Ezra demonstrates why a double cheeseburger is $.99 and more expensive than a salad. It’s the warping affect of billions in farm subsides. Some of the best action is in the comments:

If you manage the mortality-and-morbidity right, then Social Security won’t need its cap lifted, but Medicare, like a sinkhole, will slowly disappear the rest of the Federal budget.

That 99 cent double cheeseburger isn’t a sandwich, it’s a policy initiative.

It might make us fat and unhealthy, but it might thin the herd and help with Social Security costs.

Senate Again Passes Child Health Bill – New York Times
In a situation of unusual political complexity, Republicans dictated the decision to pass the legislation speedily. It appeared their goal was to short-circuit attempts by supporters of the bill to reach a compromise that could attract enough votes in the House to override Bush’s veto.

About damned time the dems took on the characteristics of other vertebrates.

An intelligent bipartisan compromise is reached concerning providing children with health care. Naturally Bush’s reaction will be to veto, after all he is a uniter not a divider. Can’t have kids getting guvermint health care cuz they might all turn commie. or something.

Jon Stewart does much better skewering Bush on this.

Fills in some more details I find interesting, like using the government’s bargaining power to negotiate drug prices. How’s that for market based reform? Isn’t bargaining for price a central market behavior? The plan shelters small businesses from the cost of coverage for their employees:

Unlike Edwards and Obama, she does not ask of small employers what she’s asking of large employers: that they contribute to health insurance costs either by providing employees with coverage or paying a tax to help defray the cost of all those subsidies. Instead, she offers them a tax credit.

This turns a potential revenue source into an expenditure–which might not seem like such a hot idea at first blush. But campaign advisors put forward a plausible policy rationale. It goes like this: Many small employers really would struggle to bear the costs of such a mandate, even if they were adjusted to reflect firm size or income. But while a lot of individual small businesses would struggle with this, cumulatively the mandate wouldn’t generate that much money–so it’s a lot of pain for not a lot of gain. With a tax credit, which likewise wouldn’t cost much in the aggregate, those small employers who already offer coverage would have an easier time maintaining it–in keeping, again, with the idea of preserving coverage for those people who already have it.

I think this shows she has learned many of the political lessons of 1994 when small businesses strongly opposed Hillarycare 1.0. Maybe version 2.0 will fare better.

The ever reliable Ezra wonks on the Clinton proposal. Here’s my bullet point synopsis:

• Allows you to keep your current plan
• Mandated coverage
• Opens the Federal Employee Health Benefits Program to everybody (the same health plan covering members of Congress)
• Creates a new public coverage option similar to Medicare
• Eliminates price discrimination by preexisting conditions and demographic characteristics
• Requires insurers to cover anyone
• Requires coverage portability
• Provides a refundable tax credit limiting the cost of insurance to a certain percentage of family income
• The employer tax deduction will now be limited to standard plans for middle-income, gold-plated “executive” plans can be taxed
• Creates a Best Practices Institute that will vastly accelerate the amount of research done and distributed on the cost-effectiveness of treatments
• Leaves SCHIP and Medicaid intact (why?)
• Leaves out global budgets and growth caps

On balance not a bad package. She leaves out some of the more divisive bits of the 1993 “Hillarycare” plan, like centralized budgets and caps. Things like that piss off her new BFFs in the insurance industry. It does offer some sorely needed insurance market reforms. It’s unclear to me how it will address the single most obvious defect of the current system; the friggin cost. We get the least bang for the buck in world and mediocre health outcomes.

Ezra has an update.

Number of Uninsured Americans Hits Record High – washingtonpost.com
The number of Americans without health insurance rose to a record high 47 million in 2006, largely because of continuing declines in employer-sponsored insurance coverage, the Census Bureau said today.

In all, 15.8 percent of Americans lacked coverage last year, up from 15.3 percent in 2005, according to new figures from the Current Population Survey. That tied 1998 as the year with the highest percentage of uninsured people over the last two decades.

Maybe that has something to do with why the US has slipped to number 42 in life expectancy. Com’on everybody WE’RE 42, WE’RE 42, WE’RE 42, WE’RE 42!!

Children fared even worse. Last year 11.7 percent of youngsters under 18 years lacked health insurance, up from 10.9 percent in 2005. The percentage of uninsured children has increased two years in a row after declining for at least five years, according to the Census data.

Hopefully this will add to support for Congressional democrats in expanding SCHIP.

In Health Care, Cost Isn’t Proof of High Quality – New York Times
the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.

“For most consumers, the fact that there is no connection between quality and cost is one of the dirty secrets of medicine,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a California group of employers that provide health care coverage for workers.

I wonder what implication this might have for advocates of market-based solutions to the problems in US health care delivery? It has long been known that health care is a prime example of market failure in economics and disparities in information between buyers and sellers of health services. I think it’s safe to assume that market advocates will seize on this as an example of why their approach is best. I think we’ll continue to see the same type of market failure until all consumers are as qualified as their doctors to determine the best course of treatment and venue for care. In other words, never.

Particularly when you see stuff like this from further along in the article:

Pennsylvania is the first state to make such information, normally closely guarded by the hospitals and the insurers, available to everyone — including patients who may never see their hospital bills or be aware of how their hospitals compare with others in the state.

You can’t have competition until there’s some rational basis for determining if a given provider is delivering value for the dollar.

A lot of time I agree with Sully, but he gets this way wrong. Perhaps it’s my past public health education creeping out here.

I had thought that the main problem with abstinence-only sex-ed was that the victims of that misguided policy were no less likely to engage in sexual activity, but also more likely to get (or get someone else) pregnant. The problem with this take on sex ed, that it’s better to emphasize abstinence than pass out Trojans is fine from high level moral perspective. But the reality of it is that it effectively means that some students will die who would not have under a more balanced approach.

Wouldn’t it be better to say, “You should not have sex until marriage, but if you do please wear a condom to help protect from STDs and pregnancy. Condoms are not perfect, but at least offer some protection.” And of course this would be in a voluntary opt-out segment of normal classroom time. Parents who prefer to teach children that Jesus will punish them by causing their nasty bits to rot for failing to abide God’s law are free continue to allow their sons and daughters to die because it’s so obviously God’s will. Gotta have freedom for that old timey religion.

To simply ignore the whole issue or continue the abstinence only approach seems grossly irresponsible, morally reprehensible and blind to the reality of the the world around us. It’s of a piece with those who believe that preventing the spread of HPV and death from cancer is tantamount to encouraging promiscuity.

We can spend billions on tax cuts and wars of choice, but we let millions of children in the wealthiest nation the world has ever known go without basic medical care.

I agree that cost containment seems to have been left out of the formula. That seems quit strange since that’s the big issue in the world of health policy. Coverage, of course is one of the other issues. This seems to be oddly one-sided. More about this later…

Update: More on cost containment here. Ezra says that the imposition of community rating will change the market for health insurance in fundamental ways by shifting the insurers away from competing for healthy people and pricing the sick out of the market and towards actually competing on cost and efficiency. What a concept efficiency on health markets! Who would thought it possible?

It’s interesting to watch Bolten try to put lipstick on this pig. There’s a nonsensical ring to the president’s policies on this issue and “Timmah” does a pretty good job of actually asking questions that expose the inherent contradictions.

The whole thing makes me wonder why the dichotomy between public and private research? Is it morally superior if private money, rather than public money finances the destruction of embryos the presidents spokesman says are human lives? I begin to suspect that this isn’t about the 128 snowflake babies that were adopted out of 400,000 slated for destruction. They were merely stage props there for there “awwww ain’t that cute” value. It was simple misdirection.

Nothing in the bill vetoed last week would prevent the adoption of embryos by others. Maybe this has to do with him wanting big pharma to reap the benefit and profit of stem cell cures. If government research advances knowledge, we all benefit. If private industry does it, just their stock holders benefit, at least until years later when patents expire. It fits nicely with Bush’s proven track record as a empty-suit shill for wealthy interests. Sadly, once again “Christian values” are used to cover simple greed.

I wouldn’t hold my breath waiting on the beneficence of big pharma to give these possible cures. I seem to recall seeing some recent reports of pharma companies jacking up prices of treatments for rare cancers, not because of production cost increases, raw material prices or even using profits to subsidize new research, but because of inherent value. This is to say you should pay many times the old price and impoverish yourself doing so because you have no choice. It’s like watching someone finger a vial of lifesaving drugs, smile coldly at you and say, “what’s it worth to you.”

Either those 400,000 embryos are human life and deserve protection, or they are not. If it’s true then private researchers would be guilty of murder. If true, in vitro fertilization clinics should not be allowed to create life that will be destroyed. Why should in vitro be allowed if what the president believes is true? It’s nonsensical.

If you put people in charge of running a project they are ideologically committed to proving a failure, it will fail.

That neatly explains a host of failures by the Bush administration, Katrina, Iraq, corruption, Social Security, Medicare Part D, fiscal insanity, etc…

After all, prescription drug coverage didn’t have to be bafflingly complex. Drug coverage could simply have been added to traditional Medicare. If the government had done that, everyone currently covered by Medicare would automatically have been enrolled in the drug benefit.

Adding drug coverage as part of ordinary Medicare would also have saved a lot of money, both by eliminating the cost of employing private insurance companies as middlemen and by allowing the government to negotiate lower drug prices. This would have made it possible to offer a better benefit at much less cost to taxpayers.

But while a straightforward addition of drug coverage to Medicare would have been good policy, it would have been bad politics from the point of view of conservatives, who want to privatize traditional social insurance programs, not make them better.

Another example of the sacrifice of good public policy in service to politics in the Bush White House.

I blog because their leadership is thoroughly incompetent, corrupt, untrustworthy, and beholden to corporate and conservative Christian interests that are bad for me as a worker, a consumer, a believer in the separation of church and state, and a woman who values her bodily autonomy—and bad for the LGBT community, the poor, the ill lacking healthcare, undocumented workers, public school children, and lots and lots of other people, not to mention bad for our civil rights, the environment, national security, the economy, our international reputation, etc. etc. etc.

That’s exactly how I feel about the administration and my motivation for blogging. I wasn’t angry about Bush winning in 2000, I was dismayed that he was allowed to steal the election here in Florida. I was astounded that so many Americans would vote for such an obvious empty suit shill for wealthy corporate interests. Then came 9-11, and like many others I rallied our president, such as he was, because we were attacked and bloodied by a small group of radical Islamists.

I was supportive of the war in Afghanistan, but have never understood the determination with which the nation was dragged into Iraq. About that same time, the realization of what Bush was doing with tax policy became clear (see my post on Krugman’s op-ed below). It’s about incompetence and lies, not which party is in charge.

Glenn rants about the shear dishonesty and intellectual laziness displayed by Finkel:

The tactics in the article are as intellectually lazy and empty as they are transparently deceitful and trite. There is no cheaper or emptier form of argumentation than to isolate a specific individual, describe her, and then, without any basis, ascribe those attributes generally to some larger group — in this case, a much, much larger and more diverse group — of which she is ostensibly a part. Anyone who has even minimal exposure to “the blogosphere” knows that it is insusceptible to the sort of sweeping generalization oozing from every misleading paragraph in this article.

The classic straw man attack on left blogs rings hollow to those who know anything about the blogosphere. Finkel was clearly cherry picking his example comments and posts to suit an a priori assumption to a pre-ordained conclusion. I have my moments of anger about the state of affairs in this country, but it’s based on proven incompetence and mendacity from the Bush administration, not from a pathological hatred for Bush. To me he’s an empty suit serving a purpose for others. His job is to be the likable guy that makes falsehoods, idiotic tax policies and disastrous foreign policies seem like the right thing to do. To sort of “catapult the propaganda” as W once put it.

1. We pay far more for health care.
2. We don’t consume more services.
3. We lag in most measures of health.
4. Great chunks of each health care dollar is wasted in administrative overhead because of our bizarre patchwork system.
5. Public sector entities like the VA and Medicare are much more efficient.
6. The current reliance on employment based insurance is unraveling.
7. The current system is grossly unfair.
8. “Market” based reforms will make the situation worse.

TNR ends the editorial with this:

The other reason universal health care may seem an unconventional suggestion is because it is an “old” idea. The first proposals for universal health care surfaced at the end of the Progressive era, nearly a century ago. But “old” is not the same thing as “bad,” and time has only made universal health care more relevant, not less. During the twentieth century, this country saved capitalism not only from its foes abroad but also from its deficiencies at home–chief among them its tendency to visit catastrophe on a few unlucky souls. While the foreign threat to capitalism has subsided, the domestic inadequacies are becoming severe once again, as pensions and job security vanish in the hyper-competitive global economy. The historic solution to this problem was to insulate individuals from excessive risk. And, while the private sector once did this for health care, it’s no longer up to the task. Government isn’t the best way to provide all Americans with health security. It’s the only way. And it’s time for liberalism to say so openly.

With all the tools available to modern medicine — the blood tests and M.R.I.’s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930′s. “No improvement!” was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.

This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.

How can this be happening? And how is it not a source of national outrage?

Yikes! No improvement since the 1930′s?? My intrinsic mistrust of the medical profession seem well founded now. Not that I never follow medical advice. It’s that it has always seemed that most of the treatments seemed to be designed to fill the coffers of the medical and pharmaceutical industries, as well as guarantee future streams of income. Curing a disease seems a tertiary concern at best. Perhaps the application of better statistical models and artificial intelligence will help better guide diagnostics. It just seems that we really ought to be able to do better in this day and age.

Supreme Court said Tuesday it will consider the constitutionality of banning a type of late-term abortion, teeing up a contentious issue for a newly-constituted court already in a state of flux over privacy rights.

I worked in an Maternity/OB unit in a hospital for a few years during college. One of the saddest things to witness were the families having late term abortions. Not once in a little under two years can I remember a woman having a late term abortion for convenience. Every case was because the mother’s life was in danger or the fetus was not viable. It makes absolutely no sense to legislate what procedure the physician may use. The results are they same. They make a judgment on which procedure is the least stressful and best preserves the mother’s ability to have children in the future. Neither congress nor state legislatures are competent to make a blanket assessment of the best medical procedure to use, it’s ridiculous.