Category: The World

I got tagged.

The ArchCrone has asked me to submit my own Headlines for the New Year. The idea is from David Cohen. So here goes!

Headline I’m most fearful of seeing in 2008: (at the risk of riffing on ArchCrone’s theme) In wake of tragic attack on President Bush, President Cheney declares martial law, delays elections indefinitely.

Headline I most want to see in 2008: Congress overrides vetoes; SCHIP expanded to all children and orderly withdrawal of both troops and security contractors from Iraq begins.

Headline I most expect to see in 2008: Wages fail to keep pace with inflation for the 4th straight year.

Headline I least expect to see in 2008: Both parties realize election cycle too long; primary season designated as the April before a November election; campaigning prior to New Years Day prohibited.

So, who wants to add their own headlines? Don’t be shy, step on up!

Cross-posted at Central Sanity.

Granted, I’ve read Mr. Sirota’s work before, but this week he’s on fire.

First, we have this item from Truthdig called “Was Ross Perot Right?” That was actually a question Wolf Blitzer asked of Hillary Clinton last week. Her response was to make fun of Mr. Perot and make some lame comments about only remembering a bunch of charts.

Can you just imagine the uproar if, say, Dan Quayle had answered that way? Every comedian in the country would have had fresh material. Mr. Sirota reminds us: “A Democrat laughing at Perot on national television is a big mistake. Simply put, it risks alienating the roughly 20 million people who cast their votes for the Texas businessman.”

The fact of the matter is that when Mr. Perot’s biggest points are examined — that there will be an almost audible “sucking sound” as jobs flow out of America, and that depressed Mexican wages could make illegal immigration to the United States worse — he was right and Sirota has the data to prove it. Yet “[Clinton] she and other congressional Democrats are currently pushing a Peru Free Trade Agreement at the behest of their corporate campaign contributors—an agreement expanding the unpopular NAFTA model.”

The fact is that Mrs. Clinton is less “progressive” than a slot machine.

Oh, but Mr. Sirota did not stop there. He went on — albeit in another article at another website — to tell us “the dishonest argument over illegal immigration trying to divert our ire away from the corporate profiteers, outsourcers, wage cutters and foreclosers that buy influence — and protection — in Washington.”

Now make no mistake, we need some kind of immigration reform in this country simply because there needs to be a clear, simple, attainable path to legal residency and/or citizenship in this country (and no excuse for breaking the law). However, all the immigration proposals recently offered center on things like expensive eco-disaster community-rending useless fences and permanent underclass guest–worker programs and beefing up unenforced regulations on worker documentation. Why is that? Mr. Sirota tells us (emphasis mine):

The answer is exploitation. Employers looking to maximize profits want an economically desperate, politically disenfranchised population that will accept ever worse pay and working conditions. Illegal immigrants perfectly fit the bill.

Politicians know exploitation fuels illegal immigration. But they refuse to confront it because doing so would mean challenging their financiers.

Instead we get lawmakers chest-thumping about immigration enforcement while avoiding a discussion about strengthening wage and workplace safety enforcement — proposals that address the real problem.

Equally deplorable, these same lawmakers keep supporting trade policies that make things worse.

There is no such thing as “jobs Americans won’t do.” But there is such a thing as employers who won’t follow the law. Employers who without penalty don’t follow the law put companies that do follow the law at a competitive disadvantage. There’s your real sucking sound.

In closing: a Black Friday comic; someone else scratching her head about how “inappropriate” old episodes of Sesame Street are; clean, clear water and how it shapes politics and diplomacy (a trend which is likely to only get worse); beating the dead horse called FISA and the Myth of the Ticking Time Bomb (short version? What part of the DoJ can get a warrant up to 3 days after starting a wiretap don’t they get?); ’tis the charitable season, don’t forget one of my favorite charities, Child’s Play; CNN on losing holiday pounds (I take issue with their saying “It would take 27 minutes of walking to burn the 97 calories in an 8-ounce serving of cola,” because most people are in fact drinking it 12, 24, or 32 ounces at a time, but “Take small bites and eat slowly. And, don’t get stuck in guilt if you’ve eaten too much,” is good advice); and as for this study from the Heritage Foundation covered by the “right-wing” Reverend Moon owned Washington Times suggesting “Democrats like to define themselves as the party of poor and middle-income Americans, but a new study says they now represent the majority of the nation’s wealthiest congressional districts.” I’d just like to point out that the study findings that “of the 167 House districts where the median annual income was higher than the national median of $48,201, a slight majority, 84 districts, were represented by Democrats” and “the likelihood of electing a Democrat to the House is very closely correlated with how many wealthy households are in that district” are likely to be caused by Democratic policies that favor higher wages — remember, “rich” people can live wherever they like. It’s just too easy to turn this study around and make the Republicans the party of depressed wages.

So at the beginning of the week Blackwater was told they could no longer operate in Iraq by the sovereign government of Iraq. Put those last 4 words in quotes if you like, but that’s what they are supposed to be.

By Tuesday, Jill of Brilliant at Breakfast pointed out that the Iraqi government was stepping up to do the right thing — insure the safety and security of their citizens — but openly wondered “[D]oes anyone actually believe that Nouri al-Maliki will be able to keep Blackwater out of Iraq?” Even Time Magazine shared her concerns.

By Friday (yesterday) it was clear that Blackwater would continue to do whatever they pleased in Iraq. Over at the Archcrone’s site, I said “I’m beginning to think that Blackwater’s purpose in Iraq is to stir the pot of chaos and violence.”

This is the same Blackwater that caused the Battle of Falluja. That walk the streets of Iraq’s cities with huge weapons. That were apparently placed in positions of “training” Iraqi forces (or militants? your guess). The same Blackwater that cruises the crumbling infrastructure of Iraq in $70,000 vehicles able to withstand anti-tank rounds, who over earn $500 in a day, whose employees often “voice disdain for what they consider the soft, even pampered lives of most Americans….” The same Blackwater that may have improper contracts with Halliburton. The same Blackwater that may have perpetuated the so-called “road of death” to the Baghdad airport. The same Blackwater that has developed a reputation for shooting civilians, including unarmed children. How is it that they manage to get into this much trouble, when there are only 1000 of them in Iraq?

The same Blackwater that is the center of several controversies and the defendant in several lawsuits.

The same Blackwater that was sent to New Orleans after Katrina with military weapons instead of building tools or relief supplies.

As the late night infomercial says, however, “But wait! There’s more!” Federal prosecutors — who remember, serve at the President’s pleasure according to Mr. Gonzales — are investigating whether Blackwater smuggled weapons into Iraq, and then sold them to known terrorists. Some of these weapons were later seized by the government of Turkey and traced back, so now there is physical evidence; it apparently never occurred to anyone to remove the serial numbers from the illegally sold and obtained weapons.

I am going to go out on a limb and declare that — even if they are not specifically in Iraq to cause chaos, which is still my theory — the situation in Iraq will get a lot better if we will allow the Iraqi government to go ahead and throw them out of the country. The President said that when they stood up we would stand down; we need to honor that or admit that Iraq is not a sovereign nation, but an American colony. Bring Blackwater “home.”

In closing: somehow I passed over 500 posts without fanfare; illegal immigrants in the US fleeing — to Canada; realism, roommates, and the single woman, but the twist is she’s over 60; the President is scared of horses; and finally, oh look,your personal share of the National Debt is up over a half million dollars, and they even add the setup for Social Security “reform” . Mr. Bush talked about this just the other day in his press conference (cleverly scheduled to try and take attention away from hearings on Capitol Hill, but Mr. Frank cleverly outwitted him with a brief adjournment). I keep having to say this, and it is very simple: if the problem is that Social Security is not going to have enough money, the solution is either bringing in more money (raising SS taxes) or lowering what it pays out (raising retirement age, lowering benefits). Not enough money will never, ever be solved by bringing in less money.

Strangely enough, one of my areas of expertise is musicology. At one time, I was poised to become a leading researcher in the American White Gospel movement, and editor/composer Charles Gabriel (whom you might know for songs such as “His Eye is On the Sparrow”).

Aren’t you glad I gave that up?

I have been out of the research loop for a number of years now, and so it is only today that I became aware of the sad and Kafkaesque story of “Nalini Ghuman, an up-and-coming musicologist and expert on the British composer Edward Elgar.” Apparently, she was detained in the San Francisco airport last year, where she was questioned for 8 hours. During this time, her visa was ripped up in front of her, her passport defaced, she was searched and told if she moved she would be prosecuted for “assaulting” the officer searching her, and she was told to get on a plane out of the country that day or go to a detention center.

As nearly as I can tell — and nobody can tell — the only thing she did was claim to speak Welsh when she looked “Hispanic” to immigration officials. Brown people don’t speak Welsh, right?

She has lawyers and scholars and elected officials on both sides of “the pond” working on the problem but over a year later she is still unable to get a new visa to enter — let alone work in — the United States. This situation is absurd. In a nation where we are arguing about if/how we should normalize the status of illegal immigrants, we are preventing a noted scholar who already has a job at an American university from entering the country. If she were really a dangerous woman, she would have and should have been arrested at the airport. Instead, this has all the hallmarks of the State Department covering for an overzealous immigration official who broke the law by destroying her visa and defacing her passport and illegally detaining her.

Be careful what languages you claim to speak. Especially if you happen to be Brown.

In closing: background reading on maternal health; I am not sure you can consider maternal health without considering domestic violence;the always insightful Ezra on business and health care reform; one last insurance item, “insured but not covered”; now there’s as arctic passage through the sea; Real Money gives us the Real problem with Chinese imports; speaking of Chinese imports, a follow up, Wal-Mart has decided to pull those toxic flip-flops…. now that it’s September and there’s a lawsuit afoot; a White House divided against itself cannot stand (I hope) on Iran; Ted Rall expresses why many people are frustrated with Democrats in Congress (and on the campaign trail, Hillary!); and AmericaBlog points out that Gingrich is calling foul on the Petraeus report (why doesn’t that make him a traitor too, Mr. McCain?) and is threatening to run for President.

Have a great week. Be careful, it’s crazy out there.

dis·in·gen·u·ous: adj, lacking in candor; giving a false appearance of simple frankness

A new report from the head of Immigration and Customs Enforcement suggests it would cost almost $100 Billion ($100 Thousand Million) “to find, detain and remove all 12 million people believed to be staying illegally in the United States.” She went on to point out that this princely sum did not actually include “the cost of finding illegal immigrants, nor court costs — dollar amounts that are largely unknowable.” Even CNN admits these are “very rough calculations.”

Clearly, we are supposed to think that’s a lot of money that shouldn’t be spent. It’s more than double the entire Department of Homeland Security budget. We’ve already got a huge budget deficit in the Federal budget. There’s a war on, miles of bridges and other infrastructure to repair, and concerns about a possible recession. Surely it would be more cost effective to develop some sort of program to give them legal status. We can’t call it amnesty; how about a “guest worker program.” I will be utterly shocked if some variant of this does not get floated around by conservative commentators by this time tomorrow.

I find both these calculations and the resulting logic disingenuous. The fact of the matter is we don’t have to find, detain, and deport all these people. Mass deportations are a supply-side solution to what is fundamentally a demand-side problem. The city of Phoenix, AZ has already found that as their economy has slowed, “[Illegal immigrants] come for jobs and when there are no jobs they leave.”

All we have to do is insist that employers follow the law, paying a decent wage with decent conditions to legal American workers. When there are no jobs for people with no right to be here, they leave. Not only does that not cost billions of dollars, the Federal government stands to bring in more tax money as documented workers pay their taxes.

In closing: Why lead in toy paint? It’s cheaper could be retitled “Why we need consumer protections”; anti-corruption efforts at the World Bank aren’t going so well, with Paul Volcker saying part of the problem is “getting the entire bank on board with the importance of an anti-corruption effort”; health care costs for businesses are increasing at a slower rate because more costs are being shifted to consumers; thanks to Pete Abel for linking to this article on health care; the Senate is talking about doing something about prepayment penalties on subprime loans, something which is normally regulated on the state level (if it is regulated at all), so let your Senator know what you think; and finally, a must read for young men and college administrators, rapists have the power to prevent rapes.

Today, a split Appeals Court ruled that the ACLU can’t sue to stop the Bush Administration from using secret warrantless wiretaps because they can’t prove their clients were actually wiretapped. For those of you who may have forgotten, this is the very same wiretap program that Mr. Gonzales thought was so important it was worth bothering Mr. Ashcroft in his hospital bed to try and get it authorized while the fellow was on plenty of pain medication. At the risk of stating the bleeding obvious, the point of secret wiretaps is collecting information without anybody knowing.

The court’s ruling — unless overruled by the Supreme Court — means that some people will have to prove they have been a victim harmed by this program before a new suit is brought. This is of course almost impossible to prove. Just about the only way to do so beyond a reasonable doubt is to have evidence from such surveillance used against them in court; that will never happen because even a lousy lawyer will think to ask about the search warrant, and any judge will agree that there really should have been one. Oh that pesky Fourth Amendment!

All of which brings us to the point that we really should all be able to agree on: if this program were really about catching terrorists, they would seek FISA warrants. This can be done up to three days after the fact, completely dismantling any “ticking time bomb” argument that could possibly be made. And if it isn’t about catching terrorists, what exactly is it about? Who exactly are they listening to? Why?

Oh, and many thanks to Pete Abel for nominating me a Thinking Blogger. I am going to have to give some serious consideration to who makes me think, because frankly just because I enjoy somebody’s writing doesn’t mean they make me think.

In closing: the Center is Progressive; great post (by another “Thinking Blogger”) about how a school is like the military (except of course we hope there are fewer weapons in school); even Apple Geeks has something political to say; one woman’s account of being Broke (and part two); is Net Neutrality dead?; there are more contractors than American soldiers in Iraq, and that’s without counting “security” contractors like Blackwater; you can teach a kid that fruits and veggies are good for him, but you may have to bribe him to eat them; Max says it best; some people are so scared of universal health that they want to make you think it causes doctors to become terrorists??; on freedom; and finally, this item on airline delays being worse if you actually care when the passenger arrives makes this item on CPI not accounting for degaded quality even more horrifying. Have a great weekend; I’ll be thinking about who makes me think.

Update: the Chicago Tribune headline incorrectly says this ruling means domestic wiretaps are “ok” when in fact, all they are ruling on is that the plaintiffs did not have any evidence that they were a target of the program, and thus had no “damages”, or a legal reason to sue. I personally like the quote from Senator “Go **** Yourself” Leahy towards the end: “The court’s decision is a disappointing one that was not made on the merits of the case, yet closed the courthouse doors to resolving it.” Somehow he managed to distill the whole situation into one sentence.

I promised a piece on healthcare, and here it is. A couple more bits of reading before we really get started: Ezra Klein brings us commentary on consumer driven health plans (you remember, the kind that the Ownership Society, free markets crowd, and libertarians think will magically bring costs into line) that boils down to “So employees aren’t signing up, they don’t like the plans when they do sign up, and they don’t use them correctly when they’re enrolled.” Jill from Brilliant at Breakfast pointed me to this New York Times article on early symptoms of ovarian cancer have been identified, and new guidelines will hopefully save lives . The article specifically points out that “There are so many horror stories of doctors who have told women to ignore these symptoms or have even belittled them on top of that.” Jill quotes large swaths of the article for those who hate signing in at the NYT, and comments that “Tucked away in this article, so subtle that you can hardly notice it, is the spectre of cost considerations.” Yes, maybe we can save your life, assuming your doctor doesn’t tell you it’s all in your head or otherwise misdiagnose it, assuming we find it early enough, but it will cost you. We also have a Freakonomics review of an article on whether or not there really is an Autism epidemic. Some of the factors involved include “better reporting/diagnosing” (which, like ovarian cancer screening, costs money) and “more funds available for treatment….” Further down my browser tabs, we have what amounts to a frequent flier plan for healthcare: members “earn points that can be redeemed to pay for any health service, prescription, elective procedure, gym membership, wellness product, contribution to Health Savings Accounts (HSA) and many more products and services. Points can even be applied toward health insurance premiums in certain states. The rewards program can also be set up as a health points community, similar to other social networking models where all members can collectively earn points on each purchase.” Apparently there is a credit card involved. And last but not least, Maya’s Granny alerts us to an AMA plan to screen all kids for obesity and agressively treat them. Ok, yes there’s an obesity problem in this country, but this is not the answer.

Alright then. I think most of us can agree that we have a healthcare problem in this nation, namely that many people can’t afford healthcare, and many others can’t afford (or question spending lots of money on) the insurance that is supposed to help people pay for healthcare. It has gotten to the point where pretty much everyone agrees that healthcare is a major issue of the 2008 elections (kindly disregard the calendar, which foolishly points out that we’re 6 months away from 2008), and all the major candidates have a Plan that is supposed to make sure everyone has healthcare insurance, even though none of them will actually work (except Kucinich, who has for a long time insisted that we need true, single payer Universal Health). I have addressed these plans as they came up, including Mitt Romney and the Massachusetts model. This is a very complicated issue, and before we consider the solutions, we should really define the problems more clearly than “it costs too darn much!” In the interests of simplicity, I am breaking these issues into three main categories: issues faced by doctors, issues faced by patients and consumers of health insurance policies, and issues faced by insurance companies themselves.

Insurance Companies: Early on, I argued that insurance makes things cost more. Even if an insurance company is a non-profit or a mutual — and very few are anymore — they have bills to pay like rent and electricity, they have employees who deserve a living wage, they have advertising to buy, they have paperwork to process. That means they cannot put your entire premium into paying for your healthcare, and that was one of several problems that HSAs were supposed to fix (more on that later). Of course a for-profit insurance company has as its first goal “making money,” regardless of what their mission statement reads. That is not an indictment, just a fact; it’s part of what corporations are designed to do.

Because insurance is regulated at the state level, any real reform has to occur at the state level. On one hand this is great, because it gives us up to 50 tries to find something that really works. On the other hand, can you name your state insurance commissioner? Yeah, I thought not. Being state officials, they are relatively poorly paid, and they often come out of the insurance industry they are supposed to regulate. Both these problems makes them subject to certain, um, biases.

Insurance works on the principal that “bad things can’t happen to everybody all at once.” Actuaries figure out how likely bad things are to happen, and how much money the company has to charge to cover it. The goal is to get enough money from the people to whom nothing bad happens to pay for the guy that does end up with the bad thing. If there is extra money at the end, it gets invested. However, somewhere along the line insurance companies found they could save money (either boosting profits or allowing them to reduce premiums) by choosing not to insure people statistically likely to cost them money, choosing not to cover already known bad things (“pre-existing conditions”), or charging a lot more money for people apt to need lots of care. The people holding the short end of this stick are the people who would most benefit from having health insurance that covered their problem, and they are the people who will pay the most for the least coverage, assuming they can get a policy at all (again, more on that later).

Another important breakthrough for cost-containment at insurance companies are negotiated payouts. This is a fancy way of saying “Look, I know your superbill says procedure X costs $100, but we are going to pay you $52 plus the patient’s co-pay. In return, we are going to put you in our directory of official approved doctors, which should theoretically bring you more business and put you ahead. Furthermore, we actually promise to pay you within 30 days, instead of the ‘within 90’ you would get without this deal.” If one or two insurance companies control enough of a local market, they can dictate the price of healthcare down to the penny. Needless to say, this has a huge impact on doctors, which I shall address later.

Yet another cost containment strategy is the “gatekeeper” model and its cousin, “run these steps in order.” Not surprisingly, the gatekeeper model means that you have to get permission from your regular health care provider to see a specialist. They don’t call it permission, of course, they call it a “referral.” It means the same thing and it makes patients mad when they realize it is happening. Maybe that surgeon your doctor recommends is his choice because they know each other and he trusts the guy to do a good job; maybe he’s just the surgeon who can see you on the approved insurance list. You’ll never know. Particularly if you are in the emergency room. “Run these steps” probably has a fancy name, and it has a noble purpose, namely making sure everyone gets quality care and the obvious is not overlooked. It’s “When you hear hoofbeats, think horses before zebras” brought to its illogical conclusion. Basically, a cheap test for the simple thing is required before the insurance company will authorize a more expensive test for a more complicated thing. X-Ray before MRI, that sort of thing. It’s probably a good idea in a teaching hospital where there are lots of interns and residents. However, experienced doctors — particularly the ones that tend to be “zebra magnets” — tend to hate “run these steps” because they already have the diagnostic acumen to tell horse hooves from zebra hooves without some bureaucrat telling him to see if it has a solid coat before looking for stripes. All he wants is the one test that confirms his suspicions, and he sees the cheap test as a waste of time and money telling him what he already new.

Patients and consumers of healthcare plans: I have already mentioned some of the problems, such as the inability of people who really need coverage to get it. But the biggest single problem that both patients and the people who buy insurance face is that it costs a lot of money. I mention these separately because usually they are different people. The overwhelming majority of people who are insured in this country have policies purchased by their employers. Because the employer’s priorities are necessarily not the same as the patient’s priorities, there is something of a disconnect. I used to think that taking the employer out of the picture and making people responsible for their own coverage (with certain changes in the tax code and the types of insurance available) would solve the problem and bring prices down as consumers voted with their wallets. While this may have been true 10 years ago or even 5 years ago, I do not believe it is true now. Nevertheless, the argument that “people overuse healthcare because they don’t see the true cost” is practically a conservative mantra, and it resulted in the Health Savings Account (HSA). The idea is you put money into this account, buy an insurance policy that doesn’t cover very much, and use the funds in the account to pay for healthcare. The problem is that most of us don’t have thousands of dollars to set aside; if we did we wouldn’t need health insurance. Oh, and anybody who has actually tried to purchase an individual health insurance account, whether through an insurance agency or via COBRA knows exactly what insurance costs. Trust me on this. COBRA in particular is a bad joke, allowing people who have lost their job (and thus their income) to pay the complete cost of their coverage plus a handling fee.

I also consider the “people overuse healthcare because they don’t see the true cost” argument disingenuous because very few people see the doctor just for fun. They visit a doctor because they have a health issue they want fixed, whether that issue is as simple as acne or as serious as chest pain. When you have crushing chest pain, you are not in a position to go hunting for the best price on a hospital bed (besides as we have already seen the insurance company negotiates that for you).

The other issue that must be addressed concerning employer-purchased insurance plans is that not everyone has an employer. As I have said before, this is the problem with the various “reform” and “universal” plans being floated currently; they depend on employers buying insurance. Companies have tax advantages buying insurance that consumers do not. For example, Joe Average can’t deduct premiums at all (in some states he has to have a notarized letter saying he isn’t eligible for employer-based coverage), and the self-employed can only deduct health insurance premiums if their spouse is not eligible for an employer based plan. For a country that claims to value the entrepreneurial spirit, we have a funny way of showing it in our tax code! We will never know how many companies failed or were never started of health insurance.

As little as 30 years ago, there was a solution for the problem of people who just plain could not afford vital medical care. It was called the sliding scale, and it meant that poor patients did not pay as much as wealthy ones. Unfortunately, this bit of philanthropy was killed by the negotiated payments I mentioned earlier. The contract that the doctor signs with the insurance company (which he does because he figures some money is better than no money) forbids him charging a lower fee to other patients — never mind that the insurance company is actually paying far less than the posted price it demands the doctor charge others. That is how we end up with items like this USA Today story about hospital bills being a whole lot higher for the uninsured.

People who can’t afford medical care may sound like somebody else’s personal problem, but in fact it is a public health issue. Imagine if Andrew Speaker had never seen the doctor and never had his tuberculosis diagnosed. Sure, maybe if he were poor and uninsured he wouldn’t have gone on those overseas flights. Instead, he would merely have spread his germs around his neighborhood and workplace, perhaps infecting hundreds of people in a similar socio-economic position before somebody figured it out. This focus on pain and suffering completely ignores the lost productivity of people suffering symptoms, and the loss to society (as a worker, volunteer, care-giver, etc.) should the disease be fatal. Don’t forget the added expense of treating all the people who were unnecessarily exposed.

Any discussion of consumer pressures on healthcare spending would be incomplete without mentioning the extremely healthy elephant in the room: there are very simply more things to spend our healthcare money on. Now we have tests to find lots of diseases, and new treatments when we find them. We have ways to cure conditions that a few decades ago would have been a death sentence. We have hundreds of new drugs every year. We have a battery of vaccines that prevent a host of deadly ailments. We have more preventative care; a routine physical now includes a half dozen screening tests, some of which didn’t exist 30 years ago. State laws mandating that insurance cover things like preventative care and birth control pills are a double-edged sword when it comes to cost control. While it may indeed be cheaper to treat problems early, the cost of millions of tests may well outweigh the cost-benefit over hundreds of patients. I am aware that this view completely discounts quality of life issues; it is only intended in a financial context.

In addition to the healthy elephant in the living room, we have a somewhat unhealthy gorilla in the kitchen. Obesity has been on a steady rise for the last 30 years; the current rate is about 33%, and those people are at a higher risk for such expensive to treat conditions as diabetes, dyslipidemia, hypertension, heart disease, stroke, osteoarthritis, respiratory problems, and some cancers. Do not forget that there are almost as many merely overweight people as there are obese people, and they too have more health problems than people of “normal” weight. It’s hard to call it normal when about 2/3 of the population is abnormal.

Oh yeah, and there’s the fact that the baby boomers are getting older, and suffering all the common afflictions of getting older.

Doctors: It’s easy to blame the doctors. They’re the ones that charge money to the end customer, or “patient.” But they have issues of their own. First, a new doctor graduates medical school with a median student loan debt of $115,000 (in 2003, and the numbers are not getting better). At this point he only has a provisional license; to become fully licensed he must do an internship with lousy hours and lousy pay. He is at a point in his life where there are family pressures to do things like have kids and buy a house (“After all, you’re out of school, you’re a doctor now!”) And due to changes to the student loan program during the Bush 41 Administration, his loans have already started to accrue interest. Sure, there are loan forgiveness programs, working in underserved areas, but these programs are “oversubscribed” and usually involve moving to a remote area. That’s why it’s “underserved.” Oh, and politically correct language notwithstanding, most doctors are male, which is why I use male pronouns.

He has insurance problems too. In addition to things like general liability insurance, he has to buy malpractice insurance every year. If you think your health insurance premiums have gone up too darn much, you may not want to know what his is doing. For the last several years, depending on the state of course, median increases have been 15-73% to rates of as little as $10,000 or as much as $100,000. Any business student can see you can’t have increases of that magnitude without the ability to pass on the expense. At least, not if you want to stay in business.

Oh wait. Remember those negotiated fees with the insurance company? Those are often as little as 40 cents on the dollar. He has almost no power to renegotiate these agreements unless he is a member of a huge medical group so large that the insurance company can’t afford to not be accepted there. Even if he does, the agreement usually says that the insurance company can change things at any time.

The doctor has employees too, and he has to pay them a fair wage because nursing in particular is a very competitive field. Once you account for his staff — and paying for their health insurance — he probably needs to see 3 patients every hour before he can even think about paying rent on his office.

In closing: Follow-up, more states Just Say No to Real ID; if the economy is so great, how come food prices have spiked and foreclosures have almost doubled; a nice item on poverty, the media, and John Edwards; Neo-con rhetorical baby steps on civil liberties and public schools; on a related note, see the actual issues survey sent by the Republican party, and note the alarmist and biased way it is written; DINOsaurs vs. Dean-ocrats (related news, the President and a Nixon-era “hatchet man” spoke to a Baptist convention where they later broadened their political agenda to include the environment); the attorney firing scandal may yet trace back to Karl Rove, and subpoenas are in play; and finally Barbara Ehrenreich once more misses the point. She thinks “Undocumented workers shouldn’t be fined; they should get a hefty bonus!” and goes on to argue that once these people are here, they don’t do anything bad and we could only do without them if “offices clean themselves at night and salad greens spring straight from the soil onto one’s plate.” A new spin on “jobs Americans won’t do,” dear? Well here’s the thing, Barbara. Without them, the “unscrupulous employers” that you admit underpay their illegal workers and fail to provide for their safety would have to pay a decent wage to workers who can legally do the job, and who will furthermore insist upon doing things in a manner that keeps them safe. And you know what else? Sure, the majority of illegal immigrants just want a decent life, but there is a minority who are genuine Bad Guys. Because they are — how do you say — “undocumented”, we have no way of knowing which of them might be drug dealers, slave mongers, pimps, members of organized crime groups, members of terrorist groups. Lou Dobbs might be wrong about the leprosy thing, but he is right that border security is national security.

Follow-up: the ArchCrone asks Why are none of the front-runners advocating real health care for all; Forbes tells us “A new study finds large disparities in how different states perform in reference to quality of health care, with some states outdoing others by a factor of two or even three”; and Shakesville’s newest contributor gives us a different viewpoint on weight and health. Of course, she considers me “literally a freak of nature.” Read it to find out why!

Just a little round-up of ecology, pollution, and clean energy items from this week.

Remember that plant that was supposed to turn Turkey Poop into electricity without polluting? I seem to recall having said it sounded great, if it were really true. Well it turns out it’s a little messier than we were initially told.

In Japan, some folks have started invoking the Kami to prevent illegal dumping. Kami, if I may horribly oversimplify, are sort of a combination of deities and guardian spirits and (sometimes) ghosts of ancestors.

A local interest story! Just outside Las Vegas really is a terrific place for a huge solar energy farm.

Something that should have been a good idea turns into a biofuel boondoggle:

The maneuver begins with a shipload of biodiesel from, say, Malaysia, which pulls into a US port like Houston, says John Baize, an industry consultant in Falls Church, Va. Unlike domestic diesel-biodiesel blends, which typically contain from 1 to 10 percent of biodiesel, the Malaysian fuel starts off as 100 percent biodiesel, typically made from palm oil.

Then, the vessel receives from a dockside diesel supplier a “splash” of US petroleum diesel. It doesn’t take much to turn it into a diesel-biodiesel blend that is eligible for US subsidies.

If the ship holds roughly 9 million gallons, it takes only about 9,000 gallons of traditional diesel (0.1 percent of the total) to make the entire load eligible for the blenders tax credit.

Did you know there’s a giant toxic waste pool under Brooklyn?

The Economist brings us the most comprehensive article on recycling I’ve ever read.

In closing: don’t forget to check out my item yesterday on Central Sanity called Surely there is room for balance; The L.A. Times tells us something we already knew, that healthcare costs are particularly brutal for companies that provide retirement benefits; the tourism industry is worried about new passport rules; John Edwards is not afraid to say “I don’t know,” and “I wish I had an answer”; the amazing disapearing American Center for Voting Rights; an interview with al Sadr; and finally, virtual Rome.

That promised piece on healthcare will probably surface next week. In the meantime, here’s some related reading that will almost certainly be referenced: The Populist calls for A National Health Care Plan for All, citing the expense of insurance — even for rather mediocre coverage; the New York Times tells us about Health Care as if Costs Don’t Matter,, which tells us that “a big reason for that cost is the explosion of expensive, medically questionable care…,” implying that if we could stop “medically questionable” treatments, we could bring down costs for everyone (wasn’t this the problem HSAs were supposed to address?); Ezra Klein brings us commentary on that article; and finally the thoughts of a genuine Professor of Economics on the problem, Brad DeLong gives us “An Unrealistic, Impractical, Utopian Plan for Dealing with the Health Care Opportunity”. Memo to the world, the Chinese character for “crisis” includes the characters for “danger” and “opportunity” like the the word “shelf” contains “elf.”

I know I usually close with lots of strange but interesting things that have cluttered up my browser tabs, but instead I’d like to send you over to an item I wrote for Central Sanity entitled Stuff to Act Upon. If you’d like somebody else’s ideas of stuff to act upon, you can start with the BlogHers Act Week One Round-up.

Have a great weekend, everyone!