Rhinocrisy

This kid has just discovered a candy store, one I’ve been wishing for since I came to San Francisco: digital newspaper archives, going back to 1869, of the San Francisco Chronicle.^* Here’s a piece of flavor, a quote from William Coleman, head of the second Vigilance Committee. If you’re unfamiliar, the Vigilance committees were fascinating bits of early San Francisco history, spontaneous, but extremely well-organized and orderly, expressions of public wrath against corruption and criminality. In this case, the group that Coleman spoke for formed to deal with one James Casey, a felon and apparently low character elected to the position of district supervisor. Casey responded to allegations of ballot-stuffing (and other criminality) by newspaper editor James King by waiting for King and shooting him in the chest. He then surrendered himself, confident of the protection of the authorities. Unfortunately for him, the vigilance committee speedily formed (with two thousand men swearing the oath), and in a matter of days “encouraged” the sheriff to give up Casey, tried him, and hanged him. Quoting Coleman:

Who made the laws and set agents over them? The people.
Who saw those laws neglected, disregarded, abused, trampled on? The people.
Who had the right to protect those laws and administer where their servants had failed? The people.
The people are the power; it is theirs by birthright, and when they delegate it, it is expressed and implied that upon wrongdoing the servants shall be pushed aside, formally or informally, and their places promptly filled by other and better agencies.

Enough to make any anarchist teary-eyed.

Obama, this morning:

And so the question then is, are we going to be able to put together a package that includes safe, secure nuclear power; that includes new technologies so that we can use coal — which we have in abundance and is very cheap, but often is adding to our greenhouse gases — can we find sequestration technologies that clean that up; can we identify opportunities to increase our oil and natural gas production in a way that is environmentally sustainable? And that should be part of a package with our development of clean energy.

Answer: no. We’ve talked about clean coal here before, and how it’s at best on a twenty-year time horizon before it becomes viable technology. “Twenty years” basically means “never going to happen”, or “this is science fiction”, so whenever you hear someone talking about “clean coal”, understand that they’re talking through their hat. Oil and gas are tapped out domestically; that is simple geological fact against which there is no argument. The only sources left are offshore, which are expensive and environmentally problematic.

Nuclear power has been a mess for many years; some people are now discussing thorium as a safer, cleaner, cheaper, and all-around better alternative to uranium. India is really into it. Maybe that’s a reasonable plan; I don’t know enough to comment.

But I’d like to take issue with Obama saying this:

I am very firm in my conviction that the country that leads the way in clean energy — solar, wind, biodiesel, geothermal — that country is going to win the race in the 21st century global economy. … [W]e can’t overnight convert to an all-solar or an all-wind economy. That just can’t happen.

Here’s an idea: stop funding that unwinnable war in Iraq. Just end it. Then, use that money to spark research on clean energy. If you’re really very firm in your convictions, put some money where your mouth is.

The new Obama administration White House website is very snazzy, and apparently done by the same folks who designed his campaign website. I can’t help but feel a little disappointed, though. One of the things I loved most about the Bush website was the easy availability of press briefings. Transcripts were available almost as soon as the briefing was finished. By contrast, the Obama website has nothing, yet. Maybe that will change.

Anyway, to business: Gibbs’ response regarding drone attacks on Waziristan/Pakistan:

Q Exactly. There is skepticism among Republicans whether or not this could happen. What kind of reassurances is he giving? Then, on Pakistan, was he consulted before the strike, or did he consult with Pakistan on that?

MR. GIBBS: Well, let me take your Pakistan question first. As you know, I’m not going to comment on those matters.

What the fuck? If this is “transparent”, I’m going to go replace my windshield glass with corrugated cardboard.^*

^* I just realized I don’t have a windshield glass!^†
† No, it wasn’t stolen. I don’t have a car.^‡
‡ No, my car wasn’t stolen. I never bought one.

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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