What's Behind Door #1, Monty?

by Nicholas Beaudrot of Electoral Math

One of the great muckraking teases of the last three years has been Josh Marshall's reporting on the forged Niger uranium documents that lead to the "sixteen words" in Bush's 2003 State of the Union. For months, Marshall tantalized his readers with tidbits that suggested ... well, it's not clear, but it certainly sounded like something that could end up as the plot line behind a late summer action flick. Marshall suggested the story might appear 60 Minutes before the 2004 election, but in the wake of the Dan Rather/Bush National Guard/Electric Typewritter kerfuffle, CBS decided not to air it. Since then, the story behind the Niger documents has largely fallen from the public eye.

Jane Hamsher of Firedoglake spots former CIA analyst Ray McGovern suggesting ... well, I can't actually bring myself to say it, because to do so would bring voice to the idea that reality has plunged into some frightening chimera combining The Long Kiss Goodnight and Noam Chomsky's rantings. But it goes further than anything Marshall ever reported. Now, McGovern has been something of an anti-war gadfly since retirement, and he's not willing to reveal his evidence "yet", but perhaps there is something to look into here.

And now, if you'll excuse me, I have to go find my tinfoil hat.

I Want More Vacation!

The Mark Weisbrot column John links to on France's economic situation makes some good points, though it does seem to diminish France's poor economic performance by omitting statistics on such minor matters as, say, GDP growth.  That said, it does bring up a point I like to harp on whenever possible.

Another mistake that is commonly made in this debate is to compare France’s income or GDP per person to the U.S., by which France lags: $30,693 for France versus $43,144 for the U.S. (these are adjusted for purchasing power parity). But this is not a fair comparison, because the French do not work nearly as many hours as we do in the United States. Economists do not say that one person is worse off than another if she has less income simply due to working fewer hours.

Right.  Yes.  Thank you.  As a caveat, there's a certain amount of dispute as to whether the French could work more hours if they so chose, but in any case, there's not a 1:1 comparison to be made here.  If you make $80,000 and work 65 hours a week, and I make $40,000 and work $35 hours a week, there's a real question as to who is "better off," despite the efforts of economic commentators to define the term as nothing more than a measure of take-home pay.

Which reminds me: I would love it if I had the option of sacrificing some income for more vacation days.  If I could choose to make X amount less in order to have proportionately more vacation days, I'd take that bargain in an instant.  I'm young, I'm childless, I have friends and family scattered around the nation -- having more time to travel would be worth a lot to me.  I'm in Seattle for a conference, for instance, and would much rather I could tack some time onto the end of the trip and actually explore Seattle.  But such a deal is never offered.  In fact, I've never even heard of such a deal being offered.  It's a shame, and one reason I'm a bit unconvinced by the ceaseless bashing of France.  I'm more likely to get rich in American, to be sure, but I'm far less likely to have the opportunity to enjoy my wealth. 

Speaking of Which: I'm conferencing in Seattle this week, and have asked the Weekenders to pitch in.  I'll still be posting, just at slightly reduced frequency, so they're kindly helping out.

A Review, In Which Your Guest Blogger Reads Sick So That You Might Too

by Nicholas Beaudrot of Electoral Math

When I first picked up Jonathan Cohn's Sick: The Untold Story of America's Health Care Crisis—and the People Who Pay the Price (catch the author in your neck of the woods), I wasn't sure what it was, other than a book about health care. What it's not, certainly, is a policy white paper in book form. That is fine; there are plenty of books and white papers out there that make the case for substantial overhaul of America's health care delivery and financing.

What it is, instead, is a set of anecdotes detailing cases where the American hospital system, public health system, or private insurance has fallen down on the job. A former nun can't find insurance, so she goes to a hospital that suggests she might qualify for charity care, only to find the hospital suing her for unpaid bills. A self-employed diabetic falls victim to a fradulent insurer. The stories go on for eight chapters. Within each anecdote, Mr. Cohn cleverly interweaves a broader explanation of the root causes of the sob story. At it's core, though, all these anecdotes go have a common thread: "health insurance" is no longer able to spread risk. Even those with coverage find themselves making drastic cuts in other living expenses, turning down needed health care service, or facing huge financial burdens in the face of catastrophically expensive sickness.

It is clear to Mr. Cohn that private allocation of health care simply doesn't work. In the age of modern information technology and massive databses detailing patient and doctor history [and in the future, Mr. Cohn omniously warns, genetic data] the easiest way for insurers to enhance shareholder value is to reduce benefits, or deny payment of care to specific beneficiaries. What's more, health care costs suffer from a power-law distribution; the top 1% of patients account for 20% of all health care expenses, the top 5% account for 50%, and so on. Thus, insurers have enourmous incentive to determine which customers are likely to get extremely sick. Then deny them coverage. [Step 3: Profit!!!]. The consequences are straightforward. While the community-rated pools and hospital-based cooperatives of an earlier era spread both risks and costs uniformly across a population, Mr. Cohn notes that today "evolution is running in reverse", as insurers and hospitals shift an ever greater share of costs onto the sick, all while the overall reduction in insurance-provided benefits accelerates.

Mr. Cohn makes is a point that needs to be made, and made repeatedly. The health care system is in dire need of reform because it insurance is increasingly no longer able to protect the insured from financial ruin, nor provision health care. As King County (Washington) executive Ron Sims says, "there are no market forces in health care". If private insurance companies are, properly, first accountable to their shareholders, they will face tremendous pressure to reduce costs by fiat rather than improve services. Mr. Cohn cites data showing the percentage of revenue spent on reimbursements—the "medical loss ratio", a disturbing term in and of itself—hovers around 90% for non-profit insurance plans, but 75-80% for private insurance plans. John Kerry's campaign proposal to provide reinsurance for the most expensive cases might have eliminated the perverse incentive to deny coverage to the sickest of the sick, which would have helped, but it's difficult to forecast whether it would have done enough to eliminate the perverse incentives that make private health insurance so problematic.

Mr. Cohn strives to cover a wide array of demographics to emphasize that difficulties with the health care system transcend race, class, and job security; an upper-middle-class mother whose husband has good insurance through a bank goes through tremendous difficulty for her children handicapped since birth; a slaughterhouse worker whose company pulled the retirement benefits out from underneath him; a Puerto Rican small business owner finds his medicications removed from the "approved" list for Tennessee's state-funded but HMO-dominated low-cost insurance plan.

Dissapointingly, Sick doesn't take the next step of inviting the reader to put himself in the shoes of the unfortunates. While economic anxiety has increased over the past half-decade, complacency and a lack of self-interest remain barriers to increased universal health care. Indeed, in his conclusion Mr. Cohn concedes that "public opinion about health care in America remains as ambivalent as it was at the end of the Clinton health care fight ... [t]hey know that millions of Americans aren't so lucky, but, according to polls, they have a hard time believing themselves in that situation". But Sick makes no attempt to push readers to imagine that this could happen to you, too, despite impressively showing that the health care industry's problems cross class boundaries. Readers who are diabetic, or self-employed, or have friends and family with severe mental illness will undoubtedly sympathize with the stories that Cohn tells. But these readers already have some self-interest in advancing the cause of universal health care. Increasing the number of people who see nationwide coverage as in their personal interest seems key to increasing political support for further expansion of the health care safety net. Mr. Cohn makes very little effort to emphasize that medically-induced financial calamity can strike anyone, nor to emphasize the pro-business case for cost control through greater government intervention.

As for policy remedies, Sick makes an effort to debunk the critque that further market intervention in health care will lead to rationing, waiting lines, or stifle innovation. Mr. Cohn points out that Europe and Japan manage to cover all their citizens (and travelers too!) without stifling innovation or increasing waiting times [An article by Big Media Ezra in the most recent Prospect (Subscribe today!) makes the same case with more data-driven evidence)]. Further policy specifics can wait for another day; the first step to recovery is to admit that there is a problem. At the very least, we must realize that the current configuration of health care delivery and finance neither controls costs, nor provides health care for those who need it most, nor insulates the public from income shocks. The second part of the conversation—what to do about it—can wait for another book.

Everything Is Going According To Plan

By Neil the Ethical Werewolf

There's lots of good stuff in the latest Pew Poll, but one of the neatest bits is this survey of where people think the candidates stand. Higher numbers mean that people think the candidate is more liberal; lower numbers mean that people think the candidate is more conservative.

Despite being the most progressive of the three major candidates, with his perfect pro-choice voting record as a Senator from North Carolina, his opposition to funding the war, and his hard-core economic liberalism on health care and poverty, Edwards is still seen as more moderate than any other Democrat.

Which is exactly how I like it. He's the kind of candidate who not only wins a general election, but moves the country left without people realizing what's happening. Tell all your liberal friends about him, but tell them quietly.

Ending Poverty in America

by Nicholas Beaudrot of Electoral Math

That's the title of a new book edited by John Edwards along with Marion Crain and Arne Kelleberg, two UNC professors who presumably have affiliations with Edwards's Center on Poverty, Work and Opportunity. Ezra Klein readers will likely be familiar with several of the contributors: Jared Bernstein of the Economic Policy Institute, Elizabeth Warren of TPMCafe's Warren Reports, and The Great Risk Shift author Jacob Hacker. But it also includes a smattering of academics, as well as a few old guard policy wonks like the Urban Institute's Harry Holzer, plus the occasional Republican who earnestly cares about poverty like Jack Kemp. It's likely a good collection of ideas on poverty and surrounding questions of race, education, urban structure, and the like.

Also check out this month's special report on poverty in TAP. Subscribe today!

Hayes vs. Kirchick

Poor Kirchick.

[Witticism Involving "Sick" and Our Health Care System Goes Here]

by Nicholas Beaudrot of Electoral Math

I have a longer, um, "review" that I'll post later today, but it's not clear to me that the thesis of Jonathan Cohn's new book Sick suggests the problem with the American health care system it's a lack of money. Rather, it's what that money is used, or not used, to do, and who gets access to it. Those without health insurance are denied a good deal of care, and even those with insurance often find that their coverage doesn't insulate them from financial catastrophe. Instead, as Paul Krugman says, the health insurance & hospital industry spends an awful lot of money figuring out who is going to cost a lot of money to keep healthy, then deny them coverage or sue them to collect debts. Sick had surprisingly little to do with poor health care, and much more to do with poor health insurance coverage.

Of course, I could be entirely wrong about all of this.

Update: I forgot to leave out the key detail of what I was responding to: Kevin Drum's piece pushing a review of Sick appearing in this month's Washington Monthly.

Your World In Charts: Poverty Edition

From CAP's new strategy to halve poverty by 2010:

I tend to think the repetition of these numbers is important, as one of the most pernicious myths is that poverty is entirely an African-American, and occasionally an immigrant, problem. In fact, a hefty plurality of the impoverished are white. Can we help them now?

Incidentally, discussions about poverty occasionally get tripped up by the oddness of the federal poverty measure, which isn't particularly related to any working definition of what it means to be poor. At this point, the measure acts as a relatively arbitrary income baseline below which you're judged impoverished. Conservatives make a lot of hay from this fact.

Here's the fun part, though: Just about every alternate measure constructed, including the metric developed by the National Academy of Sciences, suggests that the current poverty limit is woefully inadequate, that a family of four needs more than $19,000 and change to survive, and so increases the number of poor in the country. And then, when you go and ask ordinary Americans how much a family of four requires not to be poor, they tend to offer responses around $40,000 -- only one percent thought $15,000-$20,0000 was sufficient. So you can quibble with the poverty measure, but be warned: Just about all the data we have suggests that it understates, rather than overstates, the plight of the poor.

The Reagan of our Dreams

David Brooks laments, "Conservatives have allowed a simplistic view of Ronald Reagan to define the sacred parameters of thought. Reagan himself was flexible, unorthodox and creative. But conservatives have created a mythical, rigid Reagan, and any deviation from that is considered unholy."

The transmogrification of Reagan into a hardline conservative is a rather impressive bit of PR work. As Josh Green detailed in his seminal Washington Monthly piece, "[f]ederal government expanded on his watch. The conservative desire to outlaw abortion was never seriously pursued. Reagan broke with the hardliners in his administration and compromised with the Soviets on arms control. His assault on entitlements never materialized; instead he saved Social Security in 1983. And he repeatedly ignored the fundamental conservative dogma that taxes should never be raised." The guy was a conservative, sure, but he was a conservative in tension with a Democratic Congress. He didn't touch entitlements, didn't arrest government growth, didn't -- in other words -- actualize any of the policies we associate with Reaganite conservatives.

The leader who did give those approaches a shot was Newt Gingrich. But you rarely hear any Republicans yearning for a leader from the Gingrich school of policy thought. Turns out that when you actually try and cut Medicare, you lose all your seats in Congress. That's the great Republican shell game: Reagan can be idolized because the Democratic Congress helpfully kept him from legislating out his small-government conservatism. When Republicans try, as Newt Gingrich did in the 90s and Bush did with Social Security privatization, they get murdered. So it's back to believing in Reagan, who never really tried, and thus never really failed, but he sure did sound nice talking about it.

Is it something about France that makes people stupid?

(Posted by John.)

I've basically assumed America will never, ever forgive the French in general, and Jacques Chirac in particular, for being right about Iraq.  Fine.  But the sheer volume of ignorant belief (North) Americans have about France is overwhelming sometimes, and this is unbearable with all the coverage of the French election.  Up north you've got Canadian columnists writing that the UK's economy is "far stronger than France's" (it isn't) and that France is a second-rank military power (after the US, everyone's second rank.)  In the US you've got the more common derision for the idea that the French would dare indulge in leisure time and have slightly less money.  Horrors!

Mark Weisbrot has a good column explaining that, no, France's economic problems are no more severe than those faced by any other G8 country, including the US.  At the very least, there's no convincing evidence that the usual proposed "solution" -- more liberalized market reforms -- is going to solve the problems France faces.