And yet it's so much more

Demographers and health researchers are noticing a dramatic drop in women's life expectancy is some areas of the United States:

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women's life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

[...]

"This is a story about smoking, blood pressure and obesity," said Majid Ezzati, of the Harvard Initiative for Global Health, a co-author of the paper.

The drop in life expectancy is about those things, but it's about a helluva lot more too.

It's the story of a nation that has a dangerously broken for-profit insurance to provide health coverage for most of its citizens, while leaving some 47 million uninsured. The coverage that people do have isn't necessarily even adequate to actually obtain decent health care.

It's the story of a nation that doesn't have - has never had - any sort of cohesive public health policies.

It's a story about cheap, processed foods of marginal nutritional value and mass advertising.

It's a story about poverty, and the conditions which cause poverty.

Limiting the story to just smoking, blood pressure, and obesity limits the solutions to the problems which vex us when it comes to public health in this country. By focusing on these three items, the solutions come in the form of individual interventions, in a manner of speaking. Educate people to make good choices, the logic goes. It, of course, elides over the much more complicated, and in the long-run, more damaging, structural problems that underlie the proximate causes of the decline in life expectancy.

There needs to be a much more expansive conversation about public health in this country, and it's a conversation that should make some people feel very, very uncomfortable.

Making my socialist heart go pitter-patter

When it comes to health care, John Edwards keeps saying the right things:

Nataline Sarkysian died last night at UCLA Medical Center after complications arose from a bone marrow transplant to treat her leukemia. Her insurance provider, CIGNA Healthcare, first denied the potentially lifesaving transplant, but relented after a loud public protest and outrage. By that time, though, Sarkysian passed away before the procedure could be performed.

"Are you telling me that we're gonna sit at a table and negotiate with those people?" asked a visibly angered Edwards, challenging the health care companies. "We're gonna take their power away and we're not gonna have this kind of problem again."

The insurance companies are the biggest (but not the only) obstacle to health care reform. The whole for-profit health care system is farcical, but the insurance companies stand out as especially parasitical. I'm sure whiny free-market apologists will get their undies in a bunch about creating a huge bureaucracy and usurping an important profit-generating center of the economy, but fuck them. Insurance companies are the problem, they can't be negotiated with in a way that will remove them as the problem, so let's get rid of them.

Other Dems need to take notice.

Petulant president pisses on poor children

What a load of horseshit:

President Bush yesterday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding the program would enlarge the role of the federal government at the expense of private insurance.

The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance Program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.

"Objects on philosophical grounds," my ass. Bush will expand public spending when it serves to enrich his cronies or allows him to play toy soldier in the Situation Room, but expend some scratch to provide poor kids with some health care? He's got to pretend to have principles.

The sociologist in me always wants to warn that there are structural tendencies which compel political leaders to act in certain ways, but the folks in the Bush administration are downright evil.

Dueling dipshits

Ah yes, the digital age, where anyone can be a filmmaker, no matter how grossly untalented. Meet Logan Darrow Clements:

You may remember Logan from his 2004 run for governor in California on the "privatize everything!" ticket. Or, maybe not.

Regardless, our friend Logan is ready to shake shit up this fall. Do tell:

While Michael Moore plans to release a movie, “Sicko,” in the fall advocating socialized medicine, Clements' plan is to release a movie, “Sick and Sicker,” for theatres at the same time which exposes the realities of socialized medicine.

Hoo boy, this interview should be fun...

FP: So tell us what inspired you to make this film.

Clements: I simply don't want the government to force me and everyone else into socialized medicine. I don't like being forced around when I haven't done anything wrong and I can see that nearly everything that government does is a complete and utter failure, often with deadly consequences.

I'd so love to believe he's referring to the Iraq war, but he's not. And I think we've found the only man in America who thinks that receiving health care from the government is some form of punishment.

FP: Why do you think that nearly everything that government does is a failure? Empirical reality does suggest that the free market always works the best. Why do you think this is so?

I love this question. "Empirical reality" suggests the free market always works best? What does that mean? Works best to do what? I'm fairly certain our interviewer doesn't know what "empirical reality" means if he's ignoring such free market "success stories" like energy deregulation in California.

Clements: The reason that nearly everything that government does is a failure is because everything that government does is an act of force. You are forced to do X. You are forced to not do Y. It takes money by force from its rightful owner and gives it to another person. As humans our primary tool of survival is our mind. However, when the government forces us around we are unable to use our mind. Instead of each person using their own mind and acting in their own best self interest we are forced to act in a way that suits the political interests of the people that made the law.

Since government operates on the principle of coercion, they keep you from using your mind. Logan, being the good Objectivist, doesn't believe in the "common good," of course.

FP: So what difficulties have you had, and are you having, to get this film into gear?

Clements: Fundraising.

He forgot to add "lack of talent."

FP: I can tell you that as a Canadian myself I know that most of my fellow Canadians pride themselves tremendously on their health care system. It is a way that they distinguish themselves from Americans and foster their own identity. The tragic thing is that they don’t really know anything about their own health care system but without it they would have no self-definition.

Huh. I was under the impression that Canadians loved their health care system because it provided them with high quality health care at no cost, ensuring Canadian citizens the ability to receive care for almost any condition without risking financial ruin. But you're telling me it's just a way to say, "Look at us! We're not Americans, eh?" I did not know this.

[Clements]:The pragmatic arguments against socialized medicine are that it leads to bad health outcomes. When health care is provided by the government there is always more demand than supply so health care has to be rationed through the use of waiting lists. As a result more people die from treatable illnesses, more people suffer in pain for longer periods of time, fewer new technologies and new drugs are available. Furthermore, the idea that government can provide health care more efficiently, as some proponents advocate, is laughable. When the government does anything it always costs far more than an average buyer would pay in the free market.

This all pretty much bullshit. With a mostly privatized system and the highest per-patient health care expenditures in the world, the U.S. has by far the worst health outcomes (by most measures) of any industrialized country. But "empirical reality" is no match for the siren song of Ayn Rand...

Clements: The long term solution is to remove as much government interference and create an efficient market. In all other markets you see price declining and quality improving. For example, you can buy a computer now that is many hundred times more powerful than one from several decades ago at a small fraction of the cost. We can see similar improvements in the parts of the health care industry which are not dominated by government interference. The cost for laser eye surgery for example has dropped significantly while the quality of the technique has improved. Cosmetic procedures have also gone down in price.

Anyone else enjoying how obtaining basic health care treatment is analagous to getting elective eye surgery? Or buying a computer? Or getting a boob-job? Because obtaining basic health care bears no resemblance to those other items!

And, having something paid for by a third party makes the consumer not care what the cost of it is. Imagine if a third party agreed to pay for whatever car you need. I need a Lamborghini, no, make that two Lamborghinis.

That's right! If only I had to worry about the cost, I'd see that I don't really need that liver transplant. I'll take the much cheaper take-two-aspirin-and-die-in-the-morning approach. Jesus, Logan, your bio says you have an MBA, but your understanding of basic economics is as sophisticated as that of a frat boy who slept through all but the first two weeks of Economics 101.

It's bad enough when health consumers don't care what something costs because their employer or employer's insurance agency is paying for it. Exacerbating the problem are all the people whose health treatments are paid for as part of a government program. A large percent of all health consumers have their health care bills paid for by Medicaid, Medicare and various state program. These consumers don't care if an x-ray costs $50 or $500.

Poor people on Medicaid are wasting your hard-earned tax dollars on frivolous $500 x-rays. Put that in your pipe and smoke it, hippie.

FP: So when can our readers expect to see the film?

Clements: If we receive a sufficient amount of funding we could have it out in the fall of 2007. If no one steps forward to help fund our movie we'll probably all have to suffer through Michael Moore's film and go home and take two aspirin

So the answer is never? Sounds good to me!

Welcome aboard

Despite the signaling of their indifference to my job application with cold, cold silence, the California Nurses Association is my favorite incarnation of New Labor. I like them even more now that they're affiliating with the AFL-CIO in order to push for single-payer health care.

And because the nurses couldn't say it in a family newspaper, fuck you Andy Stern.

This guy has everything working against him

If it weren't on msnbc, I'd assume that this was the beginning of a joke:

The herpes family of viruses can have a surprising upside — it can protect against the bubonic plague and other bacterial contagions, at least in mice.

Research into whether a similar mechanism applies to humans and other mammalian hosts should be conducted, said viral immunologist Skip Virgin at Washington University School of Medicine in St. Louis.

As for me? I'll dance with the Black Death, thank you very much.

And when it's actually drowned?

The WaPo does its homework and begins to connect the dots between the series of institutional failures that led to the Virginia Tech shootings.

I've had a hard time knowing exactly what to say to people who believe in Small Government as some sort of Good unto Itself. You tell them about the homeless gathering for morning coffee in the park, or the family living in the pick-up camper behind the church downtown, or the senior citizen spanging at the University. You tell of the relative with a disability who wants to work (well... kind of) but the social agency responsible for placing her is underfunded and not staffed by the most competent people in the world. But those who want to drown government in the bathtub either never see it, floating from one sanitized conclave to the next, or don't think it's their problem. Why should their tax dollars be spent on "someone else?" Someone else who probably doesn't even have a job!

Or maybe someone else is a disturbed college student...

That's not to say a well-funded system of social services, staffed by talented, committed, and respected professionals would have identified and managed someone like Cho before he completely cracked. It may not have. But the events in Blacksburg are only an extreme example of the thousands of catastrophes that happen everyday because the social safety net has been slashed beyond all recognition, and the private charities that conservatives thought would move to fill the gap are completely overwhelmed and unable to respond to the needs presented.

We've been held hostage by the Small Government theocrats in charge for the last ten or so years. It's time we start assertively pushing that they are responsible for failure after failure, Virginia Tech after Katrina, and that these failures are a intrinsic to and completely foreseeable consequence of their philosophy of government. And the goal is not to do Small Government better than they do, it's to try a different way altogether. Maybe instead of drowning it, we can take government to the lake and teach it how to swim.

C'mon, John! Swing for the fences!

John Edwards released his plan for universal health care [.pdf] today. I do like this little bit of rhetoric (from a campaign e-mail):

We have to stop using words like 'access to health care' when we know with certainty those words mean something less than universal care. Who are you willing to leave behind without the care he needs? Which family? Which child? We need a truly universal solution, and we need it now.

Hear, hear. We do need to be talking about universal care, rather than simple "access," so I'm glad to see Edwards taking the mushiness out of the terminology. But his actual plan, which consists of requiring employers to provide health insurance to their workers, while modestly expanding public insurance systems (like Medicare), providing tax incentives, and creating regional health markets, falls far short of fixing the problem of runaway costs in the health care system. What this looks like, to me, is another hand-off of taxpayer money to private insurers.

Unfortunately, private health insurers are the primary drivers behind rising insurance premiums, and any health care proposal which fails to recognize this simple truth will end up being a massively expensive boondoggle, enriching stockholders in the insurance industry, to be sure, but failing to fulfill the promise of universal quality health care.

I can appreciate the fact that Edwards is trying to thread the needle here, balancing the deep pockets of the insurance lobby with the wishes of starry-eyed leftists like myself, with statements like this:

Choice between Public and Private Insurers: Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan [emphasis added].

However, this statement makes it seem as if there's some question as to which sector, public or private, can most efficiently deliver quality health care at a reasonable cost. I think the data is pretty convincing in showing that single-payer systems come out on top. So why put on an expensive (and byzantine) beauty contest when the outcome isn't in doubt?

On balance, the Edwards plan hits a lot of the right notes: public hospitals, good preventative care, and actually promoting universal health care. But any plan which doesn't challenge the profit-driven system of private insurers will ultimately fail.

I can think of someone who should utilize his mental health benefits

To answer dave's question, the Bush health care plan is a crock of shit. Note the following:

President Bush will propose a deep tax break for Americans who purchase their own medical insurance and would finance it with an unprecedented tax on a portion of high-priced health-care plans that workers receive from their employers, according to the White House.

The initiative, which the president briefly previewed in his radio address yesterday, has a dual purpose: It would create a financial incentive for the estimated 46 million to 48 million Americans who lack health insurance to buy it. And it would rein in the soaring cost of health insurance by encouraging workers in high-priced plans to seek more modest coverage.

While it's tempting to focus on the "financial incentive" to buy health insurance for the uninsured - an incentive which would be of dubious consequence for many of the reasons dave points out - the real pernicious part of this plan is how these tax incentives would be financed.

First, the Bush plan makes the assumption that health care premium costs are driven by workers who want "high-priced [health] plans" (read: plans which allow them regular access to quality health care). This assumption is flat-out wrong. Premium cost increases are not driven by consumer demand for better coverage any more than they are by medical malpractice lawsuits. If I've said it once, I've said it a million times: health care premium increases are driven by swollen administrative costs, which are increasing at roughly three times the rate of actual medical expenditures. (Ironically, an out-of-control, inefficient administrative apparatus is always the canard tossed out against universal health care).

More significantly, the plan literally robs Peter to pay for Paul. The money to subsidize the uninsured will come from new taxes on the health care plans of employees in "high-priced" plans. So, middle-class professionals and workers who have collectively negotiated a great health care plan can expect to see their benefits taxed. I think there is an intentionally placed trojan horse here for organized labor. Imagine your next health care negotiations with the boss telling you that they're slashing your benefits in order to save your members from paying higher taxes. Nightmarish.

Fortunately, there's hope the idea may be DOA in committee:

Still, some leading Democrats are skeptical of the plan. "It is good that the president is finally talking about health care," said Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate committee that oversees health-care matters. "I question, however, why the president thinks the way to solve this problem is through the tax code."

Let's hope the Bush plan never sees the light of day, because it - much like everything else this administration has produced - is a huge, stinking turd.

Vanity pregnancies

The WaPo is reporting that doctors are ready to perform the world's first uterus transplant. I started reading, curious as to how the whole functioning of a transplanted uterus would work. What I read thoroughly creeped me out:

After performing the complex surgery, doctors would wait probably about three months to make sure the organ is functioning and has been stabilized with anti-rejection drugs.

"We'd want to make sure it was ready to provide a safe environment for the child," said Jeanetta Stega, who is working with Del Priore.

An embryo created through in vitro fertilization would then be placed in the womb. If the pregnancy goes well, the baby would be delivered by Caesarean section to minimize risks from labor and to allow doctors to simultaneously remove the uterus, so the woman could discontinue the anti-rejection drugs.

"We are calling it a temporary transplant," Del Priore said. "This minimizes the time patients have to be on the medications and makes it a much more reasonable risk to take to have a baby."

Wow. There's nothing even remotely resembling "natural" in that description. And the idea of a "disposable" uterus? Where does that concept lead us, ethically? And what is the moral and political significance of what is ultimately the complete objectification of a woman's ability to give birth?

I have had no moral qualms about surrogate births and am sympathetic to the plight of women who, for some reason, may not be able to bear children, but the actual transplantation of another's uterus - a disposable uterus, at that - into one's own body seems to me a questionable and dangerous step into frankenscience.

Bring the pain

I don't think anyone who runs in our circle is surprised by this WaPo report stating that men and women experience pain differently. And while the article makes attempts to claim that biological differences between the sexes aren't the only explanation for differing perceptions of pain, the implications drawn for improving pain relief are exclusively in the domain of targeting biological and neurological processes.

I think this runs the risk of missing out on the social causes of these differing perceptions. The medical anthropology and sociology literature makes it clear that symptoms related to the same environmental stimulus or etiological agent are experienced differently across cultures. The logic of the article would seem to dictate that we look for some sort of biological differences between racial groups in order to most effectively treat these afflictions.

My inner sociologist is screaming that the differences in how people perceive pain are primarily social. We learn to experience pain in different ways, and the processes by which we deal with pain become "hard-wired" at a point early in our lives. Take this paragraph from the WaPo article:

When I get a particularly nasty headache, I race for the ibuprofen bottle and down three 200-milligram tablets (a dose long ago approved by my doctor) and get on with whatever I was doing, comforted by the knowledge that I've taken action to dull the pain and that I will feel better soon. When my husband has a headache, he delays doing anything -- including telling me, for whatever comfort that might bring -- and succumbs to the ibuprofen (taking just two tablets) only when the pain is so severe he can't do much else.

Some might say our headache techniques are a manifestation of our quirky personalities -- and there may be some truth in that.

That just screams "socialization!!!" to me. It has nothing to do with individual personalities. It has a lot to do with the fact that our culture sends out the message that girls are sensitive and frail and that boys should just suck it up (or, as Peyton Manning so eloquently puts it, "Rub some dirt on it!").

I'm all for research being done on more effective ways of relieving pain. I'm just concerned that a search for gender-specific pain relief rooted solely biology may not be as effective (and could cause some serious harm i.e. over-medication) if the social causes of differing pain perceptions aren't controlled for in the research.

One step forward, two steps back

Many on the left look at the nations of Latin America for inspiration and hope, given the general leftward tilt of the region over the last six years. However, it also remains a profoundly patriarchal culture...:

With the exception of Cuba, every nation in this predominantly Catholic region either totally prohibits abortion or limits it to extreme circumstances. And while the global trend over the past decade has been to liberalize abortion laws, efforts to do so in Latin America have been met by an equally determined campaign to strengthen them further.

... and such a culture has consequences:

Jazmina Bojorge arrived at Managua's Fernando Vélez Paiz Hospital on a Tuesday evening, nearly five months pregnant and racked with fever and abdominal pain. By the following Thursday morning, both the pretty 18-year-old and the female fetus in her womb were dead.

The mystery of what happened during the intervening 36 hours might not ordinarily have catapulted Bojorge into the headlines of a nation with one of the highest maternal mortality rates in the Western Hemisphere.

But a week before her death on Nov. 2, Nicaragua's legislature had voted to ban all abortions, eliminating long-standing exceptions for rape, malformation of the fetus and risk to the life or health of the mother. Now, outraged opponents of the legislation have declared Bojorge its first victim.

"It's clear that fear of punishment kept the doctors from doing what they needed to do to save her -- which was to abort the pregnancy immediately," said Juanita Jiménez of the Women's Autonomous Movement, an advocacy group that is leading the campaign to reverse the ban. "This is exactly what we warned would happen if this law was passed. We've been taken back to the Middle Ages."

Bang for your buck

digby has a must-read post discussing the conservative consensus. Even though progressives won the day last Tuesday, we still operate in an environment that has been shaped for the last 40+ years by conservatives:

The Republicans may have finally jumped the shark, after failing so dramatically at governance, but they have inculcated their thinking so thoroughly into people's minds that many people don't even know it. The way most people think about government, and the vocabulary they all use, comes from the Republican playbook. It's going to take a huge effort to get people thinking about it in new ways. (There are a lot of smart people working on that, thank goodness.)

But right now, we are stuck in the same old groove:

Senate Democratic leader Harry Reid said reviving several popular business and middle-class tax breaks that expired at the end of 2005 will be at the top of his party's agenda when Congress returns next week for a postelection session.

It's not that I don't want to see middle class families and small businesses have some more money in their pockets. I do. I haven't looked at the economic implication of these tax reductions and maybe they even make sense. But I'm pretty sure this is simple politics (and undoubtedly good politics) in which the Democrats prove their tax-cutting bonafides to the constituency both parties need --- the middle class. In today's political climate, you aren't delivering, if you aren't delivering "tax relief."

That's as true blue Republican as you can get. And at some point Democrats are going to have to start rolling this back and making the case that delivering for the middle class means providing the safety net and provision for the less fortunate that allows average Americans the freedom to take risks and fuel our dynamic economy --- like taking new jobs or starting a new business. Tax cuts are like candy --- they taste good, but the individual middle class worker and her family doesn't get nearly the nutritious bang for the buck that the safety net and government programs do. Liberals and progressives need to start changing the political dialog in ways that talk about risk management and security and fair trade and wage growth --- things we really believe in and which can make an affirmative, lasting difference in people's lives.

>snip<

My first suggestion for this new vocabulary isn't really mine, but a reader's from some time back who pointed out my use of the term "tax burden" was an example of unthinking adoption of conservative rhetoric. He was right. He suggested that we start talking about it as "paying the bills" something that everyone understands. I think that makes sense. You can't blow smoke in people's faces by trying to tell them that taxes are "good." That's dreaming. But everyone knows that we have to pay the bills and our bill for the services we get --- national defense, social security for the disabled and elderly, medical research, roads and bridges,air traffic control, clean air and water, veterans benefits and on and on and on aren't free. It's a bill that has to be paid for both the individual and common good.

I've always thought that the current anti-tax mood of the American public was more a misguided desire for efficiency. The current ideological consensus posits that the free market is always more efficient than the government spending, therefore tax dollars are wasted on programs which might be more effectively handled by the private sector. This is the Republican mantra that has been repeated so many times that it's taken on the sheen of actual truth.

Now, it's true that the free market does allocate some goods better than others. I'm personally grateful that I have a choice of products to choose from when it comes to bicycles, computers, automobiles, etc. In these instances, the free market seems to work fairly efficiently (though not perfectly) in delivering the right goods for the right price.

For social goods like health care or education, on the other hand, the free market is a horribly inefficient mechanism for distribution. Health costs, for example, are constantly pushed upwards by a hopelessly bloated administrative apparatus (much bigger in our privatized health care scheme than in the "socialized" medical plans of Europe and Canada) and policies which stress acute rather than preventative care.

If we are to expand health care coverage for people in the United States, the fact of the matter is is that taxes will have to be raised to pay for it. The case needs to be made: you're going to pay for health care one way or another. Do you want to pay $2000 a year in premiums that will only provide coverage after a $3000 deductible is met, making it costly to seek preventative (mainly low-cost) health care which could prevent more costly (for both you and your insurer) treatments down the road? Or would you rather pay $2000 a year more in taxes but have the ability to see a doctor when you needed it, allowing you to take advantage of basic preventative services in order to avoid more acute treatments later? Which plan is going to give you more bang for your buck?

If there's one thing Americans seem to love, it's a good deal. Part of the progressive task in governing will be to demonstrate that the government, in many instances, can deliver the best value for one's dollar, and that these instances are worth the cost.

Missing the point

The WaPo reports on yet another study which demonstrates the benefits of drinking red wine for one's health. Leave it to a fuddy-duddy molecular biologist at Harvard to draw the exact wrong conclusion:

"We've been looking for something like this for the last 100,000 years, and maybe it's right around the corner -- a molecule that could be taken in a single pill to delay the diseases of aging and keep you healthier as you grow old," said David A. Sinclair, a Harvard University molecular biologist who led the study. "The potential impact would be huge."

The correct response, of course, would've been: "We've been looking for something like this for the last 100,000 years, and it's been under our noses this whole time! So drink up, friends!" Leave it to science to take something that's good on its own and put it in pill form, thus removing all the fun. The bastards did the same thing with pot when they formulated synthetic THC in the form of marinol.

Bastards.

The unstated assumptions

The WaPo writes up a RAND corporation study on consumer-directed health-care plans:

In contrast to traditional plans, in which beneficiaries typically pay a modest deductible and co-payments of $15 or $20 for visits to the doctor, the new plans can require consumers to shell out hundreds and sometimes thousands of dollars of their own money for drugs, doctors and hospital care before most coverage kicks in.

The annual deductible in a consumer-directed plan is generally $1,050 to $2,000 for individuals and $2,100 to $4,000 for families -- far higher than the average $220 deductible in a traditional employer-sponsored health plan. Premiums tend to be lower, however.

Consumer-directed plans have been heavily promoted by the Bush administration as a way to rein in spiraling health-care spending by giving consumers a financial incentive to shop around for the best care at a reasonable price -- and to get only the care they need.

Consumer-directed health care is just another corporate class caper to place the burdens of risk on individuals, in this case, using the shiny allure of low premiums to mask the shifting of the onus of financial responsibility onto the beneficiary.

The high deductible portends one of two things: a) you have the money to pay for treatments before your benefits kick in; or b) you are very judicious in your use of health services:

In some cases, for example, the greater cost-sharing burden on consumers meant that they did not go to the emergency room for problems that did not require it. At other times, people were forgoing necessary care and potentially jeopardizing their health.

I'm intrigued that making people "consume" their health care "responsibly" seems to be a stated rationale for pushing these types of insurance schemes. It suggests that the reason health care costs and insurance rates are so out of control is because people are going to the doctor too much. That and lawsuits (and hence the necessity for tort reform! But I digress...). That time you went to the doctor because you had a sore throat for three days and couldn't swallow, but the doc said it wasn't strep and you should just gargle warm salt water - irresponsible consumption of health care.

This is nuts. The driving force behind the increasing price of medical care is administrative costs. Preventative health care is more cost effective in the long-term than acute care. There are well-established links between access to health care and worker productivity. Why, then, is the solution to our health care crisis to discourage seeing doctors?

One of the great bogeymen of socialized medicine was the "rationing" of health care: hour long waits for doctors, 12-month queues for surgeries, a proscribed number of visits per year. Consumer-directed health-care plans accomplish a very similar goal in a neo-liberal context, forcing consumers to self-ration their own care. Funny how that works.

Will someone pay me if I make shit up and rant like a loon?

I've found myself wondering what inner workings compel David Horowitz to act like Pat Buchanan on acid. Perhaps the psychological torment of seeing his beatnik parents, reciting bon mots from Mao's Little Red Book, in carnal embrace? I sometimes feel bad that he is so completely and utterly disconnected from any semblance of reality.

And then I remember that Horowitz is being paid handsomely in wingnut largesse so that he can continue publishing his delusional drivel:

Nearly thirty years after the onset of the AIDS epidemic and several hundred thousand mainly needless deaths, the US government is finally adopting a testing policy, which would have provided a frontline defense against the spread of the disease. Testing is the standard and proven way to fight epidemics and contain them. Testing for AIDS is especially important because the retrovirus lurks in the body without visible symptoms for long periods of time. Hence an AIDS infected person will not know they have the disease and can infect others. According to the NY Times report on the new testing policy, more than 50 percent of new AIDS carriers don't know they have the disease. That's 250,000 individuals, mainly Hispanic and Black. And that's mroe [sic] than 25 years after the first cases were identified and despite hundreds of millions of dollars spent on AIDS "education."

The hundreds of thousands of preventable deaths that have occurred since the onset of the epidemic were not accidents. They were caused by a political campaign mounted by the left to prevent standard public health policies -- testing most prominent among them -- from being implemented. In the name of political correctness the left has caused the deaths of hundreds of thousands of mainly young, mainly gay men. The left's argument -- testing will stigmatize AIDS victims and the government will put them in concentration camps -- was as hysterical and insane then as its its argument that the Bush Administration has created the terrorists and if we give them what they want they will go home. But it was persuasive enough to liberals and the Democratic Party and public officials like C. Everett Koop, that hundreds of millions of dollars were wasted on education campaigns that didn't work,and unsuspecting gays were left to die.

The consequences of the left's murderous propaganda and policy demands were known at the time. Peter Collier and I sounded an alarm in 1983. Michael Fumento and other conservatives followed in an attempt to counter the left's campaign to disarm the gay community in the face of this threat with reasoned argument and evidence. But to no avail. The leftwing juggernaut was too powerful, and the grim result is now there for anyone with eyes to see. Let's hope that the left's current campaign to disarm America in the face of the Islamic threat will not succeed the way this one did.

So now we're supposed to believe that culture warrior David Horowitz is standing up for the health of fornicating sodomites because "the Left" let them down? (Apparently, we are.)

I suppose Horowitz was pushing these "standard public health measures" twenty years ago while his hero, über-president Ronald Reagan refused to publically acknowledge [pdf] the skyrocketing rates of HIV infection until 1987 - six years after the first inklings of the epidemic - effectively refusing to commit the resources of the federal government to fighting AIDS.

I also find it telling that Horowitz singles out gays and minorities in his piece (the NYT article says that the CDC recommends that HIV screening become part of routine medical care). Why single these groups out? Isn't "the Left" also waging a war against the 35% of HIV+ individuals infected by heterosexual partners?

And why bash on education when there are plenty of credible studies which clearly demonstrate the efficacy of HIV education?

Let's step back for a moment and follow Horowitz's logic: HIV education has clearly failed; that is, warning gay men (exclusively, in his fevered brain) of a disease that can kill them and giving them the tools to prevent infection has not stemmed the rate of infection. Out at the Freedom Center, one can imagine Horowitz holding forth about how AIDS education just empowers the gays to keep having libinous gay sex, which is, of course, the cause of AIDS. If those men would just stop having hours and hours of well-oiled, manly gay sex, AIDS would just go away.

And how would testing solve the problem? In Horowitz's house of mirrors, mandatory HIV screening is the first step towards criminalizing HIV transmission: containing the epidemic by compelling infected individuals to adhere to a regime which eliminates the risk of transmission (which could lead to the outlawing of homosexuality as a "public health risk, you know, like smoking"), or by containing the epidemic in our jails (where, incidentally, sticky, musky gay sex never occurs). Bigotry all tarted up in the rationalizations of the law.

Yes, crazy Dave - it's "the Left"'s fault that there is still the AIDS. It's "the Left" who has gutted inner-city public education funding, ensuring that the minorities Horowitz sees fit to defend when it serves his (wildly outlandish) rhetorical points may never have an opportunity to receive proper HIV education. And I doubt he'll savor - or even notice - the irony of his "mandatory screening during routine exams" regime failing to dent the transmission rate for exactly the same reason: the ideological anti-tax hostility ("drowning government in the bathtub") towards any sort of public health policy which would allow people from disadvantaged social milieu access to medical care.

God, the more I think about the case Horowitz makes here, the more boggled I become. It doesn't make sense on so many different levels. So the trick is to stop thinking about it.

Done.