Fifty years of black helicopters

Saturday, August 15th, 2009 · 88 Comments »

One of the things that annoys me about the healthcare circus is the claim by the White House that conservative opposition is based in racism. Yes, that is a White House claim, carefully and covertly fed to friendly media outlets: hence the spate of articles and blog posts simultaneously sounding the same note.

It bothers me, first of all, because it’s wrong. I don’t like wrong things. They chafe. Opposition to healthcare reform is as old as the concept of healthcare reform, and unless Harry Truman was a black man, it has nothing to do with racism. It’s part of the rightwing proletarian fear of government — a fear that is cynically stoked by rightwing elites who rely on control of that same government for their own power and profit. (Caveat: no doubt there are some racists involved in the town hall disturbances, just as there are racists everywhere in America. But to claim that racism is the driving factor behind these demonstrations is absurd.)

Rick Perlstein’s essay in the Washington Post, In America, Crazy Is a Preexisting Condition, recaps the last 50 years of rightwing panic. Read it; it will give you a better perspective on what’s going on right now than a thousand hysterical blog posts from the Obama noise machine.

Which brings me to the other reason the racist meme bothers me. Last year the Obama team used false accusations of racism to discredit Hillary supporters and Hillary herself (and Bill). From “fairy tale” to the doctored Mickey Kantor tape to the RFK smear, it was perhaps the ugliest aspect of the campaign — well, apart from the sexism and the caucus fraud. And it was one the Obama camp reached for again and again. How many people, even now, believe that Hillary Clinton engaged in race-baiting? How many believe that PUMAs were motivated not by feminist or democratic indignation, but by racism? Probably at least as many as believe that Saddam Hussein was behind 9-11 and Al Gore claimed to have invented the internet. If you want a lie to become the truth, just repeat it a million times.

Now the racist accusation is being trotted out again. It worked against Hillary Clinton; will it work against the town hall protestors? And if it does, should we be glad about that? “We,” of course, being those of us who are passionately on the side of healthcare reform.

You can guess what my answer is.

Ezra Klein said the other day that what’s really at stake in the healthcare debate is our democracy. He’s correct that the rightwing agitators are awash in propaganda and madness, but if he’s implying that the Obama camp represents rational political discourse, I beg to differ. Anybody who went through 2008 with their eyes open should know better. Klein may be mourning American democracy now, but that’s what I was doing a year ago. My mantra throughout much of 2008 was that if we elected Obama, we’d have the equivalent of two GOPs. Different policies (sometimes), but identical tactics.

Black helicopters all around.

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88 Responses to “Fifty years of black helicopters”

  1. myiq2xu says:

    Instead of trying to persuade the voting public to support health care reform the Obamacrats focused on demonizing their opponents.

    Strange tactics for a post-partisan unifier.

  2. Lorenzo says:

    Perlstein’s piece is not exactly a ringing endorsement of the value of government-provided and highly-regulated education. (I teach, BTW, in both government and non-government schools: the big problem is that the regulator is also the main provider, a conflict of interest whose effects tend to get worse over time.)

    The sort of phenomena Perlstein points to are typically interactive processes: it would not be hard to put together a history of over-the-top rhetoric from the other side (“vast right-wing conspiracy” anyone?).

    Moreover, sentiments which find themselves frustrated in more mainstream outlets tend to end up feeding more rabid forms if that is the only outlet they get. So Europe has rather more rabid fascism than the US in large part because the political mainstream (both politics and media) is, on certain issues, notably narrower than it is in the US.

    Which is no excuse for the paranoia, but does point to things that might lessen it rather than just saying “they’re crazy, they’re crazy!”

    Of course, one has to be willing to concede social space to some form of those sentiments for that to work. John Howard pulled the teeth of One Nation down here in Oz quite successfully, and was thoroughly vilified for his pains because denying any form of those sentiments and concerns any public space was said vilifiers’ aim in the first place.

    (As an aside, the treatment of Pauline Hanson might be a useful study of how the progressives can get quite misogynist when all fired up.)

  3. donna darko says:

    Republicans fear big government and socialism. Their protest of big government and socialism can be manifested in racism. I wrote that Republicans protest of Sotomayor was gender-based but manifested itself in racism and sexism. We know this because Latino male with the exact same qualifications and background would gotten a free pass like Obama and been treated like the Second Coming of Thurgood Marshall.

    How many believe that PUMAs were motivated not by feminist or democratic indignation, but by racism? Probably at least as many as believe that Saddam Hussein was behind 9-11 and that Al Gore said he invented the internet. If you want a lie to become the truth, just repeat it a million times.

    PUMAs are no different than the Iranian protesters protesting a stolen election and the Iranian government’s misogyny which was the basis for the stolen election in the first place. The American and Iranian elections were identical.

    You’ll love the current Ms. issue calendar which says Feministing is on a four-month tour to talk about promiscuity and how the contested 2008 election “hurt feminism.”

  4. Violet says:

    Perlstein’s piece is not exactly a ringing endorsement of the value of government-provided and highly-regulated education.

    Wait, let me guess: turning education over to the free market would result in better schools for more people, plus profits and ponies, right?

    I must say, Lorenzo, it seems that Libertarian Magic Dust is the same down in Australia as it is up here.

  5. Swannie says:

    The Profiteer -in- Chief ( say that fast its more fun)
    is more devoted to WEAKTH CARE REFORM it would seem …and prepare for more tactics that stole him the elction becuz … the very same folks are cashing in ..

    Obama Campaign Ad Firms Signed On to Push Health-Care Overhaul
    By Timothy J. Burger

    Aug. 15 (Bloomberg) — Two firms that received $343.3 million to handle advertising for Barack Obama’s White House run last year have profited from his top priority as president by taking on his push for health-care overhaul.

    One is AKPD Message and Media, the Chicago-based firm headed by David Axelrod until he left last Dec. 31 to serve as a senior adviser to the president. Axelrod was Obama’s top campaign strategist and is now helping sell the health-care plan. The other firm is Washington-based GMMB Campaign Group, where partner Jim Margolis was also an Obama strategist.

    This year, AKPD and GMMB received $12 million in advertising business from Healthy Economy Now, a coalition that includes the Washington-based Pharmaceutical Research & Manufacturers of America, known as PhRMA, that is seeking to build support for a health-care overhaul, said the coalition’s spokesman, Jeremy Van Ess.

    http://www.bloomberg.com/apps/news?pid=20601087&sid=aV3dLt6wmZH4

  6. Swannie says:

    darn.. meant to say WEALTH CARE REFORM , so sorry

  7. donna darko says:

    Now the Nutroots awarded their Steve Gillard award to the blogger who posted the picture of Trig/brought down Palin.

  8. gxm17 says:

    Obama plays a mean game of 11D healthcare circus. Maybe they’re getting single payer in an alternate universe? All I know is I’m ready for the big top to leave town.

  9. gxm17 says:

    Wealth care reform. LOL. Good one, Swannie, I hope you don’t mind if I borrow it.

  10. Aspen says:

    Fauxgressives use the racism slur of as a way of shutting down discourse, period. It’s despicable. And it’s flimsy and transparent. I understand the frustration feminists have about the primaries and anger about how feminist voices have been shut out of all of the mainstream liberal and progressive media. It’s infuriating. Thank maude for feminist blogs.
    I also have to say, that it’s important to point out that most of the indignation about racism from these fake so-called liberals and progressives is faux outrage. Note most of it tends to come from whites who seek to absolve themselves from racism by shifting the blame to other whites thereby giving themselves reason to feel morally superior. They merely pay lip service to racism, for their own self-serving interests. Little is done for POC but rah rah cheering and pats on backs. I believe in fact, for all of the running their mouths, they really don’t care about racism any more than they care about sexism.
    Regarding the right wing protestors, I do think there is a good argument to be made that this anti-government/right wing mentality is at least somewhat correlated with racism, if not unconsciously. There is a compelling article about support for social welfare programs may be lower when the perceived beneficiaries are of a different race. http://www.hks.harvard.edu/news-events/publications/insight/social/edward-glaeser I don’t totally discount racism being a part of this ideology.
    Another thing that has bothered me about some of these town hall events is that the politicians have been so inept at countering the right wing lies being fed. I saw one tape of a right wing, anti-tax protestor claiming that half of all small business have an income of over 250,000$ and would see tax hikes those income brackets. This is an absolute lie, see: http://www.cbpp.org/cms/index.cfm?fa=view&id=2697 and should have been easily countered by the Democratic politician. As should the rest of these socialist oogie boogie man claims. I’m sorry the Democrats cannot seem to find the time to do their homework or learn effective communication skills. The common person knows this small business tripe is just a cover to effect policies to favor the top Richie Rich McRichardsons and corporations, and throw the working people + the middle class who make them rich under the bus.

  11. sister of ye says:

    Republicans fear big government and socialism.

    Not precisely right. Republicans fear “socialist” measures that help average citizens and, especially, the poor. They’re perfectly happy to get tax abatements/incentives, have the public build them sports stadiums, utilize law enforcement to enforce foreclosures, let laws narrow how consumers can get satisfaction, and so on.

    On the social side, they’re perfectly happy to use constitutional amendments to prevent gay people from marrying, and even prosecute them for having sex in their own homes. Not to mention cutting back on women’s reproductive rights.

    I’d be perfectly happy about the rightwing scuttling Obama’s non-plan except for one thing – how they do it sets the frame for future efforts to get health reform. Or more specifically, hampers future efforts for health reform.

    Oh, and Lorenzo? There was a vast right-wing conspiracy to take down the Clintons. Take a look at the funding for digging into their every move in Arkansas. Linda Tripp, who encouraged Monica Lewinsky to pursue an affair with Bill Clinton, was a Republican operative.

    The saddest part is that the Dems allowed it all to happen with no pushback, because while the vendetta was back for the country’s welfare, it handicapped the Clintons in intra-Dem party politics.

  12. sister of ye says:

    That should be “bad for the country’s welfare.” Should have proofread one more time.

  13. Nora says:

    “Regarding the right wing protestors, I do think there is a good argument to be made that this anti-government/right wing mentality is at least somewhat correlated with racism, if not unconsciously. There is a compelling article about support for social welfare programs may be lower when the perceived beneficiaries are of a different race. ”

    Not only is this absurd, its insulting. It is becoming clear that there is no real difference between the left ‘wingnuts’ and the right ‘wingnuts’. You are both all about demonizing those who don’t agree with you. We are lost.

  14. Violet says:

    Aspen, I think the Glaeser interview is interesting. But I’m skeptical of applying the race argument for a couple of reasons.

    First of all, healthcare reform is being perceived on the right not as a wealth redistribution issue, but as a government takeover of everyone’s healthcare. People are alarmed about their own situation, not indignant at somebody else getting healthcare. (Some people are, of course, but I’m talking about the general mood.)

    Secondly, I really question the extent to which racial diversity tracks to welfare hostility. I’d like to see numbers on that for all the states and metropolitan areas. If diversity breeds antagonism to welfare, then places like New York City should be the most hostile to social programs. But I don’t think that’s the case. And whitebread towns like Colorado Springs should be most friendly to social programs, but I don’t think that’s the case either.

  15. yttik says:

    I really worry about the racism meme. I worry that it will breed resentment, that people will lose interest in fighting against real racism. I worry it will be the little people who suffer, some black woman that gets pulled over by a cop, some young guy applying for a job. People who may not have even supported Obama who will be paying the price for all the resentment he is breeding by his cronies constant accusations of racism.

  16. Michele Braa-Heidner says:

    I think sexism, not racism, is the reason for the overwhelming lack of funding for social welfare programs. These programs were designed to take care of others, primarily low income mothers and their children. This taking care of others has been traditionally and historically handled by women and thus, dismissed as not important, underpaid or not paid at all. Further, in current times, domestic workers that are still primarily women are among the lowest paid. Why should Social Welfare programs be any different? We live in a society that deems male self serving accomplishments worthy, and the taking care of others, not worthy.This is about priorities and in our patriarchal society holistic thinking is not held in high regard. I believe that unfortunately this is why we are having such a hard time getting universal health care. This kind of health care would serve everyone regardless of their status or income. The health care system that we have currently was born from patriarchal capitalism and consequently is self serving in nature. A universal health care system on the other hand would be holistic in nature and thereby a threat to the status quo.

  17. Lori says:

    I don’t think you should ever take the right at face value. I don’t think they fear Obama’s reform. I think they’re bloodthirsty thugs, with a strong sociopathic streak, who just want to bring Obama down and deny people healthcare – kind of a two-fer for them. I suspect if someone put a gun to the head of the guy who wheeled his son in the wheelchair up to Dingell’s podium, it would turn out that he knew perfectly well what the Dems were proposing and that his son would not be at risk but found vastly more emotionally satisfying to endorse the hype. I don’t think you can discount the sociopathy running through the right. These people are rarely sincere. Their hysteria looks like theatre.

    As for the racism and the Clintons, one of the things that didn’t get pointed out during the primary, is that Clinton’s foundation is helping provide AIDS medication for two million adults and 200,000 children – the majority of which are in Africa. That’s an astonishing thing for a racist to do. it’s a shame that wasn’t more aggressively pointed out. actions ultimately speak louder than words and that Bill Clinton gets up everyday and goes to work raising money to save the lives of poor Africans says a lot about what he values. It’s gratifying to know that ultimately his presidency will be seen in the light of what he did after he left office. He is singular.

    Also, Obama was willing to risk Clinton’s fury at being called a racist perhaps derailing that help for all those people. that’s the thing about sociopaths – they always set up situations where someone else pays the price. Clinton is too responsible to do that, but it doesn’t change the fact that Obama and his camp were willing to run the risk.

    I’m starting think that conservatives are people who are highly vulnerable to marketing. They are heavily marketed to, but unlike the rest of us, they don’t turn the radio off when they hear crap. They keep listening and embed the hate in their own values and lives. They use it to define who they are. Most people won’t go there. But they do and it sets them apart from the rest of the nation.

  18. Alison says:

    “I don’t think you should ever take the right at face value. I don’t think they fear Obama’s reform. I think they’re bloodthirsty thugs, with a strong sociopathic streak, who just want to bring Obama down and deny people healthcare – kind of a two-fer for them.”

    Lori, do you know anyone on the right who fits that description? I think this is a terrible and dangerous stereotype. I am undecided about which way to go in health care reform (single payer, regulating private sector better, etc.) but I do hang out with a diverse group of people, some of them conservatives. Conservatives do not like the idea of something so personal, such as a person’s health care and whether or not they get treatment, in the hands of the government. Yes, they would prefer to go to have the private sector make these decisions instead. They also do not trust the budget in the proposed bill by Congress. It’s a very philosophical difference and is not nearly as juicy as you describe. Most are not “sociopathic” monsters who enjoy keeping health care from poor families. I don’t know what gave you that idea.

    And interesting for me, as someone who is undecided. Believe me when I say that most people I know want to pummel me for daring to play devil’s advocate over things like single payer, private sector reform, Congress’s present plan, etc. Those who have made their decision are pissed at those who don’t agree with them (or are still trying to learn more) and it’s really hard to have dialogue.

  19. Nora says:

    Lori says: “I’m starting think that conservatives are people who are highly vulnerable to marketing.”

    LOL, I do believe you are thinking of Obots.

    I am rather surprised at the willingness to use a brush to characterize all “conservatives” or all “republicans” as . I used to do it myself untill 2008. I grew up, maybe you should too.

  20. SYD says:

    “I am rather surprised at the willingness to use a brush to characterize all “conservatives” or all “republicans” as . I used to do it myself untill 2008. I grew up, maybe you should too.”

    Same here, Nora.

    Meeting the nuts (and the well meaning) on both sides of the aisle helps a lot.

    Nobody is more susceptible to modern marketing than the average Obot. The propaganda they will swallow whole is beyond explanation.

  21. foxx says:

    Many people in these right wing protests are being manipulated and actually believe what they are saying. But the real purpose of the protests is to make Obama’s plan (= giveaway to the insurance companies) appear liberal and to drown out discussions of medicare for all.

  22. yttik says:

    I hear this meme all the time, Republicans are genetically mutated troglodytes who hate poor people, by default Dems are the knights in shining armor, put in office to bless us with all things wonderful.

    Now that’s a successful marketing campaign.

    It’s also the reason we don’t have the equal rights amendment, we don’t have gay marriage, we’ve gone more than 40 yrs failing to strengthen Roe v Wade. Here we are again struggling with health care and what becomes the excuse for the Dem majority’s failure? Troglodytes. There are these evil trolls who won’t let us ram this bill thru without doing any work to convince the country that we know what we’re doing, that we have a good plan, that we won’t screw you over.

    If we ever get over this idea that Republicans are hopeless and should not even have a seat at the table and that Dems are automatically wonderful, the people might unite with each other and really freak out the government. There would be some serious accountability demanded if blaming it on the other party was no longer a valid excuse.

  23. Elise says:

    We know this because Latino male with the exact same qualifications and background would gotten a free pass like Obama and been treated like the Second Coming of Thurgood Marshall.

    I really have to push back on this one: Miguel Estrada. Please don’t bother to tell me he didn’t have exactly the same qualifications. He was qualified and he was shot down because of his ethnicity.

    Beyond that, I have to agree with some of the later commenters. As long as those on the Right think the Left is full of evil crazies who want to euthanize grandma and the Left thinks the Right is full of crazed troglodytes who want poor people dead we’re stuck in a very bad place. If we stay stuck there then I want to split the country: the Rightists who think the Left is murderous get their own country; the Leftists who think the Right is murderous get their own country. And I want a country to call my own where the rest of us work things out without this kind of insane viciousness poisoning every single political argument.

  24. donna darko says:

    Elise, I mean if a Latino male like the Latino male who was on the short list or Estrada were the nominee like Sotomayor, he would have been given a free pass during the hearing.

  25. donna darko says:

    California Supreme Court Justice Carlos Moreno.

  26. octogalore says:

    What Elise, yttik, SYD and Nora said.

    Also, the characterization of Dems as “pro HC reform” and others as against misses the mark. There are alternatives to a public option which inevitably would morph into a wholesale government takeover. Tort reform, coupled with focus on those citizens who cannot afford health care, would go a long way.

  27. Moo says:

    First of all, I just want to say I’m new to the blog, I was lead here by others attracted to your Palin musings.I really like what Ive seen so far from you Violet. Its refreshing and I love reading the comments, it shows me there are people of differing views willing to discuss whats going on and come to agreements and conclusions without acting like children. Of course no blog or article is completely free of trolls wanting to hurl insults to make themselves feel better.
    I consider myself a conservative woman, and I wanted to share how I feel about social programs. I do agree they are needed, I have never been raised (by my conservative family) to discount these programs, and am a believer and supporter of planned parenthood. But we are wary of the fraud, abuse, and waste that tend to plague some programs.
    http://www.democratandchronicle.com/article/20090814/NEWS01/908140341/Brooks+says+aid+program+flawed&referrer=NEWSFRONTCAROUSEL
    Just a recent read I came by yesterday that makes me roll my eyes and wonder how the government can do HC better. This is the kind of stuff that annoys the crap out of us. I don’t feel that the conservative majority wants women and children to suffer but we are painfully aware that our hard earned money is going towards people that would rather have fancy cars, tv’s, and phones and that some people receiving assistance have no intentions of helping themselves or their children lead healthy productive lives and we are reminded that these people are out there getting money better used else where. My feelings are, lets correct the problems we see with these programs, instead of throwing more money at the problems (I would like these politicians to have a well thought out plan before implementing it, and I don’t think dems or repubs are capable of doing so). You see churches, food banks, private charities of all sorts, and Celebrities and yes the Clinton’s themselves kicking ass where the govt. looks like a bunch of bumbling idiots.
    I feel HC reform needs to happen but why not discuss alternatives, maybe tackle this one piece at a time? If you went to a town hall meeting to get some insight and all you are presented with are the views of proponents and no dissenting arguments I think it wouldn’t set well with you. I don’t condone getting into shoving and screaming matches but we all have a right to hear all sides here. We are always having to dig and look and check who’s lying/misleading or has something to gain, this is exhausting…add to the fact we are at each others throats…

    Anyways thanks for the blog! I’m hooked.

  28. Violet says:

    Many people in these right wing protests are being manipulated and actually believe what they are saying.

    I agree with you.

    I think the common denominator there isn’t racism, but ignorance. Of course, America is an ignorant country all around. But people on the right are typically ignorant of how economics and government work, to a really distressing degree (distressing since that’s precisely the area where they think they have great insight). Their confusion is largely due to having listened for decades to the preachers of free market religion — which is a religion, make no mistake. Runs on faith, no evidence required. (Indeed, all the evidence shows that unregulated capitalism is a nightmare.) They actually believe that the free market makes everything better, that a society pooling its resources can’t do anything right, etc. And they adamantly refuse to actually study the question, or god forbid look at how other countries do it.

    Just on this blog I’ve been amazed to see how many people don’t understand how insurance works or what it’s for, or what Medicare is, or how other countries handle healthcare, or anything else. Appalling.

  29. Violet says:

    My feelings are, lets correct the problems we see with these programs, instead of throwing more money at the problems

    If you looked into it, you would learn that private insurance has 30% overhead, while Medicare has only 3%. The waste is in the private insurance industry, which gobbles up profits and creates enormous overhead.

    but we are painfully aware that our hard earned money is going towards people that would rather have fancy cars, tv’s, and phones and that some people receiving assistance have no intentions of helping themselves or their children lead healthy productive lives and we are reminded that these people are out there getting money better used else where.

    So you would personally rather continue to spend 30% more than you have to — of your “hard-earned money” — on private health insurance just so you can keep poor people from having health insurance. Well, chalk one up for game theory.

    Also: “fancy cars”? Yeah, being poor is a real trip.

  30. Branjor says:

    Heaven forbid any poor people should have a phone. They might be able to call for help in an emergency.

  31. Toonces says:

    Malpractice suits are not the cause of high healthcare/medical costs:

    http://www.law.harvard.edu/programs/petrie-flom/workshops_conferences/2008_workshops/lakdawalla.pdf

    http://www.citizen.org/documents/NPDB%20Report_Final.pdf

  32. Nora says:

    This study concludes that “often claimed Medicare Admin cost advantage” is not accurate.

    http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf

  33. AniEm says:

    Elise: “And I want a country to call my own where the rest of us work things out without this kind of insane viciousness poisoning every single political argument.”

    Wow. That sentence speaks for so many of us in this country who are tired of the circuses and games right and left.

    I think most of the people in this country would agree with Elise, but at this time our political leadership is incapable of soul-searching or integrity and the “war” between the two parties is pure charade, designed to give constituents the illusion of choice.

  34. tinfoil hattie says:

    Also: “fancy cars”? Yeah, being poor is a real trip.

    Come on, Violet. You know that poor people don’t deserve anything nice, ever. They don’t deserve television, the cheapest entertainment (okay, that’s debatable) available. Their children don’t deserve toys, they don’t deserve computers or high speed internet. Let them use the well-funded public librarires! Poor people also don’t deserve birthday cakes, ice cream, organic produce, or anything other than beans, rice, iceberg lettuce, hand-me-down clothing, and crappy cars.

    Get with it, will you?

  35. Violet says:

    This study concludes that “often claimed Medicare Admin cost advantage” is not accurate.

    The study is from a health insurance industry front group! Jesus Christ! Do you also think cigarettes are harmless because the tobacco industry says so?

  36. Toonces says:

    If I didn’t have healthcare and got sick, it probably wouldn’t matter much to me whether I was being denied out of hate or indifference.

  37. octogalore says:

    Toonces, per a recent article in the New England Journal of Medicine, tort reform would alleviate “a substantial driver of the escalation of health care costs.”

    http://content.nejm.org/cgi/content/full/NEJMp0903765

  38. Toonces says:

    LOL, they don’t offer any numbers. LOL, was I not supposed to actually read the link?

    Here’s the full quote with some extra:

    There are at least three reasons why government champions of health care reform might consider bundling medical liability reform in the same package. First, one piece of conventional wisdom that is shared by those on both sides of the political aisle is that “defensive medicine” spurred by concern about malpractice liability is a substantial driver of the escalation of health care costs. These costs are notoriously difficult to estimate, and analysts disagree about the magnitude of their contribution to overall health expenditures.2 But trimming even 1% of total health care spending would save around $22 billion per year — not a trivial amount, particularly in lean times.

    Second, health care reformers understand that they will have to garner physician support for an omnibus bill that will no doubt create a more stringent financial environment for health care providers. Expansions of public insurance programs, including models generating stiffer market competition between public and private health plans, will entail changes in the payer mix that are unfavorable for providers and exert continued downward pressure on reimbursement rates. What can reformers offer physicians as a quid pro quo? The answer is malpractice reform. Most physicians find the litigation system unfair, financially and psychologically burdensome, and unhelpful in promoting safety and quality. They would welcome relief of some sort.

    Third, bundling tort and health care reform may help to attract support from congressional Republicans for a health care reform package. Many key Republicans agree with physicians about the problems with the tort system and have worked hard in the past to develop proposals for medical liability reform. A bundling strategy would offer them the chance to advance their agenda in exchange for helping the President achieve his vision of bipartisan health care reform legislation.

    The second cite just leads to Baucus’s site… WTF?? *head scratching*

  39. reader says:

    Well Octo, that would depend on the nature of the tort reform. Check out:
    http://www.tortdeform.com/

  40. reader says:

    Also Octo what the article says is “First, one piece of conventional wisdom that is shared by those on both sides of the political aisle is that “defensive medicine” spurred by concern about malpractice liability is a substantial driver of the escalation of health care costs. These costs are notoriously difficult to estimate, and analysts disagree about the magnitude of their contribution to overall health expenditures.”

  41. Elise says:

    But Estrada *wasn’t* given a free pass during his hearings. He was filibustered to death. As for Medicare, it appears that part of its low administrative overhead is its decision to ignore fraud. Something to keep in mind when someone like Arlen Specter talks about saving money stamping out fraud. It may well work but Medicare won’t have administrative costs of 3% any longer. Yes, there are other costs in private insurance like marketing which it might be nice to do without but some of the costs also have to with administering a zillion different plans and I like having that choice.

    As for ignorance, reality, and insanity, I don’t agree that people on the Right are ignorant – or crazy any more than people on the Left are. My personal belief is that capitalism is the best engine for driving progress but that untrammeled capitalism is a disaster. The trick is to balance freeing up that engine with making sure it doesn’t run over everyone in its path. I know very few people who are for untrammeled capitalism. Even Megan McArdle who considers herself primarily a libertarian has up a post in which she acknowledges the need to correct for free-rider problems and negative externalities – while also talking about the cost to innovation if we go to a government-run system.

    Frankly, the idea that if only people really knew the facts and really thought about things correctly they’d all come to the same conclusion is pretty insulting. When you say that you’re telling me that either: I’m not too bright; I’m not too knowledgeable; I’ve been fooled into thinking what I think (which is really just the first two in a different form); or I’m deliberately lying about the truth.

    Ironically, I got into a vicious fight at neoneocon with a few guys who insisted that what I thought I knew about feminism was all wrong. If I really knew the facts and thought about things correctly, I’d come to the same conclusions they had. Since my conclusions differed, it was clear to them that I was an idiot who’d been fooled by evil socialists into thinking women were oppressed and feminism was the answer – or I was an evil socialist myself. I didn’t like that attitude any better coming from the right than I do coming from the left.

    I don’t always manage it but the creed I strive to live by is from Joseph Addison:

    A man must be both stupid and uncharitable who believes there is no virtue or truth but on his own side.

    (The guy’s like 300 years old so I forgive him the word “man”.)

    What would I like from health care reform? The one thing everyone has forgotten about: insuring the uninsured.

  42. alwaysfiredup says:

    It’s a really tough issue, hence why we haven’t gotten health reform yet. I’m just going to throw some things out here.

    I will look around for support links, but I am under the impression that the real driver of health costs in this country is that we are constantly upgrading to newer and more expensive technology, which gives us really good care in some areas but costs an arm and a leg and is completely out of reach for a substantial portion of the population.

    Let’s say I am an old hospital in a growing suburb. My competition just built a shiny new facility with the very latest in medical imaging machines and when you walk into the place it just feels 21st century hi-tech. All of my patients now want to go there. So I shell out a ton of cash to buy the latest machines and remodel my space to look super high-tech too.

    Now what we have is two very nice, very expensive facilities. Is this a bad thing? We probably could have gotten more use for less cost without undertaking the remodel. But if that becomes the policy, doing without updates to save money, in a very few years everything in the place is obsolete and falling apart and people are getting worse care than they otherwise could. And if people have a choice as to hospitals, the one that did not update will lose patients. To curb this trend you would have to have central planning for how many hospitals each area needs and limits on who gets shiny new equipment. But this will also result in worse care than would otherwise have been provided because the latest medical imaging machines will catch cancer sooner and the remodeled space is easier to clean and helps lower the incidence of hospital infections. And central planning inevitably moves too slow so the upgrades a hospital may desperately need will be delayed because of red tape.

    For all it faults, a market can tell what is going to be needed, and provide it, more efficiently than any central planning agency. It’s not a perfect mechanism, it’s just the best we know of. So I’m leaning toward finding a way to preserve the market. Maybe we could get by with creating some kind of government reinsurance program where the government assists with the cost of catastrophic illness care in exchange for no pre-existing condition limitations. Maybe we should all be required to have health insurance of some kind to prevent people from just getting it as soon as they get sick. I do not think giving patients financial incentives to use less health care, like the HSAs, is helpful because patients do not have very good information; they just want what their doctor says they need.

    Any thoughts on allowing insurers to offer very low cost plans in exchange for insureds promising not to sue? I know it’s hugely against public policy in many states to limit people’s right to legal redress, but it might also reduce the practice of defensive medicine and obviate the need for tort reform. Maybe there could also be a pool of money available to assist people who have been seriously injured by a medical mistake. But this just begs another question: Is it better for poor people to get care and have their legal rights circumscribed than to be free to sue but get insufficient healthcare?

    As I said, no good choices. Sorry for the extended post.

  43. Violet says:

    I will look around for support links, but I am under the impression that the real driver of health costs in this country is that we are constantly upgrading to newer and more expensive technology, which gives us really good care in some areas but costs an arm and a leg and is completely out of reach for a substantial portion of the population.

    No, the real driver of health costs in this country is private insurance, which has a built-in profit factor and huge overhead.

    alwaysfiredup, with all due respect: your comment is a pretty good example of the kind of mass confusion that reigns on this issue. No one is talking about central planning agencies; people now don’t have much choice about hospitals (it’s up to their insurer) and in fact would have more choice under Medicare for All; and the free market competition you’re imagining fundamentally does not exist or even apply in the healthcare business.

  44. Violet says:

    If people would stop drinking the free market kool-aid for just a half-second and think about the issue — or, god forbid, study how every other industrialized nation in the world deals with healthcare — this miasma of confusion would dissipate.

    If we need two trillion dollars to pay for everybody’s healthcare in this country, the cheapest, simplest thing to do is to have everybody chip in so we have a two trillion dollar kitty. End of story.

    The most ridiculous thing to do would be to instead filter everyone’s healthcare through private insurance companies which would automatically jack up the price by their profit margin, would deny claims wherever possible (because it serves their bottom line to avoid paying for people’s health care), and would be too expensive for most people to pay for unless they’re employed — and that’s another feature, these private insurance plans would be available through employers, thus tying healthcare to jobs (and to main breadwinners), rather than to individuals. And of course some 47 million Americans would be completely uncovered. And all for two and a HALF trillion dollars!

    Our current system makes no sense. If Rube Goldberg designed a healthcare system, it couldn’t be more absurd than what we have now.

  45. Violet says:

    Yes, there are other costs in private insurance like marketing which it might be nice to do without but some of the costs also have to with administering a zillion different plans and I like having that choice.

    Most people would like to have the choice of going to any doctor they like and having their bills covered, which is what Medicare for All would do. You prefer the “choice” of having to choose from different insurance plans, each of which probably restricts the doctors you can see, requires co-pays, and limits what you can have done. And costs more.

    So: you prefer to pay more to get less.

  46. RKMK says:

    It’s a really tough issue, hence why we haven’t gotten health reform yet.

    It’s actually really, really not. Many other countries have figured it out, with a minimum of fuss. Either the US values the health and lives of its citizens, regardless of their income, or it doesn’t.

    (Clearly, it doesn’t, and never really has.)

  47. alwaysfiredup says:

    It’s a tough issue if you don’t like any of the current models for health care delivery. I suppose it’s easy if you have one you like.

    Regarding choice: I don’t even really think I have much in the way of insurance choice right now; I get what my employer offers. I have very little idea of the overall cost since I’m only exposed to my premiums and copays, which don’t represent the whole apple. I do have a wide selection of doctors and hospitals to choose from, as I have also had under most past insurers.

    “No one is talking about central planning agencies”? Violet, I thought you were a proponent of single payer? I guess I am not familiar enough with your medicare-for-all term to know what all would be included. But some agency has to administer medicare-for-all, so that suggests some kind of centralized planning agency.

    If we are talking about HB 3200, my understanding is that PPOs are to be eliminated and we are all to go to HMOs approved, and possibly may choose one provided, by the federal government. But that would leave insurance companies in the mix and I believe I have read enough to know you do not approve of health insurance companies, so maybe that is not what we are talking about.

    My ruminations about central planning came from stories abt the British system, which does decide where new hospitals will be built and who will be allowed to go to them and who will get what new equipment and such. I also know a truly free market doesn’t exist in US healthcare, any more than it exists in any other industry here. But some markets are more free than others and some policies can lead to freer markets than others. I am not here to spout right-wing talking points; I don’t even like many of their proposals, such as those catastrophic plans coupled with health-savings accounts. The one thing I am absolutely sure of is that markets are able to allocate resources more effectively than central planning, so an ideal system would include functioning market elements. And yes, this does mean profit, and greed, will have to be part of the system. To claim that a plan without those elements will function is to deny human nature IMO.

  48. Violet says:

    “No one is talking about central planning agencies”? Violet, I thought you were a proponent of single payer? I guess I am not familiar enough with your medicare-for-all term to know what all would be included. But some agency has to administer medicare-for-all, so that suggests some kind of centralized planning agency.

    Single payer = Medicare. Single payer = Tricare. It’s not “single provider”; it’s single-payer.

    My ruminations about central planning came from stories abt the British system, which does decide where new hospitals will be built and who will be allowed to go to them and who will get what new equipment and such.

    The British system is National Health, in which doctors are employed by the government and hospitals are owned by the government. No one is proposing that system for the U.S.

    Single payer does not equal national health. Two completely different things.

    What I said about mass confusion. Which is clearly no bar to strong opinions.

  49. Violet says:

    alwaysfiredup, you don’t know how Medicare works, do you? No clue, right? But that doesn’t stop you from arguing that it would be bad to extend it to more people.

  50. Violet says:

    I am not here to spout right-wing talking points

    You’re not? But where did you get the idea that single-payer means something other than Medicare? Where did you get the idea that single-payer means nationalized health with government-owned hospitals and government-paid doctors and some kind of Communist central planning board?

    Because the only place you could possibly get that is from right-wing liars.

  51. donna darko says:

    Elise, at the federal level, men of color seem to get a free pass like Obama. It was outrageous last year compared to the sexism Clinton and Palin faced. Moreno would have gotten a free pass too.

  52. RKMK says:

    It’s a tough issue if you don’t like any of the current models for health care delivery. I suppose it’s easy if you have one you like.

    Yep, I like my Canadian, single-payer healthcare, that I estimate costs me (probably) a max of $200-300 a month, where I can choose any doctor I like and can go to whatever drop-in clinic, doctor’s office, or hospital I choose, by simply flashing my provincial health card at the reception desk.

    (As my old politics professor said: “Canada: where a pack a cigarettes is $14, but a heart transplant is free.”)

  53. Elise says:

    Dr. Socks, what’s an example of a country that has a Medicare for All type system of the sort you favor here?

  54. alwaysfiredup says:

    Ha. I suppose I might be accidentally spouting right-wing talking points at that. I will therefore prove my ignorance.

    My understanding is Medicare works by enrolling people in a program, enrollees with higher incomes pay a monthly premium but poorer enrollees do not, enrollees visit doctors, doctors apply to Sebelius’ department for reimbursement for tests, procedures, hospital stays etc, and most reimbursements inevitably come back lower than the cost of providing care. Any services that are reimbursed above the cost of provision are mercilessly exploited so that the docs and hospitals aren’t drowning in red ink. AKA “fee for service” compliments of uncle sam. I also understand there are some tests, procedures, care etc. that Medicare won’t cover, so people who can afford it purchase Medicare Advantage health plans (like regular health insurance) to cover those costs at an additional monthly premium.

    I now understand that when you say “medicare for all” you are envisioning people able to choose whatever health provider they want and the gov’t pays for it. I do not know how the gov’t will be able to afford to do so unless the docs agree to accept medicare rates. Do you envision forcing them to do so?

  55. Violet says:

    I think Canada is the closest analog, though not identical. No countries have identical systems, since each nation has its own history and particular markets and mix of policies and approach to revenue. But the general Canadian approach is what’s called single-payer.

    Medicare for All in this country would be an expansion of our existing Medicare system, which is already a single-payer system for everyone over the age of 65.

  56. Violet says:

    alwaysfiredup, I see you are here to spout rightwing talking points. Excuse me for not indulging you, but I don’t have a whole lot of patience with rightwing bullshit.

    Here’s a website for you to study: http://www.pnhp.org/

    I won’t be approving any more comments from you until you can demonstrate that you’ve read and thoroughly understood everything there.

  57. Toonces says:

    http://content.nejm.org/cgi/content/full/354/19/2024

    “Our findings point toward two general conclusions. One is that portraits of a malpractice system that is stricken with frivolous litigation are overblown. Although one third of the claims we examined did not involve errors, most of these went unpaid. The costs of defending against them were not trivial. Nevertheless, eliminating the claims that did not involve errors would have decreased the direct system costs by no more than 13 percent (excluding close calls) to 16 percent (including close calls). In other words, disputing and paying for errors account for the lion’s share of malpractice costs. A second conclusion is that the malpractice system performs reasonably well in its function of separating claims without merit from those with merit and compensating the latter. In a sense, our findings lend support to this view: three quarters of the litigation outcomes were concordant with the merits of the claim.
    However, both of these general conclusions obscure several troubling aspects of the system’s performance. Although the number of claims without merit that resulted in compensation was fairly small, the converse form of inaccuracy — claims associated with error and injury that did not result in compensation — was substantially more common. One in six claims involved errors and received no payment. The plaintiffs behind such unrequited claims must shoulder the substantial economic and noneconomic burdens that flow from preventable injury.33,34 Moreover, failure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims.10,11
    In addition, enthusiasm about the precision of the malpractice system must be tempered by recognition of its costs. Among the claims we examined, the average time between injury and resolution was five years, and one in three claims took six years or more to resolve. These are long periods for plaintiffs to await decisions about compensation and for defendants to endure the uncertainty, acrimony, and time away from patient care that litigation entails.
    In monetary terms, the system’s overhead costs are exorbitant. The combination of defense costs and standard contingency fees charged by plaintiffs’ attorneys (35 percent of the indemnity payment) brought the total costs of litigating the claims in our sample to 54 percent of the compensation paid to plaintiffs. The fact that nearly 80 percent of these administrative expenses were absorbed in the resolution of claims that involved harmful errors suggests that moves to combat frivolous litigation will have a limited effect on total costs. Substantial savings depend on reforms that improve the system’s efficiency in the handling of reasonable claims for compensation.

    http://www.ajph.org/cgi/content/abstract/96/8/1375

    Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care.
    We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.

  58. Toonces says:

    Also, hold onto your pants, but we’re already a mostly socialized system. Yup, even the private insurance is subsidized by us, the taxpayers. We just pay more for less (well, less care but more CEO vacations).

    http://www.pnhp.org/facts/singlepayer_faq.php#publicl_financed

  59. Elise says:

    I’m nobly resisting the temptation to fight about the Canadian health system but I do – in all seriousness – have a question about single-payer health care in general. Why do those on the left trust the government with this? You refer to Klein’s article in which he says it’s insane for citizens to think their government is capable of madness. But there are libertarian responses out there that argue otherwise, citing specific examples of government madness. Wilkinson, for example, speaks of the Iraq war and the war on drugs as reasons why no one should trust the government to do the right thing. So why should I – and why do you?

    I’m not arguing that insurance companies – or even necessarily medical care providers – are more trustworthy. But they do have constraints on their ability to misbehave both in terms of their own self-interest and in terms of the government acting as a balance of power. (I live in NJ where the latter is very much in evidence.) The government is unconstrained. If the economy is still in the doldrums in 2012 and the country reacts by electing a Republican President and Congressional majority what would prevent them from deciding that single-payer simply won’t pay for some services? Yes, the obvious stuff to worry about is abortion and birth control but I’m actually thinking of something more subtle – like refusing to pay for alcohol and drug addiction treatment. Given the high recidivism rate it would be incredibly easy to make the case that such treatment is a waste of tax dollars. And beyond that it’s a simple step to restricting other types of treatments for people who are alcoholics or drug addicts since they’re a bad bet for general health. Who will say them Nay?

  60. RKMK says:

    Well, Elise, the short answer is that our population is plagued by crazed wingnuts and widespread ignorance. We are not afflicted by a strange hatred and disregard for our citizens. We are lead by the principles of Peace, Order, and Good Government.

    The slightly longer answer is that we don’t operate by a reimbursement principle. I walk into a clinic for my birth control, for example, where the receptionist logs my health card number. I go in and see the doctor, who prescribes my birth control (for example) and administers it on the spot. (I have to pay up front for the drugs themselves, but they are covered by my employer drug plan.) Then I leave, without seeing a bill. The clinic then sends the bill for the doctor appointment to the province. (Note that there is no maximum doctor visits. If I go in for birth control one week, and for flu treatment the next, and a sprained ankle the next, same procedure applies.)

    At no time does the government tell me what doctor to see, or what services that doctor can provide for me. If I am admitted to a hospital for more serious care, everything is handled in a similar fashion. The doctor has deemed the care necessary for my health, so the province foots the bill. They cannot deny coverage, because I don’t submit forms for reimbursement.

    (This includes abortion, by the way. This shocks American sensibilities, but the procedure is classified (rightly) as a component of women’s general health care, even if it’s “elective.”)

    As for widespread public health issues that affect tax dollars, minimizing things like cancer, heart disease, obesity, etc, usually take the form of public health campaigns (healthy living and exercise promotion) and industry regulations (i.e. water quality, tobacco industry, etc.). But individual freedoms are rarely compromised (the caveat being such things as secondhand smoke regulations – smoking isn’t illegal, but where you smoke, and how it affects the health of others, is.)

  61. RKMK says:

    Well, Elise, the short answer is that our population is plagued by crazed wingnuts and widespread ignorance.

    Cough. Is NOT plagued.

    I do admit that some measures need to be firmly set in place in the American system so that wingnuts can’t limit health care based on their personal politics, because I can totally see Republicans getting all up in people’s birth control, etc.

  62. Toonces says:

    Elise, these may not completely answer your question(s) but they may help:

    http://www.pnhp.org/facts/singlepayer_faq.php#rationing

    http://www.pnhp.org/facts/singlepayer_faq.php#run_system

    http://www.pnhp.org/facts/singlepayer_faq.php#bureaucracy

    http://www.pnhp.org/facts/singlepayer_faq.php#board

    http://www.pnhp.org/facts/singlepayer_faq.php#walter_reed

    http://www.pnhp.org/facts/singlepayer_faq.php#response-papers

  63. iiii says:

    Funny, I keep wondering why those on the right are so convinced that single-payer would be worse than what we have now. I seriously do not get it.

    My father had really good insurance as part of his retirement package. He saw a doctor regularly. Actually, he saw a rotating cast of doctors, rarely the same one twice. He kept telling them about the abdominal pain. Without doing any tests, they told him it was a pulled muscle. He eventually pointed out that he’d been an athlete in his youth and knew what a pulled muscle felt like, this did not feel like a pulled muscle, and it was not normal for a pulled muscle to take over a year to heal. Without doing any tests, they told him it was diverticulitis and began treatment for that. He dropped a hundred pounds in six months. My sister went with him to an appointment and argued with the doctors and the bureaucrats until they did the damn tests they should have done three years before. By then the stomach cancer was totally inoperable.

    Dad died nine weeks later.

    My mother died on Medical, so it’s not like I have an overly rosy vision of what government-paid health care is like. It’s just, I’ve seen both. Private insurance has all the defects of government-paid, *and* it’s more expensive.

    I don’t get it.

  64. donna darko says:

    They are very brave. They go and they get beat up every day and they come back and they say I hurt, I hurt there, and then the next day they go back and they get pepper sprayed, beaten up, it’s amazing.

    PUMAs or Iranian women protesters?

  65. Elise says:

    Apparently I was not clear enough, RKMK. My question was addressed to Dr. Socks and was not intended as a question about the Canadian health care system although I appreciate the information you provided – if not the editorial content. (I guess Anne Doig and Robert Ouellet are the Canadian version of ignorant wingnuts.)

    At no time does the government tell me what doctor to see, or what services that doctor can provide for me. If I am admitted to a hospital for more serious care, everything is handled in a similar fashion. The doctor has deemed the care necessary for my health, so the province foots the bill. They cannot deny coverage, because I don’t submit forms for reimbursement.

    No limits at all? Cosmetic surgery for example or some forms of alternative care like accupuncture or herbal medicine? Extremely expensive procedures with a very low success rate? I’m not saying those *should* be covered, I’m just trying to figure out where the limits are – or if the care is truly unlimited.

  66. Elise says:

    Toonces, thanks. I did read through those – that was the homework Dr. Socks assigned. The FAQ explains why those who support single-payer think it will work and work better than what we have now but do not really answer my question about trust.

    I found it ironic that the FAQ offered up Walter Reed as an example of why single-payer is better: even if you buy their argument about IAP it was political pressure that resulted in IAP being given the contract. I’m not likely to find that reassuring in this context – it’s kind of like Obama’s smooth move in referencing the USPS.

  67. RKMK says:

    Cosmetic surgery for example or some forms of alternative care like accupuncture or herbal medicine?

    Medically necessary treatment is covered; cosmetic surgery is a grey area – i.e. I broke my nose and have a deviated sceptum, ergo, OHIP would cover rhinoplasty for me. I imagine burn victims would have skin grafts covered, etc.

    Because the government covers medically necessary treatment, employers often offer extra coverage, i.e. extended dental and visual, chiropractory, acupuncture, etc.

  68. RKMK says:

    Oops, meant to include a link to OHIP

  69. RKMK says:

    (Oh, and from the Ministry Programs page, information on public addiction and mental health assistance.)

  70. octogalore says:

    Toonces, your first link in #57 backs up the need for reform. Certainly, malpractice cases need to be pursued, but reform in terms of the attorney fee structure is critical. With needed specialties like orthopedics coming along with low to mid six figure malpractice policies annually, and shortages resulting, that’s a problem. Additionally, while the second link shows fairly low cost savings from their chosen models, others, per my sister in law who’s a med mal attorney, are much more effective.

  71. Toonces says:

    I was never arguing against tort reform. It seems it might be a good idea considering the number of medical errors that aren’t addressed. But what you said was that tort reform would go a long way towards reducing the cost of healthcare, and that’s simply your opinion, apparently based on the opinions of two doctors who wrote an article, which is… based on their opinions. In other words, you’ve provided no data to back up that assertion.

    This study estimates the costs of malpractice suits as 5.7% of increased healthcare expenditures:

    http://www.law.harvard.edu/programs/petrie-flom/workshops_conferences/2008_workshops/lakdawalla.pdf

    Policymakers and the public are concerned about the role of medical malpractice liability in driving up the total cost of medical care. We use variation in the generosity of local juries to identify the causal impact of malpractice liability on medical costs and mortality. In stark contrast to the literature on malpractice costs and outcomes for high-risk patients, we find modest effects of malpractice on total medical costs—growth in malpractice payments over the last decade and a half contributed no more than 5.7% to the total real growth in medical expenditures, which topped 33% over this period. Moreover, while malpractice liability leads to only modest improvements in patient health outcomes, the value of these improvements more than likely exceeds the impact of malpractice on medical costs. Therefore, tort reform is unlikely to have a major impact on US health care spending, and is also unlikely to be cost-effective over conventionally accepted ranges for the value of a statistical life.

    The findings here, as in my link in #57, are that the malpractice system produces “rational outcomes” rather than the Litigious Librulz driving up costs for everyone else with their frivolous lawsuits, and in fact, if there is any need for reform it is needed to favor the patient:

    http://www.citizen.org/documents/NPDB%20Report_Final.pdf

    Key Findings
    Part I: The Medical Liability System Produces Rational Outcomes
    a. Annual Number of Malpractice Payments Is Down
    b. Medical Malpractice Payments per Population Continue to Decline
    c. Total Value of Malpractice Payments Flat Since 1991
    d. Judgments Are Not Irrational
    e. Million-Dollar Judgments Are Less Than 1 Percent of the Total Number of Payments
    f. Million-Dollar Judgments Were Less Than 3 Percent of Total Value of Payments in 2005
    g. Severe Injuries Account for a Majority of Payments
    h. Medical Liability System Is Rational In Outcomes
    i. 82 Percent of Total Value of Payments Compensate Most Severe Injuries
    j. The Proportion of Surgical and Obstetrics Payments Flat Since 1991
    Part II: Patient Safety and Doctor Discipline
    k. Some Common, Preventable Errors Are Increasing
    l. Easily Preventable Errors Show a Marked Increase Since 2003
    m. Since the Beginning of the NPDB, 5.9 Percent of U.S. Doctors Were Responsible for 57.8 Percent of the Number of Medical Malpractice Payments
    n. Doctors with Repeated Malpractice Payments Experience Few Consequences
    o. Many Serious Repeat Offender Doctors Are Not Disciplined

  72. Toonces says:

    Also:

    http://www.pnhp.org/facts/singlepayer_faq.php#malpractice

    What will happen to malpractice costs under national health insurance?

    They will fall dramatically, for several reasons. First, about half of all malpractice awards go to pay present and future medical costs (e.g. for infants born with serious disabilities). Single payer national health insurance will eliminate the need for these awards. Second, many claims arise from a lack of communication between doctor and patient (e.g. in the Emergency Department). Miscommunication/mistakes are heightened under the present system because physicians don’t have continuity with their patients (to know their prior medical history, establish therapeutic trust, etc) and patients aren’t allowed to choose and keep the doctors and other caregivers they know and trust (due to insurance arrangements). Single payer improves quality in many ways, but in particular by facilitating long-term, continuous relationships with caregivers. For details on how single payer can improve the quality of health care, see “A Better Quality Alternative: Single Payer National Health Insurance.” For these and other reasons, malpractice costs in three nations with single payer are much lower than in the United States, and we would expect them to fall dramatically here. For details, see “Medical Liability in Three Single-Payer Countries” paper by Clara Felice and Litsa Lambkros.

  73. octogalore says:

    Toonces, my opinions aren’t based simply on one study. Having practiced law and having some familiarity with this field, it’s clear to me that your study estimating the costs of malpractice suits as a percentage of increased healthcare expenditures doesn’t take into account a number of factors, such as the full extent to which doctors pass along increased costs of malpractice insurance to patients. The study looks at total medical costs and doesn’t adequately isolate this factor.

    Additionally, your cite in #72 is based on various assumptions about single payer which are not definitively proven, and about which there are vehement arguments on both sides. Also, the “half of all awards” appears to deal with compensatories. Punitives are much larger.

    I appreciate the time you have taken to find cites and there is no reason why you should find my arguments compelling without them. Mine are based on a kind of gut experience as well as conversations with people in both legal and medical fields, and while it’s easy to pull up partisan views on either side, we all form the conclusions we feel are best.

  74. RKMK says:

    Having practiced law and having some familiarity with this field…

    Mine are based on a kind of gut experience as well as conversations with people in both legal and medical fields

    Ah, anecdata.

  75. Elise says:

    Ah, anecdata.

    Sadly, given the hyper-partisanship surrounding almost all issues these days it is very difficult to find unbiased research. Or perhaps more accurately, it is quite easy to find research supporting whichever side of an issue you happen to like (which you can then cite approvingly) as well as research supporting whichever side of an issue you happen to despise (which you can then shred for a whole armful of methodological, data, and bias problems). Your opponents can then explain why your research suffers from its own similar problems and dredge up yet more research to support their side. Which you can then shred and so on.

    Since we all have lives – or at least a reasonable facsimile thereof – we don’t have the time to wade through all the claims and counterclaims and we’re pretty much left with our guts (or anecdata, I like that). So we give more weight to facts that support our views and less to those that contradict them. (See “confirmation bias”.) The best we can hope for is that we keep a mind open enough to actually recognize actual information that actually contradicts our viewpoint. Failing that we can hope for the ability to realize that people who hold the opposing viewpoint may have perfectly valid reasons for doing so.

    To me, the bottom line is that in a subject as complicated as health, health care, and health insurance, there is no one right answer; there are many right answers and many wrong answers. Right now I’m enamored of Goldhill’s plan in the Atlantic if we want to do a complete overhaul. But there are other approaches short of a complete overhaul that I think will accomplish my goal (she said tiresomely): insuring the uninsured. Or, if you prefer, getting everyone decent health care.

  76. octogalore says:

    RKMK, as Elise said, it’s quite simple, if time-consuming, to find support on either side of this issue. Because you don’t like my views, it’s easy for you to write off my experience as meaningless; to me it’s helpful in making determinations as to which studies have fewer holes.

    Here is an example: http://en.wikipedia.org/wiki/Tort_reform.

    There are a number of cites making the point I’m making and also cites opposing that point. Any of us here, myself humbly included, have the very rudimentary skills needed to put forward those studies in support of our own views. Therefore, it is also legitimate to note the context of our views.

    To give examples of studies showing tort reform reduces health care costs considerably, the Journal of the AMA 2005 study referenced in the wiki cite shows that:

    “93% of physicians surveyed reported practicing defensive medicine, or “[altering] clinical behavior because of the threat of malpractice liability.” [32] Of physicians surveyed, 43% reported using digital imaging technology in clinically unnecessary circumstances, which includes costly MRIs and CAT scans.[32] Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious.[32] This practice restriction hits rural areas especially hard, as small towns find themselves without practitioners in high-risk areas such as obstetrics and emergency medicine, or practices without competition as physicians consolidate into single practices to distribute the high costs of malpractice insurance premiums.”

  77. Violet says:

    Or perhaps more accurately, it is quite easy to find research supporting whichever side of an issue you happen to like (which you can then cite approvingly) as well as research supporting whichever side of an issue you happen to despise (which you can then shred for a whole armful of methodological, data, and bias problems).

    It is easy to find bad research, phony research, paid-for research — yes. But as someone said, you have the right to your own opinions; you don’t have the right to your own facts.

    There are facts about healthcare, and these are discernible. There is reputable research by physicians, the New England Journal of Medicine, and countless other groups.

    Then there is paid-for research by the insurance industry and Big Pharma. What I’ve noticed is that conservatives cite this research as if it’s every bit as reliable as the real investigative reports on which the case for single-payer is made.

    And when I point this out, the answer I get is very similar to what Elise says here — that all research is equally suspect, etc., etc. Very post-modern! It seems that people on the right genuinely believe that everyone is just as craven and dishonest as industry hacks and rightwing think-tanks.

    I even had a rightwinger suggest that Surgeon General reports on lung cancer were no more reliable than tobacco inudstry reports.

    In right-wing thinking, it is apparently impossible that doctors might support single-payer because they’ve done the research and the facts recommend it. In their world, it must be the other way around: doctors support single-payer, so they cobble up a highly tendentious set of facts to buttress their a priori position. (As Elise said upthread, dismissing the findings of the Physicians for a National Health Program: oh, they’re just people who support single-payer. Implication: they’ll say anything! Couldn’t possibly be that they’re physicians who support single-payer because the facts back it up.)

    I really think this must be the result of rightwingers listening to years and years and years of pure bullshit from their pundits and knowing, deep down, that it IS bullshit. And so they assume that everything is bullshit.

  78. Elise says:

    (As Elise said upthread, dismissing the findings of the Physicians for a National Health Program: oh, they’re just people who support single-payer. Implication: they’ll say anything! Couldn’t possibly be that they’re physicians who support single-payer because the facts back it up.)

    That’s not at all what I said. I said that the homework Dr. Socks assigned explained why this organization believed single-payer would work and why they believed it would work better than what we have now. I did not in any way dismiss what they said – I haven’t done the research that would be necessary before I can either accept or dismiss their claims. My point was that they addressed practical questions but nothing they said addressed the question I had actually asked which was about trusting the government. My exact comment was:

    The FAQ explains why those who support single-payer think it will work and work better than what we have now but do not really answer my question about trust.

    It is hard for me to imagine a more neutral way of describing the FAQ. I would use exactly the same language to introduce my own writing:

    This post explains why I think Goldhill’s plan will work and will work better than what we have now.

    It takes quite a leap to read that as dismissive.

    And, no, I don’t think all research is equal. (I also don’t believe – but am willing to be proven wrong – that all reputable physicians and all reputable medical organizations support single-payer.) My point was that it’s possible to find what looks to me like perfectly reputable research supporting both sides of almost any issue and it is often difficult to sort the wheat from the chaff without doing more research than most of us have time for. At that point we have to rely on what our own experience has taught us.

    There are some issues with single-payer that I find distressing but since this is Dr. Sock’s blog and Dr. Sock’s rules I saw no reason to drag them back here – to me that approaches being trollish. Which is why I restricted my question to the one about trusting the government. This is something that deeply puzzles me about the left given their abiding contempt for the government during the previous administration. Although I consider Ezra Klein to be a jackass with an unreasoning aversion to hyperlinks I considered Dr. Socks an intelligent, reasonable person who I had hoped could provide an answer I could understand.

    As for my views about post-modernism you can read this or this:

    Postmodernists believe that truth is myth, and myth, truth. This equation has its roots in pop psychology. The same people also believe that emotions are a form of reality. There used to be another name for this state of mind. It used to be called psychosis. – Brad Holland

    And just for the record, I believe smoking is unhealthy and even believe in evolution.

  79. Violet says:

    I considered Dr. Socks an intelligent, reasonable person who I had hoped could provide an answer I could understand.

    Well, I wrote a whole post in reply yesterday, but if you didn’t understand it, I’m sorry.

  80. Toonces says:

    Well, since I’m just a bumpkin with too much time on my hands I might as well point out that the study octogalore cites from the AMA is a) local to Pennsylvania and b) comes to this conclusion:

    Conclusion Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

    http://jama.ama-assn.org/cgi/content/short/293/21/2609

    They didn’t actually study the costs, let alone the cost implications for healthcare overall, just reports (a survey) of physicians practicing defensive medicine, in Pennsylvania, in highly-specialized areas.

    Toonces, my opinions aren’t based simply on one study.
    This: http://content.nejm.org/cgi/content/full/NEJMp0903765

    is not a study. It’s an opinion piece. It says “Perspective” at the top to make sure that that is clear.

    Also, I have to ask because I must be out of the loop: Is Harvard Law now considered some kind of commie-pinko leftist think-tank? Seriously?

  81. octogalore says:

    Toonces, I appreciate your tireless efforts in this regard and I regret that I have not been able to make such a detailed study of your sources. I did note that the Harvard Law study appears also not to be a final analysis, as it is labeled “Preliminary,” presumably to make sure that that is clear.

    This particular study, by the Massachusetts Medical Society, which publishes the New England Journal of Medicine, is a recent survey of physicians. Although I am sure you will want to look at the complete text, I will encapsuate some findings here:

    “this first-of-its-kind survey of physicians … has shown that the practice is widespread and adds billions of dollars to the cost of health care in the Commonwealth. The physicians’ group says such defensive practices, conservatively estimated to cost a minimum of $1.4 billion, also reduce access to care and may be unsafe for patients. The Investigation of Defensive Medicine in Massachusetts is the first study of its kind to specifically quantify defensive practices across a wide spectrum and among a number of specialties. The study is also the first of its kind to link such data directly with Medicare cost data.”

    In all seriousness, I think this is an area where we may have to agree to disagree. I think the friendships and collaboration possible here — in an environment in which there are so few true feminist sites — can too easily be cratered by inevitable disagreements on other issues. I would love, as I know you would as well, to have the luxury of being able to ensure that all feminists I hang out, work, or sleep with, agrees with me on virtually all policy positions. I’ve decided to settle for one out of three (and if I weren’t monogamously married, I’d probably bend that one as well).

  82. Toonces says:

    Octogalore, I don’t care whether or not you agree with me. I care whether you present the issue honestly. Saying that tort reform is needed or that defensive medicine costs a lot of money is completely different from presenting the issue as causing the healthcare costs in America to be so much higher than other than the rest of the industrialized world.

    America is the standout on costs. It is not the only country with medical malpractice suits, lawyers, or doctors who practice defensive medicine:

    http://www.chspr.ubc.ca/files/publications/1998/bco98-01D.pdf

    https://www.researchgate.net/publication/6627853_Defensive_medicine_practices_among_gastroenterologists_in_Japan

    “AIM: To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS: A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS: A total of 131 (77%) out of 171 gastroenterologists completed the survey. Three (2%) respondents were sued, and most respondents (96%) had liability insurance. Nearly all respondents (98%) reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common (96%). Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists (those in practice for more than 20 years) adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread (91%). Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION: Defensive medicine may be highly prevalent among gastroenterologists throughout Japan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.”

    I’m sure I could find many more studies from other countries. It didn’t take as long to find those as you seem to think. But it appears to bother you that I am linking so much so I’ll only leave the two.

  83. octogalore says:

    First para’s a strawargument. Show me where I made that claim.

    My claim is and remains as you stated it above: “what you said was that tort reform would go a long way towards reducing the cost of healthcare.”

    That is, was, and continues to be what I’m claiming. Nothing dishonest there.

  84. Toonces says:

    Your claim was that tort reform would go a long way towards healthcare reform:

    “Also, the characterization of Dems as “pro HC reform” and others as against misses the mark. There are alternatives to a public option which inevitably would morph into a wholesale government takeover. Tort reform, coupled with focus on those citizens who cannot afford health care, would go a long way.”

    I’ve believe I’ve shown that claim, several times now, to be false. If you are claiming that tort reform might reduce malpractice suit costs or that defensive medicine may result in waste, here in the US and also abroad in countries where the costs are not out of control, then that would be true.

  85. Toonces says:

    Also, if you didn’t meant that tort reform would alleviate the rising costs of healthcare, what did you mean when you said this?

    ‘Toonces, per a recent article in the New England Journal of Medicine, tort reform would alleviate “a substantial driver of the escalation of health care costs.” ‘

  86. octogalore says:

    And I believe you haven’t. Sorry.

    I cited a survey of physicians that shows tort reform could alleviate defensive practices that add billions of dollars to the cost of health care (in addition to increasing access to care, which wasn’t part of the core argument). You have cited countering arguments, which don’t specifically quantify defensive practices across a wide spectrum and among a number of specialtiesor link the data directly with Medicare cost data.

    I think we’re at a stalemate, and I’m going to agree to disagree at this point as I don’t think it’s productive to continue further, and I see this going towards a place of insults (eg, I am not presenting the issue honestly, allegedly) which isn’t conducive to my blogging enjoyment. I’m going to adjourn and I hope you have a great evening.

  87. RKMK says:

    You’re talking to the dining room table, Toonces: blind ideology-adherence in the face of clearr evidence to the contrary.

  88. donna darko says:

    Medicare has a 3% administrative overhead while private insurance has a 30% overhead. That in addition to poll showing seniors satisfaction with Medicare may have something to do with trust of the government plan. I happened to read that terrible article by Goldhill in The Atlantic the other day. Note that Marc Ambinder and Matt Yglesias, former Atlantic wrirers, are central to the current health care privatization crisis. That’s what Obama is doing as illustrated in his FedEx-US Postal Office analogy. He is doing the opposite of what Republicans say he’s doing which is to bail out the private insurance industry. His elderly father died of a hospital-borne illness and he goes on to write thirteen pages of nonsensical text how Medicare is central to our health care crisis.