Insurer Denies Sick Girl Coverage

A couple days ago, I wrote about framing health care debates as people vs. insurer profits.  Today, the Los Angeles Times spells out, with sickening, graphic detail, what I mean.

The story highlights lawsuits against insurers who, when their patients get sick, drop coverage.  This should be illegal, but as the story notes, it didn't stop Blue Cross/Blue Shield (which is incidentally, a non-profit organization), from refusing to pay cancer treatments for a formerly insurerd four-year old girl.

When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.

Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.

<snip>

The way Steve and Leslie Shaeffer saw it, their $498 monthly premium was the price of peace of mind. The self-employed tile installer and stay-at-home mother wanted to make sure that they and their two children got whatever care they needed and that the bills would never bury them.

As I said before, I think these sorts of personal stories are key to exposing the problems with the current insurer system.  I honestly can't fathom how anyone, upon seeing a four year old girl denied coverage, could say that the insurer system works. For that matter, seeing the family, who has $50,000 in debt and may have to sell off their home (which the father designed), would pull at a lot of heart strings.

To me, this highlights the difference between looking at statistics and people.  The economics of this are pretty basic: Insurers have thousands of people making fixed monthly payments, and to make money, these payments from healthy people have to exceed the costs of the sick people.  The problem is the profit motive:

Blue Shield -- a nonprofit led by an executive who advocates universal coverage regardless of medical history -- says it can't afford to break ranks with the industry practice of selecting the healthiest customers.

Otherwise, "we will end up with all the high-risk people," said Blue Shield spokesman Epstein.

I am sure that no one at Blue Shield wants a little girl to die of cancer.  I am sure that no one at Blue Shield wants their family to go into hock in an effort to save their little daughter's life.  But the economics of health insurance demand it.

Turns out, cronyism doesn't work

The Washington Post has a pretty devastating story about how the Bush administration picked officials to head up reconstruction efforts in Iraq.

The article focuses on three examples:

* "A 24-year-old who had never worked in finance -- but had applied for a White House job -- was sent to reopen Baghdad's stock exchange."

* An Evangelical charity leader who replaced an MD/Masters in Public Health to lead the rebuilding of Iraq's hospital system.

* And disgraced former NYPD chief Bernie Kerik, who took his job so seriously, he "held only two staff meetings while in Iraq, one when he arrived and the other when he was being shadowed by a New York Times reporter, according to Gerald Burke, a former Massachusetts State Police commander who participated in the initial Justice Department assessment mission...With no help on the way, the task of organizing and training Iraqi officers fell to U.S. military police soldiers, many of whom had no experience in civilian law enforcement."

What qualified these people for their new, high-profile jobs?
According to the article:

To pass muster with O'Beirne, a political appointee who screens prospective political appointees for Defense Department posts, applicants didn't need to be experts in the Middle East or in post-conflict reconstruction. What seemed most important was loyalty to the Bush administration.

O'Beirne's staff posed blunt questions to some candidates about domestic politics: Did you vote for George W. Bush in 2000? Do you support the way the president is fighting the war on terror? Two people who sought jobs with the U.S. occupation authority said they were even asked their views on Roe v. Wade .

That certainly helps explain why, for $56 billion in reconstruction costs, the stock market failed, security is terrible, and, as the article notes about the health system:

When Haveman left Iraq, Baghdad's hospitals were as decrepit as the day the Americans arrived. At Yarmouk Hospital, the city's largest, rooms lacked the most basic equipment to monitor a patient's blood pressure and heart rate, operating theaters were without modern surgical tools and sterile implements, and the pharmacy's shelves were bare.

Nationwide, the Health Ministry reported that 40 percent of the 900 drugs it deemed essential were out of stock in hospitals. Of the 32 medicines used in public clinics for the management of chronic diseases, 26 were unavailable.

It's certainly not news that the Iraqi reconstruction has been a pretty major failure, nor is it really news that this administration is deeply corrupt.  We've known this for quite some time.

But this article (adapted from the soon-to-be-released Imperial Life in the Emerald City highlights just how silly, how completely unserious the administration has been about this war.  

But let's think about the larger context of this war, for a second.  President Bush  has made statements to the effect of that "I do think Iraq is a central front in the war on terror and so does Osama bin Laden," over and over.  

That is, in the central front, in a war that President Bush has recently compared to Naziism and Stalinism and other much larger, historical threats, this administration took reconstruction so lightly that they hired a 24 year-old kid, who knew nothing about finance, who initially balked at the idea of being appointed to head up the exchange, to rebuild the Iraqi stock exchange.  

In other words: In facing what the first battle of what President Bush has

called World War III, his administration saw the logistical challenges as so minor that they chose cronies over competence.

Just one more marker of grave incompetence.  Or massive corruption.  Or, I suppose, both.

How to Talk About Universal Care

This piece makes some important points, though not terribly artfully, about framing health care debates, following Gov. Schwarzengger's recent veto of a universal coverage bill.

The key line, which I'll expand on a bit, is:

The universal health care movement needs a new brand. Why not call it something simple like the “California Health Plan?” Wouldn't the public support a plan that allowed them to choose their doctors and hospitals, pay less for better quality and access, and not have to worry about losing coverage when they change jobs?

Why not help voters understand that under the California Health Plan the billions of dollars wasted by insurance companies and HMOs on middlemen, CEO pay, corporate profits, overhead and advertising would be redirected to providing care? What if voters knew that such a plan would pay for doctor visits, preventive screening, pregnancy coverage, hospitalization and emergency treatment?

Again, let me reiterate, I think that reframing the way we talk about universal health care is vital, though, to be fair to proponents of the California bill, their website is called Health Care for All and their website header says "Achieve Universal Health Insurance."

Mainstream news reports do often use the phrase "single payer system" but that is the most neutral framing, so you can't complain too much.

But let's look at another quote from Flanagan's and Dugan's piece.

The essence of the new brand is the cost efficiency of a health care system that will spend only 2 to 3 percent on overhead and prevent disease rather than treat it after it becomes chronic. Our advocacy must make the case for a government role in better allocating wasted resources and fixing crumbling infrastructure.

Did your eyes glaze over? Admit it--listening to percentage declines of preventive care vs. chronic care is not terribly interesting. I've worked on and off in health fields for years, and I get bored reading that stuff.

So while axing the phrase "single payer care" will help, I think a far more vital mission is to personalize the debates. The California Nurses Association has pointed out, rightly, that uninsured people wait until they need emergency care, which is not only more expensive but much worse than preventive care.

But again, that was a boring sentence. But highlighting stories of people whose health and finances have been ruined by being uninsured--well, that would pull at heart strings, drum up support for universal care, and make anyone who opposed providing everyone with insurance look heartless. Basically, use Ronald Reagan's Welfare Queen strategy, you know, without the whole lying thing.

Personalize the damn debate.

That would help put private insurers--and really, the whole system of employee-based health care--on the defensive, which is really, I think, the second part of the problem.

Let's look at another point from the Tompaine.com article:

Insurance premiums, driven by insurer and drug company bloat, are increasing two to three times faster than underlying medical inflation, such as hospital and doctor fees.
[snip]
HMOs and health insurers waste 25 percent of our money on overhead and profit. Including duplicative administrative tasks forced on doctors and hospitals, as much as 50 percent of every dollar spent on health care is wasted.

In other words, insurers, HMOs, etc. suck up huge amounts of money and add precious little value to the economy, given that the government could do their primary role, pooling risk, much more easily and efficiently.

So why not exploit this? Find doctors' offices and so on that have seen their costs skyrocket due to hiring administrative people to comply with byzantine insurer rules.

And more importantly, link insurer profits to the uninsured. Hammer on the fact that we're leaving our poor, indigent citizens--the personalized part of the campaign--so that insurance companies can profit on something the government can do better.

Make insurers explain to the public what, specifically, it is that they do, and why they are so much better at it than Medicare or the Veteran's system, both of which tend to receive higher satisfaction ratings.

My final point is that something like the "California Health Plan" is simply to vague and benign.

Look at how the republicans have turned the estate tax into the death tax. "Death tax" is incorrect and misleading, but it drives home the point nicely, doesn't it?

We need this debate to look like: Anyone who opposes universal cares more about insurer profits than sick children. It is crass, but unlike the welfare queen or death tax, it is also true.

NCAA vs. Walmart

There's been some interesting chatter today about NCAA labor practices, which are pretty much as terrible as Walmart's, with the added bonus that the universities that exploint college athelets are supposedly non-profit entities, producers of knowledge, guardians of our teenage folk, etc., etc., etc.

But what does the NCAA do instead?

A reader, Marcus Detry, alerted me to the case of Ramon McElrathbey, and if you had any lingering doubts about the ridiculousness of the NCAA, this should dispel them.

The case is written up nicely by "The Wizard of Odds" but the gist of it is this. McElrathbey is a cornerback for the Clemson University football team. He is one of seven children. His mother is a crack addict, and his father has a gambling problem and is no where to be found. He grew up bouncing around foster homes. This summer, he decided--with his mother's consent--to take custody of his 11 year old brother. They now live in a cramped off campus apartment, as McElrathbey tries to be a student, athlete, brother and father simultaneously. When a story was published about McElrathbey in alocal paper, he was deluged with donations and gifts and offers to help. But of course Clemson had to step in and say no. Why? Because receiving any kind of outside financial assistance, if you are an amateur college athlete, is against the NCAA's rules.

That's from Malcolm Gladwell, and naturally, it provides an excellent synopsis of the most recent ridiculous NCAA scandal. And the pay, or lack thereof, is certainly one of the NCAA's flaws.

NCAA universities supposedly give room/board/tuition to compensate their players, but that poses a second problem: they don't really educate their students. Student athletes have enormous obligations to their programs, for one thing, and can't take the time to really focus on classes, and as a result, are steered toward easy classes. And still, very few athletes in big time programs graduate.

And even those who graduate may not have really received an education. Take, for example, Dexter Manley who made it through four years at Oklahoma State functionally illiterate. The focus is not on education but sports.

One shudders to think how many Dexter Manley's there are. Sure, we know that he was illiterate (he has since learned to read, according to the occasionally accurate wikipedia.) But we would never have found out if he had not been one of the exceptional college atheletes who made it through to the NFL. How many athletes made it through, only not to be drafted? Who knows.

In any case, what's phenomenal is that there is so little movement to do anything about this system. I am a grad student, and am constantly surrounded by a lot of pompous nonsense about how university people are better than everyone else, because we don't work for the bottom line.

But it seems to me that the bottom line has to be the reason this system perpetuates. That, or blind, delusional stupidity. No one, with a speck of information and a half a brain, could find this system to be the sort of decent, equitable system that non-profit universities should want to impose upon their students.

Subsidizing Big Oil

This is nice to see: Rep. Ed Markey (D-Mass.) is proposing that Congress remove the legal loophole that makes purchasing a large SUV a smart choice, at least financially. The original tax break is designed to make it easier for small business owners to afford pickups, etc. for work, but it has inadvertantly encouraged people to buy gas guzzlers. The press release from Markey notes:

The tax bias in favor of an SUV can be quite substantial, according to the report. It compares, for example, the hypothetical purchase of an Audi station wagon versus a Jeep SUV. The purchase of the 20.5 mpg Audi incurs a $1300 gas guzzler tax; the purchase of the less efficient 15.8 mpg Jeep is gas-guzzler-tax free. Similarly, a 21.7 mpg Chrysler 300C, a large sedan, pays a gas guzzler tax of $1000, but the 13.9 mpg GMC Yukon Sierra, a very large SUV, pays no tax.

There are all sorts of obvious concerns about global warming and pollution, but let's leave those aside and look at this from a national security and economic perspective.

The BBC is running this story about peak oil that notes a growing belief in the energy community that we will soon reach our peak oil production capacity, at which point, there will be a sharp, rapid global drop in production capacity.

Twilight in the Desert provides some excellent background, but the basic thrust of peak oil theory is this: By far the vast majority of Saudi oil comes from a few fields that have been prodcued heavily, if not overproduced, for years. Oil fields, once they reach peak, tend to see rapid declines due to loss of pressure. Nobody has discovered a major oil field in decades. Although oil executives (as well as Saudis) suggest that we won't have to worry about oil reserves for decades, most evidence seems to suggest otherwise.

The reason that peak oil production is important is this: Globally, we consume nearly as much oil as we produce, and there is very little spare capacity. Spare capacity matters because if there is no way to increase oil production, there is no way to accomodate rising demand.

And rest assured, demand is rising, particularly in the developing world. In China, for example, the number of cars on the road has tripled in the past five years, and the number of cars continues to multiply.

What does that mean? Well, Bloomberg recently reported that numerous wall street analysts see the price of oil nearly tripling to $200 a barrel, which would pretty much cause ridiculous global recessions.

Optimists argue that new technology will allow us to expand capacity and continue to meet oil demand for at least two or three more decades. And there may be some truth to this theory--predicting oil production capacity is a dubious proposition, given the potential for new/unknown drilling technologies.

But it seems pretty stupid to bet on technology, when a great deal of evidence suggests production declines.

Rep. Markey's proposal will not solve our problems. It is relatively small idea, really just some minor surgery on the tax code. All the same, passing it (which of course will never happen) would send an important message about our priorities.

And you know, I think we can have better things to do with nearly $16 billion than subisidize ridiculous cars that are threatening our national security, and economic and environmental well-being.

15 Cents

This is a wonderful CS Monitor here, though I wish it told us how much Pakistani border guards make.

The lede?

For a little more than the price of tea, Abdul Razzak, a trader, says he crosses illegally from Pakistan into
Afghanistan every day.


Mr. Razzak, who stood recently near the border, preparing to cross, has no passport or identification documents of any kind. But that doesn't matter: For only 10 rupees (about 15 cents), he bribes the border security forces to let him through. Sometimes he pays 20.

"I bargain for the price. All of these people," he says, indicating the throngs of pedestrians moving toward the border check post, "when crossing the border, don't have documents. They're all paying the Frontier Constabulary [the border security forces]."

In other words, the Pakistani/Afghani border is, for all intents and purposes, unguarded. Which is something we should know about. It's a sort of reminder that no matter how angry we get, or how many people we bomb, force alone is insufficient. We needs governments that work, all the way down to the lowest level bureaucrats.

Why I'd like to know the average salary is this: It's not clear if it's the Pakistani government who is pretending to cooperate with Bush and then whisper other things in private to guards, or if the guards themselves simply need the money. If it's the government, maybe we should, you know, say something to them. Object a bit.

If the guards are letting these people in because they need the money, maybe we could help out with the salaries. I think trading the $20 a day in bribes a guard gets for a more secure border around where Osama Bin Laden is hanging out would be well worth it.

And also, of course, there's the Taliban. According to the Monitor:

The first step in preventing the Taliban from organizing in Pakistan is to impede their mobility to and from Afghanistan. In an effort to bring more military muscle to the border, Pakistan and Afghanistan agreed to a breakthrough deal last week. Under the agreement, Afghanistan and Pakistan's military forces - with participation from
NATO troops - will conduct simultaneous patrols of the border, and may also begin using more high-tech equipment to communicate with one another.

But the joint patrols - designed to bring some level of enforcement to the vast wilderness stretches of the 1,500-mile border - may not be effective if the official border crossing in Chaman remains so lax.

Yup. Controlling space like borders is strategically important. Maybe if we weren't expending all of our resources in Iraq, we could help the Pakistanis and Afghanis do a more adequate job.

Have you no shame?

What could be sillier than a woman attempting to lose her virginity through a magazine contest?

Well, a statue of "Tomkitten's" first solid bowel movement.

It seems like every day, somebody invents a new way to whore him or herself out, and I think these two items are just symptoms of that. I mean, there's a reason we have toilets. It's because we want to be as far away from our own waste as possible.

We do not, under any circumstances, wish to save our shit for posterity.

At least I don't.

On the bright side, even though the artist here hopes to make $30,000 on the poop, the highest bid, thus far, is $41.

Expectations

Bush today in an interview with Brian Williams: "The key for me is to keep the expectations low."

Bush a couple of years ago: "We are challenging the soft bigotry of low expectations."

That, of course, was not the only time Bush used the phrase "soft bigotry of low expectations."  He has been using that saying for years.

The Newsmax article I linked to above offers some interesting points about the effects of low expectations, according to our President.

President Bush, in a searing speech Thursday night touting his administration's accomplishments and laying out the challenges ahead, fired some of his heaviest ammunition at the Democrat and education establishments: "We are challenging the soft bigotry of low expectations."

In noting the gains achieved by the No Child Left Behind law, the president took indirect but unmistakable aim at complainers such as Sen. Teddy Kennedy, the nine White House wannabes and the teachers' unions who oppose the successes of school choice and are one of the Democrats' biggest special-interest sources of money. "All children can learn," the president reminded 800 cheering supporters at a fund-raiser.

Under his education reform, "we're insisting on results"...

Insisting that children do well produces results.  Bush's key to success is that people think so poorly of him that he doesn't have to produce.

This is not a small quibble.  Bush has made high expectations one of the central components of his education program.  For Bush, high expectations are tremendously important in improving education.

Or put differently: The president now holds children to a higher standard than he holds himself.

It's the Economy Stupid

Henry Paulson, net worth of something like $700 million, was recently complaining that if it weren't for rising health and gas costs, even the poorest Americans could appreciate the strong U.S. economy as measured by aggregate growth.

The Christian Science Monitor todayspelled out in exquisite detail why aggregate growth is such a poor measure of health and welfare for poor people.  Among their findings:

In terms of the percent of its population living at or below the poverty line, for instance, the US ranks worst among 16 wealthy countries, according to the Luxembourg Income Study. That study found that 17 percent of Americans are poor. As for child poverty, the US also sits on the bottom, with 21.9 percent.

And...

* The US has about the same or worse income mobility between generations. The poor have a slim chance of escaping their parents' poverty, says Professor Smeeding.

* The US has an educational system that is "not terribly great," says Smeeding. International tests indicate that the "outcomes" for US students are about average for rich nations.

"Our smartest kids do as well as smartest kids anywhere," he says. But that's not the case for low-income families. The odds of their children entering or graduating from college are not good.

* The US spends more on healthcare per capita than any other rich nation. Americans with adequate health insurance get good health care. But about 16 percent of Americans have no insurance.

For all that spending, the life expectancy in America shares with Denmark the bottom ranking out of 16 wealthy countries. Denmark spends about half as much per capita as the US does.

The whole article does an excellent job of pointing out the flaws in macroeconomic understandings.  By focusing only on GDP growth, we leave a fifth of our children in poverty, a sixth of our population uninsured, and don't even achieve high economic mobility--one of the supposed promises of the American free market.

It reminds me a bit of the macroeconomic measure of core inflation, which, paradoxically, measures the rate of inflation for items other than food and energy.  

You might expect core inflation to measure the rate of inflation on food and energy--I mean, people need food and gas far more than they need to know the annual price increase on big screen televisions--but somehow, the core measure excludes these points.

David Sirota has spent a huge chunk of time pointing out the gross and growing inequality in our system, and I think he notes, rightly, that one of the chief weaknesses of democrats in recent years is to tacitly accept supply-side policies rather than point out their inherent, massive flaws.

I am absolutely certain that the one sixth of Americans who lack insurance would far rather vote for politicians who promised health coverage than for politicians who can add 0.1% to the GNP (though dems do that better, too.)  

But the focus needs to be there.  And part of it needs to come in the form of excellent reporting, like this CS Monitor story, that highlights the difference between macroeconomic growth and meaningful growth for those on the lower end of the economic spectrum.

Homeland Security Tried to Cut Screening Funding

This associated press article provides some interesting insight into what matters to the Bush administration.  Check the lede:

As the British terror plot was unfolding, the Bush administration quietly tried to take away $6 million that was supposed to be spent this year developing new explosives detection technology.

Lovely, really.  So not only does President Bush stay on vacation despite the apparent increased security risk but he then tries to cut funding from technology that could help discover bombs on planes.

At the same time, the New York Times is reporting that:

That picture of Republican disunity eased dramatically this week with the defeat on Tuesday of Senator Joseph I. Lieberman in the Democratic primary in Connecticut and the news on Thursday that Britain had foiled a potentially large-scale terrorist plot.

The White House and Congressional Republicans used those events to unleash a one-two punch, first portraying the Democrats as vacillating when it came to national security, and then using the alleged terror plot to hammer home the continuing threat faced by the United States.

So somehow, the white house can cut funding for bomb screening at the same time it portrays itself as the party of national security.  

That same NY Times article quotes Dick Cheney as saying, "[the terrorists] clearly are betting on the proposition that ultimately they can break the will of the American people in terms of our ability to stay in the fight and complete the task."  

This is a perfectly logical argument, assuming that we can somehow fight a war without funding it.