Thursday, December 31, 2009

Will and process

Back in August, I got involved in a rather heated discussion over at Reclusive Leftist. Among other things, I asked why those on the Left were so eager to turn health care over to the government (RL favors single-payer) when they were forever complaining about government when it came to war, domestic surveillance, and so on down the whole litany of things the Left hates about the government. What if, I wanted to know, all health care is controlled by government and the Republicans return to power? Don’t you worry that certain procedures - including abortions - will be eliminated from government-paid health care?

Reclusive Leftist’s response was (emphasis mine):

It’s not a question of trusting goverment. It’s a question of using government for what it’s best at, which is managing shared resources and doing things which require society’s collective action. Government is just society imposing its will as a group. [snip]

A drawback in this country is that government-funded programs are susceptible to political attrition, particularly when Republicans get in office; but at least we have recourse in terms of voting.

As the health care bills moved through Congress and the attendant battles over covering abortion made the headlines, I wondered if those on the Left who are also feminists would begin to see that perhaps government-paid health care was not necessarily a totally good idea. Certainly the refusal to allow Federal money to pay for abortions is about as clear an example of society imposing its will as we can find: 61% of those polled by CNN in mid-November “[oppose] using public money for abortions for women who can not afford the procedure”; only 37% favor such use. Clearly the position that Congress has taken on funding (or rather not funding) abortion under the new Exchange reflects the will of society.*

Now it looks like society imposing its will as a group is not such a good thing after all. In a post entitled “Abortion restrictions violate women’s Freedom of Religion”, Reclusive Leftist quotes approvingly RiverDaughter’s argument that:

With anti-abortion measures, women are not just subject to the state, they are forced to recognize a religious presence in their lives whether they have faith or not. Men do not need to recognize any faith. They are allowed complete freedom of conscience.

RL then says:

... it’s absurd for the government to honor the anti-abortion scruples of conservative Christians while simultaneously forcing the rest of us to pay taxes for war or torture or capital punishment or any number of policies we abhor. [snip]

Anti-abortion laws essentially force every woman in this country to be a conservative Christian whether she likes it or not. No matter what she personally believes — whether she’s an atheist or a Unitarian or a Jew or a Muslim — she must obey fundamentalist Christian law.

It’s no different than forcing every woman into a sharia court if she wants a divorce, or forcing her to wear a veil.

Oh, dear. Where to start? Let’s get the Christianity thing out of the way first. It’s not just conservative Christianity and Catholicism that oppose abortion. Some very minimal research - a look at the Wikipedia article on “Religion and abortion” - uncovers the fact that all five major religions have objections to abortion. So while Leftist feminists are certainly free to pursue the religious freedom argument they’ll have to move away from using it to bash fundamentalist and evangelical Christians and Catholics.

Even with that, however, a lot of activities we forbid by law are also forbidden by some or all of the major religions; murder, theft, and perjury spring to mind. One simply cannot argue with a straight face that if a religion prohibits an activity, then prohibiting it by law violates religious freedom.

That leaves us with the argument that only those who are deeply or conservatively religious have reservations about using government money to finance abortions. This doesn’t hold water either. Abortion pits a woman’s right to bodily integrity against the fetus’ personhood. You don’t have to be deeply religious to accept the fetus’ personhood any more than you have to be not at all religious to accept a woman’s right to bodily integrity. Abortion is simply not a strictly religious issue. And, of course, funding abortion has even less to do with religion than abortion itself.

The argument the Leftist feminists should be making, of course, is the slippery slope argument: the government refusing to pay for abortions is the first step to the government refusing to pay for other procedures people can now purchase on their own. They cannot, of course, make this argument since it validates the central argument against single-payer or any type of government-paid health care: the fear of rationing. I hope I will be forgiven for finding their dilemma somewhat amusing.

More seriously, what the Leftist feminist’s line of reasoning is really about, of course, is two things. First, the desire on the part of Leftist feminists to avoid recognizing that a policy they believed would be an unalloyed good - government health care - is not as totally wonderful as they thought it would be. This is human and understandable: no one wants to think they’ve fought hard for something that didn’t work out and no one wants to give up the dream of something that will fix everything that’s wrong. That doesn’t exactly make them reality-based but we all have our blind spots.

The second underlying issue is more serious and far more dangerous. It’s about ends and means and whose will should be considered society’s will. If the legislative process produces the end result desired by Leftist feminists - government health care - then the legislative process is the means by which society’s will should be expressed. However, when that process produces a result not desired by Leftist feminists - exclusion of abortion from government health care - then the legislative process is invalid and it is the courts through which society’s will should be expressed. Clearly it is not really society’s will that is to be expressed by government but the will of those who know best what society’s will should be.

I don’t imagine this is a new phenomenon. I’m sure that throughout our nation’s history every political group has sought to insure that its will is considered society’s will and is therefore the will government expresses. But as the health reform effort makes clear, the more government does the higher the stakes become. And, therefore, the more dangerous is the idea that any one group’s will is the correct will for the government to express.

I have a very good friend who has always said his preferred form of government is a benevolent dictatorship - with himself as dictator of course. The fact that that is everyone’s preferred form of government seems to me to be the basis of democracy. That formulation acknowledges both our own conviction that we always know best and some healthy laughter at that conviction. Out of that acknowledgment and that laughter comes the understanding that we must let everyone’s policy aims play out in an open, democratic manner or risk ending up with just the benevolent dictatorship we desire - but with someone else as the dictator. To be so convinced that one’s own policies are the correct ones that one is willing to insure those who prefer other policies are not permitted an equal shot at achieving their goals is to undermine the very bedrock of democracy.

I have a fair number of half-finished posts laying around and at some point I realized that a common thread running through many of them was a concern with process. Democracy is not about outcomes; it is about process. In some sense democracy begins with the idea that in many policy areas there is no “better” outcome; there is simply what the majority of the citizens want. In our particular form of democracy, the founders attempted to insure both a good process and protection for those policy areas where there was a “better” outcome. Then they gave us a process to change the protections if we so desired. But process is all-important.

In writing about the passage of the Senate’s health care bill, Megan McArdle said:

But to a libertarian, process matters. Having a good process is better than getting a good outcome, because a good process is one that maximizes your chances of getting good outcomes over time.

This is not an argument in favor these days with either side of the political aisle. We have become a nation focused solely on outcomes and seem to scarcely even remember we have a process - except of course when we accuse the other guys of making an end run around it. Somehow we have managed to forget that when we distort the process to get the outcome we want today, we open the door for those who oppose us to distort the process to get the outcome they want tomorrow. We forget that our “good process” is our only protection against that benevolent dictatorship where - I can absolutely guarantee you - all but one of us is not going to be the dictator.


* I simply have to comment on another result of that CNN poll: 26% of those polled thought that “abortion should be legal under any circumstances”. I find this impossible to believe. Surely a quarter of the country does not support a perfectly healthy woman expected to give birth without difficulty to a perfectly healthy baby having an abortion when she is 8-1/2 months pregnant. And I sincerely hope that a quarter of the country does not support having an abortion simply because the mother - or father - is unhappy with the baby’s sex. I’d really like to see some more in-depth answers from the “any circumstances” people.



FindLaw: An interesting FindLaw article by Marcia A. Hamilton that argues the Stupak Amendment is unconstitutional on three grounds. I’m unimpressed but expect to hear much more of these arguments. She credits the United States Conference of Catholic Bishops with achieving the Stupak amendment and seems to think that proves this is a strictly religious issue. I doubt that anyone on either side of the health care reform issue would similarly interpret the USCCB’s support for universal health care as clear evidence such reform is a religious issue prohibited under the Establishment Clause of the Constitution.

Interestingly, Hamilton makes a slippery slope argument but only in a limited sense: that not funding abortions will lead to not funding contraception. I took a brief look at her other writings for FindLaw and recommend this one: “The Case for Instituting Healthcare Reform at the State, Not Federal, Level”.

Grim writes approvingly of RiverDaughter’s concerns about taxes being used in ways an individual taxpayer does not want and proposes a system to make sure that doesn’t happen.

I hate HaloScan

I’m just about to put up a post and all I need to finish it is a link to something at Grim’s. I go to his blog to get the URL. What do I see? A blank screen and in my status bar at the bottom the ominous message: Connecting to

Time passes. Oceans rise and fall. Kingdoms prosper and crumble. Look! Transferring data from Now I have the red screen and I can see the words.

I simply do not understand HaloScan. Sometimes it loads right up and all is well. Other times I could read War and Peace before it deigns to respond. If I disable it via AdBlock the blogs that use it load super-fast but I can’t comment.

I hate HaloScan. But not as much as I hate those vertical banner ads that display on top of the text in my iMac/Firefox configuration. Luckily I can disable those without losing functionality.

When I started this blog, I decided I’d never have videos, ads, continuously refreshing links, bottleneck access points, or slow-loading graphics. Every time I'm tempted to reverse that decision, I go into a Website that has one or more of those “enhancements” and remember I’m fighting the good fight for all of us who access the Internet from our home computers rather than our employers’ - and don’t have blazing fast access and more memory than NASA and NORAD combined.

Thursday, December 24, 2009

The best things

Cassandra has written an amazing post, rich with themes to be explored. She writes of the political and the cultural and she is concerned but hopeful. Not so two of those she links: Vanderleun talks of national diminishment; InstaPunk talks of despair, of an existential crisis. The distress of both those writers is driven by politics in general, by Obama in particular.

Yet, at this moment in my life, I read Cassandra’s words not as a call for political solutions but as a reminder of the need for private virtue independent of what our government or our neighbors are doing. Cassandra writes:

What if the malaise that seems to have taken hold of America is not the disease itself but the cure for what ails us?

If we are able to turn this malaise into a cure, to grow larger than Vanderleun’s smallness, to replace Instapunk’s crisis with opportunity, it will not be because we elect a different President or Congressman or Governor; because we successfully pass a particular piece of legislation or successfully thwart it; because we write the perfect editorial or post; because we make the most cogent argument. If we as a nation are able to regain our energy, our surefootedness, our faith in our ability - and our desire - to “continue improving our lot”, to “leave the world a better place than we found it” we will do so based not on what we do in the political realm but on what we do as individuals, how we each live our lives.

Twenty-one years ago, I read an essay in Time magazine. I tore it out and it has traveled with me ever since. The entire essay is worth reading; written by Alan Paton, the author of Cry, the Beloved Country, it pays homage to the power and beauty of words. But despite my own love of words that’s not why I treasured it.

I’m not particularly religious; I’m not even sure I’m particularly spiritual - whatever that means. And yet one of the quotations from Paton’s essay resonated so strongly that it has lived on my bulletin board for all these years, transcribed by me in fading purple ink on fading purple paper. Its impact has never diminished and it remains for me a remarkable description of courage and faith:

In the year 1652 when throughout England all things sacred were either profaned or neglected, this church was built by Sir Robert Shirley, Bart., Whose special praise it is to have done the best things in the worst times and to have hoped them in the most calamitous.

Merry Christmas.

Tuesday, December 15, 2009


[A note about names. In this post I often refer rather familiarly to Senator Joe Lieberman as “Joe” and to Hadassah Lieberman as “Hadassah”. I simply couldn’t think of a better way to alleviate any confusion about which Lieberman I’m discussing when. Using “Senator Lieberman” would do for Joe but “Mrs. Lieberman” doesn’t provide enough of a visual clue for Hadassah - at least if you desperately need new glasses as I do. So my apologies for the familiarity.]

When I read this morning that FireDogLake was calling on Susan G. Komen for the Cure (the breast cancer foundation) to disavow any knowledge of Hadassah Lieberman, wife of Joe Lieberman, I spent some time trying to track down the ins and outs of this story. Here’s how it seems to go.

In the Spring of 2006 (probably) Hadassah Lieberman quits working for Hill & Knowlton after less than a year of employment. She seems to have made $77,000 during her time there.

Hadassah Lieberman joins Komen. I cannot find the exact date but this post was written in November of 2007 and Hadassah was already at Komen.

On November 5 (yes, November) of this year, Joe Conason wrote a Salon article in which he discussed the contradictions he saw in Hadassah Lieberman’s work with Komen and her husband’s opposition to Democratic forms of health reform (which I am hereinafter going to refer to as Demcare simply for lack of a better term). Depending on how you read it, it’s either a plea for Hadassah to convince Joe to support Demcare or a sarcastic slap at the idea that Mrs. Lieberman could possibly be sincere in her support women’s health issues given her husband’s political position on Demcare and her ties to “the insurance-pharmaceutical-lobbying complex that employed her for decades.” (Given Conason’s earlier - 2008 - article about Hadassah Lieberman, I’m betting on the latter.)

On the night of Tuesday, December 8 (yes, December now) of this year, the New York Times reported “Reid Says Deal Resolved the Impasse on the Public Option”. The deal “would sideline but not kill the public option”; proposed the buy-in to Medicare for those aged 55-64; and did that weird thing where the Office of Personnel Management would re-create the Federal Employee Health Benefits Plan. According to the NYT:

In announcing the agreement, Mr. Reid was apparently trying to create a sense of momentum for the health care legislation, which has been on the Senate floor for nine days, with no immediate end in sight.

On the morning of Wednesday, December 9, Joe Lieberman released the following statement:

“I am encouraged by the progress toward a consensus on proposals to send to the Congressional Budget Office to review. I believe that it is important to pass legislation that expands access to the millions who do not have coverage, improves quality and lowers costs while not impeding our economic recovery or increasing the debt.

“My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today.

“Regarding the ‘Medicare buy-in’ proposal that is being discussed, we must remain vigilant about protecting and extending the solvency of the program, which is now in a perilous financial condition.

“It is my understanding that at this point there is no legislative language so I look forward to analyzing the details of the plan and reviewing analysis from the Congressional Budget Office and the Office of the Actuary in the Centers for Medicare and Medicaid services.”

The Corner said this statement:

pours some cold water on the talk of a huge Senate health-care breakthrough. He signals that the public-option trigger won’t work for him, he raises a red flag about the Medicare “buy-in” expansion ... , and he says the proposals will have to be fully scored by CBO and analyzed by the CMS actuary before they can be taken up — all of which are problems for the Dems.


Reid’s strategy depends on building a sense of inevitability with this proposal. That doesn’t seem to be happening this morning, if Lieberman’s reaction is any guide.

On the morning of Friday, December 11, Jane Hamsher of FireDogLake put up a post (hereinafter “the letter post”) reproducing a letter she sent to Komen explaining why it was inappropriate for Komen to associate with Hadassah Lieberman. She explains that her concerns were caused by that Salon article from November.

Late Friday afternoon, The Plum Line reported that Komen did not intend to sever its ties to Hadassah Lieberman.

On Sunday, December 13, Joe Lieberman:

[makes] the rounds [of the Sunday political shows] to say that no, he will not vote for any plan that has a medicare buy in, a public option, or basically any of the other proposals to throw liberals a bone.

The progressives are, of course . . . well, livid is probably too weak a word.

On Monday, December 14, Hamsher puts up a post calling for the celebrities who support Komen to “join me in asking the Foundation to end its ties with [Hadassah] Lieberman, whose professional agenda is antithetical to the cause they purport to advance.” Let’s call this “the celebrity post”.

Also on December 14, Joe Lieberman told The Washington Times that “the campaign to push his wife out of Komen” is "over the line and offensive.”

On December 15, Hamsher responds to Lieberman’s statement with another post. Let’s call this one “the outrage post”.

Somewhere along the line - I don’t know exactly when because it’s not dated - Komen put up a statement on Hadassah Lieberman in which they state, in part:

Hadassah Lieberman has long been associated with Susan G. Komen for the Cure®, working with us on breast cancer education and awareness in other countries as a Susan G. Komen Global Ambassador. Her efforts have been invaluable and we intend to keep tapping her expertise to fulfill our goal to bring breast cancer programs to women in countries who have few resources to battle this disease.

Mrs. Lieberman’s efforts on our behalf are separate and unrelated to our advocacy on health reform.

To me this looks mostly like a simple case of Hamsher going after Hadassah Lieberman because Joe Lieberman is obstructing - or is seen as obstructing - Democratic attempts to pass a health reform bill that includes something approximating a public option, although I suspect Hamsher’s previous very ugly history with Lieberman figures in as well. I don’t like this for a number of reasons. First, I don’t in general think we should attack or punish politicians we don’t agree with by trying to take their spouses’ jobs away from them. I think this principle holds whether we’re talking about a very rich politician whose spouse has a very nice job or a not so rich politician whose spouse has a crummy job. Family should be off limits and family member’s jobs should especially be off limits.

Second, this is very sexist. Hamsher’s letter post is somewhere between hysterically funny and deeply disturbing to anyone who has managed to pass Feminism 101. Basically Hamsher urges Komen to dump Hadassah partly because:

It is widely known, however, that not only has Senator Lieberman been an instrument of obstruction to the kind of health care reform advocated by Susan G. Komen for the Cure... [snip]

... as Hadassah travels the globe under the banner of Susan G. Komen for the cure, decrying the inadequacies of our health care system and the desperate need to reform it, her husband is at home to kill the reform efforts we so desperately need.

In other words, Hadassah should lose her job because her husband (at least according to Hamsher) doesn’t support the kind of work her employer is doing. This is ludicrous. Women get to have lives separate from their husband’s. They even get to have opinions that disagree with those of their husbands. Why, I hear that Mary Matalin often does work her husband doesn’t support.

Third, this is the same old “lobbyist” bugaboo which pretty much ignores reality. Besides her husband’s politics, Hamsher also attacks Hadassah Lieberman for having worked for a major player in the health industry. Well, yes she did. In fact, she’s worked for several major players in the health industry. To put it another way, Hadassah Lieberman has lots (see also the linked pdf for more detail) of professional experience in the health care industry. She also has lots of community service credentials and she has political connections through her husband’s job. In other words, her background makes her perfect for an organization like Komen. The hard truth is that people who truly understand a problem or an organization or an industry must - almost by definition - be insiders. This is even more true if those people have some influence and some political connections. Someone like me, on the other hand, would have no possible conflicts of interest, no ties to other players - and no hope of even getting anyone’s attention much less getting anything done. As comment 47 (well worth reading in its entirety) on Hamsher’s post asks:

So, what do we fear? That Mrs. Lieberman will suddenly be advocating for what? Increased cancer rates to profit current clients of her former employer? The thing we seem to be saying here is, you once worked for a company that represented clients we don’t like. Now you’re disqualified from meaningful work in a cause you may care about. Let’s applaud her for working for a good cause, for which she is probably being paid much less than she was as a lobbyist. And if its volunteer, let’s thank her for working hard on a cause we care about.

Fourth, it’s not like Hadassah Lieberman just joined Komen. She’s been there for at least two years. If Hamsher is so terribly, terribly concerned about Hadassah’s pernicious influence on Komen she should have said something earlier. Yet I can find no indication that she did so. Neither Hamsher herself nor any of the other blogs I’ve read about Hamsher’s crusade mention any previous objections by Hamsher to Hadassah’s tenure at Komen.

So, no, I don’t like Hamsher attacking Hadassah Lieberman in order to further her little war with Lieberman. But what I like even less is Hamsher attacking Komen itself to further that war. Yet, unable to persuade Komen to dump Hadassah, that’s exactly what she does. Hamsher’s celebrity post is presented as an attempt to get those celebrities who support Komen to pressure Komen to drop Hadassah. Rather, the post is actually an attack on the Komen Foundation itself.

Hamsher begins by writing that she asked the Foundation to “stop using money that was raised for cancer research to pay Hadassah Lieberman”. (Not exactly but we’ll let that slide.) The Foundation, reports Hamsher, “issued a statement saying that they refuse to do so.” Hamsher then calls upon celebrities “to join me in asking the Foundation to end its ties with Lieberman, whose professional agenda is antithetical to the cause they purport to advance” (emphasis mine).

Hamsher continues:

The death of health care reform will no doubt please the clients of Hadassah Lieberman’s lobbying firms, but it would appear to be out of step with the goals of the Susan B. Komen Foundation. ... They are by far the biggest breast cancer organization, with close ties to the Republican Party. Executive Director Nancy Brinker was appointed by George Bush as Ambassador to Hungary in 2001, shortly after the Komen Foundation helped defeat a meaningful Patients Bill of Rights and promoted the watered down version Bush advocated. [snip]

Despite the obvious questions this raises about the impact of environmental factors on breast cancer occurrence, the Komen Foundation focuses its resources on developing treatments that increase the profitability of pharmaceutical companies like the ones that employ Mrs. Lieberman rather than prevention. Unlike other breast cancer organizations, they refused to sign on to the 2006 Consensus Statement on Breast Cancer and the Environment.

The drugs that are developed by the Komen money are being put out of the financial reach of average middle class women by Hadassah Lieberman’s lobbying firms. ... When the underlying causes of breast cancer are never addressed in a way that benefits women who will never be able to pay those high prices to stay alive, the name might as well be the “Race for the Cure You Can’t Afford.”

Translation? Komen isn’t really helping women with breast cancer or women who may get breast cancer or their families or the search for a cure. No, Komen is just an arm of the Republican Party funneling money not just to Hadassah Lieberman but also to pharmaceutical companies. Real translation? If Komen won’t support Hamsher’s quest to punish Lieberman, then Hamsher is going to do her damnedest to make sure people stop supporting Komen.

But wait. Perhaps I’m being too harsh. Surely if Komen is so awful then Hamsher has always had these concerns about Komen and this is the umpty-umpth time she’s taken the Foundation to task. If so, I can’t find any evidence of it. Rather Hamsher’s concerns about the Komen Foundation seem to have sprung full-grown like Athena from the head of Zeus. Using Google as a search engine and looking within the FireDogLake domain for entries that contain the word “Komen” and do not contain the word “Hadassah” I found 10 entries. In most of these, Komen appears only in the comments. For example, in this post comment #179 provides a link to a Komen Foundation press release on a study of the role of environmental factors in breast cancer. There is one FireDogLake post that actually mentions the Komen Foundation in the body of the post. Written by Lisa Derrick, the post applauds Obama’s choices for the Presidential Medal of Freedom. In describing former recipients of the Medal, Derrick says:

The recipients all share a commitment to bettering the human condition, and include: ... Nancy Goodman Brinker, founder of Susan G. Komen for the Cure, the world’s leading breast cancer grass roots organization;

So while there’s no evidence Hamsher previously supported the Komen Foundation there’s also no evidence she ever previously felt compelled to detail its manifold transgressions. Until, of course, it got between her and Joe Lieberman.

Threatening the vocational or avocational status of a private citizen to punish her husband is cruel, sexist, stupid, and tiresome. Threatening the financial well-being of an entire charitable organization because you hate the husband of one of its employees is monstrous.



About money. In cruising around the blogosphere, I’ve found a number of commenters who insist that Komen paid Hadassah Lieberman lots of money or hundreds of thousands of dollars. As far as I can tell, there are no reliable figures on what Komen paid Lieberman. In her celebrity post, Hamsher says:

How much is she being paid? It’s hard to tell — the Senate Finance report only indicates that it’s “more than $1000.” But money paid to spouses is one of the primary ways that members of Congress manage to wander into serious money while in office, and Hadassah made $328,000 in speaking fees in one year.

In this formulation, Hamsher is pretty clear that the $328,000 is from all speaking fees not just from Komen. By her outrage post, Hamsher is not being quite so clear:

If Senator Lieberman would like to talk about the “merits,” he should explain what his wife has done to merit $328,000 in speaking fees in one year rather than trying to obscure the issue with his theatrical brand of “outrage.”

Although Hamsher refers to “speaking fees” without claiming the entire amount came from Komen, the context - Hamsher is responding to Lieberman’s comments on his wife’s association with Komen - leaves the impression the entire amount came from Komen. (The reviews of Hadassah Lieberman on the Harry Walker Speaker Bureau site come entirely from Jewish groups which leads me to believe those groups are where Hadassah does most of her speaking.)

The simple fact is that we don’t know how much Komen paid Hadassah Lieberman or what they paid her for. (You can view Komen’s most recent annual report here. Download the “2007-2008 Annual Report - low resolution” pdf and see page 13 for a general breakdown of revenue and expense.)

About faux manufacturing. In her outrage post, Hamsher refers to Joe Lieberman’s “manufactured outrage”. In an August 2006 post about Lieberman, Hamsher refers to his “faux indignation”. Apparently nothing Hamsher ever says about Joe or Hadassah Lieberman is ever truly outrageous and therefore any reaction to it must be faux manufacturing.

About slippery writing. It seems to be thick on the ground at FireDogLake. Hamsher’s easily misinterpreted reference to how much money Hadassah Lieberman makes is one example. Similarly when I read her celebrity post statement that:

The drugs that are developed by the Komen money are being put out of the financial reach of average middle class women by Hadassah Lieberman’s lobbying firms ...

I assumed Komen was contributing money to drug companies. But in Komen’s statement in support of Hadassah they say:

It’s been reported that Susan G. Komen for the Cure provides funding to pharmaceutical companies. That is simply not true. We have never funded pharmaceutical company research – our grants, totaling $450 million, have gone to research institutions in the U.S. and abroad. Another $900 million in Susan G. Komen for the Cure funding has gone to programs in communities world-wide. We will commit another $50 million to research in the coming year.

After I read that, I reread Hamsher’s post and realized that she never actually said Komen was giving money to drug companies; she merely let it be understood.

In her outrage post Hamsher slides into shape-shifting territory. Responding to Lieberman’s statement that:

My wife is a private citizen in a movement that is looking for a cure for breast cancer and educating women about what they should do to protect themselves from breast cancer.

Hamsher replies:

If Hadassah Lieberman wants to volunteer to educate women about breast cancer, I think that’s great. But she has no special qualifications for this - nothing that Komen should be paying her for ...

Yet Lieberman never claimed his wife was educating women and as I’ve discussed above Hadassah Lieberman’s “special qualifications” lie in the fund-raising and interest-garnering fields. Surely Hamsher understands that charities must raise money and attract interest so she is being rather disingenuous here.

On Susan G. Komen for the Cure. I don’t know much about them except that when you say “breast cancer charity” almost everyone thinks of them. In the course of researching this post, I did a little reading and I discovered that Jane Hamsher’s is not the first attempt to drag them into a political fight. This article on one pro-life group’s clash with Komen will sound very familiar to anyone who reads Hamsher’s posts.

On one point of agreement with Jane Hamsher. In May of 2007 Hamsher wrote:

[Battling breast cancer] is scary enough when you have insurance and the resources to be able to get the treatment you need — I can't even imagine how frightening it must be to know you can't.

On that point, Ms. Hamsher and I are in perfect agreement.

Sunday, December 13, 2009

Catastrophic comparison, Part 2.1

Now, where as I? Ah, yes. Before getting side tracked into my Five Health Insurance Issues series I was discussing three proposals for government-paid or government-provided catastrophic health care. As I said in my previous post:

So all three proposals are designed to make individuals see clearly what they are paying for their own health care because, the authors believe, that will result in careful decision making about what treatments are really worthwhile and which doctors and hospitals provide the best value which will in turn result in less spending on health care. At the same time all three writers want to make sure everyone has access to care and no one is financially destroyed by medical costs. Their goals are the same; the methods differ.

The question for today is: Are these plans paid for? Please note that this is a different question from whether we can afford them, either nationally or as individual taxpayers. Here I’m just examining whether the income streams they depend on are sufficient to cover the costs of the health care they must pay for.

Let’s start with Martin Feldstein's proposal since there’s no math involved. Feldstein proposes that the government give everyone a voucher to buy catastrophic health insurance from a private insurance company. The catastrophic amount would be 15% of the individual’s or family’s income. He would pay for this by taxing employer health insurance payments. He does not address the issue of low income individuals; that is, those with employer-paid health insurance and low incomes.

I simply don’t see how Feldstein’s plan can possibly be paid for. I said in my earlier post that I discuss his plan with trepidation because it makes no sense to me and that’s even more true when it comes to the question of paying for it.

Feldstein relies on taxing employer health insurance payments to pay for the vouchers everyone is going to get:

My calculations, based on the government's Medical Expenditure Panel Survey, indicate that the budget cost of providing these insurance vouchers could be more than fully financed by ending the exclusion of employer health insurance payments from income and payroll taxes.

But surely the value of employer health insurance payments will drop like a rock under his plan. Employer health insurance payments are based on the value of the coverage: the better the coverage, the higher the payments. Yet Feldstein himself anticipates - indeed, hopes - that the value of coverage will be squeezed from the bottom:

Because employer payments for health insurance are tax-deductible for employers but not taxed to the employee, current tax rules encourage most employees to want their compensation to include the very comprehensive "first dollar" insurance that pushes up health-care spending.

Clearly Feldstein anticipates that once employer payments for health care are being taxed, the plans will become less generous. In fact, he counts on this effect to reduce overall national health care spending. But less generous coverage - the higher deductibles he hopes for - means lower employer premium payments which means less revenue from taxing those payments. So based just on Feldstein’s own anticipated consequences for his plan, the revenue stream he’s counting on is already reduced.

Even worse for his revenue stream, the value of coverage has - by definition - been squeezed from the top. Right now an employer-paid health plan must cover the possibility of extremely large health care costs; the higher the possible health care costs, the higher the premiums; the higher the premiums, the more money you collect when you tax them. Under Feldstein’s plan, employer-paid health insurance plans will never have to cover more than the catastrophic deductible: no more than 15% of payroll. The possible health care costs go down, the premiums go down, the money you collect when you tax them goes down. Now not just Feldstein’s hopes for less generous coverage but the economic reality of such coverage will erode his proposal’s own funding base.

Furthermore, I can see employer-paid health insurance disappearing completely under Feldstein’s proposal. Once employer-paid health insurance is taxable (both income and payroll - ouch) it’s rational for employees to decide they’d rather have the money as salary. They can spend it on health care if they need it but if they don’t it’s available to them for other purchases. This would completely eliminate the money Feldstein is counting on to fund his catastrophic insurance plan.

As I’ve now said twice, I fear I’m missing something since the problems in Feldstein’s plan seem so obvious. Unless someone can explain what that something is, however, I consider Feldstein’s plan unworkable and will not consider it further.

In the next installment, I’ll look at whether DeLong’s plan is paid for.

Thursday, December 10, 2009

That's funny

The most exciting phrase to hear in science, the one that heralds new discoveries, is not 'Eureka!' but 'That's funny...' - Isaac Asimov

Deafening Silence has up an excellent post on ClimateGate, examining the parallels - and divergences - between climate science now and the study of physics at the turn of the last century. And, like me, she’s wondering about ghosts.

Go, read.

Tuesday, December 8, 2009

Medicare nation

In discussing the possibility of allowing people between the ages of 55 and 65 to buy into Medicare, The Nation is horribly confused. Most of their article makes it sound like Americans will be able to start collecting Medicare benefits at age 55 rather than having to wait until age 65. They quote John Kenneth Galbraith:

I would also argue for lowering the age of eligibility for Medicare to (say) fifty-five, to permit workers to retire earlier and to free firms from the burden of managing health plans for older workers.

They claim that in the Senate health reform struggles “the idea of dropping the Medicare eligibility age from 65 to 55 has resurfaced as a prospect.” They refer to the need for determining exact “funding mechanisms”. They report:

Several progressive members of the House and Senate have confirmed to this reporter that lowering the Medicare eligibility age would have serious appeal in their caucuses. But there is some disagreement about how serious the prospect may be, especially considering the determination of some conservative and moderate members of the Democratic caucus in the Senate to control entitlement costs.

In other words, about 99% of their article talks about this proposal as if it’s a straight expansion of the Medicare entitlement: start collecting your Medicare benefits early. Only in one small sentence do they mention the true nature of the proposal (emphasis mine):

Under the proposal, which is being weighed by Senator Jay Rockefeller, D-West Virginia, and several other senators who are in the thick of the latest negotiations, Americans as young as 55 who lack affordable coverage could buy plans under Medicare.

Got that? Buy. This is not lowering the age of eligibility for Medicare; this is not enlarging an entitlement. This is letting people under 65 purchase insurance “policies” from Medicare just like they now purchase them from Aetna or Blue Cross Blue Shield.

Will there be government subsidies? Maybe. I think that depends on whether the final bill raises the ceiling for Medicaid coverage; it may be that anyone who would have been subsidized to buy into Medicare will simply be eligible for Medicaid instead. Which is, of course, just another kind of subsidy. But since apparently Medicaid reimbursement rates are lower even than Medicare reimbursement rates, it should cost less to subsidize people in Medicaid than in Medicare.

Which brings me to another point. If we’re going down this road it seems to me it makes more sense to let people buy into Medicaid rather than Medicare. Given Medicaid’s lower reimbursement rate, people should be able to buy into Medicaid more cheaply than into Medicare. Medicaid also appears to allow some variation from State to State so issues like abortion coverage could be taken care of at the State level.

Allowing some people to buy into Medicare is just one of the options on the table. Another?

Senate Democrats in search of a health reform compromise Sunday zeroed in on a new alternative to a government-run insurance plan — signaling that the chances a final bill will include a pure public option are diminishing.

The new idea — for the government to create a national health insurance plan similar to the Federal Employee Health Benefits Plan — seemed to gather momentum as the weekend went on, and the differences between liberals and moderates on the public option became even clearer.

That sounds familiar in a half-witted sort of way. Guys, there is no reason to re-invent the wheel. The Federal Employees Health Benefits Plan already exists. Just piggyback on it. Yes, you’ll need a separate risk pool so Federal employees don’t see their premiums rise to subsidize “outsiders” but all the legwork is done. We know which treatments are covered and which aren’t; we don’t need a bill or a separate government agency to figure all that out. Whatever Federal employees get - and that includes Congress - outsiders who buy in get. That should take care of fears that Congress will end up rationing care. Reimbursement rates are set; the insurance companies are already in. Just use what’s already there. Figure out some formula for subsidies based on the cheapest rate available in each State and let ‘er rip. Really poor people get subsidized decent coverage. People with more money can buy higher end policies.

This approach would also obviate the need for “the Exchange” so beloved by the various Democratic health reform bills. The Exchange, like this new “national health insurance plan”, simply replicates FEHBP. This is not necessary. We’re all supposed to be green now, remember? So refill, reuse, recycle. FEHBP already exists. Don’t waste all that energy building it anew.

Sunday, December 6, 2009

The specter of ClimateGate

I miss Michael Crichton. A lot.

And in my more whimsical moments I wonder if perhaps the East Anglia Climate Research Unit had a ghost in its computer.