Archive for September 2013

One Dares Call It Murder

September 30, 2013

It’s not just this DFH anymore.  Senator Angus King (I-ME) goes there:

….he [King] doesn’t mince words with those who’d take risks with other people’s health security.

“That’s a scandal — those people are guilty of murder in my opinion,” Sen. Angus King, a Maine Independent who caucuses with Democrats, told me in a Friday interview. “Some of those people they persuade are going to end up dying because they don’t have health insurance. For people who do that to other people in the name of some obscure political ideology is one of the grossest violations of our humanity I can think of. This absolutely drives me crazy.” (h/t TPM)

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Just to go over the ground once again:  health insurance saves lives.  When you deny our fellow citizens coverage — well take it away, Senator:

…ACA opponents are loathe to grapple with the life-or-death nature of their advocacy and tend to lash out when confronted with it. As such, the debate over the law tends to center around other moral questions. But King doesn’t think they should be let off the hook.

“That’s bunk. You can’t wish that reality away because you don’t like the policy outcome,” he said.

…“To me it boils down to a moral question, and that is would you allow someone sitting in front of you on the subway to die, or would you take some action — call 911 or a doctor or do CPR yourself. Most people would say no I would not allow someone to die. You have to realize that as a society we’re answering ‘yes’ to 25,000 a year who are dying before our eyes and saying we don’t care.”

The House Republican caucus and their allies in the Senate and in the Koch et al. penumbra are demanding those deaths everytime they attempt to defund or “delay” Obamacare as the price for keeping government open.  I’ve tried, but I just don’t have any polite words to describe those actions or those actors.  King dares call it murder — and he’s right.

Good for him for saying so.  May others pick up the message.

Image: Pieter Breughel the Elder, The Triumph of Death, c. 1562

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The House Republican Caucus: Conspiring to Murder American Citizens

September 28, 2013

The breathlessly awaited Saturday meeting of House GOP caucus is over, and we now know what these feral children want in exchange for not blowing up the American economy:

 The federal government on Saturday barreled toward its first shutdown in 17 years after House Republicans, choosing a hard line, demanded a one-year delay of President Obama’s health care law and the repeal of a tax to pay for the law before approving any funds to keep the government running.

In all the talk about defunding or delaying Obamacare, there’s one thing that hasn’t been discussed  much, certainly not by the Village.  That would be what  delaying Obamacare would actually mean in the real world.

There, we’re looking at dead Americans, needlessly and avoidably cut down before their time.

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Here’s the train of thought behind that claim:

The primary goal of the health care reform is to cover as many Americans who lack insurance as possible. As of this year, that is in the neighborhood of 48 million people — roughly 15% of the total US population.  Under the terms of the ACA, that number will be cut by 14 million next year, with more to come as the law persists.  That’s still well short of the goal for a civilized society, in my view, but 14 million people with access to health care is a real and important social and ethical good (not to mention an economic plus, in many analyses).

Those 14 million people — 14 million individual human beings with hopes and aspirations and real desires to avoid pain, misery and worse — are the primary victims of the morally bankrupt cabal that calls itself the House Republican caucus.  If they were to get their way and either fund the government or commit to allow the Treasury to continue to meet obligations already undertaken only on condition that those 14 million must once again go without health care coverage then the suffering that follows is on their heads.

In that context, it’s important to note that this means that the House GOP caucus will thus almost certainly be guilty of causing some significant number of unecessary, premature deaths.  The study of the connection between mortality and health insurance status is somewhat complicated, and a couple of very well publicized studies recently [PDF] have suggested that there isn’t any correlation and/or that Medicaid coverage in particular makes things worse.  Those studies and even more, the trumpeting by such deep thinkers as our old friend, Megan McArdle, have in their turn been strongly criticized, to put it mildly, and they are outliers against a background of some decades of work that show real and deadly links between whether or not you are covered and whether or not you die.

To put this all in a nutshell, take a look at the good recent-ish summary of the state of play of the uninsurance-death argument  comes from Dr. David Gorski writing in the Science Based Medicine blog.  The key point:

analysis of survey data from patients who were uninsured but then became old enough to be enrolled in Medicare suggests that “acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.” In summary, there is a large and robust body of evidence suggesting that people do, in fact, die because of lack of health insurance.

J. Michael McWilliams, MD, PhD, Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital … speculates:

How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number.

In other words, it’s hard given our current state of knowledge to point to John Doe over there, and say that lack of coverage killed him.  The Republican House doesn’t have to worry about answering a bill of indictment charging them in Mr. Doe’s murder.  But next year, were the House Republican branch of the Bolshevik party to succeed in delaying (or killing) health care reform, the some significant number of uninsured Does and Roes will die.  My truly primitive back of envelope calculation yields an estimate  of the number to be sacrificed to meet Republican Congressional priorities in the single digit thousands.  Let’s just say the death toll would be on the scale of  a couple of 9-11s.

The men who flew planes into the towers were terrorists.

What, then, should we call the House Republican Caucus, and their Ted Cruz-led Senate colleagues?

As our Roman friends would have said:  “res ipsa loquitur.

One more thing:  Factio Grandaeva Delenda Est.

Image: Josse Liefernixe, St. Sebastian interceding for the plague-stricken,  1497-1499.

For A Good Time On the ‘Tubes: David Dobbs, Sociable Genes edition

September 18, 2013

Dear all,

A little late — but it’s that time of the month again.  I’ll be doing my regular gig as one of the hosts of Virtually Speaking Science this evening at 6 EDT — just a little more than two hours from now.

My guest this time is David Dobbs, a wonderful science writer and (full disclosure) a good friend.  David has been focusing on neuroscience, genes and behavior for some time now.  Some of you may recall his big Atlantic feature on “the orchid hypothesis.”  There, David wrote about a fascinating line of scientific research that, among much else, showed how subtle and powerful the interactions of genes and environment can be.  Nature or nurture, that old debate, turns out (in this and in many other good works) to be a much richer, and much less dichotomized point of inquiry.

Jacopo_Bassano_-_Paradiso_terrestre_ca_1573

Flash forward to now.  David has been working on a book, The Orchid and the Dandelion, to be published by Crown in 2015, that extends the ideas and arguments of that magazine feature into a nuanced (and very tricky to write) account of how scientists are now trying to piece together the gene-to-behavior chain.  Some of that work led to the essay he just published at one of the delightful new web-based venues for serious, long-form public intellection, The Pacific Standard.  In that piece, “The Social Life Of Genes,” David writes about fascinating work on the way experience affects gene expression — which both takes the nature-nurture interaction to new, much more ephemeral time scales (itself a delightful shocker, at least to me) and points to the way the extraordinary advances in genetic and genomic research have reached a peculiar moment.  We know vastly more than we ever have before about the informational content of life.  We have tools that allow us to produce intimate moments in the daily life of genes and attendant molecules.  But that knowledge has gone just far enough to demonstrate how much more complex, intricate and so far ill-deciphered the genetic view of life remains.  We know more — and yet that knowledge leaves us much less certain about how a lot of biology works than we thought we understood a decade ago.

Which, of course, is just great.  (Physicists would kill for such wide open spaces!)  We live in interesting times — which, as I hope this conversation will demonstrate, is not always an accursed thing.

Tune in:  audio and later podcast here.

Also — do check out David’s website. Lots of good stuff there, but I’d draw the attention of any writers (or devoted readers) to David’s links to good work, and to his own  and others’ fine analyses of writing craft.

Image:  Jacopo Bassano, Earthly Paradisec. 1573

MSM Delenda Est, Chuck Todd edition

September 18, 2013

A couple of commenters in the last thread picked up the same item that’s had me stewing for a few hours already, so I thought I’d share the bile with the lot of you:

During a segment on “Morning Joe,” former Pennsylvania Gov. Ed Rendell (D) speculated that most opponents of the Affordable Care Act have been fed erroneous information about the law. Todd said that Republicans “have successfully messaged against it” but he disagrees with those who argue that the media should educate the public on the law. According to Todd, that’s President Barack Obama’s job.

“But more importantly, it would be stuff that Republicans have successfully messaged against it,” Todd told Rendell. “They don’t repeat the other stuff because they haven’t even heard the Democratic message. What I always love is people say, ‘Well, it’s you folks’ fault in the media.’ No, it’s the President of the United States’ fault for not selling it.”

Back in the old days (Get Offa My Lawn!….), us print folks used to snort at the way TV types styled themselves journalists.  When we did, we’d point to folks our Mr. Todd resembles: stenographers with cameras.

An-Officer-dictating-a-Letter-1655-58-Gerard-ter-Borch

Nowadays, of course (and much more than we wanted to admit back then) there’s nothing medium-specific about the utter intellectual failure of elite American political journalism.  But after today I’d say that even in that dismal lineup Todd is a special snowflake.

What’s infuriating is that he really isn’t stupid.  He has a body of knowledge and some genuine expertise.  But the claim above is so — self-castrating is about the best I can say for it.  What professional with any jot or tittle of pride in his or her work would say “hey! Don’t look at me! I don’t write this stuff; I just deliver my lines.”

Truly:  Todd’s quote reads to these eyes like a resignation letter. If you can’t rouse yourself to meet the minimum requirement of a cub reporter covering a school council meeting — ask if that thing Councilmember Doe just said, was, you know, actually true? — then perhaps you should take a bit more time with your family.

Or rather:

Yo! Chuck:  you’re stealing paychecks from the Peacock and wasting everyone else’s time.  Go home.

Image: Gerard ter Borch, An Officer Dictating a Letter, c. 1655-1658

American Exceptionalism, Healthcare Division

September 18, 2013

With a h/t to my spouse, this piece from a couple of days ago offers a beautiful (not really the mot juste) window onto the multiple levels of fail of US medical business and (or rather, hence) practice.  The action gets going as a young physicians assistant named Andrew T. Gray describes waking up an upset stomach, which over the course of the day blossoms into really nasty pain.  Then comes the twist:

Crawling into bed, however, I realized that my pain had coalesced in the right lower quadrant of my abdomen. Could it be appendicitis?

Panic flooded me. After six weeks at my new job, I now qualified for health insurance, but I’d neglected to fill out the necessary paperwork.

Only an hour after leaving the clinic, I returned. Almost hysterically, I completed and faxed in the insurance forms.

“Go to the emergency room right now,” urged one of my supervising physicians.

Instead, Gray waited overnight so as to reduce the odds of insurance company shenanigans.  The next morning, though he can’t wait anymore:

Waiting for the ER doctor, I recalled that, at some point in my schooling, I’d read a Swedish study about treating appendicitis with antibiotics. Googling the study on my smartphone, I found it.

By the time the ER resident approached, I was ready.

“I don’t have health insurance,” I said calmly. “Can I be treated with antibiotics instead of surgery?”

“I doubt they’re going to let you do that here,” he said. “But keep expressing interest.”

When the ER attending physician came in, I repeated the question.

“Absolutely not,” he replied flatly. “This is America, not Sweden. If you have appendicitis, we operate.”

The story gets better — which is to say from a policy and medical care point of view, worse.  Go read the whole thing.

As to it’s relevance beyond itself. Well, Gray’s telling an anecdote, of course, a single encounter in a system that touches millions every day.  Even so, there are at least two key points I draw from it:  (a)  there are structural problems with the culture of medical practice in the US that both drive up costs and affect (not for the better) patient outcomes.  “This is America…we operate.”

Hans_Holbein_d._J._-_Henry_VIII_and_the_Barber_Surgeons_-_WGA11566

And (b):  there are lots of reasons medical costs in the US seem both arbitrary and excessive. But (a) they are and (b) it actually matters to know what happens elsewhere, because from such knowledge it finally becomes much easier to see that US health care is exceptional alright — but not how the foaming hordes raving against tyranny in the form of Obamacare would have it.  We sure do lead the world in what we pay. Just not in getting what (we think) we’re paying for.*

*This is not to say that for particular conditions in particular cities there is no better place in the world to receive care than, say, my current dwelling place, Boston.  But brilliant tertiary care available  to those clued in and covered in just the right ways doth not a system make.

Image:  Hans Holbein, Henry VIII and the Barber Surgeons, 1543.

Things I Hate With The White Hot Heat Of A Thousand Suns

September 16, 2013

This, for one:

Gary Humes, a programs manager with the Navy, was entering the building where the shootings took place around 8:20 a.m. when he was met by people fleeing the building and warning of a shooter inside. He and more than 100 others ran to another building across the street, while others ran to the Navy museum nearby.

“I decided to go into work a little late this morning,” he said. “I guess God was with me.”” (from The Navy Times story on today’s mass shooting*).

Should we thus infer that God was not with the dead and wounded?

I’m not going to get into the problem of evil in this space.  There are ways religious believers reconcile themselves to the obvious fact that bad things happen to good people — or at least people for whom the evil outcomes are undeserved by any reasonable calculation.  There are certainly logically coherent ways to understand the presence of evil in the world as a strong indicator of the absence of deity actively intervening in human affairs.  Neither of those true statements is in play here.

Rather:  hosannas like the one above are to me the markers of failed religion.  I don’t me Mr Humes himself.  Dodging the kind of horror he did today would make anyone — me certainly – feel an almost giddy (and guilty) sense of relief.  He gets a pass from me on anything he says in the moment.  But it’s still possible to read something in the verbal formula that someone in such straits reaches for in such moments of trial.  And the “God is with me” trope — that to me is the signal of a religious culture thoroughly getting it wrong.

Or, to put it in another frame, what would Jesus say?

Aelbert_Cuyp_-_Landscape_with_cattle_-_Google_Art_Project

This, for example:

40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’ (Matthew 25)

 

Image: Aelbert Culp, Landscape with Cattle,  c. 1639-1649

 

Least Surprising News Ever, Media Edition

September 11, 2013

Via  Peter Lauria at Buzzfeed, Tina Brown and the Daily Beast are parting ways:

According to a source with direct knowledge of the situation, The Daily Beast parent company IAC, owned by media mogul Barry Diller, does not plan to renew [Tina] Brown’s contract when it expires in January.

What might be driving this (not very) unexpected news?  The obvious, as reported in The Atlantic Wire:

At the end of August, AdWeek said The Daily Beast was on track to lose $12 million this year in a report that strongly foreshadowed today’s news….as AdWeek put it, Diller’s “goodwill may be running out.” Diller lost a fortune when IAC bought Newsweek, merged it with the Beast, and then sold it off again. He recently admitted that buying the newsweekly was a “mistake.”

Henri_Rousseau_-_The_Merry_Jesters

I’ve met Barry Diller all of exactly once, making a presentation to him for a very ill-starred media venture sponsored by another mogul.  He was polite beyond his reputation, perfectly attentive to a project in which he had no interest, and left me with just one impression:  not a man for whom you’d like to lose a pile of bucks.

One thing though — given the record of Tina Brown’s Beast before Diller bought it — what the hell did he expect?  Someday I may rouse myself to write at my usual logorrheaic length about how the failure of the Beast/Newsweek experiment — truly the least surprising possible outcome of that endeavor — is another demonstration (if any were needed) that elite media grasp of modern audiences and the shifting ownership of cultural capital falls somewhere between disastrous and catastrophic.  But today’s not that day (I hear you saying “for which the FSM make us truly grateful” — yah bastids).

But as long as you’re sticking around: one more thing.  My standard first half of a title on a Megan McArdle post is “MM is always wrong part (n).  And that’s true, of course, when it comes to matters pollitical, economic, intellectual, culinary, and pretty much anything to do with the actual stuff of what she writes.  But I have to concede that she has not-terrible career judgment.  I thought she was making a profoundly dumb move when she left the Atlantic for the Beast (unless she was pushed, which would make Tina the more of a sap for offering a damaged brand a soft landing).  But even if it was purely an error for MM to bail on The Atlantic, she was on top of her game when she abandoned the good ship Beast for her current Bloomberg News gig — as I kind of wondered in this post :*

I’m wondering if McArdle’s finely honed survival skills are in play, in which case we may be getting a leading indicator on the prospects for our Beastly friends.

Bye, bye, Tina. You’ll not be missed, but please go away.

*Andrew Sullivan’s turn to self-publishing doesn’t look that bad a move either, even if he hasn’t yet met his numbers.

Image:  Henri Rousseau, The Merry Jesters 1906.