Month: August 2009

Advanced Directives are in the news.

Figures are thrown about and studies are rare, but it’s not life-preserving technology that explains the ‘end of life’ share of billings, although dying in an ICU might.

What else is going on? Seventy percent of Medicare’s budget is spent on 10 percent of its patients. Why is dying in Miami four times more costly than Minnesota?

A doctor met with a 90 year old, a “100 pound guy who glowed yellow. He looked skeletal. His skin was paper thin, like cellophane wrapped around a chicken breast”. The doctor recommended hospice for the old man and went home.

When he returned the next shift:

I stared at the chart for a while. I was a little tired and foggy brained. But I couldn’t believe it. The poor guy was zonked out in his bed, exhausted from all the tests and procedures that had been administered that day.

In the interval, an astounding amount of medicine had been practiced. Consults had gone out to GI, oncology, and nephrology (creatinine 1.9). The GI guy had ordered an MRCP and, based on some mild distal narrowing of the common bile duct, had scheduled the patient for a possible ERCP in the morning. A stat CT guided biopsy of the liver lesions had also been done. The oncologist had written a long note about palliative chemotherapy options and indicated he would contact the son about starting as soon as possible. The nephrologist had sent off a barrage of blood and urinary tests.

That’s fee-for-service in a nutshell.

An insider’s view, 27 years in the enforcement division of the SEC.

Much of the problem arose from decades of deregulation dating back to the beginning of the Reagan administration. Elected deregulators appointed their own kind to head regulatory agencies and they, in turn, removed career regulators from management positions and replaced them with appointees who had worked in or represented the regulated industries. These new managers and, in many cases,the people they recruited and promoted, advanced or adhered to a regulatory scheme that, at least with respect to the most important issues, advanced the interests of regulated.

…the industry “captured” the regulators and the regulatory system.

But not in the passive sense that true regulators over time came to identify too closely with the interests of the regulated. This is not a case of financial regulators falling victim to the Stockholm syndrome. The vast majority of capture resulted from intentional efforts by the finance industry to advance their narrow interests at all costs and defeat meaningful regulation.

Unfortunately, we live in a country that can be bought from the top down and the finance industry exploited the situation very successfully. But do not blame the regulators. Career regulators are as much the victims of these events as the public’s economic welfare.

As Frank Rich wrote in the NYTimes,

“What disturbs Americans of all ideological persuasions is the fear that almost everything, not just government, is fixed or manipulated by some powerful hidden hand, from commercial transactions as trivial as the sales of prime concert tickets to cultural forces as pervasive as the news media.”

David Foley:

I have a graduate degree in economics. I never used it professionally, because I think it’s mostly bunk: sophistry masquerading as science. Economics provides few insights that wouldn’t be obvious to a reasonably bright 16-year-old with a grasp of calculus.

To diagnose and solve our current situation, sure, take a look at economics – but then consider the insights of systems science, the structure of networks, futurism, ecology and forms of whole-systems thinking.

Otherwise, we’re going to blow it.

Once they bought America. Now they buy its lies.

Dana Blakenhorn, “Nixon used scorn — his nattering nabobs of negativism.”

President Obama has a problem. His thesis is based on consensus, yet he must overthrow the Nixon Thesis of Conflict.

They refuse to join. They refuse to deal. They would rather lie, they would rather bully, they would rather kill The Other. This is what the last generation of American politics has taught them. It’s the only way they know to behave.

Outrage over corporate politics reached a high point in 1904. What’s next? In all the hate and worry, there’s very little election reform.

The founders were wary of corporate influence on politics — and their rhetoric sometimes got pretty heated.

In an 1816 letter, Thomas Jefferson declared his hope to “crush in its birth the aristocracy of our moneyed corporations, which dare already to challenge our government to a trial of strength and bid defiance to the laws of our country.”

Jefferson offers encouragement too:

“I have no fear that the result of our experiment will be that men may be trusted to govern themselves without a master.”

But as Senator Dick Durbin once said, “They own the place”.

CEOs in America pull in the big bucks because there’s a shortage of people willing to destroy the lives of many other human beings.

Thom Hartmann

Over time, balance and democratic oversight will always produce the best results.

An “unregulated” marketplace is like an “unregulated” football game — chaos. And chaos is a state perfectly exploited by sociopaths, be they serial killers, warlords, or CEOs.

Camel-sparrows. Beetle-ness. Pondering daffodilty and barely imagined beings:

“We are so disconnected from the living world that we can live in the midst of a mass extinction, of the rapid invasion everywhere of new and noxious species, entirely unaware that anything is happening.

“Happily, changing all this turns out to be easy.

Just find an organism, any organism, small, large, gaudy, subtle — anywhere, and they are everywhere — and get a sense of it, its shape, color, size, feel, smell, sound… meditate, luxuriate in its beetle-ness, its daffodility.”

A Canadian visits Nixon’s library to find cliché-tourist whitewash. He found a few guidelines:

1. Focus on childhood; humble beginnings are good.
2. Be a fighter, a man of strong moral conviction.
3. Put emphasis on the First Lady and the First Family.
4. Show children or that children are adoring.
5. Be with great people. The aura of greatness rubs off.
6. Concentrate on strengths. Ignore failures.

Said Richard Nixon, “Only if you have been in the deepest valley, can you ever know how magnificent it is to be on the highest mountain.”

Bhopal, India:
The High Court ordered the Central Bureau of Investigation to arrest Warren Anderson, former chair of Union Carbide Corporation, and bring him before the court “without delay“.

Anderson was proclaimed an absconder from justice in 1992 after he ignored a summons to appear in court in India.

Union Carbide and Anderson are charged with “culpable homicide not amounting to murder”, “grievous assault” and other serious crimes in relation to the 1984 Bhopal pesticide plant explosion. [wiki]

The first global paint report:

1. University of Cincinnati found that 73 percent of consumer paint brands tested from 12 countries representing nearly half the global population exceeded current US standard of 600 parts per million for lead in paint.

2. Nearly 70% of the brands had at least one sample exceeding 10,000 ppm.

3. American consumer paints are required to lower the permissible lead limit from 600 ppm to 90 ppm as of Aug 9.

wikipedia: Lead causes nervous system damage, hearing loss, stunted growth, and delayed development; can cause kidney damage and affects every organ system of the body. It also is dangerous to adults, and can cause reproductive problems for both men and women. Paint with significant lead content is still used in industry and by the military. For example, leaded paint is sometimes used to paint roadways and parking lot lines.

The private sector already rations healthcare to at least 12.6 million working-age Americans, denying 36% of those who tried to purchase health insurance in the individual insurance market.

No more:

• No Discrimination for Pre-Existing Conditions
• Insurance companies will be prohibited from refusing you coverage because of your medical history.
• No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
• Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
• No Cost-Sharing for Preventive Care
• Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
• No Dropping of Coverage for Seriously Ill
• Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
• No Gender Discrimination
• Insurance companies will be prohibited from charging you more because of your gender.
• No Annual or Lifetime Caps on Coverage
• Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
• Extended Coverage for Young Adults
• Children would continue to be eligible for family coverage through the age of 26.
• Guaranteed Insurance Renewal
• Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

Health Insurance Consumer Protections

We spent on all pharmaceuticals in the United States last year $260 billion.

That means all those vaccinations to prevent diseases, all those pills to treat diseases, all those pills to cure them so we don’t have to treat them anymore. We spent in all branches of all our pharmaceutical suppliers, $260 billion.

How much did we spend in the United States last year on tobacco? $88 billion. That’s a significant piece of 260. How much did we spend last year on alcohol? The government doesn’t subsidize that, you don’t have a right to it, it’s discretionary spending and if you were really in trouble you would probably spend a little less on alcohol. We spent $90 billion.

Last year what did we spend in the United States on soft drinks? $121 billion. Nearly half of what we spend on all of our pharmaceuticals, on soft drinks. I’m not against soft drinks—I think you ought to buy all the soft drinks you want.

Last year what did we spend supporting professional sports? $409 billion.

Dean Kamen, Segway Inventor:

Well, I hate to tell you the news but as soon as medicine started being able to do incredible things that are very expensive, we started rationing.

The reason 100 years ago everyone could afford their healthcare is because healthcare was a doctor giving you some elixir and telling you you’ll be fine. And if it was a cold you would be fine. And if it turns out it was consumption; it was tuberculosis; it was lung cancer—you could still sit there. He’d give you some sympathy, and you’d die. Either way, it’s pretty cheap.

Robert Shrum:

In 2009, the hisses of the old plutocracy have escalated into the caterwauling of a manufactured mobocracy intent on shouting down members of Congress and fellow citizens who come to community centers to ask honest questions.

The screamers have been summoned into battle by Limbaugh, Beck and assorted demagogues, whose own hate speech is abetted by prominent Republicans ranging from Senate minority leader Mitch McConnell to Newt Gingrich and the shameless Sarah Palin, with her despicable prevarication that the “evil” Obama health reform provides for a “death panel” with the power to deny care to her Down’s Syndrome child.

Ironically, the lies and legions of the right reached fever pitch at the moment the news arrived that, once again, activist government is succeeding in the wake of free market failure on a scale not seen since the Great Depression.

Jon Taplin:

One of the things that is so pathetic about the demagoguery of Rush Limbaugh and Glenn Beck is that their understanding of history is so puerile that in any civilized debate they would be laughed off the stage.

Of course they don’t allow a civilized debate.

More than half of all health spending is wasted.

Analysis by PricewaterhouseCoopers finds that $1.2 trillion of the $2.2 trillion spent on our health system is wasted, and we’re all responsible for throwing our money away.

1) Patients waste.
2) Health providers waste.
3) Insurance companies waste.

Medical costs are expected to increase in 2010 by 9%, which is slightly less than recent years; 9.2% in 2009 and 9.9% in 2008, rates that outpace both real incomes and the rate of inflation.

Tip to Robert Oak at EconomicPopulist who noticed “We could bail out Goldman Sachs with that amount of money!”

Insurers and providers have made little effort to cut costs or automate. Every insurance company has its own forms and most facilities are pushing paper for patient and billing files as well as handling prescriptions. Errors are costly and devastating. As defense, too many tests and procedures are ordered.

Captured precisely not in an open marketplace, 160 million Americans receive health insurance through employers that offer few competitive alternatives while dealing with dominant players and cumbersome policy contracts.

Insured, underinsured and uninsured are increasingly obese, continue smoking, drink excessively, do not follow their doctor’s orders, and stretch expensive emergency services.

This revealing chart, ‘Identified Waste‘, is part of a 3-page .pdf summary, The Price of Excess: Identifying waste in healthcare spending. More reports at Health Research Institute.

Arlo Guthrie, everyone’s favorite folksinger, has a thing or two to say:

“You guys wearing sacred clothing, holding the Holy Koran in hand, while your thugs beat, maim and kill your fathers, brothers, sisters & mothers – Yeah you guys (if you’re reading this) – You have shown the entire world that you would sacrifice your own children for your temporary authority over them even as you KNOW you will grow old and pass away, and they will live to create a world of their own. The only question is how many will perish before you come to your senses or stand before your creator… How much blood will be spilt before your shame overcomes you and you shed tears for forgiveness? If the power of your authority comes only from clubs and guns, what does that say of your God? It would be better to have no faith than to have as little as yours… adg

p.s. Same goes for any nation anywhere, anytime (including ours) when tyrants cover the rotting stench of their cold dying hearts with the outward appearance of holiness.

What’s the most costly credit for a customer? Overdraft fees. What’s low risk for a bank? Overdrafts. They likely have the next paycheck. Fees are nearly double since 2000, are more than three-quarters of all service charges, and are almost $40 billion; almost pure profit while float rates are very low. The guilty can hardly complain, but….

interesting comment via an oil-patch blog:

“One persistent knock against the Obama administration’s energy team is that it is one-dimensional — everyone has a clean-tech background, the mirror image of the oil industry bent of the Bush White House.”

Our GDP is about $14 trillion.
Our deficit will reach $1.8 trillion.
All our combined debt is more than $52 trillion.
Federal, State and Local debt is about $14 trillion.
Corporate, private and personal debt about $38 trillion.

Comstock Partners says, “We are in the process of deleveraging the most leveraged economy in history.” Credit and debt are required for growth, but we’ve gone too far and delivered too little.

The stock market is exploding as firms shrink faster than income falls, but

“…if you step back and look at the larger picture, you can see that the stock market is still down over 35% from the highs reached in 2007 and also down over 33% from the highs reached in early 2000.”

Sara Robinson:

Now, the guessing game is over.

We know beyond doubt that the Teabag movement was created out of whole cloth by astroturf groups like Dick Armey’s FreedomWorks and Tim Phillips’ Americans for Prosperity, with massive media help from FOX News.

We see the Birther fracas — the kind of urban myth-making that should have never made it out of the pages of the National Enquirer — being openly ratified by Congressional Republicans.

We’ve seen Armey’s own professionally-produced field manual that carefully instructs conservative goon squads in the fine art of disrupting the democratic governing process — and the film of public officials being terrorized and threatened to the point where some of them required armed escorts to leave the building. We’ve seen Republican House Minority Leader John Boehner applauding and promoting a video of the disruptions and looking forward to “a long, hot August for Democrats in Congress.”

This is the sign we were waiting for — the one that tells us that yes, kids: we are there now. America’s conservative elites have openly thrown in with the country’s legions of discontented far right thugs. They have explicitly deputized them and empowered them to act as their enforcement arm on America’s streets, sanctioning the physical harassment and intimidation of workers, liberals, and public officials who won’t do their political or economic bidding.

This is the catalyzing moment at which honest-to-Hitler fascism begins. It’s also our very last chance to stop it.

MarketPipeline asks why banks sought to leverage so many mortgages: capital reserve arbitrage puffed the balance sheet.

1. A bank with $4 billion in reserve could hold $100 billion in loans.
2. But that same $4 billion could instead be used to invest in $250 billion worth of mortgage backed securities.

Another way of looking at this is that banks were basically making money—turning $100B into $250B—by flipping mortgages into securities.

James Haught, editor of the Charleston Gazette, reviews memoir by former French President Jacques Chirac:

Incredibly, President George W. Bush told French President Jacques Chirac in early 2003 that Iraq must be invaded to thwart Gog and Magog, the Bible’s satanic agents of the Apocalypse.

Honest. This isn’t a joke. The president of the United States, in a top-secret phone call to a major European ally, asked for French troops to join American soldiers in attacking Iraq as a mission from God.

Now out of office, Chirac recounts that the American leader appealed to their ‘common faith’.

Bush told him: “Gog and Magog are at work in the Middle East…. The biblical prophecies are being fulfilled…. This confrontation is willed by God, who wants to use this conflict to erase his people’s enemies before a New Age begins.”

This bizarre episode occurred while the White House was assembling its “coalition of the willing” to unleash the Iraq invasion.

Chirac says he was boggled by Bush’s call and “wondered how someone could be so superficial and fanatical in their beliefs.”

After the 2003 call, the puzzled French leader didn’t comply with Bush’s request. Instead, his staff asked Thomas Romer, a theologian at the University of Lausanne, to analyze the weird appeal.

Not incredibly, “George W. Bush gets Revelations so wrong–you see.” points out Brad Delong.

Gog and Magog do not arrive until 1000 years after an angel comes down from heaven and binds the Devil and casts him into the bottomless pit.

From snippets in the NYTimes, Robert Oak at EconomicPopulist found something I betcha you don’t know, America.

“…from July 1999, when the economy was booming and companies were complaining about how hard it was to find workers, through July of this year, when the economy was mired in the deepest and longest recession since World War II.

“For the decade, there was a net gain of 121,000 private sector jobs, according to the survey of employers conducted each month by the Bureau of Labor Statistics.”

In an economy with 109 million jobs, the annual growth rate for 10 years is 0.01 percent.”

David Sirota on the Me-First, Forget-Everyone-Else Crowd:

1. American businesses pay excessively high taxes? GAO reports most corporations pay zero federal income tax and the corporate tax rate is the third lowest in the industrialized world.
2. Including payroll, state and local, the top 5 percent pay about 40 percent of the taxes because they make about 40 percent of the total national income.

Doug Powell at BarfBlog says, “Fresh fruits and vegetables are one of, if not the most, significant sources of foodborne illness today in the U.S. – and it’s been that way for over a decade.”

New FDA rules point out, “In addition, effective management of food safety requires that responsibility be clearly established among the many parties involved in the production of fresh produce.

“There may be many different permutations of ownership and business arrangements during the growing, harvesting packing, processing, and distribution of fresh and fresh-cut tomatoes.

“For this reason, it is important to identify which responsibilities rest with which parties, and to ensure that these responsibilities are clearly defined.” [previous link: http://barfblog.foodsafety.ksu.edu/2009/08/articles/food-safety-communication/greens-and-melons-and-tomatoes-oh-my-will-new-guidelines-make-produce-safer/]