Department of Homeland Security

Customs is now part of the "Department of Homeland Security" but I avoid using this name. Whenever I see it, I hear "Reichsicherheitshauptamt".

not neither=not either

At least for Shakespeare.

How Obama Can Save Money

The grim deficit news counsels even more strongly that funding come from within the health-care system; other revenue is going to be needed to deal with the spiraling debt. The most sensible such source is the tax-free treatment of employer-sponsored health insurance. Capping the exclusion of health benefits from taxable income would both generate revenue and help slow cost growth. As vital is dealing with Medicare costs. The best approach is giving the Medicare advisory council power to implement, not merely advocate, cost-saving measures, subject to presidential or congressional override.

I don't think Americans will swallow it, though.

Would Tort Reform Lower Costs?

I guess not. I don't now if the blog says anything about taxing employer-provided insurance, or loosening up the licensing system for health care providers, i.e. letting more people become doctors and also letting physician's assistants or even nurses provide a lot of basic care.

Taxpayers shouldn't pay for UAW's rich health care benefits

I'll say. Now of course, my health care benefits are sacrosanct.

What unites Democrats and Republicans?

What unites Democrats and Republicans is an unwillingness to have a serious debate about how big government should be. Spending is the crucial issue, because it determines taxes and deficits. If they become too large, the resulting depressed economy may make paying for government even harder. Ideally, liberals would see that spending needs to be cut substantially; if it isn't, tomorrow's tax increases or deficits will be horrendous. Ideally, conservatives would accept that taxes must ultimately rise; no plausible spending cuts can bridge the gap between government's promises and its tax base.

There is no sign of this. Liberals and conservatives agree to evade. Spending for the elderly dominates the federal budget, but no one discusses who among retirees deserves government subsidies and at what age. Liberals would increase spending (a.k.a., President Obama's health proposal) even before addressing existing deficits. President George W. Bush and congressional Republicans could have curbed spending. But they increased it even while cutting taxes, and Obama would keep most tax cuts except for people making over $250,000.

Good Novels?

The novel is getting entertaining again. Writers like Michael Chabon, Jonathan Lethem, Donna Tartt, Kelly Link, Audrey Niffenegger, Richard Price, Kate Atkinson, Neil Gaiman, and Susanna Clarke, to name just a few, are busily grafting the sophisticated, intensely aware literary language of Modernism onto the sturdy narrative roots of genre fiction: fantasy, science fiction, detective fiction, romance. They're forging connections between literary spheres that have been hermetically sealed off from one another for a century. Look at Cormac ­McCarthy, who for years appeared to be the oldest living Modernist in captivity, but who has inaugurated his late period with a serial-killer novel followed by a work of apocalyptic science fiction. Look at Thomas Pynchon—in "Inherent Vice" he has swapped his usual cumbersome verbal calisthenics for the more maneuverable chassis of a hard-boiled detective novel.

The therapeutic ritual

...one way that placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.

Is Obama as bad as Bush?

So far:

"There's no question in my view that Bush was the most fiscally irresponsible president in the history of the republic," said David M. Walker, the comptroller general under Bush who now advocates for deficit reduction. Obama "was handed a bad deck," he said. "But the question is, are you making it better or not? And so far the answer is no."

The American Medical Association—a doctors' cartel

According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually,on average, because U.S. doctors make twice as much as their OECD peers. And even the poorest in specializations like radiology and surgery routinely rake in around $400,000 annually.

Doctors—and many Republicans—constantly carp about the costs of "defensive medicine" because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does. "While the U.S. malpractice system is extraordinary," the study notes, "it is only a small contributor to the higher cost of health care in the United States." Meanwhile, other studies have found that doctors' salaries contribute more to soaring medical costs than the $40 billion or so that the uninsured cost in uncompensated care--the president's bete noir.

Republican "principles"

... now the party is advocating a genuinely bad idea.

Not much DIY in China

Nobody in any office under the age of 25 has ever had a job before the job they’ve got now. Chances are, Chinese people under 35 have only ever worked in one industry in one city since college. They have never had part time or after school jobs or had to put themselves through college. They never rebuilt their first car (or any car) when they were 15. The can’t change a tire, the oil, wiper blades or a taillight. At home, they don’t know how to change the lights, build Ikea-type furniture or wire a stereo/TV or fix anything when it breaks. Why?

The One Child Policy and Low Cost Labor.

First, if you have one child and 4-6 adults in every house, the kid isn’t going to do anything but go to school, eat, play and complain. School is more important than anything else because he (usually a he) has a lot of people to take care of and school is the ticket for all 7 people to retire happily.

Second, it only costs 10RMB to have someone from the apartment management office come up and fix anything/everything for them. So why do anything yourself? (For a $1.25 I don’t do anything here either.)

Third, there is face in NOT doing manual labor type jobs and paying other people to do it for you.

Finally, because there is so much cheap labor everyone is incredibly specialized (limited) in their variety of job skills. Basically, everyone does their own (one) job very very well but no one has a clue about anyone else’s job here because they’ve never had another job and chances are their parents were farmers (meaning they didn’t learn business from their parents/environment growing up).

Cash For Clunkers

Expect the followup on this "successful" stimulus program to be about as dogged and high-profile as news from the war in Afghanistan.

Classical music online: newyorker.com

Classical music online: newyorker.com

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Whatever happened to Cindy Sheehan?

Cindy Sheehan

Old news but still true

With recent complaints of putative sugar shortages and a so-called milk cartel, this piece about Dairy Programs & Sugar Programs should be required reading.

What kind of rationing do we want?

...universal, unlimited insurance completely fixes things! Everyone will get all the medical care they want. No one will ever be denied or disappointed again!

But that's nuts. It's the same as claiming that rent control guarantees everyone affordable shelter or that the minimum wage guarantees everyone a decently paying job. To which from long, long history we discover that that might be correct, if you can find a vacant apartment or an available job. (Which is followed by liberals shrugging: hey, it's not our fault if you can't find an apartment or a job. It's the fault of greedy landlords and stupid employers. Besides, we meant well, so we're proud of ourselves, and that's all that really matters.)

Krugman-itis

One of the unfortunate symptoms of Krugman-itis is that it may blind you to the dishonesty of your political allies. As long as folks on the other side (especially Rush Limbaugh) are saying things that are completely off the wall, you have license to ignore the disingenuity on your own side of the aisle. In fact, you may even believe that the policies you favor are right simply because such awful people oppose them.

Change?

a new study by the Pew Research Center's Project for Excellence in Journalism and the Pew Forum on Religion & Public Life finds that Obama's faith-based initiative has so far generated little of the contentious press coverage associated with Bush's effort. And the program is not as closely associated with the current president as it was with the man he succeeded.

The new study examines newspaper coverage of the faith-based initiative during the first six months of the Obama and Bush administrations and finds that the topic received nearly seven

When Bush did it, it was bad; when Obama does it; it's good.

Profit Margin: Health Insurance Industry Ranks #86

Despite what Obama et al. suggest.

Obama doesn't really care about costs

Obama's program would do little to reduce costs and would increase spending by expanding subsidized insurance. The House legislation would cut the number of uninsured by 37 million by 2018, estimates the Congressional Budget Office. The uninsured get care now; with insurance they'd get more.

"You'd be adding a third medical entitlement on top of Medicare and Medicaid," says James Capretta, a top official at the Office of Management and Budget from 2001 to 2004.

Just imagine what the health-care debate would be like if it truly focused on controlling spending.

For starters, we wouldn't be arguing about how to "pay for" the $1 trillion or so of costs over a decade of Obama's "reform." Congress wouldn't create new benefits until it had disciplined the old. We'd be debating how to trim the $10 trillion, as estimated by the CBO, that Medicare and Medicaid will spend over the next decade, without impairing Americans' health. We'd use Medicare as a vehicle of change. Accounting for more than one-fifth of all health spending, its costs per beneficiary, now about $12,000, rose at an average annual rate of 8.5 percent a year from 1970 to 2007. (True, that's lower than the private insurers' rate of 9.7 percent. But the gap may partly reflect cost-shifting to private payers. When Medicare restrains reimbursement rates, hospitals and doctors raise charges to private insurers.)

Medicare is so big that shifts in its practices spread to the rest of the delivery system. But changing Medicare, and through it one-sixth of the U.S. economy, requires more than a few demonstration projects of "comparative outcomes" research or economic incentives. What's needed is a fundamental restructuring. Fee-for-service medicine -- Medicare's dominant form of payment -- is outmoded. The more doctors and hospitals do, the more they get paid. This promotes fragmentation and the overuse of services.

We should move toward coordinated care networks that take responsibility for their members' medical needs in return for fixed annual payments (called "capitation"). One approach is through vouchers; Medicare recipients would receive a fixed amount and shop for networks with the lowest cost and highest quality. Alternatively, government could shift its reimbursement of hospitals and doctors to "capitation" payments. Limited dollars would, in theory, force improvements in efficiency and effective care.

Of course, the Republicans' record isn't any better.

Community organizing no longer good

Mark Steyn wrote:

DISSENT IS THE HIGHEST FORM OF PATRIOTI- . . . No, wait, that bumper sticker expired January 20. Under the stimulus bill, there’s a new $1.3 trillion bills-for-bumpers program whereby, if you peel off old slogans now recognized as environmentally harmful (“QUESTION AUTHORITY”), you can trade them in for a new “CELEBRATE CONFORMITY” sticker, complete with a holographic image of President Obama that never takes his eyes off you.

“The right-wing extremist Republican base is back!” warns the Democratic National Committee. These right-wing extremists have been given their marching orders by their masters: They’ve been directed to show up at “thousands of events,” told to “organize,” “knock on doors” . . .

No, wait. My mistake. That’s the e-mail I got from Mitch Stewart, Director of “Organizing for America” at BarackObama.com. But that’s the good kind of “organizing.” Obama’s a community organizer. We’re the community. He organizes us. What part of that don’t you get?

When the community starts organizing against the organizer, the whole rigmarole goes to hell.

and Glenn Reynolds wrote:

"Protest is patriotic!" "Dissent is the highest form of patriotism!"

These battle-cries were heard often, in a simpler America of long ago -- that is, before last November. Back then, protests -- even if they were organized by the usual leftist apparatchik-groups like ANSWER or ACORN -- were seen - at least in the media - as proof of popular discontent.

When handfuls of Code Pink ladies disrupted congressional hearings or speeches by Bush
administration officials, it was taken as evidence that the administration's policies were unpopular, and that the thinking parts of the populace were rising up in true democratic fashion.

Even disruptive tactics aimed at blocking President Bush's Social Security reform program were merely seen as evidence of boisterous high spirits and robust, wide-open debate. On May 23, 2005, the Savannah Morning News reported:

“By now, Jack Kingston is used to shouted questions, interruptions and boos. Republican congressmen expect such responses these days when they meet with constituents about President Bush's proposal to overhaul Social Security.

“Tinkering with the system is always controversial. To make Bush's plan even more so -- political foes are sending people to Social Security forums armed with hostile questions.

By now, Kingston, a Savannah lawmaker and part of the GOP House leadership, has held 10 such sessions and plans at least seven more.”

On March 16, USA Today reported that Pennsylvania Sen. Rick Santorum "was among dozens of members of Congress who ran gantlets of demonstrators and shouted over hecklers at Social Security events last month. Many who showed up to protest were alerted by e-mails and bused in by anti-Bush organizations such as MoveOn.org and USAction, a liberal advocacy group. They came with prepared questions and instructions on how to confront lawmakers."

This was just good, boisterous politics: "Robust, wide-open debate." But when it happens to Democrats, it's something different: A threat to democracy, a sign of incipient fascism, and an opportunity to set up a (possibly illegal) White House "snitch line" where people are encouraged to report "fishy" statements to the authorities.

House Speaker Nancy Pelosi calls the "Tea Party" protesters Nazis, New York Times columnist Paul Krugman --forgetting the events above -- claims that left-leaning groups never engaged in disruptive tactics against Social Security reform, and various other administration-supporting pundits are trying to spin the whole thing as a deadly move toward "mob rule" and – somewhat contradictorily -- as a phony "astroturf" movement.

Remember: When lefties do it, it's called "community organizing." When conservatives and libertarians do it, it's "astroturf."
But some people are noticing the truth. As Mickey Kaus notes, "If an 'astroturfing' campaign gets real people to show up at events stating their real views, isn't it ... community organizing?" Why yes, yes it is.

Preventive care won't save money

In yet more disappointing news for Democrats pushing for health care reform, Douglas W. Elmendorf, director of the Congressional Budget Office, offered a skeptical view Friday of the cost savings that could result from preventive care -- an area that President Obama and congressional Democrats repeatedly had emphasized as a way health care reform would be less expensive in the long term.

"Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive.

"For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."...

Elmendorf cited an article published last year in the New England Journal of Medicine which he said provides a good summary of the available evidence on how preventive care affects costs..

The article by Joshua T. Cohen, Peter J. Neumann and Milton C. Weinstein, “Does Preventive Care Save Money? Health Economics and the Presidential Candidates,” was recently updated and can be read HERE.

France Fights Universal Care's High Cost

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis...

France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.

The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.

Obama Doesn't Like Community Organizing

With public anger toward ObamaCare rising, the president and his allies have decided to pour kerosene on the embers and flames (and fearful Democrats have taken to canceling town-hall meetings). It is an old and sad story we are seeing play out: rather than facing the rancor at town-hall meetings as a sign of growing frustration and unrest, the president and his team are outright denying it. They are reacting defensively, bitterly, and aggressively. And Barack Obama — the man of unsurpassed equanimity and a calm temperament, who praises Lincoln because he always understood the views of those with whom he disagreed, the man who would usher in a “new era” of politics and civility, of enlightened public discourse and comity among previously warring factions — is allowing his representatives to mock and demonize his critics.

Too much

The underreported news is the new spending [on government-run health care] that will continue to increase well beyond the 10-year period that CBO examines, and that this blowout will overwhelm even the House Democrats’ huge tax increases, Medicare spending cuts and other “pay fors.”
...
That’s what White House budget director Peter Orszag told the House Budget Committee in June.

Cash-for-clunkers didn't help me, either

What about the estimated 12 percent of Americans aged 15 years and above who don't drive, period? What about all the adults who live in the 8 percent of households that don't have a vehicle? What about half the residents of Manhattan, who took transit planners' decades-old dream to heart and "got out of their cars"? What about those who are too poor to drive? The answer: All of these people are subsidizing whoever turns in an SUV or crappy old $800 K-Car like the one I used to drive. Not only that, but what do you think happens to the $800 car market when the guvmint is handing out $4,500 checks to have the things destroyed? I'll go ahead and state the obvious: It shrinks, making it more expensive for the truly poor people, the ones who want to make that daring leap from the bus system to an awful old bucket of rust.

So no, not "everyone" was helped by cash-for-clunkers. Ah, but what about how it's better for the environment, and therefore "everyone"? Tell it to those smokestack apologists at, uh, The New York Times, The New Republic, and The Guardian.

... Cash-for-clunkers is indeed very "popular." So is the home mortgage interest deduction, the prescription drug benefit, and any number of federal programs that siphon from the diffuse pool of tax revenue+debt and blast out concentrated benefits to the broad middle class. The standard for judging these things shouldn't be popularity–Richard Nixon's wage-and-price control spasm of 1971, to name one of many historical measures now widely and rightly considered asinine, was hugely popular at the time–but whether they make sense in both the short and long term.

Big surprise?

On Friday, the Bureau of Economic Analysis released its advance estimate of real G.D.P. for the second quarter of 2009. Although some say it provides some of the first evidence of the stimulus law’s efficacy, a close inspection of the results shows that the government sector’s contribution to real G.D.P. growth so far has been trivial at best.

Sustainability

Sustainability is a compelling concept these days, although it always seems to be applied to people’s private choices. Meanwhile, everybody knows the federal government has committed to an unsustainable flow of future expenditures. The promises the federal government already has made for Social Security and health care cannot possibly be met. If our legislators took the concept of sustainability seriously, Congress would be looking for ways to cut back on government programs, not add more.

Sustainability

Sustainability is a compelling concept these days, although it always seems to be applied to people’s private choices. Meanwhile, everybody knows the federal government has committed to an unsustainable flow of future expenditures. The promises the federal government already has made for Social Security and health care cannot possibly be met. If our legislators took the concept of sustainability seriously, Congress would be looking for ways to cut back on government programs, not add more.

For California, Read Illinois

California has reached a tipping point. Its government made more promises than its economy can easily support. For years, state leaders papered over the contradiction with loans and modest changes. By overwhelming these expedients, the recession triggered an inevitable reckoning.

Here's the national lesson. There's a collision between high and rising demands for government services and the capacity of the economy to produce the income and tax revenue to pay for those demands. That's true of California, where poor immigrants and their children have increased pressures for more government services. It's also true of the nation, where an aging population raises Social Security and Medicare spending. California is leading the transformation of politics into a form of collective torture: pay more (higher taxes), get less (lower services).

Make no mistake: The spending cuts and tax increases the state enacted to bridge its budget deficits are not cosmetic. In February, the Legislature agreed to a penny increase in the state sales tax, bringing the total -- including local sales taxes -- to about nine cents or more. Top income tax rates, already among the highest in the country, were raised. So were motor vehicle registration fees. Spending cuts approved in February and July are deep. Together, the cuts equal almost 30 percent of the general revenue fund and will affect schools, prisons, colleges and welfare.

...

National parallels again seem apparent. Federal budget deficits -- reflecting the urge to spend and not tax -- predate the recession and, as baby boomers retire, will survive any recovery. Amazingly, the Obama administration would worsen the long-term outlook by expanding federal health insurance coverage. There's much mushy thinking about how we'll muddle through.

...

On paper, the state could solve its budget problems by raising taxes further. But in practice, that might backfire by weakening the economy and tax base. California scores poorly in state ratings of business climate. In a CNBC survey, it ranked 32nd overall but last in "cost of business" and 49th in "business friendliness."

In 2009, Illinois ranked 38th in "cost of doing business" and 47th in "business friendliness".

...

So California is stretched between a precarious economy and a strong popular desire for government. The state's wrenching experience suggests that, as a nation, we should begin to pare back government's future commitments to avoid a similar fate. But California's experience also suggests we'll remain in denial, prisoners of wishful thinking, until the fateful reckoning arrives in the unimagined future.