Friday, July 31, 2009

The genius of Duane & single-payer health care

I haven't gone, just taking a bit of a break. But there's nothing like the intellectually bankrupt comments of a committed liberal to prompt a new post.

Off-and-on commenter "Duane" had the following in the midst of his comments on health care:
Single payer means we can all stop paying for medical insurance. Yes taxes will go up but the disappearance of the massive overhead that insurance companies add will take care of that "increased demand" you think comes with third party payer.
1) Single-payer does nt mean that we can all stop paying for medical insurance. It means that medical insurance will be paid for through taxes. Some folks will end up paying exorbitant prices for their health insurance while others will pay nothing. Liberals addicted to progressive punishment of wealth accumulation will love that arrangement, no doubt. In the end, however, there just isn't any such thing as a free lunch.

2) Yes, taxes will go up, unless we borrow the money and grow the deficit. Though we could do both, which is what would apparently happen under the latest version of the Obamacare plan.

3) The single-payer plan is unlikely to significantly decrease the "massive overhead" that private insurance adds to health insurance costs, except through rationing of health care services (providing less service would probably reduce the need for overhead). Governments tend to operate less efficiently than private concerns since the latter need to concern themselves with profits. Massive overhead is a drag on profits, so private companies are highly motivated to keep overhead costs under control. Medicare, as I understand it, runs higher administrative costs per patient than does private insurance.

4) The third-party payment problem is a classic economic phenomenon. It's like me just "thinking" that printing more money so that everyone will have twice as much will devalue the currency by half, in principle. It's basic economics, not just my personal opinion. When somebody else is paying for something, the demand for that something dependably goes up. Insurance companies know that. That's why co-pays and deductibles are featured prominently in most insurance plans. Plans without co-pays and deductibles are extremely expensive merely because the high premium is likely to make up for the increased use of services.

Tuesday, July 14, 2009

Did AG Eric Holder doublecross his boss?

When I first heard that Attorny General Eric Holder was at this late date considering prosecutions for detainee mistreatment, I assumed that he was again pondering the windown left open to him by President Obama. That is, to consider prosecuting administration officials who developed detainee treatment policies.
... Obama added that prosecutions for those who drafted the memos would be up to Attorney General Eric Holder. "With respect to those who formulated those legal decisions, I would say that that is going to be more of a decision for the Attorney General within the parameters of various laws, and I don't want to prejudge that. I think that there are a host of very complicated issues involved there."
Holder had appeared to let that window close for the most part by leaving it up to bar associations to discipline administration lawyers for dispensing bad advice.

But Holder seems to have found another window of opportunity.
"For those who carried out some of these operations within the four corners of legal opinions or guidance that had been provided from the White House, I do not think it's appropriate for them to be prosecuted," (Obama) told reporters.
The flip side of the president's statement, of course, is that it might be appropriate to prosecute those who strayed from the guidelines for detainee treatment provided by the Bush administration. Those who overstepped the lines drawn by the administration, in other words.

Have we ever had a president so artful in his deployment of English words and phrases? Since Bill Clinton, anyway?

On the one hand, Obama committed to backing the CIA in the name of unity. But he left the door open to prosecuting agents who overstepped the authority granted by the old administration. It is something of a balancing act. One would hope that agents who went beyond their orders have already received in-house discipline. Holder could go well beyond that to charging agents with war crimes, and the CIA might not feel fully supported by the administration if that occurs.

As with Clinton, it helps to keep a magnifying glass on hand to deal with the fine print when the POTUS opens his mouth.

Is it politics?

The CIA, of course, also faces criticism from the left in Congress, stemming from Speaker of the House Nancy Pelosi's charges that the CIA regularly lies to Congress. Pelosi never did much to make her case, but a handful of Democrats recently tried to put a tooth or two in the charge.

Is the Holder story part of a political battle in the federal government among factions in the Democratic Party?

If Obama does not treat carefully, he risks having his CIA turning against him as it did on occasion with President Bush.

The Steven Crowder investigation of Canadian health care

Steven Crowder is a funny guy.

But his low-budget expose of the Canadian health care system relegates his comedy to the role of comedy relief. Some of the things we see of the system adopted by our neighbors to the north are downright scary.

Waiting hours in the emergency room? I expect that occurs frequently enough in the States, so most people won't think that's any big deal despite the hints we have that it is always that way in Canada.

Waiting years to have a family physician? That has to open a few eyes, or at least raise a few eyebrows.

Video: Cougar retrofit testing at Aberdeen

The Baltimore Sun featured a nifty story on the Force Protection Cougar. Specifically, the testing of the upgraded Cougar at the Aberdeen Test Center. And they made it available for embed:

Though the embed isn't exactly a technical marvel itself. Click the "story" link above to see the video at its original location.

The upgrade features more armor and the Oshkosh-built independent suspension system.
Test driver Pat Hamilton has logged many miles in the original fixed-axle Cougar and the newer version with the independent suspension. He said both he and his kidneys greatly prefer the latter model.

"It's like a Honda Civic versus a Cadillac ride," he said. "It cushions the ride so much better."

Monday, July 13, 2009

Did Slate deliberately avoid unflattering comparison to protect Obama?

We all know about the conservative media bias. Or something.

The St. Petersburg Times chose to print a story from Slate about White House staff salaries.

The story talks about the levels of compensation. The highest paid staffer under President Obama makes $193,000. Not too outrageous.

The story talks about how salaries are determined via a formula depending on rank. Assistants to the president earn the most. And we learn that Obama has more assistants than did his predecessor, 22 compared to 18. Plus experience can help a staffer earn more within his pay classification.

We learn from the story that "President Bush requested a total of $51.9 million for White House office salaries."

Some of us begin to wonder about how much Obama's staff will cost.

The story says the salaries go up every year. Obama, however, put a freeze on the salaries of staffers making $100,000 or more.

Some of us still wonder how much Obama's staff will cost.

Author Christopher Beam gives us a brief history of the growth of the White House staff, followed by an expert's estimate of the total cost of the staffing connected to the White House--obviously a number we cannot fairly compare with the amount Bush requested for office salaries.

Is that a hole in the story or what? If Beam can't tell us how Obama's staff compares with Bush's then he should explain why not. Otherwise, folks might think Beam is carrying water for the guy.

Unless he just didn't want to embarrass Bush with Obama's lower costs?

Sunday, July 12, 2009

SPT attaches editorial to gimpy Laughlin wagon

The St. Petersburg Times published an editorial this week echoing the (non-objective) story it published last Sunday on the Guantanamo detention facilities.

I touched on some of the problems with that story with my previous post.

The editorial causes me to question again the credulity of the Times' editorial staff.
The American prison camp at Guantanamo Bay, Cuba, has always been built on a great lie: that it would only house the "worst of the worst."
I was surprised at the difficulty I found in tracking that "worst of the worst" quotation to its original source. It is commonly attributed to former secretary of defense Donald Rumsfeld. There's a future project for me, but I strongly suspect that the editorial has led with a lie of its own.
But rather than be honest about the tragic missteps of the past and confront the lingering issues over detainee treatment, the Pentagon puts on a preposterous dog-and-pony show when reporters come calling.
As for the supposed "tragic missteps of the past," the reports of detainee mistreatment cited in Laughlin's report, even if we generously supposed their accuracy, occurred well before the date of the 2008 report she used as her source. The Pentagon itself is as able to deal with press inquiries about the past as is the present staff at Guantanamo--perhaps better. How many beatings would Laughlin and the Times' editors give that dead horse?

The editors at the Times have the luxury of debriefing their reporter in-depth. Readers at home lacking that luxury would have detected many signs of anti-Pentagon bias in Laughlin's piece. We expect that the Pentagon will not grant full access to the press, but hope that the press is granted access sufficient to speak to the general conditions at the facility. The resulting story left readers in a poor position to render good judgment after accounting for the reporter's bias. It matters not whether Laughlin acquired her bias before or after doing her investigation, since the reader can't know which is the case.
The demonstration undermines the Pentagon's credibility and makes President Barack Obama's job harder as he wrestles with an intransigent Congress to shutter Guantanamo once and for all.
Again, maybe the demonstration undermines the Pentagon's credibility and maybe it doesn't. All we know for sure is that Laughlin's story tries to undermine the Pentagon's credibility and the editors at the Times back her judgment.
St. Petersburg Times staff writer Meg Laughlin and photographer Chris Zuppa spent two days at Guantanamo recently. Defense Department personnel led them through hours of tightly controlled interviews. Laughlin was not allowed to interview a single detainee, despite having obtained permission from at least six attorneys to meet with their detainee clients.
I can imagine how disappointing that must have been for the Times and for Laughlin, but it is hardly scandalous. The attorneys could give Laughlin permission to carry a gun in to a client, but that doesn't mean the facility is obligated to let her deliver the gun to the client. Is this not a case of press coercion? Give the Times the access it desires or suffer the consequences?
She would only hear the Pentagon's side of the story. And what a whopper of a story it was — short on facts, corroboration and the truth.
The Times resembles that remark.


My criticism of Laughlin's story focused on its claims of detainee abuse. The Times editorial repeated some of those in its third paragraph:
Pentagon personnel wouldn't discuss the torturing of prisoners with sleep deprivation, wall slamming and exposure to extreme heat and cold, all documented in a 2008 Justice Department report, except to say that these techniques weren't defined as torture at the time.
The story indicated, at least, that it was intimated those techniques are no longer employed at Guantanamo. So what type of discussion should we have expected?

As for the use of the term "torture"--if it is meant to refer to a breach of the law, isn't it libelous to use the term prior to a judicial confirmation of guilt? In the original context of the story, that seems to have been the point of the military's representative. But the Times twisted it into some type of dodge.

As for the claims of abuse, the IG report cited in Laughlin's story made a very weak case for sleep deprivation having been used as torture. It did not mention wall slamming as a technique used at Gitmo (according to my observations, anyway), and the "extreme heat and cold" probably fell within the range of 55-100 degrees fahrenheit, since 95 degrees was the high estimate from the report and the "extreme cold" was produced by leaving the air conditioning running constantly.
There are limits to how cold the room temperature can be made. When operating in a suitably sized room, most air conditioners will cool to around 21c. Mobile air conditioners are designed for peoples comfort. The ideal summer temperature for most people is around 21- 24c.
Twenty-one degrees Celsius converts to about 70 degrees Fahrenheit. Brrrr!

Sure, we can call anything torture. Including being subjected to the editorial content of the Times. Using the term carries a subjective judgment minus a legal determination.

Sunday, July 05, 2009

Behind Meg Laughlin's account of Guantanamo

The Sunday version of the St. Petersburg Times featured a front page story by Meg Laughlin, titled "Behind Guantanomo's walls, there are more walls."

Laughlin's story deals with the barriers which persist in limiting journalistic access to goings-on at the detention facilities at Guantanamo Bay.

The story drew my attention because a story like that in a liberal paper like the Times means I'll have a good chance to evaluate some bad reporting.

Expectation fulfilled.

Sure, there was the unsurprising-though-unexpected snideness from the reporter, transmitted through the frequent use of one word/short phrase quoted snippets from officials at the facility. Allowing the facade of journalistic objectivity to routinely slip has turned passe, however. Laughlin made her award-winning flub by attributing a string of facts to an unnamed report from the Department of Justice:

Camp X-Ray is infamous for the prisoners' exposure to the elements and the interrogations that took place there. According to a 2008 Department of Justice report, interrogation techniques used on detainees — many of whom have since been released — included the following:

Hands and feet shackled together so closely they couldn't stand, sit or lie down comfortably for days; exposure to extreme heat and cold; being forced to wear leashes and perform dog tricks with women's underwear on their heads; sleep deprivation for days with rock music, strobe lights, gurgling noise machines and ice-water dousing; bending thumbs back, wrapping heads in duct tape, slamming prisoners into walls and punching them to the ground.

The techniques listed in the second paragraph were used on many prisoners who have since been released? That is what the first paragraph implies, and it also implies that the techniques were used routinely. We will see that the impression conveyed by Laughlin is misleading.

I'm over 90 percent sure that Laughlin's supposed source for the interrogation techniques was an inspector general's report for the Department of Justice from May 2008, called "A Review of the FBI's Involvement in and Observations of Detainee Interrogations in Guantanamo Bay, Afghanistan, and Iraq."

Equipped with the source, we can evaluate Laughlin's claims about the treatment meted out to detainees at Guantanamo Bay.

"Hands and feet shackled together so closely they couldn't stand, sit or lie down comfortably for days"

From page 157 of the report:

The agents who were interviewed reported a variety of observations regarding detainee mistreatment, including:

  • A detainee was shackled in a stress position

The "they" is not justified on the basis of the above evidence, at least in terms of its suggestion of plurality.

The report includes a subsection devoted to "Prolonged Shackling and Stress Positions," starting on page 179. A portion of that subsection relates eyewitness accounts where an FBI agent was told by MPs that a detainee(s?) was "short-shackled" since the previous day. Did Laughlin extrapolate those accounts into the "days" mentioned in her story?

"(E)xposure to extreme heat and cold"

A relevant segment in the report, titled "Extreme Temperatures," begins on page 184:
Approximately 29 agents provided information to the OIG regarding the use of extreme temperatures on detainees at GTMO. Some agents simply observed that most interview rooms were cold. In a few cases, however, it appears that detainees were intentionally subjected to extreme temperatures by unknown interrogators in an apparent effort to break the detainee's resolve to resist cooperating.
The report goes on to say that the "most common version of this technique" consisted of using an air conditioner to cause the prisoner "moderate discomfort"--quoting an earlier document known as the Church Report.

The section on stress positions mentions some specific cases in which a detainee was kept in a room in which an FBI agent estimated the temperature at 90-95 degrees. Another account revealed how a short-shackled prisoner was kept in a room with the air conditioner on all night. The FBI agent found a "shivering" detainee the next day, but the report does not include any estimate of the temperature.

I suspect that the ordinary reader of the Times thinks of something in excess of 100 degrees Fahrenheit when hearing of detainees being subjected to "extreme heat." "Extreme cold" is probably below 55 degrees or so in most minds, I would think.

"(B)eing forced to wear leashes and perform dog tricks with women's underwear on their heads"

We should expect to find at least some evidence supporting this claim from a section titled "Placing Women's Clothing on a Detainee."

The incident listed there:
(D)uring their fourth interview Al-Shihri told them that "the mean ladies" came and got him from his cell in the middle of the night and interrogated him for hours. Al-Shihri said that during this interrogation he was also forced to listen to a recorded loop of the "meow mix" jingle for hours, was sprayed with perfume, and had a woman's dress draped on him.
That doesn't sound like a match.

Nor does the rest of the section help Laughlin out much, summed up with the following:
Other FBI employees told us they heard rumors of the use of women's clothing on detainees. And FBI Investigative Report Specialist said that while at GTMO he heard rumors that a detainee was forced to wear women's clothing and makeup during an interrogation and that this same detainee was also given a "lap dance" by a female guard.
No leash? No dog tricks?

The leash and dog tricks apparently came solely from the case of Muhammed Al-Qahtani, one of the earlier Gitmo detainees and a 9-11 co-conspirator (p. x, xi):
Between late November 2002 and mid-January 2003, the military used numerous aggressive techniques on Al-Qahtani, including attaching a leash to him and making him perform dog tricks, placing him in stress positions, forcing him to be nude in front of a female, accusing him of homosexuality, placing women's underwear over his head and over his clothing, and instructing him to pray to an idol shrine.
I do not get the impression from the IG report that all of the techniques listed were applied simultaneously. But I don't see how one gets the underwear on Al-Qahtani's head while he's doing dog tricks without making an assumption along those lines.

"(S)leep deprivation for days with rock music, strobe lights, gurgling noise machines and ice-water dousing"

If the reader received the impression that sleep deprivation took place "for days" and in conjunction with all the additional factors she lists (suggested by the use of "and"), that's too bad, since the report does not suggest it except in a footnote mention specific to the interrogation of Al-Qahtani:

Is this sleep deprivation for "days"?

A detainee named Mohamedou Ould Slahi gave an unconfirmed claim of sleep deprivation (page 124):

Slahi made allegations to military interrogators that he had been mistreated during the summer of 2003. He made similar allegations in interviews with the OIG. He alleged that:

  • He was left alone in a cold room known as "the freezer," where guards would prevent him from sleeping by putting ice or cold water on him or making noise;
  • He was subjected to sleep deprivation for a period of 70 days by means of prolonged interrogations, strobe lights, threatening music, forced intake of water, and forced standing.
Laughlin's claim of sleep deprivation for "days" could not have come from the uncorroborated claim of a detainee, could it?

From page 183 of the report, dealing with the collected observations of FBI employees:

An FBI agent ... stated that under the program detainees were moved every 4 hours, but that that (sic) the program could only be continued for about a week or two.

That immediate section contained no reference to any sleep disruption apart from that occurring as a consequence of the times reassigning of quarters.

Again from the report (page 184):

(O)ne Uighur detainee, Bahtiyar Mahnut (#277) claimed that the night before his interrogation by Chinese officials he was awakened at 15-minute intervals the entire night and into the next day.
Sleep deprivation for "days"?

A section in the report titled "Use of Bright Flashing Lights or Loud Music" mentions nothing about the use of those techniques in conjunction with sleep deprivation. They are mostly reported as occurring during interrogation sessions, though a footnote adds that during the Camp X-ray period music was played through a PA system audible throughout the camp--but again without any mention of its use to disrupt sleep.

Despite the absence of an account suggesting sleep deprivation via music and flashing lights in the body of the report, other than in the case of Al-Qahtani,the conclusion of the report suggests otherwise (p. 209-210):

Other FBI agents described observing military interrogators using bright lights, loud music, and extreme temperatures to keep detainees awake or otherwise wear down their resistance.

I suppose the discrepancy may be explained if detainees might have taken naps while left alone in the interrogation rooms. The detainees would thus be kept awake without being subjected to sleep deprivation.

With all due respect to Foy's opinion from the footnote, it seems ludicrous to automatically define a technique as sleep deprivation if it simply keeps a person awake instead of rousing him after he nods off. Context ought to matter, and the report offers insufficient evidence to properly judge Foy's consideration of context.

Though it might be satisfying to see one of my old high school teachers charged with a crime for keeping me awake with their lectures.

"Bending thumbs back"

The bending of thumbs, plural, did apparently occur. But the plural applies primarily because the one detainee involved had two thumbs, both of which may have been bent back.

The following account occurs on page 175:

After the military interrogators were finished with this detainee, Brett asked the Marine guard what the female interrogator had done to the detainee. The guard told Brett she was bending his thumbs back and grabbing his genitals.
Is it possible that the same interrogator performed the same technique on a different prisoner? Sure, that's possible. But only one incident occurs in the report, and the evidence may be criticized as hearsay. Footnote 123 (page 176) includes a similar observation that may be the same incident but without the bending back of thumbs.

"(W)rapping heads in duct tape"

From the report (page 191):
Five OIG respondents stated that they observed or heard about the use of duct tape on a detainee. We believe that most or all of these agents were referring to the same incident.
Times readers may be forgiven if they assumed, based on Laughlin's account, that "wrapping heads in duct tape" occurred either routinely or more than once.

So were these heads gift-wrapped in duct tape? Kind of like the Sand People from the "Star Wars" saga?

Apparently not:
Lyle said that two bands of tape went entirely around the detainee's head, one that covered his eyes and one that covered his mouth. Lyle said that the detainee had a full head of hair and a beard.
The incident is described in more detail on page 192. On the other hand, a summary of allegations on page 158 says:
  • A detainee's entire head was duct-taped to stop him from chanting the Koran.
The phrase "wrapping heads," does not come from the report, though the summary does mention the lone example above by describing it (p. 210) as "wrapping a detainee's head in duct tape."

Laughlin's version sustains the misleading impression contained in the report itself and expands it to the point of making the incident look more commonplace.

"(S)lamming prisoners into walls and punching them to the ground"

The AG report mentions one instance of slamming a prisoner into a wall (p. 1, quoting a separate Army report):

(A)llowing a military police guard to stitch the wound of a detainee who was injured after being slammed against the wall in his cell ...

Two problems: First, there is no mention of who did the slamming. Second, it happened in Iraq instead of at Guantanamo. Laughlin strongly implies that the techniques from her list were done at Guantanamo.

The report also references something akin to "punching"--again from Iraq (p. 3):

The forms of abuse included punching and kicking detainees ...
Guantanamo detainees made a number of allegations of beatings, but apparently without any corroboration (pp. 178, 179).

It remains a mystery to me what Laughlin had in mind when she added this item to her list.


Laughlin makes two characteristic errors in her descriptions of alleged detainee treatment. First, she conflates disparate events together, implying that the simultaneous application of techniques that probably occurred separately if they occurred at all. Second, she reports isolated events as though they were not isolated events.

Laughlin's story on the whole fails to sustain the impression of objective reporting, and while her persistence in pressing her hosts for a little bit more information in every instance is laudable in some respects, I find it easy to empathize with GTMO officials when they stymied her attempts.

Laughlin was at her best in trying to get accurate information about current treatment of detainees, and at her worst in trying to get the present GTMO staff to comment on past allegations of abuse. The latter had nothing to do with the reason she was permitted at GTMO, and it served only to diffuse the focus of the objective story. Unless we give credit for using the abuse allegations as a vehicle for editorializing.

The Times ought to run a correction notice with respect to the claims about the contents of the IG report. Laughlin's account is fundamentally misleading, for it conveys an impression far different than one gets from a careful reading of the report.

Note: The time stamp on this post is misleading. I started the post last Sunday and kept working on it until I finally published it Saturday morning.

Entering "The Twilight Zone" with Robyn Blumner

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There is a fifth dimension beyond that which is known to man. It is a dimension as vast as space and as timeless as infinity. It is the middle ground between light and shadow, between science and superstition, and it lies between the pit of man's fears and the summit of his knowledge. This is the dimension of imagination. It is an area which we call "The Twilight Zone."
I'm totally there, dude.

I checked the online St. Petersburg Times for the latest idiocy penned by editorial columnist Robyn Blumner, but lo and behold her column almost makes sense.
When race is involved no case is minor, but Ricci vs. DeStefano gained blockbuster status after the Supreme Court nomination of Judge Sonia Sotomayor. She was part of an appellate panel that threw out the claims of the 18 white firefighters, one of whom is Hispanic, who lost out on a promotion due to the city's actions.

I believe that she and her fellow appellate judges were wrong as a matter of law and basic fairness.

That calls for a Borat-style "Whaaaaat?" Shocked incredulity stretching the vowel sound for emphasis.

Judge Sotomayor is the top choice of President Obama for the Supreme Court. Remember? And Obama is the guy who isn't George W. Bush. Is Ms. Blumner prepared to transfer her disaffection for Bush to his successor in office or what?

Not only does Blumner part with Sotomayor, she also acknowledges that the conservative justices she loves to not love drove the majority opinion with which she agreed.
In the majority opinion by Justice Anthony Kennedy and joined by the court's conservatives, the court said that test results cannot be discarded for the purposes of racial balance unless there is a strong showing that the test is deficient or there were other equally valid but less discriminatory tests readily available.

Expecting Rod Serling any moment, now.

The analysis of the column is spot on throughout. So why do I say it almost makes sense?

Blumner wants Democrats in control of the federal government. She wants a Democrat in the White House. She tends to disparage conservatives on the Supreme Court. If she had her way, the Ricci case would have gone the other way courtesy of a collection of more liberal justices, albeit not to the point of ruling as Judge Sotomayor did. The dissent from the Supreme Court liberals would have remanded the case back to the lower court instead of reversing the decision.

Hey, well, credit where it's due. This week's column is good, and it tends to make a shambles of Blumner's overall approach to politics and law.

July 12, 2009: Changed "lastest" idiocy to "latest"--even though I half liked the typo.

TANSTAAFL and single payer health care

In economics, it is said that there ain't no such thing as a free lunch.

That is the phrase behind the acronym "TANSTAAFL."

Various observers have noted that contemporary advocates of single-payer health care appear to throw TANSTAAFL out the window. They appear to believe that something may be had for nothing.

I was reminded of this while doing some research on single-payer health care. I was actually just trying to compile a list of nations who use a single-payer universal system, but I kept running into these crazy pages advocating the single-payer system. I eventually locked in on a page that peddled the single-payer system as an economic stimulus, and offered a study to back it up.

How intriguing, I thought.

The study was produced by the Institute for Health and Socio-Economic Policy, a "research arm" of the California Nurses Association. The CNA spins the study like this:
Medicare for All (Single Payer) Reform Would Be Major Stimulus for Economy with 2.6 Million New Jobs, $317 Billion in Business Revenue, $100 Billion in Wages. The number of jobs created by a single payer system, expanding and upgrading Medicare to cover everyone, parallels almost exactly the total job loss in 2008, according to the findings of a groundbreaking study released today.
Isn't that awesome? Single-payer health care features all kinds of benefits!

Could there be a catch?

The study certainly does put the very best face on single-payer health care by emphasizing the economic benefits. Despite that emphasis, the catch is difficult to hide. It comes through clearly in the conclusion of the study:
This study demonstrates that a comprehensive Medicare based Single Payer system can make significant contributions to access of quality care for all U.S. residents and in the process generate a much needed and very substantial economic stimulus in the form of jobs, enhanced business and public revenues and increased wages for the public at large.

All this comes at a relatively modest increase in net costs of $63 billion.
Not to insult anyone's intelligence, but the study just explained to you that the benefits will cost us $63 billion. So this "economic stimulus" is perfectly Keynesian. And, of course, the problem with Keynesian stimulus is that the bill comes due eventually. That $63 billion in red ink--who pays for that year after year?


Either somebody pays the tab--resulting in a subtraction of a portion of the economic pie ($63 billion net)--or else the government eventually has to start denying services in order to meet its financial obligations.

Ironically, these numbers the CNA trumpets as economic stimulus come largely from an increase in the demand for health care services created by the expansion in coverage. That is the curse of third-party payment. This study spins one of the big drawbacks of the single-player version of universal health care into a positive!

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These ladies love the idea of single-payer health care because it takes from other parts of the economy to bolster their segment of the economy. At least until the government institutes wage caps and/or rationing of services. But maybe nobody explained that part to them.

President Obama's recent public statements on health care seem to perform the same type of illusionist's tricks with the economics involved. Obama tells us that we can't afford to do nothing, since the price of insurances is going up so fast. That is why we need to reform things. But even in a system pulled as far from free market principles as ours, the rising cost of health insurance would do exactly what Obama is preaching.

Obama, after all, is saying that we need to spend less on health care. That, coincidentally, is exactly what high prices do. They decease demand for services. Would you use a cell phone if it cost you $5,000 per month? Probably not.

So the increase in prices would automatically tend to decrease health care expenditures.

On the downside, people will get less health care. But how is that different from the plan Obama supports? Just try to divine the source of the savings in his plan.

Digitalizing medical records? That will cost money up front, and it isn't clear it will save much in the long run.

Preventive care? In certain cases preventive care saves money, but many preventive measures are not cost effective at all. And in any event preventive care tends to simply delay an eventual big expense later on. The cardiac arrest you avoid tomorrow may turn into the inoperable cancer you get 10 years hence. The health care system saves money if you die of the sudden cardiac arrest, bottom line.

Let's look at one savings that Obama has emphasized particularly:
The biggest thing we can do to hold down costs is to change the incentives of the health care system that automatically equates expensive care with good care. Now, this is an important concept, so I want everybody to really focus on this. We are -- we've been under the illusion that the more health care we get, the healthier we become. And it turns out that every study shows that the question is, are you getting the right care, are you getting the best care, the high-quality care, rather than are you having a whole bunch of tests ordered that are unnecessary, getting a bunch of treatments that are unnecessary, staying in hospitals longer than may be necessary -- all of which drives up your costs, but doesn't make you better.
One question: How?

You can cut down on diagnostic tests if doctors somehow reduce their liability, but I have yet to detect a thread of tort reform in the Obama prescription for health care.

I don't see how, minus tort reform, the health care system will reduce so called expensive care without the government telling doctors how to do their jobs. Do you? Single-payer advocates help me out. How is that supposed to work?

Wednesday, July 01, 2009

Grading PolitiFact: Paul Krugman and a mere $1.8 trillion

In which Paul Krugman benefits from PolitiFact's penchant for tunnel vision.

Fact-checking the fact checkers

The issue:

The fact checkers:

Angie Drobnic Holan: writer, researcher
Bill Adair: editor


Time and time again, PolitiFact waffles between addressing the literal truth of a statement and the underlying argument that the statement would supposedly help support. This fact check involving the capable economist/left-wing hack op-ed writer for the New York Times, Paul Krugman, again manifests the problem of finding nothing wrong with the literal truth of a statement while effectively ignoring the underlying argument. That, in fact, was the same pattern Drobnic used in another PolitiFact item I evaluated.

In this case, PolitiFact concerns itself over whether the Bush tax cuts cost the federal government $1.8 billion in revenue. Krugman compares that figure with the proposed cost of a universal health plan, in particular the Kennedy plan recently evaluated by the Congressional Budget Office.

As with that other item, Drobnic offers a number of clues that she perceives an underlying argument. The "Truth-O-Meter" blurb reproduced above notes that Krugman is comparing the cost of the health care reform bill to the "cost" to the government of the Bush tax cuts. I use quotation marks for the second use of "cost" simply because the tax cuts represented decreased income while the former represents an outlay.

But the comparison all by itself means nothing. Who cares whether one is less expensive than the other minus other considerations? Krugman is clear about those other considerations, but Drobnic never picks up on it for purposes of her analysis even though she quotes the relevant passage:
"I'm not that worried about the issue of costs," Krugman wrote. "Yes, the Congressional Budget Office's preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."
(bold emphasis added)
There was a time--not that long ago--that Paul Krugman was concerned about that type of cost. Back when the federal deficit was much smaller than it is now:

"[The 2003 tax cut] was wildly irresponsible, third-world irresponsible, banana-republic irresponsible," said Krugman. "We can't afford any of it."

The tax cut came despite indication that the United States would be facing a "catastrophic" deficit, about $550 billion next year.

(The Daily of the University of Washington)

For comparison, the federal budget deficit will reach an estimated $1.1 trillion for 2009. Deficits under President Bush never exceeded $500 billion despite Krugman's claims, though it is fair to pin a substantial portion of the 2009 deficit to the TARP program that both Bush and Obama supported.

So, even though Krugman regarded the $500 billion deficit as "catastrophic" back in 2003 and flatly stated that the U.S. "can't afford" the second round of Bush tax cuts, somehow we can afford to spend about that much if the budget deficit doubles from its "catastropic" levels to an even higher percentage of the GDP.

Will Drobnic take note of any of this? No such luck:
We wanted to know if Krugman was right that the initial cost estimates for health care legislation by the Congressional Budget Office were less than "the $1.8 trillion cost of the Bush tax cuts."
So Drobnic seems willing to let the underlying argument escape scrutiny in favor of double-checking the comparison of the initial CBO estimate to the estimated loss of revenue from the Bush tax cuts.

In the course of that meaningless exercise, Drobic at least pays attention to the respective durations of the tax cuts and the health care reform bill. However, she appears to overlook at least one critical point in comparing the two: The CBO estimate offers no apparent attempt to calculate the cost of financing health care reform through deficit spending. As Drobnic notes, the think-tank estimate that best supports Krugman explicitly applied that factor to the Bush tax cuts:

The left-leaning Center on Budget and Policy Priorities agrees with Krugman. The center's 2009 report on the Bush tax cuts states:

"The 2001 and 2003 tax cuts added about $1.7 trillion to deficits between 2001 and 2008. Because they (were) financed by borrowing — which increases the national debt — this figure includes the extra interest costs resulting from that additional debt. This figure also includes the cost of 'patching' the Alternative Minimum Tax to keep the tax from hitting millions of upper-middle-class households, a problem the tax cuts helped cause. Over the next decade (2009-2018), making the tax cuts permanent would cost $4.4 trillion, assuming that the tax cuts remain deficit-financed."

So even the wrong analysis was performed badly.

In addition, the initial CBO report explicitly stated that it had not taken into account several factors likely to increase the costs of the bill. As a result, it should have been obvious that in the end it did not really matter to Krugman what the reform bill would cost. If the CBO had estimated the costs at $2.2 trillion instead of $1 trillion we should expect Krugman to say that the costs don't really bother him since we can supposedly clearly afford it. Even though that runs directly counter to what he was claiming in 2003.

Mr. Krugman can take comfort in the knowledge that PolitiFact has not found him out as the inconsistent political hack that he is. PolitiFact rates Krugman "Mostly True" since it is "probably" true that the CBO's initial cost estimate for the Kennedy health care reform bill was less than the estimated revenue cost of the Bush tax cuts.
After reading many studies on the cost of the Bush tax cuts, it seems to us that Krugman is in the ballpark with his $1.8 trillion estimate. But we believe there are a couple of important caveats to his comparison. First, his wording implies that CBO's much-discussed estimate is for universal coverage, but it's not. Also, he doesn't offer a time frame for the Bush tax cuts, so we can't be sure he is comparing the same number of years. Finally, the health care plan is still very much in flux, and the CBO estimate is based on an early and incomplete bill. So we find Krugman's claim Mostly True.
Can we afford it like Krugman said? Or can we not afford it like Krugman said?

The grades:

Angie Drobnic Holan: F
Bill Adair: F

Ignoring the interesting part of Krugman's statement was the equivalent of intentionally offering softball questions to an interview subject.


Drobnic's piece had a hilarious little interlude where Kenneth Thorpe declared the relatively easy affordability of a universal health plan:

There's one other implicit assumption in Krugman's statement. He writes, "But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts." We know the CBO report scored the first draft at $1 trillion, but we also know that CBO determined the draft was not a "universal" plan — only about a third of the uninsured would be covered. But would a truly "universal" bill still come in under $1.8 trillion?

"Absolutely," said Kenneth Thorpe, a health care expert at Emory University. He said draft version of the bill could be modified to expand coverage to everyone and trim costs, and he thinks the total cost of that would likely be just over $1 trillion. He said the Senate Finance Committee is working on a new plan, though it has not been released to the public.

"I think that you can provide universal health care coverage for all 46 million of the uninsured for just over $1 trillion," he said.

I cannot disagree with Thorpe. All 46 million could be insured for just over $1 trillion. Would they get great care? Probably not. Would the result tend to decrease quality of care for the system overall and progressively degrade the system? Very probably. Can we afford it? Pay attention to Paul Krugman, circa 2003.

The common thread in the push for health care reform is the issue of controlling costs. Third party payment is a dependable disaster in terms of controlling costs. That remains about as true for private insurance as for government insurance. Private insurers use a number of methods to control their risk, including the refusal to cover preexisting conditions. Unless the government does the same thing, it will have two primary methods of controlling costs:

1) Capping/dropping the pay of health care workers
2) Rationing services

Be careful what you wish for, single-payer advocates.

Oshkosh garners the big M-ATV contract

Oshkosh Truck, collaborating with Plasan, won the coveted Defense Department M-ATV competition.

The Pentagon on Monday announced the award of a contract for 2,244 M-ATV vehicles, with the contract valued at about $1.1 billion.

Oshkosh fared poorly in earlier in the earlier MRAP competitions, starting with the "Alpha" vehicle produced in cooperation with Protected Vehicles, Inc. That vehicle fared poorly during testing and an initial order for 100 of those vehicles was eventually canceled.

In this competition the company seems to have produced a quality product, and certainly delivered an effective public relations campaign at the same time.

Oshkosh wasted no time in issuing a press release:
“We are proud that Oshkosh was chosen to provide its M-ATV offer to the the U.S. Armed Forces. Our M-ATV design combines the crew protection warfighters have come to expect in MRAP vehicles with the extreme mobility and durability needed to negotiate Afghanistan’s mountainous off-road terrain,” said Robert G. Bohn, Oshkosh Corporation chairman and chief executive officer.
I've posted a number of pics of the M-ATV version of the Sandcat, but here's one more: