Rhinocrisy

Governments throughout history have been tools of oppression; they need not be.

A large part of the reason for my new-found Mike Gravel fanhood is his National Initiative, a piece of legislation/Constitutional amendment he has been promoting for several years. In his own words, the problem with representative democracy:

We’re accustomed to thinking that, when we go to the polls on election day, that we’re exercising our power. Really, what we’re doing is we’re giving our power away, and giving it to politicians who have manipulated the electoral process; and then, once they get in office, they obviously - dictates of human nature require that they will put their interests before the public interest. That’s the way representative government works.

This gives me paroxysms of joy to hear. Yes! finally, someone who actually believes in democracy!

Gravel proposes changes allowing a national initiative process, whereby people can vote directly on federal laws. The details can be read here, if you’re curious. I’m sure there’s room for improvement (for example I’m dubious of the use of public opinion polling as part of the qualification process), but at first pass it seems well-organized and attempts to address some of the major pitfalls of state-level ballot initiatives. Read the section titled “A Strong Deliberative Process” and you will hopefully get a warm, happy feeling in the pit of your stomach.

An interesting twist, as Gravel acknowledges, is that Congress is unlikely to enact legislation which directly undermines its power. To answer that, Gravel proposes that the people vote directly on the issue of creating the initiative (as organized by his non-profit company Philadelphia II, where you can, in fact, start the first part of approving the initiative right now). Would it fly? Who knows? But it’s certainly worth trying, and I think if it did NOT fly, despite approval by a majority of the electorate, it would be quite revealing enough to shake the foundations of this country.

Finally, here’s Gravel himself on the subject. If you don’t already know, you can get your fill of Gravel on YouTube - he posts Q&As with random questions from folks on a regular basis. Golden.

Hillary Clinton, who has a very strong chance of becoming our next President, recently rolled out her new health care proposal. Clinton, as we all know, proposed a widely-unpopular health care reform package back in 1993, when her husband was President. The gist of that package was “all employers must insure their employees via HMO” - along with restrictions on which HMOs were allowed, based on benefits provided. This was poorly-received in all quarters: businesses hated it because it forced them to spend, and didn’t allow them to spend cheaply. HMOs hated it because it privileged some HMOs over others. And everyone else hated it because it didn’t actually solve the problem of managed care in general; it just forced everyone into its arms.

The modern plan is pretty much identical to the one passed by Mitt Romney in Massachusetts: that is, we will reduce the numbers of the 50 million uninsured by requiring individuals to purchase healthcare if they are not covered, or else face penalties. A key difference between Romney’s scheme and Clinton’s is that the latter deals with affordability via tax cuts, whereas the former has a subsidized state-run health program.

No one seems to be advocating single-payer healthcare, which seems like the obvious solution. First, despite wild fears of “socialism” and “bureaucracy”, it’s well-demonstrated that government-run health care is more efficient than private health care, in terms of cost. An article in the New England Journal of Medicine comparing the systems of the United States and Canada says:

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada.

In addition to efficiency, there is the added issue of keeping down costs. These are related, of course; before 1950, many people didn’t even have private insurance, and medical costs could be paid out of pocket. But health care costs, as a percentage of GNP, have been rising steadily since then. Costs in the US are the highest in the industrial world. There’s considerable debate over why this is, and a number of competing explanations have been advanced. A series of reviews in the Annals of Internal Medicine summarizes seven possibilities:

1. High and rising costs are not such a serious problem.
2. High and rising costs are a problem, but they are created by factors external to the health care system.
3. High and rising costs are caused by the absence of a free market; the remedy is to give patients more responsibility for costs of care and to encourage competition among health insurers and providers.
4. High and rising costs result from medical technologies creating innovation in the diagnosis and treatment of illness.
5. High and rising costs are in part the result of excessive costs of administering the health care system.
6. High and rising costs are explained by the absence of strong cost-containment measures.
7. High and rising costs are the result of the market power of health care providers.

The gist (if I can so blithely summarize a summary of such a complex topic) is that rising costs (and the disparity between the US and the rest of the industrial world) are related mostly to the spread of new medical technology; the relatively greater power of health care providers (e.g. hospitals, pharma companies, etc.) in the market; the fact that doctors are grossly overpaid^* and, in the US, overspecialized, with a lower fraction of general practitioners (and thus, presumably, primary care); and, lastly, a more complicated administrative scheme. This more or less illustrates that cost-containment and coverage are essentially separate problems.

Some attention should be given to the idea of cost containment by removal of third-party payment mechanisms entirely (that is, all medical expenses are paid out-of-pocket, the solution advocated by, e.g., the Cato Institute). A free market in health care seems, at first glance, to be a pretty barbaric solution to any problem, since pricing people out of the market is generally not considered fair for conditions that are often the result of happenstance. Compare:
Ralph: I can’t afford this yacht. I guess I’ll swim at the Y this summer.
with:
Stanley: I can’t afford to have this pituitary adenoma removed. I guess I’ll just live with my gigantism. [ Dunks. ] Swish!

Medical cost is very unevenly distributed; 70% of costs are attributed to only 10% of patients. For the very sick, we must imagine that costs are an unbearable burden, the reverse lottery: I pay you $100,000, and at the end I get to stay exactly the same as I was before (sans hair).

However, other forms of free-market competition can successfully lower costs. Insurance companies were successful in forcing hospitals to lower prices in the 80s and 90s by offering selective contracts on the basis of prices. Private hospitals responded by consolidating into agglomerated networks, effectively forcing insurance companies to play ball and allowing them to raise costs (i.e. make more money). In theory, competition between insurance providers for purchasers could also help lower premiums.

The latter would be unavailable in a single-payer system, meaning that cost containment would have to result from pro-active measures on the part of government. But inter-HMO competition has arguably been rendered ineffective by consolidation amongst hospitals (not to mention consolidation amongst insurance companies). Cost-containment still demands dealing with provider power, and there’s certainly no reason not to remove one layer of enormous complexity, which still leaves the patient as the agent enforcing competition by seeking the best available care.

Keeping down administrative costs is also not to be sneered at. Compare the US and Canada: “After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.” This means a 14% reduction in costs merely by removing the administrative overhead associated with a private insurance system. This doesn’t suffice to close the yawning gap between the US and other industrialized nations in terms of health care costs, but it helps.

Single-payer systems, however, are radically different from the current wild-haired and thoroughly American mess. They inevitably mean that the government must take more of an interest in actively managing cost-containment by controlling things like the proportion of specialists in the population, information infrastructure, hospital administration, and ultimately, prices and renumeration of physicians, etc. They also mean that the government must be proactive about the supply-side of the equation, by encouraging the population to be healthier in the first place (certainly a laudable form of health care cost-containment). Though there is ample evidence that these measures are effective at reducing per-capita health care outlays, I suspect that they’re just too fucking socialist for the American political class.

^* “The ratio of average physician income to average employee compensation is 5.5 in the United States compared to 1.5 in the United Kingdom and Sweden.”

One in every 6.5 Iraqis is now a refugee (4.2 million out of 27.5 million). Normally that .5 would be a statistical artifact, but in this case, partial people are among the escapees. Which means that maybe the 800 allowed into the U.S. since 2003 made up as many as 1,600 individuals, if the statisticians were counting blown-up people as 1/2 a person each. Which would be very good news since that would mean we had let in 1 out of every 2,625 refugees, rather than just 1 in every 5,250. That would be cheery news, and I haven’t had any of that since the whales escaped Sacramento.

I’ll tell those cocksucking motherfuckers what kind of asshole shit I consider obscene. And maybe why I like cunts too.

It is embarrassing to live in a country that allows torture and the execution of minors but thinks families need to be “protected” from the word “fuck.”

Strange. I was reading about the Venezuelan terrorist just freed on bail when I saw this Google Ad at the bottom of the screen that said something like “Coffins for everyone!” I had to click. It was for these mass-casualty coffins, easily folded and stacked and then assembled and stacked again. Clever! Too bad they are 100% tropical hardwood. Boo hiss. What’s wrong with a pine box?

But on the topic of the terrorist, it’s sad to see liberals agitating against Posada’s bail. I agree he should face murder and terror charges at least, if not extradition to Cuba or Venezuela. But bail is ok. I don’t support the hypocrisy of letting a CIA asset right-wing nutjob off the hook for terrorism. But I do support bail for all, even those facing terror charges. Prisons suck.

The next day I saw his picture in the Daily News, beneath a caption saying he had been “mugged.” Poor fool, poor blind fool, I thought with sincere compassion, mugged by an invisible man!

Where I come from (a watery planet called Earth) this is news.

Congressman Kucinich Will Hold Press Conference to Announce Introduction of Articles of Impeachment Relating To Vice President Richard Cheney

But on this strange desert world, where the sand has blinded the rich, this impeachment is the action of an invisible man. It will be funny if it prevails.

It got a few minutes on CNN followed by senior political correspondent Candy Crowley, who spoke in a tone that said “he’s not one of us, we’re responsible, I’ve never even seen him before!”

“This is not what the Democrats were elected to do,” she said. Her tone made it sound like even honoring the news with a report was akin to holding soiled toilet paper. But I should give her credit — the cool kids haven’t even gone as far as her. The story isn’t on the web sites of the Washington Post, the allegedly “newspaper of record” New York Times, LA Times, or Chicago Tribune. It isn’t on Bloomberg or the Wall Street Journal. Not even the most liberal major newspaper website in the USA, SFGate (of the San Francisco Chronicle), has anything about it. But who can blame them? Even my favorite liberal blogs have blacked (tee hee) out the news. Nothing on Eschaton or Talking Points Memo.

I don’t care if the reporters and editors think this is a stupid move by a fringe candidate. When someone moves to impeach the Vice President of the United States, the public deserves to know.

Fortunately, they have these news sources:
CQ
Associated Press
AND
And blogs like Tiny Revolution, which I believe beat all but CNN, and the liberal uber-blog Daily Kos, which even (holy cow!) has a discussion on the topic.

I suppose the situation goes along with the rest of Kucinich’s “Invisible Man” campaign. The media love to say that none of the Democratic candidates have a comprehensive plan to reform the American health care system, ignoring Kucinich’s repeated call for a single-payer Canadian-style insurance system. And they say the Dems don’t have a plan for Iraq, ignoring his call to shrink the military and create a Department of Peace. Funny, I might even have to vote this year for an invisible man.

I’ve been thinking about that U.S. Attorney purge. I’ve been having a great time following it from the safe distance of the Internet, watching it like a soap opera on Talking Points Memo. It’s great drama. While no one knows why these particular prosecutors got canned, I have a theory — all of them but the Californians come from jurisdictions likely to be “battleground states” in the 2008 presidential race. And the Californians had problems of their own.
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I know how low my expectations of U.S. government have fallen when, upon reading this report, I am not only furious but also relieved, like the time I hurled up a burger that had been out too long.

The U.S. Chemical Safety Board decided to slam oil company BP for screwing the pooch on safety at its Texas City, Texas refinery and contributing to an explosion that killed 15 people and injured 180 in 2005. Their press release is terrifying. It says a tanker-truck worth of flammable hydrocarbons spewed out of a vat in less than two minutes. It vaporized and spread over the property before being ignited and bang. “High overpressures from the resulting vapor cloud explosion totally destroyed 13 trailers and damaged 27 others. People inside trailers were injured as far as 479 feet away from the blowdown drum, and trailers nearly 1000 feet away sustained damage.”

It wasn’t surprising that fuels can burn and even explode. Or that refineries might suffer from design flaws. The two surprises were how open the investigators were about negligence by the oil company and in recommending federal regulation as a cure.

For BP’s part, here was a particularly damning section:

the refinery only investigated three of the eight known previous ISOM blowdown release incidents, where flammable and potentially explosive vapor was released from the same blowdown drum involved in the March 23 accident. In 2004, an internal BP audit graded the refinery’s analysis of incident information as “poor.”

And there was that subhead, “Dysfunctional Safety Culture Existed at All Levels of BP,” followed by lines like “BP executives made spending cuts without assessing the safety impact of those decisions.”

I know I’m not including BP’s side of the story here, because my point isn’t to provide a news story. I’m just pleased that any U.S. federal agency would speak such clear truth to power. And even more surprised that they would call on the government, rather than voluntary industry action, as the remedy. They did so in a section called “OSHA Should Increase Petrochemical Inspections, Enforcement.”

Proposed OSHA fines during the twenty years preceding the March 2005 disaster - a period when ten fatalities occurred at the refinery - totaled $270,255; net fines collected after negotiations totaled $77,860….

Federal OSHA conducted only nine [in depth, multi-week] inspections [between 1995 and 2005], and none in the refining sector. State agencies in the 26 states that operate their own workplace safety programs conducted a total of 48 [such] inspections, including six at refineries. However, a number of states - including Texas, Louisiana, and New Jersey, where much of the U.S. oil and chemical industry is concentrated - rely upon federal OSHA to enforce workplace safety rules….

California’s Contra Costa County, which has its own industrial safety ordinance, inspects each covered facility every three years. A county staff of five engineers performs an average of 16 inspections per year.

I can think of a few other places where the U.S. Chemical Safety and Hazard Investigation Board’s straightforward analysis could come in handy.

Daylight savings time starts tonight in the United States, 5 weeks earlier than it has in prior years. The theory behind the change was that it would save energy. The theory, from what I can tell, was based on studies that dated to the Nixon Administration. Like so much in the Bush Administration, it was a “no-brainer” fix, a painless step that seemed like a win-win. I bet you $1 that it turns out to be lose-lose.

The win-win idea was that it would cost little to implement the change, consumers would save money, and the U.S. would become more energy-independent. All of these are likely to turn out false.
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Brass band with tubas! Silly parade float. Tumblers! Clowns! Tumbling clowns! Tumbling clowns with tubas! Hooray! The Democrats have saved us from… err.. wait, what’s that? Is that a cloud? Is someone raining on my parade? No! Nooo!! Quick! Cover the crepe-paper flowers decorating the giant bust of Richard Helms! Secure those blue-liveried donkeys! Cover those color guard girls with a plastic tarp! For the love of god, someone get John Kerry off the mic before something terrible happens!

Gosh, isn’t that just awful? Even AFTER losing their majority in the Senate and the House, the Bush Administration has the gall, the nerve, the gumption to refuse the right of Guantanamo prisoners to challenge their detention? And on top of that to further claim that they can arbitrarily detain any non-citizen in the United States without the right to a hearing? Those rat bastards! How do they think they can get away with this? Rubbing their lawlessness in our faces!

Wait… what? What’s that you say, small boy?

[Puts hand to ear.]

You say this is all on the legal-up-and-up? They passed the Military Commissions Act of 2006 just at the end of October, stripping away habeas corpus rights for non-citizens and legalizing the detention process? What, even creating legal means for allowing torture to be used as testimony?? Oooh, the nerve! The sheer nerve! Well, their last-minute-Charleying won’t save them, this time! The new Democratic majority will overturn that law, lickety-split. We’ll show them to mess with the will of the American People!

What is it now? Be quiet, small boy, be quiet! No one wants to hear from you. Wait… say that again… are you certain? It passed both the Senate and the House with substantial support from the Democrats? They sold us out? Even when electoral victory was imminent? Why? Why, small boy, why would they do such a thing?

Now what do we do? Who shall save us when our saviors themselves have left us in the mud? Leave me alone, small boy. I’m going to sit in this puddle and weep.