Frankly, it is sensible for people of like purpose to strive together to achieve their aims, and there is nothing necessarily insidious about the practise. In fact, it’s a cornerstone of Democracy and civil society.

It is also, however, the entry way for corruption because the crux of the matter is not that people have differing and competing interests: it’s that they differ so greatly in terms of their power to realize those interests. When the power to realize those interests is used to unjustly deny the interests of less powerful, but equally or more deserving citizens, through a donation that is traded for a piece of unjust legislation, then it can be said that a positive feedback loop of corruption has been initiated.
The overly simple analysis that follows attempts to describe the basic workings of this system.

There’s a New Squid in Town: the view from the belly of the beast part II

In the first installment of my three-part series on healthcare, I covered the insanity of trying to get things covered by the private insurers.  Today I’m going to examine the second half of the problem: getting things paid.   If you are a healthcare consumer, you are likely at least a little familiar with the former, but not so much the latter. I know I’m spending a lot of time describing the problems with the system. But the thing is, we cannot adequately discuss solutions, or what proposed solutions will and will not work, and WHY, without having a very thorough understanding of just what the problems are from both the patient and the provider end.

I’ll first have to give a quick, VERY simplified primer on how medical services are billed.  Providers do not send a bill to an insurance company saying “20-minute office visit for diabetes and jock itch, $74.”  They use a system called CPT, or Current Procedural Terminology, that assigns a specific numerical code to everything a doctor does, from office visits to counseling to procedures. Office visits are rated from 1-5, depending on how complex the presentation, and how many medical problems were dealt with that visit. There’s a lot of these codes – the current CPT book is a good 4 inches thick. The codes are then fed into a computer, and the insurance pays accordingly, by a contracted fee schedule.   Diagnoses are entered via a separate set of codes, ICD, that must match up with and “justify” the CPT codes used. Got it?

I mentioned in part one the “perpetual adversarial chess game”, and it comes into play here.  The providers are always trying to figure out how to “correctly code” what they did, and the insurance companies are always trying to figure out ways to have the computer reject any given code combination.  Please keep in mind that because there are  so many similar codes,  the “game” gets interesting.  There may be 5 different diagnosis codes for a single illness, and THIS insurance company decides that they require you to use the second one, while THAT one kicks it out unless you use the 3rd one in conjunction with certain CPT codes.  Oh, and they change what will “kick out” all the time, so the code that resulted in your getting paid last month will not necessarily go through this month. Confused yet?

This was the plan all along

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Glenn Greenwald finally gets it:

That’s obviously true. In fact, it’s so obviously true that no matter how dumb one might think Democrats are, they’re certainly not so dumb that they failed to realize that the GOP was highly unlikely to help Obama pass health care reform no matter what the bill contained. From the start, it’s been obvious to everyone — the Obama White House and Senate Democrats included — that the GOP would not help Obama pass health care reform. Why would the GOP want to help Obama achieve one of his most important and politically profitable goals? Of course they were going to try to sabotage the entire project and would oppose health care reform no matter what form it took. Everyone knew that from the start for exactly the reason that it was so obvious to Benen.

The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill. But — given the impossibility of achieving that goal — isn’t it fairly obvious that a desire for GOP support wasn’t really the reason the Democrats were constantly watering down their own bill? Given the White House’s central role in negotiating a secret deal with the pharmaceutical industry, its betrayal of Obama’s clear promise to conduct negotiations out in the open (on C-SPAN no less), Rahm’s protection of Blue Dogs and accompanying attacks on progressives, and the complete lack of any pressure exerted on allegedly obstructionists “centrists,” it seems rather clear that the bill has been watered down, and the “public option” jettisoned, because that’s the bill they want — this was the plan all along. (emphasis added)

Well no shit, Sherlock! That’s why I keep saying – “Failure is a feature, not a bug.” I’m glad to see that people smarter than me are starting to figure it out too.

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One more time:

“Because that’s the bill they want — this was the plan all along”

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Unsocialized Government (a play in 1/2 an act)

(I totally stole this from Violet Socks)

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{{ring}}

Dispatcher:  Midvale Fire Department, how may I help you?

Homeowner:  My house is on fire!

Dispatcher:  May I have your policy number?

Homeowner:  My what?

Dispatcher:  Your homeowners insurance policy number.

Homeowner: What do you need that for?  MY HOUSE IS ON FIRE!

Dispatcher:  I have to verify coverage, sir.

Homeowner:  What the f u . . .?  Just a second, let me find the card in my wallet.

Dispatcher:  I’ll hold, sir.

Homeowner:  Here it is, it’s X123456789

Dispatcher:  Thank you, sir.  Okay, I see you are covered for basic fire.  Is anyone trapped in the house?

Homeowner:  No, everyone got out.

Dispatcher:  That’s good, because you’re not covered for rescues from burning buildings.

Homeowner:  No, everyone’s out.  But the house is burning, can you please hurry?

Dispatcher:  Just a few more questions, sir.  There is a $10,000 co-pay due at the time of service, will you be paying with cash or major credit card?

Homeowner:  I don’t have that kind of cash and my cards are maxed out.  Will you take a check?

Dispatcher:  I’m afraid not sir, would you like to fill out a credit application?

Homeowner:  Yes, yes, whatever.  Just send the damn fire trucks!

Dispatcher:  There is no need for profanity sir.  Do you know how the fire started?

Homeowner:  I think my son was playing with matches.

Dispatcher:  Oh, I’m sorry sir, your policy carries an exclusion for arson.  Have a nice day.

{{click}}

Homeowner:  Hello?  Hello?

THE END

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Total spending on health care, per person, 2007:

United States: $7290
France: $3601
United Kingdom: $2992
Italy: $2686

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Buy a clue, Ezra

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Ezra Klein in today’s WaPo:

Monday was the day of the liberal revolt on health-care reform. If you want a nice round-up of the commentary, see Mike Allen. What’s been striking, however, is the implicit argument that this is somehow a simple failure of liberal will. Rachel Maddow called it “a collapse of political ambition.” The problem, she said, is that “Democrats are too scared of their own shadow to use the majority the American people elected them to in November to actually pass something they said they favored.”

[…]

The problem, I think, is that there is a tendency to understand heath-care reform as an equal negotiation in which all sides want a deal, and you can game out various bargaining stratagems. But health-care reform is not a negotiation. It’s a campaign. Reformers wants a deal, even as some differ on its precise shape. The opposition wants to kill the deal entirely. And that gives the opponents a lot more power to say “no.” “No” isn’t their fallback position. It’s their position. The supporters — if they’re not sociopaths of some sort — actually do want to extend health-care coverage to 40 million people and regulate the insurance industry and create out-of-pocket caps and make life better for millions and millions of people. That makes it hard to say “no.” Being a decent person turns out to be a terrible weakness. And the pressure is even greater because the history of this stuff is that you don’t get a deal at the end of the day. Failure isn’t an unlikely outcome. It’s the default.

No, no, no ,no, no, NO!

Ezra just doesn’t get it:

FAILURE IS A FEATURE NOT A BUG!

Follow the money Mr. Klein. Which candidate got the most money from the health insurance industry and Big Pharma last year? Which party got the most money from the health insurance industry and Big Pharma last year?

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What do you think the health insurance industry and Big Pharma were paying for? (Hint: It wasn’t to buy us all ponies)

As they say in Chicago, “An honest politician stays bought.”

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We’re being played (again)

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Single payer is off the table and now that ObamaCare is going down in flames they are trying to stampede us into supporting something they call “public option” that isn’t really public option.

When hustlers are running their scams and the mark (that’s us) is getting cold feet, one trick they use is to have an associate appear eager to take the deal.  The mark (that’s us) is afraid they are going to lose a good bargain and takes the bait.  So what are we seeing right now?  A big push for us to take the deal before it’s too late.

I ain’t buying it.

Marc Ambinder:

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius “misspoke” when she told CNN this morning that a government run health insurance option “is not an essential part” of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president’s view, the most important element of the reform package.

I’ll give credit where credit is due – the Obama Permanent Campaign is very good at message control.  That’s why I find it highly implausible that Kathleen Sebelius went off script yesterday.  That leaves two possibilities – she was either floating a “trial balloon” or she was part of an attempt to manipulate us.

If there is one thing that the OPC excells at it is manipulation.

From what I’ve seen this “public option” is gonna be an option for about 10 million people that can afford health insurance but can’t get it because of pre-existing conditions.  Those pre-existing conditions mean they will probably incur higher costs, which means their premiums will be higher or the plan will have to be government subsidized.  Meanwhile the private plans can focus on the most profitable categories of clientele – the young and healthy.

A true public option would be open to everyone and would prohibit private insurance companies from dumping people (or raising their rates) because of pre-existing conditions.  I’m not saying that offering insurance to people who can’t get it elsewhere is bad, but it isn’t public option.

I’m gonna have to disagree with the Big Dawg and others who think it is important that something, even a bad bill, be passed so that Obama can claim a victory on health care reform.

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NOTE: My trip to Netroots Nation

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You may have noticed my absence over the weekend. On the spur of the moment I decided to attend the annual blogging convention in Pittsburgh.

I had a great time listening to the speakers, rubbing elbows and having my picture taken with the elites and hoi polloi of Left Blogistan. Then I sobered up and realized I was at a Denny’s in Bakersfield.

Better luck next year.

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What Happened to Obama Nation?

Remember when all the Obots at the previously liberal blogs told us that Barack Obama would be the best candidate for President because Hillary Clinton would have to deal with all the old scandals of the ’90s? And remember how the Obots then dug up all the old right-wing attacks and used them against Hillary in the primaries?

Remember how they told us the Republicans would have a field day if the Clintons were back in the White House? How they told us that Obama would be able to get things done that Hillary couldn’t because he was new and fresh and charismatic? And when we asked them what Obama stood for, whether there was any issue that was so important to him that he’d stand and fight, they attacked us and called us racists and Republicans or told us to “go read his website?”

Well here we are, just seven months into Obama’s term and the Republicans have already gained the upper hand in the health care debate. The crazies are out in force–shouting down Democrats at town halls and carrying nutty signs claiming Obama is a socialist and claiming he’s not a U.S. citizen. How long before the Republicans start accusing him of dealing drugs and murder–just like they did the Clintons? Worst of all, we no longer have any semblance of an independent media to debunk the nonsense being spread by the right wing noise machine. As Rick Perlstein points out in a piece written for tomorrow’s Washington Post:

Conservatives have become adept at playing the media for suckers, getting inside the heads of editors and reporters, haunting them with the thought that maybe they are out-of-touch cosmopolitans and that their duty as tribunes of the people’s voices means they should treat Obama’s creation of “death panels” as just another justiciable political claim….

It used to be different. You never heard the late Walter Cronkite taking time on the evening news to “debunk” claims that a proposed mental health clinic in Alaska is actually a dumping ground for right-wing critics of the president’s program, or giving the people who made those claims time to explain themselves on the air. The media didn’t adjudicate the ever-present underbrush of American paranoia as a set of “conservative claims” to weigh, horse-race-style, against liberal claims. Back then, a more confident media unequivocally labeled the civic outrage represented by such discourse as “extremist” — out of bounds.

The tree of crazy is an ever-present aspect of America’s flora. Only now, it’s being watered by misguided he-said-she-said reporting and taking over the forest.

Let’s face it, President’s Obama’s health care initiative is in danger of going down in flames. Last week Organizing for America sent out e-mails to supporters asking for help in defeating the right-wing memes that have already overwhelmed the health care “debate.” The e-mails asked supporters to get out in force to defend the President’s plan (whatever it is–I don’t think anyone really knows).

Christians and health care

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Last December on Santa Claus’ birthday I pointed out that Jeebus was a DFH moobat librul. As we watch the Great Astroturf War of 2009 and see the Tea Party movement get their collective panties in a wad over socialized medicine, I think it’s appropriate to review what the man from Nazareth is supposed to have said on the topic.

Those of you who were raised in one of the various Christian denominations are familiar with the parable I am going to discuss. It is commonly known as “The Good Samaritan.”

On one occasion an expert in the law stood up to say to Jesus. “Teacher,” he asked, “what must I do to inherit eternal life?”

“What is written in the Law?” he replied. “How do you read it?” asked Jesus. The man answered: ” ‘Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind’ and, ‘Love your neighbor as yourself.'” “You have answered correctly,” Jesus replied. “Do this and you will live.” But he wanted to justify himself, so he asked Jesus, “and who is my neighbor teacher?”

In reply Jesus said:
“A man was going down from Jerusalem to Jericho, when he fell into the hands of robbers. They stripped him of his clothes, beat him and went away, leaving him half dead with no clothes. A priest happened to be going down the same road, and when he saw the man, and he passed by on the other side. So too, a Levite, when he came to the place and saw him, he too passed by on the other side. But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and looked after him. The next day he took out two silver coins and gave them to the innkeeper. ‘Look after him,’ he said, ‘and when I return, I will reimburse you for any extra expense you may have.’ “Which of these three do you think was a neighbour to the man who fell into the hands of robbers?” The expert in the law replied, “The one who had mercy on him.” Jesus told him, “Go and do likewise.”

It is important to understand that two millennia ago in the Galilee region of the place now known as Israel or Palestine that the people from Samaria (Samaritans) were not well liked.  You could think of them as the equivalent of illegal aliens.

I’ll also point out that Jeebus had a low opinion of the religious leaders of His day.  Many historians believe that He was a member of the Essene sect of Judaism because he was so critical of the Sadducees and the Pharisees, the other two major sects of that time.  Levites were members of the Tribe of Levi and they had special religious and political duties in what was kind of like a hereditary priesthood.

So when Jeebus mentions the priest and the Levite he was talking about two members of the upper crust of local society.  In the parable these two upstanding citizens practiced compassionate conservatism by leaving the injured crime victim laying on the side of the road.  Jeebus was specific – they saw the man and crossed the road to avoid him.

Then this despised Samaritan comes along and helps the injured man.  He goes out of his way and even incurs some expense, but he asks nothing in return.

So if you should run across one of those fundiegelical right-wingers that is wearing a WWJD bracelet while protesting against single payer and he is complaining that he doesn’t want to subsidize lazy bums help pay for health care for any his neighbors that are less fortunate than himself, tell him what Jeebus would do.

If he doesn’t believe you tell him to open his Bible to the Gospel of Luke, chapter 10, verses 25-37.  (Strangely enough, many of Jeebus’ followers seem to be unfamiliar with His teachings.)

You might also point out that Jeebus is supposed to have spent quite a bit of time healing the sick and injured. I don’t recall any Bible verses mentioning that He asked anyone for their insurance billing information first.

BTW – Luke was a physician.

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